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Regional Anesthesia and Pain Medicine

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https://www.readbyqxmd.com/read/28806217/the-effect-of-ondansetron-on-acute-opioid-tolerance-in-patients-receiving-intrathecal-opioids-prior-to-cesarean-delivery
#1
Kevin C Greer, Abdullah S Terkawi, Siny Tsang, Priyanka Singla, Marcel E Durieux, Mohamed Tiouririne
BACKGROUND: Multiple animal studies suggest that ondansetron ameliorates opioid-induced hyperalgesia and tolerance. In this study, we aimed to determine if the administration of ondansetron prior to spinal anesthesia would have an effect on intrathecal opioid-induced acute opioid tolerance, postoperative pain, and analgesic requirements in patients undergoing cesarean delivery with spinal anesthesia. METHODS: Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (n = 44) or placebo (n = 42) in a prospective, double-blind design...
August 11, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28806216/psoas-versus-femoral-blocks-a-registry-analysis-of-risks-and-benefits
#2
Hagen Bomberg, Andrea Huth, Stefan Wagenpfeil, Paul Kessler, Hinnerk Wulf, Thomas Standl, André Gottschalk, Jens Döffert, Werner Hering, Jürgen Birnbaum, Claudia Spies, Bernd Kutter, Jörg Winckelmann, Gerald Burgard, Oliver Vicent, Thea Koch, Daniel I Sessler, Thomas Volk, Alexander Raddatz
BACKGROUND AND OBJECTIVES: Psoas blocks are an alternative to femoral nerve blocks and have the potential advantage of blocking the entire lumbar plexus. However, the psoas muscle is located deeply, making psoas blocks more difficult than femoral blocks. In contrast, while femoral blocks are generally easy to perform, the inguinal region is prone to infection. We thus tested the hypothesis that psoas blocks are associated with more insertion-related complications than femoral blocks but have fewer catheter-related infections...
August 11, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28796132/optimal-point-of-insertion-and-needle-angle-in-neuraxial-blockade-using-a-midline-approach-a-study-in-computed-tomography-scans-of-adult-patients
#3
Mark Vogt, Dennis J van Gerwen, Wouter Lubbers, John J van den Dobbelsteen, Martin Hagenaars
BACKGROUND AND OBJECTIVES: Neuraxial blockade using a midline approach can be challenging. Part of this challenge lies in finding the optimal approach of the needle to its target. The present study aimed at finding (1) the optimal point of insertion of the needle between the tips of 2 adjacent spinous processes and (2) the optimal angle relative to the skin at which the needle should approach the epidural or subarachnoid space. METHODS: A computer algorithm systematically analyzed computed tomography scans of vertebral columns of a cohort of 52 patients...
August 8, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28796131/beyond-ultrasound-guidance-for-regional-anesthesiology
#4
De Q Tran, André P Boezaart, Joseph M Neal
Despite its popularity, ultrasound (US)-guided regional anesthesiology is associated with significant limitations. The latter can be attributed to either the US machine (ie, decreased ability to insonate deep neural structures, as well as the thoracic spine) or the operator. Shortcomings associated with the operator can be explained by errors in perception (ie, ambiguous criteria for needle/catheter tip-to-nerve proximity and subparaneural local anesthetic injection) or interpretation. Perhaps the greatest confusion afflicting US-guided regional anesthesiology originates from an intellectual misconception pertaining to its application...
August 8, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28796754/perioperative-patient-beliefs-regarding-potential-effectiveness-of-marijuana-cannabinoids-for-treatment-of-pain-a-prospective-population-survey
#5
Yury Khelemsky, Andrew T Goldberg, Yasmin L Hurd, Gary Winkel, Allen Ninh, Lucia Qian, Anna Oprescu, Jeffrey Ciccone, Daniel J Katz
BACKGROUND AND OBJECTIVES: Cannabinoids have an expanding presence in medicine. Perioperative patients' perceptions of the effectiveness of these compounds, and acceptance if prescribed for pain, have not been previously described. Our primary objective was to describe patients' beliefs regarding the potential effectiveness of cannabinoids for the treatment of acute and chronic pain, as well as gauge patient acceptance of these compounds if prescribed by a physician. In addition, demographic and pain history data were collected to elucidate the predictors of the aforementioned patient attitudes...
August 7, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28786899/cadaveric-study-of-the-articular-branches-of-the-shoulder-joint
#6
Maxim S Eckmann, Brittany Bickelhaupt, Jacob Fehl, Jonathan A Benfield, Jonathan Curley, Ohmid Rahimi, Ameet S Nagpal
BACKGROUND AND OBJECTIVES: This cadaveric study investigated the anatomic relationships of the articular branches of the suprascapular (SN), axillary (AN), and lateral pectoral nerves (LPN), which are potential targets for shoulder analgesia. METHODS: Sixteen embalmed cadavers and 1 unembalmed cadaver, including 33 shoulders total, were dissected. Following dissections, fluoroscopic images were taken to propose an anatomical landmark to be used in shoulder articular branch blockade...
