Journal of anesthesia
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Journal of anesthesia · Feb 2019
Randomized Controlled Trial Comparative StudyLocal anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study.
Previous work showed that 20 mL of local anesthetic (LA) did not spread into the paravertebral space (PVS) via the intramuscular quadratus lumborum block (QLBi). If spread of LA into the PVS can be achieved by increasing the total LA volume, QLBi can be more effective. We hypothesized that a larger volume of LA for the QLBi would spread into the PVS. ⋯ LA administered by the QLB2 spreads into the PVS of T10-T12, resulting in lower and lateral abdominal sensory loss. In contrast, LA administered by the QLBi does not spread into the PVS and results in only lateral abdominal sensory loss.
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Journal of anesthesia · Feb 2019
Randomized Controlled Trial Comparative StudyThree versus five lumbar paravertebral injections for inguinal hernia repair in the elderly: a randomized double-blind clinical trial.
The objective of the study was to compare three nerve stimulator-guided paravertebral injections versus five injections for elderly patients undergoing inguinal hernia repair in terms of the amount of intraoperative fentanyl and propofol consumption and conversion to general anesthesia. The secondary objective was postoperative pain. ⋯ The five PVB injection technique is more suitable as a sole anesthetic technique for elderly patients undergoing herniorrhaphy, since it required less intraoperative supplemental analgesia and provided lower postoperative pain scores compared to the three PVB injection technique.
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Journal of anesthesia · Feb 2019
ReviewRoles of inflammation, neurogenic inflammation, and neuroinflammation in pain.
Inflammation is the body's response to injury and infection, involving a complex biological response of the somatosensory, immune, autonomic, and vascular systems. Inflammatory mediators such as prostaglandin, proinflammatory cytokines, and chemokines induce pain via direct activation of nociceptors, the primary sensory neurons that detect noxious stimuli. ⋯ A characteristic feature of neuroinflammation is the activation of glial cells in dorsal root ganglia, spinal cord, and brain which leads to the production of proinflammatory cytokines and chemokines in the PNS and CNS that drives peripheral sensitization and central sensitization. Here, we discuss the distinct roles of inflammation, neurogenic inflammation, and neuroinflammation in the regulation of different types of pain conditions, with a special focus on neuroinflammation in postoperative pain and opioid-induced hyperalgesia.
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Journal of anesthesia · Feb 2019
Postoperative thoracic and low back pain following endovascular aortic repair associated with stenting location.
We have noted that patients frequently complain of thoracic or low back pain after undergoing an endovascular aortic repair, which we speculated was caused by the indwelling stent. ⋯ Thoracic and low back pain after an endovascular aortic repair procedure were associated with stenting site.
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Journal of anesthesia · Feb 2019
ReviewHow neuraxial labor analgesia differs by approach: dural puncture epidural as a novel option.
Neuraxial analgesia techniques are not limited to just standard epidural and CSE blocks. A novel approach called dural puncture epidural (DPE) which is a modification of CSE in terms of practice has gained popularity after its description and use in the obstetric population. The aim of this review is to address the practice of DPE technique as a novel option by reviewing its benefits as well as side and/or adverse effects and to understand how neuraxial labor analgesia differs by approach based on the information available in the current literature DISCUSSION: Despite controversies and concerns, more rapid onset of analgesia, early bilateral sacral analgesia, lower incidence of asymmetric block and fewer maternal and fetal side effects are provided with DPE when compared to epidural. ⋯ DPE offers a favorable risk-benefit ratio for management of neuraxial analgesia as a novel option.