Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2013
The κ-opioid receptor agonist U-50488 blocks Ca2+ channels in a voltage- and G protein-independent manner in sensory neurons.
κ-Opioid receptor (κ-OR) activation is known to play a role in analgesia and central sedation. The purpose of the present study was to examine the effect of the κ-OR agonist, U-50488 (an arylacetamide), on Ca channel currents and the signaling proteins involved in acutely isolated rat dorsal root ganglion (DRG) neurons expressing the putative promoter region of the tetrodotoxin-resistant Na channel (NaV 1.8) that is known to be involved in pain transmission. ⋯ These results suggest that the antinociceptive actions mediated by U-50488 are likely due to both a direct block of Ca channels in sensory neurons as well as G protein modulation of Ca currents via κ-OR-expressing neurons.
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Reg Anesth Pain Med · Jan 2013
Randomized Controlled TrialLong-term pain and functional disability after total knee arthroplasty with and without single-injection or continuous sciatic nerve block in addition to continuous femoral nerve block: a prospective, 1-year follow-up of a randomized controlled trial.
This is a follow-up to determine long-term outcomes after total knee arthroplasty (TKA) in patients enrolled in a previous randomized trial that found reduced postoperative pain after addition of sciatic nerve block to continuous femoral nerve block for TKA. ⋯ No differences were detected in the secondary outcomes we examined. Thus, improved postoperative outcome did not translate into improved functional outcome or long-term pain.
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Reg Anesth Pain Med · Jan 2013
Local anesthetic-induced inhibition of human neutrophil priming: the influence of structure, lipophilicity, and charge.
Local anesthetics (LAs) are widely known for inhibition of voltage-gated sodium channels underlying their antiarrhythmic and antinociceptive effects. However, LAs have significant immunomodulatory properties and were shown to affect human neutrophil functions independent of sodium-channel blockade. Previous studies suggest a highly selective interaction between LAs and the α-subunit of G protein-coupled receptors of the Gq/G11 family as underlying mechanism. Providing a detailed structure function analysis, this study aimed to determine the active parts within the LA molecule responsible for the effects on human neutrophil priming. ⋯ Local anesthetics significantly attenuated Gαq-protein-mediated neutrophil priming. The most potent inhibition was achieved by ester compounds, inversely correlated with their octanol-buffer coefficient, and enhanced by permanent charges within the LA molecule. No correlation to their potency of blocking sodium channels was found.
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Reg Anesth Pain Med · Jan 2013
Bilateral loss of neural function after interscalene plexus blockade may be caused by epidural spread of local anesthetics: a cadaveric study.
Interscalene brachial plexus blockade is widely used in surgical procedures of the upper limb. Recently, we experienced the complication of a contralateral blockade after ultrasound-guided interscalene block. The clinical appearance was a blockade of both the ipsilateral and the contralateral cervical segments 6 to 8. We hypothesized that epidural spread of local anesthetics could be cause for this phenomenon. ⋯ Contralateral blockade after ultrasound-guided interscalene injection of local anesthetics is very likely to be the effect of epidural spread. Future in vivo studies are needed to understand the implications of needle location and volume on epidural spread in interscalene blockade.