Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2013
EditorialBurning mouth syndrome: current clinical, physiopathologic, and therapeutic data.
Primary burning mouth syndrome (BMS) is defined as an "intraoral burning for which no medical or dental cause was found." Lifetime prevalence ranges from 3.7% to 18% - 40% in the elderly. There is no consensus among experts on the diagnostic criteria of BMS, the etiology is poorly understood, and there are no existing clinical guidelines. Therefore, BMS is often underdiagnosed and its management complex. ⋯ We discuss the multifactorial origin, involving peripheral nerve dysfunction and hormonal dysfunction, as well as psychological traits. We also describe the results of randomized clinical trials for each treatment through a pathophysiologic approach. This review should help clinicians recognize BMS, understand its pathophysiology, and gain an enhanced scientific understanding of therapeutic alternatives.
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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.
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Reg Anesth Pain Med · Sep 2013
Cervical epidural anesthesia is associated with increased cancer-free survival in laryngeal and hypopharyngeal cancer surgery: a retrospective propensity-matched analysis.
Regional anesthesia preserves perioperative immune competence and may reduce the risk of recurrence and metastasis after cancer surgery. Cervical epidural anesthesia provides adequate analgesia for head and neck cancer surgery, but its impact on cancer recurrence is unknown. ⋯ The association between cervical epidural anesthesia and increased cancer-free survival found in this retrospective study should be an important hypothesis to further investigate in head and neck cancer surgery.