Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2008
ReviewClonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials.
Clonidine is added to intrathecal local anesthetics to improve intraoperative analgesia and to increase the duration of sensory and motor block. The aim of this systematic review is to quantify beneficial and harmful effects of clonidine when used as an adjuvant to intrathecal local anesthetics for surgery. ⋯ This study may serve as a rational basis to help clinicians decide whether or not to combine clonidine with an intrathecal local anesthetic for surgery. The optimal dose of clonidine, however, remains unknown.
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Reg Anesth Pain Med · Mar 2008
ReviewPatient-controlled drug delivery for acute postoperative pain management: a review of current and emerging technologies.
Postoperative pain management has dramatically improved with the advent of patient-controlled analgesia (PCA) delivery. The optimal PCA system would encompass several key characteristics, including consistent efficacy across a number of surgeries; safety of both the analgesic drug delivered and the delivery system; ease of setup, maintenance, and administration; patient comfort during analgesic delivery; avoidance of analgesic gaps; minimal invasiveness; and it would be associated with high patient satisfaction. Existing PCA modalities (using intravenous or epidural routes) encompass some of these characteristics (e.g., they have demonstrated efficacy across a number of surgeries); however, they are limited by the need for an indwelling catheter and the time and resources required for system setup and use. ⋯ New PCA technologies are on the horizon that address some of the limitations to existing modalities; however, the added complexity of these newer systems are a concern, and their benefits and drawbacks remain to be assessed. These technologies include "smart" intravenous PCA infusion pumps to improve the safety of analgesic administration; needle-free options, such as the fentanyl HCl iontophoretic transdermal system for transdermal delivery; and a number of PCA devices for intranasal delivery, as well as several new options for patient-controlled regional analgesia. This review will discuss the benefits and drawbacks of both existing and emerging PCA modalities in the context of the ideal PCA system, and provide a critical evaluation of their use in postoperative settings.
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Reg Anesth Pain Med · Mar 2008
Randomized Controlled Trial Comparative StudyPerioperative interscalene block versus intra-articular injection of local anesthetics for postoperative analgesia in shoulder surgery.
Up to 70% of patients report moderate to severe pain after shoulder surgery, which can compromise early rehabilitation and functional recuperation. Postoperative shoulder pain control is improved with both interscalene block and intra-articular local anesthetic injection. The present study hypothesized that perioperative interscalene analgesia would offer pain control superior to perioperative intra-articular local anesthetics over the first 24 hours after surgery. ⋯ PACU measurements of immediate postoperative pain and narcotic consumption favor perioperative interscalene analgesia over intra-articular analgesia. This benefit does not translate into lower overall pain for the first 24 hours after surgery.
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Reg Anesth Pain Med · Mar 2008
Feasibility of real-time ultrasound for pudendal nerve block in patients with chronic perineal pain.
Compared with conventional fluoroscopic-guided pudendal nerve block, ultrasonography has potential advantages for visualizing anatomical landmarks such as the internal pudendal artery and nerve, the sacrospinous and sacrotuberous ligaments, and local anesthetic spread. We examined the clinical utility of performing pudendal nerve block under real-time ultrasound guidance. ⋯ Pudendal nerve block at the ischial spine level can be reliably performed under real-time ultrasound guidance.