Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2016
Comparative StudyLocal Infiltration of Analgesics at Surgical Wound to Reduce Postoperative Pain After Laparotomy in Rats.
There is an increasing use of local infiltration analgesia (LIA) to reduce postoperative pain. Despite widespread use of LIA, wide variations in drug combinations and concomitant use of systemic analgesics have made it difficult to determine the optimal drug combinations for LIA. Using a previously validated rat laparotomy model, the optimal LIA combination of medications to reduce postoperative pain was determined. ⋯ Our animal study suggests that clinical trials with low-dose LIA combinations of local anesthetic, nonsteroidal anti-inflammatory drug, and corticosteroid may be useful for reducing postoperative pain after laparotomy.
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Reg Anesth Pain Med · Nov 2016
Case ReportsNecrotizing Fasciitis as a Complication of a Continuous Sciatic Nerve Catheter Using the Lateral Popliteal Approach.
Necrotizing fasciitis is an infection of the soft tissue that is characterized by rapidly spreading inflammation and subsequent necrosis. It is a rare complication of peripheral nerve blocks. We report a rare case of necrotizing fasciitis after placement of a peripheral nerve catheter. ⋯ Multiple reports have been published of necrotizing fasciitis after single-shot peripheral nerve block injections, neuraxial anesthesia, and intramuscular injections. This case highlights the potential for the rare complication of necrotizing fasciitis after peripheral nerve catheter placement.
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Reg Anesth Pain Med · Nov 2016
The Impact of Paravertebral Block Analgesia on Breast Cancer Survival After Surgery.
The impact of regional anesthesia on breast cancer recurrence is controversial. We tested the hypothesis that the use of paravertebral block (PVB) analgesia during breast cancer surgery prolongs the recurrence-free survival (RFS) and overall survival (OS) of women with breast cancer. ⋯ This retrospective study does not support the hypothesis that the use of regional analgesia is associated with longer survival after surgery for breast cancer.
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Reg Anesth Pain Med · Nov 2016
The Use of Epinephrine in Caudal Anesthesia Increases Stroke Volume and Cardiac Output in Children.
Caudal anesthesia is a common and effective regional anesthesia technique in pediatric patients. The addition of epinephrine to local anesthetics in caudal anesthesia is a frequent practice; however, changes in hemodynamic and cardiac parameters produced by epinephrine in caudal anesthesia are not well studied. Using data collected with the ICON noninvasive cardiac output monitor, we examined the hemodynamic changes associated with the administration of epinephrine containing local anesthetics during caudal anesthesia in children. ⋯ Epinephrine added to local anesthetic injected for caudal anesthesia produces significant increases in SV, CO, and CI in children. Stroke volume and CI changes from epinephrine added to local anesthetic for caudal anesthesia seem to take place only in children 6 months or older.
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Reg Anesth Pain Med · Nov 2016
Time Since Inciting Event Is Associated With Higher Centralized Pain Symptoms in Patients Diagnosed With Complex Regional Pain Syndrome.
We hypothesized that patients with complex regional pain syndrome (CRPS) with a longer time since their inciting event would demonstrate more symptoms of centralized pain. ⋯ Our findings suggest that the longer the patients have CRPS the more likely they are to report symptoms suggestive of centralized pain. These data may explain why some patients with a longer duration of CRPS do not respond to peripherally directed therapies.