Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2004
ReviewNeuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence.
Epidural, intrathecal, and sympathetic blocks are used for the treatment of pain caused by herpes zoster (HZ) and postherpetic neuralgia (PHN). This study was undertaken to evaluate and synthesize existing evidence for using these nerve blocks with various injectates (local anesthetic [LA] alone, LA + steroids) in treating pain of HZ, PHN (>6 months), and its prevention. ⋯ Evidence for the beneficial effect of epidural LA + steroid in HZ, and intrathecal LA + steroid in PHN appears to be consistent (grade A). If given within 2 months of HZ, epidural LA + steroid may reduce the incidence of PHN after 1 year (grade A). Evidence for use of sympathetic blocks in HZ and PHN, although generally useful (Grade B), requires RCTs for validation.
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Reg Anesth Pain Med · Sep 2004
Randomized Controlled Trial Comparative Study Clinical TrialRadiofrequency lumbar facet denervation: a comparative study of the reproducibility of lesion size after 2 current radiofrequency techniques.
Radiofrequency facet denervation procedures are widely used for the treatment of chronic low-back pain. Currently, both temperature-controlled and voltage-controlled techniques are used. In this combined in vivo and in vitro study, the electrophysiologic consequences and the effects on lesion size of these techniques were determined. ⋯ There is no consistent relation between voltage and the temperature obtained during radiofrequency lumbar facet denervation. Temperature-controlled radiofrequency lesioning is preferred to create reproducible lesion sizes.
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Reg Anesth Pain Med · Sep 2004
Randomized Controlled Trial Clinical TrialPeripheral opioid analgesia in laparoscopic cholecystectomy.
Recent research has revealed that opioids can act directly on the peripheral terminals of afferent nerves to mediate antinociception. The aim of this study was to assess the influence of peripheral morphine administration on the nociception process in the postoperative period. ⋯ Results of the study confirm the possibility of modifying the nociception process in the postoperative period through peripheral opioid administration.