Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2015
Review Meta AnalysisThe Effects of Perioperative Regional Anesthesia and Analgesia on Cancer Recurrence and Survival After Oncology Surgery: A Systematic Review and Meta-Analysis.
Potentially, perioperative regional anesthesia and analgesia (RA) could influence the outcomes of patients with cancer. The aim of this systematic review and meta-analysis was to evaluate the effects of perioperative RA on survival and cancer recurrence after oncologic surgery. ⋯ Our meta-analysis suggests that RA may improve overall survival but not reduce cancer recurrence after oncologic surgery.
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Reg Anesth Pain Med · Sep 2015
ReviewPathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade.
This review synthesizes anatomical, anesthetic, surgical, and patient factors that may contribute to neurologic complications associated with peripheral nerve blockade. Peripheral nerves have anatomical features unique to a given location that may influence risk of injury. Peripheral nerve blockade-related peripheral nerve injury (PNI) is most severe with intrafascicular injection. Surgery and its associated requirements such as positioning and tourniquet have specific risks. Patients with preexisting neuropathy may be at an increased risk of postoperative neurologic dysfunction. Distinguishing potential causes of PNI require clinical assessment and investigation; a definitive diagnosis, however, is not always possible. Fortunately, most postoperative neurologic dysfunction appears to resolve with time, and the incidence of serious long-term nerve injury directly attributable to peripheral nerve blockade is relatively uncommon. Nonetheless, despite the use of ultrasound guidance, the risk of block-related PNI remains unchanged. ⋯ Since the 2008 Practice Advisory, new information has been published, furthering our understanding of the microanatomy of peripheral nerves, mechanisms of peripheral nerve injection injury, toxicity of local anesthetics, the etiology of and monitoring methods, and technologies that may decrease the risk of nerve block-related peripheral nerve injury.
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Reg Anesth Pain Med · Sep 2015
ReviewNeurological Complications Associated With Elective Orthopedic Surgery: Part 2, Common Hip and Knee Procedures.
Many anesthesiologists may not be familiar with the rate of surgical neurological complications of the hip and knee procedures for which they are providing local anesthetic-based anesthesia and/or analgesia. Part 2 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common hip and knee procedures, including arthroscopic hip and knee surgery and total hip and knee replacement.
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Reg Anesth Pain Med · Sep 2015
ReviewNeurological Complications Related to Elective Orthopedic Surgery: Part 3: Common Foot and Ankle Procedures.
Part III of a review series on neurological complications of orthopedic surgery, this article describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common elective foot and ankle procedures for which anesthesiologists may administer regional anesthesia. Relevant information is broadly organized according to type of surgical procedure to facilitate reference by anesthesiologists and members of the anesthesia care team.
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Reg Anesth Pain Med · Sep 2015
ReviewAnatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine: 2015 Update.
In March 2012, the American Society of Regional Anesthesia and Pain Medicine convened its second Practice Advisory on Neurological Complications in Regional Anesthesia and Pain Medicine. This update is based on the proceedings of that conference and relevant information published since its conclusion. This article updates previously described information on the pathophysiology of spinal cord injury and adds new material on spinal stenosis, blood pressure control during neuraxial blockade, neuraxial injury subsequent to transforaminal procedures, cauda equina syndrome/local anesthetic neurotoxicity/arachnoiditis, and performing regional anesthetic or pain medicine procedures in patients concomitantly receiving general anesthesia or deep sedation. ⋯ Since publication of initial recommendations in 2008, new information has enhanced our understanding of 5 specific entities: spinal stenosis, blood pressure control during neuraxial anesthesia, neuraxial injury subsequent to transforaminal techniques, cauda equina syndrome/local anesthetic neurotoxicity/arachnoiditis, and performing regional anesthetic or pain procedures in patients concomitantly receiving general anesthesia or deep sedation.