Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Dec 2023
Real-world study of intranasal ketamine for use in patients with refractory chronic migraine: a retrospective analysis.
Subanesthetic ketamine infusion has been used for managing refractory headache in inpatient or outpatient infusion settings. Intranasal ketamine may be an alternative option for outpatient care. ⋯ In this descriptive study, intranasal ketamine served as an acute treatment for refractory chronic migraine by reducing headache intensity and improving quality of life with relatively tolerable adverse events. Most patients found intranasal ketamine effective and continued to use it despite these adverse events. Given the potential for overuse, it should be reserved for those clearly in need of more effective rescue treatment with appropriate safety precautions. Well-designed prospective placebo-controlled trials are necessary to demonstrate the efficacy and safety of intranasal ketamine in patients with migraine.
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Reg Anesth Pain Med · Dec 2023
Observational StudyContralateral oblique view can prevent dural puncture in fluoroscopy-guided cervical epidural access: a prospective observational study.
Although the contralateral oblique (CLO) view at 50°±5° is clinically useful for cervical epidural access, no previous studies have confirmed its safety. This prospective observational study was conducted to assess the safety profile, including the risk of dural puncture, in fluoroscopically guided cervical epidural access using the CLO view. ⋯ The fluoroscopy-guided CLO view at 50°±5° avoided dural puncture or spinal cord injury and decreased the incidence of false LOR during cervical epidural access with a paramedian approach.
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Reg Anesth Pain Med · Dec 2023
Identification of interfascial plane using injection pressure monitoring at the needle tip during ultrasound-guided TAP block in cadavers.
Consistency in needle tip positioning within interfascial planes while performing infiltrative blocks under ultrasound guidance can be difficult. The exact determination of such planes may beyond the physical limits of common ultrasound machines. Aim of this pilot study was to understand if real-time continuous injection pressure monitoring at the needle tip, combined with ultrasound guidance, can help to immediately and consistently identify an interfascial plane needle tip placement. ⋯ The identified injection pressure pattern, together with ultrasound image, may help in determine real-time the needle tip position, while performing a TAP block.