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Peripheral nerve blocks

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https://www.readbyqxmd.com/read/29338149/injection-pressure-mapping-of-intraneural-vs-perineural-injections-further-lessons-from-cadaveric-studies
#1
Andrzej Krol, Arber Vala, Leonidas Phylactides, Matthew Szarko, Miguel A Reina, Jose de Andrés
BACKGROUND: The aim of the study was to investigate the difference between intraneural and perineural injection pressures in human cadavers. Targeted nerves included the cervical roots, the supraclavicular and infraclavicular brachial plexus, the sciatic-subgluteal nerve and the common peroneal and tibial nerves. METHODS: Ten readings were obtained for each nerve location. 1mL of 0.9% NaCl was injected over ten seconds - deliberately slower than in clinical practice to eliminate the risk of aberrant readings relating to the speed of injection...
January 16, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29337237/uridine-5-triphosphate-partially-blocks-differentiation-signals-and-favors-a-more-repair-state-in-cultured-rat-schwann-cells
#2
Marta Palomo-Guerrero, Jose Miguel Cosgaya, Alejandro Gella, Núria Casals, Carmen Grijota-Martinez
Schwann cells (SCs) play a key role in peripheral nerve regeneration. After damage, they respond acquiring a repair phenotype that allows them to proliferate, migrate and redirect axonal growth. Previous studies have shown that Uridine-5'-Triphosphate (UTP) and its purinergic receptors participate in several pathophysiological responses in the nervous system. Our group has previously described how UTP induces the migration of a Schwannoma cell line and promotes wound healing. These data suggest that UTP participates in the signaling involved in the regeneration process...
January 11, 2018: Neuroscience
https://www.readbyqxmd.com/read/29319659/residual-neurological-symptoms-after-peripheral-nerve-blocks-for-pediatric-knee-surgery
#3
Robert J Tamai, Brian T Sullivan, Rushyuan J Lee
BACKGROUND: Peripheral nerve blocks (PNBs) provide excellent pain control and reduce the need for systemic analgesics in orthopaedic surgery. PNBs rarely cause complications; however, a few studies of adults have reported neurological complications during the early postoperative period. We investigated complications associated with the use of PNBs during pediatric knee surgery. METHODS: We reviewed the medical records of all 121 children (aged ≤18 y) who underwent knee surgery by 1 orthopaedic surgeon between October 2014 and September 2016...
January 9, 2018: Journal of Pediatric Orthopedics
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
#4
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/29314840/development-of-stem-cell-mobilizing-agents-targeting-cxcr4-receptor-for-peripheral-blood-stem-cell-transplantation-and-beyond
#5
Chien-Huang Wu, Jen-Shin Song, Hsuan-Hao Kuan, Szu-Huei Wu, Ming-Chen Chou, Jiing-Jyh Jan, Lun Kelvin Tsou, Yi-Yu Ke, Chiung-Tong Chen, Kai-Chia Yeh, Sing-Yi Wang, Teng-Kuang Yeh, Chen-Tso Tseng, Chen-Lung Huang, Mine-Hsine Wu, Po-Chu Kuo, Chia-Jui Lee, Kak-Shan Shia
The function of the CXCR4/CXCL12 axis accounts for many disease indications, including tissue/nerve regeneration, cancer metastasis and inflammation. Blocking CXCR4 signaling with its antagonists may lead to moving out CXCR4+ cell types from bone marrow to peripheral circulation. We have discovered a novel series of pyrimidine-based CXCR4 antagonists, a representative (i.e., 16) of which was tolerated at a higher dose and showed better HSC-mobilizing ability at the maximal response dose relative to the approved drug 1 (AMD3100), and thus considered a potential drug candidate for PBSCT indication...
January 9, 2018: Journal of Medicinal Chemistry
https://www.readbyqxmd.com/read/29313904/peripheral-nerve-injury-arising-in-anaesthesia-practice
#6
REVIEW
D W Hewson, N M Bedforth, J G Hardman
In this article, we will discuss the pathophysiology of peripheral nerve injury in anaesthetic practice, including factors which increase the susceptibility of nerves to damage. We will describe a practical and evidence-based approach to the management of suspected peripheral nerve injury and will go on to discuss major nerve injury patterns relating to intra-operative positioning and to peripheral nerve blockade. We will review the evidence surrounding particular strategies to reduce the incidence of peripheral nerve injury during nerve blockade, including nerve localisation methods, timing of blocks, needle techniques and design, injection pressure-monitoring and local anaesthetic and adjunct choice...
