Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Apr 2020
Centralized pain and pain catastrophizing mediate the association between lifetime abuse history and self-reported pain medication side effects.
Self-reported side effects of pain medication are important determinants of treatment course that can affect patient adherence, medication discontinuation and physician decisions. Yet, few studies have investigated patient-level predictors of self-reported pain medication side effects. The present study sought to fill this gap by exploring the impact of physical or sexual abuse history on self-reported pain medication side effects and considered a mediation model in which those effects are transmitted through a centralized pain phenotype and pain catastrophizing. ⋯ This suggests that individuals who experience abuse may develop a heightened physiological sensitivity to stimuli, as well as a tendency to interpret stimuli negatively, exaggerate the impact of aversive stimuli and undermine their ability to cope with the stressor. This study highlights the need for physicians to understand patient-level predictors of medication tolerance and to consider a history of abuse and trauma in decisions regarding treatment and medication management.
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Reg Anesth Pain Med · Apr 2020
Thoracoscopic lung biopsy under regional anesthesia for interstitial lung disease.
Interstitial lung disease (ILD) management guidelines support lung biopsy-guided therapy. However, the high mortality associated with thoracoscopic lung biopsy using general anesthesia (GA) in patients with ILD has deterred physicians from offering this procedure and adopt a diagnostic approach based on high-resolution CT. Here we report that thoracoscopy under regional anesthesia could be a safer alternative for lung biopsy and effectively guide ILD treatment. ⋯ Thoracoscopy using regional anesthesia might be a safer alternative to lung biopsy in patients with ILD.
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Reg Anesth Pain Med · Apr 2020
Does cryoneurolysis result in persistent motor deficits? A controlled study using a rat peroneal nerve injury model.
Cryoneurolysis of peripheral nerves uses localised intense cold to induce a prolonged block over multiple weeks that has the promise of providing potent analgesia outlasting the duration of postoperative pain following surgery, as well as treat other acute and chronic pain states. However, it remains unclear whether persistent functional motor deficits remain following cryoneurolysis of mixed sensorimotor peripheral nerves, greatly limiting clinical application of this modality. To help inform future research, we used a rat peroneal nerve injury model to evaluate if cryoneurolysis results in persistent deficits in motor function. ⋯ When applied to a mixed sensorimotor nerve, cryoneurolysis did not result in persistent motor deficits.