Current opinion in anaesthesiology
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Moderate-to-severe pain is common and remains a significant problem. Compared with opioid analgesia alone, single-shot peripheral nerve blockade has been associated with improved pain relief and the potential of decreased side effects. Single-shot nerve blockade, however, is limited by its relatively short duration of action. In this review, we aim to summarize the evidence related to local anaesthetic adjuncts for peripheral nerve blockade. ⋯ Intravenous dexamethasone is the local anaesthetic adjunct of choice, increasing the duration of sensory and motor blockade as well as the duration of analgesia by 477, 289 and 478 min, respectively. In view of this, we recommend consideration of the intravenous administration of dexamethasone at a dose of 0.1-0.2 mg/kg for all patients undergoing surgery whatever the level of postoperative pain, mild, moderate or severe. Further research should focus on the potential synergism of action between intravenous dexamethasone and perineural dexmedetomidine.
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Curr Opin Anaesthesiol · Oct 2023
ReviewComparative review of airway anesthesia and sedation methods for awake intubation.
Successful awake intubation hinges upon adequate airway anesthesia and sedation for patient comfort. This review will summarize relevant anatomy and regional anesthesia techniques to achieve airway anesthesia, and compare various airway anesthesia and sedation regimens. ⋯ Emerging evidence has indicated that nerve blocks for airway anesthesia may be superior to other methods of topicalization. Additionally, dexmedetomidine can be useful, both as monotherapy and with supplemental sedatives, to safely provide anxiolysis for the patient and increase success. However, it is crucial to note that the method of airway anesthesia and sedation regimen should be adapted to each patient and clinical situation, and knowledge of multiple techniques and sedation regimens can best equip anesthesiologists to do so.
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This review looks to overview advances in endometriosis-associated pain, both in understanding the pain mechanisms involved and increasing treatment options with well designed clinical trials and meta-analyses. ⋯ Following growth in other areas of chronic pain, there have been significant advances in our understanding of endometriosis-associated pain. However, there remains lots to explore and we are currently a long way from our goal of timely personalized holistic multidisciplinary treatment for all sufferers of endometriosis-associated pain.
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Curr Opin Anaesthesiol · Oct 2023
ReviewAdvances in the management of persistent pain after total knee arthroplasty.
Total knee arthroplasty (TKA) is one of the most commonly performed surgical procedures, with additional growth anticipated as the US population ages. Because the prevalence of chronic postsurgical pain ranges from 15 to 25%, identifying persons at risk for persistent pain following surgery allows for preoperative optimization of risk factors as well as early identification and intervention in the postsurgical period. ⋯ Identification and early intervention to address persistent pain after TKA is important to optimize patient outcomes. The anticipated growth in TKA underscores the need for future investigations to more fully define potential therapies for chronic pain following TKA.
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Curr Opin Anaesthesiol · Oct 2023
ReviewInnovations in diagnostic and treatment options for pediatric epilepsy and their anesthetic implications.
To provide an overview of anesthetic techniques for innovative diagnostic and therapeutic epilepsy procedures performed on pediatric patients. ⋯ The number of diagnostic and treatment options being used for the management of pediatric epilepsy has increased significantly. In the past few years, a handful of articles have been published, which describe the anesthetic considerations for these procedures. These studies are helpful to anesthesiologists who are planning an upcoming anesthetic or who are developing a 'best practice' model for their institution. Because unlike other diagnostic studies, failure to understand what effects anesthetics have on the brain, may negate the utility of the study. Although these new findings can be used to provide some anesthesia practice recommendations for epilepsy procedures in which the best management is still unclear, additional high-quality studies are needed.