Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Mar 2012
Neurologic complications after chlorhexidine antisepsis for spinal anesthesia.
Recent reports of infectious complications after neuraxial procedures highlight the importance of scrupulous aseptic technique. Although chlorhexidine gluconate (CHG) has several advantages over other antiseptic agents; including a more rapid onset of action, an extended duration of effect, and rare bacterial resistance, it is not approved by the US Food and Drug Administration for use before lumbar puncture because of absence of clinical safety evidence. The objective of this retrospective cohort study was to test the hypothesis that the incidence of neurologic complications associated with spinal anesthesia after CHG skin antisepsis is not different than the known incidence of neurologic complications associated with spinal anesthesia. ⋯ The incidence of neurologic complications possibly associated with spinal anesthesia (0.04%) after CHG skin antisepsis is consistent with previous reports of neurologic complications after spinal anesthesia. These results support the hypothesis that CHG can be used for skin antisepsis before spinal placement without increasing the risk of neurologic complications attributed to the spinal anesthetic.
-
Reg Anesth Pain Med · Mar 2012
In vitro antiseptic effects on viability of neuronal and Schwann cells.
Chlorhexidine is recommended by several anesthesiology societies for antisepsis before regional anesthesia, but there is concern it may be neurotoxic. We evaluated the cytotoxicity of chlorhexidine and povidone-iodine in human neuronal and rat Schwann cells. ⋯ Chlorhexidine gluconate and povidone-iodine were cytotoxic to SH-SY5Y (neuronal) and RSC96 (Schwann) cells. Chlorhexidine was more potent than povidone-iodine at more dilute concentrations. However, the toxicity of the two was not different at concentrations used clinically. When using either of these agents for antisepsis before regional anesthesia, it is prudent to allow adequate drying time after application.
-
Reg Anesth Pain Med · Mar 2012
Ultrasound-guided injection of lumbar zygapophyseal joints: an anatomic study with fluoroscopy validation.
Diagnostic and therapeutic injections of the zygapophyseal joint (z-joint) are routinely performed under radiologic guidance (eg, fluoroscopy, computed tomography). Technically, these procedures could also be completed using ultrasound guidance, but existing evidence insufficiently supports this alternative imaging method, and it cannot therefore be recommended as a standard practice. There has also been no published proof-of-concept study using a routine fluoroscopy control for ultrasound-guided z-joint injections. ⋯ Ultrasound may be a viable alternative to fluoroscopy or computed tomography as a guidance method for lumbar z-joint injections.
-
Reg Anesth Pain Med · Mar 2012
Modulating pain in the periphery: gene-based therapies to enhance peripheral opioid analgesia: Bonica lecture, ASRA 2010.
This article provides a brief overview of earlier work of our group on the peripheral signaling of pain, summarizes more recent studies on the role of opioids in chronic neuropathic pain, and speculates on the future of gene-based therapies as novel strategies to enhance the peripheral modulation of pain. Neurophysiologic and psychophysical studies have revealed features of primary afferent activity from somatic tissue that led to improved understanding of the physiology and pathophysiology of pain signaling by nociceptive and nonnociceptive fibers. ⋯ Our work has focused on characterizing this peripheral opioid analgesia in chronic neuropathic pain such that it can be exploited to develop novel and potent peripheral analgesics for its treatment. Ongoing research on virus-mediated gene transfer strategies to enhance peripheral opioid analgesia is presented.