Regional anesthesia and pain medicine
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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
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 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
Comparative StudySleep apnea and total joint arthroplasty under various types of anesthesia: a population-based study of perioperative outcomes.
The presence of sleep apnea (SA) among surgical patients has been associated with significantly increased risk of perioperative complications. Although regional anesthesia has been suggested as a means to reduce complication rates among SA patients undergoing surgery, no data are available to support this association. We studied the association of the type of anesthesia and perioperative outcomes in patients with SA undergoing joint arthroplasty. ⋯ Barring contraindications, neuraxial anesthesia may convey benefits in the perioperative outcome of SA patients undergoing joint arthroplasty. Further research is needed to enhance an understanding of the mechanisms by which neuraxial anesthesia may exert comparatively beneficial effects.