Study design: Systematic review. Objective: To investigate the efficacy of nonsurgical interventional treatments for chronic low back pain (LBP) caused by facet joint syndrome (FJS). Methods: A systematic review of the literature was conducted to identify studies that compared interventional treatments for LBP due to FJS among them, with usual care or sham procedures. Studies were evaluated for pain, physical function, disability, quality of life and employment status. The RoB-2 and MINORS tools were utilized to assess the risk of bias in included studies. Results: Eighteen studies published between January 2000 and December 2021 were included (1496 patients, mean age: 54.31 years old). Intraarticular (IA) facet joint (FJ) injection of hyaluronic acid (HA) did not show significant difference compared to IA corticosteroids (CCS) in terms of pain and satisfaction. FJ denervation using radiofrequency (RF) displayed slightly superior or similar outcomes compared to IA CCS, physical therapy, or sham procedure. IA CCS showed better outcomes when combined with oral diclofenac compared to IA CCS or oral diclofenac alone but was not superior to IA local anesthetic and Sarapin. IA platelet-rich plasma (PRP) led to an improvement of pain, disability and satisfaction in the long term compared to IA CCS. Conclusion: FJS is a common cause of LBP that can be managed with several different strategies, including nonsurgical minimally invasive approaches such as IA HA, CCS, PRP and FJ denervation. However, available evidence showed mixed results, with overall little short-term or no benefits on pain, disability, and other investigated outcomes.

Background: Pericapsular nerve group (PENG) block, although effective for pain management following total hip arthroplasty (THA), does not cover skin analgesia. In this randomized controlled trial, we compared the effectiveness of PENG block combined with lateral femoral cutaneous nerve (LFCN) block or wound infiltration (WI) on postoperative analgesia and functional outcomes. Methods: Fifty patients undergoing posterior-approached THA under spinal anesthesia were randomly allocated to receive LFCN block with 10 mL of 0.5% ropivacaine or WI with 20 mL of 0.5% ropivacaine. In both groups, PENG block was performed by injecting 20 mL of 0.5% ropivacaine. Primary outcomes were static and dynamic pain scores (0–10 numeric rating scale) measured in the first 24 h after surgery. Secondary outcomes included postoperative opioid consumption, functional assessment and length of hospital stay. Results: Postoperative static NRS of patients receiving LFCN was higher than that of patients receiving WI at 6 h but lower at 24 h, with a median (IQR) of 3 (2–4) vs. 2 (1–2) (p < 0.001) and 2 (2–3) vs. 3 (3–4) (p = 0.02), respectively. Static pain scores at 12 h did not show significant differences, with an NRS of 3 (2–4) for WI vs. 3 (3–4) for LFCN (p = 0.94). Dynamic pain and range of movement followed a similar trend. No significant differences were detected in other outcomes. Conclusions: LFCN block was not inferior to WI for postoperative analgesia and functional recovery in association with PENG block during the first postoperative day, although it had worse short-term pain scores. Based on these results, it is reasonable to consider LFCN block as a valid alternative to WI or even a complementary technique added to WI to enhance skin analgesia during the first 24 h after THA. Future studies are expected to confirm this hypothesis and find the best combination between PENG block and other techniques to enhance analgesia after THA.

