Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · May 2015
Practice GuidelineGuidelines for fellowship training in regional anesthesiology and acute pain medicine: third edition, 2014.
Directors for Regional Anesthesiology and Acute Pain Medicine fellowships develop and maintain guidelines for fellowship training in the subspecialty. The first edition of the guidelines was published in 2005 with a revision published in 2010. This set of guidelines updates the 2010 revision. The guidelines address 3 major topics: organization and resources, the educational program, and the evaluation process.
-
Reg Anesth Pain Med · May 2015
Evaluation of the skin to epidural and subarachnoid space distance in young children using magnetic resonance imaging.
Epidural catheters placed for perioperative analgesia in young children confer clinical benefits but are technically challenging to insert. Approximations of the skin to epidural space depth in this population are limited to direct needle measurement and ultrasonography. Magnetic resonance imaging (MRI) is the most comprehensive imaging modality of the spine. This study aims to produce a more clinically useful formula from MRI data to estimate pediatric epidural depth. ⋯ We provide the first predictive formulae, based on MRI data, for pediatric epidural depth estimation.
-
Reg Anesth Pain Med · May 2015
Aberrant analgesic response to medial branch blocks in patients with characteristics of fibromyalgia.
Facet interventions for spine pain have high failure rates, and preprocedural prediction of response is nearly impossible. A potential explanation may be aberrant central pain processing as that existing in conditions like fibromyalgia. To test this hypothesis, we conducted a retrospective study investigating the impact of having characteristics of fibromyalgia on the acute analgesic response to a first diagnostic medial branch block (MBB). ⋯ Characteristics of fibromyalgia may indicate pain that is more centralized in nature, a factor that may explain the aberrant analgesic response to this peripheral intervention. This may have implications for future prediction of treatment response, although prospective studies are needed.
-
Reg Anesth Pain Med · May 2015
Radiofrequency Ablation Near the Bone-Muscle Interface Alters Soft Tissue Lesion Dimensions.
Radiofrequency (RF) lesions are safe and effective in the treatment of spine pain; however, models developed to study factors affecting lesion dimensions have been performed in homogeneous media that may not accurately simulate human anatomy and electrophysiology. We present a novel ex vivo porcine model for performing RF lesion studies and report the influence of bone on projection of RF ablation lesions into soft tissue. ⋯ Bone adjacent to RF lesions alters the surrounding electrophysiological environment causing RF lesions to project further perpendicularly from the needle axis, vertically to bone, than previously expected. This phenomenon should be considered in the future modeling and clinical practice of RF.