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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Skeletal muscle toxicity is a rare and uncommon side effect of local anesthetic drugs. Intramuscular injections of these agents regularly result in reversible myonecrosis. The extent of muscle damage is dose dependent and worsens with serial or continuous administration. ⋯ In this respect, the quantitative impact of further mitochondria-mediated pathways--at least in bupivacaine toxicity--is still to be established. Although experimental myotoxic effects are impressively intense and reproducible, only a few case reports of myotoxic complications in patients after local anesthetic administrations have been published. In particular, the occurrence of clinically relevant myopathy and myonecrosis has been described after continuous peripheral blocks, infiltration of wound margins, trigger point injections, and peri- and retrobulbar blocks.
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Reg Anesth Pain Med · May 2004
Review Comparative StudyPostoperative cognitive function as an outcome of regional anesthesia and analgesia.
It has been suggested that intraoperative neuraxial (spinal, epidural) anesthesia may decrease postoperative cognitive dysfunction when compared with general anesthesia, but the issue remains controversial. We systematically reviewed the data from published studies to determine the effect of intraoperative neuraxial anesthesia versus general anesthesia on postoperative cognitive dysfunction and delirium. ⋯ The use of intraoperative neuraxial anesthesia does not appear to decrease the incidence of postoperative cognitive dysfunction when compared with general anesthesia. There are methodologic and study-design issues present in many studies, and further elucidation of the pathophysiology of postoperative cognitive dysfunction may provide a direction for future studies.