Regional anesthesia and pain medicine
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A cautionary summary of the benefits and potential risks of perineural dexamethasone.
"...there have been no reports of neurotoxicity or complications of any kind attributed to perineural dexamethasone in the nearly 700 patients who have received it in published studies of peripheral nerve blocks ... We must acknowledge that complications in regional anesthesia are rare, and 700 patients are woefully inadequate to declare dexamethasone safe for routine perineural use." (Noss 2014)
Noss concludes that:
- Perineural dexamethasone is probably safe, though conclusive safety evidence is still lacking.
- Systemic effects from IV dex is unlikely to explain the profound block prolongation.
- Prolongation is not enough on its own.
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Reg Anesth Pain Med · Nov 2014
Randomized Controlled TrialEffect of Intravenous Lidocaine on Postoperative Recovery of Patients Undergoing Mastectomy: A Double-Blind, Placebo-Controlled Randomized Trial.
One of the modalities of treatment for breast cancer surgery pain is opioids, and opioids are associated with adverse effects such as itching and postoperative nausea and vomiting (PONV). Intravenous (IV) lidocaine has been shown to reduce opioid consumption and to improve overall postoperative outcomes in abdominal surgery. In this study, we tested the effect of intraoperative IV lidocaine infusion on the quality of postoperative recovery after breast cancer surgery. ⋯ Our findings did not show a significant effect of IV lidocaine during breast cancer surgery on opioid consumption, pain score, PONV, or fatigue, indicating that the benefit of this approach does not generalize across all types of surgery.
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Reg Anesth Pain Med · Nov 2014
Randomized Controlled TrialContinuous Right Thoracic Paravertebral Block Following Bolus Initiation Reduced Postoperative Pain After Right-Lobe Hepatectomy: A Randomized, Double-Blind, Placebo-Controlled Trial.
We hypothesized that continuous right thoracic paravertebral block, following bolus initiation, decreases opioid consumption after right-lobe hepatectomy in patients receiving patient-controlled intravenous analgesia with sufentanil. ⋯ Continuous right thoracic paravertebral block, following bolus initiation, has an opioid-sparing effect on sufentanil patient-controlled intravenous analgesia for right-lobe hepatectomy patients and reduces numerical rating scale pain scores at rest and with coughing in the first 24 postoperative hours.
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Reg Anesth Pain Med · Nov 2014
Multicenter Study Comparative StudyUsing an International Clinical Registry of Regional Anesthesia to Identify Targets for Quality Improvement.
Despite the widespread use of regional anesthesia, limited information on clinical performance exists. Institutions, therefore, have little knowledge of how they are performing in regard to both safety and effectiveness. In this study, we demonstrate how a medical institution (or physician/physician group) may use data from a multicenter clinical registry of regional anesthesia to inform quality improvement strategies. ⋯ To our knowledge, this is the first large-scale effort to use a clinical registry to provide comparative outcome rates representing the safety and effectiveness of regional anesthesia. These results can be used to help inform quality improvement strategies.