Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2011
ReviewNeedle to nerve proximity: what do the animal studies tell us?
Recent animal studies have provided insight and understanding, as well as promising clinical tools, to help identify needle-to-nerve contact and potentially hazardous intraneural injection. This narrative review describes and summarizes the contemporary animal studies primarily relating to indicators of needle-to-nerve contact and intraneural injection. Resultant nerve injury, whenever sought, is discussed.
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Reg Anesth Pain Med · May 2011
Comparative StudyIntraoperative neuraxial anesthesia but not postoperative neuraxial analgesia is associated with increased relapse-free survival in ovarian cancer patients after primary cytoreductive surgery.
Regional anesthesia has been shown to blunt the response to surgical stress and decrease the use of volatile anesthetics and the consumption of opioids, which may reduce immune compromise and potentially delay tumor recurrence. The goal of this study was to find a possible association between intraoperative regional anesthesia and decreased cancer recurrence. ⋯ Intraoperative use of epidural anesthesia was associated with an increased time to tumor recurrence after surgery in ovarian cancer patients. This may be a result of preservation of the immune system function.
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Reg Anesth Pain Med · May 2011
Comparative StudyNeurotoxicity of adjuvants used in perineural anesthesia and analgesia in comparison with ropivacaine.
Clonidine, buprenorphine, dexamethasone, and midazolam (C, B, D, M) have been used to prolong perineural local anesthesia in the absence of data on the influence of these adjuvants on local anesthetic-induced neurotoxicity. Therefore, the impact of these adjuvants on ropivacaine (R)-induced death of isolated sensory neurons was assessed. ⋯ Results with R reaffirm the need to identify ways to mitigate local anesthetic-induced neurotoxicity. While having no protective effect on R-induced neurotoxicity in vitro, future research with adjuvants should address if the C + B + D combination can enable reducing R concentrations needed to achieve equianalgesia (and/or provide equal or superior duration, in preclinical in vivo models).
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Reg Anesth Pain Med · May 2011
Editorial CommentThat bow is perfect, but your shoes are on the wrong feet.
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Reg Anesth Pain Med · Mar 2011
Comparative StudyNewly designed, self-coiling catheters for regional anesthesia--an imaging study.
A major concern with the use of continuous peripheral nerve block is the difficulty encountered in placing the catheters close enough to the nerves to accomplish effective analgesia. The aim of this study was to investigate if a self-coiling catheter would remain close to the sciatic nerve once introduced through needles placed under ultrasound guidance and if contrast dye injected through the pigtail catheter made direct contact to the nerves. ⋯ By using self-coiling catheters, it is possible to blindly introduce the catheter through needles placed under ultrasound guidance with a low risk of catheter misplacement away from the targeted nerves.