Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2015
Randomized Controlled TrialImpact of pregabalin on the occurrence of postthoracotomy pain syndrome: a randomized trial.
Postthoracotomy pain syndrome (PTPS) is a frequent cause of chronic postoperative pain. Pregabalin might reduce the incidence of chronic postoperative pain. The goal of this study was to evaluate the impact of perioperative pregabalin on the occurrence of PTPS, defined as any surgical site pain 3 months after surgery. ⋯ Pregabalin did not reduce the incidence of PTPS in this study. Future research on PTPS should focus on the impact of regional analgesia on central sensitization.
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Reg Anesth Pain Med · May 2015
Practice GuidelineInterventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the american society of regional anesthesia and pain medicine, the European society of regional anaesthesia and pain therapy, the american academy of pain medicine, the international neuromodulation society, the north american neuromodulation society, and the world institute of pain.
Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. ⋯ The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.
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Reg Anesth Pain Med · May 2015
ReviewTales From the Wild West of US Drug Pricing: The Case of Intravenous Acetaminophen.
This article aims to discuss and provide insight into the effects of the increased use and price (from $12.43 to $35.40 in 2014) of intravenous acetaminophen, which has rapidly gained acceptance in the field of perioperative medicine. Overall use and characteristics are described for selected surgeries with absolute use particularly high in orthopedic surgeries associated with substantial costs (up to an additional $160,000 per year per hospital for just orthopedic use). The availability of large-scale data on costs and use of intravenous acetaminophen in the United States will greatly benefit the ongoing discussions on its place in current practice.
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Reg Anesth Pain Med · May 2015
Review Case ReportsThe parturient with implanted spinal cord stimulator: management and review of the literature.
Spinal cord stimulation (SCS) is an approved treatment for complex regional pain syndrome and other chronic pain conditions. These devices enable women with chronic pain to maintain relatively normal lives, with some encountering pregnancy. Use of previously implanted SCS systems in pregnant women is considered controversial due to lack of long-term prospective studies evaluating both maternal and fetal safety. ⋯ Management approaches and outcomes in our patients, as well as those previously reported are discussed within this article. Definitive conclusions cannot be drawn from this small cohort. We believe that management of a parturient with an implanted SCS requires careful planning between all peripartum physicians.
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Reg Anesth Pain Med · May 2015
Observational StudyEvaluation of anxiety in procedure-naive patients during cervical and lumbar epidural steroid injection procedures.
The lack of studies that identify patient and procedural risk factors for increased levels of anxiety during spine injections represents a major barrier to the development of safe tailored sedation practices. We measured and compared anxiety in procedure-naive patients undergoing a cervical or lumbar interlaminar epidural steroid injection to identify predictors of patient movement and vasovagal responses in the periprocedural period. ⋯ No group differences in anxiety were seen between cervical and lumbar groups. Anxiety levels were not associated with patient movement or vasovagal symptoms. Our results suggest that the practice of routine prevention or treatment of injection-related anxiety in the procedure-naive general population with a duration of pain less than 6 months and without a history of an anxiety disorder should be reevaluated.