Pain physician
-
A survey on teaching ultrasound-guided chronic pain procedures in pain medicine fellowship programs.
Over the last decade ultrasound guidance (USG) has been utilized very successfully in acute pain procedures to confirm nerves' anatomic location and obtain live images. Not only the utilization, but the teaching, of USG has become an essential part of anesthesiology residency training. Prior to the introduction of USG, chronic pain procedures were always done either under fluoroscopy or blindly. USG offers advantages over fluoroscopy for completion of chronic pain procedures. USG decreases radiation exposure and the expenses associated with operating a fluoroscopy machine and allows live visualization of soft tissues and blood flow, a feature that fluoroscopy does not directly offer. Even today, the utilization and teaching of the technique for chronic pain procedures has not been as widely accepted as in acute pain management. ⋯ The teaching of ultrasound guided chronic pain procedures varies significantly between individual programs. Though many program directors do require that fellows demonstrate competency in the technique before graduation, as of today there is no ACGME guideline regarding this. The advancement in ultrasound technology and the increase in number of trained faculty may significantly impact the use of USG in training fellows to perform chronic pain procedures.
-
Randomized Controlled Trial Comparative Study
Comparative efficacy of levobupivacaine and ropivacaine for epidural block in outpatients with degenerative spinal disease.
Levobupivacaine has less toxic potential on both the cardiovascular and central nervous system and has been widely used for postoperative epidural analgesia in surgical patients. However, there are few reports on the efficacy of epidural levobupivacaine in outpatients with lumbosacral radiculopathy. This study was carried out to evaluate the comparative efficacy of levobupivacaine and ropivacaine for epidural block in outpatients with degenerative spinal disease and sciatica. ⋯ The results showed that 0.125% levobupivacaine and 0.2% ropivacaine for epidural block by a caudal approach provide similar lumbosacral pain relief, hemodynamic effects, and the degree and the recovery of motor blockade in outpatients with degenerative spinal disease and sciatica.
-
Observational Study
The role of pain catastrophizing in the provision of rescue analgesia by health care providers following major joint arthroplasty.
After surgery, patient reports or health care professional evaluations of heightened acute pain intensity should lead to extra analgesia provision, which is designated by rescue analgesia (RA). Whether RA is administered or not, it is not directly dependent on the patient but rather on clinical decisions, which should be based on pain management guidelines. There is a general lack of studies focusing on pain-related decision-making regarding RA provision. ⋯ The findings of this study shed light on the importance of psychological factors in determining RA provision following MJA. This encourages further reflection on acute post-surgical pain management by health care providers, namely by raising clinicians' awareness about the factors that influence patient-provider interactions, as well as their impact on decision-making regarding RA provision. A global assessment of patients, wherein psychological variables are taken into account, is warranted in order to improve the quality of surgical pain management. Finally, these findings provide support for the design of acute post-surgical pain management interventions directed at clinicians, in order to augment professionals' awareness about the potential influence of patient-related psychological factors on RA decisions.