Hosted by RAPM Editor Eric Schwenk, MD, this episode of RAPM Focus welcomes RAPM Associate Editor Mark Bicket, MD, PhD, and medical student Sama Ramo following the recent publication of their original research paper, “Risk Factors for Persistent Postoperative Opioid Use: An Entity Distinct from Chronic Postsurgical Pain,” included in the February 2025 special edition of RAPM, titled “Tackling the Challenge of Chronic Postsurgical Pain.”

Persistent postoperative opioid use results when patients continue to take prescription opioids well beyond the time their pain after surgery would be expected to resolve. In some cases, this is a couple days; in other cases, this is several weeks. There are many challenges associated with prescription opioid use, including the lack of a truly safe dose, so there is risk across the continuum. Patients facing persistent postoperative opioid use potentially confront worse outcomes, higher rates of health care utilization, and higher rates of mortality compared to patients not enduring persistent postoperative opioid use.

Dr. Mark Bicket is an associate professor of anesthesiology with tenure at the University of Michigan and a joint appointment in the Department of Health Management and Policy at the School of Public Health. Additionally, he is co-director of the Overdose Prevention Engagement Network (OPEN). A clinician-scientist and practicing physician anesthesiologist, Dr. Bicket has pioneered evidence-based approaches to reduce opioid-related harms and improve the treatment of persons who experience pain. He currently leads an NIH R01 study examining pain-related outcomes for persons with opioid use disorder who have surgery and serves as PI for two pragmatic trials funded by the Patient-Centered Outcomes Research Institute including the CARES study, an international randomized clinical trial examining commonly prescribed treatments for postoperative pain. He previously served on the National Academy of Medicine ad hoc committee on evidence for opioid prescribing guidelines in 2018-2019 and a workshop on opioid disposal in 2023. Dr. Bicket has advised the White House, FDA, CMS, state governments, and national organizations on pain and opioid issues. His research, which includes 120 peer-reviewed articles, has appeared in JAMA, NEJM, and BMJ, and has been supported by the Foundation for Anesthesia Education and Research (FAER), SAMHSA, and CDC.

Sama Ramo is a second-year medical student at Oakland University William Beaumont School of Medicine. She is a Foundation for Anesthesia Education and Research scholar.

*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 X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

This episode of RAPM Focus introduces something new—an episode generated completely by artificial intelligence, specifically Google Notebook. As part of RAPM’s commitment to exploring innovative ways to deliver content, RAPM is trialing this approach and would love to hear your feedback.

This AI-generated episode is centered around an original research paper first published in RAPM in November 2024, “Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks.”

This podcast episode highlights the power of clear communication in medicine, and the ways in which nomenclature brings order to the world of medical terminology. Specifically, the inconsistent naming of nerve blocks can lead to confusion and chaos that result in real consequences.

Different doctors and researchers using different names for the same techniques leads to difficulties in comparing results and sharing knowledge. “Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks” dives into how convoluted the names of nerve blocks have become. This leads to a recipe for miscommunication—not ideal in the world of pain management. By standardizing the nomenclature of nerve blocks, patient safety is increased for those undergoing surgeries involving nerve blocks.

The study lays out a clear system for naming nerve blocks in order to standardize the language of nerve blocks. This system showcases the importance of nomenclature in not just nerve blocks, but in pain management and medicine as a whole.

*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 health care 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.

Find RAPM on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is thrilled to welcome Kesavan Sadacharam, MD, and Allison Fernandez, MD, following the April 2024 publication of their original research paper, “Multisite prospective study of perioperative pain management practices for anterior cruciate ligament reconstruction in adolescents: Society for Pediatric Anesthesia Improvement Network (SPAIN) Project Report.”

Unwarranted variation in health care refers to differences in health care delivery that cannot be attributed to patient illness, medical evidence, or patient preferences. Instead, these variations arise from differing local medical practices, resource availability, and physician decision-making processes. Unwarranted variations can lead to sub-optimal patient outcomes, with some patients receiving unnecessary or harmful treatments while others may not receive beneficial interventions.

Two individuals are behind a multi-center collaborative initiative that looks at the utilization of regional anesthesia and pain medicine techniques for ACL reconstruction.

Dr. Allison Fernandez is an associate professor at Johns Hopkins All Children’s Hospital, practicing pediatric anesthesia, and pediatric acute and chronic pain management. Dr. Fernandez started a video series, Women of Impact in Anesthesia, empowering women in medicine.

