Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2011
Comparative StudyHas central sensitization become independent of nociceptive input in chronic pancreatitis patients who fail thoracoscopic splanchnicectomy?
Central sensitization due to visceral pancreatic nociceptive input may be important in chronic pancreatitis pain. We investigated whether bilateral thoracoscopic splanchnicectomy (BTS) to reduce nociceptive input in chronic pancreatitis patients (CPP) with poor pain control affects supraspinal and spinal sensitization. ⋯ Reduced supraspinal-but not spinal-central sensitization after BTS was associated with significantly reduced pain scores in a majority of CPP. A subgroup showed no reductions in supraspinal central sensitization after BTS, coupled to no significant pain NRS reduction. Our results suggest that a subgroup of CPP has altered pain processing that may be independent of ongoing peripheral nociceptive input, resulting in persisting pain despite BTS. If confirmed, these results indicate the importance of sensory testing for indications and management of pain treatments.
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Reg Anesth Pain Med · Nov 2011
Comparative StudyAre sympathetic blocks useful for diagnostic purposes?
Sympathetically maintained pain (SMP) can occur in patients with neuropathic pain. Sympathetically maintained pain is frequently diagnosed clinically by assessing the analgesic effect of an appropriate sympathetic block (SB). The diagnostic value of such blocks depends on both the degree of sympathetic activity disruption achieved and its duration without unintentional concomitant sensory block. ⋯ Sympathetic blocks are useful in the diagnosis of SMP. However, their value is limited by the potential for false positives (unintentional sensory block) or false negatives (insufficient SB). Adequate monitoring of the sympathetic and somatosensory function for a minimum of 90 minutes after the intervention is essential to ensure that a valid diagnosis of SMP is made.
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Reg Anesth Pain Med · Nov 2011
Comparative StudyPerineural ultrasound-guided catheter bacterial colonization: a prospective evaluation in 747 cases.
Ultrasound guidance is increasingly used for catheter insertion and could make it more complicated to guarantee aseptic insertion of catheters. The current study evaluated the incidence of colonization of ultrasound-guided perineural catheter (US-PNC) placed for postoperative analgesia. ⋯ Although infection rate is low, there is a risk of ultrasound-guided catheter colonization that deserves careful monitoring of the insertion site in the postoperative period.
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Reg Anesth Pain Med · Nov 2011
Comparative StudyUnintentional subdural placement of epidural catheters during attempted epidural anesthesia: an anatomic study of spinal subdural compartment.
Although infrequent, subdural block is a complication of epidural anesthesia with obvious implications. Knowledge of the spinal subdural compartment (dura-arachnoid interface) may help elucidate controversies arising from evidence that subdural catheter placement is feasible and may be difficult to identify clinically. ⋯ Dura mater and arachnoid layers act as a single unit but may be pulled apart by traction forces during cadaver processing of the dural sac or in vivo placement of catheters. This generates subdural spaces, either parallel or concentric, because of the minimal resistance offered by the tissue, which may be explained by its few specialized membrane junctions.
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Reg Anesth Pain Med · Nov 2011
Biography Historical ArticleDaniel C. Moore, MD, and the renaissance of regional anesthesia in North America.
While much attention is paid to the early days of organized regional anesthesia in North America under the leadership of Gaston Labat in New York, there was a period of decline in energy and activity in those techniques after the demise of his original American Society of Regional Anesthesia in 1940. In the years after World War II, questions were raised about the safety and utility of regional blockade. ⋯ Moore emerged as a colorful and enthusiastic advocate of regional techniques, effectively leading a renaissance of regional anesthesia interest through his textbook, teaching, and research in Seattle, Washington. His protégés were instrumental in the rebirth of American Society of Regional Anesthesia and the extensive spread of regional anesthesia today.