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Regional Anesthesia and Pain Medicine

Marshall P Bahr, Brian A Williams
β-Adrenergic blockade is an important mechanism for reducing morbidity and mortality in patients with hypertension and heart failure. Esmolol has been used widely for its chronotropic and antihypertensive effects. However, there has been recent inquiry regarding perioperative esmolol use and nociceptive modulation. Conventional postoperative analgesic treatment has relied primarily on opioids, which present their own adverse effects and pharmacoepidemiologic repercussions. Esmolol, to date, has not shown any direct analgesic or anesthetic properties; however, recent studies suggest that esmolol may have antinociceptive and postoperative opioid-sparing effects...
September 13, 2018: Regional Anesthesia and Pain Medicine
Peter S Staats, Timothy B Chafin, Stanley Golovac, Christopher K Kim, Sean Li, William B Richardson, Ricardo Vallejo, Sayed E Wahezi, Edward P Washabaugh, Ramsin M Benyamin
BACKGROUND AND OBJECTIVES: This study evaluated the long-term durability of the minimally invasive lumbar decompression (MILD) procedure in terms of functional improvement and pain reduction for patients with lumbar spinal stenosis and neurogenic claudication due to hypertrophic ligamentum flavum. This is a report of 2-year follow-up for MILD study patients. METHODS: This prospective, multicenter, randomized controlled clinical study compared outcomes for 143 patients treated with MILD versus 131 treated with epidural steroid injections...
September 7, 2018: Regional Anesthesia and Pain Medicine
Nagy Mekhail, Gerges Azer, Youssef Saweris, Diana S Mehanny, Shrif Costandi, Guangmei Mao
BACKGROUND AND OBJECTIVES: Despite the observation that select nicotine receptor agonists have analgesic effects, smokers report higher pain scores and more functional impairments than lifelong nonsmokers, attributable to exaggerated stress responses, receptor desensitization, and altered pharmacokinetics compounded by accelerated structural damage resulting from impaired bone healing, osteoporosis, and advancement of disk disease. We hypothesized that smoking diminishes the analgesic response to spinal cord stimulation (SCS) in patients with chronic spine-related pain conditions...
September 5, 2018: Regional Anesthesia and Pain Medicine
Hesham Elsharkawy, Robert Maniker, Robert Bolash, Prathima Kalasbail, Richard L Drake, Nabil Elkassabany
BACKGROUND AND OBJECTIVES: Fascial plane blocks are rapidly emerging to provide safe, feasible alternatives to epidural analgesia for thoracic and abdominal pain. We define a new option for chest wall and upper abdominal analgesia, termed the rhomboid intercostal and subserratus plane (RISS) block. The RISS tissue plane extends deep to the erector spinae muscle medially and deep to the serratus anterior muscle laterally. We describe a 2-part proof-of-concept study to validate the RISS block, including a cadaveric study to evaluate injectate spread and a retrospective case series to assess dermatomal coverage and analgesic efficacy...
August 30, 2018: Regional Anesthesia and Pain Medicine
Lena F Carstensen, Morten Jenstrup, Jørgen Lund, Jørgen Tranum-Jensen
BACKGROUND AND OBJECTIVES: The popularization of ultrasound-guided nerve blocks in cosmetic and reconstructive breast surgery calls for better anatomical understanding of chest wall innervation. When inserting subpectoral implants, pain from pocket dissection, stretching of muscle, and release of costal attachments may be relieved by blocking the pectoral nerves in the interpectoral (IP) space.We describe the variable anatomy of the pectoral nerves in the IP space in order to define the area to be covered for sufficient blockade, based on cadaver dissections...
August 8, 2018: Regional Anesthesia and Pain Medicine
Fei Xiao, Dan Drzymalski, Lin Liu, Yinfu Zhang, Lizhong Wang, Xinzhong Chen
BACKGROUND AND OBJECTIVES: While prophylactic phenylephrine infusions during cesarean delivery are often used to counteract the sympathectomy associated with spinal anesthesia, their use has been associated with decreased rostral spread of local anesthetic. The purpose of this study was to determine the median effective dose (ED50) and 95% effective dose (ED95) of intrathecal hyperbaric bupivacaine for cesarean delivery in the presence and absence of prophylactic phenylephrine infusion...
July 30, 2018: Regional Anesthesia and Pain Medicine
Laura Girón-Arango, Philip W H Peng, Ki Jinn Chin, Richard Brull, Anahi Perlas
Fascia iliaca block or femoral nerve block is used frequently in hip fracture patients because of their opioid-sparing effects and reduction in opioid-related adverse effects. A recent anatomical study on hip innervation led to the identification of relevant landmarks to target the hip articular branches of femoral nerve and accessory obturator nerve. Using this information, we developed a novel ultrasound-guided approach for blockade of these articular branches to the hip, the PENG (PEricapsular Nerve Group) block...
