Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Dec 2024
Anatomical study of the innervation of the posterior elbow joint capsule: implications for ultrasound-guided peripheral nerve block and radiofrequency ablation procedures.
Ultrasound-guided peripheral nerve block and radiofrequency ablation have been developed for pain management in various joints including the hip, knee and shoulder, but not the elbow. Precise three-dimensional (3D) localization of the articular branches and landmarks visible on ultrasound are needed. The objectives of this anatomical study were to determine the presence, course, frequency, landmarks and areas innervated by the articular branches supplying the posterior elbow joint. ⋯ The 3D data of the articular branches supplying the posterior elbow joint provide an anatomical basis for the development of peripheral nerve block and radiofrequency ablation protocols to treat elbow joint pain. Further anatomical and clinical studies are necessary to identify target sites and evaluate the proposed landmarks in vivo.
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Reg Anesth Pain Med · Dec 2024
Review Case ReportsIntrathecal baclofen pump in pregnancy: case report, literature review, and management considerations.
Baclofen, a gamma-aminobutyric acid receptor type B agonist in the central nervous system, is the first-line medication among central nervous system modulating agents for the treatment of neurogenic muscle spasticity. While baclofen is most often administered enterally, patients with severe spasticity may be candidates for baclofen delivered by intrathecal pump. Currently, there are only nine studies reporting on the use of intrathecal baclofen (ITB) during pregnancy and childbirth. ⋯ Our case, alongside the existing literature on ITB during pregnancy, suggests that ITB therapy in pregnancy poses a low risk of teratogenicity and infant withdrawal seizures; however, larger, controlled studies are necessary to make those conclusions with confidence. Healthcare providers caring for pregnant ITB patients should be cognizant of the potential for such patients to require increased doses of ITB during pregnancy to achieve adequate symptom control.
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Reg Anesth Pain Med · Dec 2024
ReviewApproaches to neuropathic amputation-related pain: narrative review of surgical, interventional, and medical treatments.
Neuropathic amputation-related pain can consist of phantom limb pain (PLP), residual limb pain (RLP), or a combination of both pathologies. Estimated of lifetime prevalence of pain and after amputation ranges between 8% and 72%. ⋯ Multimodal approaches combining pharmacotherapy, surgery and invasive neuromodulation procedures would appear to be the most promising strategy for preventive and treating PLP and RLP. Future efforts should focus on cross-disciplinary education to increase awareness of treatment options exploring best practices for preventing pain at the time of amputation and enhancing treatment of chronic postamputation pain.
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Reg Anesth Pain Med · Dec 2024
Observational StudyUltrasound estimates of the epidural depth in the paramedian sagittal oblique and transverse median planes: the correlation between estimated and actual depth to the epidural space in children with scoliosis.
The present study aimed to compare the correlation and agreement of epidural depth estimation using ultrasound in the paramedian sagittal oblique (PSO) versus the transverse median (TM) plane relative to the actual epidural depth observed during midline epidural punctures in children with scoliosis. ⋯ The PSO view can be a reliable guide to facilitate epidural puncture in children with scoliosis with better visualization.
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Reg Anesth Pain Med · Dec 2024
ReviewLiterature review of spinal hematoma case reports: causes and outcomes in pediatric, obstetric, neuraxial and pain medicine cases.
The risk of spinal epidural hematoma (SEH) has been described in the literature but the impact in various patient populations has not been assessed in the same study. We identified the risk factors for SEH and calculated the OR for recovery in the pediatric, adult and obstetric (OB) patients based on the degree of neurological deficit before surgery. ⋯ Our data show a preponderance of spontaneous SEH in all patient populations. SEH developed even though the ASRA guidelines were followed, especially in patients on multiple anticoagulants. Patients with less impairment prior to surgery had a higher likelihood of complete recovery, regardless of the interval between surgery and onset of symptoms.