Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2005
ReviewThe impact of technology on the analgesic gap and quality of acute pain management.
National surveys continue to document the undertreatment of acute postoperative pain, despite the availability of evidence-based, clinical practice guidelines and the Joint Commission on Accreditation of Healthcare Organizations standards. This article surveys factors that contribute to persistent gaps during the acute pain management process, including deficiencies in providing continuous analgesia, disparities in access to medical care, the acute pain medicine culture itself, a lack of adequate pain assessment, health care provider biases, and limited health care resources. ⋯ However, the use of these systems may be limited because of the amount of health care resources necessary for their administration and limitations in payment for professional services. Therefore, there exists a need for additional technologies that will simplify the pain management process and reduce the amount of health care resources necessary to provide patients with quality acute pain management.
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Reg Anesth Pain Med · May 2005
ReviewTwo-pore domain potassium channels: new sites of local anesthetic action and toxicity.
Potassium (K+) channels form the largest family of ion channels with more than 70 such genes identified in the human genome. They are organized in 3 superfamilies according to their predicted membrane topology: (1) subunits with 6 membrane-spanning segments and 1-pore domain, (2) subunits with 2 membrane-spanning segments and 1-pore domain, and (3) subunits with 4 membrane-spanning segments and 2-pore domains arrayed in a tandem position. The last family has most recently been identified and comprises the so-called 2-pore domain potassium (K2P) channels, believed responsible for background or leak K+ currents. ⋯ K2P channels are widely expressed in the central nervous system and are involved in the control of the resting membrane potential and the firing pattern of excitable cells. This article will therefore review recent findings on actions of local anesthetics with respect to 2P channels. It begins with an overview of the role of background K+ channels in neuronal excitability and nerve conduction and is followed by a description of the K2P channel family including experimental evidence for the contribution of K2P channels to the mechanism of action and toxicity of local anesthetics.
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Reg Anesth Pain Med · May 2005
Randomized Controlled Trial Comparative Study Clinical TrialMedial canthus single-injection peribulbar anesthesia: a prospective randomized comparison with classic double-injection peribulbar anesthesia.
The authors report the first prospective randomized comparison of the medial canthus single-injection peribulbar anesthesia (also called caruncular anesthesia) with the classic double-injection peribulbar technique. ⋯ Medial canthus single-injection peribulbar anesthesia appears to be an effective alternative to the usual double-injection peribulbar anesthesia.
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Reg Anesth Pain Med · May 2005
Clinical TrialClinical efficacy of the brachial plexus block via the posterior approach.
The posterior approach to the brachial plexus remains underused. We assessed the clinical effectiveness of this technique for shoulder surgery. ⋯ This study reports the clinical effectiveness of the single-injection nerve-stimulation technique for the brachial plexus block via the posterior approach in patients undergoing shoulder surgery. It appears to be effective, relatively safe, and well tolerated.
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This case report describes the accidental placement of a lumbar labor epidural catheter into the subdural space resulting in the rapid onset of massive subdural anesthesia. ⋯ Massive subdural anesthesia is a complication of epidural catheter placement and may have a rapid onset causing a loss of consciousness, respiratory arrest, and absent pulses.