Regional anesthesia and pain medicine
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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.
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Reg Anesth Pain Med · Jul 2020
Incidence and etiology of postoperative neurological symptoms after peripheral nerve block: a retrospective cohort study.
Nerve injury from peripheral nerve block (PNB) is an uncommon but potentially serious complication. We present a retrospective cohort study to evaluate the incidence and etiology of new postoperative neurological symptoms after surgery and regional anesthesia. ⋯ This retrospective review of 19 219 patients receiving PNBs for anesthesia or analgesia suggests that determining the etiology and causative factors of postoperative neurological symptoms is a complex, often challenging process that requires a multidisciplinary approach. We suggest a classification of cases based on the etiology. A most likely cause was identified in 70% of cases. This type of classification system can help broaden the differential diagnosis, help consider non-regional anesthesia and non-surgical causes and may be useful for clinical and research purposes.
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Reg Anesth Pain Med · Jul 2020
CommentAnalgesic efficacy of cannabinoids for acute pain management after surgery: a systematic review and meta-analysis.
Evidence regarding the role of cannabinoids in managing acute postoperative pain is conflicting. The purpose of this systematic review and meta-analysis was to determine the analgesic efficacy of perioperative cannabinoid compounds for acute pain management after surgery. ⋯ Our quantitative and qualitative review of the literature suggests that the analgesic role of perioperative cannabinoid compounds is limited, with no clinically important benefits detected when cannabinoids are added to traditional systemic analgesics compared with traditional systemic analgesics alone. Notably, there appears to be a signal towards increased postoperative pain and hypotension associated with the addition of perioperative cannabinoids to traditional systemic analgesics. These results do not support the routine use of cannabinoids to manage acute postoperative pain at the present time.
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Reg Anesth Pain Med · Jul 2020
Editorial CommentCannabinoids and pain medicine: what could possibly go wrong?