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Regional Anesthesia and Pain Medicine

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https://www.readbyqxmd.com/read/27922951/anatomic-and-ultrasonographic-evaluation-of-the-knee-sensory-innervation-a-cadaveric-study-to-determine-anatomic-targets-in-the-treatment-of-chronic-knee-pain
#1
Jorge M Orduña Valls, Ricardo Vallejo, Pablo López Pais, Eliezer Soto, Daniel Torres Rodríguez, David L Cedeño, Carlos Tornero Tornero, Maximino Quintáns Rodríguez, Aurora Baluja González, Julián Álvarez Escudero
BACKGROUND AND OBJECTIVES: Osteoarthrosis is a main cause of knee pain in the elderly. Pain associated with this condition is often refractory to conservative treatment. Total knee replacement may be the best option for severe pathologies; however, the occurrence of a chronic pain state after knee replacement has been well documented in the literature. The previous descriptions of the genicular nerves have been considered somewhat inaccurate. This innervation is complex and exhibits significant interindividual variability...
December 5, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27922950/a-prospective-randomized-comparative-trial-of-targeted-steroid-injection-via-epidural-catheter-versus-standard-c7-t1-interlaminar-approach-for-the-treatment-of-unilateral-cervical-radicular-pain
#2
Zachary L McCormick, Ariana Nelson, Meghan Bhave, Mikhail Zhukalin, Mark Kendall, Robert J McCarthy, Dost Khan, Geeta Nagpal, David R Walega
BACKGROUND AND OBJECTIVES: No study has compared cervical interlaminar epidural steroid injection (CIESI) with epidural catheter advancement to the side and level of pathology versus standard C7-T1 CIESI. This study investigated whether cervical radicular pain is more effectively treated by CIESI with a targeted epidural catheter versus a standard C7-T1 approach. METHODS: Prospective, randomized, single-blinded trial. PRIMARY OUTCOME: Numerical Rating Scale (NRS) pain at 1 month...
December 5, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27922949/the-neurological-safety-of-an-epidurally-administered-lipo-pge1-agonist-in-rats
#3
Eunjoo Choi, Sun Min Im, Hyung-Seok Yoo, Francis Sahngun Nahm, Yang Hyun Kim, Gheeyoung Choe, Pyung Bok Lee
BACKGROUND AND OBJECTIVE: Liposomal prostaglandin E1 (Lipo-PGE1) can inhibit platelet aggregation and vasodilatation and has been found to be therapeutic in ischemia and spinal diseases including stenosis. However, the neurologic safety of epidural administration of lipo-PGE1 requires further study. We investigated the neurotoxicity of epidurally administered lipo-PGE1 agonist in rats. METHODS: Twenty-seven rats were randomly divided into three groups: Epidural isotonic sodium chloride solution administration (negative control, group N, n = 9); epidural lipo-PGE1 agonist (group L, n = 9); and epidural alcohol (positive control, group A, n = 9)...
December 5, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27922948/fluoroscopic-guidance-increases-the-incidence-of-thoracic-epidural-catheter-placement-within-the-epidural-space-a-randomized-trial
#4
Michelle C Parra, Kristin Washburn, Jeremiah R Brown, Michael L Beach, Mark P Yeager, Patricia Barr, Kathy Bonham, Kathryn Lamb, Randy W Loftus
BACKGROUND AND OBJECTIVES: Thoracic epidural analgesia can reduce postoperative pain and cardiopulmonary morbidity, but it is associated with a high rate of clinical failure. Up to 50% of clinical failure is thought to be related to technical insertion. In this study, patients undergoing thoracic surgery were randomized to one of two catheter insertion techniques: fluoroscopically guided or conventional loss of resistance with saline/air. Our primary aim was to examine whether fluoroscopic guidance could increase the incidence of correct catheter placement and improve postoperative analgesia...
