Current opinion in anaesthesiology
-
There has recently been a growing interest in developing and modulating the techniques of neuraxial analgesia to meet the changing individual needs of parturients for pain relief during the course of labour and delivery. ⋯ Labour epidural analgesia still remains the 'gold standard' of obstetric pain management, although spinal analgesia with the single-injection technique is an attractive option due to its simplicity, reliability and efficacy. Up till now, there has been no single new drug to overcome the superiority of neuraxial analgesia in obstetrics.
-
Epidural blocks (caudal, lumbar or thoracic) are of common use in paediatric patients for special procedures such as open fundoplication as well as for postoperative analgesia. However, because neonates and infants have lower metabolic capacities and specific anatomy as compared to adults, the dose of local anaesthetics and the way of their administration need careful attention. ⋯ Pharmacokinetic studies allowing safer dosing, especially with ropivacaine have recently been published. New techniques of thoracic epidural with puncture at the lumbar level are also proposed. However, all these new techniques need to pass the test of time.
-
In recent years there has been a renewed interest in regional anesthesia, particularly peripheral nerve blockade, in order not only to improve the patient's well being, but also to meet the requirements of modern orthopedic surgery. These requirements include appropriate conditions to perform early and efficient rehabilitation. ⋯ Early rehabilitation is currently a key point for the success of orthopedic surgery. The rapid development of peripheral nerve blockade gives the anesthesiologist the means to face this new challenge.
-
As a result of its accompanying co-morbidity, our lack of understanding regarding its mechanisms, and its resistance to conventional treatment, central pain is one of the most formidable challenges pain physicians are faced with. The objective of this review is to summarize recent advances in our understanding of the etiology, clinical presentation, and treatment of central pain, with special emphasis being placed on studies published within the past year. ⋯ Injury to the spinothalamocortical pathways is a necessary, but not sufficient factor in the pathogenesis of central pain. Perhaps because of the similarities in mechanisms, there is considerable overlap between effective treatments for central pain and those for peripheral neuropathic pain. Our poor understanding of the etiology of central pain and the relative lack of effective treatments emphasize the need for further research into this elusive disorder.
-
Development of new drugs and special techniques, as well as changes in health care organization have markedly influenced the use of spinal block and its indications. The present review overviews recent developments in local anesthetic drugs, side effects and special techniques for intrathecal anesthesia. ⋯ The changes in health care organization observed during the past few years have forced us to change the indications for and clinical uses of intrathecal anesthesia techniques in accordance with the changing needs of surgery. The development of new drugs and special techniques for spinal anesthesia will further improve the clinical use of this old but trusted technique.