Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2014
ReviewLearning and Teaching Motor Skills in Regional Anesthesia: A Different Perspective.
Existing literature on learning in regional anesthesia broadly covers the rate of skill acquisition and the structure of educational programs. A complementary body of literature spanning psychology to medical education can be found describing skill acquisition in other fields. ⋯ This review introduces a selection of these complementary educational concepts, applying them to ultrasound-guided regional anesthesia skills education. Key educational concepts presented in this article can be divided into 3 sections, namely, how residents acquire manual skills, how tutors teach, and type of feedback.
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Reg Anesth Pain Med · May 2014
Comparative StudyA Comparison of the Effects of Epidural Analgesia Versus Traditional Pain Management on Outcomes After Gastric Cancer Resection: A Population-Based Study.
This retrospective audit could find no difference in either cancer recurrence or median survival between patients receiving an epidural versus those who did not for analgesic management of total or partial gastrectomy.
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Reg Anesth Pain Med · May 2014
Review Case ReportsIntravenous Corticosteroid Therapy for Bilateral Parsonage-Turner Syndrome: A Case Report and Review of the Literature.
Parsonage-Turner syndrome (PTS) is a distinct clinical disorder characterized by pain, sensory loss, and impaired mobility of the upper extremities and, less commonly, the lower extremities. Manifestations vary from minor to fairly extensive involvement of the brachial and/or lumbosacral plexus. No evidence-based treatment protocol exists, with only anecdotal support of varied palliative efforts. ⋯ This case supports the use of intravenous corticosteroids in the literature as a treatment option for PTS to ameliorate intractable pain as well as to impede the progression of motor dysfunction.
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Reg Anesth Pain Med · May 2014
Comparative StudyClinical Effectiveness of Percutaneous Adhesiolysis Versus Transforaminal Epidural Steroid Injection in Patients With Postlumbar Surgery Syndrome.
A number of patients with postlumbar surgery syndrome (PLSS) do not experience satisfactory results after epidural injection. A main reason for failure is surgically induced perineural fibrosis impeding injected material from spreading effectively into the target area. Percutaneous adhesiolysis (PA) has the ability to eliminate the deleterious effects of such adhesions. This study was to evaluate the effectiveness of PA versus transforaminal epidural steroid injection (TFESI) for treating patients with PLSS and to compare the clinical efficacy of PA according to the type of surgery. ⋯ Percutaneous adhesiolysis was more effective than TFESI in treating patients with PLSS and also showed better clinical efficacy in the decompression subgroup than in the fusion subgroup.
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Reg Anesth Pain Med · May 2014
Case ReportsConvulsions in 2 Patients After Bilateral Ultrasound-Guided Transversus Abdominis Plane Blocks for Cesarean Analgesia.
Transversus abdominis plane (TAP) block is commonly used for postcesarean section analgesia and compares favorably with other systemic and regional analgesia techniques. No major complications of ultrasound-guided TAP block have previously been reported in this indication. We report 2 cases of systemic local anesthetic toxicity in this context leading to seizures and treated with lipid emulsion. ⋯ These cases cast a cautionary note for the use of TAP blocks after cesarean delivery. The risk of systemic local anesthetic toxicity after this procedure remains unknown in this population and plasma concentration of local anesthetics should be measured in case of suspected toxicity. To limit this risk, a low concentration of local anesthetic solution should be chosen when a "20 mL bilaterally" regimen is necessary to achieve the required spread for a successful block.