Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2017
ReviewChronic Poststernotomy Pain: Incidence, Risk Factors, Treatment, Prevention, and the Anesthesiologist's Role.
Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. ⋯ Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery.
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Reg Anesth Pain Med · Nov 2017
Clinical TrialDetermination of ED50 and ED95 of 0.5% Ropivacaine in Adductor Canal Block to Produce Quadriceps Weakness: A Dose-Finding Study.
Adductor canal block (ACB) is popular for knee analgesia because of its favorable effect on quadriceps strength. The aim of this study was to find the minimum volume of local anesthetic, which can be injected into the ACB that would result in quadriceps weakness. ⋯ This study was registered at ClinicalTrials.gov, identifier NCT02541552.
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Reg Anesth Pain Med · Nov 2017
Historical ArticleProcaine and Local Anesthetic Toxicity: A Collaboration Between the Clinical and Basic Sciences.
In 1924, the Therapeutic Research Committee of the American Medical Association appointed a special committee to investigate deaths following the administration of local anesthetics. The Committee for the Study of Toxic Effects of Local Anesthetics found procaine, although a safer clinical alternative to cocaine, was capable of causing death when large doses were injected into tissues and advised that it should be used with caution. ⋯ Isenberger then traveled to the Mayo Clinic to conduct research on various procaine local and spinal anesthesia doses and sodium amytal's protective effect against procaine-induced toxicity. Lundy and Isenberger's work would add to the ongoing discovery of systemic reactions to local anesthetics.
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Reg Anesth Pain Med · Nov 2017
Electron Microscopy of Dural and Arachnoid Disruptions After Subarachnoid Block.
It has been customary to attribute postdural puncture headache (PDPH) incidence and severity to size and nature of the dural hole produced during major neuraxial blockade or diagnostic dural puncture. Needle orientation in relation to the direction of dural fibers was thought to be of importance because of the propensity for horizontal bevel placement to cause cutting rather than splitting of the dural fibers. ⋯ Accepted theories of the etiology of PDPH need to be revised. This article marks the first time that arachnoid layer damage has been quantified. Dural fibers tend to have sufficient "memory" to close back the hole created by a spinal needle, whereas arachnoid has diminished capacity to do so. The pathogenesis of PDPH and its resolution algorithm are a far more complex process that involves many more "stages" of development than hitherto imagined.
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Reg Anesth Pain Med · Nov 2017
Bleeding and Neurologic Complications in 58,000 Interventional Pain Procedures.
Interventional pain procedures are commonly performed on patients receiving antiplatelet therapy. However, there is limited evidence to support or refute the safety of this practice. The goal of this investigation was to assess the rate of bleeding complications in a large cohort of patients undergoing intermediate- and low-risk pain procedures, with a specific focus on antiplatelet and anticoagulant medication use and baseline coagulation abnormalities. ⋯ Bleeding complications are rare in patients undergoing low- or intermediate-risk pain procedures even in the presence of antiplatelet medications. This is consistent with recently released guidelines.