Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2011
Comparative StudyInterventional pain physicians' experiences of and attitudes toward surgical privileging.
No consensus guidelines exist on surgical privilege credentialing for nonsurgeons. We queried a group of academic interventional pain physicians about their experiences acquiring such credentials after training, how this process reflected their training, and their current attitudes toward both processes. ⋯ Experience doing implantation procedures during fellowship training and subsequent experience with hospital surgical credentialing seems to vary widely, even among interventional pain physicians associated with academic training programs.
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Reg Anesth Pain Med · Sep 2011
Randomized Controlled Trial Multicenter Study Comparative StudyIntraoperative local infiltration analgesia for early analgesia after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial.
High-volume local infiltration analgesia (LIA) is widely applied as part of a multimodal pain management strategy in total hip arthroplasty (THA). However, methodological problems hinder the exact interpretation of previous trials, and the evidence for LIA in THA remains to be clarified. Therefore, we evaluated whether intraoperative high-volume LIA, in addition to a multimodal oral analgesic regimen, would further reduce acute postoperative pain after THA. ⋯ Intraoperative high-volume LIA with ropivacaine 0.2% provided no additional reduction in acute pain after THA when combined with a multimodal oral analgesic regimen consisting of acetaminophen, celecoxib, and gabapentin and is therefore not recommended.
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Reg Anesth Pain Med · Sep 2011
Randomized Controlled Trial Comparative StudyDoes continuous sciatic nerve block improve postoperative analgesia and early rehabilitation after total knee arthroplasty? A prospective, randomized, double-blinded study.
The aim of this prospective, randomized, double-blind study was to evaluate whether continuous sciatic nerve block can improve postoperative pain relief and early rehabilitation compared with single-injection sciatic nerve block in patients undergoing total knee arthroplasty (TKA) and lumbar plexus block. ⋯ Continuous sciatic nerve block improves analgesia, decreases morphine request, and improves early rehabilitation compared with single-injection sciatic nerve block in patients undergoing TKA and lumbar plexus block.
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Reg Anesth Pain Med · Sep 2011
Comparative StudyGlutamate release and neurologic impairment after intrathecal administration of lidocaine and bupivacaine in the rat.
Local anesthetic-induced neurotoxicity is one of the potential causes of postspinal anesthesia neurologic injury. Many experimental and clinical studies have demonstrated that lidocaine is more neurotoxic than bupivacaine. The mechanisms of local anesthetic-induced neurotoxicity remain unclear. Glutamate is an excitatory amino acid and widely exists in the central nervous system. Overstimulation of the glutamate receptors may produce neuronal toxic effect. In this study, we used in vivo microdialysis to examine the glutamate release in cerebrospinal fluid (CSF) after intrathecal lidocaine and bupivacaine injection. ⋯ Intrathecal lidocaine caused a concentration-dependent increase of the CSF glutamate release and postinjection neurologic impairment; these effects can be reversed by MK-801. However, intrathecal bupivacaine shows no influence. We suggest that glutamate may be involved in the pathogenesis of lidocaine-induced spinal neurotoxicity.