Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2010
ReviewDuloxetine: a review of its pharmacology and use in chronic pain management.
Duloxetine is a serotonin and norepinephrine reuptake inhibitor that possesses antidepressant and pain-relieving properties. Compared with other antidepressants, it has a high affinity for both norepinephrine and serotonin reuptake transporters, which are relatively balanced. Analgesic onset has been observed within the first week of administration in randomized controlled trials and is likely obtained by enhancing the tone of the descending pain inhibition pathways of the central nervous system. ⋯ Studies have also suggested that pain associated with major depressive disorder can be reduced with this medication. Modest effects for headache, osteoarthritic pain, and pain secondary to Parkinson disease have also been documented, but data are obtained from single-blinded or open-label trials that require further corroboration with larger randomized studies. Duloxetine has not yet been directly compared with other antidepressants or anticonvulsants for the treatment of pain syndromes.
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Lidocaine, a local anesthetic and antiarrhythmic drug that alters depolarization in neurons by blocking the fast voltage-gated sodium (Na+) channels in the cell membrane, is used for regional anesthesia, as antiarrhythmic drug, and as analgesic for various painful conditions. It is unclear whether monotherapy with intravenous lidocaine has an analgesic effect in healthy individuals. To address this important question, we studied pain perception before, during, and after the administration of intravenous lidocaine in 16 human volunteers. Our hypothesis was that lidocaine, administered as a short intravenous infusion, does not have an analgesic effect in healthy volunteers. ⋯ The observed sustained analgesic effect of systemic lidocaine in the ischemic pain model suggests that lidocaine may be used to treat acute pain.
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Reg Anesth Pain Med · May 2010
ReviewClinical sonopathology for the regional anesthesiologist: part 2: bone, viscera, subcutaneous tissue, and foreign bodies.
The use of ultrasound to facilitate regional anesthesia is an evolving area of clinical, education, and research interests. As our community's experience grows, it has become evident that anesthesiologists performing "routine" ultrasound-guided blocks may very well be confronted with atypical or even pathologic anatomy. As an educational resource for anesthesiologists, the following articles present examples of common sonopathology that may be encountered during ultrasound-guided regional anesthesia. This present article describes sonopathology related to bone, viscera, and subcutaneous tissue.