Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2004
ReviewManagement of perioperative pain in patients chronically consuming opioids.
The prevalence of licit and illicit opioid use is growing, and a greater percentage of chronically opioid-consuming patients are presenting for surgery. These patients can be expected to experience increased postoperative pain, greater postoperative opioid consumption, and prolonged use of healthcare resources for managing their pain. ⋯ We present strategies for providing adequate analgesia to these patients that include the optimal use of opioids, adjuvant medications, and regional anesthetic techniques.
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In situ knowledge about the anatomic structures and the path of a needle percutaneously placed into the paravertebral space is an area that continues to be investigated. We describe an endoscopic technique that permits imaging of the contents and boundaries of the thoracic paravertebral space in cadavers. ⋯ The images help show the relationship of structures that are encountered during a paravertebral block. This new technique may be helpful in examining the spread of local anesthetic using dye or imaging the location of continuous catheters without having to dissect the insertion area.
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Reg Anesth Pain Med · Nov 2004
Case ReportsTraumatic syrinx after implantation of an intrathecal catheter.
This case report describes the diagnosis and subsequent management of a very unusual complication of intrathecal pump insertion, namely that of traumatic syrinx secondary to the presence of an intrathecal catheter within the substance of the spinal canal. ⋯ Insertion of an intrathecal catheter may be associated with spinal cord trauma in patients receiving general anesthesia. Serial neurologic examinations and MRI are helpful in guiding treatment.
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Reg Anesth Pain Med · Nov 2004
Clinical hypnosis modulates functional magnetic resonance imaging signal intensities and pain perception in a thermal stimulation paradigm.
This study was designed to describe regional changes in blood oxygenation level dependent signals in functional magnetic resonance images (fMRI) elicited by thermal pain in hypnotized subjects. These signals approximately identify the neural correlates of the applied stimulation to identify neuroanatomic structures involved in the putative effects of clinical hypnosis on pain perception. ⋯ Our observations indicate that clinical hypnosis may prevent nociceptive inputs from reaching the higher cortical structures responsible for pain perception. Whether the effects of hypnosis can be explained by increased activation of the left anterior cingulate cortex and the basal ganglia as part of a possible inhibitory pathway on pain perception remains speculative given the limitations of our study design.