Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2019
Efficacy of the ketamine metabolite (2R,6R)-hydroxynorketamine in mice models of pain.
Ketamine has been shown to reduce chronic pain; however, the adverse events associated with ketamine makes it challenging for use outside of the perioperative setting. The ketamine metabolite (2R,6R)-hydroxynorketamine ((2R,6R)-HNK) has a therapeutic effect in mice models of depression, with minimal side effects. The objective of this study is to determine if (2R,6R)-HNK has efficacy in both acute and chronic mouse pain models. ⋯ This study demonstrates that (2R,6R)-HNK is superior to ketamine in reducing mechanical allodynia in acute and chronic pain models and suggests it may be a new non-opioid drug for future therapeutic studies.
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Reg Anesth Pain Med · Jan 2019
Randomized Controlled Trial Comparative StudyInterfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial.
In the context of opioid-sparing perioperative management, there is still little evidence from randomized controlled trials regarding the effectiveness of interfascial thoracic blocks. This study hypothesizes that receiving a serratus plane block reduces opioid requirements, pain scores, and rescue medication needs. ⋯ Interfascial serratus plane block reduces opioid requirements and is associated with better pain scores and lower and later rescue analgesia needs in the first 24 hours, compared with conventional intravenous analgesia, in breast surgery.
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Reg Anesth Pain Med · Jan 2019
Implementation of an enhanced recovery program in pediatric laparoscopic colorectal patients does not worsen analgesia despite reduced perioperative opioids: a retrospective, matched, non-inferiority study.
Enhanced recovery protocols (ERPs) decrease length of stay and postoperative morbidity, but it is important that these benefits do not come at a cost of sacrificing proper perioperative analgesia. In this retrospective, matched cohort study, we evaluated postoperative pain intensity in pediatric patients who underwent laparoscopic colorectal surgeries before and after ERP implementation. ⋯ Implementation of our ERP for pediatric laparoscopic colorectal patients was associated with less perioperative opioids without worsening postoperative pain scores. In addition, patients who received the protocol had faster return of bowel function, shorter postoperative hospital stays, and a lower rate of 30-day hospital readmissions. In pediatric laparoscopic colorectal patients, the incorporation of an ERP was associated with a pronounced decrease in perioperative morbidity without sacrificing postoperative analgesia.
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Reg Anesth Pain Med · Jan 2019
"Pseudo-suprascapular notch": is it a sonographic trap in suprascapular nerve block?
The aim of the study was to describe the radiological anatomy of the pseudo-suprascapular notch-a structure localized at the floor of the supraspinatus fossa, just below the true suprascapular notch. In sonographic examination, it may imitate the suprascapular notch leading to misidentification of these structures. ⋯ The pseudo-suprascapular notch is a hollow for nutrient vessels that can be mistaken for the regular suprascapular notch in cases of difficult sonographic navigation.