Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2019
Quantitative analysis of the distal, lateral, and posterior articular branches of the axillary nerve to the shoulder: implications for intervention.
The terminal sensory branches innervating the shoulder joint are potential therapeutic targets for the treatment of shoulder pain. This cadaveric study investigated in detail the anatomic pathway of the posterior terminal sensory branch of the axillary nerve (AN) and its relationship to nearby anatomic structures for applications, such as nerve block or ablation of the shoulder joint. ⋯ The terminal sensory branches of the AN consistently innervate the inferior and lateral aspects of the posterior humeral head and shoulder capsule. These nerves are easily accessible and would provide a practical target for nerve block or ablation to relieve shoulder pain without compromising motor integrity.
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Reg Anesth Pain Med · Jul 2019
Botulinum toxin for chronic pelvic pain in women with endometriosis: a cohort study of a pain-focused treatment.
Many women with endometriosis continue to have pelvic pain despite optimal surgical and hormonal treatment; some also have palpable pelvic floor muscle spasm. We describe changes in pain, spasm, and disability after pelvic muscle onabotulinumtoxinA injection in women with endometriosis-associated pelvic pain, a specific population not addressed in prior pelvic pain studies on botulinum toxin. ⋯ These findings suggest pelvic floor spasm may be a major contributor to endometriosis-associated pelvic pain. Botulinum toxin injection may provide meaningful relief of pain and associated disability.
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Reg Anesth Pain Med · Jul 2019
Phenotypic features of patients with complex regional pain syndrome compared with those with neuropathic pain.
We hypothesized that patients with complex regional pain syndrome (CRPS) would describe a more negative pain phenotype including higher pain severity, more neuropathic pain descriptors, more centralized pain symptoms, poorer physical function, and more affective distress when compared with patients with neuropathic pain of the extremities not meeting CRPS criteria. ⋯ Counter to our hypothesis, the present study suggests that patients with CRPS do not have a worse clinical phenotype compared with patients not meeting CRPS criteria, with the exception of higher physical disability and more neuropathic pain symptoms. This corresponds to recent evidence that patients with CRPS are similar to other patient populations with chronic pain.
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Reg Anesth Pain Med · Jul 2019
Success of bedside ultrasound to identify puncture site for spinal anesthesia in neonates and infants.
Spinal anesthesia (SA) may be difficult in small infants. Conceptual advantages of ultrasound imaging to view critical neuraxial structures and exploiting the acoustic window unique to infants have been described but not clinically verified. We present 14 preterm-infants aged 35-48 weeks, weighing 1575-5800 g, and describe ultrasound imaging to locate an appropriate puncture site for SA. ⋯ The mean dural depth was 8 mm (1.6). The inferior medullary cone location was just above L3-L4 in 85.7% of patients. Ultrasound imaging for SA in infants may offer advantages.