Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Feb 2025
ReviewChronic postsurgical pain and transitional pain services: a narrative review highlighting European perspectives.
Chronic postsurgical pain (CPSP) is a significant, often debilitating outcome of surgery, impacting patients' quality of life and placing a substantial burden on healthcare systems worldwide. CPSP (pain persisting for more than 3 months postsurgery) leads to both physical and psychological distress. Recognized as a distinct chronic pain entity in International Classification of Diseases, 11th Revision, CPSP enables better reporting and improved management strategies. Despite advancements in surgical care, CPSP remains prevalent, affecting 5%-85% of patients, with higher rates following thoracotomies, amputations, mastectomies and joint replacements. ⋯ Future research should focus on large-scale studies integrating various factors to facilitate CPSP prediction, refine prevention strategies and reduce its long-term impact.
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Reg Anesth Pain Med · Jan 2025
ReviewEfficacy of long-acting local anesthetics versus their mixture with shorter-acting local anesthetics for peripheral nerve blocks guided by ultrasound: a systematic review with meta-analysis of randomized controlled trials.
Local anesthetic (LA) mixtures are used in peripheral nerve blocks (PNB) to improve onset, though study results remain conflicting. ⋯ LA mixtures may not affect sensory and motor block onset in ultrasound-guided PNB but could shorten the duration of sensory blockade.
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Reg Anesth Pain Med · Jan 2025
Influence of antithrombotic medication on size and neurological outcome of spinal epidural hematoma after neuraxial anesthesia: a systematic review.
Anticoagulation guidelines were developed to reduce the potential risk of epidural bleeding following neuraxial anesthesia. However, the influence of antithrombotic medication on size of spinal epidural hematoma and neurological outcome is unclear. Therefore, our aim was to analyze whether there is a correlation. ⋯ Antithrombotic medication is not significantly associated with hematoma size; however, the use of antithrombotic medication doubled the risk for persistent neurological deficit after spinal epidural hematoma.
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Reg Anesth Pain Med · Jan 2025
ReviewBuprenorphine versus full agonist opioids for acute postoperative pain management: a systematic review and meta-analysis of randomized controlled trials.
Opioids continue to play a key role in managing acute postoperative pain, but their use contributes to adverse outcomes. Buprenorphine may offer effective analgesia with a superior safety profile. ⋯ CRD42023447715.
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Reg Anesth Pain Med · Dec 2024
Review Case ReportsIntrathecal baclofen pump in pregnancy: case report, literature review, and management considerations.
Baclofen, a gamma-aminobutyric acid receptor type B agonist in the central nervous system, is the first-line medication among central nervous system modulating agents for the treatment of neurogenic muscle spasticity. While baclofen is most often administered enterally, patients with severe spasticity may be candidates for baclofen delivered by intrathecal pump. Currently, there are only nine studies reporting on the use of intrathecal baclofen (ITB) during pregnancy and childbirth. ⋯ Our case, alongside the existing literature on ITB during pregnancy, suggests that ITB therapy in pregnancy poses a low risk of teratogenicity and infant withdrawal seizures; however, larger, controlled studies are necessary to make those conclusions with confidence. Healthcare providers caring for pregnant ITB patients should be cognizant of the potential for such patients to require increased doses of ITB during pregnancy to achieve adequate symptom control.