Regional anesthesia and pain medicine
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Suprascapular nerve blockade (SSNB) is a simple and safe technique for providing relief from various types of shoulder pain, including rheumatologic disorders, cancer, and trauma pain, and postoperative pain due to shoulder arthroscopy. Posterior, superior, and anterior approaches may be used, the most common being the posterior. ⋯ The different techniques of SSNB and indications for SSNB will be discussed. The complications of SSNB and outcomes of SSNB on the management of acute and chronic shoulder pain will be reviewed.
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Reg Anesth Pain Med · Jul 2011
ReviewClinical trial methodology of pain treatment studies: selection and measurement of self-report primary outcomes for efficacy.
The past century has seen immense progress in the advancement of methodology to evaluate efficacy of treatment interventions for acute and chronic pain. Continuing challenges revolve around how to best select and measure primary efficacy outcomes for a given analgesic trial. ⋯ In the setting of emerging new pain treatment strategies, careful consideration must be given to match current or novel outcome measures to the specific goals of a proposed trial. Future research is needed to directly compare current methods with newer measurement approaches for the critical goal of maximizing validity, reliability, and utility of different outcome measures in clinical trials of pain treatment.
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Reg Anesth Pain Med · May 2011
ReviewNeedle to nerve proximity: what do the animal studies tell us?
Recent animal studies have provided insight and understanding, as well as promising clinical tools, to help identify needle-to-nerve contact and potentially hazardous intraneural injection. This narrative review describes and summarizes the contemporary animal studies primarily relating to indicators of needle-to-nerve contact and intraneural injection. Resultant nerve injury, whenever sought, is discussed.
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Reg Anesth Pain Med · Mar 2011
ReviewMeralgia paresthetica: what an anesthesiologist needs to know.
Meralgia paresthetica (MP) is an entrapment pain syndrome of the lateral femoral cutaneous nerve (LFCN) of thigh. Diagnosis is principally made on clinical ground with pain and paresthesia of the anterolateral thigh. Electrophysiological test and nerve block play important roles when the diagnosis is uncertain. ⋯ Surgical options should be considered in patients refractory to those treatment options. Anesthesiologists are commonly involved in the management of MP because of their expertise in pain management and performance of the LFCN block. Blockade of the LFCN with local anesthetics and steroid serves both the diagnostic and therapeutic role.
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Reg Anesth Pain Med · Mar 2011
ReviewA review of the benefits and pitfalls of phantoms in ultrasound-guided regional anesthesia.
With the growth of ultrasound-guided regional anesthesia, so has the requirement for training tools to practice needle guidance skills and evaluate echogenic needles. Ethically, skills in ultrasound-guided needle placement should be gained in a phantom before performance of nerve blocks on patients in clinical practice. However, phantom technology is varied, and critical evaluation of the images is needed to understand their application to clinical use. ⋯ Fresh-frozen cadavers retain much of the textural feel of live human tissue and are nearly as echogenic. Similar to clinical practice, this makes needles inserted at steep angles practically invisible, unless they are highly echogenic. This review describes the uses and pitfalls of phantoms that have been described or commercially produced.