Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2006
ReviewThe role of the dorsal root ganglion in cervical radicular pain: diagnosis, pathophysiology, and rationale for treatment.
Cervical radicular pain affects 83 per 100,000 adults annually. Diagnosis by means of physical examination, imaging, and electrophysiological studies is characterized by high specificity but low sensitivity. In this review, we focus on the role of the dorsal root ganglion and those treatment modalities that aim at pathophysiological mechanisms occurring after injury to the dorsal root ganglion. ⋯ Although many treatment modalities are described in the literature, the available evidence for efficacy does not allow us to formulate definitive conclusions on the optimal therapy. A lack of evidence is reported for cervical spine surgery. Interlaminar epidural steroid administration and radiofrequency techniques adjacent to the cervical dorsal root ganglion have the highest, but still weak recommendations.
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Reg Anesth Pain Med · Mar 2006
Randomized Controlled Trial Comparative StudyEvaluation of the effect of perioperative rofecoxib treatment on pain control and clinical outcomes in patients recovering from gynecologic abdominal surgery: a randomized, double-blind, placebo-controlled clinical study.
In this randomized, placebo-controlled, double-blind study, the efficacy and safety of rofecoxib 50 mg was evaluated in patients undergoing major abdominal gynecologic surgery. ⋯ Compared with placebo, perioperative administration of rofecoxib 50 mg provided significant opioid sparing, significantly better pain control, improved clinical outcomes, and was well tolerated.
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Reg Anesth Pain Med · Mar 2006
Randomized Controlled Trial Comparative StudyEfficacy of low-dose intrathecal morphine for postoperative analgesia after abdominal aortic surgery: a double-blind randomized study.
Several studies suggest that intrathecal morphine (ITM) improves analgesia after aortic surgery. We tested the hypothesis that in combination with multimodal postoperative pain management, low-dose ITM associated with general anesthesia would decrease postoperative analgesic requirements in patients undergoing abdominal aortic surgery. ⋯ In patients undergoing abdominal aortic surgery, intrathecal morphine (0.2 mg) improves postoperative analgesia and decreases the need in intraoperative and postoperative analgesics. Further studies are indicated to evaluate the role of ITM in postoperative recovery.
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Reg Anesth Pain Med · Mar 2006
Comparative StudyTotal hip arthroplasty as an overnight-stay procedure using an ambulatory continuous psoas compartment nerve block: a prospective feasibility study.
Total hip arthroplasty (THA) results in severe postoperative pain requiring hospitalization to provide potent analgesia. Consequently, the average duration of hospitalization after THA in the United States is 4 to 5 days. This prospective study investigated the feasibility of converting THA into an overnight-stay procedure using a continuous psoas compartment nerve block provided at home with a portable infusion pump. ⋯ These results suggest that for a subset of patients without major comorbidities, it is feasible to convert THA into an overnight-stay procedure using an ambulatory continuous psoas compartment nerve block as part of a multimodal analgesic regimen provided at home. Additional research is required to replicate these results in a controlled trial, define the appropriate subset of patients, and assess the incidence of complications associated with this practice before its mainstream use.