December 5, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27902645/effect-of-nerve-stimulation-use-on-the-success-rate-of-ultrasound-guided-subsartorial-saphenous-nerve-block-a-randomized-controlled-trial
#5
Shaylyn H Montgomery, Colleen M Shamji, Grace S Yi, Cynthia H Yarnold, Stephen J Head, Scott C Bell, Stephan K W Schwarz
BACKGROUND AND OBJECTIVES: Ultrasound-guided subsartorial saphenous nerve block is commonly used to provide complete surgical anesthesia of the foot and ankle in combination with a popliteal sciatic nerve block. However, in part owing to its small caliber and absence of a prominent vascular landmark in the subsartorial plane distal to the adductor canal, the saphenous nerve is more difficult to reliably block than the sciatic nerve in the popliteal fossa. Although the saphenous nerve is a sensory nerve only, neurostimulation can be used to elicit a "tapping" sensation on the anteromedial aspect of the lower leg extending toward the medial malleolus...
November 29, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27875368/analgesic-effect-and-functional-improvement-caused-by-radiofrequency-treatment-of-genicular-nerves-in-patients-with-advanced-osteoarthritis-of-the-knee-until-1-year-following-treatment
#6
María M Santana Pineda, Luc E Vanlinthout, Ana Moreno Martín, Jan van Zundert, Fernando Rodriguez Huertas, José P Novalbos Ruiz
BACKGROUND AND OBJECTIVES: Radiofrequency ablation of genicular nerves has proved to be successful in relieving pain and incapacity caused by osteoarthritis of the knee. However, long-term efficacy of such a treatment remains to be assessed. The current study aimed to reproduce radiofrequency neurotomy of genicular nerves to manage gonarthrosis pain and disability and establish therapeutic response until 1 year after intervention. METHODS: This single-center, prospective, observational, noncontrolled, longitudinal study included patients with grade 3 to 4 gonarthrosis suffering from intractable knee pain, scoring 5 or more on the visual analog scale (VAS) during >6 months...
November 22, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27846186/ocular-motor-palsy-after-spinal-puncture
#7
Monica Del-Rio-Vellosillo, José J Garcia-Medina, Maria Dolores Pinazo-Duran, Antonio Abengochea-Cotaina, Manuel Barbera-Alacreu
Ocular motor palsy is a rare but alarming complication of subarachnoid puncture. In order to better understand this condition, a literature search was performed in English of PubMed articles for cranial nerves III, IV, and VI palsies after spinal puncture. Sixty-five articles (dated 1930-2015) were identified, and 114 cases were obtained for analysis. Subarachnoid anesthesia was the most frequent cause (45.6%), with a higher incidence for females than males. The age of patients was 40.24 ± 13.35 years (age range, 6-71 years)...
November 15, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27846187/classification-and-treatment-of-chronic-neck-pain-a-longitudinal-cohort-study
#8
Richard Liu, Connie Kurihara, Hue-Ting Tsai, Peter J Silvestri, Michael I Bennett, Paul F Pasquina, Steven P Cohen
BACKGROUND AND OBJECTIVES: Neck pain exerts a steep personal and socioeconomic toll, ranking as the fourth leading cause of disability. The principal determinant in treatment decisions is whether pain is neuropathic or nonneuropathic, as this affects treatment at all levels. Yet, no study has sought to classify neck pain in this manner. METHODS: One hundred participants referred to an urban, academic military treatment facility with a primary diagnosis of neck pain were enrolled and followed up for 6 months...
November 14, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27831958/anesthetic-and-obstetrical-factors-associated-with-the-effectiveness-of-epidural-analgesia-for-labor-pain-relief-an-observational-population-based-study
#9
Marie-Pierre Bonnet, Caroline Prunet, Christophe Baillard, Laure Kpéa, Béatrice Blondel, Camille Le Ray
BACKGROUND AND OBJECTIVES: The effectiveness of labor epidural analgesia is difficult to explore, as it includes the maternal satisfaction with analgesia as well as the overall childbirth experience. In this population-based study, we sought to identify factors associated with the effectiveness of epidural analgesia for labor pain relief. METHODS: We performed a secondary analysis of the 2010 French National Perinatal Survey, a cross-sectional study of a representative sample of births in France...
