RAPM Focus BMJ Group

In this episode of RAPM Focus, Dr. Brian Sites discusses the perioperative use of hallucinogens with Trent Emerick, MD, MBA, following the February 2023 publication of Dr. Emerick’s paper, “Perioperative considerations for patients exposed to hallucinogens.”
Dr. Trent Emerick is currently an associate professor in the departments of anesthesiology and perioperative medicine and bioengineering at the University of Pittsburgh Medical Center and School of Medicine. He was a fellowship director for the chronic pain fellowship, and associate chief in the medical director of the UPMC chronic pain division. He is also the designated pain specialist for the NLF Pittsburgh Steelers.
Medicine is always changing, providing a career steeped in creativity. Hallucinogen use in the general population is growing, becoming more and more common. There is a renewed interest in the therapeutic benefits of drugs commonly classified as hallucinogens. These drugs are complicated and alter the sensorium. Psychedelics, a type of hallucinogen, are mediated by serotonin to a receptor and can help to soothe pain.
*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.
Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

In this episode of RAPM Focus, Dr. Brian Sites sits down with Daryl Henshaw, MD, and Christopher Edwards, MD, to discuss “Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial,” first published in June 2023.
Dr. Daryl Henshaw completed his medical school residency in regional anesthesia and acute pain fellowship training at Wake Forest. He is the associate vice chair of clinical operations at Atrium Health Wake Forest Baptist, the section head of regional anesthesia and acute pain management, and the medical director of acute pain services.
Dr. Christopher Edwards is a graduate of Louisiana State University Health Sciences at Wake Forest for both anesthesia and fellowship training in RAPM. He is the medical director for regional anesthesia and acute pain.
Dr. Henshaw and colleagues performed a prospective observational trial, where they asked the question if current guidelines to hold full anti-coagulation dose of Lovenox for 24 hours before surgery resulted in adequate anti-Xa level activity to support the performance of neuraxial or deep anesthetic type nerve block procedures. Consenting patients on treatment-dose enoxaparin were randomized to either a 24-hour group (last dose at 07:00 the day prior to surgery) or a 36-hour group (last dose at 19:00 2 days prior to surgery). On arrival for surgery, blood samples were obtained to assess residual anti-Xa level activity and renal function. The primary outcome was residual anti-Xa level activity following the last treatment dose of enoxaparin. Incorporating all patients, linear regression modeling was performed to predict the timepoint at which the level of anti-Xa activity reliably fell below 0.2 IU/mL.
*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.
Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

In this podcast episode, RAPM Editor-In-Chief Brian D. Sites discusses the massive growth opportunities in the exciting future of pain medicine. Sites highlights the importance that “anesthesiologists help define the value of medical interventions that we offer for pain management.”
As RAPM begins to receive more submissions relating to costs, Dr. Sites stresses how critical it is to understand how costs are factored into the interventions offered in health care, as costs can be prohibited. Dr. Sites hopes we may start to connect the dots to larger outcomes like the chronification of pain, mortality, major morbidity, extended length of stay, and more, as the interventions we offer can positively impact these outcome metrics. Watch the full podcast episode for more information.
For more on the World Day of Pain initiative, please see: https://esraeurope.org/meeting/1st-world-day-of-regional-anesthesia-pain-medicine/.

