Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · May 2014
Randomized Controlled TrialRelationship Between Endogenous Opioid Function and Opioid Analgesic Adverse Effects.
Our recent work indicates that endogenous opioid activity influences analgesic responses to opioid medications. This secondary analysis evaluated whether endogenous opioid activity is associated with degree of opioid analgesic adverse effects, and whether chronic pain status and sex affect these adverse effects. ⋯ No consistent relationships were observed between endogenous opioid function and morphine-related adverse effects. This is in stark contrast to our previous observation of strong relationships between elevated endogenous opioid function and smaller morphine analgesic effects.
-
Reg Anesth Pain Med · May 2014
Randomized Controlled Trial Comparative StudyContinuous Versus Single-Injection Sciatic Nerve Block Added to Continuous Femoral Nerve Block for Analgesia After Total Knee Arthroplasty: A Prospective, Randomized, Double-Blind Study.
The benefit of adding sciatic nerve block (SNB) to femoral nerve block to improve analgesia after total knee arthroplasty (TKA) is uncertain. We hypothesized that the effective duration of single-injection SNB is too short to improve postoperative analgesia and that this contributes to conflicting results on the efficacy of SNB after TKA. We evaluated this hypothesis in a prospective double-blind randomized controlled trial. ⋯ The combination of continuous femoral and SNB provides a superior opioid sparing effect and improves analgesia after TKA.
-
Reg Anesth Pain Med · May 2014
Randomized Controlled TrialA Prospective Randomized Observer-Blinded Study to Assess Postoperative Analgesia Provided by an Ultrasound-Guided Bilateral Thoracic Paravertebral Block for Children Undergoing the Nuss Procedure.
This prospective, randomized, single-blinded study evaluates the effectiveness of the ultrasound-guided bilateral thoracic paravertebral (BTPV) block for providing postoperative pain control in children undergoing the Nuss procedure. ⋯ Ultrasound-guided BTPV block provides improved postoperative analgesia for children undergoing the Nuss procedure as compared with intravenous PCA and decreases the incidence of postoperative behavioral disturbance.
-
Reg Anesth Pain Med · Mar 2014
Randomized Controlled TrialMinimum Effective Volume of Combined Lidocaine-Bupivacaine for Analgesic Subparaneural Popliteal Sciatic Nerve Block.
The aim of this study was to determine the minimum effective volume (MEV) of combined lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 μg/mL in 90% of patients (MEV90) for ultrasound-guided subparaneural popliteal sciatic nerve block. ⋯ For ultrasound-guided subparaneural (analgesic) popliteal sciatic nerve block, the MEV90 of combined lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 μg/mL is 13.3 mL (95% confidence interval, 10.2-16.4 mL).
-
Reg Anesth Pain Med · Mar 2014
Randomized Controlled TrialEndogenous opioid inhibition of chronic low-back pain influences degree of back pain relief after morphine administration.
Factors underlying differential responsiveness to opioid analgesic medications used in chronic pain management are poorly understood. We tested whether individual differences in endogenous opioid inhibition of chronic low-back pain were associated with the magnitude of acute reductions in back pain ratings after morphine administration. ⋯ Morphine appears to provide better acute relief of chronic back pain in individuals with lower natural opioidergic inhibition of chronic pain intensity. Possible implications for personalized medicine are discussed.