Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2011
Comparative StudyUltrasound-guided versus anatomic landmark-guided ankle blocks: a 6-year retrospective review.
Ultrasound-guided (USG) ankle block has been described; however, its clinical efficacy compared with conventional anatomic landmark-guided (ALG) techniques remains undetermined. ⋯ This study demonstrates that the USG technique of ankle block improves clinical efficacy compared with a conventional ALG technique, particularly in the hands of less-experienced practitioners.
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Reg Anesth Pain Med · Nov 2011
Randomized Controlled TrialA translational study of the effects of ketamine and pregabalin on temporal summation of experimental pain.
Central sensitization is often seen in chronic pain. A relevant and potent mechanism of central sensitization is the central integration of nociceptive impulses. Temporal summation in humans and the wind-up process in animals share common features of central integration. This preclinical and clinical translational study investigated the effect of ketamine and pregabalin on temporal summation (TS) and wind-up of wide dynamic range (WDR) neurons of nociceptive electrical stimuli in healthy volunteers and rats. ⋯ It was shown that TS shares common features with wind-up of WDR neurons and that pregabalin does not affect this component of central sensitization.
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Reg Anesth Pain Med · Nov 2011
Randomized Controlled Trial Comparative StudyA randomized comparison between subepineural and conventional ultrasound-guided popliteal sciatic nerve block.
This prospective, randomized, observer-blinded trial compared a subepineural sciatic injection at the neural bifurcation (SUB group) and separate postbifurcation injections around the tibial and peroneal nerves. ⋯ Compared with separate injections around the tibial and peroneal divisions, a single subepineural injection at the neural bifurcation provides a higher success rate and requires shorter performance, onset, and total anesthesia-related times. Further studies are required to validate the safety of the subepineural technique.
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Reg Anesth Pain Med · Nov 2011
ReviewProspective trial registration for clinical research: what is it, what is it good for, and why do I care?
Optimizing evidence-based medicine--and therefore the care of our patients--requires a public record of both the benefits and the risks of various medical interventions. Unfortunately, available evidence is often skewed because some clinical trials are withheld from publication; only selected data are reported, and statistical techniques are often inappropriately determined following data analysis. Prospective clinical trial registration (PCTR) is the public documentation of trial protocols--today primarily on the Internet--before data analysis (and ideally before trial commencement). ⋯ Multiple organizations endorse (in some cases mandate) PCTR, including prominent committees of medical editors, the World Health Organization, the World Medical Association (responsible for the Helsinki Declaration), and, more recently, the US Food and Drug Administration. Although Regional Anesthesia and Pain Medicine does not currently require registration for published articles, PCTR in this and other anesthesiology and pain journals may become mandatory within the next few years. Potential authors/investigators will therefore benefit from becoming familiar with PCTR before mandatory registration implementation, and familiarity among readers may improve interpretation and understanding of clinical research results.
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Reg Anesth Pain Med · Nov 2011
Ultrasound imaging of the thoracic spine in paramedian sagittal oblique plane: the correlation between estimated and actual depth to the epidural space.
Ultrasound (US) imaging of the spine has been shown to be a reliable tool to facilitate lumbar epidural needle placement; however, its feasibility in thoracic epidural placement is still unknown. The objective of this study was to assess the accuracy and reliability of prepuncture US imaging in the paramedian sagittal oblique plane to estimate the depth to the epidural space and optimum insertion point for guiding epidural needle placement at the mid-low thoracic level. ⋯ We found a good correlation between the US-estimated distance to the epidural space and the actual measured needle distance in our patients. We suggest that our proposed prepuncture US method, using the paramedian sagittal oblique approach, can be a useful guide to facilitate the placement of epidural needles at mid-low thoracic levels. A randomized controlled trial is necessary to confirm the utility of prepuncture US in thoracic epidural placement.