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Regional Anesthesia and Pain Medicine

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https://www.readbyqxmd.com/read/29975257/acute-pain-is-associated-with-chronic-opioid-use-after-total-knee-arthroplasty
#1
Hung-Lun Hsia, Steven Takemoto, Thomas van de Ven, Srinivas Pyati, Thomas Buchheit, Neil Ray, Samuel Wellman, Alfred Kuo, Arthur Wallace, Karthik Raghunathan
BACKGROUND AND OBJECTIVES: Pain scores are routinely reported in clinical practice, and we wanted to examine whether this routinely measured, patient-reported variable provides prognostic information, especially with regard to chronic opioid use, after taking preoperative and perioperative variables into account in a preoperative opioid user population. METHODS: In 32,874 preoperative opioid users undergoing primary total knee arthroplasty at Veterans Affairs hospitals between 2010 and 2015, we compared preoperative and perioperative characteristics in patients reporting lower versus higher acute pain (scores ≤4/10 vs >4/10 averaged over days 1-3)...
July 2, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29923955/lipid-emulsion-pretreatment-decreased-the-maximum-total-and-free-plasma-concentration-of-levobupivacaine-for-femoral-and-sciatic-nerve-block-in-below-knee-fracture-surgery
#2
Ying Chen, Jian Zhang, Zhe Chen, Quanguang Wang, Bing Li, Rujing Lai, Xuzhong Xu, Zhifang Cao, Lizhen Yu
BACKGROUND AND OBJECTIVES: Although intravenous lipid emulsion has been proved a powerful antidote for local anesthetic toxicity, there are few pharmacokinetic data on using lipid infusion as a pretreatment for other clinical applications. We assessed the influence of lipid pretreatment on the pharmacodynamics and pharmacokinetics of levobupivacaine. METHODS: Altogether, 12 patients undergoing below-knee surgery for a fracture were randomly assigned to 2 groups (6 patients per group): pretreatment with 1...
June 19, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29923954/is-a-retrolaminar-approach-to-the-thoracic-paravertebral-space-possible-a-human-cadaveric-study
#3
A Sassan Sabouri, Lane Crawford, Sarah K Bick, Ala Nozari, Thomas A Anderson
BACKGROUND AND OBJECTIVES: The retrolaminar block (RB) is used for truncal analgesia, but its mechanism of neural blockade remains obscure. We sought to learn the pattern of local anesthetic spread after thoracic RB using cadaveric models. METHODS: In 8 fresh cadavers, an ultrasound-guided T4 RB was performed with 20 mL of methylene blue 1% and bupivacaine 0.5%. For comparison, an RB at T9 in 1 cadaver and a T4 thoracic paravertebral block in another cadaver were performed...
June 19, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29923953/ketamine-for-refractory-headache-a-retrospective-analysis
#4
Eric S Schwenk, Amir C Dayan, Ashwin Rangavajjula, Marc C Torjman, Mauricio G Hernandez, Clinton G Lauritsen, Stephen D Silberstein, William Young, Eugene R Viscusi
BACKGROUND AND OBJECTIVES: The burden of chronic headache disorders in the United States is substantial. Some patients are treatment refractory. Ketamine, an N-methyl-D-aspartate antagonist, provides potent analgesia in subanesthetic doses in chronic pain, and limited data suggest it may alleviate headache in some patients. METHODS: We performed a retrospective study of 61 patients admitted over 3 years for 5 days of intravenous therapy that included continuous ketamine to determine responder rate and patient and ketamine infusion characteristics...
June 19, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29923952/a-cadaver-study-investigating-structures-encountered-by-the-needle-during-a-retroclavicular-approach-to-infraclavicular-brachial-plexus-block
#5
Sushil F Sancheti, Vishal Uppal, Robert Sandeski, M Kwesi Kwofie, Jennifer J Szerb
BACKGROUND AND OBJECTIVES: Retroclavicular block is designed to overcome the negative aspects of the commonly utilized ultrasound-guided parasagittal approach to the infraclavicular block. However, this approach necessitates the needle traversing an area posterior to the clavicle inaccessible to ultrasound wave conduction. This study sought to document the structures vulnerable to needle injury during a retroclavicular block. METHODS: A Tuohy needle was inserted using a retroclavicular approach to the infraclavicular block in 3 lightly embalmed cadavers followed by a catheter insertion 4 cm beyond the needle tip...
