Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2017
Comparative StudyOpening Injection Pressure Is Higher in Intraneural Compared With Perineural Injections During Simulated Nerve Blocks of the Lower Limb in Fresh Human Cadavers.
Needle-induced nerve trauma and intraneural injection can lead to neurologic injury during peripheral nerve blocks. In this study, we assessed the utility of opening injection pressure (OIP), time to OIP, and rate of rise to OIP in detecting needle-nerve contact and intraneural injection. ⋯ In our fresh human cadaver model, OIP detected intraneural needle placement. Monitoring of OIP could be useful in detecting and/or preventing intraneural injection during nerve blocks in the clinical setting.
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Reg Anesth Pain Med · May 2017
Review Meta Analysis Comparative StudyPerineural Versus Intravenous Dexamethasone as an Adjuvant for Peripheral Nerve Blocks: A Systematic Review and Meta-Analysis.
Dexamethasone is a useful adjuvant in regional anesthesia that is used to prolong the duration of analgesia for peripheral nerve blocks. Recent randomized controlled trials (RCTs) have demonstrated conflicting results as to whether perineural versus intravenous (IV) administration is superior in this regard, and the perineural use of dexamethasone remains off-label. Therefore, we sought to perform a systematic review and meta-analysis of RCTs. ⋯ Perineural dexamethasone prolongs the duration of analgesia across the RCTs included in our meta-analysis. The magnitude of effect of 3.77 hours raises the question as to whether perineural dexamethasone should be administered routinely over its IV counterpart-or reserved for selected patients where such prolongation would be clinically important.
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Reg Anesth Pain Med · May 2017
ReviewReporting of Design Features and Analysis Details in Randomized Clinical Trials of Procedural Treatments for Cancer Pain: An ACTTION Systematic Review.
The objective of this study was to assess the reporting of randomized clinical trials investigating procedural treatments (eg, nerve blocks, targeted drug delivery) for cancer pain, with a focus on aspects that are particularly challenging in these trials. ⋯ The goal of highlighting these deficiencies in reporting is to promote transparent reporting of details affecting the completion and interpretation of procedural cancer pain trials so that their quality can be more easily evaluated.
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Reg Anesth Pain Med · May 2017
ReviewReview of Sympathetic Blocks: Anatomy, Sonoanatomy, Evidence, and Techniques.
The autonomic nervous system is composed of the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is implicated in situations involving emergent action by the body and additionally plays a role in mediating pain states and pathologies in the body. Painful conditions thought to have a sympathetically mediated component may respond to blockade of the corresponding sympathetic fibers. ⋯ Although initially injected using landmark-based techniques, fluoroscopy and more recently ultrasound imaging have allowed greater visualization and facilitated injections of these structures. In addition to treating painful conditions, sympathetic blockade has been used to improve perfusion, treat angina, and even suppress posttraumatic stress disorder symptoms. This review explores the anatomy, sonoanatomy, and evidence supporting these injections and focuses on ultrasound-guided/assisted technique for the performance of these blocks.
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Reg Anesth Pain Med · May 2017
Randomized Controlled Trial Comparative StudyAnterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: A Randomized Controlled Patient- and Assessor-Blinded Trial.
The interscalene brachial plexus block (ISB), a potent option to control pain after shoulder surgery, has notable adverse effects. The anterior suprascapular nerve block (SSNB) might provide comparable analgesia and cause less grip-strength impairment. These characteristics were studied in this randomized controlled patient- and assessor-blinded trial. ⋯ For outpatients undergoing arthroscopic shoulder surgery under general anesthesia, the SSNB seems preferable to ISB. It provides excellent postoperative analgesia without exposing patients to impaired mobility and to risks of the more potent but also more invasive ISB.