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
ReviewAnaesthesia for neuroradiology: thrombectomy: 'one small step for man, one giant leap for anaesthesia'.
Endovascular management of acute thrombotic strokes is a new management technique. Anaesthesia will play a key role in the management of these patients. To date there is no established method of managing these patients from an anaesthetic perspective. ⋯ There is a paucity of robust evidence for the best anaesthetic practice in this cohort of patients. Airway protection seems to be an issue in 2.5% of cases. Timing of the procedure is vital, and any delay may be detrimental to neurological outcome. In a survey of neurointerventionalists, the main concern they expressed was the potential delay to revascularization posed by anaesthesia. Patients complain of pain during mechanical clot retrieval if awake. The overall consensus seems to be favouring conscious sedation over general anaesthesia in the acute setting.
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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.