Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jun 2021
CommentInvasive placebos in research on peripheral nerve blocks: a follow-up study.
The Serious Harm and Morbidity "SHAM" grading system has previously been proposed to categorize the risks associated with the use of invasive placebos in peripheral nerve block research. SHAM grades range from 0 (no potential complications, eg, using standard analgesia techniques as a comparator) through to 4 (risk of major complications, eg, performing a sub-Tenon's block and injecting normal saline). A study in 2011 found that 52% of studies of peripheral nerve blocks had SHAM grades of 3 or more. ⋯ The use of invasive placebos that may be associated with serious risks in peripheral nerve block research has decreased in contemporary peripheral nerve block research.
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Reg Anesth Pain Med · Jun 2021
CommentReal-time ultrasound-guided low thoracic epidural catheter placement: technical consideration and fluoroscopic evaluation.
Thoracic epidural analgesia can significantly reduce acute postoperative pain. However, thoracic epidural catheter placement is challenging. Although real-time ultrasound (US)-guided thoracic epidural catheter placement has been recently introduced, data regarding the accuracy and technical description are limited. Therefore, this prospective observational study aimed to assess the success rate and describe the technical considerations of real-time US-guided low thoracic epidural catheter placement. ⋯ Real-time US guidance appears to be a feasible option for facilitating thoracic epidural insertion. Whether or not this technique improves the procedural success and quality compared with landmark-based techniques will require additional study.
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Reg Anesth Pain Med · Jun 2021
CommentDaring discourse: should acute pain medicine be a stand-alone service?
Acute pain medicine (APM) has been incorporated into healthcare systems in varied manners with some practices implementing a stand-alone acute pain service (APS) staffed by consultants who are not simultaneously providing care in the operating room (OR). In contrast, other practices have developed a concurrent OR-APS model where there is no independent team beyond the intraoperative care providers. ⋯ In this daring discourse, we present two opposing perspectives on whether or not APM should be a stand-alone service. While evidence to guide best practice is limited, our goal is to encourage discussion of the varied APS practice models and research into their impact on outcomes and costs.