Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2012
Comparative StudyBeyond repeated-measures analysis of variance: advanced statistical methods for the analysis of longitudinal data in anesthesia research.
Research in the field of anesthesiology relies heavily on longitudinal designs for answering questions about long-term efficacy and safety of various anesthetic and pain regimens. Yet, anesthesiology research is lagging in the use of advanced statistical methods for analyzing longitudinal data. The goal of this article was to increase awareness of the advantages of modern statistical methods and promote their use in anesthesia research. ⋯ Based on their advantages over RM-ANOVA, GEE and MEM should be strongly considered for the analysis of longitudinal data. In particular, GEE should be used to explore overall average effects, and MEM should be used when subject-specific effects (in addition to overall average effects) are of primary interest.
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Reg Anesth Pain Med · Jan 2012
ReviewBeyond opioid patient-controlled analgesia: a systematic review of analgesia after major spine surgery.
Postoperative pain control in patients undergoing spine surgery remains a challenge for the anesthesiologist. In addition to incisional pain, these patients experience pain arising from deeper tissues such as bones, ligaments, muscles, intervertebral disks, facet joints, and damaged nerve roots. ⋯ The problem is compounded by the fact that many of these patients are either opioid dependent or opioid tolerant, making them less responsive to the most commonly used therapy for postoperative pain (opioid-based intermittent or patient-controlled analgesia). The purpose of this review was to compare all published treatment options available that go beyond intravenous opiates and attempt to find the best possible treatment modality.
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled Trial Comparative StudyUltrasound-guided obturator nerve block: interfascial injection versus a neurostimulation-assisted technique.
Interfascial injection of local anesthetic under ultrasound guidance has been proposed as a new technique for performing an obturator nerve block. We hypothesized that interfascial needle placement could supplant nerve stimulation as the end point for local anesthetic injection during ultrasound-guided obturator nerve block after the division of the obturator nerve. ⋯ In ultrasound-guided obturator nerve block performed after the division of the nerve, injection of local anesthetic between the planes of the adductor muscles is comparable to nerve stimulation.
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Reg Anesth Pain Med · Jan 2012
Practice GuidelineAmerican Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version.
In 2010, the American Society of Regional Anesthesia and Pain Medicine (ASRA) issued a practice advisory on local anesthetic systemic toxicity (LAST). The executive summary of this work contained a document that was intended to serve as a checklist for the management of LAST. Based on testing the checklist during a simulated episode of LAST, ASRA has issued an updated version that should replace the previous 2010 version. Electronic copies of the ASRA Checklist, suitable for lamination and inclusion in a local anesthetic toxicity kit, are available from the ASRA Web site (www.asra.com).
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Reg Anesth Pain Med · Jan 2012
Comparative StudyOptical detection of vascular penetration during nerve blocks: an in vivo human study.
Complications resulting from vascular penetration during nerve blocks are rare but potentially devastating events that can occur despite meticulous technique. In this in vivo human pilot study, we investigated the potential for detecting vascular penetration with optical reflectance spectroscopy during blocks of the sympathetic chain and the communicating ramus at lumbar levels. ⋯ The results from this study suggest that optical spectroscopy has the potential to detect intravascular needle placement, which may in turn increase the safety of nerve blocks.