Regional anesthesia and pain medicine
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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.
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Reg Anesth Pain Med · Nov 2011
ReviewUltrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part III: shoulder.
Application of ultrasound for musculoskeletal injections is increasingly popular. The common targets for shoulder injection are the subacromial subdeltoid bursa, glenohumeral joint, acromioclavicular joint, and the long head of biceps tendon. This review describes and summarizes the anatomy and sonoanatomy relevant to the injection of these structures. The feasibility, accuracy, and effectiveness of the injections into and around these shoulder structures, as well as the injection techniques, are also described in detail.
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Reg Anesth Pain Med · Nov 2011
Ultrasound imaging of the thoracic spine in paramedian sagittal oblique plane: the correlation between estimated and actual depth to the epidural space.
Ultrasound (US) imaging of the spine has been shown to be a reliable tool to facilitate lumbar epidural needle placement; however, its feasibility in thoracic epidural placement is still unknown. The objective of this study was to assess the accuracy and reliability of prepuncture US imaging in the paramedian sagittal oblique plane to estimate the depth to the epidural space and optimum insertion point for guiding epidural needle placement at the mid-low thoracic level. ⋯ We found a good correlation between the US-estimated distance to the epidural space and the actual measured needle distance in our patients. We suggest that our proposed prepuncture US method, using the paramedian sagittal oblique approach, can be a useful guide to facilitate the placement of epidural needles at mid-low thoracic levels. A randomized controlled trial is necessary to confirm the utility of prepuncture US in thoracic epidural placement.
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Reg Anesth Pain Med · Nov 2011
Comparative StudyUltrasound-guided versus anatomic landmark-guided ankle blocks: a 6-year retrospective review.
Ultrasound-guided (USG) ankle block has been described; however, its clinical efficacy compared with conventional anatomic landmark-guided (ALG) techniques remains undetermined. ⋯ This study demonstrates that the USG technique of ankle block improves clinical efficacy compared with a conventional ALG technique, particularly in the hands of less-experienced practitioners.
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Reg Anesth Pain Med · Nov 2011
Comparative StudyHas central sensitization become independent of nociceptive input in chronic pancreatitis patients who fail thoracoscopic splanchnicectomy?
Central sensitization due to visceral pancreatic nociceptive input may be important in chronic pancreatitis pain. We investigated whether bilateral thoracoscopic splanchnicectomy (BTS) to reduce nociceptive input in chronic pancreatitis patients (CPP) with poor pain control affects supraspinal and spinal sensitization. ⋯ Reduced supraspinal-but not spinal-central sensitization after BTS was associated with significantly reduced pain scores in a majority of CPP. A subgroup showed no reductions in supraspinal central sensitization after BTS, coupled to no significant pain NRS reduction. Our results suggest that a subgroup of CPP has altered pain processing that may be independent of ongoing peripheral nociceptive input, resulting in persisting pain despite BTS. If confirmed, these results indicate the importance of sensory testing for indications and management of pain treatments.