Data describing the relationship between specific traumatic injuries and opioid use is lacking, which is why RAPM is so delighted to support the work of Matthew Mauck, MD, PhD, and colleagues. In this episode of RAPM Focus, RAPM Editor-in-Chief Brian Sites, MD, discusses “Incidence of persistent opioid use following traumatic injury with Dr. Mauck, first published in June 2023.
Dr. Mauck is an assistant professor and vice chair of research for the University of North Carolina’s department of anesthesiology. He is a practicing pain physician, and his main research focus is on preventing the transition of acute to chronic pain following traumatic injury.
Upon individuals hospitalized after surgery, up to 60% continue to experience chronic pain at 12 months. Dr. Mauck and colleagues used insurance claims data from over a 20-year period to estimate the incidents of new persistent opioid use in three hospitalized trauma populations. Burn injury, motor vehicle collision, and orthopedic injury. New persistent opioid use is defined as the receipt of greater than one opioid prescription 90-180 days following injury in an individual with no opioid prescriptions during the year prior.
*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.
Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.
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#opioiduse
#persistentopioiduse
#traumaticinjury
#regionalanesthesia
#acutepain
#chronicpain
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RAPM Editor-in-Chief Brian Sites, MD, joins Hsiangkuo Yua, MD, PhD, and Aniket Natekar, MD, twocoauthors of “Real-world study of intranasal ketamine for use in patients with refractory chronicmigraine,” first published in May 2023.Dr. Hsiangkuo Yuan received his medical degree from National Yang-Ming University in Taipei, Taiwan,and a PhD in biomedical engineering at Duke University. He joined Jefferson Headache Center in 2014 asa research fellow, then completed a neurology residency and headache fellowship at Thomas JeffersonUniversity. Dr. Yuan is currently an associate professor of neurology and the director of clinical researchat the Jefferson Headache Center. He is also the vice chair of ASRA Headache SIG and an associate editorof RAPM. His research interests include real world analysis of novel migraine therapeutics and afundamental understanding of CSF dynamics in patients with CSF high and low pressure headaches.Dr. Aniket Natekar pursued his medical education at the John A. Burns School of Medicine at theUniversity of Hawaii in Honolulu. He attended Thomas Jefferson University Hospital in Philadelphia,where he completed his residency in general neurology, and then a fellowship in headache medicine atthe Jefferson Headache Center. Dr. Natekar is currently a practicing neurologist with a subspecialtytraining in headache management.Migraine is a common and disabling headache disorder with huge societal implications in terms ofhuman suffering and loss of productivity. The World Health Organization recognizes its importance byranking it in seventh place among worldwide diseases causing disability. Refractory chronic migraineheadache is a subset condition of migraines. As the name suggests, it is an extremely unfortunatesituation with limited treatment options.*The purpose of this podcast is to educate and to inform. The content of this podcast does notconstitute medical advice, and it is not intended to function as a substitute for a healthcarepractitioner’s judgement, patient care, or treatment. The views expressed by contributors are those ofthe speakers. BMJ does not endorse any views or recommendations discussed or expressed on thispodcast. Listeners should also be aware that professionals in the field may have different opinions. Bylistening to this podcast, listeners agree not to use its content as the basis for their own medicaltreatment or for the medical treatment of others.Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.#headache#headachedisorder#migraine#refractorychronicmigraine#respiratorycomplications#intranasalketamine
#regionalanesthesia#chronicpain#anesthesia#pain#painmanagement#MedEd#medicine

RAPM Editor-in-Chief Brian Sites, MD, joins Lei Xu, MD, and Ed Mariano, MD, MAS, FASA, FASRA, twocoauthors of “Rate of occurrence of respiratory complications in patients who undergo shoulderarthroplasty with a continuous interscalene brachial plexus block and associated risk factors,” firstpublished in May 2023.Dr. Xu is a clinical assistant professor in the department of anesthesiology at Stanford. She received hermedical degree from Stanford before completing her residency in anesthesiology at the University ofCalifornia San Francisco, and then a fellowship in regional anesthesia and acute pain medicine atStanford. She is interested in the application of regional anesthesia outside the operating room. Herresearch interests include studying the functional outcomes of clinical pathways that include regionalanesthesia in the primary arthroplasty in acute trauma populations.Dr. Mariano is a professor and senior vice chair in the department of anesthesiology at Stanford. He hasdeveloped techniques and patient care pathways to improve post-operative pain, patient safety, andother outcomes, and has published over 250 peer-reviewed articles. He has held leadership positions inthe California Society of Anesthesiologists, American Society of Anesthesiologists, American Society ofRegional Anesthesia and Pain Medicine, and multiple journal editorial boards.In their retrospective observational study, over 1,000 patients were evaluated undergoing total shoulderreplacement with a continuous interscalene block. Respiratory complications were categorized into fourgroups: none, mild, moderate, and severe. Interscalene blocks are important to the success of thesesurgeries, but there remain concerns about respiratory morbidity.*The purpose of this podcast is to educate and to inform. The content of this podcast does notconstitute medical advice, and it is not intended to function as a substitute for a healthcarepractitioner’s judgement, patient care, or treatment. The views expressed by contributors are those ofthe speakers. BMJ does not endorse any views or recommendations discussed or expressed on thispodcast. Listeners should also be aware that professionals in the field may have different opinions. Bylistening to this podcast, listeners agree not to use its content as the basis for their own medicaltreatment or for the medical treatment of others.Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.#interscalenebrachialplexusblock#interscaleneblock#respiratorymorbidity#respiratorycomplications#arthoplasty#shoulderarthoplasty
#localanesthetic#regionalanesthesia#chronicpain#anesthesia#pain#painmanagement#MedEd#medicine