Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2019
RNA expression preoperatively and postoperatively following total knee replacement: a pilot study in patients with and without chronic postsurgical pain.
Differences in gene expression may provide insight into the biological pathways involved in chronic postsurgical pain (CPSP). We compared blood RNA microarrays preoperatively and postoperatively following total knee arthroplasty (TKA) in patients with and without CPSP. ⋯ Despite a lack of clinical differences, patients who develop CPSP have upregulated pain pathways preoperatively; however, only the chemokine pathway remained differentially upregulated at 6 months postsurgery.
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Reg Anesth Pain Med · Jan 2019
Complete relief of CRPS-associated pain during magnesium infusion in a patient with postpartum preeclampsia.
A pregnant patient with chronic regional pain syndrome (CRPS) and indwelling spinal cord stimulator presented with twin gestation for induction of preterm labor due to preeclampsia. Intravenous magnesium was initiated and a lumbar epidural catheter was placed uneventfully for labor analgesia. The patient reported complete relief of her CRPS-associated pain during and for 24 hours after delivery, while receiving intravenous magnesium, with her pain symptoms returning shortly after discontinuing magnesium. To our knowledge, there are no case reports that describe CRPS-associated pain relief while on peripartum magnesium therapy.
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Reg Anesth Pain Med · Jan 2019
Lower extremity regional anesthesia: essentials of our current understanding.
The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine's ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.