Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2019
Transversus abdominis plane block and intrathecal morphine use in cesarean section: a retrospective review.
Cesarean delivery is an extremely common surgical procedure practiced worldwide. It is an open abdominal surgery, and is associated with significant postoperative pain. One modality that helps alleviate this pain is the transversus abdominis plane (TAP) block. This analysis sought to evaluate postoperative pain when this block was used in conjunction with intrathecal morphine. ⋯ TAP blocks performed in conjunction with intrathecal morphine may decrease opioid use in the first 24 hours and improve pain scores for at least 36 hours following cesarean section. Because of the favorable safety profile, TAP blocks may contribute meaningfully to multimodal anesthesia for cesarean sections.
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Reg Anesth Pain Med · Sep 2019
Analysis of quantitative sudomotor axon reflex test patterns in patients with complex regional pain syndrome diagnosed using the Budapest criteria.
Although the quantitative sensory axon reflex test (QSART) is used to evaluate sudomotor dysfunction in the diagnosis of complex regional pain syndrome (CRPS), its validity remains controversial. This study investigated the diagnostic performance of the QSART for CRPS and assessed associations between results of the QSART and other clinical variables. ⋯ The QSART showed low diagnostic value as a screening or a confirmatory test for CRPS according to the Budapest research criteria. CRPS type II was more likely than CRPS type I to result in abnormal QSART results.
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Reg Anesth Pain Med · Sep 2019
Settled science or unwarranted variation in local anesthetic dosing? An analysis from an International Registry of Regional Anesthesiology.
Variation in clinical practice is often considered unwarranted when it does not reflect patient preference or evidence-based medicine. Complications from regional anesthesia such as nerve injury and systemic toxicity are dose dependent. It is currently unclear if there is significant variation with the dosing of local anesthetics (LA) in the context of the modern practice of peripheral regional anesthesia. ⋯ Large variation in dosing for regional blocks exists within and among hospitals, which is unlikely to be warranted. For many blocks, the variation of dosing is larger than the mean dose. Hospital site had strong impact on variation in LA dose and moderate impact on mean LA dose.
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Reg Anesth Pain Med · Sep 2019
Neuromodulatory effects of pudendal nerve stimulation on bladder hypersensitivity are present in opioid-pretreated rats.
Bilateral electrical pudendal nerve stimulation (bPNS) reduces bladder hypersensitivity in rat models and anecdotally reduces pain in humans with pelvic pain of urologic origin. Concomitant opioids are known to alter responses to neuromodulation in some systems. So prior to the development of a clinical trial for purposes of regulatory approval, the preclinical interaction between opioids and stimulation effectiveness was examined. ⋯ This study suggests that inhibitory effects of bPNS can still be evoked in subjects who are receiving opioid therapy, thus giving guidance to potential clinical trials seeking regulatory approval for the treatment of chronic bladder pain.