Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · May 2005
ReviewTwo-pore domain potassium channels: new sites of local anesthetic action and toxicity.
Potassium (K+) channels form the largest family of ion channels with more than 70 such genes identified in the human genome. They are organized in 3 superfamilies according to their predicted membrane topology: (1) subunits with 6 membrane-spanning segments and 1-pore domain, (2) subunits with 2 membrane-spanning segments and 1-pore domain, and (3) subunits with 4 membrane-spanning segments and 2-pore domains arrayed in a tandem position. The last family has most recently been identified and comprises the so-called 2-pore domain potassium (K2P) channels, believed responsible for background or leak K+ currents. ⋯ K2P channels are widely expressed in the central nervous system and are involved in the control of the resting membrane potential and the firing pattern of excitable cells. This article will therefore review recent findings on actions of local anesthetics with respect to 2P channels. It begins with an overview of the role of background K+ channels in neuronal excitability and nerve conduction and is followed by a description of the K2P channel family including experimental evidence for the contribution of K2P channels to the mechanism of action and toxicity of local anesthetics.
-
Reg Anesth Pain Med · Mar 2005
ReviewLumbar discography: a comprehensive review of outcome studies, diagnostic accuracy, and principles.
Since its advent more than 50 years ago, the use of discography has been mired in controversy. The purpose of this review is to provide a clinical overview of lumbar discography and discogenic back pain, with special emphasis on determining the accuracy of discography and whether or not the procedure improves outcomes for surgery. ⋯ Although discography, especially combined with CT scanning, may be more accurate than other radiologic studies in detecting degenerative disc disease, its ability to improve surgical outcomes has yet to be proven. In the United States and Europe, there are inconsistencies in the use of lumbar discography such that it is routinely used before IDET, yet only occasionally used before spinal fusion.
-
Reg Anesth Pain Med · Mar 2005
Review Historical ArticlePosterior lumbar plexus block: anatomy, approaches, and techniques.
Lumbar plexus is an effective but underused regional technique that was described nearly 3 decades ago. The original description has been modified several times based on advances in technology, localization, and imaging techniques. This review provides an overview of the history, anatomy, and techniques described to perform this block.
-
Reg Anesth Pain Med · Mar 2005
Review Case ReportsDealing with difficult patients in your pain practice.
Pain patients can be difficult. They can provoke negative feelings of frustration and anger among clinicians and damage the doctor-patient relationship. ⋯ Issues of comorbid psychopathology, hostility, suicidality, aberrant drug behavior, and chronic noncompliance are discussed. Specific recommendations are also given of the best ways to manage patients with difficult behavior.