Articles: nerve-block.
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Randomized Controlled Trial Multicenter Study
Ambulatory continuous peripheral nerve blocks to treat post-amputation phantom limb pain a multicenter, randomized, quadruple-masked, placebo-controlled clinical trial.
Phantom limb pain is thought to be sustained by reentrant neural pathways, which provoke dysfunctional reorganization in the somatosensory cortex. We hypothesized that disrupting reentrant pathways with a 6-day-long continuous peripheral nerve block reduces phantom pain 4 weeks after treatment. We enrolled patients who had an upper- or lower-limb amputation and established phantom pain. ⋯ Patients given local anesthetic had improved global impression of change and less pain-induced physical and emotional dysfunction, but did not differ on depression scores. For subjects who received only the first infusion (no self-selected crossover), the median decrease in phantom limb pain at 6 months for treated subjects was 3.0 (0, 5.0) vs 1.5 (0, 5.0) for the placebo group; there seemed to be little residual benefit at 12 months. We conclude that a 6-day continuous peripheral nerve block reduces phantom limb pain as well as physical and emotional dysfunction for at least 1 month.
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Reg Anesth Pain Med · Mar 2021
ReviewUltrasound-guided subparaneural popliteal sciatic nerve block: there is more to it than meets the eyes.
The popliteal sciatic nerve block is routinely used for anesthesia and analgesia during foot and ankle surgery. This article reviews our current understanding of the anatomy of the sciatic nerve and discusses how fascial tissue layers associated with the nerve may affect block outcomes. ⋯ The tibial and common peroneal nerves within the sciatic nerve trunk appear to be centrally separated by the Compton-Cruveilhier septum and encompassed by their own paraneural sheaths. This unique internal architecture of the sciatic nerve appears to promote proximal spread of local anesthetic to the internal aspect of the sciatic nerve trunk after a subparaneural injection at or below the divergence of the tibial and common peroneal nerves.
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Langenbecks Arch Surg · Mar 2021
Meta AnalysisTransversus abdominis plane block versus thoracic epidural analgesia in colorectal surgery: a systematic review and meta-analysis.
The efficacy of transversus abdominis plane (TAP) block compared with thoracic epidural analgesia (TEA) in abdominal surgery has been controversial. We conducted this systematic review and meta-analysis to assess outcomes of TAP block and TEA in a procedure-specific manner in colorectal surgery. ⋯ Perhaps more germane to minimally invasive procedures, TAP block is equivalent to TEA in terms of postoperative pain control and provides better functional recovery with lower incidence of adverse events in patients undergoing colorectal surgery.
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The erector spinae plane (ESP) block is an emerging regional anesthetic technique with significant potential for clinical benefit. Nevertheless, its exact mechanism(s) of action has been much debated. We reviewed the available literature to explore the possible mechanisms of analgesia for the ESP block. ⋯ A systemic effect of local anesthetic is also plausible, but unlikely to be a major contributor to clinical analgesic efficacy. The evidence for significant analgesia due to other proposed mechanisms, such as fascia-mediated analgesia or lymphatic spread, are currently limited and thus remain speculative. Understanding the mechanisms of action could assist clinicians in further investigating and refining ESP block performance, with the ultimate goal of optimizing analgesic efficacy and improving postoperative patient outcomes.
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J Pain Palliat Care Pharmacother · Mar 2021
Defining an Opioid Sparing Treatment Pathway for Chronic Abdominal Pain of Somatic and Visceral Origin: A Case Series.
Chronic non-malignant abdominal pain presents a treatment challenge for pain physicians. Treatment algorithms are often defined by single specialty and are unimodal with a dependence on opioids. We present a treatment algorithm for chronic abdominal pain using a combination of interventional therapy using transversus abdominis plane (TAP) blocks along with post injection medical management for treatment of somatic and visceral pain. ⋯ Patients receiving TAP blocks along with post injection medical management saw their VAS scores decrease by 68.5%. Their total daily milligram morphine equivalents (MME) consumption decreased by a mean of 68.9%. There were no readmissions for abdominal pain within the 1 year follow up period.