Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Oct 2021
The role for regional anesthesia in medical emergencies during deep space flight.
As humanity presses the boundaries of space exploration and prepares for long-term interplanetary travel, including to Mars, advanced planning for the safety and health of the crewmembers requires a multidisciplinary approach. In particular, in the event of a survivable medical emergency requiring an interventional procedure or prolonged pain management, such as traumatic limb injury or rib fracture, anesthetic protocols that are both safe and straightforward to execute must be in place. In this daring discourse, we discuss particular considerations related to the use of regional techniques in space and present the rationale that regional anesthesia techniques may be the safest option in many medical emergencies encountered during prolonged space flight.
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Reg Anesth Pain Med · Oct 2021
ReviewPsychological interventions to reduce postoperative pain and opioid consumption: a narrative review of literature.
Evidence suggests that over half of patients undergoing surgical procedures suffer from poorly controlled postoperative pain. In the context of an opioid epidemic, novel strategies for ameliorating postoperative pain and reducing opioid consumption are essential. Psychological interventions defined as strategies targeted towards reducing stress, anxiety, negative emotions and depression via education, therapy, behavioral modification and relaxation techniques are an emerging approach towards these endpoints. ⋯ Some preoperative psychological interventions can reduce pain scores and opioid consumption in the acute postoperative period; however, there is a clear need to strengthen the evidence for these interventions. The optimal technique, strategies, timing and interface requires further investigation.
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Reg Anesth Pain Med · Oct 2021
Randomized Controlled TrialUltrasound-guided genicular nerve blocks following total knee arthroplasty: a randomized, double-blind, placebo-controlled trial.
Local anesthetic blockade of the genicular nerves, known targets of radiofrequency ablative techniques for knee pain, has not previously been studied in a randomized controlled trial evaluating acute pain after knee arthroplasty. We hypothesized that genicular nerve blockade added to an existing block regimen in total knee arthroplasty would result in a reduction in 24 hours opioid consumption. ⋯ Genicular nerve blockade was associated with a reduction in opioid consumption at 24 hours in primary total knee arthroplasty patients.
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Reg Anesth Pain Med · Oct 2021
ReviewLocal anesthetic systemic toxicity in children: a review of recent case reports and current literature.
Local anesthetic systemic toxicity (LAST) in children occurs at an estimated rate of 8 per 100 000 blocks (95% CI 0.3 to 1.6). Due to the potential lethality of this iatrogenic complication, a better clarity of risk factors, clinical presentation, and prognosis may be clinically useful for contemporary treatment and prevention. ⋯ Infants represented a disproportionately large number of reports of LAST. The majority of local anesthetic doses were within currently published guidelines. Among the reported cases, penile and caudal blocks were the most commonly associated with LAST. Needle aspiration and test dosing with epinephrine failed to predict LAST with certainty. When LAST presented with severe cardiac compromise, intravenous lipid emulsion was given within 10 min in 43% of cases (13 of 30 reported cases). The vast majority of children were under general anesthesia when local anesthetic medications were administered. In children under general anesthesia, LAST presented with cardiac manifestations in 90% of cases (19 of 21 cases). There were no deaths or long-term morbidity reported.