Citations 2
Prioritization of outcome measures in regional anesthesia research
El‐Boghdadly, Kariem , Ayad, Amany E. , Memtsoudis, Stavros G. , Schreiber, Kristin L. , Radcliffe, Gillian , Rivett, Kate, Princova, Zuzana, Adhikary, Sanjib Das , Candido, Kenneth D., Coppens, Steve , Hanna, Marie N. , Kandil, Enas , Kohan, Lynn , Muse, Iyabo O. , Nsiri, Afak , Pasternak, Jeffrey J., Tolba, Reda, Wolmarans, Morné , Elkassabany, Nabil , Memtsoudis, Stavros G , Schreiber, Kristin L , Adhikary, Sanjib , Albrecht, Eric , Bowness, James , Coppens, Steve , Gupta, Rajnish K , Johnson, Rebecca L , Kohan, Lynn R , Kopp, Sandra , Lobo, Clara , Moka, Eleni , Pino, Carlos A , Singh, Vinita , Van de Putte, Peter B C , Wolmarans, Morné , Elkassabany, Nabil M , El-Boghdadly, K , Narouze, Samer , Myles, Paul S. , Albrecht, Éric , Gupta, Rajnish K. , Johnson, Rebecca L. , Kopp, Sandra L. , Lobo, Clara , Μoka, Εleni , Pino, Carlos A. , Singh, Vinita , Theron, Andre
Regional Anesthesia & Pain Medicine | October 29, 2025 | Volume: No volume available | Issue: No issue available | Pages: rapm-2025-107087
Background Outcome selection in regional anesthesia and acute pain research is inconsistent, often lacking patient-centered priorities and validated instruments. We aimed to prioritize key outcomes and propose suitable measurement tools to improve the quality, consistency, and relevance of regional anesthesia research. Methods We conducted a multiround Delphi process, including two electronic voting rounds, a multiday in-person meeting, and a patient panel. Experts and patients evaluated existing and proposed outcomes for importance, validity, and relevance. Outcomes reaching ≥70% agreement were prioritized, and appropriate measurement instruments were identified. Results Thirty-two experts and three patients participated. Across three Delphi rounds, 10 outcomes were prioritized for future regional anesthesia research: seven efficacy outcomes (pain scores; opioid consumption; Brief Pain Inventory; functional outcomes; cognitive function; length of stay; block duration); two multidimensional outcomes (quality of recovery and development of a regional anesthesia-specific quality-of-recovery instrument); one safety outcome (chronic postsurgical pain). Patients prioritized cognitive recovery, function, chronic pain, and pain scores. Conclusions This consensus-based, patient-centered framework defines the core priorities for future regional anesthesia and acute pain research. Future work should focus on developing and validating a regional anesthesia-specific quality-of-recovery instrument, refining multidimensional measures such as functional recovery, cognitive outcomes, and the Brief Pain Inventory, and standardizing the reporting of chronic pain and opioid-related outcomes. Adoption of these priorities will enhance methodological consistency, comparability, and patient relevance in future clinical trials.
To trial or not to trial before peripheral nerve stimulation for chronic pain: a retrospective multicenter comparative analysis of temporary-to-permanent and direct-to-permanent implantation approaches
D’Souza, Ryan S. , Yu, Yue , Singh, Vinita , Javed, Saba , Her, Yeng F , Chai, Nita, Hussain, Nasir , Karri, Jay , Javed, Saba , Hoffmann, Chelsey , Hussain, Nasir , D'Souza, Ryan S , Singh, Vinita , Karri, Jay , Warner, David O.
Regional Anesthesia & Pain Medicine | July 14, 2025 | Volume: No volume available | Issue: No issue available | Pages: rapm-2025-106734
Background Peripheral nerve stimulation (PNS) is an emerging neuromodulation therapy for chronic pain, yet its use in clinical practice varies significantly. Although temporary PNS is widely incorporated, either as a screening trial or a treatment itself, the evidence supporting the use of temporary PNS prior to permanent implantation is limited. We aimed to compare pain relief, opioid consumption, and adverse events between an approach implementing temporary PNS before permanent implantation (temporary-to-permanent (TTP)) vs proceeding directly to permanent PNS implantation (direct-to-permanent (DTP)). Methods A multicenter retrospective study was undertaken at seven major academic institutions from January 1, 2014, to January 1, 2024. Adult patients who underwent permanent PNS implantation for the treatment of chronic pain conditions were included and were divided into TTP or DTP cohorts based on their clinical approach. The dual primary outcomes were pain relief and opioid consumption (in oral morphine equivalents) at 6 months compared with baseline before any PNS therapy. Multivariable Tobit regression analysis was performed to identify predictors of pain relief at 6 months using a stepwise approach. Results A total of 130 patients were analyzed (54 in TTP approach, 76 in DTP approach). Patient-reported percentage pain relief was 56.7%±27.9% at 6 months compared with baseline (before PNS implantation) in the TTP cohort, and 45.1%±33.6% in the DTP cohort. The estimated mean percentage pain relief at 6 months was similar in the TTP and DTP cohorts (between-group difference 15.24%; 95% CI −0.32 to 30.80, p=0.052), with consistent findings after sensitivity analysis with multiple imputation. Opioid consumption declined similarly in the TTP (−3.1±9.9 mg) and DTP (−2.1±8.1 mg) cohorts at 6 months with no statistical difference between cohorts (mean between-group difference: −1.00, 95% CI −4.57 to 2.57, p=0.580), and with consistent findings after sensitivity analysis. Device explantation rates and adverse event profiles were comparable between cohorts. Conclusion Although temporary PNS is widely performed prior to permanent PNS implantation, there was no evidence that the TTP approach is associated with superior analgesic outcomes compared with the DTP approach. Further, patients in both approaches achieved clinically meaningful pain relief at 6 months compared with baseline status prior to PNS therapy.