Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2019
Acute postoperative pain is an independent predictor of chronic postsurgical pain following total knee arthroplasty at 6 months: a prospective cohort study.
Approximately 15% of patients report persistent knee pain despite surgical success following total knee arthroplasty (TKA). The purpose of this study was to determine the association of acute-postsurgical pain (APSP) with chronic postsurgical pain (CPSP) 6 months after TKA controlling for patient, surgical and psychological confounding factors. ⋯ APSP is a risk factor for CPSP following TKA even after adjusting for confounding variables such as pain catastrophizing, anxiety, depression and functional status. Studies are needed to determine if APSP is a modifiable risk factor for the development of CPSP.
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Reg Anesth Pain Med · Mar 2019
Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management.
Buprenorphine is a partial µ-receptor agonist resistant to displacement from receptors by conventional opioids, which can block the effect of conventional opioids and may interfere with postoperative pain management. We aimed to quantify perioperative opioid use in patients receiving transdermal buprenorphine (TdBUP). ⋯ Analgesic management for patients receiving TdBUP therapy must account for increased opioid needs, and greater preoperative doses of TdBUP were associated with greater postoperative opioid requirements.
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Reg Anesth Pain Med · Mar 2019
Perioperative impact of sleep apnea in a high-volume specialty practice with a strong focus on regional anesthesia: a database analysis.
Obstructive sleep apnea (OSA) is a risk factor for adverse postoperative outcome and perioperative professional societies recommend the use of regional anesthesia to minimize perioperative detriment. We studied the impact of OSA on postoperative complications in a high-volume orthopedic surgery practice, with a strong focus on regional anesthesia. ⋯ We showed that, even in a setting with almost universal regional anesthesia use, OSA was associated with increased odds for prolonged LOS, and pulmonary and gastrointestinal complications. This puts forward the question of how effective regional anesthesia is in mitigating postoperative complications in patients with OSA.
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Reg Anesth Pain Med · Mar 2019
Randomized controlled trial of a simplified adductor canal block performed for analgesia following total knee arthroplasty.
The objective of the study was to determine if injection of local anesthetic into the vastus medialis and sartorius muscles adjacent to the adductor canal produces sensory changes comparable with adductor canal block (ACB). This could result in a technically easier and potentially safer alternative to ACB. ⋯ The SAC block is technically easier to perform and potentially safer than ACB. This procedure can be performed using easily visible ultrasound landmarks and has the potential for use among a wide range of healthcare providers.
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Reg Anesth Pain Med · Mar 2019
Retrospective cohort study of healthcare utilization and opioid use following radiofrequency ablation for chronic axial spine pain in Ontario, Canada.
Radiofrequency ablation (RFA) is a common treatment modality for chronic axial spine pain. Controversy exists over its effectiveness, and outcomes in a real-world setting have not been evaluated despite increasing use of RFA. This study examined changes in healthcare utilization and opioid use after RFA in Ontario, Canada. ⋯ Healthcare utilization was significantly reduced in the 12 months following RFA, and some patients eliminated opioid use. Selection criteria for RFA are not standardized in Ontario, and appropriate use guidelines for spine interventions may improve outcomes and reduce unnecessary procedures.