Current opinion in anaesthesiology
-
Ultrasound guidance is frequently utilized for needle placement and observation of local anesthetic spread when performing peripheral nerve blocks. Although there is evidence that ultrasound technology can reduce complications, there are limitations to 2-dimensional (2-D) ultrasound. Three-dimensional (3-D) and especially real-time 3-D (4-D) ultrasound may allow for optimized and well tolerated needle positioning and enhanced observation of local anesthetic spread around the target structure. This article reviewed the current literature regarding the use of 3-D and 4-D ultrasound technology in a regional anesthesia setting. ⋯ At present, there are limited data regarding the use of 3-D ultrasound and a complete lack of randomized controlled clinical trials evaluating the potential benefits of real-time 3-D (4-D) ultrasound. This may be in part due to technical limitations associated with these techniques.
-
Curr Opin Anaesthesiol · Oct 2015
ReviewAcute pain assessment tools: let us move beyond simple pain ratings.
This review highlights challenges and current trends in tools used to assess acute pain across the lifespan. ⋯ Valid and pragmatic assessment of pain is essential for effective pain management. Unidimensional scales that capture self-reported pain intensity ratings undervalue to the complexity of the pain experience. Pain is a biopsychosocial experience and assessment is a complex social transaction and an exchange of the meaning of pain that demands a more comprehensive approach.
-
Increased understanding of the pathophysiology in traumatic brain injury (TBI) has resulted in the development of core physiological targets and therapies to preserve cerebral oxygenation, and in doing so prevent secondary insult. This review addresses the many systemic complications of TBI that make achieving these targets challenging and can influence outcome. ⋯ Effective management of TBI should go beyond formulaic-based pursuit of physiological targets and requires a detailed understanding of the multisystem response of the body.
-
Monitoring and therapy of patients in neurocritical care are areas of intensive research and the current evidence needs further confirmation. ⋯ Although strong evidence is lacking, multimodal monitoring is of great value in neurocritical care patients and may help to provide patients with the optimal therapy based on the individual pathophysiological changes.
-
Effective analgesia is necessary for optimal recovery after surgery, but children often do not attain adequate postoperative pain control. This review examines the current trends in paediatric regional anaesthesia. ⋯ By using a multimodal approach that includes regional anaesthesia, paediatric pain management should aim to reduce patients' pain to an acceptable level without compromising their degree of mobilization. Undoubtedly, peripheral nerve blocks improve analgesia, but future large prospective studies should be conducted to further delineate their effectiveness, duration and safety.