Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2020
CommentCaudal analgesia versus abdominal wall blocks for pediatric genitourinary surgery: systematic review and meta-analysis.
Caudal block is a well-established technique for providing perioperative analgesia in pediatric genitourinary surgery, but abdominal wall blocks such as ilioinguinal-iliohypogastric (II-IH) and transversus abdominis plane (TAP) block are increasingly being used. ⋯ This meta-analysis was limited by unclear risk of selection and performance biases and significant heterogeneity. In summary, II-IH and TAP block are a non-invasive and reasonable alternative to caudal analgesia in pediatric genitourinary surgery.
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Reg Anesth Pain Med · Nov 2020
Randomized Controlled TrialAnalgesic efficacy of infiltration between the popliteal artery and capsule of the knee (iPACK) block added to local infiltration analgesia and continuous adductor canal block after total knee arthroplasty: a randomized clinical trial.
A combination of motor-sparing analgesia with local infiltration analgesia (LIA) and continuous adductor canal block (CACB) may improve postoperative pain and functional recovery for total knee arthroplasty (TKA). We hypothesized that the addition of a novel technique for posterior knee block, known as the infiltration between the popliteal artery and capsule of the knee (iPACK) block, to LIA with CACB would reduce opioid requirements. ⋯ The addition of an iPACK block to the LIA and CACB does not reduce the postoperative opioid consumption nor improve analgesia. However, it may improve immediate functional performance and reduce the length of hospitalization after TKA.
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Reg Anesth Pain Med · Nov 2020
Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service.
Chronic postsurgical pain and opioid use is a problem among patients undergoing many types of surgical procedures. A multidisciplinary approach to perioperative pain management known as a transitional pain service (TPS) may lower these risks. ⋯ These data suggest that a TPS is an effective strategy for preventing new COU and reducing overall opioid use following orthopedic joint procedures in a Veterans Affairs hospital.
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Reg Anesth Pain Med · Nov 2020
CommentSpinal versus general anesthesia for outpatient joint arthroplasty: can the evidence keep up with the patients?
Total joint arthroplasty (TJA) is transitioning to be an outpatient rather than an inpatient procedure under national and institutional pressures to increase volumes while reducing hospital costs and length of stay. Innovative surgical and anesthesia techniques have allowed for earlier ambulation and physical therapy participation, maximizing the chance that an appropriately selected patient may be discharged within a day of surgery. The choice of anesthesia type is a modifiable factor that has a major impact on both surgical outcomes and discharge readiness. ⋯ Multimodal analgesia for all TJA patients may also help minimize differences in pain. Perhaps even more important than anesthesia technique is the proper selection of patients likely to meet the necessary milestones for early discharge. In this article, we provide two contrasting viewpoints on the optimal primary anesthetic for outpatient TJA.
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Reg Anesth Pain Med · Nov 2020
Pocket pain, does location matter: a single-centre retrospective study of patients implanted with a spinal cord stimulator.
Spinal cord stimulation (SCS) is an effective therapy for alleviating pain but reported complication rates vary between healthcare centers. This study explored the prevalence of pain associated with Implantable Pulse Generators (IPGs), the component that powers the SCS system. ⋯ These findings suggest that IPG site pain is a common complication, contributing to SCS revisions and explantation. This study shows that anatomical factors and baseline characteristics of individual patients may contribute to IPG site pain and indicates that exploration of potential factors leading to IPG revision is required.