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Peripheral nerve blockade

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https://www.readbyqxmd.com/read/29753264/perineural-dexamethasone-successfully-prolongs-adductor-canal-block-when-assessed-by-objective-pinprick-sensory-testing-a-prospective-randomized-dose-dependent-placebo-controlled-equivalency-trial
#1
James D Turner, Daryl S Henshaw, Robert S Weller, J Douglas Jaffe, Christopher J Edwards, J Wells Reynolds, Gregory B Russell, Sean W Dobson
STUDY OBJECTIVE: To determine whether perineural dexamethasone prolongs peripheral nerve blockade (PNB) when measured objectively; and to determine if a 1 mg and 4 mg dose provide equivalent PNB prolongation compared to PNB without dexamethasone. SETTING: Multiple studies have reported that perineural dexamethasone added to local anesthetics (LA) can prolong PNB. However, these studies have relied on subjective end-points to quantify PNB duration. The optimal dose remains unknown...
May 8, 2018: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29742785/-peripheral-regional-anesthesia-without-any-complications-a-dream-comes-true
#2
Thomas Wiesmann, Jens Döffert, Thorsten Steinfeldt
Peripheral regional anesthesia procedures, such as femoral nerve block, are relatively safe procedures in clinical anesthesia. Nevertheless, it may lead to typical, usually transient and rarely even persistent complications. This article aims to highlight key aspects of complications in peripheral regional anesthesia and, in particular, strategies to reduce risk. Moreover, beside general complications, which might potentially occur in any peripheral nerve blockade ("bleeding/infection/nerve damage"), accidental co-blockades of other nerval structures are discussed using the example of the brachial plexus...
April 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29721648/comparison-of-adductor-canal-block-and-ipack-block-interspace-between-the-popliteal-artery-and-the-capsule-of-the-posterior-knee-with-adductor-canal-block-alone-after-total-knee-arthroplasty-a-prospective-control-trial-on-pain-and-knee-function-in-immediate
#3
S R Sankineani, A R C Reddy, Krishna Kiran Eachempati, Ajit Jangale, A V Gurava Reddy
BACKGROUND: Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty which however does not relieve posterior knee pain. The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves. MATERIALS AND METHODS: A prospective study was conducted from September 2016 to March 2017 in a total of 120 patients undergoing unilateral total knee arthroplasty...
May 2, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/29666885/referred-cramping-phantom-hand-pain-elicited-in-the-face-and-eliminated-by-peripheral-nerve-block
#4
Caroline Dietrich, Sandra Nehrdich, Annette Zimmer, Alexander Ritter, Gunther O Hofmann, Wolfgang H R Miltner, Thomas Weiss
Phantom limb pain is a restricting condition for a substantial number of amputees with quite different characteristics of pain. Here, we report on a forearm amputee with constant phantom pain in the hand, in whom we could regularly elicit the rare phenomenon of referred cramping phantom pain by touching the face. To clarify the underlying mechanisms, we followed the cramp during the course of an axillary blockade of the brachial plexus. During the blockade, both phantom pain and the referred cramp were abolished, while a referred sensation of "being touched at the phantom" persisted...