July 30, 2018: Regional Anesthesia and Pain Medicine
Abhijit Biswas, Valera Castanov, Zhi Li, Anahi Perlas, Richelle Kruisselbrink, Anne Agur, Vincent Chan
BACKGROUND AND OBJECTIVES: Although serratus plane block reportedly provides satisfactory analgesia for breast and thoracic surgeries, the optimal technique for consistent success has not been studied. The goal of this anatomical study was to evaluate the impact of volume, level, and site of injection on the extent of injectate spread that can influence anesthetic coverage. METHODS: Ultrasound-guided dye injection and subsequent dissection were performed in 39 cadaveric hemithoraces...
July 30, 2018: Regional Anesthesia and Pain Medicine
Shaul Cohen, Danielle Levin, Scott Mellender, Rong Zhao, Preet Patel, William Grubb, Geza Kiss
BACKGROUND AND OBJECTIVES: Postdural puncture headache (PDPH) is a severe and debilitating complication of unintentional dural puncture. The criterion-standard treatment for PDPH has been epidural blood patch (EBP), but it is an invasive intervention with the potential for severe complications, such as meningitis and paralysis. We believe this is the first ever 17-year retrospective chart review in which we compare the effectiveness of sphenopalatine ganglion block (SPGB) to EBP for PDPH treatment in postpartum patients...
July 30, 2018: Regional Anesthesia and Pain Medicine
Stephen C Haskins, Richelle Kruisselbrink, Jan Boublik, Christopher L Wu, Anahi Perlas
This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthesiologist and pain specialist is significant as our clinical practice often involves providing deep sedation without a secured airway. Given that pulmonary aspiration is a well-known cause of perioperative morbidity and mortality, the ability to evaluate for NPO (nil per os) status and risk stratify patients scheduled for anesthesia is a powerful skill set...
July 27, 2018: Regional Anesthesia and Pain Medicine
Takayuki Yoshida, Tatsuo Nakamoto, Chikako Hashimoto, Satoshi Aihara, Kota Nishimoto, Takahiko Kamibayashi
BACKGROUND AND OBJECTIVES: The lateral and anterior approaches for proximal sciatic nerve (SN) block can be used in patients lying supine. We assume that the posterior femoral cutaneous nerve (PFCN) is simultaneously blocked more often via the lateral approach than via the anterior approach, given the proximity of these 2 nerves at the injection level. However, locating the SN is difficult when using the original landmark-based lateral approach. We have introduced ultrasound guidance to alleviate the technical difficulty of the lateral approach and tested the hypothesis that an ultrasound-guided lateral approach would achieve PFCN block more often than the ultrasound-guided anterior approach for SN block...
July 24, 2018: Regional Anesthesia and Pain Medicine
Jiabin Liu, David H Kim, Daniel B Maalouf, Jonathan C Beathe, Answorth A Allen, Stavros G Memtsoudis
BACKGROUND AND OBJECTIVES: The need for hospital-based acute care following outpatient surgical procedures is expensive and measured as marker for quality. However, little information is available about events leading to emergency department visit or inpatient admission after ambulatory anterior cruciate ligament (ACL) surgery. METHODS: We studied adult patients who underwent outpatient ACL surgery in New York State between 2009 and 2013 using the Healthcare Cost and Utilization Project database...
July 20, 2018: Regional Anesthesia and Pain Medicine
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
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No abstract text is available yet for this article.
October 2018: Regional Anesthesia and Pain Medicine
Susan M Moeschler, Nafisseh S Warner, Halena M Gazelka
No abstract text is available yet for this article.
October 2018: Regional Anesthesia and Pain Medicine
Jason Ivanusic, Tessa Eves, Yasutaka Konishi, Michael J Barrington
No abstract text is available yet for this article.
October 2018: Regional Anesthesia and Pain Medicine
Ki Jinn Chin, Sanjib Das Adhikary, Mauricio Forero
No abstract text is available yet for this article.
October 2018: Regional Anesthesia and Pain Medicine
Lucas Rovira, Jorge Úbeda, José de Andrés
No abstract text is available yet for this article.
October 2018: Regional Anesthesia and Pain Medicine
Philip Cornish
No abstract text is available yet for this article.
October 2018: Regional Anesthesia and Pain Medicine
James A Hruschka, Christopher D Arndt
No abstract text is available yet for this article.
October 2018: Regional Anesthesia and Pain Medicine
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