Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2014
Randomized Controlled TrialEfficacy of Ketamine as an Adjunct to Lidocaine in Intravenous Regional Anesthesia.
The addition of ketamine to lignocaine-based IVRA (Bier's block) significantly improved analgesia and patient satisfaction without increasing side effects.
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Reg Anesth Pain Med · Sep 2014
Randomized Controlled TrialPreoperative Fascia Iliaca Compartment Block for Positioning Patients With Hip Fractures for Central Nervous Blockade: A Randomized Trial.
Appropriate pain management may positively affect outcome following hip fractures. Positioning patients for spinal anesthesia (SA) can be extremely painful. Peripheral nerve blockades are gaining popularity in this setting. This prospective, randomized study compares the efficacy of fascia iliaca compartment block (FICB) to intravenous (IV) fentanyl for positioning hip fracture patients for SA. ⋯ Performing an FICB before positioning for SA provides superior pain management compared with IVFE administration, facilitates spinal performance, and yields satisfactory postoperative analgesia and wide patient acceptance, hence improving overall quality and efficiency of care.
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Reg Anesth Pain Med · Jul 2014
Randomized Controlled TrialAdherence to guidelines for the management of local anesthetic systemic toxicity is improved by an electronic decision support tool and designated "reader".
A hardcopy or paper cognitive aid has been shown to improve performance during the management of simulated local anesthetic systemic toxicity (LAST) when given to the team leader. However, there remains room for improvement to ensure a system that can achieve perfect adherence to the published guidelines for LAST management. Recent research has shown that implementing a checklist via a designated reader may be of benefit. Accordingly, we sought to investigate the effect of an electronic decision support tool (DST) and designated "Reader" role on team performance during an in situ simulation of LAST. ⋯ In a prospective, randomized single-blinded study, a designated Reader with an electronic DST improved adherence to guidelines in the management of an in situ simulation of LAST. Such tools are promising in the future of medicine, but further research is needed to ensure the best methods for implementing them in the clinical arena.
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Reg Anesth Pain Med · Jul 2014
Randomized Controlled TrialThoracic paravertebral block and its effects on chronic pain and health-related quality of life after modified radical mastectomy.
Patients undergoing breast cancer surgery frequently experience chronic postoperative pain. The primary objective of this randomized study was to determine if thoracic paravertebral block (TPVB) reduced the incidence of chronic pain after a modified radical mastectomy (MRM) when compared with general anesthesia (GA). ⋯ There is no significant difference in the incidence or relative risk of chronic pain at 3 and 6 months after an MRM when TPVB is used in conjunction with GA. Nevertheless, patients who receive a TPVB report less severe chronic pain, exhibit fewer symptoms and signs of chronic pain, and also experience better physical and mental HRQOL.
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Reg Anesth Pain Med · Jul 2014
Randomized Controlled Trial Comparative StudySubparaneural Versus Circumferential Extraneural Injection at the Bifurcation Level in Ultrasound-Guided Popliteal Sciatic Nerve Blocks: A Prospective, Randomized, Double-Blind Study.
Subparaneural injection for popliteal sciatic nerve block shows faster onset and longer duration than circumferential extraneural injection.
pearl