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
Review Meta AnalysisNeural Blockade for Persistent Pain After Breast Cancer Surgery.
Persistent pain after breast cancer surgery is predominantly a neuropathic pain syndrome affecting 25% to 60% of patients and related to injury of the intercostobrachial nerve, intercostal nerves, and other nerves in the region. Neural blockade can be useful for the identification of nerves involved in neuropathic pain syndromes or to be used as a treatment in its own right. ⋯ In this systematic review, we found only 7 studies (n = 135) assessing blocks directed at 3 neural structures-stellate ganglion, paravertebral plexus, and intercostal nerves-but none focusing on the intercostobrachial nerve. The quality of the studies was low and efficacy inconclusive, suggesting a need for well-designed, high-quality studies for this common clinical problem.
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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
Ultrasound-Guided Injection of the Intrapelvic Portion of the Obturator Internus in a Cadaver Model.
Musculoskeletal dysfunction of the pelvic floor is common. One of the intrapelvic muscles, the obturator internus (OI), can be substantially stressed during its sharply angulated exit from the pelvis. However, there may be considerable overlap between symptoms and signs arising from the OI and other potential pain generators including the levator ani in the pelvic region. Accurate diagnosis for the OI might permit more efficient treatment combined with OI-specific exercise and behavior modification. Therefore, we hypothesized that ultrasound (US)-guided needle insertion in the intrapelvic portion of the OI would be accurate when a pararectal approach is used for diagnostic and therapeutic purposes. ⋯ The newly developed US-guided pararectal approach allowed accurate insertion of a needle into the intrapelvic portion of the OI. This US-guided method facilitated a more precise approach to the intrapelvic portion of the OI and may help differentiate conditions or symptoms caused by other structures.