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2 Minute Medicine Rewind July 13, 2026
1. Erector spinae plane blocks reduced PACU opioid requirements and modestly shortened PACU stay, they did not produce a clinically meaningful reduction in total opioid consumption over 24 hours.
2. Pain control and patient satisfaction were comparable between groups, suggesting ESP blocks offer limited added analgesic benefit over standard analgesia alone in this setting.
Evidence Rating Level: 1 (Excellent)
The erector spinae plane (ESP) block has emerged as a potentially safer alternative to the paravertebral block, the traditional gold-standard regional technique for breast surgery, given its lower risk of pneumothorax. This randomized trial compared bilateral ultrasound-guided ESP blocks (30 mL of 0.25% ropivacaine per side at T4) plus standard analgesia against standard analgesia alone in 78 patients undergoing breast reduction mammoplasty. The primary outcome assessed was cumulative opioid consumption (oral morphine milligram equivalents) over the first 24 postoperative hours. Patients receiving the ESP block had a statistically significant but clinically insignificant reduction in 24-hour opioid use (10.6 vs 17.5 MME; p=0.014). PACU discharge time was modestly shorter in the block group (170 vs 213 minutes; p=0.012), and fewer block-group patients required any opioids during PACU stay (59% vs 86.8%; p=0.006). No significant differences emerged in PACU nausea/vomiting, pain scores at discharge or at 24 hours, or overall anesthesia satisfaction.
Image-guided alcohol neurolysis for treatment of chronic hip pain secondary to avascular necrosis
1. Chemical neurolysis of the anterior hip capsular branches appears to be a safe and effective analgesic option for AVN-related hip pain refractory to conservative management, with durable benefit in a subset of patients through 6 months.
Evidence Rating Level: 3 (Average)
Avascular necrosis (AVN) of the hip frequently causes refractory pain that persists despite conservative management, prompting interest in minimally invasive interventional options. This case series evaluated percutaneous chemical denervation of the articular branches innervating the anterior hip capsule using image-guided neurolysis with 100% ethanol in nine patients with chronic AVN-related hip pain refractory to conservative therapy. Pain was assessed via the Numerical Rating Scale (NRS) at baseline and at 1, 3, and 6 months post-procedure. Baseline pain averaged 6.7±1.2. Two patients did not respond to treatment. Among the seven responders, mean NRS scores decreased to 2.9±1.2 at 1 month and 3.0±1.4 at 3 months, with five of these seven maintaining at least 50% pain relief at both time points. Of the five patients who completed 6-month follow-up, mean NRS was 3.0±1.7, with three sustaining 50% or greater relief. No adverse events or complications were reported throughout follow-up.
Pain prevalence and intensity in advanced pancreatic cancer: a nationwide cohort study
1. Chemotherapy appears to be independently associated with reduced pain severity, reinforcing the importance of routine, longitudinal pain assessment and proactive, individualized symptom management from diagnosis through palliative care.
Evidence Rating Level: 2 (Good)
Pain is a highly prevalent and debilitating symptom in advanced pancreatic cancer, yet longitudinal, population-based data on its course and modifiable determinants remain limited. This nationwide Dutch cohort study analyzed prospectively collected patient-reported outcomes from 794 patients with locally advanced (LAPC, 40%) or metastatic pancreatic cancer (mPC, 60%) enrolled in the PACAP-PROM registry (2016-2023). Pain was assessed at baseline and through 18 months using five items from validated EORTC and EQ-5D-5L questionnaires, with associations between chemotherapy exposure and pain severity evaluated via multivariable ordinal mixed-effects models. At baseline, 54% to 78% of patients reported pain across the five domains, with no significant differences between LAPC and mPC. Pain prevalence decreased at 3 months but followed variable patterns thereafter. Patients receiving best supportive care reported significantly more pain and greater functional interference than those receiving anticancer treatment. Chemotherapy exposure was independently associated with lower odds of higher pain severity for both current pain (OR 0.51) and pain interference (OR 0.44).
Sitting-related Sacral Pain in Patients with Sacral Metastases: Retrospective Cross-Sectional Study
1. Although neurological symptoms (motor deficits, sensory impairment) were more frequent in patients with sitting-related sacral pain on univariate comparison, this association did not hold in multivariable analysis (aOR 0.83, 95% CI 0.21–2.95, p=0.780), indicating spinal instability—not neurological compromise—was the primary driver of this pain.
2. Patients with sitting-related sacral pain had significantly poorer transfer and ambulatory function, as reflected by lower Functional Ambulation Categories and Barthel Index transfer/walking scores compared with those without this pain.
Evidence Rating Level: 2 (Good)
Sacral metastases can cause debilitating pain, neurological deficits, and instability, yet sitting-related pain, though frequently observed clinically, has not been systematically studied. This retrospective cross-sectional study reviewed 71 patients with radiologically confirmed, symptomatic sacral metastases who underwent inpatient rehabilitation at a single Japanese university hospital between 2011 and 2022. Sitting-related sacral pain was defined as a sitting-position numerical rating scale score of 4 or higher, and its association with spinal instability (Spinal Instability Neoplastic Score, SINS) and neurological symptoms was examined using Firth’s penalized logistic regression. Sitting-related sacral pain was reported by 32 patients (45%) and was associated with significantly higher SINS and poorer transfer and ambulation function. In multivariable analysis, higher SINS was independently associated with sitting-related sacral pain (adjusted OR 1.56 per point), while neurological symptoms were not independently associated despite differing significantly in univariate comparisons. Sensitivity analyses, including a modified SINS excluding its pain subscore, confirmed the robustness of this association.
1. Immediate septoplasty is more costly but more clinically effective than medical management for deviated septum.
2. Over a 24-month horizon, immediate septoplasty becomes highly likely to be cost-effective, whereas its value at 12 months remains uncertain and sensitive to surgical costing methods.
Evidence Rating Level: 1 (Excellent)
Deviated nasal septum is commonly managed with either medical therapy (nasal sprays) or septoplasty, but robust cost-effectiveness evidence comparing these strategies has been lacking. The NAIROS trial, a multicentre, open-label RCT across 17 UK otolaryngology clinics, randomised 307 adults with moderate-to-severe nasal obstruction to immediate septoplasty or 6 months of medical management (steroid/saline nasal sprays) with the option for deferred septoplasty. Costs (NHS/personal social service perspective) and QALYs (derived from SF-36/SF-6D) were assessed at 12 months (within-trial analysis) and extrapolated to 24 months using a decision-tree model. Seemingly unrelated regression and multiple imputation were used to estimate incremental costs and effects, with bootstrapping and probabilistic sensitivity analysis to quantify uncertainty. At 12 months, immediate septoplasty was more costly (+£1193) and more effective (+0.044 QALYs) than medical management, yielding an ICER of £27,114/QALY (15% probability cost-effective at £20,000/QALY threshold; 79% using micro-costed surgery costs). At 24 months, septoplasty remained more costly (+£833) but more effective (+0.06 QALYs), with the ICER falling to £13,221/QALY and a 99% probability of cost-effectiveness.
Image: PD
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