Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2010
Randomized Controlled TrialUltrasound-guided popliteal block distal to sciatic nerve bifurcation shortens onset time: a prospective randomized double-blind study.
Popliteal sciatic nerve block (SNB) in combination with saphenous nerve block provides anesthesia and analgesia for foot and ankle surgeries. Landmark-based and image-guided techniques, to date, aim at blocking the sciatic nerve proximal to its bifurcation. Sciatic nerve block is usually associated with a long onset time (30-60 mins). We hypothesized that SNB distal to its bifurcation (blocking its 2 main branches tibial and common peroneal nerves separately) is associated with a shorter onset time than blockade proximal to its bifurcation. ⋯ Our data suggest that popliteal SNB distal to the bifurcation has a shorter onset time than SNB proximal to its bifurcation, and therefore, it may be a good option when a fast onset for a surgical block is required.
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Reg Anesth Pain Med · May 2010
ReviewDuloxetine: a review of its pharmacology and use in chronic pain management.
Duloxetine is a serotonin and norepinephrine reuptake inhibitor that possesses antidepressant and pain-relieving properties. Compared with other antidepressants, it has a high affinity for both norepinephrine and serotonin reuptake transporters, which are relatively balanced. Analgesic onset has been observed within the first week of administration in randomized controlled trials and is likely obtained by enhancing the tone of the descending pain inhibition pathways of the central nervous system. ⋯ Studies have also suggested that pain associated with major depressive disorder can be reduced with this medication. Modest effects for headache, osteoarthritic pain, and pain secondary to Parkinson disease have also been documented, but data are obtained from single-blinded or open-label trials that require further corroboration with larger randomized studies. Duloxetine has not yet been directly compared with other antidepressants or anticonvulsants for the treatment of pain syndromes.
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Reg Anesth Pain Med · May 2010
ReviewClinical sonopathology for the regional anesthesiologist: part 1: vascular and neural.
The use of ultrasound to facilitate regional anesthesia is an evolving area of clinical, education, and research interests. As our community's experience grows, it has become evident that anesthesiologists performing "routine" ultrasound-guided blocks may very well be confronted with atypical or even pathologic anatomy. As an educational resource for anesthesiologists, the following articles present examples of common sonopathology that may be encountered during ultrasound-guided regional anesthesia. This present article describes sonopathology related to blood vessels and nerves.
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This report describes the production of a low-cost ultrasound phantom of the lumbosacral spine. The phantom should be a very useful tool to teach the basic skills for ultrasound-guided procedures of the lumbosacral spine. ⋯ This teaching tool can provide trainees with an opportunity to familiarize themselves with sonoanatomy of the lumbosacral spine in addition to practicing probe handling techniques and needle placement.
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Reg Anesth Pain Med · May 2010
Intrathecal infusion of pyrrolidine dithiocarbamate for the prevention and reversal of neuropathic pain in rats using a sciatic chronic constriction injury model.
Recent studies have suggested that nuclear factor κB (NF-κB) may play a role in mediating nerve injury-induced neuropathic pain. Here, we examined the effects of intrathecal pyrrolidine dithiocarbamate (PDTC), a NF-κB inhibitor, on the development of neuropathic pain, spinal microglial activation, and CX3CR1 expression induced by sciatic chronic constriction injury (CCI) model in rats. ⋯ In this study, we have shown the protective effect of intrathecal PDTC on the development of nociceptive behaviors induced by CCI in rats. The activation of NF-κB pathway may contribute to spinal microglial activation and CX3CR1 up-regulation.