November 9, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27831957/a-time-out-checklist-for-pediatric-regional-anesthetics
#10
Anna Clebone, Barbara K Burian, David M Polaner
BACKGROUND AND OBJECTIVES: Although pediatric regional anesthesia has a demonstrated record of safety, adverse events, especially those related to block performance issues, still may occur. To reduce the frequency of those events, we developed a Regional Anesthesia Time-Out Checklist using expert opinion and the Delphi method. METHODS: A content development and review was performed by the authors and the Society for Pediatric Anesthesia Quality and Safety Committee...
November 9, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27811528/clinical-efficacy-of-an-ultrasound-guided-greater-occipital-nerve-block-at-the-level-of-c2
#11
Matthew J Pingree, Joshua S Sole, Travis G Oʼ Brien, Jason S Eldrige, Susan M Moeschler
BACKGROUND AND OBJECTIVES: The purpose of this prospective open-label study was to investigate the analgesic effects of an ultrasound-guided greater occipital nerve (GON) block at the level of C2, as the nerve courses superficially to the obliquus capitis inferior muscle. METHODS: Patients with a diagnosis of occipital neuralgia or cervicogenic headache were recruited for the study. Ultrasound-guided GON blocks at the level of C2 were performed by experienced clinicians according to a standardized protocol...
November 2, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27811527/a-cadaveric-study-evaluating-the-feasibility-of-an-ultrasound-guided-diagnostic-block-and-radiofrequency-ablation-technique-for-sacroiliac-joint-pain
#12
Shannon L Roberts, Robert S Burnham, Anne M Agur, Eldon Y Loh
BACKGROUND AND OBJECTIVES: Ultrasound (US)-guided diagnostic block/radiofrequency ablation (RFA) along the lateral sacral crest (LSC) has been proposed for managing sacroiliac joint (SIJ) pain. We sought to investigate (1) ease of visualization of bony landmarks using US; (2) consistency of US-guided needle placement along the LSC; and (3) percentage of the posterior sacral network (PSN) innervating the SIJ complex that would be captured if an RFA strip lesion were created between the needles...
November 2, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27811526/prospective-double-blind-randomized-study-to-evaluate-single-injection-adductor-canal-nerve-block-versus-femoral-nerve-block-postoperative-functional-outcomes-after-total-knee-arthroplasty
#13
George I Macrinici, Carol Murphy, Lori Christman, Michelle Drescher, Brittany Hughes, Victor Macrinici, Gloria Diab
BACKGROUND AND OBJECTIVES: Despite multiple clinical trials comparing the adductor canal block (ACB) with femoral nerve block (FNB) for total knee arthroplasty, none looked at the aforementioned nerve blocks from early functional results to up to 6 months after surgery. METHODS: For this prospective, double-blind, randomized, single-center trial, we enrolled 98 patients set to undergo total knee arthroplasty. The patients were randomized, with 93 patients included in the intention-to-treat analysis...
November 2, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27776095/ultrasound-guided-cervical-medial-branch-radiofrequency-neurotomy-can-multitined-deployment-cannulae-be-the-solution
#14
Roderick J Finlayson, Atikun Thonnagith, Maria Francisca Elgueta, Jordi Perez, John-Paul B Etheridge, De Q H Tran
BACKGROUND AND OBJECTIVES: Novel multitined cannulae constitute an attractive option for ultrasound-guided radiofrequency neurotomy of cervical medial branches. The deployment tines increase the cannula's active area, thus altering its lesion size. Despite their theoretical benefits, multitined cannulae have not been assessed. In this bench study, we sought to investigate the lesions produced by a standard 18-gauge and 2 commercially available multitined deployment cannulae. We created ex vivo models to evaluate lesion morphology at a periosteal interface using approach angles likely to be encountered during an ultrasound-guided technique...
October 21, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27776094/influence-of-medical-insurance-under-the-affordable-care-act-on-access-to-pain-management-of-the-trauma-patient
#15
Daniel H Wiznia, Theodore Zaki, Julianna Maisano, Chang-Yeon Kim, Thomas M Halaszynski, Michael P Leslie
BACKGROUND AND OBJECTIVES: The Affordable Care Act intended to "extend affordable coverage" and "ensure access" for vulnerable patient populations. This investigation examined whether the type of insurance (Medicaid, Medicare, Blue Cross, cash pay) carried by trauma patients influences access to pain management specialty care. METHODS: Investigators phoned 443 board-certified pain specialists, securing office visits with 235 pain physicians from 8 different states...
