Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2003
Near-total esophagectomy: the influence of standardized multimodal management and intraoperative fluid restriction.
Esophagectomy can be associated with high morbidity and mortality. We present our experience managing these patients using a standardized multimodal approach that emphasizes intraoperative fluid restriction and early extubation. ⋯ Significant reduction in esophagectomy-related morbidity is possible using a standardized multimodal approach in routine clinical practice. Intraoperative fluid restriction may facilitate early extubation and reduce pulmonary complications without compromising renal function. This preliminary observation warrants further study in a randomized clinical trial.
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Postoperative pain is the expected but nonetheless undesirable byproduct of all surgical procedures. Humanitarian concerns and recent quasi-governmental regulations have heightened awareness about the importance of treating postoperative pain. This guideline builds upon the foundation created by the Agency for Health Care Policy and Research guideline published in 1993, highlights changes that have occurred over the past 10 years, and makes recommendations based on the current scientific evidence. In addition, it takes advantage of the versatile information management inherent in a web-based format to make the information readily available. ⋯ This postoperative pain guideline provides readily accessible information and evidence-based guidance to a variety of providers. It highlights deficiencies in our understanding of the pain and recovery processes and how they might guide our choices of postoperative analgesic techniques. In combination with the powerful system-wide data collection capabilities of the VHA, there may be improved understanding of what techniques are useful. Finally, it may lead to the development of reliable, individualized analgesic plans for specific surgical procedures that incorporate the full range of pharmacologic and nonpharmacologic techniques.
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Reg Anesth Pain Med · Jul 2003
Case ReportsApplying ultrasound imaging to interscalene brachial plexus block.
Previous studies have examined ultrasound-assisted brachial plexus blocks, but few have applied this imaging technology to the interscalene region. We report a case of interscalene brachial plexus block using ultrasound guidance to show the clinical usefulness of this technology. ⋯ Advanced ultrasound technology is useful for nerve localization and can generate brachial plexus images of high resolution in the interscalene groove, guide block needle placement and advancement in real time to targeted nerves, and assess adequacy of local anesthetic spread at the time of injection. Ultrasound imaging guidance can potentially improve success during interscalene brachial plexus block.
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Reg Anesth Pain Med · Jul 2003
Clinical TrialPostherpetic neuralgia: a descriptive analysis of patients seen in pain clinics.
Postherpetic neuralgia (PHN) is a common ailment that pain specialists must often cope with. The goal of the present survey is to investigate the pain characteristics of 119 PHN patients with persistent pain seen at different pain clinics. Methods information on demographic features, pain characteristics (MPQ-SV, VAS, VRS), and treatment was recorded by means of a standard case report form. ⋯ This study reveals a subset of patients, mostly suffering from long-term PHN, where pain persists. The most frequent qualitative traits of PHN patients are described. Some variables were involved in modulation of pain characteristics in these patients. The effect of study design in interpretation of results is discussed.
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Reg Anesth Pain Med · Jul 2003
Case ReportsUltrasound guidance for ulnar nerve block in the forearm.
The objective of this study was to establish the feasibility of ulnar nerve block under direct imaging. ⋯ Ultrasound guidance for ulnar nerve block in the forearm is a promising technique that includes block of the dorsal cutaneous branch. Anatomic and sonographic considerations are discussed.