Regional anesthesia and pain medicine
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In the last 2 decades, a growing body of research aimed at investigating the health benefits of Tai Chi in various chronic health conditions has been recognized in the literature. This article reviewed the history, the philosophy, and the evidence for the role of Tai Chi in a few selected chronic pain conditions. The ancient health art of Tai Chi contributes to chronic pain management in 3 major areas: adaptive exercise, mind-body interaction, and meditation. ⋯ Only 5 pain conditions were reviewed: osteoarthritis, fibromyalgia, rheumatoid arthritis, low back pain, and headache. Of these, Tai Chi seems to be an effective intervention in osteoarthritis, low back pain, and fibromyalgia. The limitations of the Tai Chi study design and suggestions for the direction of future research are also discussed.
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Reg Anesth Pain Med · Jul 2012
Looking into learning: visuospatial and psychomotor predictors of ultrasound-guided procedural performance.
Despite widespread use of ultrasound in regional anesthesia, little understanding of the psychomotor and visuospatial skills required to achieve and maintain procedural proficiency exists. Despite its procedural nature, anesthesiology lags behind other fields in assessing technical aptitude among practitioners and trainees. The goals of this study were to measure relevant visuospatial and psychomotor aptitudes of anesthesia residents-in-training and to evaluate the relationship between these skill sets and the performance of ultrasound-guided regional anesthesia. ⋯ This study reveals that visuospatial aptitude is a better predictor of ultrasound-based procedural performance than psychomotor ability. The type of real-time visual feedback (indirect versus direct) used for hand-eye coordination significantly impacts procedural performance and has implications for anesthesia and other procedural specialties. The learning effect noted during initial ultrasound skill trials suggests visuospatial assimilation and underscores the importance of early ultrasound instruction.
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Reg Anesth Pain Med · Jul 2012
Comparative StudyInjection inside the paraneural sheath of the sciatic nerve: direct comparison among ultrasound imaging, macroscopic anatomy, and histologic analysis.
There exists little anatomic knowledge regarding the structure and sonographic features of the sheath enveloping the sciatic nerve in the popliteal fossa. We investigated the spread of an injection inside the sheath to (1) determine whether the sheath is a structure distinct from the nerve or part of the epineurium and (2) to develop an ultrasound-guided injection technique. ⋯ There is a distinct tissue layer surrounding the popliteal sciatic nerve as a paraneural sheath that has distinct gross anatomic, histologic, and sonographic features. This sheath may have implications for regional anesthesia involving the popliteal sciatic nerve. We suggest that the ultrasound-guided injection technique described here could be used in future clinical studies investigating the importance of the paraneural sheath.
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Reg Anesth Pain Med · Jul 2012
Effect of adjuvant drugs on the action of local anesthetics in isolated rat sciatic nerves.
There is increasing clinical use of adjuvant drugs to prolong the duration of local anesthetic-induced block of peripheral nerves. However, the mechanistic understanding regarding drug interactions between these compounds in the periphery is quite limited. Accordingly, we undertook this study to determine whether selected adjuvant drugs are efficacious in blocking action potential propagation in peripheral nerves at concentrations used clinically and whether these drugs influence peripheral nerve block produced by local anesthetics. ⋯ These results suggest that the reported clinical efficacy of clonidine, buprenorphine, and dexamethasone influences the actions of local anesthetics via indirect mechanisms. Further identification of these indirect mechanisms may enable the development of novel approaches to achieve longer-duration, modality-specific peripheral nerve block.