Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Feb 2018
Review Practice GuidelineThe Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017.
The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. ⋯ Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.
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Reg Anesth Pain Med · Feb 2018
Review Practice GuidelineThe European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia.
Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. ⋯ High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.
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Reg Anesth Pain Med · Jan 2018
ReviewTransversus Abdominis Plane Catheters for Analgesia Following Abdominal Surgery in Adults.
Transversus abdominis plane (TAP) catheters are increasingly being used as an opioid-sparing analgesic technique following abdominal surgery. The aim of this systematic review is to evaluate the efficacy and safety of TAP catheters for postoperative analgesia following abdominal surgery in adults. ⋯ Because of the extremely heterogeneous nature of the studies, a specific consensus regarding their results, or the ability to construct a meta-analysis, is unviable. Although there are promising indications for the benefit of TAP catheter techniques, extrapolation/comparison of results and application to patient care will be better elucidated when there is more standardization of TAP catheter techniques and the methodology for measuring efficacy.
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Reg Anesth Pain Med · Jan 2018
ReviewTransversus Abdominis Plane Catheters for Analgesia Following Abdominal Surgery in Adults.
Transversus abdominis plane (TAP) catheters are increasingly being used as an opioid-sparing analgesic technique following abdominal surgery. The aim of this systematic review is to evaluate the efficacy and safety of TAP catheters for postoperative analgesia following abdominal surgery in adults. ⋯ Because of the extremely heterogeneous nature of the studies, a specific consensus regarding their results, or the ability to construct a meta-analysis, is unviable. Although there are promising indications for the benefit of TAP catheter techniques, extrapolation/comparison of results and application to patient care will be better elucidated when there is more standardization of TAP catheter techniques and the methodology for measuring efficacy.
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Reg Anesth Pain Med · Jan 2018
ReviewRadiofrequency Procedures to Relieve Chronic Hip Pain: An Evidence-Based Narrative Review.
Chronic hip pain from osteoarthritis and other degenerative conditions is a common problem. A few publications have recently reported analgesic success of radiofrequency (RF) procedures on nerves innervating the hip, but interpretation is hampered by lack of clarity regarding indications, clinical protocols, anatomic targets, and longevity of benefit from RF procedures. ⋯ Radiofrequency treatments for the sensory innervation of the hip joint have the potential to reduce pain secondary to degenerative conditions. Ongoing concerns remain regarding the anatomic targets, as well as quality, procedural aspects, and monitoring of outcomes in publications on this topic. Randomized controlled trials of high methodological quality are required to further elaborate the role of these interventions in this population.