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  Regional stuff

  Analgesia Pain Regional anesthesia

   
  • Randomized Controlled Trial

    Adductor Canal Block Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty: A Randomized, Double-blind Study.

    Reg Anesth Pain Med. 2013 Nov 1; 38 (6): 526-32.

    Quadriceps strength is better preserved after adductor canal block for total knee arthroplasty than femoral nerve block with similar analgesic effect.

    pearl

  • Randomized Controlled Trial

    Adductor Canal Block versus Femoral Nerve Block for Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial.

    Anesthesiology. 2014 Mar 1;120(3):540-50.

    Adductor canal block analgesia is comparable to femoral nerve block while improving early (6-8 h) quadriceps strength after total knee arthroplasty.

    pearl

  • Randomized Controlled Trial

    Adjuvant dexamethasone with bupivacaine prolongs the duration of interscalene block: a prospective randomized trial.

    J Anesth. 2011 Oct 1; 25 (5): 704-9.

    Dexamethasone added to bupivacaine significantly prolongs the duration of interscalene analgesia and motor blockade.

    pearl

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  Magnesium the new 'roid

  Analgesia Magnesium

   
  • Review

    Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis.

    Anaesthesia. 2013 Jan 1;68(1):79-90.

  • Randomized Controlled Trial

    Is magnesium sulfate effective for pain in chronic postherpetic neuralgia patients comparing with ketamine infusion therapy?

    J Clin Anesth. 2015 Jun 1; 27 (4): 296-300.

  • Review

    Influence of the perioperative administration of magnesium sulfate on the total dose of anesthetics during general anesthesia. A systematic review and meta-analysis.

    J Clin Anesth. 2017 Jun 1; 39: 129-138.

    Perioperative magnesium reduces propofol induction and maintenance doses, and similarly reduces neuromuscular drug needs.

    pearl

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  Does intravenous lidocaine/lignocaine improve post-operative recovery?

  Analgesia Lidocaine Local anesthetics Pain

   

  There is some evidence supporting the benefit of perioperative intravenous lignocaine/lidocaine infusion in both laparoscopic and open abdominal surgery.

  The strongest evidence supports both improved analgesia and reduction in nausea, with weaker evidence suggesting faster improvement in GIT function and earlier discharge from hospital.

  Safety data is reassuring but far from conclusive due to the small size of most studies.

  summary

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  • Randomized Controlled Trial

    Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery.

    Anesth. Analg.. 2012 Aug 1;115(2):262-7.

    Intraoperative intravenous lidocaine improves the quality of recovery following ambulatory laparoscopic surgery.

    pearl

  • Randomized Controlled Trial

    Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery.

    Clin J Pain. 2012 Sep 1;28(7):567-72.

  • Review

    Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials.

    Drugs. 2010 Jun 18;70(9):1149-63.

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  Is remifentanil associated with Opioid Induced Hyperalgesia and Acute Opioid Tolerance?

  Analgesia Opioid Remifentanil

   
  • Remifentanil infusions above 0.20-0.25 μg/kg/min are associated with hyperalgesia (OIH = Opioid Induced Hyperalgesia) and tolerance (AOT = Acute Opioid Tolerance) respectively.
  • Some of these effects can be mitigated by multimodal analgesia (notably ketamine), and possibly by gradual weaning of a remifentanil infusion.
  • The findings have been predominately identified in rats and volunteer human studies. The clinical and longterm significance is still uncertain.
  • Although OIH and AOT arise from different physiological mechanisms, they are clinically difficult (if not impossible) to differentiate.
  • The clinical priority for management is prevention.

  summary

  
  ...and 1 more note

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  • Review

    Remifentanil-acute opioid tolerance and opioid-induced hyperalgesia: a systematic review.

    Am J Ther. 2015 May 1; 22 (3): e62-74.

  • Randomized Controlled Trial

    Gradual withdrawal of remifentanil infusion may prevent opioid-induced hyperalgesia.

    Br J Anaesth. 2016 Apr 1; 116 (4): 524-30.

  • Review

    Opioid-induced hyperalgesia in clinical anesthesia practice: what has remained from theoretical concepts and experimental studies?

    Curr Opin Anaesthesiol. 2017 Aug 1; 30 (4): 458-465.

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