Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2013
Randomized Controlled Trial Comparative StudyThe effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers.
Adductor canal block (ACB) has been suggested as an analgesic alternative to femoral nerve block (FNB) for procedures on the knee, but its effect on quadriceps motor function is unclear. We performed a randomized, blinded study to compare quadriceps strength following adductor canal versus FNB in volunteers. Our hypothesis was that quadriceps strength would be preserved following ACB, but not FNB. Secondary outcomes included relative preservation of hip adduction and degree of balance impairment. ⋯ Compared with FNB, ACB results in significant quadriceps motor sparing and significantly preserved balance.
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Reg Anesth Pain Med · Jul 2013
Exercise training attenuates postoperative pain and expression of cytokines and N-methyl-D-aspartate receptor subunit 1 in rats.
Exercise creates a variety of psychophysical effects, including altered pain perception. We investigated whether physical exercise reduces postincisional pain and cytokine and N-methyl-D-aspartate receptor 1 (NR1) expression in a rat model of skin/muscle incision and retraction (SMIR)-evoked pain. ⋯ These results suggest that exercise training decreases persistent postsurgical pain caused by SMIR surgery. There appears to be a protective effect, probably relating to the decrease of NR1, TNF-α, and IL-6 expression in the spinal cord of SMIR rats, after exercise intervention.
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Reg Anesth Pain Med · May 2013
Development and evaluation of a score to predict difficult epidural placement during labor.
Difficult epidural placement (DEP) during labor may be distressing for the patient and may increase the risk of dural puncture. A score predicting DEP based on the combination of individual risk factors could identify high-risk patients. This study aimed to identify risk factors for DEP and build a prediction score. ⋯ This study confirms risk factors for DEP and proposes a score to predict DEP. The score identifies high-risk patients who may benefit from an intervention to decrease DEP. This hypothesis should be evaluated in an impact study.
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Reg Anesth Pain Med · May 2013
Cervical spine disease is a risk factor for persistent phrenic nerve paresis following interscalene nerve block.
The use of interscalene blocks (ISBs) for shoulder surgery improves postoperative pain control, reduces recovery room times, and reduces overall hospital stays. The most common and potentially disabling adverse effect associated with ISBs is phrenic nerve paresis. Fortunately, persistent phrenic nerve paresis (PPNP) is rare. ⋯ Patients with PPNP had a significantly higher incidence of cervical spine disease (85.7%) compared with the control group (30.9%), P < 0.01. Persistent phrenic nerve paresis remains a perplexing complication of ISB, and many questions remain unanswered. Our data identify an important risk factor that can aid in the risk stratification of patients undergoing ISB.