Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Apr 2020
History and evolution of regional anesthesiology and acute pain medicine fellowship training.
In 2016, individual training programs in regional anesthesiology and acute pain medicine (RA/APM) became eligible for accreditation by the Accreditation Council for Graduate Medical Education (ACGME), thereby culminating a process that began 15 years earlier. Herein, we review the origins of regional anesthesia training in the USA, the events leading up to accreditation and the current state of the fellowship. ⋯ The history of RA/APM training in the USA is a tortuous one. It began with short 'apprenticeships' under the tutelage of the early proponents of regional anesthesia and continues today with 84 official RA/APM programs and a robust fellowship directors' group. RA/APM programs teach skills essential to the practice and improvement of anesthesiology as a specialty.
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Reg Anesth Pain Med · Apr 2020
Does cryoneurolysis result in persistent motor deficits? A controlled study using a rat peroneal nerve injury model.
Cryoneurolysis of peripheral nerves uses localised intense cold to induce a prolonged block over multiple weeks that has the promise of providing potent analgesia outlasting the duration of postoperative pain following surgery, as well as treat other acute and chronic pain states. However, it remains unclear whether persistent functional motor deficits remain following cryoneurolysis of mixed sensorimotor peripheral nerves, greatly limiting clinical application of this modality. To help inform future research, we used a rat peroneal nerve injury model to evaluate if cryoneurolysis results in persistent deficits in motor function. ⋯ When applied to a mixed sensorimotor nerve, cryoneurolysis did not result in persistent motor deficits.
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Reg Anesth Pain Med · Apr 2020
Current status of pain medicine training in anesthesiology and pain medicine residency programs in university hospitals of Korea: a survey of residents' opinions.
In Korea, anesthesiologists are expected to be mainstream pain medicine (PM) practitioners. However, anesthesiology and pain medicine (APM) residency programs mostly emphasize anesthesia learning, leading to insufficient PM learning. Therefore, this study evaluated the current status of PM training in APM residency programs in 10 Korean university hospitals. ⋯ Dissatisfaction with PM training was probably due to a structural tendency of the current program towards anesthesia training and insufficient clinical experience, which needs to be rectified, with a change in PM curriculum.
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Reg Anesth Pain Med · Apr 2020
Vulnerability of different nerves to intrafascicular injection by different needle types and at different approach angles: a mathematical model.
We assume that intrafascicular spread of a solution can only occur if a large enough portion of the distal needle orifice is placed inside the fascicle. Our aim is to present and evaluate a mathematical model that can calculate the theoretical vulnerability of fascicles, analyzing the degree of occupancy of the needle orifice in fascicular tissue by performing simulations of multiple positions that a needle orifice can take inside a cross-sectional nerve area. ⋯ Our results suggest that clinicians may want to consider needle insertion angle and bevel type as they perform peripheral nerve blocks. Furthermore, researchers may want to consider this mathematical model when estimating vulnerabilities of various nerves, needle types and angles of approach of needles to nerves.