Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2020
Tranexamic acid administration during total joint arthroplasty surgery is not associated with an increased risk of perioperative seizures: a national database analysis.
Tranexamic acid (TXA) has been used extensively to minimize blood loss in cardiac surgery and more recently in orthopedic surgery. Despite a generally good safety profile, an increased risk of seizures has been observed in patients with cardiac disease. However, this issue has not been adequately addressed in the orthopedic literature. ⋯ Despite increasing TXA utilization in total joint arthroplasty, we found an overall low seizure incidence. TXA use was not associated with elevated odds of perioperative seizure, even in patients with history of seizure.
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Cervical erector spinae plane (ESP) block has been described to anesthetize the brachial plexus (BP), however, the mechanism of its clinical effect remains unknown. As the prevertebral fascia encloses the phrenic nerves, BP and erector spinae muscles to form a prevertebral compartment, a local anesthetic injected in the cervical ESP could potentially spread throughout the prevertebral compartment. This study utilizes cadaveric models to evaluate the spread of ESP injections at the C6 and C7 levels to determine whether the injection can reach the BP and its surrounding structures. ⋯ Ultrasound-guided cervical (C6 and C7) ESP injections consistently stain the roots of the BP and dorsal rami. This study supports the notion that the cervical ESP block has the potential to provide analgesia for patients undergoing shoulder and cervical spine surgeries.
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Reg Anesth Pain Med · Jul 2020
CommentRegional anesthesia training model for resource-limited settings: a prospective single-center observational study with pre-post evaluations.
Educational initiatives are a sustainable means to address provider shortages in resource-limited settings (RLS), yet few regional anesthesia curricula for RLS have been described. We sought to design a reproducible training model for RLS called Global Regional Anesthesia Curricular Engagement (GRACE), implement GRACE at an RLS hospital in Ghana, and measure training and practice-based outcomes associated with GRACE implementation. ⋯ GRACE applied in an RLS hospital led to the design, implementation, and measurement of a regional anesthesia curriculum tailored to institutional specifications that was associated with positive Kirkpatrick outcomes.
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Reg Anesth Pain Med · Jul 2020
CommentDaring discourse - no: cannabinoids should not be used for acute postoperative pain management.
As anesthesiologists and acute pain medicine specialists, we will care for patients in the perioperative period who use cannabinoids for chronic pain and/or marijuana recreationally. We will have to address difficult questions from patients regarding the potential applications for cannabinoids in acute pain management. While we must remain compassionate and understand our patients' desire to find relief from suffering using available non-opioid medications, we are ethically bound to do no harm and provide them with treatment options supported by the best available evidence. Today, we cannot support cannabinoids in the management of acute postoperative pain.