Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2015
ReviewThe European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine Joint Committee Practice Advisory on Controversial Topics in Pediatric Regional Anesthesia.
Some topics in the clinical management of regional anesthesia in children remain controversial. To evaluate and come to a consensus regarding some of these 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 pediatric regional anesthesia (PRA). ⋯ High-level evidence is not yet available for the topics evaluated, and most recommendations are based on Evidence B studies. The ESRA/ASRA recommendations intend to provide guidance for the safe practice of regional anesthesia in children.
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Reg Anesth Pain Med · Sep 2015
ReviewRegional Anesthesia in Patients With Preexisting Neurologic Disease.
Since publication of initial recommendations in 2008, there is limited new information regarding the performance of regional anesthesia in patients with preexisting neurologic diseases. However, the strength of evidence has increased since 2008 regarding (1) the concern that diabetic nerves are more sensitive to local anesthetics and perhaps more susceptible to injury and (2) the concern that performing neuraxial anesthesia and analgesia in patients with preexisting spinal canal pathology may increase the risk of new or worsening neurologic symptoms. This increased evidence reinforces our initial recommendations. In addition, since the initial recommendations in 2008, the concept of postsurgical inflammatory neuropathy has been described and is potentially a contributor to postoperative neurologic dysfunction.
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Reg Anesth Pain Med · Sep 2015
Randomized Controlled TrialChronological Changes in Ropivacaine Concentration and Analgesic Effects Between Transversus Abdominis Plane Block and Rectus Sheath Block.
Transversus abdominis plane block (TAPB) and rectus sheath block (RSB) are popular methods of controlling postoperative pain. Chronological changes in blood concentrations of local anesthetics have not been described, although a large amount of local anesthetic is required to block these compartments. We postulated that blood concentrations of anesthetics would peak earlier during TAPB than RSB (primary end point). Secondary end points were elapsed time from block until first postoperative rescue analgesia and affected dermatomes. ⋯ Peak ropivacaine concentrations were comparable during TAPB and RSB, but peaked earlier during TAPB. Although 150 mg of ropivacaine remained effective significantly longer during TAPB than RSB during laparoscopic surgery, this dose could cause local anesthetic systemic toxicity. The analgesic effects of blocks with less ropivacaine should be assessed.
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Reg Anesth Pain Med · Sep 2015
Case ReportsA Novel Modified Retrocrural Approach for Celiac Plexus Block: The Single-Needle Retroaortic Technique.
For patients with pain from upper abdominal malignancies, celiac plexus neurolysis can provide an effective means of pain control. However, there are instances when traditionally described percutaneous approaches may not be technically feasible. ⋯ We present 4 cases of patients with pain from upper abdominal malignancies in whom we performed celiac plexus neurolysis using a novel single-needle retroaortic approach. All 4 patients had significant pain relief and no significant adverse effects from the retroaortic approach.
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Reg Anesth Pain Med · Sep 2015
Case ReportsRotational Thromboelastometry-Guided Hemostatic Therapy for Management of Cerebrospinal Fluid Catheter in Patients Undergoing Endovascular Aortic Repair.
Central neuraxial techniques are typically avoided in patients with underlying coagulopathy or abnormal coagulation tests. Vertebral canal hematoma is a rare but devastating complication of those procedures. Although the sensitivity and specificity of standard laboratory tests in predicting this event are rather poor or unknown, these tests are commonly used to allow or advise against the insertion of an epidural or spinal catheter. Furthermore, the role of viscoelastic point-of-care tests, which are widely used to monitor coagulation in the perioperative setting, is unexplored. ⋯ Thromboelastometry proved useful to guide hemostatic therapy before subarachnoid catheter placement and extraction in a patient with severe coagulopathy when standard coagulation tests were of less benefit.