Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2017
Perioperative Patient Beliefs Regarding Potential Effectiveness of Marijuana (Cannabinoids) for Treatment of Pain: A Prospective Population Survey.
Cannabinoids have an expanding presence in medicine. Perioperative patients' perceptions of the effectiveness of these compounds, and acceptance if prescribed for pain, have not been previously described. Our primary objective was to describe patients' beliefs regarding the potential effectiveness of cannabinoids for the treatment of acute and chronic pain, as well as gauge patient acceptance of these compounds if prescribed by a physician. In addition, demographic and pain history data were collected to elucidate the predictors of the aforementioned patient attitudes. Secondarily, we sought to characterize the subgroup of patients who reported marijuana use. Predictors of marijuana use, effectiveness, and adverse effects were also reported for this subgroup. ⋯ Patients generally believe that marijuana could be at least somewhat effective for the management of pain and are willing to use cannabinoid compounds for this indication, if prescribed by a physician.
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Reg Anesth Pain Med · Sep 2017
Comparative StudyMeasurement Error of a Simplified Protocol for Quantitative Sensory Tests in Chronic Pain Patients.
Large-scale application of Quantitative Sensory Tests (QST) is impaired by lacking standardized testing protocols. One unclear methodological aspect is the number of records needed to minimize measurement error. Traditionally, measurements are repeated 3 to 5 times, and their mean value is considered. When transferring QST to a clinical setting, reducing the number of records would be desirable to meet the time constraints encountered in a routine clinical environment and to reduce the testing burden to chronic pain patients. However, there might be a trade-off between measurement error and number of records. We determined the measurement error of a single versus the mean of 3 records of pressure pain detection threshold (PPDT), electrical pain detection threshold (EPDT), and nociceptive withdrawal reflex threshold (NWRT) in 429 chronic pain patients recruited in a routine clinical setting. ⋯ This study contributes to a standardized QST protocol, and based on the minimal measurement error of 1 single record of PPDT, EPDT, and NWRT, we submit to reduce the testing burden. This would allow saving time, resources, and patient discomfort.
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Reg Anesth Pain Med · Sep 2017
Case ReportsNeuralgic Amyotrophy Attributed Incorrectly to Block-Related Injury: Understanding Errors in Clinical Reasoning.
We report a case of misdiagnosed neuralgic amyotrophy (brachial plexus neuritis, Parsonage-Turner syndrome). Our primary objective is to review the scientific basis for errors in clinical reasoning. ⋯ Cognitive bias may lead to errors in clinical reasoning and consequent misdiagnosis. Temporal proximity may falsely implicate regional anesthesia as the causative agent.
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Reg Anesth Pain Med · Sep 2017
Observational StudySerum Bupivacaine Concentration After Periarticular Injection With a Mixture of Liposomal Bupivacaine and Bupivacaine HCl During Total Knee Arthroplasty.
A relatively new technique to reduce postoperative pain for total knee arthroplasty is to inject a mixture of 266 mg of liposomal bupivacaine and 125 mg of 0.25% bupivacaine HCl with epinephrine 1:300,000 around the knee joint at the time of surgery. Currently, no publications report serum bupivacaine concentrations over time after periarticular injection of liposomal mixed with free bupivacaine. This information is important to ensure safe serum bupivacaine concentrations are maintained especially when considering supplemental or rescue peripheral nerve blocks. ⋯ Total serum concentrations of bupivacaine after periarticular administration of liposomal bupivacaine mixed with bupivacaine HCl remained below the described toxicity threshold (2.5 μg/mL) within the first 48 hours, and no patients demonstrated signs or symptoms of toxicity. However, peak serum concentration time was not achieved within the 48-hour interval. Additional studies are needed to describe the course of serum bupivacaine levels after 48 hours and to ascertain the risk of toxicity when combining this method of periarticular injection with peripheral nerve blocks.
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Reg Anesth Pain Med · Sep 2017
Comparative StudyAntioxidation Role of Different Lateral Stellate Ganglion Block in Isoproterenol-Induced Acute Myocardial Ischemia in Rats.
To determine whether stellate ganglion block (SGB) treatment exerts protective effects against isoproterenol (ISO)-induced acute myocardial ischemia (AMI) due to its antioxidant effects, we aimed to evaluate the protective effects of different lateral SGB agents on the tissue antioxidant status in ISO-induced AMI in male Sprague-Dawley rats. ⋯ These findings suggest that SGB could have antioxidative effects against AMI, and the protective effect of right SGB was more effective than that of left SGB. Thus, the right SGB could be an effective and safe method of local anesthesia to protect against cardiac damage due to oxidative stress.