Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2015
Randomized Controlled TrialAddition of Dexamethasone and Buprenorphine to Bupivacaine Sciatic Nerve Block: A Randomized Controlled Trial.
Sciatic nerve block provides analgesia after foot and ankle surgery, but block duration may be insufficient. We hypothesized that perineural dexamethasone and buprenorphine would reduce pain scores at 24 hours. ⋯ Pain scores were very low at 24 hours after surgery in the context of multimodal analgesia and were not improved by additives. However, perineural buprenorphine and dexamethasone prolonged block duration, reduced the worst pain experienced, and reduced opioid use. Intravenous buprenorphine caused troubling nausea and vomiting. Future research is needed to confirm and extend these observations.
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Reg Anesth Pain Med · Jul 2015
Multicenter StudyDevelopment and Validation of an Assessment of Regional Anesthesia Ultrasound Interpretation Skills.
Interpretation of ultrasound images and knowledge of anatomy are essential skills for ultrasound-guided peripheral nerve blocks. Competency-based educational models promoted by the Accreditation Council for Graduate Medical Education require the development of assessment tools for the achievement of different competency milestones to demonstrate the longitudinal development of skills that occur during training. ⋯ This study provides evidence for the reliability, content validity, and construct validity of a 47-item multiple choice-style online test of ultrasound interpretation skills for regional anesthesia, which can be used as an assessment of competency milestone achievement in anesthesiology training.
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Reg Anesth Pain Med · Jul 2015
Observational StudyProspective Observational Study of Patient-Controlled Intrathecal Analgesia: Impact on Cancer-Associated Symptoms, Breakthrough Pain Control, and Patient Satisfaction.
Although data exist for the efficacy of intrathecal therapy (ITT), there are no prospective data on patient-controlled intrathecal analgesia (PCIA) in refractory cancer pain. This study examines the effect of PCIA on cancer symptom scores, patient satisfaction, and analgesic efficacy with an emphasis on breakthrough pain (BTP). ⋯ In patients with poorly controlled cancer pain, PCIA is associated with improved pain control, improved cancer-related symptoms, and high satisfaction. Compared with conventional BTP regimens, PCIA provides superior analgesia and a 3-fold faster onset of action.
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Reg Anesth Pain Med · Jul 2015
Biography Historical ArticlePeggy's Pain and the Creation of Gone With the Wind.
Margaret Mitchell (1900-1949), author of the best-selling novel Gone With the Wind had chronic, widespread pain for most of her adult life. She was accident prone and sustained injuries leading to unexpectedly prolonged periods of recovery and had unusual illnesses that puzzled her physicians. ⋯ In this report, the details of her health problems are reviewed. During her life, her diagnoses were problematic and remain so now, but would most likely include fibromyalgia and irritable bowel syndrome.
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Reg Anesth Pain Med · Jul 2015
Pneumoperitoneum Does Not Influence Spread of Local Anesthetics in Midaxillary Approach Transversus Abdominis Plane Block: A Descriptive Cadaver Study.
The transversus abdominis plane (TAP) block can be used as part of a multimodal analgesia protocol after abdominal surgery. This study investigated whether a pneumoperitoneum during abdominal surgery influences the spread of local anesthetics. ⋯ The stretch of the abdominal wall caused by the insufflation of the abdomen does not influence the spread of dye in the abdominal wall. Because of the absence of posterior spread, regardless of the timing of a midaxillary ultrasound-guided approach, we believe that a posterior approach should be chosen if posterior spread is desired.