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Regional Anesthesia and Pain Medicine

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https://www.readbyqxmd.com/read/29346228/analgesia-of-combined-femoral-triangle-and-obturator-nerve-blockade-is-superior-to-local-infiltration-analgesia-after-total-knee-arthroplasty-with-high-dose-intravenous-dexamethasone
#1
Charlotte Runge, Jan Mick Jensen, Louise Clemmesen, Henriette Bach Knudsen, Carsten Holm, Jens Børglum, Thomas Fichtner Bendtsen
BACKGROUND AND OBJECTIVES: High-dose intravenous dexamethasone reduces the postoperative opioid requirement and is often included in the multimodal analgesia strategy after total knee arthroplasty (TKA). Combined obturator nerve and femoral triangle blockade (OFB) reduces the opioid consumption and pain after TKA better than local infiltration analgesia (LIA). The question is whether preoperative high-dose intravenous dexamethasone would cancel out the superior analgesic effect of OFB compared with LIA...
January 17, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29346227/refractory-pain-management-in-amyloid-associated-peripheral-neuropathy
#2
Nafisseh S Warner, James C Watson, Markus A Bendel, Susan M Moeschler
OBJECTIVE: Systemic amyloidosis is a disease that often involves multiple organ systems, including the peripheral nervous system. Patients may present with severe, refractory neuropathic pain; however, the optimal treatment approach for pain for these patients remains unclear. CASE REPORT: A man with severe, refractory neuropathic pain in his bilateral upper and lower extremities and the trunk secondary to amyloid neuropathy is presented. Multiple medication trials, including neuropathic and opioid agents, produced considerable adverse effects and minimal relief...
January 17, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29346229/anatomical-variations-of-the-vertebral-artery-in-the-upper-cervical-spine-clinical-relevance-for-procedures-targeting-the-c1-c2-and-c2-c3-joints
#3
Maria Francisca Elgueta, Johanna Ortiz Jimenez, Nina Nan Wang, Almudena Pérez Lara, Jeffrey Chankowsky, Roshanak Charghi, De Q Tran, Roderick J Finlayson
BACKGROUND AND OBJECTIVES: Accidental breach of the vertebral artery (VA) during the performance of cervical pain blocks can result in significant morbidity. Whereas anatomical variations have been described for the foraminal (V2) segment of the VA, those involving its V3 portion (between the C2 transverse process and dura) have not been investigated and may be of importance for procedures targeting the third occipital nerve or the lateral atlantoaxial joint. METHODS: Five hundred computed tomography angiograms of the neck performed in patients older than 50 years for the management of cerebrovascular accident or cervical trauma (between January 2010 and May 2016) were retrospectively and independently reviewed by 2 neuroradiologists...
January 16, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29319605/epidural-hematoma-following-interlaminar-epidural-injection-in-patient-taking-aspirin
#4
Rebecca A Sanders, Markus A Bendel, Susan M Moeschler, William D Mauck
OBJECTIVE: We present a case report of a patient who developed an epidural hematoma following an interlaminar epidural steroid injection with no risk factors aside from old age and aspirin use for secondary prevention. CASE REPORT: A 79-year-old man developed an epidural hematoma requiring surgical treatment following an uncomplicated interlaminar epidural steroid injection performed for neurogenic claudication. In the periprocedural period, he continued aspirin for secondary prophylaxis following a myocardial infarction...
January 9, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29319604/the-european-society-of-regional-anaesthesia-and-pain-therapy-american-society-of-regional-anesthesia-and-pain-medicine-recommendations-on-local-anesthetics-and-adjuvants-dosage-in-pediatric-regional-anesthesia
#5
Santhanam Suresh, Claude Ecoffey, Adrian Bosenberg, Per-Anne Lonnqvist, Gildasio S de Oliveira, Oscar de Leon Casasola, José de Andrés, Giorgio Ivani
BACKGROUND AND OBJECTIVES: Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. METHODS: Representatives from both ASRA and ESRA composed the joint committee practice advisory...
January 9, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29315130/ultrasound-identification-of-diaphragm-by-novices-using-abcde-technique
#6
Jaasmit Khurana, Stephanie C Gartner, Latha Naik, Ban C H Tsui
BACKGROUND AND OBJECTIVES: In this study, we examined the consistency, rapidity, and reproducibility of the ABCDE technique for diaphragm identification. Operators using this method place the probe at the Anterior axillary line, watch for Breathing (lung sliding), and then move the probe Caudally to identify the Diaphragm for Examination. METHODS: A convenience sample of 100 patients was recruited from the preadmission clinic. Two novice operators each scanned the diaphragm using a linear ultrasound transducer in B-mode...
