Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2013
ReviewMusculoskeletal Pain, Fear Avoidance Behaviors, and Functional Decline in Obesity: Potential Interventions to Manage Pain and Maintain Function.
Individuals with musculoskeletal pain exhibit abnormal movement patterns, including antalgic gait, postural dysfunction, increased thoracolumbar stiffness, decreased proprioception, and altered activation of abdominal and extensor muscles. Additionally, aberrant or increased biomechanical forces over time produce joint or structural damage that results in pain. A large body habitus resulting from excessive weight can accelerate these musculoskeletal complaints. ⋯ Morbid obesity is a medical condition that alters biomechanical forces on the tissues of the body. This condition provides the opportunity to examine accelerated development of musculoskeletal pain syndromes and etiology. The proposed therapeutic interventions can have multiple benefits in the obese population including weight loss, improved psychological outlook and self-efficacy, reduced kinesiophobia levels, reduced risk of functional dependence, and improved quality of life.
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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 · Nov 2013
Comparative StudyComparison of Anatomic Landmarks and Ultrasound Guidance for Intercostal Nerve Injections in Cadavers.
Intercostal nerve (ICN) injections are routinely performed under anatomic landmark or fluoroscopic guidance for acute and chronic pain indications. Ultrasound (US) is being used increasingly to perform ICN injections, but there is lack of evidence to support categorically the benefits of US over conventional techniques. We compared guidance with US versus anatomic landmarks for accuracy and safety of ICN injections in cadavers in a 2-phase study that included evaluation of deposition of injected dye by dissection and spread of contrast on fluoroscopy. ⋯ Ultrasound confers higher accuracy and allows use of lower volumes of injectate compared with anatomic landmarks as a guidance method for ICN injections in cadavers. Ultrasound may be a viable alternative to anatomic landmarks as a guidance method for ICN injections.