June 19, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29923951/lack-of-association-between-levels-and-length-of-intraoperative-controlled-hypotension-and-acute-kidney-injury-in-total-hip-arthroplasty-patients-receiving-neuraxial-anesthesia
#6
Sarah M Weinstein, Jacques T YaDeau, Stavros G Memtsoudis
BACKGROUND AND OBJECTIVES: Previous research suggests that increased duration and lower levels of intraoperative hypotension (IOH) are associated with postoperative acute kidney injury (AKI). However, this association has not been evaluated in the context of intraoperative controlled hypotension (IOCH), a practice that has been linked in the past to improved outcomes with respect to blood loss and transfusion needs. This study aimed to investigate whether IOCH is associated with postoperative AKI among total hip arthroplasty patients at an institution where this technique is commonly practiced...
June 19, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29923950/ultrasound-guided-infraclavicular-brachial-plexus-block-prospective-randomized-comparison-of-the-lateral-sagittal-and-costoclavicular-approach
#7
Banchobporn Songthamwat, Manoj Kumar Karmakar, Jia Wei Li, Winnie Samy, Louis Y H Mok
BACKGROUND AND OBJECTIVES: It has recently been proposed that an infraclavicular brachial plexus block (BPB) at the costoclavicular (CC) space may overcome some of the limitations of the lateral sagittal (LS) approach. In this study, we hypothesized that the CC approach will produce faster onset of sensory blockade of the 4 major terminal nerves of the brachial plexus than the LS approach. METHODS: Forty patients undergoing elective upper extremity surgery under a BPB were randomized to receive either the LS (Gp-LS, n = 20) or CC approach (Gp-CC, n = 20) for infraclavicular BPB...
June 19, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29923949/hypertonic-sodium-chloride-preinjectate-increases-in-vivo-radiofrequency-ablation-size-histological-and-magnetic-resonance-imaging-findings
#8
David A Provenzano, Eric R Cosman, Jared T Wilsey
BACKGROUND AND OBJECTIVES: Emphasis has been placed on methods to enlarge monopolar radiofrequency (RF) lesion size for pain management. Ex vivo research has suggested that fluid modulation may be an effective method to enlarge lesion zone. To date, these findings have not been confirmed in vivo. The purpose of this study was to determine the effect of hypertonic saline on in vivo lesion size through both histological and magnetic resonance imaging (MRI) analysis. A secondary purpose was to validate in vivo characterization of RF lesions using contrast-enhanced MRI...
June 19, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29905631/ultrasound-guided-selective-versus-conventional-block-of-the-medial-brachial-cutaneous-and-the-intercostobrachial-nerves-a-randomized-clinical-trial
#9
Philippe Magazzeni, Denis Jochum, Gabriella Iohom, Gérard Mekler, Eliane Albuisson, Hervé Bouaziz
BACKGROUND AND OBJECTIVES: For superficial surgery of anteromedial and posteromedial surfaces of the upper arm, the medial brachial cutaneous nerve (MBCN) and the intercostobrachial nerve (ICBN) must be selectively blocked, in addition to an axillary brachial plexus block. We compared efficacy of ultrasound-guided (USG) versus conventional block of the MBCN and the ICBN. METHODS: Eighty-four patients, undergoing upper limb surgery, were randomized to receive either USG (n = 42) or conventional (n = 42) block of the MBCN and the ICBN with 1% mepivacaine...
June 13, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29905630/ultrasound-guided-percutaneous-peripheral-nerve-stimulation-neuromodulation-of-the-sciatic-nerve-for-postoperative-analgesia-following-ambulatory-foot-surgery-a-proof-of-concept-study
#10
Brian M Ilfeld, Rodney A Gabriel, Engy T Said, Amanda M Monahan, Jacklynn F Sztain, Wendy B Abramson, Bahareh Khatibi, John J Finneran, Pia T Jaeger, Alexandra K Schwartz, Sonya S Ahmed
BACKGROUND AND OBJECTIVES: Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducing needle followed by the delivery of electric current. This modality has been reported to treat chronic pain as well as postoperative pain the day following knee surgery. However, it remains unknown if this analgesic technique may be used in ambulatory subjects following foot procedures beginning within the recovery room immediately following surgery, and with only short series of patients reported to date, the only available data are derived from strictly observational studies...
