Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2013
Randomized Controlled TrialLong-term pain and functional disability after total knee arthroplasty with and without single-injection or continuous sciatic nerve block in addition to continuous femoral nerve block: a prospective, 1-year follow-up of a randomized controlled trial.
This is a follow-up to determine long-term outcomes after total knee arthroplasty (TKA) in patients enrolled in a previous randomized trial that found reduced postoperative pain after addition of sciatic nerve block to continuous femoral nerve block for TKA. ⋯ No differences were detected in the secondary outcomes we examined. Thus, improved postoperative outcome did not translate into improved functional outcome or long-term pain.
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Reg Anesth Pain Med · Jan 2013
Local anesthetic-induced inhibition of human neutrophil priming: the influence of structure, lipophilicity, and charge.
Local anesthetics (LAs) are widely known for inhibition of voltage-gated sodium channels underlying their antiarrhythmic and antinociceptive effects. However, LAs have significant immunomodulatory properties and were shown to affect human neutrophil functions independent of sodium-channel blockade. Previous studies suggest a highly selective interaction between LAs and the α-subunit of G protein-coupled receptors of the Gq/G11 family as underlying mechanism. Providing a detailed structure function analysis, this study aimed to determine the active parts within the LA molecule responsible for the effects on human neutrophil priming. ⋯ Local anesthetics significantly attenuated Gαq-protein-mediated neutrophil priming. The most potent inhibition was achieved by ester compounds, inversely correlated with their octanol-buffer coefficient, and enhanced by permanent charges within the LA molecule. No correlation to their potency of blocking sodium channels was found.
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Reg Anesth Pain Med · Jan 2013
Randomized Controlled TrialProphylactic ondansetron does not prevent shivering or decrease shivering severity during cesarean delivery under combined spinal epidural anesthesia: a randomized trial.
Prophylactic ondansetron does not prevent shivering during cesarean section under regional block.
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Reg Anesth Pain Med · Jan 2013
Case ReportsRespiratory impact of analgesic strategies for shoulder surgery.
Shoulder surgery is associated with significant postoperative pain in many patients. The use of an interscalene nerve block offers good analgesia but is associated with a high incidence of an ipsilateral phrenic nerve block. ⋯ Possible strategies are (1) using very low volumes of local anesthetics, (2) targeting the brachial plexus at a lower level in the neck, (3) applying a suprascapular nerve block, and (4) applying the combination of a suprascapular and an axillary nerve block. Using systemic analgesics is a less favorable strategy because this may result in less potent analgesia and may cause more adverse effects, including respiratory depression and nausea.