January 2018: Anaesthesia
https://www.readbyqxmd.com/read/29309950/management-of-antiplatelet-therapy-in-patients-undergoing-elective-invasive-procedures-proposals-from-the-french-working-group-on-perioperative-hemostasis-gihp-and-the-french-study-group-on-thrombosis-and-hemostasis-gfht-in-collaboration-with-the-french-society
#7
Anne Godier, Pierre Fontana, Serge Motte, Annick Steib, Fanny Bonhomme, Sylvie Schlumberger, Thomas Lecompte, Nadia Rosencher, Sophie Susen, André Vincentelli, Yves Gruel, Pierre Albaladejo, Jean-Philippe Collet
The French Working Group on Perioperative Hemostasis (GIHP) and the French Study Group on Hemostasis and Thrombosis (GFHT) in collaboration with the French Society for Anesthesia and Intensive Care (SFAR) drafted up-to-date proposals for the management of antiplatelet therapy in patients undergoing elective invasive procedures. The proposals were discussed and validated by a vote; all proposals but one could be assigned with a high strength. The management of antiplatelet therapy is based on their indication and the procedure...
January 5, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29309274/temporary-persistence-of-conduction-block-after-prolonged-kilohertz-frequency-alternating-current-on-rat-sciatic-nerve
#8
Narendra Bhadra, Emily Foldes, Tina Vrabec, Kevin Kilgore, Niloy Bhadra
OBJECTIVE: Application of kilohertz frequency alternating current (KHFAC) waveforms can result in nerve conduction block that is induced in less than a second. Conduction recovers within seconds when KHFAC is applied for about 5-10 min. This study investigated the effect of repeated and prolonged application of KHFAC on rat sciatic nerve with bipolar platinum electrodes. APPROACH: Varying durations of KHFAC at signal amplitudes for conduction block with intervals of no stimulus were studied...
January 8, 2018: Journal of Neural Engineering
https://www.readbyqxmd.com/read/29303925/local-anesthetic-systemic-toxicity-a-review-of-recent-case-reports-and-registries
#9
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/29288797/peripheral-synthesis-of-an-atypical-protein-kinase-c-mediates-the-enhancement-of-excitability-and-the-development-of-mechanical-hyperalgesia-produced-by-nerve-growth-factor
#10
Joanne Kays, Yi Hong Zhang, Alla Khorodova, Gary Strichartz, Grant D Nicol
Nerve growth factor plays a key role in the initiation as well as the prolonged heightened pain sensitivity of the inflammatory response. Previously, we showed that NGF rapidly augmented both the excitability of isolated rat sensory neurons and the mechanical sensitivity of the rat's hind paw. The increase in excitability and sensitivity were blocked by the myristolated pseudosubstrate inhibitor of atypical PKCs (mPSI), suggesting that an atypical PKC may play a key regulatory role in generating this heightened sensitivity...
December 27, 2017: Neuroscience
https://www.readbyqxmd.com/read/29288650/cooling-relief-of-acute-and-chronic-itch-requires-trpm8-channels-and-neurons
#11
Radhika Palkar, Serra Ongun, Edward Catich, Natalie Li, Neil Borad, Angela Sarkisian, David D McKemy
Cooling or the application of mentholated liniments to the skin has been used to treat itch for centuries, yet remarkably little is known of how counter-stimuli such as these induce itch relief. Indeed, there is no clear consensus in the scientific literature as to whether or not cooling does in fact block the transduction of itch signals or if it is simply a placebo effect. This gap in our understanding led us to hypothesize that cooling is antipruritic and, like cooling analgesia, requires function of the cold-gated ion channel TRPM8, a receptor for menthol expressed on peripheral afferent nerve endings...
December 27, 2017: Journal of Investigative Dermatology
https://www.readbyqxmd.com/read/29282807/blocking-of-cytokines-signalling-attenuates-evoked-and-spontaneous-neuropathic-pain-behaviours-in-the-paclitaxel-rat-model-of-chemotherapy-induced-neuropathy
#12
S Al-Mazidi, M Alotaibi, T Nedjadi, A Chaudhary, M Alzoghaibi, L Djouhri
BACKGROUND: Chemotherapy-induced peripheral neuropathic pain (CIPNP) is a serious dose-limiting neurotoxic effect of cancer drug treatment. The underlying mechanism(s) of this debilitating condition, which lacks effective drug treatment, is incompletely understood. However, neural-immune interactions, involving increased expression and release of cytokines, are believed to be involved. Here, we examined, in the paclitaxel rat model of CIPNP, whether plasma levels of 24 cytokines/chemokines change after paclitaxel treatment, and whether blocking of signalling of some of those cytokines would reverse/attenuate behavioural signs of CIPNP...
December 27, 2017: European Journal of Pain: EJP
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
#13
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/29279280/the-path-towards-effective-antivirals-against-rabies
#14
Dirk Jochmans, Johan Neyts
Rabies virus remains an important burden of disease claiming an estimated 60,000 lives each year, mainly children, and having a huge economical and societal cost. Post-exposure prophylaxis (PEP) is highly effective, however in patients that present with neurological symptoms the case-fatality ratio is extremely high (>99%). During the last decades several attempts to identify potent and effective antivirals were made. Only a few of these demonstrated improvement in clinical signs in animal studies and none of the trials in humans showed significant efficacy...
