Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2013
Biography Historical ArticleReconceptualizing John F. Kennedy's Chronic Low Back Pain.
When the medical records for John Fitzgerald Kennedy were made public, it became clear that the 35th President of the United States suffered greatly from a series of medical illnesses from the time he was a toddler until his assassination in November of 1963. Aside from having Addison disease, no condition seemed to cause him more distress than did his chronic low back pain. ⋯ Herein, the mechanisms underlying his pain are evaluated based on more contemporary pain research. This reconceptualizing of John Fitzgerald Kennedy's pain could serve as a model for other cases where the main cause of the pain is presumed to be located in the periphery.
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Reg Anesth Pain Med · Sep 2013
Randomized Controlled TrialEffect of Chronic β-Blockade on the Utility of an Epinephrine-Containing Test Dose to Detect Intravascular Injection in Nonsedated Patients.
A test dose containing epinephrine is routinely used during epidural blockade to detect accidental intravenous needle or catheter placement before the administration of local anesthetics to avert local anesthetic systemic toxicity. β-Blocker therapy may interfere with the expected hemodynamic response from an intravascular injection. This study describes a cohort of 24 patients and their response to an epinephrine test dose (ie, if expected increased heart rates during test-dose administration are valid in this population.) ⋯ Epinephrine test-dose administration in nonsedated, chronically β-blocked patients cannot distinguish intravenous injection at the classic threshold increase of 20 bpm. The response in individuals is varied, and thresholds for a positive test need revising for this population of patients on therapeutic β-blockers.
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Reg Anesth Pain Med · Sep 2013
Investigation of current infection-control practices for ultrasound coupling gel: a survey, microbiological analysis, and examination of practice patterns.
Ultrasound coupling gel may serve as a vector for the spread of bacteria and has been the causative agent for significant health care-associated infections. The purpose of this study was to document existing infection-control procedures and level of contamination present within nonsterile ultrasound gel from several clinical departments at a single institution. A second purpose was to examine the effectiveness of clinician education and manufacturer-based ultrasound additives on ultrasound gel contamination and in vitro bacterial proliferation, respectively. ⋯ The source of contamination for in-use ultrasound gel may be of manufacturer or human origin. Because additives to the ultrasound gel are not bactericidal, sterile ultrasound gel should be used for invasive and high-risk cases, and improving infection-control policies is warranted.
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Reg Anesth Pain Med · Sep 2013
Sonoanatomy Relevant for Lumbar Plexus Block in Volunteers Correlated With Cross-sectional Anatomic and Magnetic Resonance Images.
Ultrasound imaging of the anatomy relevant for lumbar plexus block (LPB) is challenging because of its deep anatomic location and the "acoustic shadow" of the overlying transverse processes. A paramedian transverse scan (PMTS) of the lumbar paravertebral region with the ultrasound beam being insonated through the intertransverse space (ITS) and directed medially toward the intervertebral foramen (PMTS-ITS) may overcome the problem of the "acoustic shadow" and allow clear visualization of the anatomy relevant for LPB. This study assessed the feasibility of using PMTS-ITS for imaging the anatomy relevant for LPB in healthy volunteers. ⋯ A PMTS-ITS can be used to image the sonoanatomy relevant for LPB including the lumbar nerve root, lumbar paravertebral space, lumbar plexus, and the psoas compartment.