August 3, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28786898/focused-cardiac-ultrasound-for-the-regional-anesthesiologist-and-pain-specialist
#7
Stephen C Haskins, Christopher Y Tanaka, Jan Boublik, Christopher L Wu, Erik Sloth
This article in our point-of-care ultrasound (PoCUS) series discusses the benefits of focused cardiac ultrasound (FoCUS) for the regional anesthesiologist and pain specialist. Focused cardiac US is an important tool for all anesthesiologists assessing patients with critical conditions such as shock and cardiac arrest. However, given that ultrasound-guided regional anesthesia is emerging as the new standard of care, there is an expanding role for ultrasound in the perioperative setting for regional anesthesiologists to help improve patient assessment and management...
August 3, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28759501/ultrasound-guided-regional-anesthesia-simulation-training-a-systematic-review
#8
Xiao Xu Chen, Vatsal Trivedi, AbdulHadi A AlSaflan, Suzanne Clare Todd, Andrea C Tricco, Colin J L McCartney, Sylvain Boet
BACKGROUND AND OBJECTIVES: Ultrasound-guided regional anesthesia (UGRA) has become the criterion standard of regional anesthesia practice. Ultrasound-guided regional anesthesia teaching programs often use simulation, and guidelines have been published to help guide URGA education. This systematic review aimed to examine the effectiveness of simulation-based education for the acquisition and maintenance of competence in UGRA. METHODS: Studies identified in MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC were included if they assessed simulation-based UGRA teaching with outcomes measured at Kirkpatrick level 2 (knowledge and skills), 3 (transfer of learning to the workplace), or 4 (patient outcomes)...
July 28, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28759502/quadratus-lumborum-block-versus-transversus-abdominis-plane-block-in-children-undergoing-low-abdominal-surgery-a-randomized-controlled-trial
#9
Gözen Öksüz, Bora Bilal, Yavuz Gürkan, Aykut Urfalioğlu, Mahmut Arslan, Gökçe Gişi, Hafize Öksüz
BACKGROUND AND OBJECTIVES: Truncal blocks have a place within multimodal analgesia techniques in abdominal surgery. The quadratus lumborum block is a new abdominal truncal block used for somatic analgesia of both the upper and lower abdomen. In this prospective, double-blind, randomized study, we aimed to compare quadratus lumborum block and transversus abdominis plane block in pediatric patients undergoing lower abdominal surgery. METHODS: Fifty-three children undergoing unilateral inguinal hernia repair or orchiopexy surgery were randomized into 2 groups: transversus abdominis plane block and quadratus lumborum block...
July 27, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28742627/measurement-error-of-a-simplified-protocol-for-quantitative-sensory-tests-in-chronic-pain-patients
#10
Monika Müller, José Alberto Biurrun Manresa, Andreas Limacher, Konrad Streitberger, Peter Jüni, Ole Kæseler Andersen, Michele Curatolo
BACKGROUND AND OBJECTIVES: Large-scale application of Quantitative Sensory Tests (QST) is impaired by lacking standardized testing protocols. One unclear methodological aspect is the number of records needed to minimize measurement error. Traditionally, measurements are repeated 3 to 5 times, and their mean value is considered. When transferring QST to a clinical setting, reducing the number of records would be desirable to meet the time constraints encountered in a routine clinical environment and to reduce the testing burden to chronic pain patients...
July 24, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28727584/thoracic-epidural-catheter-placement-in-a-preoperative-block-area-improves-operating-room-efficiency-and-decreases-epidural-failure-rate
#11
Yehoshua Gleicher, Oskar Singer, Stephen Choi, Paul McHardy
BACKGROUND AND OBJECTIVES: The primary aim of this study was to review the impact of inserting thoracic epidural catheters in a preoperative block room setting on operating room efficiency. METHODS: We conducted a retrospective preintervention/postintervention review of thoracic epidurals inserted over a 12-month period. The review included 6 months of data prior to implementation of the regional anesthesia block room and 6 months of data following implementation...