April 17, 2018: Experimental Brain Research. Experimentelle Hirnforschung. Expérimentation Cérébrale
https://www.readbyqxmd.com/read/29628554/comparison-of-ultrasound-with-peripheral-nerve-stimulator-guided-technique-for-supraclavicular-block-in-upper-limb-surgeries-a-randomized-controlled-trial
#5
Vinu Mervick Alfred, Gnanasekaran Srinivasan, Mamie Zachariah
Background: The supraclavicular approach is considered to be the easiest and most effective approach to block the brachial plexus for upper limb surgeries. The classical approach using the anatomical landmark technique was associated with higher failure rates and complications. Ultrasonography (USG) guidance and peripheral nerve stimulator (PNS) have improved the success rates and safety margin. Aims: The aim of the present study is to compare USG with PNS in supraclavicular brachial plexus block for upper limb surgeries with respect to the onset of motor and sensory blockade, total duration of blockade, procedure time, and complications...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29627342/blockade-of-%C3%AE-2-adrenergic-or-metabotropic-glutamate-receptors-induces-glutamate-release-in-the-locus-coeruleus-to-activate-descending-inhibition-in-rats-with-chronic-neuropathic-hypersensitivity
#6
Ken-Ichiro Hayashida, Masafumi Kimuram, James C Eisenach
Locus coeruleus (LC)-spinal noradrenergic projections are important to endogenous analgesic mechanisms and can be activated by local glutamate signaling in the LC. The current study examined the local glutamatergic, GABAergic, and noradrenergic influences on glutamate release in the LC and noradrenergic descending inhibition in rats 6 weeks after spinal nerve ligation (SNL). Intra-LC injection of the α2 adrenoceptor antagonist idazoxan or the group 2 metabotropic glutamate receptor (mGluR) antagonist (RS)-α-Methyl-4-tetrazolylphenylglycine (MTPG) increased withdrawal thresholds in SNL animals and this was reversed by the blockade of α-amino-3-hydroxy-5-methyl- 4-isoxazolepropionic acid (AMPA) receptors in the LC or α2-adrenoceptors in the spinal cord, but not in normal animals...
April 5, 2018: Neuroscience Letters
https://www.readbyqxmd.com/read/29592785/increased-expression-of-ca-v-3-2-t-type-calcium-channels-in-damaged-drg-neurons-contributes-to-neuropathic-pain-in-rats-with-spared-nerve-injury
#7
Xue-Jing Kang, Ye-Nan Chi, Wen Chen, Feng-Yu Liu, Shuang Cui, Fei-Fei Liao, Jie Cai, You Wan
Ion channels are very important in the peripheral sensitization in neuropathic pain. Our present study aims to investigate the possible contribution of CaV 3.2 T-type calcium channels in damaged dorsal root ganglion neurons in neuropathic pain. We established a neuropathic pain model of rats with spared nerve injury. In these model rats, it was easy to distinguish damaged dorsal root ganglion neurons (of tibial nerve and common peroneal nerve) from intact dorsal root ganglion neurons (of sural nerves). Our results showed that CaV 3...
January 2018: Molecular Pain
https://www.readbyqxmd.com/read/29578948/hcn-channels-contribute-to-spontaneous-activity-in-l4-c-fiber-nociceptors-but-not-a%C3%AE-non-nociceptors-after-axotomy-of-l5-and-inflammation-of-l4-spinal-nervesin-the-rat-in-vivo
#8
Laiche Djouhri, Trevor Smith, Ahmad Ahmeda, Mohammad Alotaibi, Xiechuan Weng
Peripheral neuropathic pain (PNP) associated with partial nerve injury is believed to be driven partly by aberrant spontaneous activity (SA) in both injured and uninjured dorsal root ganglion (DRG) neurons. The underlying ionic mechanisms are not fully understood, but hyperpolarization-activated cyclic nucleotide gated (HCN) channels which underlie the excitatory Ih current have been implicated in SA generation in axotomized A-fiber neurons following L5-spinal nerve ligation/axotomy (SNL/SNA). Here, using a modified model of SNA (mSNA) which involves, in addition to L5-SNA, loose ligation of the L4-spinal nerve with neuroinflammation-inducing chromic-gut, we examined whether HCN channels also contribute to SA in the adjacent L4-neurons...