Total knee replacement is a common surgical procedure associated with significant postoperative pain, which can delay recovery and increase healthcare costs. Regional anesthesia techniques, including local infiltration analgesia and fascial plane blocks, play a crucial role in multimodal pain management strategies. These approaches aim to enhance pain relief while minimizing opioid use and preserving motor function. This narrative review evaluates the effectiveness and safety of motor-sparing fascial plane blocks for total knee replacement, categorizing techniques based on their anatomical target areas: anterior, posterior, and other approaches. A comprehensive literature search was conducted using databases such as MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The search included studies on motor-sparing regional anesthesia techniques for total knee replacement using relevant keywords such as “regional anesthesia,” “peripheral nerve block,” “motor-sparing techniques,” and specific block names. The selection criteria included randomized controlled trials, systematic reviews, meta-analyses, and relevant case studies. The techniques were analyzed based on their effectiveness in pain relief, impact on motor function, and overall contribution to enhanced recovery after total knee replacement. The review highlights that the most evidence-supported technique for anterior knee pain management is the block targeting the adductor canal, which provides effective analgesia while preserving motor function. For posterior compartment pain relief, the infiltration between the popliteal artery and the knee capsule is the preferred approach. Emerging techniques, such as the dual subsartorial block and the para-sartorial compartment block, show promise but require further validation. The review also underscores the importance of integrating different techniques to ensure adequate pain control for both the anterior and posterior compartments, facilitating early mobilization in fast-track recovery protocols. Achieving optimal postoperative pain management after total knee replacement requires a combination of targeted regional anesthesia techniques. Current evidence supports the use of adductor canal block for anterior knee analgesia and the infiltration between the popliteal artery and the knee capsule for posterior pain relief. While newer techniques show potential, further research is needed to validate their efficacy and safety. Future studies should focus on refining fascial plane block strategies to optimize analgesic benefits while minimizing motor impairment, thereby improving functional recovery and reducing the reliance on opioid medications.

Article: Transversus abdominis plane block versus thoracic epidural analgesia for laparoscopic surgery: advancing the definitive evolution of ERAS? - Minerva Anestesiologica 2023 Sep 28 - Minerva Medica - Journals

Foot and ankle surgery is often associated with significant postoperative pain that may delay mobilization and recovery. For this reason, effective perioperative analgesia is essential to improve outcomes, minimize opioid use, and enable safe early discharge when appropriate. This review provides an updated overview of regional anesthesia techniques for foot and ankle surgery, highlighting anatomical considerations, ultrasound guidance, and patient-tailored block selection. Different techniques will be specifically addressed over neuraxial and nerve blocks, such as the Mayo block and intravenous regional anesthesia (Bier block), as well as the emerging WALANT approach for selected cases. Ultrasound guidance has become a gold-standard, enhancing precision and safety compared to landmark-based methods. Multimodal analgesia combining regional blocks with non-opioid medications and adjuvants like intravenous dexamethasone further optimizes pain control while limiting opioid requirements. In ambulatory settings, motor-sparing techniques and short-acting spinal agents are emphasized to support rapid recovery and same-day discharge. By integrating anatomical knowledge with ultrasound and multimodal strategies, perioperative pain management for foot and ankle surgery can be tailored to balance effective analgesia with early mobilization and patient safety.

Background: Total abdominal hysterectomy is a procedure associated with moderate to severe postoperative pain. Regional anesthesia techniques, such as fascial plane blocks, have shown promise in improving postoperative pain control. While continuous wound infusion is recommended for cesarean section, it is not recommended for open abdominal hysterectomy. Our aim is to compare surgically placed catheter for wound infusion with the transverse abdominis plane block. Methods: A single-center prospective randomized controlled trial was conducted in Italy from January to July 2023. Patients undergoing elective hysterectomy were randomly assigned to receive either bilateral transverse abdominis plane block or continuous wound infusion. The primary outcome measure was the assessment of static pain in the recovery room and at 6, 12, 24, and 48 hours postoperatively using the numeric rating scale (NRS) for pain. Of the 34 patients assessed for eligibility, 32 were randomized and equally distributed between the continuous wound infusion and transverse abdominis plane block groups. Result: Patients receiving continuous wound infusion consistently reported lower static NRS pain scores compared to those receiving transverse abdominis plane block across all postoperative time points. The median NRS scores were significantly lower in the wound infusion group at 6, 12, 24, and 48 hours post surgery ( P < 0.05). Importantly, similar significant differences were also observed between the groups for dynamic NRS scores. However, no significant differences were observed between the groups for secondary outcomes, including nausea and vomiting, and recovery of functional capacity. Conclusion: Continuous wound infusion with a properly positioned catheter is noninferior to transverse abdominis plane block for postoperative pain management following total abdominal hysterectomy and may even provide superior pain control. These findings suggest continuous wound infusion as a viable alternative for effective pain management in total abdominal hysterectomy procedures.