ASRA Pain Medicine consensus practice infection control guidelines for regional anesthesia and pain medicine.

Background: To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management.

Methods: Following board approval, in 2020 the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) commissioned evidence-based guidelines for best practices for infection control. More than 80 research questions were developed and literature searches undertaken by assigned working groups comprising four to five members.

Influence of DOAC Levels and Thrombin Generation on Postoperative Bleeding [SONAR]: A Nested Case-Control Study.

A DOAC concentration threshold above which an impact on surgical hemostasis starts to occur is unknown. Thrombin generation assays (TGAs) provide a measure of the coagulation phenotype. This study aimed to determine whether preoperative TGA parameters are associated with postoperative bleeding, and whether this is partly due to residual DOAC levels.

S-ketamine alleviates morphine-induced hyperalgesia via decreasing the gut Enterobacteriaceae levels: Comparison with R-ketamine.

Background: Opioid-induced hyperalgesia (OIH) is a serious complication during the pain treatment. Ketamine has been commonly reported to treat OIH, but the mechanisms remain unclear. Gut microbiota is recently recognized as one of the important mechanisms underlying the occurrence and treatment of OIH.

Electroencephalographic Depth-of-Anesthesia Monitoring.

EEG-based DoA monitoring is a powerful tool for ensuring the optimal balance between maintaining unconsciousness and preventing excessive sedation during procedures. Understanding the role, indications, equipment, and troubleshooting of EEG-based DoA monitoring is necessary for the effective use of this tool in clinical decision-making.

Dopamine Drives Feedforward Inhibition to Orexin Feeding System, Mediating Weight Loss Induced by Morphine Addiction.

Feeding behavior changes induced by opioid addiction significantly contribute to the worsening opioid crisis. Activation of the reward system has shown to provoke binge eating disorder in individuals with opioid use disorder, whereas prolonged opioid exposure leads to weight loss. Understanding the mechanisms underlying these phenomena is essential for addressing this pressing societal issue.

Hospital Safety-Net Burden is Associated with Perioperative Outcomes in Primary Total Hip Arthroplasty: A Multistate Retrospective Analysis, 2015-2020.

Total hip arthroplasty (THA) is a widely performed surgical procedure in the United States, but disparities in THA outcomes related to hospital-level factors, such as safety-net burden, are underexplored. This study expands on previous research by analyzing multicenter, multistate data from 2015 to 2020 to investigate the impact of hospital safety-net burden-defined as the proportion of services billed to Medicaid and uninsured patients-on THA outcomes. This study is a retrospective analysis using data from the State Inpatient Databases for Florida, Kentucky, Maryland, New York, Washington, New Jersey, and North Carolina.

Comparison of perioperative analgesic effectiveness of ultrasound-guided erector spinae plane block and transversus abdominis plane block in patients undergoing laparoscopic nephrectomy.

Objectives: In this study, we aimed to compare the efficacy of two regional anesthesia methods, transversus abdominis plane (TAP) block and erector spinae plane (ESP) block, for intraoperative and postoperative pain relief in patients undergoing laparoscopic nephrectomy.

Methods: Fifty patients aged 18-80 years with American Society of Anesthesiologists (ASA) classification I-II scheduled for elective laparoscopic nephrectomy were included after ethical approval and informed consent. Patients were randomly assigned to either Group TAP (receiving TAP block) or Group ESP (receiving ESP block).

Autoantibodies cause nociceptive sensitization in a mouse model of degenerative osteoarthritis.

Previous preclinical and translational studies suggest that tissue trauma related to bony fracture and intervertebral disk disruption initiates the formation of pronociceptive antibodies that support chronic musculoskeletal pain conditions. This study tested this hypothesis in the monosodium iodoacetate (MIA) mouse model of osteoarthritis (OA) and extended the findings using OA patient samples. Monosodium iodoacetate was injected unilaterally into the knees of male and female wild-type (WT) and muMT mice (lacking B cells) to induce articular cartilage damage.

Efficacy and Safety of Adding 1μg/Kg Dexmedetomidine to 20ml Bupivacaine in Supraclavicular Brachial Plexus Block: A Randomized Trial.

Background: For surgical procedures of the upper limbs, ultrasound-guided supraclavicular brachial plexus block (SCBPB) represents a safe substitute for general anesthesia. The present study evaluated the effectiveness and safety of incorporating 1μg/kg dexmedetomidine (DEX) into 20 ml bupivacaine, as opposed to using 20 ml and 30 ml bupivacaine without additives, in SCBPB.

Methods: This randomized, controlled, double-blind study included 75 patients assigned to elective upper-limb surgery under the mid-humerus level.

Head to Toe: A Perioperative Surgical Home Approach to Sepsis and Airway Obstruction in a Geriatric Patient.

The perioperative surgical home (PSH) is a care delivery model designed to improve the perioperative and long-term outcomes of patients undergoing surgery by promoting holistic care and seamless cooperation between different services and subspecialties. An aging population and increased surgical complexity have led to renewed interest in PSH models. An 86-year-old female with diabetes and critical limb ischemia presented with sepsis due to right calcaneal gangrene.

