Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2011
Randomized Controlled Trial Comparative StudyS-ketamine modulates hyperalgesia in patients with chronic pancreatitis pain.
Upper abdominal pain is a dominant feature of chronic pancreatitis. A key phenomenon in this context is hyperalgesia, typically associated with N-methyl-d-aspartate receptor activation. This exploratory study evaluates acute effects of S-ketamine, a noncompetitive N-methyl-d-aspartate antagonist, in modulating generalized hyperalgesia in chronic pancreatitis pain. ⋯ S-ketamine infusion is more effective than placebo in increasing PPTs in chronic pancreatitis pain patients immediately after infusion. This effect did not outlast the infusion. Further research is warranted into S-ketamine use for reducing generalized hyperalgesia and chronic pancreatitis pain.
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Reg Anesth Pain Med · May 2011
ReviewNeedle to nerve proximity: what do the animal studies tell us?
Recent animal studies have provided insight and understanding, as well as promising clinical tools, to help identify needle-to-nerve contact and potentially hazardous intraneural injection. This narrative review describes and summarizes the contemporary animal studies primarily relating to indicators of needle-to-nerve contact and intraneural injection. Resultant nerve injury, whenever sought, is discussed.
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Reg Anesth Pain Med · May 2011
Comparative StudyHand motion analysis using the imperial college surgical assessment device: validation of a novel and objective performance measure in ultrasound-guided peripheral nerve blockade.
The Imperial College Surgical Assessment Device (ICSAD) has been validated in various settings as an objective tool to measure technical performance. We sought to establish (1) the construct validity of the ICSAD as an assessment tool in ultrasound-guided supraclavicular block by determining its ability to discriminate between operators of different experience level and (2) the concurrent validity of the ICSAD by correlating it with a task-specific checklist and a global rating scale. ⋯ The ICSAD is both valid and useful in assessing performance of ultrasound-guided supraclavicular block.
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Reg Anesth Pain Med · May 2011
Comparative StudyTransient heat hyperalgesia during resolution of ropivacaine sciatic nerve block in the rat.
Preliminary studies using perineural sciatic ropivacaine in rat demonstrated unexpected heat hyperalgesia after block resolution. To better characterize the time course relative to mechanical anesthesia-analgesia, we tested the hypothesis that ropivacaine 0.5% leads to transient heat hyperalgesia in rats independent of mechanical nociception. We also evaluated functional toxicity (eg, long-term hyperalgesia and/or tactile allodynia 2 weeks after injection). ⋯ Ropivacaine 0.5% induces transient heat hyperalgesia in the setting of resolved mechanical analgesia, further suggestive of modality and/or nociceptive fiber specificity. Whether this finding partially translates to "rebound pain" after patients' nerve blocks wear off requires further study.