Regional anesthesia and pain medicine
-
Epidural steroid injections (ESIs) are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews. Despite the extensive literature on the subject, there continues to be considerable controversy surrounding their safety and efficacy. The results of clinical trials and review articles are heavily influenced by specialty, with those done by interventional pain physicians more likely to yield positive findings. ⋯ Serious complications are rare following ESIs, provided proper precautions are taken. Although there are no clinical trials comparing different numbers of injections, guidelines suggest that the number of injections should be tailored to individual response, rather than a set series. Most subgroup analyses of controlled studies show no difference in surgical rates between ESI and control patients; however, randomized studies conducted by spine surgeons, in surgically amenable patients with standardized operative criteria, indicate that in some patients the strategic use of ESI may prevent surgery.
-
Reg Anesth Pain Med · Mar 2013
Increasing the NaCl concentration of the preinjected solution enhances monopolar radiofrequency lesion size.
The effect of altering the sodium chloride (NaCl) concentration of the preinjected solution on monopolar radiofrequency (RF) lesion characteristics has not been investigated with conventional pain medicine equipment. The purpose of this study was to examine the effects of increasing NaCl concentration on lesion dimensions. ⋯ Increasing NaCl concentrations significantly increases lesion size. NaCl may produce a larger lesion as a result of reduced impedance surrounding the RF cannula and increased power output.
-
Reg Anesth Pain Med · Mar 2013
Epinephrine administered with lidocaine solution does not worsen intrathecal lidocaine neurotoxicity in rats.
Epinephrine can potentially worsen the neurotoxic effects of local anesthetics when used for spinal or epidural anesthesia. The vasoconstrictive property of epinephrine reduces dural blood flow, which in turn reduces the clearance of local anesthetics from the subarachnoid space. This study examined the histological and neurofunctional effects of intrathecally administered lidocaine combined with epinephrine in rats. ⋯ Intrathecal epinephrine prolonged the action of intrathecal lidocaine but did not worsen lidocaine-induced histological damage and functional impairment.