Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2017
Observational StudyClassification and Treatment of Chronic Neck Pain: A Longitudinal Cohort Study.
Neck pain exerts a steep personal and socioeconomic toll, ranking as the fourth leading cause of disability. The principal determinant in treatment decisions is whether pain is neuropathic or nonneuropathic, as this affects treatment at all levels. Yet, no study has sought to classify neck pain in this manner. ⋯ Although pure neuropathic pain comprised a small percentage of our cohort, 50% of our population consisted of mixed pain conditions containing a possible neuropathic component. There was significant overlap between the various classification schemes.
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Reg Anesth Pain Med · Jan 2017
Anatomic and Ultrasonographic Evaluation of the Knee Sensory Innervation: A Cadaveric Study to Determine Anatomic Targets in the Treatment of Chronic Knee Pain.
Osteoarthrosis is a main cause of knee pain in the elderly. Pain associated with this condition is often refractory to conservative treatment. Total knee replacement may be the best option for severe pathologies; however, the occurrence of a chronic pain state after knee replacement has been well documented in the literature. The previous descriptions of the genicular nerves have been considered somewhat inaccurate. This innervation is complex and exhibits significant interindividual variability. A precise description of these nerves will increase our knowledge on different patterns and targets, to guide treatment and improve outcomes. The objective of this study was to determine sensory innervation patterns of the knee joint and correlate them with dynamic visualization via ultrasound imaging. ⋯ We conclude that reproducible correlations showing the sensory innervations for the knee are linked to muscular structures. However, high variability among individuals makes it difficult to predict their paths. Our systematic approach, using direct visualization via ultrasound, allows a more accurate placement of the needle for therapeutic purposes.
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Reg Anesth Pain Med · Jan 2017
Randomized Controlled TrialFluoroscopic Guidance Increases the Incidence of Thoracic Epidural Catheter Placement Within the Epidural Space: A Randomized Trial.
Thoracic epidural analgesia can reduce postoperative pain and cardiopulmonary morbidity, but it is associated with a high rate of clinical failure. Up to 50% of clinical failure is thought to be related to technical insertion. In this study, patients undergoing thoracic surgery were randomized to one of two catheter insertion techniques: fluoroscopically guided or conventional loss of resistance with saline/air. Our primary aim was to examine whether fluoroscopic guidance could increase the incidence of correct catheter placement and improve postoperative analgesia. Our secondary aim was to assess the potential impact of correct epidural catheter positioning on length of stay in the postanesthesia care unit and total hospital length of stay. ⋯ Fluoroscopic guidance increases the incidence of epidural catheter positioning within the epidural space and may reduce postanesthesia care unit and hospital lengths of stay. Future work should validate the effectiveness of this approach.This clinical trial is registered with ClinicalTrials.gov (NCT02678039).
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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
Influence of Medical Insurance Under the Affordable Care Act on Access to Pain Management of the Trauma Patient.
The Affordable Care Act intended to "extend affordable coverage" and "ensure access" for vulnerable patient populations. This investigation examined whether the type of insurance (Medicaid, Medicare, Blue Cross, cash pay) carried by trauma patients influences access to pain management specialty care. ⋯ Access to pain specialists for management of pain medication in the postoperative trauma patient proved challenging. Despite the Affordable Care Act, Medicaid patients still experienced curtailed access to pain specialists and confronted the highest incidence of barriers to receiving appointments.