Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Oct 2018
ReviewGastric Ultrasound for the Regional Anesthesiologist and Pain Specialist.
This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthesiologist and pain specialist is significant as our clinical practice often involves providing deep sedation without a secured airway. Given that pulmonary aspiration is a well-known cause of perioperative morbidity and mortality, the ability to evaluate for NPO (nil per os) status and risk stratify patients scheduled for anesthesia is a powerful skill set. ⋯ In this review, we will cover the relevant scanning technique and the desired views for gastric US. We provide a methodology for interpretation of findings and for guiding medical management for adult patients. We also summarize the current literature on specific patient populations including obstetrics, pediatrics, and severely obese subjects.
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Reg Anesth Pain Med · Oct 2018
A Novel Technique of Ultrasound-Guided Selective Mandibular Nerve Block With a Lateral Pterygoid Plate Approach: A Cadaveric Study.
We aimed to describe a novel technique of ultrasound-guided selective mandibular nerve block with a lateral pterygoid plate (LPP) approach and to assess its feasibility and accuracy in a soft cadaver model. ⋯ This study was registered at the Thai Clinical Trials Registry (ClinicalTrials.in.th), identifier TCTR20160601004.
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Reg Anesth Pain Med · Oct 2018
Hypertonic Sodium Chloride Preinjectate Increases In Vivo Radiofrequency Ablation Size: Histological and Magnetic Resonance Imaging Findings.
Emphasis has been placed on methods to enlarge monopolar radiofrequency (RF) lesion size for pain management. Ex vivo research has suggested that fluid modulation may be an effective method to enlarge lesion zone. To date, these findings have not been confirmed in vivo. The purpose of this study was to determine the effect of hypertonic saline on in vivo lesion size through both histological and magnetic resonance imaging (MRI) analysis. A secondary purpose was to validate in vivo characterization of RF lesions using contrast-enhanced MRI. ⋯ This study validates the ability of hypertonic saline to increase in vivo RF lesion size. With further refinement, MRI may be a viable method to assess RF lesion size.
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Reg Anesth Pain Med · Oct 2018
Randomized Controlled Trial Comparative StudyPerineural Versus Systemic Dexamethasone in Front-Foot Surgery Under Ankle Block: A Randomized Double-Blind Study.
Among the different adjuvants, dexamethasone is one of the most accepted to prolong the effect of local anesthetics. This study aims to determine the superiority of perineural over systemic dexamethasone administration after a single-shot ankle block in metatarsal osteotomy. ⋯ This study was registered at ClinicalTrials.gov, identifier NCT02904538.
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Reg Anesth Pain Med · Oct 2018
Observational StudyAcute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty.
Pain scores are routinely reported in clinical practice, and we wanted to examine whether this routinely measured, patient-reported variable provides prognostic information, especially with regard to chronic opioid use, after taking preoperative and perioperative variables into account in a preoperative opioid user population. ⋯ Acute pain predicts chronic opioid use. Prospective studies of efforts to reduce acute pain, in terms of long-term effects, are needed.