Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2024
ReviewLocal anesthetic dosing and toxicity of adult truncal catheters: a narrative review of published practice.
Anesthesiologists frequently use truncal catheters for postoperative pain control but with limited characterization of dosing and toxicity. ⋯ Practitioners frequently administer ropivacaine and bupivacaine above the package insert limits, at doses associated with toxicity. Patient safety would benefit from more specific recommendations to limit excessive dose and risk of toxicity.
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Reg Anesth Pain Med · Mar 2024
Spread of local anesthetic injected in the paravertebral space, intertransverse processes space, and erector spinae plane: a cadaveric model.
Paraspinal fascial plane blocks have become popular and include the erector spinae plane (ESP) and intertransverse process (ITP) blocks. Controversy exists regarding the exact mechanism(s) of these blocks. We aimed to evaluate the spread of local anesthetic (LA) following ESP and ITP blocks as compared with paravertebral (PV) blocks in a cadaveric model. ⋯ Based on the results of this cadaveric experimental model of paraspinal fascial plane blocks, LA spread following ITP blocks extends into both the PV space and the erector spine fascial plane, and thus may offer a more favorable analgesic profile than ESP blocks.
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Reg Anesth Pain Med · Mar 2024
Intraoperative neurophysiological monitoring and spinal cord stimulator implantation.
Spinal cord injury (SCI) is one of the most dreaded complications after spinal cord stimulation (SCS) implantation surgery. As a result, intraoperative neurophysiological monitoring (IONM) has been proposed to avoid accidental damage to nervous structures under anesthesia and confirm positioning for optimal stimulation. Our study uses a large administrative claims database to determine the 30-day risk of SCI after SCS implantation. ⋯ Increased SCI risk among patients with IONM likely reflects higher baseline risk, and further research is needed for risk mitigation.
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Reg Anesth Pain Med · Mar 2024
Randomized Controlled Trial Multicenter StudyCooled radiofrequency ablation versus standard medical management for chronic sacroiliac joint pain: a multicenter, randomized comparative effectiveness study.
Low back pain is the leading cause of disability worldwide, with sacroiliac joint pain comprising up to 30% of cases of axial lower back pain. Conservative therapies provide only modest relief. Although placebo-controlled trials show efficacy for sacral lateral branch cooled radiofrequency ablation, there are no comparative effectiveness studies. ⋯ In patients with sacroiliac joint pain, cooled radiofrequency ablation provided statistically superior improvements across the spectrum of patient outcomes compared with standard medical management.
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Reg Anesth Pain Med · Mar 2024
Neurostimulation in the patient with chronic pain: forecasting the future with data from the present - data-driven analysis or just dreams?
Chronic pain involves a structured and individualized development of neurophysiological and biological responses. The final expression in each patient correlates with diverse expressions of mediators and activations of different transmission and modulation pathways, as well as alterations in the structure and function of the brain, all of which develop according to the pain phenotype. Still today, the selection process for the ideal candidate for spinal cord stimulation (SCS) is based on results from test and functional variables analysis as well as pain evaluation. ⋯ Structural and functional quantitative information provided by imaging biomarkers will allow establishing a clinical decision support system that improve the effectiveness of the SCS implantation, optimizing human, economic and psychological resources. A correct programming of the neurostimulator, as well as other factors associated with the choice of leads and their position in the epidural space, are the critical factors for the effectiveness of the therapy. Using a model of SCS based on mathematical methods and computational simulation, the effect of different factors of influence on clinical practice studied, as several configurations of electrodes, position of these, and programming of polarities, in order to draw conclusions of clinical utility in neuroestimulation therapy.