Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2024
ReviewNeuraxial pathology and regional anesthesia: an education guide to decision-making.
In current clinical practice, spinal anesthesia and analgesia techniques-including epidural and subarachnoid procedures-are frequently executed without imaging like X-ray or epidurography. Unrecognized spinal pathology has resulted in serious morbidity in the context of performing neuraxial anesthesia. Typically, preoperative consultations incorporate a patient's medical history but lack a detailed spinal examination or consideration of recent MRI or CT scans. ⋯ Such collaborative settings rely on exhaustive clinical history and scrutinization of recent imaging studies, which may influence the decision to proceed with invasive spinal interventions. There are no epidemiological data concerning rates of the different baseline pathologies that would potentially pose morbidity risks from neuraxial procedures, but the most common among these is canal stenosis, which significantly affects almost 20% of people over 60 years of age. This paper aims to elucidate these critical findings and advocate for incorporating meticulous preoperative assessments for individuals slated for spinal anesthesia or analgesia procedures, thereby attempting to mitigate potential risks.
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Reg Anesth Pain Med · Nov 2024
Observational StudyImpact of psychosocial factors on the success of neuromodulation treatment for patients with persistent pain.
Significant interindividual variability in spinal cord stimulation (SCS) outcomes exists. Due to its high cost and risks of complications, criteria to guide patient selection for SCS trials and their outcomes would be helpful. With increased focus on the use of patient-reported outcomes to improve care, we aim to evaluate the National Institute of Health Patient Reported Outcome Measurement Information System measures for an association with successful SCS trials in patients with persistent pain. ⋯ We found that patients with high levels of depression, anxiety, and sleep disturbance using the PROMIS CAT were predictive of unsuccessful trials. In addition, we found that patients with successful SCS trials reported lower levels of these domains on PROMIS CAT administered at the end of the trial.
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Reg Anesth Pain Med · Nov 2024
Real-time ultrasound-guided mid-thoracic epidural access using a novel paramedian cross (PX) view and drip infusion technique: a brief technical report.
Real-time ultrasound guidance (USG) has been applied for lower thoracic epidural access, but the more challenging mid-thoracic epidural (MTE) access remains underexplored. This report presents a technique of real-time US guidance with a novel paramedian cross view, termed "the PX view," for securing MTE catheters, along with an outcome analysis from a retrospective case series. ⋯ The combination of the PX view and the drip infusion method proved effective for real-time ultrasound-guided MTE catheter placement.
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Different approaches to the obturator nerve have been described. However, few have focused on the injection point inferior the iliopubic ramus, specifically at the exit of the obturator canal. This study aims to anatomically evaluate the ultrasound-guided obturator nerve block at the exit of the obturator canal, detailing anatomical landmarks and solution distribution. ⋯ In conclusion, sagittal approaches using the iliopubic ramus as an anatomical reference achieve the most complete obturator nerve block. Our anatomical study details the structures of the obturator canal and access to the obturator nerve at its exit. Future studies are needed to confirm its safety and efficacy.