Regional anesthesia and pain medicine
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A cautionary summary of the benefits and potential risks of perineural dexamethasone.
"...there have been no reports of neurotoxicity or complications of any kind attributed to perineural dexamethasone in the nearly 700 patients who have received it in published studies of peripheral nerve blocks ... We must acknowledge that complications in regional anesthesia are rare, and 700 patients are woefully inadequate to declare dexamethasone safe for routine perineural use." (Noss 2014)
Noss concludes that:
- Perineural dexamethasone is probably safe, though conclusive safety evidence is still lacking.
- Systemic effects from IV dex is unlikely to explain the profound block prolongation.
- Prolongation is not enough on its own.
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Reg Anesth Pain Med · Nov 2014
Randomized Controlled TrialEffect of Intravenous Lidocaine on Postoperative Recovery of Patients Undergoing Mastectomy: A Double-Blind, Placebo-Controlled Randomized Trial.
One of the modalities of treatment for breast cancer surgery pain is opioids, and opioids are associated with adverse effects such as itching and postoperative nausea and vomiting (PONV). Intravenous (IV) lidocaine has been shown to reduce opioid consumption and to improve overall postoperative outcomes in abdominal surgery. In this study, we tested the effect of intraoperative IV lidocaine infusion on the quality of postoperative recovery after breast cancer surgery. ⋯ Our findings did not show a significant effect of IV lidocaine during breast cancer surgery on opioid consumption, pain score, PONV, or fatigue, indicating that the benefit of this approach does not generalize across all types of surgery.
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Reg Anesth Pain Med · Nov 2014
Perineural Hematoma May Result in Nerve Inflammation and Myelin Damage.
Perineural hematoma may occur during performance of peripheral nerve blocks. The aim of this study was to test the hypothesis that an iatrogenic hematoma in the immediate vicinity of a peripheral nerve may cause histologic evidence of nerve injury. ⋯ Our data suggest that hematoma adjacent to nerve tissue may result in structural nerve injury and inflammatory changes.
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Reg Anesth Pain Med · Nov 2014
Cadaveric Study of Sacroiliac Joint Innervation: Implications for Diagnostic Blocks and Radiofrequency Ablation.
Optimization of clinical outcomes of lateral branch radiofrequency ablation or blocks for sacroiliac joint (SIJ) pain requires precise nerve localization; however, there is a lack of comprehensive morphological studies. The objectives of this cadaveric study were to document SIJ innervation relative to bony landmarks in 3 dimensions and to identify reference points visible under ultrasound and fluoroscopy for optimal needle placement. ⋯ Based on the innervation pattern and using bony landmarks identifiable under ultrasound and fluoroscopy, 2 radiofrequency ablation techniques were proposed. Further research is required to determine the accuracy and reliability of needle placement and to evaluate clinical outcomes.