Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Nov 2011
Randomized Controlled TrialA translational study of the effects of ketamine and pregabalin on temporal summation of experimental pain.
Central sensitization is often seen in chronic pain. A relevant and potent mechanism of central sensitization is the central integration of nociceptive impulses. Temporal summation in humans and the wind-up process in animals share common features of central integration. This preclinical and clinical translational study investigated the effect of ketamine and pregabalin on temporal summation (TS) and wind-up of wide dynamic range (WDR) neurons of nociceptive electrical stimuli in healthy volunteers and rats. ⋯ It was shown that TS shares common features with wind-up of WDR neurons and that pregabalin does not affect this component of central sensitization.
-
Reg Anesth Pain Med · Nov 2011
Randomized Controlled Trial Multicenter Study Comparative StudyLumbar transforaminal epidural dexamethasone: a prospective, randomized, double-blind, dose-response trial.
Serious adverse events related to particulate steroids have curtailed the use of transforaminal epidural steroid injections for radicular pain. Dexamethasone has been proposed as an alternative. We investigated the efficacy, dose-response profile, and safety of 3 doses of epidural dexamethasone. ⋯ Transforaminal epidural dexamethasone provides statistically significant and clinically meaningful improvement in radicular pain at 12 weeks after injection, with parallel improvements in disability, impression of change, and satisfaction measures. There was no difference in efficacy for dexamethasone 4 mg compared with 8 or 12 mg. The optimal dose of epidural dexamethasone may be lower than 4 mg, further increasing the long-term safety and tolerability of this treatment. Current data are reassuring with regard to the safety of dexamethasone for transforaminal epidural steroid injection.
-
Reg Anesth Pain Med · Nov 2011
Randomized Controlled Trial Comparative StudyIs pulmonary function affected by bilateral dual transversus abdominis plane block? A randomized, placebo-controlled, double-blind, crossover pilot study in healthy male volunteers.
Transversus abdominis plane (TAP) blocks have been shown to reduce postoperative pain after various abdominal surgical procedures in several studies. The motor nerves of the abdominal wall are located in the same plane as the sensory nerves affected by the TAP block. The aim of this study was to examine whether the application of an ultrasound-guided TAP block would affect the muscles of the anterior abdominal wall with respect to their function as accessory respiratory muscles and hence pulmonary function. ⋯ The administration of ultrasound-guided bilateral dual TAP blocks does not result in clinically relevant or statistically significant changes in the pulmonary function in healthy male subjects.
-
Reg Anesth Pain Med · Nov 2011
Randomized Controlled Trial Comparative StudyA randomized comparison between subepineural and conventional ultrasound-guided popliteal sciatic nerve block.
This prospective, randomized, observer-blinded trial compared a subepineural sciatic injection at the neural bifurcation (SUB group) and separate postbifurcation injections around the tibial and peroneal nerves. ⋯ Compared with separate injections around the tibial and peroneal divisions, a single subepineural injection at the neural bifurcation provides a higher success rate and requires shorter performance, onset, and total anesthesia-related times. Further studies are required to validate the safety of the subepineural technique.
-
Reg Anesth Pain Med · Nov 2011
ReviewProspective trial registration for clinical research: what is it, what is it good for, and why do I care?
Optimizing evidence-based medicine--and therefore the care of our patients--requires a public record of both the benefits and the risks of various medical interventions. Unfortunately, available evidence is often skewed because some clinical trials are withheld from publication; only selected data are reported, and statistical techniques are often inappropriately determined following data analysis. Prospective clinical trial registration (PCTR) is the public documentation of trial protocols--today primarily on the Internet--before data analysis (and ideally before trial commencement). ⋯ Multiple organizations endorse (in some cases mandate) PCTR, including prominent committees of medical editors, the World Health Organization, the World Medical Association (responsible for the Helsinki Declaration), and, more recently, the US Food and Drug Administration. Although Regional Anesthesia and Pain Medicine does not currently require registration for published articles, PCTR in this and other anesthesiology and pain journals may become mandatory within the next few years. Potential authors/investigators will therefore benefit from becoming familiar with PCTR before mandatory registration implementation, and familiarity among readers may improve interpretation and understanding of clinical research results.