Dr. Kesavan Sadacharam is a pediatric anesthesiologist and associate professor at Nemours Children’s Health, located in Wilmington, DE. He is currently the director of regional anesthesia and practices both acute and chronic pain management.

*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 X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is thrilled to welcome Laura Graham, PhD, MPH, and Sesh Mudumbai, MD, MS, following the April 2024 publication of their brief technical report, “Use of natural language processing method to identify regional anesthesia from clinical notes.”

One definition of medicine is the science and practice of the diagnosis treatment in prevention of disease. Science itself involves diagnoses and relies on the process of assessing data to determine cause and effect in therapies. However, in the busy world of clinical productivity and limited resources, the science of medicine is often overlooked.

Physicians struggle to extract meaningful data from electronic medical records, despite their great potential. This is often due to the prioritization of funding for billing and compliance, which leads to challenges in accessing meaningful data. Additionally, barriers such as data license agreements and institutional review board considerations further complicate matters. This is why Dr. Sites is excited about new technologies, such as artificial intelligence that can assist physicians in the practice in the science of medicine.

Dr. Laura Graham is an epidemiologist with VA’s Health Economics Resource Center at the VA Palo Alto Health Care System and an associate faculty with the Stanford-Surgery, Policy, Improvement Research, and Education Center at the Stanford University School of Medicine. Her research interests include causal inference methods and improving clinical processes of care for surgery.

*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 X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this special episode, RAPM Focus takes a break from its usual format of discussing specific research projects to discuss instead how research in health care is increasingly vital yet often hindered by escalating costs and time constraints. Editor-in-Chief Brian Sites, MD, discusses these challenges with Alexander (Xan) Abess, MD, and Jonathan Weed, MD.

Traditional, large scale, randomized controlled trials are resource intensive, making them challenging for clinicians to conduct. As a result, innovative approaches to engage in knowledge acquisition are becoming paramount. Creating a scholastic environment within the anesthesia department not only fosters a culture of continuous learning, but also becomes essential for attracting and retaining talent.

Dr. Abess is an anesthesiologist at Dartmouth Hitchcock Medical Center and assistant professor of anesthesiology and perioperative medicine at Geisel School of Medicine at Dartmouth. He has previously served as the vice chair of quality and safety, department of anesthesiology and perioperative medicine, and is actively involved with the Multi-Center Perioperative Outcomes Group (MPOG). He is the founder and Director of IDEA Lab (Innovation, Development, and Entrepreneurship in Anesthesiology). Xan has a wide range of clinical experience (private practice, academic medicine, military medicine) and medical device development experience, having previously started his own medical device company. He understands well the challenges of medical innovation and truly enjoys helping others achieve their development goals while also attempting to improve the quality of health care delivery and simultaneously addressing our broader economic and workforce challenges.

Dr. Weed is a clinical assistant professor of anesthesiology at Dartmouth Hitchcock Medical Center. He is a graduate of Tulane Medical School and completed his anesthesiology residency at Beth Israel Deaconess Medical Center, followed by a fellowship at Dartmouth Hitchcock Medical Center in regional anesthesia. He spent several years as a residency program director at Tulane Medical Center before returning to Tulane Medical Center in 2021. His most recent interests relate to the use of the electronic health record to improve clinical workflow in research within the department.

*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 health care practitioner’s judgment, 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 X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is delighted to be joined by Alexander Stone, MD, and Kamen Vlassakov, MD, following the April 2024 publication of their original research paper, “Anesthesia Start Time Documentation Accuracy where Peripheral Nerve Block is the Primary Anesthetic.”

Understanding the intricacies of billing is crucial for anesthesiologists in all practice settings, not just in private practice. Proper billing practices not only ensure fair compensation for services rendered, but also impact patient care, hospital finances, and overall health care delivery. Anesthesiologists who engage with billing gain a better understanding of health care economics, which is essential for navigating the complex landscape of modern health care.

Dr. Stone is a regional anesthesiologist at Brigham and Women’s Hospital. He is an assistant professor of anesthesia at Harvard Medical School and Associate Editor of RAPM.

Dr. Vlassakov is the chief of the division of regional and orthopedic anesthesiology, as well as the program director of the regional anesthesiology and acute pain medicine fellowship at Brigham and Women’s Hospital. He is an associate professor of anesthesia at Harvard Medical School and also an Associate Editor of RAPM.

