International anesthesiology clinics
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Int Anesthesiol Clin · Jan 2012
Forecast for perineural analgesia procedures for ambulatory surgery of the knee, foot, and ankle: applying patient-centered paradigm shifts.
Although much of the current clinical research is directed toward practitioner-centered refinement of RA techniques and technology, it is important to consider pharmacologic advances in perineural analgesia as the next major patient-centered advancement of our specialty. With all due respect to excellent bench science work with novel drugs and toxins that may not gain approval of the Food and Drug Administration for many years, it is useful to know that four Food and Drug Administration-approved drugs are commercially available for potentially ground-breaking off-label use, pending ongoing research. ⋯ Research is also needed to determine the extent to which these four drugs may reduce the needed local anesthetic concentration to achieve a surgical nerve block (on bolus injection). Ongoing research in this direction seems to represent the next major advancement in the subspecialty, being distinguished from refinement research involving strictly techniques and technology.
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PVB remains an underused block. It is easy to perform reliable and effective blocks for a wide variety of applications both for acute or chronic pain. As evidence continues to be published showing the advantages of PVB versus traditional methods of pain control, it is hoped that PVB will become part of the standard repertoire of blocks used in teaching hospitals and in private practice.
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Int Anesthesiol Clin · Jan 2012
Special considerations and recommendations for interventions for pediatric chronic pain.
In select cases, interventional pain management techniques can bean effective adjunct to the multidisciplinary care of pediatric patients with chronic pain. The secret to success stems in proper patient selection and in delineating clear goals and expectations—motivated patients do well. Comfort measures ranging from distraction through general anesthesia should be employed to alleviate anxiety and distress, and to provide optimal working conditions for the proceduralist. In the appropriate context, the occasion to provide interventional care can be a rewarding role for the anesthesiologist to play in chronic pediatric pain patient care.