Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2014
Randomized Controlled TrialUltrasound-Guided Single-Penetration Dual-Injection Block for Leg and Foot Surgery: A Prospective, Randomized, Double-blind Study.
A single-penetration dual-injection block of the sciatic and saphenous nerves was faster to perform but equally effective as traditional techniques.
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Reg Anesth Pain Med · Jan 2014
Randomized Controlled TrialIncreases in the Use of Prescription Opioid Analgesics and the Lack of Improvement in Disability Metrics Among Users.
In the United States, use of oral opioid analgesics has been associated with increasing rates of addiction, abuse, and diversion. However, little is known about the recent national use of non-illicit prescription opioid analgesics (those prescribed in a physician-patient relationship), the primary source of these drugs for the general US population. Our primary objective was to examine trends in the use of prescription opioid analgesics in the United States and to identify defining characteristics of patient users of prescribed opioids from 2000 to 2010. ⋯ The use of prescription opioid analgesics among adult Americans has increased in recent years, and this increase does not seem to be associated with improvements in disability and health status among users. On a public health level, these data suggest that there may be an opportunity to reduce the prescribing of opioid analgesics without worsening of population health metrics.
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Reg Anesth Pain Med · Jan 2014
Case ReportsEpidural Hematomas After Removal of Percutaneous Spinal Cord Stimulator Trial Leads: Two Case Reports.
We report 2 cases of spinal epidural hematoma formation after the removal of percutaneous spinal cord stimulator trial leads and discuss the possible etiologies of these complications. ⋯ Currently, the neuromodulation community ascribes to the American Society of Regional Anesthesia and Pain Medicine guidelines, which state that nonsteroidal anti-inflammatory drugs do not significantly increase the risk for epidural hematoma with neuraxial anesthesia and, therefore, there is no need to discontinue these drugs before epidural or spinal anesthesia. We suggest that these guidelines may not be appropriate for neuromodulatory techniques that likely subject the surrounding vasculature to more trauma than neuraxial anesthesia. We recommend discontinuing nonsteroidal anti-inflammatory drugs, particularly aspirin, before neuromodulation procedures. Further investigation will establish a timeframe for holding these drugs to optimize patient safety.
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Reg Anesth Pain Med · Jan 2014
Novel Use of Noninvasive High-Intensity Focused Ultrasonography for Intercostal Nerve Neurolysis in a Swine Model.
High-intensity focused ultrasound (HIFU) is a noninvasive thermal ablation technique. High-intensity focused ultrasound has been used in small-animal models to lesion neural tissue selectively. This study aimed to evaluate the efficacy of HIFU in a large-animal model for ablation of nerves similar in size to human nerves. ⋯ High-intensity focused ultrasound may be used as a noninvasive neurolytic technique in swine. High-intensity focused ultrasound may have potential as a neuroablation technique for patients with chronic and cancer pain.