Regional anesthesia and pain medicine
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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
Observational StudySpinal Anesthesia Does Not Impact Prostate Cancer Recurrence in a Cohort of Men Undergoing Radical Prostatectomy: An Observational Study.
Prior studies suggest a possible association between the use of neuraxial-general anesthesia and a decrease in prostate cancer recurrence after radical prostatectomy. We examine the correlation of a spinal anesthesia-only technique on prostate cancer recurrence. ⋯ This was a retrospective study of patients with prostate cancer who have undergone radical prostatectomy during a time period when the practice of anesthesia for prostatectomy at our institution was transitioned from spinal to general anesthesia. In our study, when controlling for other predictors of advanced prostate cancer, the type of anesthetic given during prostatectomy had no effect on the risk of biochemical recurrence.
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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.