January 9, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29315129/relative-contributions-of-adductor-canal-block-and-intrathecal-morphine-to-analgesia-and-functional-recovery-after-total-knee-arthroplasty-a-randomized-controlled-trial
#7
Abhijit Biswas, Anahi Perlas, Meela Ghosh, KiJinn Chin, Ahtsham Niazi, Barjind Pandher, Vincent Chan
BACKGROUND AND OBJECTIVES: Effective postoperative analgesia may enhance early rehabilitation after orthopedic surgery. This randomized double-blind trial investigates the relative contributions of adductor canal block and low-dose intrathecal morphine (ITM) to postoperative analgesia and functional recovery after total knee arthroplasty. METHODS: Two-hundred one patients undergoing elective unilateral total knee arthroplasty under spinal anesthesia were randomized to 3 groups...
January 9, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29303925/local-anesthetic-systemic-toxicity-a-review-of-recent-case-reports-and-registries
#8
Marina Gitman, Michael J Barrington
This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade...
January 5, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29280923/local-anesthetic-systemic-toxicity-in-total-joint-arthroplasty-incidence-and-risk-factors-in-the-united-states-from-the-national-inpatient-sample-1998-2013
#9
Daniel S Rubin, Monica M Matsumoto, Guy Weinberg, Steven Roth
BACKGROUND: Local anesthetic systemic toxicity (LAST) is a rare and potentially devastating complication of regional anesthesia. Single-institution registries have reported a decreasing incidence, but these results have limited broad applicability. A recent study using a US database found a relatively high incidence of LAST. We used the National Inpatient Sample, a US database of inpatient admissions, to identify the national incidence and associated risk factors for LAST in total joint arthroplasties...
December 26, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29278606/local-application-of-ultrasound-attenuates-neuropathic-allodynia-and-proinflammatory-cytokines-in-rats-after-thoracotomy
#10
Ching-Hsia Hung, Chong-Chi Chiu, Chen-Chih Liu, Yu-Wen Chen
BACKGROUND AND OBJECTIVES: We aimed to investigate the effect of therapeutic ultrasound (TU) on pain sensitivity and the concentration inflammatory cytokines in a thoracotomy rat model. METHODS: Rats were distributed randomly into 4 groups: (1) sham operated, (2) thoracotomy and rib retraction (TRR), (3) TRR rats that received TU (TRR + TU-1), and (4) TRR rats that received TU with the ultrasound turned off (TRR + TU-0). Ultrasound was set at 1-MHz frequency (1...
December 22, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29278605/erector-spinae-plane-block-for-surgery-of-the-posterior-thoracic-wall-in-a-pediatric-patient
#11
Maria Alejandra Hernandez, Lucio Palazzi, Julio Lapalma, Mauricio Forero, Ki Jinn Chin
OBJECTIVE: Historically, regional anesthesia for surgery on the posterior thoracic wall has been limited to neuraxial and paravertebral nerve blocks. The erector spinae plane (ESP) block is a novel technique that anesthetizes the dorsal rami of the spinal nerves innervating the posterior thoracic wall. We report the use of the ESP block for this clinical application in a pediatric patient. CASE REPORT: A healthy 3-year-old girl was scheduled for resection of a giant paraspinal lipoma extending over the T4-T7 dermatomes...
December 22, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29278604/sensory-assessment-and-regression-rate-of-bilateral-oblique-subcostal-transversus-abdominis-plane-block-in-volunteers
#12
Yue Chen, KeJian Shi, Yun Xia, Xuezheng Zhang, Thomas J Papadimos, Xuzhong Xu, Quanguang Wang
BACKGROUND AND OBJECTIVES: The analgesic effect and duration of a transversus abdominis plane (TAP) block remain controversial. Transversus abdominis plane blocks are effective for somatic/incisional pain but do not provide analgesia for visceral pain from intra-abdominal procedures. The purpose of this study was to assess the area and extent of cutaneous sensory blockade and the regression of dermatomal anesthesia after bilateral oblique subcostal TAP block. METHODS: This observational, prospective clinical study consisted of 12 healthy volunteers...
December 22, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29278603/interventional-spine-and-pain-procedures-in-patients-on-antiplatelet-and-anticoagulant-medications-second-edition-guidelines-from-the-american-society-of-regional-anesthesia-and-pain-medicine-the-european-society-of-regional-anaesthesia-and-pain-therapy-the
#13
Samer Narouze, Honorio T Benzon, David Provenzano, Asokumar Buvanendran, José De Andres, Timothy Deer, Richard Rauck, Marc A Huntoon
The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures...
December 22, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29278602/ethnic-differences-identified-by-pain-sensitivity-questionnaire-correlate-with-clinical-pain-responses
#14
Brooke A Bell, Ruth Ruscheweyh, Bernard Joseph Kelley, Timothy J Ness, Thomas R Vetter, Alethia Baldwin Sellers
BACKGROUND AND OBJECTIVES: The Pain Sensitivity Questionnaire, English version (PSQ-E), is predictive of pain-related responses to experimental stimuli. Ethnic differences have been noted in experimental measures of pain sensation using quantitative sensory testing. The present study sought to determine if the PSQ-E also identified similar ethnic differences. METHODS: Fifty-seven subjects who self-identified as African Americans (AAs) and who were scheduled to undergo a low-back interventional procedure completed the PSQ-E and other questionnaires...
