Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2009
ReviewUltrasound-guided regional anesthesia and analgesia: a qualitative systematic review.
Ultrasound guidance has become popular for performance of regional anesthesia and analgesia. This systematic review summarizes existing evidence for superior risk to benefit profiles for ultrasound versus other techniques. Medline was systematically searched for randomized controlled trials (RCTs) comparing ultrasound to another technique, and for large (n > 100) prospective case series describing experience with ultrasound-guided blocks. ⋯ Current evidence does not suggest that use of ultrasound improves success of regional anesthesia versus most other techniques. However, ultrasound was not inferior for efficacy, did not increase risk, and offers other potential patient-oriented benefits. All RCTs are rather small, thus completion of large RCTs and case series are encouraged to confirm findings.
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Reg Anesth Pain Med · Nov 2008
ReviewNeedle visualization in ultrasound-guided regional anesthesia: challenges and solutions.
Needle visualization is important for safe and successful ultrasound-guided peripheral nerve block. However, accurate and consistent visualization of the needle tip can be difficult to achieve. This review article describes many of the challenges affecting needle visualization, summarizes the relevant literature on ultrasound imaging of needles, and offers practical strategies for improving needle tip visibility. Finally, future directions for research and development are suggested.
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Reg Anesth Pain Med · Sep 2008
Review Meta AnalysisPregabalin as a treatment for painful diabetic peripheral neuropathy: a meta-analysis.
Painful diabetic peripheral neuropathy (DPN) is an increasingly prevalent disorder that is best managed through a multimodal approach. We examined the effects of pregabalin on pain control, sleep disturbance, and the patient's global impression of change (PGIC) for the treatment of this disorder. ⋯ Pregabalin has significant effects on the pain associated with DPN as well as secondary endpoints that affect patients' quality of life.
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Reg Anesth Pain Med · Sep 2008
ReviewPathophysiology of peripheral nerve injury during regional anesthesia.
Despite attention to technical details in performance of regional anesthetics, damage to nerves continues to be a concern. Understanding of pathophysiological mechanisms may aid in decreasing the incidence and severity of such injuries. ⋯ The relative importance of these pathogenic factors in cases of nerve injury after regional anesthesia is not resolved.
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Reg Anesth Pain Med · Sep 2008
Review Practice GuidelineRegional anesthesia in anesthetized or heavily sedated patients.
The American Society of Regional Anesthesia and Pain Medicine (ASRA) Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine includes an evidence- and expert opinion-based section on performing procedures on anesthetized or heavily sedated patients. This practice advisory is based on existing scientific literature, pathophysiological principles, and expert opinion. ⋯ The advisory panel also considered whether or not the ability to recognize and report symptoms could actually affect the occurrence of nerve injury or local anesthetic systemic toxicity. The advisory contains recommendations pertaining to both adult and pediatric patients.