Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Apr 2022
Novel approach for pericapsular radiofrequency ablation of sacrococcygeal junction for patients with coccydynia.
Coccydynia is a multifactorial complex clinical challenge. A multimodal approach with both conservative measures and procedural interventions is often recommended. We described a novel approach of radiofrequency (RF) ablation for the management of coccydynia. ⋯ The configuration of the two bipolar lesions with multi-tined needles in this case series stimulates the thinking of new approach for the ablation technique for pain from coccyx. Further prospective large case cohort study is needed.
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Reg Anesth Pain Med · Apr 2022
A retrospective cohort study of three wound catheter infusion analgesia regimes after midline laparotomy.
Local anesthetic wound infusion catheters are increasingly used postmidline laparotomy to reduce pain and opioid use, however there is little evidence to support any particular infusion regime. ⋯ Intermittent wound infusion catheter infusion regimes were associated with lower maximum daily dynamic pain scores, although the magnitude of this change may be of limited clinical significance.
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Reg Anesth Pain Med · Apr 2022
Anatomical study and clinical significance of rami communicantes of the lumbar spine.
Rami communicantes (RC) infiltration and radiofrequency lesions are new techniques for the treatment of discogenic low back pain (DLBP). Their efficacy is controversial, and the classification of RC remains unclear. We aimed to explore the differences between RC and reclassify RC according to their anatomical characteristics. ⋯ RC should play an important role in the innervation of the lumbar spine. Detailed knowledge of RC in the lumbar region may help surgeons improve the efficacy of infiltration and percutaneous radiofrequency as a supplementary treatment for DLBP.
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Reg Anesth Pain Med · Apr 2022
Association of perioperative midazolam use and complications: a population-based analysis.
The benzodiazepine midazolam is the main sedative used in the perioperative setting, resulting in anxiolysis and a reduction in anesthetic dose requirements. However, benzodiazepine use is also associated with potentially serious side effects including respiratory complications, and postoperative delirium (POD). A paucity of population level data exists on current perioperative midazolam use in adult orthopedic surgery and its effects on complications. Using a large national dataset, we aimed to determine perioperative midazolam utilization patterns and to analyze its effect on postoperative outcomes. ⋯ Perioperative midazolam use was associated with an increase in postoperative patient falls, and a decrease in cardiac complications. Notably, the combined use of midazolam and gabapentinoids was associated with a substantial increase in the odds for respiratory failure and delirium. Given the high prevalence of benzodiazepines perioperatively, the risk benefit profile should be more clearly established to inform perioperative decision making.