Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2014
Randomized Controlled Trial Comparative StudySubparaneural Versus Circumferential Extraneural Injection at the Bifurcation Level in Ultrasound-Guided Popliteal Sciatic Nerve Blocks: A Prospective, Randomized, Double-Blind Study.
Subparaneural injection for popliteal sciatic nerve block shows faster onset and longer duration than circumferential extraneural injection.
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Reg Anesth Pain Med · Jul 2014
Comparative StudyComparison Between Digital Subtraction Angiography and Real-time Fluoroscopy to Detect Intravascular Injection During Lumbar Transforaminal Epidural Injections.
Infrequent but serious complications of transforaminal epidural steroid injection (TFESI) are thought to be due to inadvertent intravascular injection (embolization of corticosteroid particulates via the vertebral or thoracolumbar radiculomedullary arteries). Recent studies suggest that real-time fluoroscopy often fails to detect intravascular injection and that digital subtraction angiography (DSA) may help reduce the incidence of accidental vascular injection. The goal of this prospective study was to evaluate the sensitivity of real-time fluoroscopy versus DSA in detecting intravascular injection during TFESI. ⋯ Digital subtraction angiography is superior to real-time fluoroscopy for detecting intravascular injections.
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Reg Anesth Pain Med · Jul 2014
Randomized Controlled TrialThoracic paravertebral block and its effects on chronic pain and health-related quality of life after modified radical mastectomy.
Patients undergoing breast cancer surgery frequently experience chronic postoperative pain. The primary objective of this randomized study was to determine if thoracic paravertebral block (TPVB) reduced the incidence of chronic pain after a modified radical mastectomy (MRM) when compared with general anesthesia (GA). ⋯ There is no significant difference in the incidence or relative risk of chronic pain at 3 and 6 months after an MRM when TPVB is used in conjunction with GA. Nevertheless, patients who receive a TPVB report less severe chronic pain, exhibit fewer symptoms and signs of chronic pain, and also experience better physical and mental HRQOL.
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Reg Anesth Pain Med · Jul 2014
Multicenter StudyCan Changes in Vital Signs Be Used to Predict the Response to Lumbar Facet Blocks and Radiofrequency Denervation? A Prospective, Correlational Study.
Facet joint radiofrequency (RF) ablation is characterized by a high failure rate, which is partly due to the fact that pain relief after diagnostic blocks is inherently subjective. An area that has yet to be explored is whether more objective measures, such as changes in vital signs after blocks, might be used to predict treatment outcomes. ⋯ Although a decrease in DBP of more than 7.5 mm Hg had 97.3% specificity and 85.7% positive predictive value for predicting positive RF ablation outcomes, the low negative predictive value (56.3%) precludes its use as a solitary screening tool. An algorithm based on age, baseline NRS pain score, and a significant decrease in DBP was able to predict 76.7% (range, 65.8%-86.3%) of RF denervation outcomes.
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Reg Anesth Pain Med · Jul 2014
Comparative StudyAn Ex Vivo Comparison of Cooled-Radiofrequency and Bipolar-Radiofrequency Lesion Size and the Effect of Injected Fluids.
Radiofrequency (RF) neuroablation is a common therapy for alleviating chronic pain. Larger lesion volumes lead to higher chance of ablating small sensory nerves; therefore, bipolar-RF and cooled-RF are improved alternatives to conventional monopolar-RF. This work provides an ex vivo comparison of bipolar-RF to cooled-RF lesioning in the presence of bone structure using some conventional temperature and time programs and in conjunction with injection of a variety of clinically used substances. ⋯ Cooled-RF yields larger lesions than bipolar-RF under the conditions used in this study. The spherical shape of cooled-RF lesions provides larger volume coverage than lesions obtained with bipolar-RF at IED equals 5, 10, or 15 mm under similar electrode tip temperature and lesioning time.