Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2011
Review Case Reports Comparative StudyStroke, regional anesthesia in the sitting position, and hypotension: a review of 4169 ambulatory surgery patients.
Despite frequent incidence of hypotension, no cases of stroke were observed in this audit of 4,169 shoulder surgeries performed in the beach-chair position. Notably though, 97% of the cases were performed under brachial plexus block with intravenous sedation rather than a general or relaxant technique.
The authors estimate the upper limit incidence of stroke in the sitting position under regional anaesthesia as 1 in 1,429 (0.07%).
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Reg Anesth Pain Med · Sep 2011
Review Comparative StudyIs sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A systematic review.
Sciatic nerve block (SNB) is commonly performed in combination with femoral nerve block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). This systematic review examines the effects of adding SNB to FNB for TKA compared with FNB alone on acute pain and related outcomes. Four intermediate-quality randomized and 3 observational trials, including a total of 391 patients, were identified. ⋯ Only 2 trials specifically assessed posterior knee pain. We were unable to uncover any clinically important analgesic advantages for SNB beyond 24 hours postoperatively. At present, there is inconclusive evidence in the literature to define the effect of adding SNB to FNB on acute pain and related outcomes compared with FNB alone for TKA.
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Suprascapular nerve blockade (SSNB) is a simple and safe technique for providing relief from various types of shoulder pain, including rheumatologic disorders, cancer, and trauma pain, and postoperative pain due to shoulder arthroscopy. Posterior, superior, and anterior approaches may be used, the most common being the posterior. ⋯ The different techniques of SSNB and indications for SSNB will be discussed. The complications of SSNB and outcomes of SSNB on the management of acute and chronic shoulder pain will be reviewed.
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Reg Anesth Pain Med · Jul 2011
ReviewClinical trial methodology of pain treatment studies: selection and measurement of self-report primary outcomes for efficacy.
The past century has seen immense progress in the advancement of methodology to evaluate efficacy of treatment interventions for acute and chronic pain. Continuing challenges revolve around how to best select and measure primary efficacy outcomes for a given analgesic trial. ⋯ In the setting of emerging new pain treatment strategies, careful consideration must be given to match current or novel outcome measures to the specific goals of a proposed trial. Future research is needed to directly compare current methods with newer measurement approaches for the critical goal of maximizing validity, reliability, and utility of different outcome measures in clinical trials of pain treatment.
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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.