Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2017
The Neurological Safety of an Epidurally Administered Lipo-PGE1 Agonist in Rats.
Liposomal prostaglandin E1 (Lipo-PGE1) can inhibit platelet aggregation and vasodilatation and has been found to be therapeutic in ischemia and spinal diseases including stenosis. However, the neurologic safety of epidural administration of lipo-PGE1 requires further study. We investigated the neurotoxicity of epidurally administered lipo-PGE1 agonist in rats. ⋯ Liposomal prostaglandin E1 agonist did not cause any apparent neurologic abnormalities in the spinal cord or dorsal root ganglion, suggesting it is neurologically safe for epidural injection in this species. Additional mammalian study is warranted.
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Reg Anesth Pain Med · Jan 2017
Randomized Controlled Trial Comparative StudyA Prospective Randomized Comparative Trial of Targeted Steroid Injection Via Epidural Catheter Versus Standard C7-T1 Interlaminar Approach for the Treatment of Unilateral Cervical Radicular Pain.
No study has compared cervical interlaminar epidural steroid injection (CIESI) with epidural catheter advancement to the side and level of pathology versus standard C7-T1 CIESI. This study investigated whether cervical radicular pain is more effectively treated by CIESI with a targeted epidural catheter versus a standard C7-T1 approach. ⋯ This trial showed no significant difference in clinical outcomes with CIESI using a targeted epidural catheter compared to a standard C7-T1 approach for the treatment of unilateral cervical radicular pain at the C5 or C6 level. Both techniques were associated with clinically meaningful improvement across outcome domains of pain, function, disability, and medication use. These effects persisted to 6-month follow-up.The study was registered at Clinical Trials.gov (NCT02095197).
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Reg Anesth Pain Med · Jan 2017
Observational StudyAnalgesic Effect and Functional Improvement Caused by Radiofrequency Treatment of Genicular Nerves in Patients With Advanced Osteoarthritis of the Knee Until 1 Year Following Treatment.
Radiofrequency ablation of genicular nerves has proved to be successful in relieving pain and incapacity caused by osteoarthritis of the knee. However, long-term efficacy of such a treatment remains to be assessed. The current study aimed to reproduce radiofrequency neurotomy of genicular nerves to manage gonarthrosis pain and disability and establish therapeutic response until 1 year after intervention. ⋯ Ultrasound-guided radiofrequency neurotomy of genicular nerves alleviates intractable pain and disability in the majority of patients with advanced osteoarthritis of the knee. Such a treatment is safe and minimally invasive and can be performed in an outpatient setting. The beneficial effect of treatment started to decline after 6 months, but even 1 year after the intervention, 32% of patients reported 50% improvement or greater in pretreatment VAS scores.
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Ocular motor palsy is a rare but alarming complication of subarachnoid puncture. In order to better understand this condition, a literature search was performed in English of PubMed articles for cranial nerves III, IV, and VI palsies after spinal puncture. Sixty-five articles (dated 1930-2015) were identified, and 114 cases were obtained for analysis. ⋯ Treatments included the horizontal position along with analgesics, fluid therapy, and corticosteroids. The usefulness of blood patch remains controversial. It is important for anesthesiologists and other physicians to recognize the cardinal features of this process to ensure early diagnosis, avoid unnecessary tests, and guide appropriate treatment.
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Shoulder surgery can result in significant postoperative pain. Interscalene brachial plexus blocks (ISBs) constitute the current criterion standard for analgesia but may be contraindicated in patients with pulmonary pathology due to the inherent risk of phrenic nerve block and symptomatic hemidiaphragmatic paralysis. Although ultrasound-guided ISB with small volumes (5 mL), dilute local anesthetic (LA) concentrations, and LA injection 4 mm lateral to the brachial plexus have been shown to reduce the risk of phrenic nerve block, no single intervention can decrease its incidence below 20%. ⋯ One intriguing solution lies in the combined use of infraclavicular brachial plexus blocks and suprascapular nerve blocks. Theoretically, the infraclavicular approach targets the posterior and lateral cords, thus anesthetizing the axillary nerve (which supplies the anterior and posterior shoulder joint), as well as the subscapular and lateral pectoral nerves (both of which supply the anterior shoulder joint), whereas the suprascapular nerve block anesthetizes the posterior shoulder. Future randomized trials are required to validate the efficacy of combined infraclavicular-suprascapular blocks for shoulder surgery.