Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2016
Randomized Controlled Trial Comparative StudyDetermining the Learning Curve for Acquiring Core Sonographic Skills for Ultrasound-Guided Axillary Brachial Plexus Block.
The objectives of this study were to determine the learning curve for capturing sonograms and identifying anatomical structures relevant to ultrasound-guided axillary brachial plexus block and to determine if massed was superior to distributed practice for this core sonographic skill. ⋯ The proficiency of participants in capturing sonograms and identifying anatomical structures improved significantly over 8 to 10 learning sessions. Because of sample size issues, we cannot make a firm conclusion regarding massed versus distributed practice for this core sonographic skill.
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Reg Anesth Pain Med · Nov 2016
Case ReportsLocal Anesthetic-Induced Myotoxicity After Continuous Adductor Canal Block.
Local anesthetic-induced myotoxicity occurs consistently in animal models, yet is reported rarely in humans. Herein, we describe 3 sentinel cases of local anesthetic myotoxicity after continuous adductor canal block (ACB). ⋯ Clinically apparent local anesthetic-induced myotoxicity has been documented rarely in humans undergoing non-ophthalmic surgery. We report 3 sentinel cases associated with continuous ACB.
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Reg Anesth Pain Med · Nov 2016
Case ReportsLabor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal.
Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. ⋯ This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis. We believe a similar mechanism may explain the pain that patients sometimes experience after administration of large epidural volumes.
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Reg Anesth Pain Med · Nov 2016
Randomized Controlled Trial Comparative StudyEffect of Topical Morphine on Acute and Chronic Postmastectomy Pain: What Is the Optimum Dose?
Poorly controlled postoperative pain is strongly associated with the development of chronic pain. We aimed to investigate the effect of topical morphine (in 1 of 3 doses: 5, 10, or 15 mg) on acute and chronic neuropathic pain after modified radical mastectomy for cancer breast. ⋯ Topical morphine controlled acute postmastectomy pain in a dose-dependent manner and reduced the incidence and severity of chronic postmastectomy pain syndrome.
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Reg Anesth Pain Med · Nov 2016
Comparative StudyLocal Infiltration of Analgesics at Surgical Wound to Reduce Postoperative Pain After Laparotomy in Rats.
There is an increasing use of local infiltration analgesia (LIA) to reduce postoperative pain. Despite widespread use of LIA, wide variations in drug combinations and concomitant use of systemic analgesics have made it difficult to determine the optimal drug combinations for LIA. Using a previously validated rat laparotomy model, the optimal LIA combination of medications to reduce postoperative pain was determined. ⋯ Our animal study suggests that clinical trials with low-dose LIA combinations of local anesthetic, nonsteroidal anti-inflammatory drug, and corticosteroid may be useful for reducing postoperative pain after laparotomy.