Regional anesthesia and pain medicine
-
Baclofen is a GABA(B) agonist that is administered spinally via an implanted drug delivery device to treat spasticity. It has been shown to have powerful antinociceptive effects in experimental animal models at doses that produce little or no motor-blocking effects but has rarely been used as a spinal analgesic agent in patients without spasticity. ⋯ To date, only 3 studies have shown it to be effective in patients with peripheral nociceptive or neuropathic pain mechanisms. Combinations of baclofen and morphine or clonidine are more effective than each drug alone in clinical as well as animal studies.
-
Reg Anesth Pain Med · May 2004
Review Comparative StudyPostoperative cognitive function as an outcome of regional anesthesia and analgesia.
It has been suggested that intraoperative neuraxial (spinal, epidural) anesthesia may decrease postoperative cognitive dysfunction when compared with general anesthesia, but the issue remains controversial. We systematically reviewed the data from published studies to determine the effect of intraoperative neuraxial anesthesia versus general anesthesia on postoperative cognitive dysfunction and delirium. ⋯ The use of intraoperative neuraxial anesthesia does not appear to decrease the incidence of postoperative cognitive dysfunction when compared with general anesthesia. There are methodologic and study-design issues present in many studies, and further elucidation of the pathophysiology of postoperative cognitive dysfunction may provide a direction for future studies.
-
Reg Anesth Pain Med · May 2004
Review Case ReportsSpinal cord compression from intrathecal catheter-tip inflammatory mass: case report and a review of etiology.
The majority of intrathecal pumps are implanted by anesthesiologists. Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature. The present case report describes a patient with spinal cord compression as a result of an inflammatory mass and reviews the current literature as to the etiology of inflammatory mass formation. ⋯ Delivery of high-dose intrathecal opioids can result in the formation of an inflammatory mass, leading to poor pain control and neurologic complications. Anesthesiologists should be vigilant as to these complications when managing patients receiving intrathecal pump therapy.
-
Reg Anesth Pain Med · May 2004
ReviewSelective nerve root blocks for low back pain and radiculopathy.
In the management of patients with low back pain and radiculopathy, selective nerve root blocks (SNRBs) are now a common procedure for both diagnostic and therapeutic purposes. This article reviews the available studies as well as the relevant anatomy, pathology, technical considerations, and complications.