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Regional Anesthesia and Pain Medicine

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 ( 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
Chang Amber Liu, Jinghu Sui, Charles J Coté, Thomas A Anderson
BACKGROUND AND OBJECTIVES: Caudal anesthesia is a common and effective regional anesthesia technique in pediatric patients. The addition of epinephrine to local anesthetics in caudal anesthesia is a frequent practice; however, changes in hemodynamic and cardiac parameters produced by epinephrine in caudal anesthesia are not well studied. Using data collected with the ICON noninvasive cardiac output monitor, we examined the hemodynamic changes associated with the administration of epinephrine containing local anesthetics during caudal anesthesia in children...
October 11, 2016: Regional Anesthesia and Pain Medicine
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
Goodarz Golmirzaie, Lindsay S Holland, Stephanie E Moser, Mohit Rastogi, Afton L Hassett, Chad M Brummett
BACKGROUND AND OBJECTIVES: We hypothesized that patients with complex regional pain syndrome (CRPS) with a longer time since their inciting event would demonstrate more symptoms of centralized pain. METHODS: We conducted a cross-sectional analysis of 160 patients with CRPS using validated measures of pain, negative mood, and functioning at the time of their new patient evaluation. The 2011 Fibromyalgia Survey Criteria is a validated self-report measure of widespread body pain and comorbid symptoms (eg, trouble thinking, headaches)...
October 11, 2016: Regional Anesthesia and Pain Medicine
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
Arnoley S Abcejo, Hans P Sviggum, Michelle L Mauermann, James R Hebl, Carlos B Mantilla, Andrew C Hanson, Yi Lin, Adam K Jacob
BACKGROUND AND OBJECTIVES: There are multiple risk factors for developing perioperative nerve injury (PNI). Perioperative nerve injury after peripheral nerve blockade (PNB) is rare. Exposure to systemic chemotherapy may cause peripheral neuropathy, but its role as a risk factor for PNI after PNB is unknown. The objective of this retrospective study was to determine the incidence of PNI in patients undergoing PNB as part of extremity surgery after prior exposure to systemic chemotherapy...
October 6, 2016: Regional Anesthesia and Pain Medicine
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
Timothy J Ness, Alan Randich, Dwight E Nelson, Xin Su
BACKGROUND AND OBJECTIVES: Neuromodulation has been reported to reliably improve symptoms of bladder overactivity and sometimes pain. The effect of electrical stimulation of several nerve pathways demonstrated to alter cystometric responses to bladder distension was examined on nociceptive responses in models of bladder hypersensitivity. METHODS: Bladder hypersensitivity was produced by several published methods including neonatal inflammation, acute inflammation, and chronic stress...
September 28, 2016: Regional Anesthesia and Pain Medicine
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
Michael J Barrington, Samuel R Gledhill, Roman Kluger, Alexander L Clarke, Daniel M Wong, Henry Davidson, Rowan Thomas
BACKGROUND: Ultrasound-guided techniques improve outcomes in regional anesthesia when compared with traditional techniques; however, this assertion has not been studied with novices. The primary objective of this study was to compare sensory and motor block after axillary brachial plexus block when performed by novice trainees allocated to an ultrasound- or nerve-stimulator-guided group. A secondary objective was to compare the rates of skill acquisition between the 2 groups. METHODS: This study was a prospective, randomized, observer-blinded, 2-arm controlled trial...
September 28, 2016: Regional Anesthesia and Pain Medicine
Thomas Fichtner Bendtsen, Bernhard Moriggl, Vincent Chan, Jens Børglum
Peripheral nerve block for total knee arthroplasty is ideally motor sparing while providing effective postoperative analgesia. To achieve these goals, one must understand surgical dissection techniques, distribution of nociceptive generators, sensory innervation of the knee, and nerve topography in the thigh.
September 28, 2016: Regional Anesthesia and Pain Medicine
Brian M Ilfeld, Stuart A Grant
No abstract text is available yet for this article.
