Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jan 2017
A Cadaveric Study Evaluating the Feasibility of an Ultrasound-Guided Diagnostic Block and Radiofrequency Ablation Technique for Sacroiliac Joint Pain.
Ultrasound (US)-guided diagnostic block/radiofrequency ablation (RFA) along the lateral sacral crest (LSC) has been proposed for managing sacroiliac joint (SIJ) pain. We sought to investigate (1) ease of visualization of bony landmarks using US; (2) consistency of US-guided needle placement along the LSC; and (3) percentage of the posterior sacral network (PSN) innervating the SIJ complex that would be captured if an RFA strip lesion were created between the needles. ⋯ The findings suggest that US-guided needle placement along the LSC is consistent and could capture most or all of the PSN. A clinical study evaluating the outcomes of this technique is in progress.
-
Reg Anesth Pain Med · Jan 2017
Randomized Controlled Trial Comparative StudyProspective, Double-Blind, Randomized Study to Evaluate Single-Injection Adductor Canal Nerve Block Versus Femoral Nerve Block: Postoperative Functional Outcomes After Total Knee Arthroplasty.
Despite multiple clinical trials comparing the adductor canal block (ACB) with femoral nerve block (FNB) for total knee arthroplasty, none looked at the aforementioned nerve blocks from early functional results to up to 6 months after surgery. ⋯ The ACB showed better preservation of quadriceps muscle strength and improved ambulation in the first 24 hours postoperatively without compromising pain control.
-
Reg Anesth Pain Med · Jan 2017
Observational StudyAnalgesic Effect and Functional Improvement Caused by Radiofrequency Treatment of Genicular Nerves in Patients With Advanced Osteoarthritis of the Knee Until 1 Year Following Treatment.
Radiofrequency ablation of genicular nerves has proved to be successful in relieving pain and incapacity caused by osteoarthritis of the knee. However, long-term efficacy of such a treatment remains to be assessed. The current study aimed to reproduce radiofrequency neurotomy of genicular nerves to manage gonarthrosis pain and disability and establish therapeutic response until 1 year after intervention. ⋯ Ultrasound-guided radiofrequency neurotomy of genicular nerves alleviates intractable pain and disability in the majority of patients with advanced osteoarthritis of the knee. Such a treatment is safe and minimally invasive and can be performed in an outpatient setting. The beneficial effect of treatment started to decline after 6 months, but even 1 year after the intervention, 32% of patients reported 50% improvement or greater in pretreatment VAS scores.
-
Reg Anesth Pain Med · Jan 2017
Observational StudyClassification and Treatment of Chronic Neck Pain: A Longitudinal Cohort Study.
Neck pain exerts a steep personal and socioeconomic toll, ranking as the fourth leading cause of disability. The principal determinant in treatment decisions is whether pain is neuropathic or nonneuropathic, as this affects treatment at all levels. Yet, no study has sought to classify neck pain in this manner. ⋯ Although pure neuropathic pain comprised a small percentage of our cohort, 50% of our population consisted of mixed pain conditions containing a possible neuropathic component. There was significant overlap between the various classification schemes.
-
Reg Anesth Pain Med · Jan 2017
Randomized Controlled TrialEffect of Nerve Stimulation Use on the Success Rate of Ultrasound-Guided Subsartorial Saphenous Nerve Block: A Randomized Controlled Trial.
Ultrasound-guided subsartorial saphenous nerve block is commonly used to provide complete surgical anesthesia of the foot and ankle in combination with a popliteal sciatic nerve block. However, in part owing to its small caliber and absence of a prominent vascular landmark in the subsartorial plane distal to the adductor canal, the saphenous nerve is more difficult to reliably block than the sciatic nerve in the popliteal fossa. Although the saphenous nerve is a sensory nerve only, neurostimulation can be used to elicit a "tapping" sensation on the anteromedial aspect of the lower leg extending toward the medial malleolus. Our objective was to test the hypothesis that the addition of nerve stimulation use to an ultrasound (US)-guided technique will increase the success rate of subsartorial saphenous nerve block. ⋯ The addition of the use of nerve stimulation did not improve the success rate of US-guided subsartorial saphenous nerve block. However, in the NS group, an inability to elicit a "tapping" sensation in the saphenous nerve distribution was associated with block failure.