Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2023
Randomized Controlled Trial Multicenter StudyComparison of cooled versus conventional radiofrequency treatment of the genicular nerves for chronic knee pain: a multicenter non-inferiority randomized pilot trial (COCOGEN trial).
Radiofrequency (RF) treatment of the genicular nerves has the potential to reduce chronic knee pain due to osteoarthritis or persistent postsurgical pain, however, a direct comparison between the two main modalities used, conventional and cooled, is lacking. ⋯ Both conventional and cooled RF treatment reduced pain in the osteoarthritis and persistent postsurgical pain population. This pilot study did not demonstrate statistically significant differences in the proportion of patients experiencing ≥50% pain reduction between techniques. The non-inferiority analysis was inconclusive. These results warrant further research.
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Reg Anesth Pain Med · May 2023
ReviewStellate ganglion block catheters for refractory electrical storm: a retrospective cohort and care pathway.
Electrical storm can be challenging to treat, requiring a multidisciplinary team to coordinate medical management and invasive procedures. As the stellate ganglion provides efferent sympathetic outflow to the myocardium, stellate ganglion blocks (SGB) can be used to combat ventricular arrhythmias that arise from sympathetic overactivity. Data are scarce regarding SGB catheters as a treatment for electrical storm. We reviewed our use of SGB catheters for refractory electrical storm using our pathway collaboratively developed by critical care, cardiology, and regional anesthesia teams. ⋯ SGBs can interrupt or treat electrical storm. SGB catheters allow for prolonged arrhythmia cessation without repeated blocks and decrease the risk of repeat episodes of ventricular arrhythmias.
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Reg Anesth Pain Med · May 2023
Case ReportsNovel use of continuous pericapsular nerve group (PENG) block technique for traumatic superior and inferior pubic rami fractures: a case report.
Pubic rami fractures are painful injuries more commonly seen in the elderly with osteoporosis after high velocity trauma. In the most cases, management is conservative and non-operative with the goal to provide optimal pain relief to facilitate early mobilization and hospital discharge. Unfortunately, opioids remain the mainstay analgesic option and regional anesthesia techniques are limited but may include lumbar epidural anesthesia. ⋯ Analgesia options are limited in pubic rami fractures. We present the first published case of a novel use of the PENG block with a continuous catheter technique for the analgesic management of a traumatic superior and inferior pubic rami fracture. The clinical utility of this technique in pubic ramus fractures warrants further clinical investigation.
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Reg Anesth Pain Med · May 2023
Clinical TrialResidual anti-Xa activity in plasma of patients presenting for electively planned neuraxial regional anesthesia.
To determine the incidence of increased anti-Xa activity within plasma levels 24 hours after administration of therapeutic dose low-molecular-weight heparin in patients presenting for elective neuraxial anesthesia. ⋯ Relevant residual anticoagulant activity, as measured by plasma anti-Xa levels within a prophylactic range, is measurable 24 hours after the last administration of therapeutic dose low-molecular-weight heparin.
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Reg Anesth Pain Med · May 2023
Association of patient characteristics with the receipt of regional anesthesia.
Regional anesthesia (RA) may improve patient-related outcomes, including decreased operative complications, shortened recovery times, and lower hospital readmission rates. More analyses are needed using a diverse set of databases to examine characteristics associated with the receipt of RA. ⋯ RA use varies with respect to race, insurance status, and type of surgery.