Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Mar 2021
Review Meta AnalysisParavertebral block for the prevention of chronic postsurgical pain after breast cancer surgery.
Patients frequently report chronic postsurgical pain (CPSP) after breast cancer surgery (BCS). The paravertebral block (PVB) is an effective technique to reduce acute postoperative pain after BCS, but its efficacy in preventing CPSP is unclear. This meta-analysis evaluates the efficacy of PVB in preventing CPSP after BCS. ⋯ Similar results were obtained at 3 and 12 months (RR 0.78 (95% CI 0.57 to 1.06), RR 0.45 (95% CI 0.14 to 1.41), respectively). Data for the 12-month time point from seven studies (2087 patients) were analyzed and showed that PVB protected against CPSNP, with low quality of evidence (RR 0.51 (95% CI 0.31 to 0.85)). In conclusion, CPSP was not found significantly prevented by PVB after BCS despite the limits in the included studies; nevertheless, PVB could prevent CPSNP by impacting the transition from acute to chronic pain.
-
Reg Anesth Pain Med · Mar 2021
Randomized Controlled TrialFemoral artery block (FAB) attenuates thigh tourniquet-induced hypertension: a prospective randomized, double-blind, placebo-controlled trial.
Prolonged tourniquet inflation during surgery frequently leads to tourniquet hypertension (TH), which is thought to arise from compression of A-δ fibers leading to sympathetically mediated C fiber activation. In the lower extremity, C fibers and other sympathetic nerve fibers are carried along the femoral artery. We hypothesized that blockade of these fibers at the femoral artery would decrease the incidence of TH. ⋯ Under these experimental conditions, injection of local anesthetic around the femoral artery reduced the incidence of TH and intraoperative esmolol requirement.
-
Reg Anesth Pain Med · Mar 2021
Validation of a new protocol for ultrasound-guided genicular nerve radiofrequency ablation with accurate anatomical targets: cadaveric study.
Ultrasound (US)-guided radiofrequency ablation (RFA) of genicular nerves (GNs) is increasingly performed to manage chronic knee pain. The anatomical foundations supporting the choice of original targets for US-guided GN-RFA have been thoroughly improved by recent anatomical studies. Therefore, this study aimed to provide a new protocol with revised anatomical targets for US-guided GN-RFA and to assess their accuracy in a cadaveric model. ⋯ US-guided GN-RFA with revised anatomical targets resulted in accurate capture of the five targeted nerves. This protocol provides precise sensory denervation of a larger panel of nerves, targeting those whose constancy regarding anatomical location has been clearly demonstrated. It is expected to improve the clinical outcomes.