Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2014
Case ReportsEpidural Hematomas After Removal of Percutaneous Spinal Cord Stimulator Trial Leads: Two Case Reports.
We report 2 cases of spinal epidural hematoma formation after the removal of percutaneous spinal cord stimulator trial leads and discuss the possible etiologies of these complications. ⋯ Currently, the neuromodulation community ascribes to the American Society of Regional Anesthesia and Pain Medicine guidelines, which state that nonsteroidal anti-inflammatory drugs do not significantly increase the risk for epidural hematoma with neuraxial anesthesia and, therefore, there is no need to discontinue these drugs before epidural or spinal anesthesia. We suggest that these guidelines may not be appropriate for neuromodulatory techniques that likely subject the surrounding vasculature to more trauma than neuraxial anesthesia. We recommend discontinuing nonsteroidal anti-inflammatory drugs, particularly aspirin, before neuromodulation procedures. Further investigation will establish a timeframe for holding these drugs to optimize patient safety.
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Reg Anesth Pain Med · Jan 2014
Are Patients Satisfied After Peripheral Nerve Blockade? Results From an International Registry of Regional Anesthesia.
Peripheral nerve blockade (PNB) is associated with superior outcomes compared with opioids; however, little is known regarding patients' perceptions of the care they have received. Patient satisfaction is emerging as an important indicator of quality of health care, and identifying deficiencies in discrete aspects of satisfaction may allow targeted interventions to improve quality. In this study, we analyze data relevant to patient satisfaction from the International Registry of Regional Anesthesia. The primary objective of this analysis was to report the results of a patient-satisfaction questionnaire and to determine predictors associated with unwillingness to have PNB repeated in the case of future surgery. ⋯ A high proportion of survey respondents were willing to undergo repeat PNB in case of future surgery and were satisfied with their anesthetic care. Targeted interventions to improve quality of PNB should be aimed at improving comfort, information provision, and physician-patient interaction.
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Reg Anesth Pain Med · Jan 2014
Biography Historical ArticleA Tribute to a Brilliant Mind: Jerry Vloka, MD, PhD.
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Reg Anesth Pain Med · Jan 2014
Case ReportsSpinal Epidural Hematoma After Spinal Cord Stimulator Trial Lead Placement in a Patient Taking Aspirin.
Spinal epidural hematoma is a rare, but potentially devastating, consequence of accessing the epidural space for anesthesia or interventional pain procedures. There is no consensus to stop aspirin therapy before interventional chronic pain procedures. ⋯ The only variable that could have led to our patient's epidural hematoma is aspirin. This is the first reported case of aspirin leading to an epidural hematoma following an interventional chronic pain procedure. Prior to interventional pain procedures, one should contemplate cessation of aspirin therapy because there are, at present, no consensus guidelines to direct such a decision.