Articles: nerve-block.
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To review the current recommendations and literature on training in regional anesthesia and suggest an improved model to prepare graduating residents better in the practice of regional anesthesia. ⋯ A structured regional anesthesia rotation, a dedicated team of mentors with training in regional anesthesia, and adequate clinical volume are a pre-requisite for adequate training, but they may not be available in many anesthesia residency training programs. As the demand for regional anesthesia continues to increase in the years to come, it is imperative to ensure adequate education of graduating residents to meet this demand. In order to achieve this goal, the present recommendations should be re-evaluated, and perhaps a proficiency in a core group of widely applicable and relatively simple nerve blocks should be mastered by all graduates.
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Many treatment options are available for the management of cancer pain including drugs, local excision, radiation, brachytherapy, and nerve blocks. Percutaneous radiofrequency ablation has been used to treat painful neurologic and bone lesions and thus could potentially be used to treat cancer pain in other sites. Two superficial subcutaneous metastatic nodules were treated with percutaneous radiofrequency ablation. The patient received significant pain relief and improved quality of life.
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Diagnostic blocks are used to obtain information about the source of a patient's pain. As such they differ in principle and in practice from regional anaesthetic blocks. In order to be valid, diagnostic blocks must be precise and target-specific. ⋯ This warns that sympathetic blocks must be controlled in each and every case lest false conclusions be drawn about the response. Medial branch blocks of the lumbar and of the cervical dorsal rami have been extensively investigated in order to establish their validity, diagnostic utility and therapeutic utility. They provide an example and benchmark for how diagnostic blocks can and should be validated.
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Anesthesia and analgesia · Dec 2002
Case ReportsContinuous sacral nerve root block in the management of neuropathic cancer pain.
Neuropathic cancer pain caused by tumor infiltration in the sacral plexus is primarily treated by nonsteroidal antiinflammatory drugs, antidepressants, anticonvulsants, and opioids. In one patient with severe pain despite pharmacotherapy, a catheter for the continuous administration of local anesthetics was inserted along the first sacral root, resulting in markedly improved analgesia.
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Selective nerve root blocks are an effective way of diagnosing and treating radicular pain in many patients. Although traditionally performed under fluoroscopic guidance, computed tomography (CT) and CT fluoroscopy have been increasingly used to direct needle placement. This article discusses the indications and technique of selective nerve root blocks in the cervical, thoracic, and lumbar spine, as well as the evidence supporting their use in the treatment of patients with radiculopathy and/or back pain.