Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2016
Case ReportsPerioperative Nerve Injury After Peripheral Nerve Block in Patients With Previous Systemic Chemotherapy.
There are multiple risk factors for developing perioperative nerve injury (PNI). Perioperative nerve injury after peripheral nerve blockade (PNB) is rare. Exposure to systemic chemotherapy may cause peripheral neuropathy, but its role as a risk factor for PNI after PNB is unknown. The objective of this retrospective study was to determine the incidence of PNI in patients undergoing PNB as part of extremity surgery after prior exposure to systemic chemotherapy. ⋯ The overall incidence of PNI in this cohort (2.2%) was not different than baseline risk established in large cohort studies. Perioperative nerve injury was possibly attributable to the PNB in 0.5% of patients. However, in the absence of a control group of surgical patients who previously received systemic chemotherapy without regional anesthesia, we cannot determine whether the higher incidence of neurologic injury is secondary to the surgical procedure, the anesthetic technique, the natural progression of chemotherapy-induced peripheral neuropathy, or a combination of factors and the relative contribution of each.
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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
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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Peripheral nerve block for total knee arthroplasty is ideally motor sparing while providing effective postoperative analgesia. To achieve these goals, one must understand surgical dissection techniques, distribution of nociceptive generators, sensory innervation of the knee, and nerve topography in the thigh.