Diagnostic and prognostic performance of urine ubiquitin carboxy-terminal hydrolase L1 across multiple acute brain injury types - A longitudinal prospective cohort study.

Introduction: Ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) is recognized as a diagnostic and prognostic blood biomarker for traumatic brain injury (TBI). This study aimed to evaluate whether UCH-L1 concentrations measured in patients' urine post-injury could serve as a diagnostic or prognostic biomarker for outcomes in various types of acute brain injuries (ABI).

Material And Methods: This pilot study included 46 ABI patients: aneurysmal subarachnoid hemorrhage (n = 22), ischemic stroke (n = 16), and traumatic brain injury (n = 8), along with three healthy controls.

Management of traumatic brain injury and acute respiratory distress syndrome-What evidence exists? A scoping review.

Introduction: Up to 20% of patients with traumatic brain injury (TBI) develop acute respiratory distress syndrome (ARDS), which is associated with increased odds of mortality. Guideline-based treatment for ARDS includes "lung protective" ventilation strategies, some of which are in opposition to "brain protective" strategies used for ventilation with patients with TBI. We conducted a scoping review of ventilation management strategies with clinical outcomes among patients with TBI and ARDS.

Real-world long-term outcomes of peripheral nerve stimulation: a prospective observational study.

Aim: We aimed to evaluate real-world outcomes of peripheral nerve stimulation (PNS) used to treat chronic neuropathic pain (CNP) at a tertiary pain management center.

Methods: Thirty adults who underwent PNS for CNP between June 2015 and September 2021 completed pain and psychosocial assessments in the 6 months before, and 2-3 years after PNS treatment. Pain intensity was measured using the NIH Patient Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short From (3A).

Evaluating remyelination compounds for new applications in opioid use disorder management.

Opioid use disorder (OUD) is associated with a reduction in brain white matter, affecting critical areas involved in decision-making, impulse control, and reward processing. The FDA has approved several drugs and natural compounds that enhance myelination, targeting oligodendrocyte progenitor cells (OPCs), directly enhancing oligodendrocyte (OL) function, or acting as cofactors for myelin production. This retrospective case study aimed to assess whether current clinical evidence supports the use of myelin-enhancing agents to promote remission in OUD.

State-of-the-art anesthesia practices: a comprehensive review on optimizing patient safety and recovery.

Objective: This review explores recent advancements in anesthesia care, focusing on the integration of innovative practices to enhance patient outcomes across the perioperative period.

Methods: Following the framework of Whitmore and Knafl, we systematically searched six databases (PubMed, Google Scholar, EMBASE, CINAHL, OVID, and Cochrane Library) for studies published from January 2020 to January 2024, relating to advancements in anesthesia care, best practice implementation, and patient outcomes. After independent screening and data extraction by two reviewers, the review focuses on innovations in anesthetic drugs, monitoring technologies, anesthesia techniques, and evidence-based practices in anesthesia and clinical guidelines.

Glioblastoma-derived migrasomes promote migration and invasion by releasing PAK4 and LAMA4.

Almost all high-grade gliomas, particularly glioblastoma (GBM), are highly migratory and aggressive. Migrasomes are organelles produced by highly migratory cells capable of mediating intercellular communication. Thus, GBM cells may produce migrasomes during migration.

Effectiveness of non-pharmacological intervention protocol for prevention of postoperative delirium in the surgical intensive care unit.

Postoperative delirium (POD) is a common adverse event in patients admitted to the intensive care unit (ICU). We aimed to determine the effectiveness of a multicomponent non-pharmacological intervention protocol to reduce the incidence of POD in elderly patients admitted to the surgical ICU (SICU). This before-and-after cohort study included 300 patients aged ≥ 65 years who were admitted to the SICU within 7 days postoperatively with an anticipated SICU stay > 24 h.

The effect of enhanced recovery protocols on postoperative rehabilitation in orthopedic surgery patients.

Orthopedics is a critical hospital department that has experienced shifts in the spectrum of orthopedic conditions due to societal advancements in recent years. While surgical interventions are effective in restoring fracture function, perioperative care remains a key factor in optimizing patient recovery. This study aims to assess the impact of orthopedic rehabilitation care based on the enhanced recovery after surgery (ERAS) protocol on postoperative rehabilitation.

Transforming Physiology and Healthcare through Foundation Models.

Recent developments in artificial intelligence (AI) may significantly alter physiological research and healthcare delivery. Whereas AI applications in medicine have historically been trained for specific tasks, recent technological advances have produced models trained on more diverse datasets with much higher parameter counts. These new, "foundation" models raise the possibility that more flexible AI tools can be applied to a wider set of healthcare tasks than in the past.

Comparing General Anesthesia-Based Regimens for Endovascular Treatment of Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis.

Background: Total intravenous anesthesia (TIVA)-based and volatile-based general anesthesia have different effects on cerebral hemodynamics. The current work compares these 2 regimens in acute ischemic stroke patients undergoing endovascular therapy.

Methods: We conducted a systematic literature search across MEDLINE, Embase, Cochrane, CINAHL, Web of Science, and Scopus.