Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2012
Randomized Controlled Trial Multicenter Study Comparative StudyBupivacaine extended-release liposome injection exhibits a favorable cardiac safety profile.
Bupivacaine extended-release liposome injection is an investigational local analgesic intended for use in postsurgical pain management. In recognition of the incompletely characterized association of bupivacaine use and cardiac effects, this article reviews the cardiac safety profile of this novel formulation of bupivacaine. ⋯ A focused assessment of ECG data from a phase 2 study and cardiac findings/AEs data from other studies in the bupivacaine extended-release development program did not reveal any cardiac safety issues.
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Reg Anesth Pain Med · Mar 2012
Randomized Controlled TrialThe analgesic effects of a bilateral sternal infusion of ropivacaine after cardiac surgery.
The aim of this study was to assess the effects of a continuous postoperative administration of local anesthetic through 2 catheters placed deeply under fascia at the lateral edges of the sternum, close to the emergence of the intercostal nerves. We focused on pain during mobilization, as this aspect is likely to interact with postoperative morbidity. ⋯ This technique may find a role within the framework of multimodal analgesia after sternotomy, although further confirmatory studies are needed.
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Reg Anesth Pain Med · Mar 2012
Randomized Controlled Trial Comparative StudyBilateral transversus abdominis plane block does not decrease postoperative pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites.
Transversus abdominis plane (TAP) block has been shown to reduce pain and analgesic requirements after abdominal surgery. Our hypothesis was that bilateral TAP blocks decrease pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. ⋯ Bilateral ultrasound-guided TAP block is equivalent to local anesthetic infiltration of trocar insertion sites for overall postoperative pain in a heterogeneous group of patients undergoing laparoscopic cholecystectomy.
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Reg Anesth Pain Med · Mar 2012
Risk factors for new-onset persistent low-back pain following nonobstetric surgery performed with epidural anesthesia.
The aim of this trial was to identify risk factors for persistent low-back pain (LBP) of new onset following nonobstetric surgery performed with lumbar epidural anesthesia. ⋯ Persistent LBP after nonobstetric surgery performed with lumbar epidural anesthesia is rather rare. Independent risk factors for this untoward outcome are higher body mass index, multiple trials at epidural placement, surgery in the lithotomy position, and operative time exceeding 2½ hrs. These results need to be validated by prospective trials using larger cohorts.
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Reg Anesth Pain Med · Mar 2012
Ultrasound imaging to estimate risk of esophageal and vascular puncture after conventional stellate ganglion block.
The most common techniques to perform stellate ganglion blocks (SGBs) are the blind C6 approach and the fluoroscopic-controlled paratracheal C7 approach, both after manual dislocation of the large vessels. Complications due to vascular or esophageal puncture have been reported. The goal of this ultrasound imaging study was to determine how frequently hazardous structures are located along the needle path of conventional SGB and to determine the influence of the dislocation maneuver on their position. ⋯ The esophagus and relevant arteries were frequently located in the needle path of conventional SGBs. The dislocation maneuver had a partial impact on moving these structures away from the target and may increase left-sided esophageal puncture risk in certain individuals. Ultrasound (US) imaging is expected to improve the safety of SGB, but it will require clinical trials to confirm this expectation.