June 13, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29905629/local-vancomycin-effectively-reduces-surgical-site-infection-at-implant-site-in-rodents
#11
Jeffrey S Kroin, Jinyuan Li, Sasha Shafikhani, Kajal H Gupta, Mario Moric, Asokumar Buvanendran
BACKGROUND AND OBJECTIVES: Infected implantable devices represent a clinical challenge, because the customary option is to surgically remove the device, and that is associated with substantial cost and morbidity to the patient, along with patient dissatisfaction with the physician. Although prophylactic systemic antibiotics and sterile technique are the mainstay of prevention of surgical site infection (SSI) after implant, the incidence of SSI remains relatively high. Although some surgeons add local antibiotic at implant site during surgery, there is no scientific research to demonstrate if there is a benefit...
June 13, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29905628/pharmacokinetics-of-400-mg-locally-infiltrated-ropivacaine-after-total-knee-arthroplasty-without-perioperative-tourniquet-use
#12
Sietske M K Bakker, Maaike G E Fenten, Daan J Touw, Bart J F van den Bemt, Petra J C Heesterbeek, Gert-Jan Scheffer, Rudolf Stienstra
BACKGROUND AND OBJECTIVES: Local infiltration analgesia (LIA) with ropivacaine for total knee arthroplasty (TKA) is increasingly used. Despite the high doses of ropivacaine, LIA is considered safe, and this perception is sustained by pharmacokinetic data demonstrating that maximum concentrations of ropivacaine stay well below the toxic threshold in plasma. These pharmacokinetic studies all involve TKA procedures with the use of a tourniquet. Recently, performing TKA without the use of a tourniquet is gaining popularity, but no pharmacokinetic data exist when LIA is administered for TKA without the use of a tourniquet...
June 13, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29894394/improving-clinical-proficiency-using-a-3-dimensionally-printed-and-patient-specific-thoracic-spine-model-as-a-haptic-task-trainer
#13
Jeffrey Bortman, Yanick Baribeau, Jelliffe Jeganathan, Yannis Amador, Faraz Mahmood, Marc Shnider, Muneeb Ahmed, Philip Hess, Robina Matyal
BACKGROUND AND OBJECTIVES: Advanced haptic simulators for neuraxial training are expensive, have a finite life, and are not patient specific. We sought to demonstrate the feasibility of developing a custom-made, low-cost, 3-dimensionally printed thoracic spine simulator model from patient computed tomographic scan data. This study assessed the model's practicality, efficiency as a teaching tool, and the transfer of skill set into patient care. METHODS: A high-fidelity, patient-specific thoracic spine model was used for the study...
June 11, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29889698/perineural-low-dose-dexamethasone-prolongs-interscalene-block-analgesia-with-bupivacaine-compared-with-systemic-dexamethasone-a-randomized-trial
#14
Richard L Kahn, Jennifer Cheng, Yuliya Gadulov, Kara G Fields, Jacques T YaDeau, Lawrence V Gulotta
BACKGROUND AND OBJECTIVES: Perineural dexamethasone and intravenous (IV) dexamethasone have been shown to prolong peripheral nerve block duration. The effects of perineural and IV dexamethasone have only been compared at doses of 4 mg or greater. This triple-blind, randomized trial examined the effect of 1 mg IV versus perineural dexamethasone on interscalene block (ISB) analgesia duration. METHODS: Patients undergoing ambulatory shoulder arthroscopy received an ultrasound-guided ISB with 15 mL bupivacaine 0...
June 8, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29794944/use-of-serratus-plane-block-for-repair-of-coarctation-of-aorta-a-report-of-3-cases
#15
Abhijit Biswas, Igor Luginbuehl, Elod Szabo, Monica Caldeira-Kulbakas, Mark W Crawford, Tobias Everett
OBJECTIVES: The practice of regional anesthesia techniques (thoracic, epidural, paravertebral) in pediatric cardiac surgery enhances perioperative outcomes such as improved perioperative analgesia, decreased stress response, early extubation, and shortened hospital stay. However, these blocks can be technically challenging and can be associated with unacceptable failure rate and complications in infants. For these reasons, regional anesthesia is sometimes avoided in pediatric cardiac surgery...
