Current opinion in anaesthesiology
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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.
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Regional anesthesia is commonly used to provide intraoperative anesthesia and postoperative analgesia. Potential complications of both neuraxial and peripheral regional techniques include infectious sequelae. This review examines important components of practice that are known to minimize the risk of infection associated with regional anesthesia. ⋯ Infectious complications associated with regional anesthesia are exceedingly rare events. Adherence to strict aseptic guidelines as published by the American Society of Regional Anesthesia and Pain Medicine, American Society of Anesthesiologists, and the Royal College of Anaesthetists may reduce the risk of infectious complications.
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Curr Opin Anaesthesiol · Oct 2011
ReviewUltrasonography of the lumbar spine for neuraxial and lumbar plexus blocks.
Ultrasonography of the spine has evolved into a well described technique that can be applied to facilitate neuraxial and lumbar plexus blockade. ⋯ Preprocedural ultrasound imaging of the spine may reduce the technical difficulty of neuraxial blockade and also improve clinical efficacy. Similar benefits are expected in the setting of lumbar plexus blockade although there is currently no evidence to confirm this. Real-time ultrasound-guided neuraxial and lumbar plexus blockade are challenging techniques that need further validation.
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Curr Opin Anaesthesiol · Oct 2011
ReviewPlacebo analgesia and beyond: a melting pot of concepts and ideas for neuroscience.
In the last two decades, some of the neuroanatomical and neurophysiological substrates of the placebo effect have been elucidated. What has emerged is the multifactorial nature of the placebo effect, such that there is not a single placebo effect but many. Here we report on recent advances in our understanding of this phenomenon, with particular emphasis on its use as an experimental model to better clarify different brain mechanisms. ⋯ The study of the placebo effect is paying dividends and bodes well for the future. Whereas in clinical practice it can increase the efficacy of a therapy, in the experimental setting it represents an excellent tool for neuroscience.