September 28, 2016: Regional Anesthesia and Pain Medicine
Juan P Cata, Mariana Chavez-MacGregor, Vicente Valero, Walter Black, Daliah M Black, Farzin Goravanchi, Ifey C Ifeanyi, Mike Hernandez, Andrea Rodriguez-Restrepo, Vijaya Gottumukkala
BACKGROUND AND OBJECTIVES: The impact of regional anesthesia on breast cancer recurrence is controversial. We tested the hypothesis that the use of paravertebral block (PVB) analgesia during breast cancer surgery prolongs the recurrence-free survival (RFS) and overall survival (OS) of women with breast cancer. METHODS: Seven hundred ninety-two women with nonmetastatic breast cancer were included in this retrospective study. Patients were divided based on the administration of PVB analgesia for mastectomy surgeries...
September 28, 2016: Regional Anesthesia and Pain Medicine
Joseph M Neal, Francis V Salinas, Daniel S Choi
OBJECTIVE: Local anesthetic-induced myotoxicity occurs consistently in animal models, yet is reported rarely in humans. Herein, we describe 3 sentinel cases of local anesthetic myotoxicity after continuous adductor canal block (ACB). CASE REPORT: Three patients underwent total knee arthroplasty that was managed with subarachnoid block plus ACB induced with 1.5% lidocaine or 1.5% mepivacaine bolus followed by 2% ropivacaine at 8 mL/h. Although initial postoperative recovery was normal, each patient on either postoperative day 1 or 2 developed progressive, profound weakness of the quadriceps muscles...
September 22, 2016: Regional Anesthesia and Pain Medicine
James Douketis, Sam Schulman, Summer Syed
No abstract text is available yet for this article.
September 22, 2016: Regional Anesthesia and Pain Medicine
Jeffrey S Kroin, Jinyuan Li, Mario Moric, Brian W Birmingham, Kenneth J Tuman, Asokumar Buvanendran
BACKGROUND AND OBJECTIVES: There is an increasing use of local infiltration analgesia (LIA) to reduce postoperative pain. Despite widespread use of LIA, wide variations in drug combinations and concomitant use of systemic analgesics have made it difficult to determine the optimal drug combinations for LIA. Using a previously validated rat laparotomy model, the optimal LIA combination of medications to reduce postoperative pain was determined. METHODS: Laparotomy was performed in an adult rat model under isoflurane anesthesia...
September 22, 2016: Regional Anesthesia and Pain Medicine
Daltry Dott, Christopher Canlas, Christopher Sobey, William Obremskey, Andrew Brian Thomson
OBJECTIVE: Necrotizing fasciitis is an infection of the soft tissue that is characterized by rapidly spreading inflammation and subsequent necrosis. It is a rare complication of peripheral nerve blocks. We report a rare case of necrotizing fasciitis after placement of a peripheral nerve catheter. CASE REPORT: A 58-year-old woman presented for an elective right second metatarsal resection and received a sciatic nerve catheter for postoperative pain control. On postoperative day 7, clinical examination and imaging supported the diagnosis of necrotizing fasciitis...
September 22, 2016: Regional Anesthesia and Pain Medicine
Chukwudi O Chiaghana, Justin M Bremer, Joshua W Sappenfield, Adam L Wendling
OBJECTIVE: Neuraxial hematoma is a rare complication of spinal or epidural anesthesia. However, variable coagulation factor defects are relatively common in patients with Fontan circulation, and may predispose such patients to either increased risk of thrombosis or coagulopathy. These defects may indirectly increase their risk of neuraxial hematoma. CASE REPORT: We report a case of delayed neuraxial hematoma after the start of full-dose anticoagulation for pulmonary embolus on a postpartum patient with Fontan physiology who had continuous spinal anesthesia for cesarean delivery 4 days earlier...
September 22, 2016: Regional Anesthesia and Pain Medicine
Sarah Lessire, Jonathan Douxfils, Anne-Sophie Dincq, François Mullier
No abstract text is available yet for this article.
September 22, 2016: Regional Anesthesia and Pain Medicine
Dana M Tilley, David L Cedeño, Courtney A Kelley, Ramsin Benyamin, Ricardo Vallejo
BACKGROUND AND OBJECTIVES: Previously, we found that application of pulsed radiofrequency to a peripheral nerve injury induces changes in key genes regulating nociception concurrent with alleviation of paw sensitivity in an animal model. In the current study, we evaluated such genes after applying spinal cord stimulation (SCS) therapy. METHODS: Male Sprague-Dawley rats (n = 6 per group) were randomized into test and control groups. The spared nerve injury model was used to simulate a neuropathic pain state...
August 9, 2016: Regional Anesthesia and Pain Medicine
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