*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 X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is delighted to be joined by Ryan D’Souza, MD, and Nasir Hussain, MD, following the February 2024 publication of their review, “Methodological and Statistical Characteristics of Meta-Analyses on Spinal Cord Stimulation for Chronic Pain: A Systematic Review.” Both of these anesthesiologists are prolific in their research and contributions to the regional anesthesia and pain medicine community.

Best practice advisories and policies tend to stem from the results of systematic reviews and metanalysis, thus the stakes are very high for a journal to ensure that the results are meaningful and valid. The mathematical principles and assumptions of systematic reviews and meta-analyses are quite complex, which often exceeds the capacity of many journals to truly adjudicate. To further complicate matters, there are emerging techniques that include network meta-analyses that take even more expertise to review. Therefore, better understanding content areas where there are strengths and weaknesses around systematic reviews is critical to best informing clinical practice.

Dr. D’Souza is a pain medicine physician and anesthesiologist at the Mayo Clinic. He is an associate professor, director of neuromodulation, and director of the in-patient pain service. He is an associate editor and social media editor for RAPM.

Dr. Hussain is a pain medicine physician and anesthesiologist at the Ohio State University Wexner Medical Center. He is an assistant professor, associate program director for anesthesiology residency, and assistant program director of the chronic pain fellowship.

*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 X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In RAPM Focus’s latest podcast series, Article Reads, Alopi Patel, MD, narrates “Artificial intelligence and regional anesthesiology education curriculum development: navigating the digital noise” by Kristopher M Schroeder and Nabil Elkassabany. Originally published in Regional Anesthesia & Pain Medicine in June 2024, this daring discourse is now available in podcast format for an all new RAPM experience.

Artificial intelligence (AI) has demonstrated a disruptive ability to enhance and transform clinical medicine. While the dexterous nature of anesthesiology work offers some protections from AI clinical assimilation, this technology will ultimately impact the practice and augment the ability to provide an enhanced level of safe and data-driven care. An essential mission of academia is education, and challenges are frequently encountered when working to develop and implement comprehensive and effectively targeted curriculum appropriate for the diverse set of learners assigned to teaching faculty. Large language models offer the promise of targeted curriculum and content development that can be individualized to a variety of learners at various stages of training. 

https://pubmed.ncbi.nlm.nih.gov/38876802

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, sits down with Michael Barrington, MD, to discuss best practice advisories and policies with systematic reviews.

Best practice advisories and policies tend to stem from the results of systematic reviews and metanalysis, thus the stakes are very high for a journal to ensure that the results are meaningful and valid. As part of a RAPM initiative to establish education and standards for researchers interested in submitting a systematic review or meta-analysis we participate in a joint publication with the journal, Anesthesia and Analgesia. 

Dr. Barrington is well known in the regional anesthesia community as he is currently the section editor for Regional Anesthesia for the journal, Anesthesia and Analgesia. He has had a recent appointment as professor of anesthesiology at OHSU and is transitioning to the University of Washington. 

Some topics covered by Dr. Sites and Dr. Barrington in this podcast are: 

• How having a broad team with a broad scope of expertise as part of the authorship team reflects some of the important components of a systematic review.

*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 X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Associate Editor Ed Mariano, MD, MAS, FASA substitutes for Editor-in-Chief Brian Sites, MD, to discuss the diverse publishing landscapes in the scientific field with Executive Editor Ruth Landau, MD.

Dr. Mariano is a professor at Stanford University School of Medicine.

Dr. Landau is the Virginia Apgar professor and the Chief of Obstetric Anesthesiology at Columbia University. She is also the director of the Center of Precision Medicine within the department and a past president for the Society for Obstetric Anesthesia and Perinatology (SOAP). Dr. Launda is known globally for her expertise and leadership with Obstetric Anesthesia, Labor Analgesia, and Maternal Health and Outcomes. In addition to her extensive work with Obstetrics, she also serves on the RAPM editorial board. 

Dr. Mariano and Dr. Landau discuss the publishing approach RAPM has taken. RAPM is dedicated to publishing research that has the potential to have a real clinical impact and better-informed decision making. There is a huge responsibility in publishing to inform clinicians, to give back to researchers, and selecting the right reviewers. 

*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 X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.