Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Oct 2013
ReviewEpidural steroids for spinal pain and radiculopathy: a narrative, evidence-based review.
Epidural steroid injections (ESIs) are the most commonly performed intervention in pain clinics across the USA and worldwide. In light of the growing use of ESIs, a recent spate of highly publicized infectious complications, and increasing emphasis on cost-effectiveness, the utility of ESI has recently come under intense scrutiny. This article provides an evidence-based review of ESIs, including the most up-to-date information on patient selection, comparison of techniques, efficacy, and complications. ⋯ The cost-effectiveness of ESI is the subject of great debate, and similar to efficacy, the conclusions one draws appear to be influenced by specialty. Because of the wide disparities regarding indications and utilization, it is likely that indiscriminate use is cost-ineffective, but that judicious use in well-selected patients can decrease healthcare utilization. More research is needed to better refine selection criteria for ESI, and to determine which approach, what dose, and how many injections are optimal.
-
Targeted intrathecal drug delivery systems (IDDS) are an option in algorithms for the treatment of patients with moderate-to-severe chronic refractory pain. This article is intended to review the literature regarding IDDS published over the last year, with special attention to the Polyanalgesic Consensus Conference 2012. ⋯ This review includes the recommendations for the use of IDDS, trialing, and recent reports of complications (especially, the occurrence of granulomas). In addition, the latest documents on cerebrospinal fluid and potential lines of future development are discussed.
-
Curr Opin Anaesthesiol · Oct 2013
ReviewUltrasound guidance, a win-win approach to peripheral nerve blockade.
The objective of the current review is to examine the likelihood of improved safety in peripheral nerve blockade attributable to ultrasound guidance. ⋯ Ultrasound is clearly superior to other techniques with the aim of achieving maximum efficacy with minimum risk: a win-win approach.
-
Curr Opin Anaesthesiol · Oct 2013
ReviewTranscranial doppler and near infrared spectroscopy in the perioperative period.
Maintenance of adequate blood flow and oxygen to the brain is one of the principal endpoints of all surgery and anesthesia. During operations in general anesthesia, however, the brain is at particular risk for silent ischemia. Despite this risk, the brain still remains one of the last monitored organs in clincial anesthesiology. ⋯ TCD and NIRS are noninvasive monitors that anesthesiologists apply to tailor cerebral oxygen delivery, aiming to safeguard brain function in the perioperative period.
-
This article reviews the current state of knowledge in functional MRI (fMRI) research related to pain with primary focus on clinical studies. ⋯ As we learn more about fMRI related to pain, functional connectivity patterns could emerge as biomarkers for specific pain conditions.