Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2013
ReviewUltrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part IV: hip.
Ultrasound-guided injection in pain medicine is emerging as a popular technique for pain intervention. It can be applied for the intervention procedures in the hip region. The objectives of this review article were to review the relevant anatomy and sonoanatomy of the hip joint and the trochanteric bursae, to describe the techniques for ultrasound-guided injections, and to examine the efficacy and accuracy of such injections.
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Reg Anesth Pain Med · Jul 2013
The impact of analgesic modality on early ambulation following total knee arthroplasty.
Total knee arthroplasty is associated with moderate to severe pain, and effective analgesia is essential to facilitate postoperative recovery. This retrospective cohort study examined the analgesic and rehabilitation outcomes associated with 48-hour continuous femoral nerve block, local infiltration analgesia, or local infiltration analgesia plus adductor canal nerve block. ⋯ Local infiltration analgesia was associated with improved early analgesia and ambulation. The addition of adductor canal nerve block was associated with further improvements in early ambulation and a higher incidence of home discharge.
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Reg Anesth Pain Med · Jul 2013
Comparative StudyRanking of tests for pain hypersensitivity according to their discriminative ability in chronic neck pain.
Quantitative sensory testing (QST) is widely used to investigate peripheral and central sensitization. However, the comparative performance of different QST for diagnostic or prognostic purposes is unclear. We explored the discriminative ability of different quantitative sensory tests in distinguishing between patients with chronic neck pain and pain-free control subjects and ranked these tests according to the extent of their association with pain hypersensitivity. ⋯ Pressure stimulation at the site of the most severe pain and parameters of electrical stimulation were the most appropriate QST to distinguish between patients with chronic neck pain and asymptomatic control subjects. These findings may be used to select the tests in future diagnostic and longitudinal prognostic studies on patients with neck pain and to optimize the assessment of localized and spreading sensitization in chronic pain patients.
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Reg Anesth Pain Med · Jul 2013
Comparative StudyNovice learner in-plane ultrasound imaging: which visualization technique?
Needle guidance under ultrasound is an acquired skill requiring fine motor control. Maintaining the image of an advancing needle in the plane of an ultrasound beam may be performed with the probe and needle orientated along the visual axis (AL) or across the visual axis (AC). This study was undertaken to determine if orientation affected task performance. ⋯ Advancing the needle along the visual axis was associated with improved task completion speed and quality of needle imaging. This ergonomic pattern, therefore, may be the more appropriate choice for novices learning ultrasound-guided in-plane needle imaging.
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Reg Anesth Pain Med · Jul 2013
Reporting functional outcome after knee arthroplasty and regional anesthesia: a methodological primer.
The introduction of ultrasound guidance for regional anesthesia has resulted in an explosion of interest in its use for postoperative analgesia, particularly for orthopedic surgery. Regional anesthesia demonstrates unequivocal superiority compared with systemic opioids with respect to analgesia, reduced opioid consumption, increased patient satisfaction, and earlier achievement of discharge criteria. Improved acute postoperative analgesia can facilitate effective rehabilitation. ⋯ Furthermore, the functional outcome measures are used inappropriately in terms of clinically meaningful difference, assessment intervals, and/or duration of follow-up. This report aims to address these issues by discussing functional outcomes used in the physiotherapy or orthopedic literature and their appropriate utilization, so that future research into the effects of regional anesthesia can be methodologically sound. Outcomes discussed include those that are physical-performance-based (ie, range of motion, quadriceps strength, Timed Up and Go test, 6-Minute Walk Test, Stair Time, and Self-paced Walk Test) and those that are self-reported (ie,Western Ontario and McMaster Universities Osteoarthritis Index, Knee Osteoarthritis Severity Score, Lower Extremity Function Scale).