Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2016
Case ReportsLocal Anesthetic-Induced Myotoxicity After Continuous Adductor Canal Block.
Local anesthetic-induced myotoxicity occurs consistently in animal models, yet is reported rarely in humans. Herein, we describe 3 sentinel cases of local anesthetic myotoxicity after continuous adductor canal block (ACB). ⋯ Clinically apparent local anesthetic-induced myotoxicity has been documented rarely in humans undergoing non-ophthalmic surgery. We report 3 sentinel cases associated with continuous ACB.
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Reg Anesth Pain Med · Nov 2016
Case ReportsLabor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal.
Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. ⋯ This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis. We believe a similar mechanism may explain the pain that patients sometimes experience after administration of large epidural volumes.
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Reg Anesth Pain Med · Nov 2016
Randomized Controlled Trial Comparative StudySingle-Dose Adductor Canal Block With Local Infiltrative Analgesia Compared With Local Infiltrate Analgesia After Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial.
A single-dose adductor canal block can provide postoperative analgesia for patients undergoing total knee arthroplasty (TKA). The purpose of this study was to assess postoperative opioid consumption after ultrasound-guided single-injection bupivacaine compared with saline adductor canal block for patients undergoing TKA. ⋯ Adductor canal blockade with bupivacaine 0.25% with epinephrine 1:300,000 effectively reduces pain and opioid requirement in the postoperative period after TKA. Adductor canal blockade is an effective pain management adjunct for patients undergoing TKA.
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Reg Anesth Pain Med · Nov 2016
Meta AnalysisThe Analgesic Efficacy of Nonsteroidal Anti-inflammatory Agents (NSAIDs) in Patients Undergoing Cesarean Deliveries: A Meta-Analysis.
Postoperative pain after cesarean delivery, which accounts for approximately 1 in 3 live births in the United States, can be severe in many patients. Nonsteroidal anti-inflammatory agents (NSAIDs) are potent analgesics that are effective in the treatment of postoperative pain. In this meta-analysis, we assessed the analgesic efficacy of NSAIDs in postoperative cesarean delivery patients. ⋯ The perioperative use of NSAIDs in cesarean delivery patients will result in a significantly lower pain scores, less opioid consumption, and less drowsiness/sedation but no difference in nausea or vomiting compared to those who did not receive NSAIDs. Further research should address the optimal NSAID regimen and examine the effect of improved analgesia on patient-centered outcomes such as patient satisfaction and quality of breastfeeding.