Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2025
Transversus abdominis plane block combined with intrathecal fentanyl versus intrathecal morphine for post-cesarean analgesia: a randomized non-inferiority clinical trial.
Intrathecal morphine is the standard for post-cesarean analgesia but often causes pruritus and may be unavailable in resource-limited settings. This study assessed whether a combination of bilateral transversus abdominis plane (TAP) block and intrathecal fentanyl provides non-inferior analgesia compared with intrathecal morphine following cesarean delivery within the multimodal analgesia context. ⋯ Bilateral TAP block with intrathecal fentanyl is not non-inferior to intrathecal morphine for post-cesarean analgesia. However, intrathecal morphine was associated with a higher incidence of pruritus, suggesting TAP block with intrathecal fentanyl as a suitable alternative when reducing pruritus is a priority.
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Reg Anesth Pain Med · Jan 2025
Disappearance of spinal catheter tip due to catheter stretching: a case report.
Continuous spinal anesthesia (CSA) offers precise, prolonged neuraxial anesthesia suitable for high-risk patients. This technique minimizes hemodynamic instability but comes with notable challenges. Vigilant catheter management is crucial to avoid complications, including the risk of catheter retention. We report a case where the mechanical properties of a spinal catheter led to diagnostic uncertainty. ⋯ This case underscores the need for awareness of the mechanical properties of spinal catheters, especially their potential for stretching and loss of tip markings. Understanding these characteristics can prevent unnecessary imaging and reduce patient and clinician anxiety.
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Reg Anesth Pain Med · Jan 2025
Evaluating the utility of large language models in generating search strings for systematic reviews in anesthesiology: a comparative analysis of top-ranked journals.
This study evaluated the effectiveness of large language models (LLMs), specifically ChatGPT 4o and a custom-designed model, Meta-Analysis Librarian, in generating accurate search strings for systematic reviews (SRs) in the field of anesthesiology. ⋯ The findings of this study highlight the significant advantage of using original search strings over LLM-generated search strings in PubMed retrieval studies. The Meta-Analysis Librarian demonstrated notable superiority in retrieval performance compared with ChatGPT 4o. Further research is needed to assess the broader applicability of LLM-generated search strings, especially across multiple databases.
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Reg Anesth Pain Med · Jan 2025
Novel use of ultrasound-guided high-intensity focused ultrasound (HIFU) may enable the neuroablation of the sacroiliac joint in a swine model: a feasibility study.
Sacroiliac joint (SIJ) dysfunction accounts for the etiology of pain in 15%-30% of low back pain cases. Some patients with conservative treatment-refractory SIJ dysfunction undergo radiofrequency (RF) ablation of the SIJ for prolonged pain relief. This procedure involves placing up to 12 RF probes in what is an invasive, resource-intensive, and time-consuming process. High-intensity focused ultrasound is an alternative neuroablative technique that is non-invasive and potentially less cumbersome. MRI-guided high-intensity focused ultrasound (MRgHIFU) had previously been successfully applied to SIJ ablation in a swine model, and more recently had been trialed in humans. However, ultrasound-guided high-intensity focused ultrasound (USgHIFU) of the SIJ may be a more practical and rapid alternative to MRIgHIFU. ⋯ The preliminary study thus demonstrates that USgHIFU can create targeted contiguous strip lesions along the SIJ and lead to thermal necrosis of the posterior sacral network without causing additional neurological damage or damage to adjacent muscle tissue or bone outside of target areas.