Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2014
Randomized Controlled TrialIncreases in the Use of Prescription Opioid Analgesics and the Lack of Improvement in Disability Metrics Among Users.
In the United States, use of oral opioid analgesics has been associated with increasing rates of addiction, abuse, and diversion. However, little is known about the recent national use of non-illicit prescription opioid analgesics (those prescribed in a physician-patient relationship), the primary source of these drugs for the general US population. Our primary objective was to examine trends in the use of prescription opioid analgesics in the United States and to identify defining characteristics of patient users of prescribed opioids from 2000 to 2010. ⋯ The use of prescription opioid analgesics among adult Americans has increased in recent years, and this increase does not seem to be associated with improvements in disability and health status among users. On a public health level, these data suggest that there may be an opportunity to reduce the prescribing of opioid analgesics without worsening of population health metrics.
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Reg Anesth Pain Med · Nov 2013
Randomized Controlled Trial Comparative StudyAdductor Canal Block Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty: A Randomized, Double-blind Study.
Quadriceps strength is better preserved after adductor canal block for total knee arthroplasty than femoral nerve block with similar analgesic effect.
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Reg Anesth Pain Med · Nov 2013
Randomized Controlled Trial Comparative StudyUltrasound-guided Sciatic Nerve Block in Overweight and Obese Patients: A Randomized Comparison of Performance Time Between the Infragluteal and Subgluteal Space Techniques.
Despite ultrasound (US) guidance, sciatic nerve block (SNB) remains among the least performed peripheral blocks. By targeting the tissue plane between the gluteus maximus and quadratus femoris muscles, the US-guided subgluteal space technique may facilitate the performance of US-guided SNB. We aimed to evaluate whether the subgluteal space technique shortens SNB performance time in overweight and obese patients compared with the conventional infragluteal technique. ⋯ The subgluteal space technique may be performed 50% faster, with no detectable differences in block success and analgesic efficacy, compared with the infragluteal technique for US-guided SNB in overweight and obese patients receiving multimodal analgesia. Injection of local anesthetics along tissue planes may produce similar block characteristics to perineural injection for US-guided SNB.
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Reg Anesth Pain Med · Nov 2013
Randomized Controlled Trial Comparative StudyA Dose-Ranging Study of 0.5% Bupivacaine or Ropivacaine on the Success and Duration of the Ultrasound-Guided, Nerve-Stimulator-Assisted Sciatic Nerve Block: A Double-Blind, Randomized Clinical Trial.
Before bifurcation, the sciatic nerve is composed of 2 component nerves encased in a common investing extraneural layer (CIEL). We examined the effect of various volumes injected beneath the CIEL on the success and duration of sciatic nerve block. ⋯ Injecting 10 mL of 0.5% bupivacaine or ropivacaine below the CIEL produces comparable onset and duration of sensory and motor blockade as volumes as large as 30 mL.
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Reg Anesth Pain Med · Sep 2013
Randomized Controlled TrialEffect of Chronic β-Blockade on the Utility of an Epinephrine-Containing Test Dose to Detect Intravascular Injection in Nonsedated Patients.
A test dose containing epinephrine is routinely used during epidural blockade to detect accidental intravenous needle or catheter placement before the administration of local anesthetics to avert local anesthetic systemic toxicity. β-Blocker therapy may interfere with the expected hemodynamic response from an intravascular injection. This study describes a cohort of 24 patients and their response to an epinephrine test dose (ie, if expected increased heart rates during test-dose administration are valid in this population.) ⋯ Epinephrine test-dose administration in nonsedated, chronically β-blocked patients cannot distinguish intravenous injection at the classic threshold increase of 20 bpm. The response in individuals is varied, and thresholds for a positive test need revising for this population of patients on therapeutic β-blockers.