Current opinion in anaesthesiology
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To review the recently published peer-reviewed literature involving regional anesthesia and analgesia in patients at home. ⋯ Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the interscalene block provides effective analgesia with minimal complications, whereas the impact and risks of intraarticular injections remain unclear. Perineural catheters are an analgesic option that offer improved pain relief among other benefits. They are now being used at home in both adult and pediatric populations.
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Interventional pain management is an emerging specialty that uses procedures to diagnose and treat chronic pain. Most of these procedures are performed percutaneously and carry a risk of bleeding. Patients undergoing these treatments may be receiving exogenous anticoagulants. The pain practitioner faces a dilemma in performing an elective procedure on a patient with a bleeding risk. ⋯ Knowledge about normal and impaired hemostasis, coupled with a bleeding risk tool, enables practitioners to make informed decisions when offering interventional pain care to their patients.
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To evaluate the risks and safety of anaesthesia performed outside the operating room. ⋯ There is an urgent need for good data on complications with anaesthesia outside the operating room.
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Curr Opin Anaesthesiol · Aug 2008
ReviewPharmacology of cyclooxygenase-2 inhibitors and preemptive analgesia in acute pain management.
NSAIDs have served as analgesic, antiinflammatory, and antipyretic medicines for over a century. A novel class of NSAIDs, cyclooxygenase-2 inhibitors, was introduced in 1999. All NSAIDs and aspirin inhibit active sites of cyclooxygenase-1 and cyclooxygenase-2. Recent studies have demonstrated an important role of cyclooxygenase-2 inhibitors in the management of acute pain processes. ⋯ On the basis of many human studies, one may conclude that perioperative cyclooxygenase-2 inhibitors, in standard doses, decrease opioid consumption. Future investigations that include different multimodal techniques, for example combining cyclooxygenase-2 inhibitors with regional blocks, may help elucidate and clarify the true benefits of perioperative cyclooxygenase-2 inhibitors in acute pain management strategies.