Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jun 2020
Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group.
The past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial. ⋯ Lumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.
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Reg Anesth Pain Med · Jun 2020
Intraindividual variation of the transversus abdominis plane block: an exploratory study in healthy volunteers.
The transversus abdominis plane block is widely used in postoperative pain management after abdominal surgery. However, large interindividual variation in the cutaneous distribution area of the block has been demonstrated. The purpose of the present study was to explore the reproducibility of the block by determining the intraindividual variation when repeating the block on two separate days. ⋯ We found a moderate-to-good reproducibility for lateral abdominal muscle thickness during maximal voluntary contraction, but a moderate-to-poor reproducibility for all other block characteristics. However, the cutaneous distribution of the block was still located primarily inferior to a horizontal line through the umbilicus and lateral relative to a vertical line through the anterior superior iliac spine.
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Reg Anesth Pain Med · Jun 2020
Implementation of a patient-specific tapering protocol at discharge decreases total opioid dose prescribed for 6 weeks after elective primary spine surgery.
At our institution, we developed an individualized discharge opioid prescribing and tapering protocol for joint replacement patients and implemented the same protocol for neurosurgical spine patients. We then tested the hypothesis that this protocol will decrease the oral morphine milligram equivalent (MME) dose of opioid prescribed postdischarge after elective primary spine surgery. ⋯ This patient-specific prescribing and tapering protocol effectively decreases the total opioid dose prescribed for 6 weeks postdischarge after elective primary spine surgery. Our experience also demonstrates the potential generalizability of this protocol, which was originally designed for joint replacement patients, to other surgical populations.
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Reg Anesth Pain Med · Jun 2020
Neuraxial anesthesia is associated with improved survival after total joint arthroplasty depending on frailty: a cohort study.
Frailty increases risk for complications after total joint arthroplasty (TJA). Whether this association is influenced by anesthetic administered is unknown. We hypothesized that use of neuraxial (spinal or epidural) anesthesia is associated with better outcomes compared with general anesthesia, and that the effect of anesthesia type on outcomes differs by frailty status. ⋯ Neuraxial anesthesia use among vulnerable patients was associated with improved survival and less wound complications. Calculating preoperative frailty prior to TJA informs perioperative risk and enhances shared-decision making for selection of anesthesia type.