Regional anesthesia and pain medicine
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The burden of chronic headache disorders in the United States is substantial. Some patients are treatment refractory. Ketamine, an N-methyl-D-aspartate antagonist, provides potent analgesia in subanesthetic doses in chronic pain, and limited data suggest it may alleviate headache in some patients. ⋯ Ketamine was associated with short-term analgesia in many refractory headache patients with tolerable adverse events. A prospective study is warranted to confirm this and elucidate responder characteristics.
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Reg Anesth Pain Med · Nov 2018
Thirty-Day Acute Health Care Resource Utilization Following Outpatient Anterior Cruciate Ligament Surgery.
The need for hospital-based acute care following outpatient surgical procedures is expensive and measured as marker for quality. However, little information is available about events leading to emergency department visit or inpatient admission after ambulatory anterior cruciate ligament (ACL) surgery. ⋯ The rate of hospital-based acute care following outpatient ACL surgery was 3.90%. Many of the events were expected complications related to surgery, such as infection and deep venous thrombosis. However, musculoskeletal pain, drug abuse, and psychotic events featured more prominently than expected. Our findings may direct efforts to address these reasons for seeking acute care after ACL surgery, reduce cost, and improve quality of care.
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Reg Anesth Pain Med · Nov 2018
Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache.
While existing studies about onabotulinumtoxinA for chronic migraines have focused on injection location and appropriate dosing, little consideration has been given to patient body habitus and its potential impact on efficacy. We hypothesized that with increasing patient body mass index (BMI) there would be more subcutaneous fat separating targeted muscle groups from the skin surface, such that standard 0.5-inch needles used in existing protocols may not allow intramuscular injection. This may have implications for treatment planning. ⋯ Our study demonstrates that with increasing BMI there is a greater distance between the skin surface and the muscle fascia of muscles that are targeted for injection in standard chronic migraine botulinum toxin injection protocols. Because of this, patient body habitus may be an important factor in injection technique.