Current opinion in anaesthesiology
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Postoperative vision loss (POVL) as related to spinal surgery and the prone position has garnered increasing attention in the US over the last 15 years, resulting in an increase of litigations submitted to the legal system. It might be associated with the development of new surgical techniques involving complex instrumentation of the spine. By 2000, the magnitude of this problem was such that the American Society of Anesthesiologists developed a Postoperative Visual Loss Registry in an effort to better understand and evaluate this devastating operative complication. ⋯ ION is still poorly understood and risk factors remain speculative. Given that there is no known treatment, increased understanding should help to prevent this postoperative complication.
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Curr Opin Anaesthesiol · Oct 2010
ReviewContinuous central and perineural infusions for postoperative pain control in children.
Continuous infusion remains the technique of choice when there is a prolonged operation or intense postoperative pain is anticipated. Supplementing a general anesthesia with a nerve block can result in a pain-free awakening and postoperative analgesia without the potentially deleterious effects associated with parenteral opioids. The literature confirms the very low rate of complications and adverse effects of regional anesthesia in children. ⋯ The introduction of high-resolution portable ultrasound brought a great advance for the pediatric anesthesiologists; ultrasound-guided visualization of anatomic structures, in fact, allows greater precision of needle and catheter placement, and confirmation that the drug is deposited in the site of choice. This article reviews the safety and efficacy of central and perineural continuous infusions for postoperative pain control in children.
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Curr Opin Anaesthesiol · Oct 2010
ReviewThe role of botulinum toxin in management of pain: an evidence-based review.
In the present review we discuss the role of botulinum neurotoxins (BoNTs) in the management of different pain conditions, with evidence-based data on the toxins' efficacy on pain and its mechanisms. ⋯ The role of BoNTs in management of pain is not yet well established. Larger studies in neuropathic pain, joint pain, and myofascial pain syndrome are needed to fully ascertain the role for BoNT therapy in those areas.
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Objective monitors to warn against adverse events specific to the performance of nerve blockade are relatively unsophisticated compared with monitors used during general anesthesia. The purpose of this review is to outline the various monitors available, and how they can be used to reduce nerve block-related complications. ⋯ Peripheral nerve blockade has evolved from an entirely blind procedure to a more reproducible subspecialty. Several monitors exist to objectively guide and monitor needle placement and application of local anesthetics. Because these monitors are complementary, best practice may involve combining all of these monitoring options when performing peripheral nerve blocks.
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The purpose of the review is to describe what is currently known about the mechanisms, incidence and risk factors for acute and chronic postcraniotomy pain. The review will also summarize the evidence supporting the prevention and management of acute and chronic postcraniotomy pain. ⋯ Acute and chronic pain following craniotomy is frequent and underrecognized. Several surgical and patient risk factors predispose patients to pain following neurosurgery. Further research is needed to determine the mechanisms, predictors, prevention and optimal treatment of acute and chronic pain following craniotomy.