Regional anesthesia and pain medicine
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Despite unprecedented interest in understanding pain mechanisms and pain management, a significant number of patients continue to experience unacceptable pain after surgery. Recent surveys show that there has been no apparent improvement since an early study in 1952 (15). It is increasingly clear that the solution to the problems of postoperative pain management lies not so much in the development of new techniques but in developing an organization to exploit existing expertise. ⋯ All senior anesthesiologists (section chiefs) working in the operating room are part of this APS. The means of providing satisfactory analgesia are already present in most hospitals. Careful planning and a multidisciplinary approach to pain management will ensure that resources are optimally utilized, and the quality of pain management is consistently maintained.
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Reg Anesth Pain Med · Jan 1999
ReviewNeuraxial techniques for cancer pain: an opinion about unresolved therapeutic dilemmas.
Epidural and intrathecal techniques are well established for minimizing cancer pain. However, several issues remain unresolved. ⋯ A subcutaneous tunnelling and fixation of the catheter, bacterial filters, minimum changes of tubings, weekly exit site care, site protection, and monitoring for any signs of infection are suggested for advanced cancer patients. Areas still needing clarification include the optimum use of spinal adjuvants, the appropriate spinal morphine-bupivacaine ratio, methods to improve spinal opioid responsiveness, and long-term catheter management during home-care programs.
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Reg Anesth Pain Med · Nov 1998
ReviewCommentary: neurotoxicity of local anesthetics--an issue or a scapegoat?
To evaluate the etiologies of cauda equina syndrome (CES) and transient radicular irritation (TRI) or transient neurologic symptoms (TNSs) following hyperbaric spinal anesthesia. ⋯ Cauda equina syndrome is, in all probability, explainable. Further investigation to pinpoint the etiology of TRI (TNSs) is needed.