Regional anesthesia and pain medicine
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Ultrasound guidance has led a surge of interest in transversus abdominis plane (TAP) block for postoperative analgesia following abdominal surgery. Despite or because of the numerous descriptive applications and techniques that have recently populated the literature, results of comparative studies for TAP block have been inconsistent. This systematic review pragmatically addresses many unanswered questions, specifically the following: what are the effects of surgical procedure, block dose, block technique, and block timing on TAP block analgesia? Eighteen intermediate- to good-quality randomized trials that included diverse surgical procedures were identified. ⋯ Eight of 9 trials using preincisional TAP block and 4 of 9 with postincisional block revealed better analgesic outcomes. Although the majority of trials reviewed suggest superior early pain control, we were unable to definitively identify the surgical procedures, dosing, techniques, and timing that provide optimal analgesia following TAP block. This review suggests that our understanding of the TAP block and its role in contemporary practice remains limited.
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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.