July 20, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28727583/serum-bupivacaine-concentration-after-periarticular-injection-with-a-mixture-of-liposomal-bupivacaine-and-bupivacaine-hcl-during-total-knee-arthroplasty
#12
Michael J Buys, Marian F Murphy, Christine M Warrick, Nathan L Pace, Jeremy M Gililland, Christopher E Pelt, Byron R Bankhead, John L Patzkowsky, Ken B Johnson
BACKGROUND AND OBJECTIVES: A relatively new technique to reduce postoperative pain for total knee arthroplasty is to inject a mixture of 266 mg of liposomal bupivacaine and 125 mg of 0.25% bupivacaine HCl with epinephrine 1:300,000 around the knee joint at the time of surgery. Currently, no publications report serum bupivacaine concentrations over time after periarticular injection of liposomal mixed with free bupivacaine. This information is important to ensure safe serum bupivacaine concentrations are maintained especially when considering supplemental or rescue peripheral nerve blocks...
July 20, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28723837/minimum-effective-volume-of-lidocaine-for-ultrasound-guided-costoclavicular-block
#13
Thitipan Sotthisopha, Maria Francisca Elgueta, Artid Samerchua, Prangmalee Leurcharusmee, Worakamol Tiyaprasertkul, Aida Gordon, Roderick J Finlayson, De Q Tran
BACKGROUND AND OBJECTIVES: This dose-finding study aimed to determine the minimum effective volume in 90% of patients (MEV90) of lidocaine 1.5% with epinephrine 5 μg/mL for ultrasound-guided costoclavicular block. METHODS: Using an in-plane technique and a lateral-to-medial direction, the block needle was positioned in the middle of the 3 cords of the brachial plexus in the costoclavicular space. The entire volume of lidocaine was deposited in this location. Dose assignment was carried out using a biased-coin-design up-and-down sequential method, where the total volume of local anesthetic administered to each patient depended on the response of the previous one...
July 19, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28665875/neuralgic-amyotrophy-attributed-incorrectly-to-block-related-injury-understanding-errors-in-clinical-reasoning
#14
Joseph M Neal, Susan S Porter, Barry P Wilson
OBJECTIVE: We report a case of misdiagnosed neuralgic amyotrophy (brachial plexus neuritis, Parsonage-Turner syndrome). Our primary objective is to review the scientific basis for errors in clinical reasoning. CASE REPORT: We herein report a patient in whom signs and symptoms compatible with neuralgic amyotrophy presented after shoulder surgery. The patient's brachial plexopathy was attributed incorrectly as a complication of interscalene brachial plexus block. The true diagnosis was made only after the patient developed neuralgic amyotrophy in the contralateral upper extremity after a subsequent shoulder surgery on that side, this time without a brachial plexus block...
June 29, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28665874/single-injection-versus-multiple-injection-technique-of-ultrasound-guided-paravertebral-blocks-a-randomized-controlled-study-comparing-dermatomal-spread
#15
Vishal Uppal, Rakesh V Sondekoppam, Parvinder Sodhi, David Johnston, Sugantha Ganapathy
BACKGROUND AND OBJECTIVES: The objective of this study was to investigate the extent of dermatomal spread following an ultrasound-guided thoracic paravertebral block (PVB) when equal volumes of local anesthetic are injected at 1 versus 5 vertebral levels. METHODS: Seventy patients undergoing a unilateral mastectomy were randomized to receive either single or multiple injections of a PVB under real-time ultrasound guidance using a parasagittal approach. The patients in the single-injection group received a PVB at T3-T4 level with 25 mL of 0...
June 29, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28633155/regional-anesthesia-and-pain-medicine-us-anesthesiology-resident-training-the-year-2015
#16
Joseph M Neal, Anne Gravel Sullivan, Richard W Rosenquist, Dan J Kopacz
BACKGROUND AND OBJECTIVES: The Anesthesiology Review Committee of the Accreditation Council for Graduate Medical Education sets core requirements for residency program accreditation. We periodically report and analyze the US anesthesiology residents' training experience in regional anesthesia and pain medicine. METHODS: Resident caseload, procedure, and pain medicine evaluation data were aggregated for the resident cohort who graduated in 2015. These data were analyzed for present-day experience and compared with previous reports from years 1980, 1990, and 2000 graduates...
July 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28632687/reply-to-dr-choquet-et-al
#17
Ki Jinn Chin
No abstract text is available yet for this article.
July 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28632686/quadratus-lumborum-1-and-transversalis-fascia-blocks-different-names-for-the-same-posterior-pararenal-space-block
#18
Olivier Choquet, Xavier Capdevila
No abstract text is available yet for this article.
July 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28632685/-don-t-throw-the-baby-out-with-the-bath-water-a-reply-to-dr-onwochei-et-al
#19
Catherine Vandepitte, Max Kuroda, Sam van Boxstael, Admir Hadzic
No abstract text is available yet for this article.
July 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28632684/if-wishes-were-horses-beggars-would-ride
#20
Desire N Onwochei, Simeon West, Amit Pawa
No abstract text is available yet for this article.
July 2017: Regional Anesthesia and Pain Medicine
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