Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2011
ReviewFunctional and structural imaging of pain-induced neuroplasticity.
The understanding of the mechanisms underlying chronic pain is of major scientific and clinical interest. This review focuses on neuroimaging studies of pain-induced neuroplastic changes in the human brain and discusses five major categories of pain-induced neuroplastic changes. ⋯ Recent work has substantially broadened our insights into neuroplastic changes that are involved in pain chronification. Future research will focus on the question of whether neuroimaging techniques can be used in the individual chronic pain patient as a biomarker that would allow for an objective diagnosis of different pain conditions and for the prediction of individual responses to specific therapies.
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Curr Opin Anaesthesiol · Oct 2011
ReviewUltrasound brachial plexus anesthesia and analgesia for upper extremity surgery: essentials of our current understanding, 2011.
Ultrasound-guidance is gaining tremendous popularity. There is growing evidence of value with emphasis on clinical relevance, but can ultrasound-guidance scientifically warrant changing the practice of upper extremity regional? The literature is searched to describe findings where ultrasound may reduce complication rates, reduce block performance times, and improve block efficacy and quality. ⋯ Intraepineurial injection requires additional investigation. Conclusions have suggested reducing typical volumes (40 ml) of local with ultrasound-directed upper extremity blockade. Increased use of perineural catheters is being advocated for prolonged analgesia, but risk-to-benefit consequences need to always be considered.
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Regional anesthesia is evolving rapidly and increasing in popularity as evidenced by the large number of publications on the topic. In this healthcare environment, continual assessment of the safety and efficacy of clinical practice is critical. Neurologic complications of regional anesthesia can result in disability and are feared by patients and clinicians. Ultrasound guidance is unique as a nerve localizing technique in terms of being able to image needle-nerve proximity and potentially prevent direct trauma to nerves. This article reviews the recent literature relevant to neurologic complications of regional anesthesia. ⋯ The pathogenesis of perioperative nerve injury is complex with multiple potential etiologies and mechanisms. The role of intraneural injections as a modifiable risk factor for neurologic complications due to regional anesthesia remains topical. Relevant publications include studies on the morphology of peripheral nerves and risk of perioperative nerve injury in the context of both neuraxial anesthesia and PNB.
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Deep brain stimulation (DBS) is a well accepted treatment modality for many movement disorders such as Parkinson's disease and an increasing number of other functional neurological disorders like dystonias and epilepsy. This review will highlight the recent developments in our knowledge regarding the effects of anesthetic agents on neurophysiologic recording and anesthetic management of patients undergoing the insertion of a DBS. ⋯ There will continue to be an increase in the use of DBS for many neurological and functional disorders, especially in the aging baby boomer population. Anesthetic technique will vary depending on the prevalent practice in individual institutions and requirements of the specific surgical procedure.
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The persistence of pain after surgical procedure or trauma has become a major focus of interest and its prevention now represents a challenge as an indicator of quality of healthcare. The only way to develop effective strategies to prevent the development of chronic pain is to better understand the mechanisms involved in the progression from acute to chronic pain, with the aim to target high-risk patients and to adapt perioperative management. ⋯ A dynamic view of both physiological and psychological response of an individual after injury (trauma, surgery) should improve our ability to target predisposed patients who might develop persistent pain. We should then be more able to provide those patients with the most appropriate preventive management.