December 22, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29219935/intrathecal-morphine-for-laparoscopic-segmental-colonic-resection-as-part-of-an-enhanced-recovery-protocol-a-randomized-controlled-trial
#15
Mark V Koning, Aart Jan W Teunissen, Erwin van der Harst, Elisabeth J Ruijgrok, Robert Jan Stolker
BACKGROUND AND OBJECTIVES: Management of postoperative pain after laparoscopic segmental colonic resections remains controversial. We compared 2 methods of analgesia within an Enhanced Recovery After Surgery (ERAS) program. The goal of the study was to investigate whether administration of intrathecal bupivacaine/morphine would lead to an enhanced recovery. METHODS: A single-center, randomized, double-blind controlled trial was performed (NL43488.101.13). Patients scheduled for laparoscopic segmental intestinal resections were considered...
December 6, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29206803/clinical-indicators-of-the-need-for-telemetry-postoperative-monitoring-in-patients-with-suspected-obstructive-sleep-apnea-undergoing-total-knee-arthroplasty
#16
Kethy M Jules-Elysée, Natasha A Desai, Yan Ma, Wei Zhang, Thuyvan H Luu, Stavros G Memtsoudis, Gregory A Liguori
BACKGROUND AND OBJECTIVES: Obstructive sleep apnea is associated with increased complication rates postoperatively. Current literature does not provide adequate guidance on management of these patients. This study used the STOP-Bang questionnaire to diagnose patients with possible obstructive sleep apnea (score ≥3). We hypothesized that a STOP-Bang score of 3 or greater would significantly correlate with the number of oxygen desaturation episodes during the first 48 hours after total knee arthroscopy...
December 4, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29189495/lumbar-spine-anatomy-in-women-sustaining-unintentional-dural-puncture-during-labor-epidural-placement-a-descriptive-study-using-magnetic-resonance-imaging-and-ultrasound
#17
Nicholas M Barrett, Cristian Arzola, Timo Krings, Kristi Downey, Jose C A Carvalho
BACKGROUND AND OBJECTIVES: Unintentional dural puncture is one of the most frequent complications of the epidural technique. One previous study suggested that atypical sonoanatomy of the ligamentum flavum/dura mater unit may be a risk factor for this complication. In this study, we describe the anatomy of the lumbar spine, assessed by magnetic resonance imaging (MRI) and ultrasound, in women sustaining unintentional dural puncture during epidural catheter placement for labor analgesia...
November 15, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29140962/anatomic-study-of-innervation-of-the-anterior-hip-capsule-implication-for-image-guided-intervention
#18
Anthony J Short, Jessi Jo G Barnett, Michael Gofeld, Ehtesham Baig, Karen Lam, Anne M R Agur, Philip W H Peng
BACKGROUND AND OBJECTIVES: The purpose of this cadaveric study was to determine the pattern of anterior hip capsule innervation and the associated bony landmarks for image-guided radiofrequency denervation. METHODS: Thirteen hemipelvises were dissected to identify innervation of the anterior hip capsule. The femoral (FN), obturator (ON), and accessory obturator (AON) nerves were traced distally, and branches supplying the anterior capsule documented. The relationships of the branches to bony landmarks potentially visible with ultrasound were identified...
November 14, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29140961/cervical-foraminal-epidural-blood-patch-for-the-targeted-treatment-of-refractory-cerebrospinal-fluid-leakage-from-a-dural-sleeve
#19
Nuj Tontisirin, Pannawit Benjhawaleemas, Sasikaan Nimmaanrat, Pornchai Sathirapanya, Teeranan Laohawiriyakamol, De Q Tran, Roderick J Finlayson
Epidural blood patches (EBPs) are routinely used to treat symptoms (eg, headaches) associated with spontaneous intracranial hypotension. Although cerebrospinal fluid leakage commonly involves the periforaminal areas of the cervical or thoracic spine, EBPs have been historically performed at the lumbar level. Recent evidence suggests that targeting the causative spinal segment may provide greater clinical benefits. While previous reports have targeted foraminal leaks with segmental thoracic or cervical injections, we present a case report detailing the novel use of a navigable epidural catheter to perform a selective EBP at the C7/T1 foramen...
November 14, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29140959/comparison-of-continuous-proximal-versus-distal-adductor-canal-blocks-for-total-knee-arthroplasty-a-randomized-double-blind-noninferiority-trial
#20
Adam W Meier, David B Auyong, Stanley C Yuan, Shin-E Lin, James M Flaherty, Neil A Hanson
BACKGROUND AND OBJECTIVES: Adductor canal blocks (ACBs) are associated with improved analgesia, preserved quadriceps strength, and decreased length of hospitalization after total knee arthroplasty (TKA). However, controversy remains regarding the ideal location of a continuous block within the adductor canal, and it remains unclear whether similar clinical benefits are obtained irrespective of block location. In this randomized, double-blind, noninferiority study, we hypothesized that a continuous proximal ACB provides postoperative analgesia that is no worse than a continuous distal ACB...
November 14, 2017: Regional Anesthesia and Pain Medicine
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