Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jan 2012
ReviewBeyond opioid patient-controlled analgesia: a systematic review of analgesia after major spine surgery.
Postoperative pain control in patients undergoing spine surgery remains a challenge for the anesthesiologist. In addition to incisional pain, these patients experience pain arising from deeper tissues such as bones, ligaments, muscles, intervertebral disks, facet joints, and damaged nerve roots. ⋯ The problem is compounded by the fact that many of these patients are either opioid dependent or opioid tolerant, making them less responsive to the most commonly used therapy for postoperative pain (opioid-based intermittent or patient-controlled analgesia). The purpose of this review was to compare all published treatment options available that go beyond intravenous opiates and attempt to find the best possible treatment modality.
-
Reg Anesth Pain Med · Jan 2012
Impact of perioperative pain intensity, pain qualities, and opioid use on chronic pain after surgery: a prospective cohort study.
A better understanding of the pathogenesis of chronic postsurgical pain is needed in order to develop effective prevention and treatment interventions. The objective of this study was to evaluate the incidence and risk factors for chronic postsurgical pain in women undergoing gynecologic surgery. ⋯ Preoperative pain, state anxiety, pain quality descriptors, opioid consumption, and early postoperative pain may be important predictors of chronic postsurgical pain, which require further investigation.
-
Reg Anesth Pain Med · Jan 2012
Randomized Controlled TrialUltrasound-guided regional anesthesia performance in the early learning period: effect of simulation training.
Success in performing ultrasound-guided peripheral nerve blockade (PNB) demands sound knowledge of sonoanatomy, good scanning techniques, and proper hand-eye coordination. The objectives of our study were to evaluate whether simulator training aids success of novice operators in ultrasound-guided PNB and to determine what number of procedures is required to attain proficiency. ⋯ Simulation training improves success rate in ultrasound-guided performance of regional anesthesia.
-
Reg Anesth Pain Med · Jan 2012
Association of perioperative use of nonsteroidal anti-inflammatory drugs with postoperative myocardial infarction after total joint replacement.
Use of nonsteroidal anti-inflammatory drug (NSAIDs) analgesics is controversial because of cardiovascular risk, but perioperative use may be advantageous for total joint replacement. Thus, we performed this single-center observational cohort study to determine any association between NSAID use and postoperative myocardial infarction (POMI). ⋯ Brief perioperative use of NSAIDs was not associated with increased risk for myocardial infarction after total hip and knee replacement; it may provide benefit in length of stay.
-
Reg Anesth Pain Med · Jan 2012
Regional hemodynamic changes after an axillary brachial plexus block: a pulsed-wave Doppler ultrasound study.
Brachial plexus block (BPB) causes vasodilatation and an increase in blood flow to the ipsilateral upper limb. However, no reports have comprehensively evaluated the regional hemodynamic changes after a BPB. ⋯ Regional hemodynamic changes that occur after an axillary BPB include a change in the morphology of the PWD spectral waveform, arterial vasodilatation, an increase in blood flow velocity, and an increase in blood flow through the ipsilateral brachial artery.