December 23, 2017: Vaccine
https://www.readbyqxmd.com/read/29261604/route-of-administration-affects-outcomes-of-dexamethasone-as-an-adjuvant-for-peripheral-nerve-blocks
#15
Po-Ting Pan, I-Shiang Tzeng, Chun-Jen Huang
No abstract text is available yet for this article.
January 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29251644/pharmacodynamics-and-pharmacokinetics-of-lidocaine-in-a-rodent-model-of-diabetic-neuropathy
#16
Werner Ten Hoope, Markus W Hollmann, Kora de Bruin, Hein J Verberne, Arie O Verkerk, Hanno L Tan, Camiel Verhamme, Janneke Horn, Marcel Rigaud, Susanne Picardi, Philipp Lirk
BACKGROUND: Clinical and experimental data show that peripheral nerve blocks last longer in the presence of diabetic neuropathy. This may occur because diabetic nerve fibers are more sensitive to local anesthetics or because the local anesthetic concentration decreases more slowly in the diabetic nerve. The aim of this study was to investigate both hypotheses in a rodent model of neuropathy secondary to type 2 diabetes. METHODS: We performed a series of sciatic nerve block experiments in 25 Zucker Diabetic Fatty rats aged 20 weeks with a neuropathy component confirmed by neurophysiology and control rats...
December 15, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29227106/hollow-silica-nanoparticles-penetrate-the-peripheral-nerve-and-enhance-the-nerve-blockade-from-tetrodotoxin
#17
Qian Liu, Claudia M Santamaria, Tuo Wei, Chao Zhao, Tianjiao Ji, Tianshe Yang, Andre Shomorony, Bruce Y Wang, Daniel S Kohane
The efficacy of tetrodotoxin (TTX), a very potent local anesthetic, is limited by its poor penetration through barriers to axonal surfaces. To address this issue, we encapsulated TTX in hollow silica nanoparticles (TTX-HSN) and injected them at the sciatic nerve in rats. TTX-HSN achieved an increased frequency of successful blocks, prolonged the duration of the block, and decreased the toxicity compared to free TTX. In animals injected with fluorescently labeled HSN, the imaging of frozen sections of nerve demonstrated that HSN could penetrate into nerve and that the penetrating ability of silica nanoparticles was highly size-dependent...
December 11, 2017: Nano Letters
https://www.readbyqxmd.com/read/29223350/%C3%AE-6-and-%C3%AE-1-integrin-heterodimer-mediates-schwann-cell-interactions-with-axons-and-facilitates-axonal-regeneration-after-peripheral-nerve-injury
#18
In Ae Chang, Ki-Joong Kim, Uk Namgung
Several isoforms of integrin subunits are expressed in Schwann cells and mediate Schwann cell interactions with axons. Here, we identify α6 and β1 integrins as heterodimeric proteins expressed in Schwann cells and define their functions in axonal regeneration. α6 and β1 integrins are induced in Schwann cells in the sciatic nerve after a crush injury, and the blocking of integrin activity by siRNA expression and by treatment with anti-integrin antibodies attenuates Schwann cell contact with cultured neurons and decreases neurite outgrowth...
December 6, 2017: Neuroscience
https://www.readbyqxmd.com/read/29217448/perioperative-outcomes-after-regional-versus-general-anesthesia-for-above-the-knee-amputations
#19
Andrew J B Pisansky, Ethan Y Brovman, Christine Kuo, Alan D Kaye, Richard D Urman
BACKGROUND: Nontraumatic lower extremity amputation (LEA) remains a common procedure among patients who frequently have significant comorbidities. Patients undergoing above knee amputation (AKA) have the highest rates of mortality in this cohort, yet there is little evidence to support selection between peripheral nerve block or neuraxial regional anesthesia (RA) versus general anesthesia (GA) techniques. The objective of this study was to determine whether RA (neuraxial or peripheral nerve block) techniques were associated with more favorable outcomes versus general anesthesia among patients undergoing AKA...
December 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29200077/consensus-statement-on-perioperative-use-of-neuromuscular-monitoring
#20
Mohamed Naguib, Sorin J Brull, Aaron F Kopman, Jennifer M Hunter, Béla Fülesdi, Hal R Arkes, Arthur Elstein, Michael M Todd, Ken B Johnson
A panel of clinician scientists with expertise in neuromuscular blockade (NMB) monitoring was convened with a charge to prepare a consensus statement on indications for and proper use of such monitors. The aims of this article are to: (a) provide the rationale and scientific basis for the use of quantitative NMB monitoring; (b) offer a set of recommendations for quantitative NMB monitoring standards; (c) specify educational goals; and (d) propose training recommendations to ensure proper neuromuscular monitoring and management...
November 30, 2017: Anesthesia and Analgesia
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