Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2005
Randomized Controlled Trial Comparative Study Clinical TrialThe value of adding sciatic block to continuous femoral block for analgesia after total knee replacement.
The benefit of adding a sciatic nerve block to the femoral block to improve analgesia after total knee replacement is controversial. The aim of this study is to address this controversy in a prospective, comparative, and randomized study. ⋯ During the 36 hours immediately after total knee replacement, the combination of continuous femoral and sciatic nerve blocks improves analgesia while decreasing morphine consumption and PONV.
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Reg Anesth Pain Med · Mar 2005
ReviewLumbar discography: a comprehensive review of outcome studies, diagnostic accuracy, and principles.
Since its advent more than 50 years ago, the use of discography has been mired in controversy. The purpose of this review is to provide a clinical overview of lumbar discography and discogenic back pain, with special emphasis on determining the accuracy of discography and whether or not the procedure improves outcomes for surgery. ⋯ Although discography, especially combined with CT scanning, may be more accurate than other radiologic studies in detecting degenerative disc disease, its ability to improve surgical outcomes has yet to be proven. In the United States and Europe, there are inconsistencies in the use of lumbar discography such that it is routinely used before IDET, yet only occasionally used before spinal fusion.
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Reg Anesth Pain Med · Mar 2005
Clinical TrialParasacral approach to block the sciatic nerve: a 400-case survey.
Parasacral sciatic nerve block has been shown to be easy to perform, but studies reported to date involve a total of only 155 patients. The aim of this study was to assess the efficacy of parasacral sciatic nerve block in a larger group of patients. ⋯ In this prospective 400-case study, we confirmed previous findings that the parasacral approach is effective, easy to perform, and easy to teach, even when performed by relatively inexperienced physicians. The parasacral approach is, therefore, an effective alternative to other approaches of sciatic nerve blockade.
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Reg Anesth Pain Med · Mar 2005
Review Historical ArticlePosterior lumbar plexus block: anatomy, approaches, and techniques.
Lumbar plexus is an effective but underused regional technique that was described nearly 3 decades ago. The original description has been modified several times based on advances in technology, localization, and imaging techniques. This review provides an overview of the history, anatomy, and techniques described to perform this block.
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Reg Anesth Pain Med · Mar 2005
Review Case ReportsDealing with difficult patients in your pain practice.
Pain patients can be difficult. They can provoke negative feelings of frustration and anger among clinicians and damage the doctor-patient relationship. ⋯ Issues of comorbid psychopathology, hostility, suicidality, aberrant drug behavior, and chronic noncompliance are discussed. Specific recommendations are also given of the best ways to manage patients with difficult behavior.