Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jul 2010
ReviewUltrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part II: axial structures.
There is a growing trend in using ultrasonography in pain medicine as evident by the plethora of published reports. Ultrasound(US) provides direct visualization of various soft tissues and real-time needle advancement and avoids exposing both the health care provider and the patient to the risks of radiation. ⋯ In a previous review, we discussed the challenges and limitations of US, anatomy, sonoanatomy, and techniques of interventional procedures of peripheral structures. In the present review, we discuss the anatomy, sonoanatomy, and US-guided techniques of interventional pain procedures for axial structures and review the pertinent literature.
-
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.
-
Reg Anesth Pain Med · May 2010
ReviewClinical sonopathology for the regional anesthesiologist: part 2: bone, viscera, subcutaneous tissue, and foreign bodies.
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 bone, viscera, and subcutaneous tissue.
-
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.
-
Reg Anesth Pain Med · Mar 2010
ReviewEvidence-based medicine: Assessment of ultrasound imaging for regional anesthesia in infants, children, and adolescents.
This review was performed to evaluate and discuss the quality and outcomes of studies assessing ultrasound imaging in pediatric regional anesthesia. Literature searches were conducted using MEDLINE and EMBASE, combining the search term "ultrasonography" with "regional anesthesia," "nerve block," "epidural anesthesia," and "spinal anesthesia," with the limit of 0 to 18 years. ⋯ The search resulted in 211 total publications in pediatric literature, of which 12 were included in the evaluation of peripheral nerve blocks and 12 in the evaluation of neuraxial anesthesia. Although there is some evidence to support ultrasound for various outcomes in pediatric regional anesthesia, more randomized controlled studies with sufficient power are required to further support these findings and to evaluate the potential for ultrasound to reduce complications for regional anesthesia in children.