Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2016
Effects of Intrathecal κ-Opioid Receptor Agonist on Morphine-Induced Itch and Antinociception in Mice.
The μ-opioid receptor (MOR) agonist-induced itch is a significant issue associated with analgesic therapies. Research suggested that systemically administered κ-opioid receptor (KOR) agonists inhibit intrathecal morphine-induced itch in primates. However, serious adverse effects induced by systemically administered KOR agonists may restrict their usefulness in humans. ⋯ Morphine 0.1 nmol + TRK-820 10 pmol significantly produced greater thermal antinociceptive effects than morphine 0.1 nmol. We demonstrated that intrathecal KOR agonists exert antipruritic effects on intrathecal morphine-induced itch without affecting sedation. The combination of intrathecal morphine and intrathecal KOR agonists produces more potent antinociceptive effects against a thermal stimulus compared with morphine alone.
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Reg Anesth Pain Med · Jan 2016
ReviewUltrasound-Guided Interventional Procedures in Pain Medicine: A Review of Anatomy, Sonoanatomy, and Procedures: Part VI: Ankle Joint.
Ultrasound-guided injections in pain medicine are emerging as a popular technique for pain interventions. Ultrasound can be applied for procedures of the ankle joint and surrounding structures. This review describes the anatomy and sonoanatomy of the ankle joint, subtalar joint, and surrounding extra-articular structures relevant for intra-articular injection. Second, it reviews injection techniques and the accuracy and efficacy of these intra-articular ankle injections.
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Reg Anesth Pain Med · Jan 2016
Serum Triamcinolone Levels Following Interlaminar Epidural Injection.
Lumbar interlaminar epidural steroid injections (ESIs) are one of the most commonly performed procedures in pain medicine, but little is known about the serum levels of steroids following injection into the epidural space. The primary objective of this study was to investigate the pharmacokinetics of fluoroscopy-guided epidural-administered triamcinolone acetonide in a cohort of patients with chronic low-back pain seeking treatment in a pain medicine clinic. ⋯ The pharmacokinetics of epidural-administered triamcinolone is consistent with previously observed adverse effects of the drug on endocrine function. The pharmacokinetics of other epidural-administered steroids should be determined and incorporated in clinical trials to investigate the potential associations between serum levels, clinical outcomes, and potential adverse endocrine effects.
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Reg Anesth Pain Med · Jan 2016
Comparative StudyA Clinical Comparison of Intravenous and Epidural Local Anesthetic for Major Abdominal Surgery.
Epidural analgesia provides good pain control after many postoperative procedures, but it can lead to complications, has some contraindications, and occasionally fails. Intravenous lidocaine infusion has been suggested as an alternative. We assessed, in our clinical practice, the effects of perioperative intravenous lidocaine infusion compared with epidural analgesia for major abdominal surgery. ⋯ Patients who received systemic lidocaine infusions with the addition of PRN (as needed) opioids administered for breakthrough pain did not have clinically significant differences in pain scores on postoperative day 2 and beyond. Intravenous lidocaine infusion in major abdominal surgery was inferior to epidural analgesia with respect to opioid consumption. However, lidocaine was associated with improvements in several important aspects of recovery.
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Reg Anesth Pain Med · Jan 2016
Real-Time Captioning for Improving Informed Consent: Patient and Physician Benefits.
New methods are needed to improve physicians' skill in communicating information and to enhance patients' ability to recall that information. We evaluated a real-time speech-to-text captioning system that simultaneously provided a speech-to-text record for both patient and anesthesiologist. The goals of the study were to assess hearing-impaired patients' recall of an informed consent discussion about regional anesthesia using real-time captioning and to determine whether the physicians found the system useful for monitoring their own performance. ⋯ Real-time speech-to-text captioning improved recall in hearing-impaired patients and proved useful for determining the information provided during an informed consent encounter. Real-time speech-to-text captioning could provide a method for assessing physicians' communication that could be used both for self-assessment and as an evaluative approach to training communication skills in practice settings.