Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2020
Observational StudyDistribution of injectate administered through a catheter inserted by three different approaches to ultrasound-guided thoracic paravertebral block: a prospective observational study.
Despite the popularity of continuous thoracic paravertebral block (TPVB), there is a paucity of information on catheter tip position and distribution of injectate through the catheter. We observed, in real time, the spread of dye, the catheter tip position and sensory block levels produced with three different (intercostal (IC), transverse process sagittal (TS) and paralaminar (PL)) approaches to ultrasound-guided TPVB in patients undergoing video-assisted thoracoscopic surgery. ⋯ Although a bolus injection through a catheter for ultrasound-guided TPVB produced multiple levels of spread and sensory blockade in more than half the patients, considerable differences existed in the spread regardless of approach.
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Reg Anesth Pain Med · Nov 2020
Role of peripheral sensory neuron mu-opioid receptors in nociceptive, inflammatory, and neuropathic pain.
The role of peripheral mu-opioid receptors (MOPs) in chronic pain conditions is not well understood. Here, we used a combination of mouse genetics, behavioral assays, and pharmacologic interventions to investigate the contribution of primary afferent MOPs to nociceptive, inflammatory, and neuropathic pain, as well as to opioid analgesia. ⋯ MOPs in primary sensory neurons contribute to the modulation of neuropathic pain behavior and opioid analgesia. Our observations highlight the clinical potential of peripherally acting opioid agonists in the management of inflammatory and neuropathic pain.
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Reg Anesth Pain Med · Nov 2020
Evaluation of nerve capture using classical landmarks for genicular nerve radiofrequency ablation: 3D cadaveric study.
Radiofrequency (RF) denervation of the superolateral genicular nerve (SLGN), superomedial genicular nerve (SMGN) and inferomedial genicular nerve (IMGN) is commonly used to manage chronic knee joint pain. However, knowledge of articular branches captured, using classical landmarking techniques, remains unclear. In order to enhance and propose new RF procedures that conceivably capture a greater number of articular branches, more detailed cadaveric investigation is required. The objectives were to (1) determine which articular branches are captured or spared using classical landmarking techniques, and (2) evaluate the anatomical feasibility of classical landmarking techniques using three-dimensional (3D) modeling technology. ⋯ This study provides anatomical evidence supporting the effectiveness of classical landmarking for genicular nerve ablation; however, each technique resulted in sparing of articular branches. The extensive innervation of the knee joint suggests the use of supplementary landmarks to improve capture rates and potentially patient outcomes.
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Reg Anesth Pain Med · Nov 2020
Observational StudyImpact of video games on ultrasound-guided regional anesthesia skills.
There is an association between video game practice and laparoscopic expertize in trainee surgeons. Ultrasound-guided regional anesthesia has many parallels with laparoscopic surgery. The aim of this study was to explore whether video game experience is associated with enhanced performance in a simulated ultrasound-guided task in novice operators. ⋯ Video game practice is associated with increased mental rotation ability and enhanced technical performance in a simulated ultrasound-guided task.