Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2011
Comparative StudyProlonged cutaneous analgesia with transdermal application of amitriptyline and capsaicin.
Capsaicin selectively binds to TRPV1, the vanilloid subtype 1 of the superfamily of transient receptor potential ion channels, which is highly expressed in pain-transmitting C fibers. Recent reports have demonstrated that the coadministration of capsaicin with a local anesthetic (LA) at the rat sciatic nerve elicits a prolonged nociceptive-selective nerve block, suggesting that activation of the TRPV1 receptor may allow LAs to enter the nerve through the TRPV1 pore. In previous studies, we demonstrated that transdermal amitriptyline achieves clinical analgesic effects and is more potent than lidocaine. Here we examine whether the combined application of amitriptyline and capsaicin as a transdermal patch will produce prolonged cutaneous analgesia compared with amitriptyline alone. ⋯ This study demonstrates that the combined application of amitriptyline and capsaicin results in prolonged cutaneous analgesia compared with amitriptyline alone, suggesting that the activation of the TRPV1 channel by capsaicin facilitates the passage of amitriptyline into nociceptors. This transdermal patch achieves far longer cutaneous analgesia than currently available patch applications such as EMLA cream. The mechanism that underlies the lesser skin irritation noted when amitriptyline is combined with higher doses of capsaicin compared with amitriptyline alone is unclear and may be related to a counteraction of amitriptyline-induced vasoconstriction.
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Reg Anesth Pain Med · May 2011
Comparative StudyHand motion analysis using the imperial college surgical assessment device: validation of a novel and objective performance measure in ultrasound-guided peripheral nerve blockade.
The Imperial College Surgical Assessment Device (ICSAD) has been validated in various settings as an objective tool to measure technical performance. We sought to establish (1) the construct validity of the ICSAD as an assessment tool in ultrasound-guided supraclavicular block by determining its ability to discriminate between operators of different experience level and (2) the concurrent validity of the ICSAD by correlating it with a task-specific checklist and a global rating scale. ⋯ The ICSAD is both valid and useful in assessing performance of ultrasound-guided supraclavicular block.
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Reg Anesth Pain Med · May 2011
Comparative StudyIntraoperative neuraxial anesthesia but not postoperative neuraxial analgesia is associated with increased relapse-free survival in ovarian cancer patients after primary cytoreductive surgery.
Regional anesthesia has been shown to blunt the response to surgical stress and decrease the use of volatile anesthetics and the consumption of opioids, which may reduce immune compromise and potentially delay tumor recurrence. The goal of this study was to find a possible association between intraoperative regional anesthesia and decreased cancer recurrence. ⋯ Intraoperative use of epidural anesthesia was associated with an increased time to tumor recurrence after surgery in ovarian cancer patients. This may be a result of preservation of the immune system function.
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Reg Anesth Pain Med · May 2011
GuidelineGuidelines for fellowship training in Regional Anesthesiology and Acute Pain Medicine: Second Edition, 2010.
The Regional Anesthesiology and Acute Pain Medicine Fellowship Directors Group develops and maintains guidelines for fellowship training in the subspecialty. These guidelines update the original guidelines that were published in 2005. The guidelines address 3 major topic areas: organization and resources, the educational program, and the evaluation process.
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Reg Anesth Pain Med · May 2011
Comparative StudyDoppler measurement of the changes of fetal umbilical and middle cerebral artery velocimetric indices during continuous epidural labor analgesia.
Although complications of the epidural technique are known to affect the fetus adversely, there are no data indicating that regional analgesia directly causes harmful effects to the fetus. Our purpose was to determine the effect of epidural labor analgesia on the Doppler velocimetric indices of the uterine and fetal umbilical and middle cerebral arteries. ⋯ These data suggest that although velocimetric indices of the maternal uterine artery are affected by continuous epidural labor analgesia, fetal circulation, as measured by Doppler velocimetric indices, is not altered.