March 22, 2018: Pain
https://www.readbyqxmd.com/read/29570507/how-central-is-central-post-stroke-pain-the-role-of-afferent-input-in-post-stroke-neuropathic-pain-a-prospective-open-label-pilot-study
#9
Simon Haroutounian, Andria L Ford, Karen Frey, Lone Nikolajsen, Nanna B Finnerup, Alicia Neiner, Evan D Kharasch, Pall Karlsson, Michael M Bottros
Central post-stroke pain is a neuropathic pain disorder, the underlying mechanisms of which are not well understood. It has been suggested that stroke-associated loss of inhibitory neurons in the spinothalamic tract causes disinhibition of thalamic neurons, which autonomously generate ectopic nociceptive action potentials responsible for the pain experience. We hypothesized that central post-stroke pain is a result of misinterpretation of afferent sensory input by the sensitized neurons within the brain, rather than generated spontaneously by the damaged CNS neurons...
March 21, 2018: Pain
https://www.readbyqxmd.com/read/29514376/contemporary-perioperative-analgesia-in-total-knee-arthroplasty-multimodal-protocols-regional-anesthesia-and-peripheral-nerve-blockade
#10
Jacob M Drew, Jonathan Neilio, Lisa Kunze
Perioperative care of the total knee arthroplasty (TKA) patient has evolved considerably over the past decade. Among the changes driving this evolution toward shorter hospitalization and accelerated rehabilitation have been regional anesthesia, peripheral nerve blockade, and multimodal analgesia protocols. These complementary techniques are increasingly supported by scientific evidence, though considerable uncertainty persists regarding the optimal combination of strategies. Continued refinement of technique and critical evaluation is trending toward greater characterization of the comparative effectiveness of myriad options...
March 7, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29505566/blood-concentration-of-bupivacaine-and-duration-of-sensory-and-motor-block-following-ultrasound-guided-femoral-and-sciatic-nerve-blocks-in-dogs
#11
Michéal O Cathasaigh, Matt R Read, Aylin Atilla, Teresa Schiller, Grace P S Kwong
Peripheral nerve blocks are becoming increasingly popular for perioperative use as anesthetics and analgesics in small animals. This prospective study was performed to investigate the duration of motor and sensory blockade following use of bupivacaine for ultrasound-guided femoral and sciatic nerve blocks in dogs and to measure the plasma concentrations of bupivacaine that result from these procedures. Six dogs were anesthetized twice using a randomized cross-over design. At the first anesthetic, dogs were assigned to receive either an ultrasound-guided femoral nerve block or sciatic nerve block with 0...
2018: PloS One
https://www.readbyqxmd.com/read/29452441/assessing-the-safety-and-efficacy-of-regional-anesthesia-for-lower-extremity-microvascular-reconstruction-enhancing-recovery
#12
Qing Zhao Ruan, Shawn Diamond, Scott Zimmer, Matthew L Iorio
BACKGROUND:  Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap. METHODS:  A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed...
May 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29424059/effective-dose-of-dexmedetomidine-as-an-adjuvant-sedative-to-peripheral-nerve-blockade-in-elderly-patients
#13
C Wang, H Zhang, Q Fu
BACKGROUND: The median effective dose (ED50 ) of sedative dexmedetomidine adjuvant to peripheral nerve block (PNB) has not yet been verified in elderly patients. This study assessed the ED50 of intravenous dexmedetomidine for sedation in elderly patients who were undergoing total knee arthroplasty (TKA) with PNB. METHODS: Forty-two patients aged 65-85 years were included and stratified into two groups according to age: young-old group (aged 65-74 years) and middle-old group (aged 75-85 years)...
February 9, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29406180/intravenous-dexamethasone-fails-to-prolong-psoas-compartment-block-when-assessed-by-objective-pinprick-sensory-testing-a-prospective-randomised-dose-dependent-placebo-controlled-equivalency-trial
#14
J D Turner, S W Dobson, R S Weller, G B Russell, D S Henshaw
BACKGROUND: Recent studies have concluded that i.v. dexamethasone can prolong the duration of peripheral nerve blockade. We hypothesized that a 4 mg dose would equally prolong the duration of psoas compartment blocks (PCBs) when compared with 8 mg, and that both doses would prolong the duration when compared with placebo. METHODS: This was a prospective, randomized, placebo-controlled, dose-dependent, equivalency trial with 115 patients undergoing total hip arthroplasty...
