Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2014
Prolonged Amelioration of Experimental Postoperative Pain by Bupivacaine Released From Microsphere-Coated Hernia Mesh.
Postoperative pain alters physiological functions and delays discharge. Perioperative local anesthetics are effective analgesics in the immediate 1- to 2-day postoperative period, but acute pain often lasts longer. The goal of this work was to develop a local anesthetic formulation adhering to an intraoperative implanted device that reduces pain for at least 3 days after surgery. ⋯ Bupivacaine slowly released for 72 hours from microspheres adsorbed to the hernia mesh significantly suppresses evoked postoperative hypersensitivity for at least 1 week and is more effective than a suspension of these microspheres or preoperative single-shot infiltration of bupivacaine.
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Reg Anesth Pain Med · Mar 2014
A Prospective Validation of Biplanar Ultrasound Imaging for C5-C6 Cervical Medial Branch Blocks.
Ultrasound (US) guidance offers an alternative to fluoroscopy for medial branch blocks of the upper cervical spine, but it may be less accurate for blocks at the C5 and C6 levels. We hypothesized that a modified technique using biplanar US imaging would facilitate level identification and provide greater accuracy for the lower cervical spine. ⋯ Ultrasound guidance using a biplanar approach is a reliable imaging modality for C5 and C6 medial branch blocks.
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Reg Anesth Pain Med · Mar 2014
Ghrelin Alleviates Neuropathic Pain Through GHSR-1a-Mediated Suppression of the p38 MAPK/NF-κB Pathway in a Rat Chronic Constriction Injury Model.
Neuropathic pain is related to the sustained activation of neuroglial cells and the production of proinflammatory cytokines in the spinal dorsal horn. Ghrelin, the endogenous ligand for growth hormone secretagogue receptor 1a (GHSR-1a), has been shown to inhibit the activation of microglia and the release of proinflammatory cytokines. The purpose of this study was to investigate the role of ghrelin/GHSR-1a signaling in neuropathic pain and to understand the associated mechanisms. ⋯ Our present study demonstrated that ghrelin alleviated neuropathic pain through a GHSR-1a-mediated suppression of the p38 MAPK/NF-κB pathway.
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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).