Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Aug 2019
Perioperative duloxetine for acute postoperative analgesia: a meta-analysis of randomized trials.
Multimodal analgesia is a fundamental part of modern surgery and enhanced recovery pathways. Duloxetine, a serotonin and norepinephrine reuptake inhibitor, has been validated for the treatment of chronic neuropathic pain. The evidence for duloxetine as an adjunct for the treatment of acute postoperative pain remains controversial. We conducted a meta-analysis to determine the efficacy of duloxetine in the acute perioperative setting. ⋯ CRD42019121416.
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Reg Anesth Pain Med · Aug 2019
Accuracy of fluoroscopic-guided genicular nerve blockade: a need for revisiting anatomical landmarks.
Genicular nerve blockade (GNB) and radiofrequency ablation (RFA) have recently emerged as treatment options for patients with chronic knee pain. However, an increasing number of anatomical studies and systematic reviews concluded that the anatomical basis for needle placement was unclear, incomplete and somewhat inaccurate. This study was designed to assess the accuracy of updated anatomical landmarks for fluoroscopy-guided blockade of the consistent genicular nerves in a cadaveric model. ⋯ This study provides physicians with precise anatomical landmarks for the five consistent GN for fluoroscopic-guided GNB. Our revised technique, which targets more nerves with increased accuracy, could potentially lead to improved therapeutic benefits on chronic knee pain.
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Reg Anesth Pain Med · Aug 2019
Feasibility of an ultrasound-guided approach to radiofrequency ablation of the superolateral, superomedial and inferomedial genicular nerves: a cadaveric study.
Genicular nerve radiofrequency (RF)denervation appears to be a promising treatment for knee pain in patients with degenerative osteoarthritis of the knee, when candidates are not suitable for arthroplasty. This study aimed to assess the accuracy and reliability of ultrasound-guided placement of RF cannulas in cadavers for genicular nerve treatment, by measuringthe needle-to-nerve proximity. ⋯ The results of this study demonstrate that ultrasound-guided treatment of the genicular nerves is feasible. However, for RF ablations, there are some limitations, which mostly can be overcome by using appropriate RF ablation settings.
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Reg Anesth Pain Med · Aug 2019
Chloroprocaine versus prilocaine for spinal anesthesia in ambulatory knee arthroscopy: a double-blind randomized trial.
In ambulatory lower limb surgery, spinal anesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-chloroprocaine would be associated with a faster motor block recovery compared with prilocaine in knee arthroscopy. A difference of 15 min was considered clinically relevant. ⋯ In knee arthroscopy, spinal anesthesia with 2-chloroprocaine results in a faster recovery of motor and sensory block, leading to quicker hospital discharge compared with prilocaine.