Regional anesthesia and pain medicine
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Topically applied single or multiagent analgesics compounded by specialty pharmacies are utilized by an unknown number of pain clinicians to unknown effect. To assess the use and perceived efficacy of these agents, an e-mail survey of members of the American Society of Regional Anesthesia and Pain Medicine was performed. Response rate was low, but identified use of compounded topical agents throughout the United States. ⋯ Use of 36 different agents of varying concentrations was reported. These clinicians perceived that 43% +/- 4% of treated patients responded favorably to the topical agents with an average of 47% +/- 3% pain relief and few side effects. Despite favorable reports of benefit, most clinicians perceived use of such compounded agents in their regions to generally be "little or none."
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Reg Anesth Pain Med · May 2002
Case ReportsPeriosteal infusion of bupivacaine/morphine post sternal fracture: a new analgesic technique.
Sternal fracture pain is severe and is difficult to alleviate due to the forces acting on the chest wall during respiration. We describe a continuous infusion regional analgesic technique for pain due to sternal fracture. ⋯ Continuous infusion of local anesthetic and opioid to a sternal fracture site using a periosteally positioned catheter led to successful analgesia and hence improved respiratory function. Clinicians should consider placing a periosteal catheter when pain associated with sternal fracture cannot be adequately controlled with conventional methods.
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Reg Anesth Pain Med · May 2002
Gabapentin produces dose-dependent antinociception in the orofacial formalin test in the rat.
High neuraxial drug infusion has been advocated for the treatment of intractable cranial and facial pain in humans. Currently, parallel animal models have not been characterized to support this methodology. We combined an accepted animal model of pain of cranial origin with a novel technique of cervico-medullary drug delivery to determine the antinociceptive potential of gabapentin. Gabapentin was chosen because of its reported efficacy in a wide array of complex cranial pain syndromes. ⋯ Gabapentin produced dose-dependent antinociception in the second phase of the orofacial formalin test in the rat after injection into the cervico-medullary cerebrospinal fluid. This animal model may be useful to assess analgesics designed for parallel clinical application in humans for the treatment of intractable head and neck pain that is refractory to conventional modalities.