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Genomics and Precision Analgesia: Is this the era?

June 10, 2025/115 Comments/in Volume 6; Issue 1: January-June 2025/by Ijraijraadmin

Vol 6 | Issue 1 | January-June 2025 | Page 15-19 | Bhuvaneswari Balasubramanian, Sandeep Diwan DOI: https://doi.org/10.13107/ijra.2025.v06.i01.116 Open Access License: CC BY-NC 4.0 Copyright Statement: Copyright © 2025; The Author(s). Submitted: 24-02-2025; Reviewed: 19-03-2025; Accepted: 19-05-2025; Published: 10-06-2025 Authors: Bhuvaneswari Balasubramanian [1] Sandeep Diwan [2] [1] Department of Anaesthesiology & Critical Care, AIIMS, Nagpur, […]

Intrafascicular Injection: Can AI, Ultrasound, Pressure Monitoring, and Echogenic Needles Prevent It?

June 10, 2025/93 Comments/in Volume 6; Issue 1: January-June 2025/by Ijraijraadmin

Vol 6 | Issue 1 | January-June 2025 | Page 08-14 | Divesh Arora DOI: https://doi.org/10.13107/ijra.2025.v06.i01.114 Open Access License: CC BY-NC 4.0 Copyright Statement: Copyright © 2025; The Author(s). Submitted: 28-02-2025; Reviewed: 22-03-2025; Accepted: 25-05-2025; Published: 10-06-2025 Authors: Divesh Arora [1] [1] Department of Anaesthesia & OT Services, Asian Hospital, Faridabad, Haryana, India. Address of […]

Genomics and Precision Analgesia: Is this the era?

June 10, 2025/115 Comments/in Volume 6; Issue 1: January-June 2025/by Ijraijraadmin

Intrafascicular Injection: Can AI, Ultrasound, Pressure Monitoring, and Echogenic Needles Prevent It?

June 10, 2025/93 Comments/in Volume 6; Issue 1: January-June 2025/by Ijraijraadmin

Full Sized Blog Element (Big Preview Pic)

Genomics and Precision Analgesia: Is this the era?

June 10, 2025/115 Comments/in Volume 6; Issue 1: January-June 2025/by Ijraijraadmin

Vol 6 | Issue 1 | January-June 2025 | Page 15-19 | Bhuvaneswari Balasubramanian, Sandeep Diwan

DOI: https://doi.org/10.13107/ijra.2025.v06.i01.116

Open Access License: CC BY-NC 4.0

Submitted: 24-02-2025; Reviewed: 19-03-2025; Accepted: 19-05-2025; Published: 10-06-2025

Authors: Bhuvaneswari Balasubramanian [1]

Sandeep Diwan [2]

[1] Department of Anaesthesiology & Critical Care, AIIMS, Nagpur, Maharashtra, India.
[2] Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence

Dr. Bhuvaneswari Balasubramanian
Department of Anaesthesiology & Critical Care, AIIMS, Nagpur, Maharashtra, India.
Email: docbhuvaneswari@gmail.com

Abstract

Interindividual variability in analgesic response reflects heritable differences in drug metabolism, receptor expression, neurotransmitter turnover, and central nervous system drug transport. Pharmacogenomic advances have clarified functional consequences of polymorphisms in CYP2D6, CYP3A4, UGT2B7, OPRM1, COMT, and ABCB1, each of which influences opioid and non-opioid pharmacokinetics and pharmacodynamics. CYP2D6 metabolizer status determines conversion of prodrugs such as codeine and tramadol to active metabolites, while CYP3A4 variation modulates systemic opioid clearance. OPRM1 A118G alters μ-opioid receptor binding affinity and signaling, COMT Val158Met influences catecholamine-mediated pain sensitivity, and ABCB1 variants affect opioid penetration across the blood–brain barrier. Clinical studies demonstrate genotype-associated differences in analgesic efficacy and toxicity, though effect sizes vary across populations and analgesic classes. Implementation remains constrained by limited genotype-stratified randomized trials, testing turnaround time, unclear cost-effectiveness, and underrepresentation of Asian and Southeast Asian ancestry groups in genomic datasets. This mini-review synthesizes mechanistic foundations, clinical evidence, population variation, and practical considerations for integrating pharmacogenomics into perioperative and chronic pain management.
Keywords: Genomics, Pharmacogenetics, Precision medicine, Analgesia, CYP2D6, Postoperative pain, Opioids

References

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How to Cite this Article: Balasubramanian B, Diwan S. Genomics and Precision Analgesia – Is This the Era? International Journal of Regional Anaesthesia. January-June 2025; 6(1): 15-19. DOI: https://doi.org/10.13107/ijra.2025.v06.i01.116

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Intrafascicular Injection: Can AI, Ultrasound, Pressure Monitoring, and Echogenic Needles Prevent It?

June 10, 2025/93 Comments/in Volume 6; Issue 1: January-June 2025/by Ijraijraadmin

Vol 6 | Issue 1 | January-June 2025 | Page 08-14 | Divesh Arora

DOI: https://doi.org/10.13107/ijra.2025.v06.i01.114

Open Access License: CC BY-NC 4.0

Submitted: 28-02-2025; Reviewed: 22-03-2025; Accepted: 25-05-2025; Published: 10-06-2025

Authors: Divesh Arora [1]

[1] Department of Anaesthesia & OT Services, Asian Hospital, Faridabad, Haryana, India.

Address of Correspondence

Dr. Divesh Arora,
Director & HOD, Department of Anaesthesia & OT Services, Asian Hospital, Faridabad, Haryana, India.
Email ID: drdivesh@gmail.com

Abstract

Intrafascicular injection represents one of the most serious complications in regional anaesthesia, potentially resulting in irreversible neurological injury. Despite the advances in ultrasound-guided techniques, inadvertent intraneural and intrafascicular injections still occur. This review synthesizes the current understanding of nerve microanatomy, mechanisms of nerve injury, and the diagnostic and preventive strategies aimed at avoiding this catastrophic event. It highlights the role of ultrasound technology, echogenic needle innovations, injection pressure monitoring, neurostimulation, and emerging applications of artificial intelligence in enhancing procedural safety. The integration of these multimodal safety tools can significantly reduce operator dependency and improve real-time feedback during nerve block procedures. With continued technological refinement, structured training, and incorporation of AI-assisted imaging and robotics, the risk of intrafascicular injection can be minimized, thereby improving patient safety and outcomes in regional anaesthesia.
Keywords: Intrafascicular injection, Regional anaesthesia safety, Ultrasound guidance, Echogenic needles, Pressure monitoring, Artificial intelligence.

References

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How to Cite this Article: Arora D. Intrafascicular Injection: Can AI, Ultrasound, Pressure Monitoring, and Echogenic Needles Prevent It? International Journal of Regional Anaesthesia. January-June 2025; 6(1): 08-14. DOI: https://doi.org/10.13107/ijra.2025.v06.i01.114

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Authors: Bhuvaneswari Balasubramanian [1]

Sandeep Diwan [2]

Authors: Divesh Arora [1]

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