Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2014
Randomized Controlled TrialEndogenous opioid inhibition of chronic low-back pain influences degree of back pain relief after morphine administration.
Factors underlying differential responsiveness to opioid analgesic medications used in chronic pain management are poorly understood. We tested whether individual differences in endogenous opioid inhibition of chronic low-back pain were associated with the magnitude of acute reductions in back pain ratings after morphine administration. ⋯ Morphine appears to provide better acute relief of chronic back pain in individuals with lower natural opioidergic inhibition of chronic pain intensity. Possible implications for personalized medicine are discussed.
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Reg Anesth Pain Med · Mar 2014
Randomized Controlled TrialTreatment of Postmastectomy Pain With Ambulatory Continuous Paravertebral Nerve Blocks: A Randomized, Triple-Masked, Placebo-Controlled Study.
We aimed to determine with this randomized, triple-masked, placebo-controlled study if benefits are afforded by adding a multiple-day, ambulatory, continuous ropivacaine paravertebral nerve block to a single-injection ropivacaine paravertebral block after mastectomy. ⋯ After mastectomy, adding a multiple-day, ambulatory, continuous ropivacaine infusion to a single-injection ropivacaine paravertebral nerve block results in improved analgesia and less functional deficit during the infusion. However, no benefits were identified after infusion discontinuation.
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Reg Anesth Pain Med · Mar 2014
Randomized Controlled Trial Comparative StudyA Randomized Comparison of the Efficacy of 2 Techniques for Piriformis Muscle Injection: Ultrasound-Guided Versus Nerve Stimulator With Fluoroscopic Guidance.
Piriformis muscle injections are most often performed using fluoroscopic guidance; however, ultrasound (US) guidance has recently been described extensively in the literature. No direct comparisons between the 2 techniques have been performed. Our objective was to compare the efficacy and efficiency of fluoroscopic- and US-guided techniques. ⋯ Ultrasound-guided piriformis injections provide similar outcomes to fluoroscopically guided injections without differences in imaging, needling, or overall procedural times.
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Reg Anesth Pain Med · Mar 2014
Case ReportsDyskinesia Caused by Ziconotide-Baclofen Combination in an Adolescent Affected by Cerebral Palsy.
To report on the first case of ziconotide-induced dyskinesia. Ziconotide, a synthetic peptide analogue of the ω-conotoxin MVIIA that blocks selectively N-type voltage-sensitive calcium channels, has been used in intrathecal administration for 30 years. Ziconotide is a drug of choice for chronic pain because of its efficacy and flexibility because it can substitute or complement other intrathecal therapies including morphine or baclofen. Whereas substantial information is available regarding its efficacy, systematic data regarding the safety of ziconotide remain scant. The adverse reactions to ziconotide described so far regard only the coordination and execution of intentional movements. ⋯ An analysis of the signaling pathways of baclofen and ziconotide revealed a possible drug interaction that allowed ziconotide to trigger dyskinesia.