Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Apr 2024
Review Meta AnalysisDoes industry funding and study location impact findings from randomized controlled trials of spinal cord stimulation? A systematic review and meta-analysis.
Concerns have been raised that effects observed in studies of spinal cord stimulation (SCS) funded by industry have not been replicated in non-industry-funded studies and that findings may differ based on geographical location where the study was conducted. ⋯ All outcomes of SCS versus usual care were not significantly different between studies funded by industry and those independent from industry. Pain intensity score and change in pain intensity from baseline for comparisons of HF-SCS to LF-SCS seem to be impacted by industry funding.
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Reg Anesth Pain Med · Apr 2024
Randomized Controlled Trial Multicenter StudyDurable multimodal and holistic response for physiologic closed-loop spinal cord stimulation supported by objective evidence from the EVOKE double-blind randomized controlled trial.
Chronic pain patients may experience impairments in multiple health-related domains. The design and interpretation of clinical trials of chronic pain interventions, however, remains primarily focused on treatment effects on pain intensity. This study investigates a novel, multidimensional holistic treatment response to evoked compound action potential-controlled closed-loop versus open-loop spinal cord stimulation as well as the degree of neural activation that produced that treatment response. ⋯ The results of this study suggest that closed-loop spinal cord stimulation can provide sustained clinically meaningful improvements in multiple domains and provide holistic improvement in the long-term for patients with chronic refractory pain.
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Reg Anesth Pain Med · Apr 2024
ReviewFascial plane approach to anesthetizing the radial, median, and ulnar nerves: an educational review.
Brachial plexus block provides effective anesthesia and analgesia for upper extremity surgery but requires injection of large anesthetic volumes near major vascular structures. Moreover, the extensive motor and sensory loss produced by plexus block often exceeds the neural distribution needed for corresponding surgical procedures. High-resolution ultrasound facilitates selective nerve blocks at nearly every level of the upper extremity. ⋯ Selective fascial plane injections can provide surgical anesthesia and postoperative analgesia in settings that might otherwise require much larger volumes of local anesthetic. These selective nerve blocks can match sensory loss with the anatomic pain distribution in each patient. Reliable techniques for selective nerve blocks of the upper extremity can expand the capabilities for ultrasound-guided regional anesthesia.
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Reg Anesth Pain Med · Apr 2024
Observational StudyCutaneous sensory block area of the ultrasound-guided subcostal transversus abdominis plane block: an observational study.
The transversus abdominis plane block (TAP) can be applied using different approaches, resulting in varying cutaneous analgesic distributions. This study aimed to assess the cutaneous sensory block area (CSBA) after ultrasound-guided TAP (US-TAP) using the subcostal approach. ⋯ The subcostal US-TAP results in a heterogeneous non-dermatomal CSBA with varying size and distribution across the medial abdominal wall.
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Reg Anesth Pain Med · Apr 2024
Transitioning from intrathecal bupivacaine to mepivacaine for same-day discharge total joint arthroplasty: a quality improvement study.
Same-day discharge total knee and hip arthroplasty is becoming more common. Anesthetic approaches that optimize readiness for discharge are important. Based on an institutional change from low-dose bupivacaine to mepivacaine, we aimed to assess the impact on postanesthesia care unit (PACU) recovery in a quaternary care, academic medical center. ⋯ Intrathecal mepivacaine was associated with increased perioperative OMME consumption and PACU pain scores, but still realized a decreased PACU length of stay.