October 21, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27755490/effect-of-topical-morphine-on-acute-and-chronic-postmastectomy-pain-what-is-the-optimum-dose
#16
Sahar Abdel-Baky Mohamed, Hala Saad Abdel-Ghaffar, Shereen Mamdouh Kamal, Khaled Mohamed Fares, Hesham Mahmoud Hamza
BACKGROUND AND OBJECTIVES: Poorly controlled postoperative pain is strongly associated with the development of chronic pain. We aimed to investigate the effect of topical morphine (in 1 of 3 doses: 5, 10, or 15 mg) on acute and chronic neuropathic pain after modified radical mastectomy for cancer breast. METHODS: In this registered clinical trial (ClinicalTrials.gov identifier: NCT02462577), 90 patients were allocated to receive 10 mL plain bupivacaine 0.5% plus either 5, 10, or 15 mg morphine (designated by the group names Morphine5, Morphine10, and Morphine15, respectively)...
October 11, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27755488/quadratus-lumborum-block-versus-transversus-abdominis-plane-block-for-postoperative-pain-after-cesarean-delivery-a-randomized-controlled-trial
#17
Rafael Blanco, Tarek Ansari, Waleed Riad, Nanda Shetty
BACKGROUND AND OBJECTIVES: Effective postoperative analgesia after cesarean delivery enhances early recovery, ambulation, and breastfeeding. In a previous study, we established the effectiveness of the quadratus lumborum block in providing pain relief after cesarean delivery compared with patient-controlled analgesia (morphine). In the current study, we hypothesized that this method would be equal to or better than the transversus abdominis plane block with regard to pain relief and its duration of action after cesarean delivery...
October 11, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27755486/the-analgesic-efficacy-of-nonsteroidal-anti-inflammatory-agents-nsaids-in-patients-undergoing-cesarean-deliveries-a-meta-analysis
#18
Angela M Zeng, Nina F Nami, Christopher L Wu, Jamie D Murphy
BACKGROUND AND OBJECTIVES: Postoperative pain after cesarean delivery, which accounts for approximately 1 in 3 live births in the United States, can be severe in many patients. Nonsteroidal anti-inflammatory agents (NSAIDs) are potent analgesics that are effective in the treatment of postoperative pain. In this meta-analysis, we assessed the analgesic efficacy of NSAIDs in postoperative cesarean delivery patients. METHODS: An electronic literature search of the Library of Medicine's PubMed, Cochrane CENTRAL, Scopus, and EMBASE databases was conducted in May 2013 and updated in January 2015 (Appendix, Supplemental Digital Content 1, http://links...
October 11, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27685350/labor-epidural-intolerance-due-to-a-congenitally-narrowed-spinal-canal
#19
David M Dickerson, Ran Dai, Barbara M Scavone, William McDade
Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. Magnetic resonance imaging revealed a congenitally narrowed spinal canal because of short pedicle syndrome. Epidural injectate occupies and compresses a percentage of the spinal canal and its neuronal contents. This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis...
September 28, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27685348/determining-the-learning-curve-for-acquiring-core-sonographic-skills-for-ultrasound-guided-axillary-brachial-plexus-block
#20
Michael J Barrington, Laura P Viero, Roman Kluger, Alexander L Clarke, Jason J Ivanusic, Daniel M Wong
BACKGROUND AND OBJECTIVES: The objectives of this study were to determine the learning curve for capturing sonograms and identifying anatomical structures relevant to ultrasound-guided axillary brachial plexus block and to determine if massed was superior to distributed practice for this core sonographic skill. METHODS: Ten University of Melbourne, third- or fourth-year Doctor of Medicine students were randomized to massed or distributed practice. Participants performed 15 supervised learning sessions comprising scanning followed by feedback...
September 28, 2016: Regional Anesthesia and Pain Medicine
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