Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2016
Meta AnalysisThe Analgesic Efficacy of Nonsteroidal Anti-inflammatory Agents (NSAIDs) in Patients Undergoing Cesarean Deliveries: A Meta-Analysis.
Postoperative pain after cesarean delivery, which accounts for approximately 1 in 3 live births in the United States, can be severe in many patients. Nonsteroidal anti-inflammatory agents (NSAIDs) are potent analgesics that are effective in the treatment of postoperative pain. In this meta-analysis, we assessed the analgesic efficacy of NSAIDs in postoperative cesarean delivery patients. ⋯ The perioperative use of NSAIDs in cesarean delivery patients will result in a significantly lower pain scores, less opioid consumption, and less drowsiness/sedation but no difference in nausea or vomiting compared to those who did not receive NSAIDs. Further research should address the optimal NSAID regimen and examine the effect of improved analgesia on patient-centered outcomes such as patient satisfaction and quality of breastfeeding.
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Reg Anesth Pain Med · Nov 2016
The Impact of Paravertebral Block Analgesia on Breast Cancer Survival After Surgery.
The impact of regional anesthesia on breast cancer recurrence is controversial. We tested the hypothesis that the use of paravertebral block (PVB) analgesia during breast cancer surgery prolongs the recurrence-free survival (RFS) and overall survival (OS) of women with breast cancer. ⋯ This retrospective study does not support the hypothesis that the use of regional analgesia is associated with longer survival after surgery for breast cancer.
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Reg Anesth Pain Med · Nov 2016
Spinal Cord Stimulation Modulates Gene Expression in the Spinal Cord of an Animal Model of Peripheral Nerve Injury.
Previously, we found that application of pulsed radiofrequency to a peripheral nerve injury induces changes in key genes regulating nociception concurrent with alleviation of paw sensitivity in an animal model. In the current study, we evaluated such genes after applying spinal cord stimulation (SCS) therapy. ⋯ Continuously applied SCS modulates expression of key genes involved in the regulation of neuronal membrane potential.
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Reg Anesth Pain Med · Nov 2016
Case ReportsPerioperative Nerve Injury After Peripheral Nerve Block in Patients With Previous Systemic Chemotherapy.
There are multiple risk factors for developing perioperative nerve injury (PNI). Perioperative nerve injury after peripheral nerve blockade (PNB) is rare. Exposure to systemic chemotherapy may cause peripheral neuropathy, but its role as a risk factor for PNI after PNB is unknown. The objective of this retrospective study was to determine the incidence of PNI in patients undergoing PNB as part of extremity surgery after prior exposure to systemic chemotherapy. ⋯ The overall incidence of PNI in this cohort (2.2%) was not different than baseline risk established in large cohort studies. Perioperative nerve injury was possibly attributable to the PNB in 0.5% of patients. However, in the absence of a control group of surgical patients who previously received systemic chemotherapy without regional anesthesia, we cannot determine whether the higher incidence of neurologic injury is secondary to the surgical procedure, the anesthetic technique, the natural progression of chemotherapy-induced peripheral neuropathy, or a combination of factors and the relative contribution of each.