Current opinion in anaesthesiology
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The study focuses on neural blocks with local anesthetics in postoperative and chronic pain. It is prompted by the recent publication of several systematic reviews and guidelines. ⋯ Recent literature strongly supports the use of regional anesthesia for postoperative pain, whereby infusions at peripheral nerves and surgical site are gaining increasing importance. Local anesthetic blocks are valid for the diagnosis of facet joint pain and effective in treating headache. There is a need for further research in diagnostic and therapeutic blocks for chronic pain.
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Curr Opin Anaesthesiol · Oct 2016
ReviewTeaching concepts in ultrasound-guided regional anesthesia.
Ultrasound-guided regional anesthesia is a challenging, complex skill and requires competence in teaching. The aim of this study was to review current literature on identification of education and learning of ultrasound-guided regional anesthesia and to summarize recent findings on teaching concepts. ⋯ Although a lot of key questions cannot be answered by the latest study results, some interesting findings were able to improve existing education programs. These results should be tailored to the individual need of a trainee, and the effects of improved training programs on patient safety and quality of care have to be investigated. The see one, do one, teach one approach is obsolete and should be abandoned.
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Abdominal wall blocks in adults have evolved much during the last decade; that is, particularly with the introduction of ultrasound-guided (USG) blocks. This review highlights recent advances of block techniques within this field and proposes directions for future research. ⋯ USG abdominal wall blocks in adults are commonplace techniques today. Most abdominal wall blocks are assigned evidence grade A or B according to the US Agency for Healthcare Policy and Research guidelines.
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Curr Opin Anaesthesiol · Oct 2016
ReviewAdjunct analgesic drugs to local anaesthetics for neuroaxial blocks in children.
This article reviews various adjunct drugs used in the context of neuroaxial blocks in children and to provide a literature and evidence-based suggestion for the rational use of such adjuncts. ⋯ Alpha-2 adrenoceptor agonists currently represent the most versatile and well-tolerated adjunct for neuroaxial blockade in children. Preservative-free morphine may be indicated in certain situations but the risk for respiratory depression and other disturbing side-effects must be taken into account. Preservative-free ketamine is an effective adjunct to caudal blockade in children but the use should be restricted to children older than 1 year of age. All other drugs must still be regarded as experimental and should not be used outside clinical trials.