Regional anesthesia and pain medicine
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Suprascapular nerve blockade (SSNB) is a simple and safe technique for providing relief from various types of shoulder pain, including rheumatologic disorders, cancer, and trauma pain, and postoperative pain due to shoulder arthroscopy. Posterior, superior, and anterior approaches may be used, the most common being the posterior. ⋯ The different techniques of SSNB and indications for SSNB will be discussed. The complications of SSNB and outcomes of SSNB on the management of acute and chronic shoulder pain will be reviewed.
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Perioperative nerve injuries are devastating complications that are commonly attributed to a variety of patient, surgical, or anesthetic factors. Well-documented causes of postsurgical neuropathy include nerve compression, stretch, contusion, or transection, which can occur following surgical trauma or patient positioning. Potential anesthetic causes of perioperative nerve injury include mechanical trauma, local anesthetic toxicity, and ischemic injury. We present a case of a diffuse, bilateral neurologic deficit of unclear etiology in a patient who underwent a combined neuraxial-general anesthetic for bilateral total hip arthroplasty. ⋯ Perioperative nerve deficits not readily explained by direct surgical or anesthesia-related causes should prompt early neurologic consultation to seek alternative etiologies such as postsurgical inflammatory neuropathy. Although this condition is poorly understood, it is believed to be an idiopathic immune-mediated response to a physiologic stress (eg, surgery, regional block) and is treated with prolonged, high-dose corticosteroids. Because suppression of the immune system with high-dose steroids may result in improved neurologic outcome, it is essential that surgeons and anesthesiologists are aware of this condition so that treatment is not delayed.
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Reg Anesth Pain Med · Jul 2011
Comparative StudyMidazolam activates the intrinsic pathway of apoptosis independent of benzodiazepine and death receptor signaling.
Midazolam has neurotoxic properties when administered neuraxially in vivo. Furthermore, midazolam induces neurodegeneration in neonatal animal models in combination with other general anesthetics. Therefore, this study focuses on the mechanism of neurotoxicity by midazolam in neuronal and nonneuronal cells. The study aims to evaluate the apoptotic pathway and to investigate the protective effects of the benzodiazepine antagonist flumazenil and the caspase inhibitor N-(2-quinolyl)valyl-aspartyl-(2,6-difluorophenoxy)-methylketone. ⋯ Midazolam induces apoptosis via activation of the mitochondrial pathway in a concentration-dependent manner. The mechanism of midazolam toxicity switches from caspase-dependent apoptosis to necrosis with increasing concentrations. The induction of apoptosis and necrosis by midazolam is presumably unrelated to GABAA receptor pathway signaling.
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Reg Anesth Pain Med · Jul 2011
Comparative StudyPatient perceptions of regional anesthesia: influence of gender, recent anesthesia experience, and perioperative concerns.
Anesthesiologists often find that patients would prefer a general anesthetic (GA) to a regional anesthetic (RA) for surgery. We surveyed patients' attitudes to RA in an Australian tertiary-care hospital, hoping to understand the reasons for acceptance or refusal. We explored how 3 main factors influence the patient's choice for subsequent RA: gender, type of anesthetic on the day of surgery, and perioperative concerns. ⋯ More patients, especially females, may accept RA if reassured appropriately about not hearing or seeing the surgery. Once patients have experienced RA, they are more likely to choose it in future. Modification of our discussion and consent process may increase the uptake of RA techniques.
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Reg Anesth Pain Med · Jul 2011
Multicenter Study Comparative StudySpinal anesthesia failure after local anesthetic injection into cerebrospinal fluid: a multicenter prospective analysis of its incidence and related risk factors in 1214 patients.
Different mechanisms have been proposed to explain spinal anesthesia failure even after LA injection into the subarachnoid space. The aim of this prospective multicenter study was to assess the incidence of spinal anesthesia failure, excluding technical problems, and then to suggest independent factors leading to failure. ⋯ The results of this study showed that the incidence of spinal anesthesia failure was 3.2%. The number of puncture attempts at 3 or more and the absence of adjuvant medication associated with local anesthetic were independent factors associated with the increased risk of failure. The failure of spinal anesthesia was rare in patients older than 70 years.