Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2013
Observational StudyValidation of the English Language Pain Sensitivity Questionnaire.
The Pain Sensitivity Questionnaire (PSQ) is predictive of pain-related responses to experimental stimuli in German-speaking individuals. Here, we explored the validation of the English translation of the PSQ (PSQ-E). ⋯ The study demonstrated that a significant correlation exists between the PSQ-E and clinically relevant pain ratings. This study validates the PSQ-E both in terms of measuring pain sensitivity and as possible means of recognizing patients with high pain sensitivity. Defining this subset of patients may have clinical utility in the future.
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Reg Anesth Pain Med · Nov 2013
Comparative StudyComparison of Anatomic Landmarks and Ultrasound Guidance for Intercostal Nerve Injections in Cadavers.
Intercostal nerve (ICN) injections are routinely performed under anatomic landmark or fluoroscopic guidance for acute and chronic pain indications. Ultrasound (US) is being used increasingly to perform ICN injections, but there is lack of evidence to support categorically the benefits of US over conventional techniques. We compared guidance with US versus anatomic landmarks for accuracy and safety of ICN injections in cadavers in a 2-phase study that included evaluation of deposition of injected dye by dissection and spread of contrast on fluoroscopy. ⋯ Ultrasound confers higher accuracy and allows use of lower volumes of injectate compared with anatomic landmarks as a guidance method for ICN injections in cadavers. Ultrasound may be a viable alternative to anatomic landmarks as a guidance method for ICN injections.
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Reg Anesth Pain Med · Nov 2013
Case ReportsAberrant Intrathecal Pump Refill: Ultrasound-guided Aspiration of a Substantial Quantity of Subcutaneous Hydromorphone.
Intrathecal drug delivery systems are an effective and increasingly common pain treatment modality for certain patient populations. Pumps are surgically inserted in a subcutaneous abdominal pocket and refilled with highly concentrated medication at regular intervals. ⋯ We describe the injection of hydromorphone into the pump's surrounding subcutaneous pocket, subsequent opioid overdose, and the novel application of ultrasound to visualize and aspirate the subcutaneous drug. Ultrasonography can be used as an effective modality for rapid diagnosis and treatment of an accidental pocket fill.
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The sensory innervation of the clavicle remains controversial. The supraclavicular, subclavian, and long thoracic/suprascapular nerves, alone or together, may be responsible for pain transmission after clavicular fracture and surgery. Peripheral nerve blocks used to anesthetize the clavicle include superficial cervical plexus blocks, interscalene blocks, and combined superficial cervical plexus-interscalene blocks. Future (randomized) trials are required to determine which constitutes the best option for emergency department (fracture) and operating room (surgical fixation) settings.
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Reg Anesth Pain Med · Nov 2013
Comparative StudyA Self-Paired Comparison of Perioperative Outcomes Before and After Implementation of a Clinical Pathway in Patients Undergoing Total Knee Arthroplasty.
Clinical pathways commonly modify multiple variables and deviate from long-established clinical practices. Therefore, it is difficult to perform prospective, randomized clinical trials comparing "standard care" to the "new clinical pathway." The goal of this investigation was to examine the impact of clinical pathways implementation on perioperative outcomes and institutional costs in patients undergoing total knee arthroplasty (TKA). ⋯ Our findings demonstrated that the use of a standardized clinical pathway reduced hospital LOS, improved clinical outcomes and patient satisfaction while reducing costs for identical surgical procedures.