May 23, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29794943/erector-spinae-plane-block-versus-retrolaminar-block-a-magnetic-resonance-imaging-and-anatomical-study
#16
Sanjib Das Adhikary, Stephanie Bernard, Hector Lopez, Ki Jinn Chin
BACKGROUND AND OBJECTIVES: The erector spinae plane (ESP) and retrolaminar blocks are ultrasound-guided techniques for thoracoabdominal wall analgesia involving injection into the musculofascial plane between the paraspinal back muscles and underlying thoracic vertebrae. The ESP block targets the tips of the transverse processes, whereas the retrolaminar block targets the laminae. We investigated if there were differences in injectate spread between the 2 techniques that would have implications for their clinical effect...
May 23, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29794942/major-laparoscopic-intraperitoneal-surgery-performed-with-combined-bilateral-subcostal-transversus-abdominal-plane-block-and-celiac-plexus-block-intravenous-sedation-without-tracheal-intubation-a-feasibility-study-of-3-cases
#17
Azeddine Taleb, MʼHamed Boumadani, Paul J Zetlaoui, Dan Benhamou
OBJECTIVES: Major abdominal surgery usually requires general anesthesia with tracheal intubation and may be supplemented with neuraxial anesthesia to provide intraoperative and postoperative pain relief. Attempts at using only neuraxial anesthesia for major abdominal surgery have often been shown to be poorly effective. This report demonstrates that laparoscopic colonic surgical procedures can be performed with ultrasound-guided blocks (bilateral transversus abdominal plane block and celiac plexus block) and intravenous sedation, while avoiding general or neuraxial anesthesia...
May 23, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29781932/postoperative-analgesic-effect-of-ultrasound-guided-intermediate-cervical-plexus-block-on-unipolar-sternocleidomastoid-release-with-myectomy-in-pediatric-patients-with-congenital-muscular-torticollis-a-prospective-randomized-controlled-trial
#18
Jin-Soo Kim, Han Bum Joe, Myong Chul Park, Hyoeun Ahn, Sook Young Lee, Yun Jeong Chae
BACKGROUND AND OBJECTIVES: Unipolar sternocleidomastoid release with myectomy (USRM) for correction of congenital muscular torticollis in pediatric patients produces moderate to severe postoperative pain. The objective of this trial was to examine the effect of ultrasound-guided intermediate cervical plexus block on postoperative pain after USRM. METHODS: Thirty-two patients (1-7 years old) were enrolled in this parallel-group, patient- and observer-blinded, randomized controlled trial...
May 17, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29781931/ultrasound-assessment-of-ice-ball-formation-by-cryoneurolysis-device-in-an-ex-vivo-model
#19
Adrian Kastler, Hannes Gruber, Elke Gizewski, Alexander Loizides
BACKGROUND AND OBJECTIVES: Real-time ice-ball formation during cryoneurolysis has sparsely been assessed with ultrasound (US). Cryoneurolysis in lower back pain syndrome represents a validated management option in cases of facet joint syndrome. Ultrasound may be a useful tool to perform facet joint cryodenervation. The objective of this study was to assess, ex vivo, the ability of US to assess the ice-ball formation of a cryoneurolysis device. METHODS: Ultrasound assessment of the ice-ball depiction was done using chicken muscle at 22°C in which several freezing cycles were performed with both 2...
May 17, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29746446/reduced-hemidiaphragmatic-paresis-with-a-corner-pocket-technique-for-supraclavicular-brachial-plexus-block-single-center-observer-blinded-randomized-controlled-trial
#20
Ryung A Kang, Yang Hoon Chung, Justin Sangwook Ko, Mi Kyung Yang, Duck Hwan Choi
BACKGROUND AND OBJECTIVE: Hemidiaphragmatic paresis is common after supraclavicular brachial plexus block (SCBPB). In this randomized trial, we compared the incidence of hemidiaphragmatic paresis in patients who had local anesthetic injected primarily in the corner pocket (defined as the intersection of the first rib and subclavian artery) during SCBPB with that of patients who underwent injection primarily inside the neural cluster. METHODS: Thirty-six patients scheduled for right elbow, forearm, wrist, or hand surgery under SCBPB (using 12...
May 10, 2018: Regional Anesthesia and Pain Medicine
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