February 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29377866/dexamethasone-as-an-adjuvant-to-femoral-nerve-block-in-children-and-adolescents-undergoing-knee-arthroscopy-a-prospective-randomized-double-blind-placebo-controlled-trial
#15
Giorgio Veneziano, David P Martin, Ralph Beltran, NʼDiris Barry, Dmitry Tumin, Candice Burrier, Kevin Klingele, Tarun Bhalla, Joseph D Tobias
BACKGROUND AND OBJECTIVES: Perineural dexamethasone has been demonstrated to extend postsurgical analgesia after peripheral nerve blockade in adults. The mechanism of action of dexamethasone as a regional anesthetic adjuvant is unclear as intravenous dexamethasone has been shown to have similar analgesic efficacy as perineural dexamethasone. The efficacy of perineural dexamethasone has not been previously explored in the pediatric population. METHODS: After obtaining informed consent, children (aged 10-18 years) presenting for arthroscopic knee surgery with a femoral nerve block were randomized to 1 of 3 groups: ropivacaine 0...
May 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29377353/blockade-of-dopamine-d2-receptors-disrupts-intrahippocampal-connectivity-and-enhances-pain-related-working-memory-deficits-in-neuropathic-pain-rats
#16
H Cardoso-Cruz, M Dourado, C Monteiro, V Galhardo
BACKGROUND: Dopamine (DA) is thought to be important to local hippocampal networks integrity during spatial working memory (sWM) processing. Chronic pain may contribute to deficient dopaminergic signalling, which may in turn affect cognition. However, the neural mechanisms that determine this impairment are poorly understood. Here, we evaluated whether the sWM impairment characteristic of animal models of chronic pain is dependent on DA D2 receptor (D2r) activity. METHODS: To address this issue, we implanted multichannel arrays of electrodes in the dorsal and ventral hippocampal CA1 field (dvCA1) of rats and recorded the neuronal activity during a classical delayed food-reinforced T-maze sWM task...
May 2018: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/29361112/what-is-new-in-pain-modification-in-osteoarthritis
#17
Rachel E Miller, Joel A Block, Anne-Marie Malfait
There is a big need for the development of novel therapies for the safe management of chronic pain associated with OA. Here we reviewed PubMed (2015 onward) and ClinicalTrials.gov for ongoing and recently completed trials where pain in OA is the primary outcome measure. Three broad categories were identified: biological therapies, small molecules and cryoneurolysis. The most promising new strategy is blockade of nerve growth factor with antibodies. Two anti-nerve growth factor antibodies, tanuzemab and fasinumab, are in active development after the 2010 hold on trials was lifted in 2015...
January 17, 2018: Rheumatology
https://www.readbyqxmd.com/read/29333621/characterization-of-mouse-neuro-urological-dynamics-in-a-novel-decerebrate-arterially-perfused-mouse-dapm-preparation
#18
Hiroki Ito, Marcus J Drake, Christopher H Fry, Anthony J Kanai, Anthony E Pickering
AIM: To develop the decerebrate arterially perfused mouse (DAPM) preparation, a novel voiding model of the lower urinary tract (LUT) that enables in vitro-like access with in vivo-like neural connectivity. METHODS: Adult male mice were decerebrated and arterially perfused with a carbogenated, Ringer's solution to establish the DAPM. To allow distinction between central and peripheral actions of interventions, experiments were conducted in both the DAPM and in a "pithed" DAPM which has no brainstem or spinal cord control...
January 15, 2018: Neurourology and Urodynamics
https://www.readbyqxmd.com/read/29313904/peripheral-nerve-injury-arising-in-anaesthesia-practice
#19
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/29303925/local-anesthetic-systemic-toxicity-a-review-of-recent-case-reports-and-registries
#20
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...
February 2018: Regional Anesthesia and Pain Medicine
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