Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2011
Comparative StudyAre sympathetic blocks useful for diagnostic purposes?
Sympathetically maintained pain (SMP) can occur in patients with neuropathic pain. Sympathetically maintained pain is frequently diagnosed clinically by assessing the analgesic effect of an appropriate sympathetic block (SB). The diagnostic value of such blocks depends on both the degree of sympathetic activity disruption achieved and its duration without unintentional concomitant sensory block. ⋯ Sympathetic blocks are useful in the diagnosis of SMP. However, their value is limited by the potential for false positives (unintentional sensory block) or false negatives (insufficient SB). Adequate monitoring of the sympathetic and somatosensory function for a minimum of 90 minutes after the intervention is essential to ensure that a valid diagnosis of SMP is made.
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Reg Anesth Pain Med · Nov 2011
Randomized Controlled Trial Multicenter Study Comparative StudyLumbar transforaminal epidural dexamethasone: a prospective, randomized, double-blind, dose-response trial.
Serious adverse events related to particulate steroids have curtailed the use of transforaminal epidural steroid injections for radicular pain. Dexamethasone has been proposed as an alternative. We investigated the efficacy, dose-response profile, and safety of 3 doses of epidural dexamethasone. ⋯ Transforaminal epidural dexamethasone provides statistically significant and clinically meaningful improvement in radicular pain at 12 weeks after injection, with parallel improvements in disability, impression of change, and satisfaction measures. There was no difference in efficacy for dexamethasone 4 mg compared with 8 or 12 mg. The optimal dose of epidural dexamethasone may be lower than 4 mg, further increasing the long-term safety and tolerability of this treatment. Current data are reassuring with regard to the safety of dexamethasone for transforaminal epidural steroid injection.
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Reg Anesth Pain Med · Nov 2011
Comparative StudyUltrasound-guided versus anatomic landmark-guided ankle blocks: a 6-year retrospective review.
Ultrasound-guided (USG) ankle block has been described; however, its clinical efficacy compared with conventional anatomic landmark-guided (ALG) techniques remains undetermined. ⋯ This study demonstrates that the USG technique of ankle block improves clinical efficacy compared with a conventional ALG technique, particularly in the hands of less-experienced practitioners.
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Reg Anesth Pain Med · Nov 2011
Randomized Controlled TrialA translational study of the effects of ketamine and pregabalin on temporal summation of experimental pain.
Central sensitization is often seen in chronic pain. A relevant and potent mechanism of central sensitization is the central integration of nociceptive impulses. Temporal summation in humans and the wind-up process in animals share common features of central integration. This preclinical and clinical translational study investigated the effect of ketamine and pregabalin on temporal summation (TS) and wind-up of wide dynamic range (WDR) neurons of nociceptive electrical stimuli in healthy volunteers and rats. ⋯ It was shown that TS shares common features with wind-up of WDR neurons and that pregabalin does not affect this component of central sensitization.