Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2015
Evaluation of the skin to epidural and subarachnoid space distance in young children using magnetic resonance imaging.
Epidural catheters placed for perioperative analgesia in young children confer clinical benefits but are technically challenging to insert. Approximations of the skin to epidural space depth in this population are limited to direct needle measurement and ultrasonography. Magnetic resonance imaging (MRI) is the most comprehensive imaging modality of the spine. This study aims to produce a more clinically useful formula from MRI data to estimate pediatric epidural depth. ⋯ We provide the first predictive formulae, based on MRI data, for pediatric epidural depth estimation.
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Reg Anesth Pain Med · May 2015
Aberrant analgesic response to medial branch blocks in patients with characteristics of fibromyalgia.
Facet interventions for spine pain have high failure rates, and preprocedural prediction of response is nearly impossible. A potential explanation may be aberrant central pain processing as that existing in conditions like fibromyalgia. To test this hypothesis, we conducted a retrospective study investigating the impact of having characteristics of fibromyalgia on the acute analgesic response to a first diagnostic medial branch block (MBB). ⋯ Characteristics of fibromyalgia may indicate pain that is more centralized in nature, a factor that may explain the aberrant analgesic response to this peripheral intervention. This may have implications for future prediction of treatment response, although prospective studies are needed.
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Reg Anesth Pain Med · May 2015
The association between incentive spirometry performance and pain in postoperative thoracic epidural analgesia.
Effective use of postoperative incentive spirometry improves patient outcomes but is limited by pain after thoracic and upper abdominal surgery. Thoracic epidurals are frequently used to provide analgesia and attenuate postoperative pulmonary dysfunction. We hypothesized that, in patients with thoracic epidurals for thoracic and abdominal surgery, high pain scores would be associated with poorer incentive spirometry performance, even when accounting for other variables. ⋯ The present study suggests that pain with deep breathing is more indicative of thoracic epidural efficacy than is pain at rest. Furthermore, incentive spirometry performance could be used as another indicator of thoracic epidural efficacy. This may be particularly useful in patients reporting high pain scores postoperatively.
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Reg Anesth Pain Med · May 2015
The training and careers of regional anesthesiology and acute pain medicine fellows, 2013.
Fellowships in regional anesthesiology and acute pain medicine (RAAPM) have grown exponentially during the past decade, both in terms of total programs and fellows trained. This survey-based study reports fellowship graduates' assessment of the strengths and weaknesses of their training and how the fellowship has affected their careers. ⋯ The results of this study should prove useful to fellowship directors as they refine the educational offerings of their programs.