Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Aug 2023
Randomized Controlled Trial Multicenter StudyGeneral anesthesia is an acceptable choice for hip fracture surgery.
The debate over the optimal type of anesthesia for hip fracture surgery continues to rage. While retrospective evidence in elective total joint arthroplasty has suggested a reduction in complications with neuraxial anesthesia, previous retrospective studies in the hip fracture population have been mixed. Recently, two multicenter randomized, controlled trials (REGAIN and RAGA) have been published that examined delirium, ambulation at 60 days, and mortality in patients with hip fractures who were randomized to spinal or general anesthesia. ⋯ While these trials were not perfect, they call into question the practice of telling patients that spinal anesthesia is a "safer" choice for their hip fracture surgery. We believe a risk/benefit discussion should take place with each patient and that ultimately the patient should choose his or her anesthesia type after being informed of the state of the evidence. General anesthesia is an acceptable choice for hip fracture surgery.
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Reg Anesth Pain Med · Aug 2023
Randomized Controlled TrialMigration rate of proximal adductor canal block catheters placed parallel versus perpendicular to the nerve after total knee arthroplasty: a randomized controlled study.
Perineural catheters placed parallel to the nerve course are reported to have lower migration rates than those placed perpendicular to it. However, catheter migration rates for a continuous adductor canal block (ACB) remain unknown. This study compared postoperative migration rates of proximal ACB catheters placed parallel and perpendicular to the saphenous nerve. ⋯ Parallel placement of the ACB catheter provided a lower postoperative catheter migration rate than perpendicular placement of the ACB catheter along with corresponding improvements in ROM and secondary analgesic outcomes.
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Reg Anesth Pain Med · May 2023
Randomized Controlled Trial Multicenter StudyComparison of cooled versus conventional radiofrequency treatment of the genicular nerves for chronic knee pain: a multicenter non-inferiority randomized pilot trial (COCOGEN trial).
Radiofrequency (RF) treatment of the genicular nerves has the potential to reduce chronic knee pain due to osteoarthritis or persistent postsurgical pain, however, a direct comparison between the two main modalities used, conventional and cooled, is lacking. ⋯ Both conventional and cooled RF treatment reduced pain in the osteoarthritis and persistent postsurgical pain population. This pilot study did not demonstrate statistically significant differences in the proportion of patients experiencing ≥50% pain reduction between techniques. The non-inferiority analysis was inconclusive. These results warrant further research.
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Reg Anesth Pain Med · Apr 2023
Randomized Controlled TrialComparison between ultrasound-guided multi-injection intertransverse process and thoracic paravertebral blocks for major breast cancer surgery: a randomized non-inferiority trial.
This study investigated whether a novel multi-injection intertransverse process block could provide non-inferior analgesia and recovery quality following major breast cancer surgery compared with the multi-injection thoracic paravertebral block. ⋯ Compared with a multi-injection thoracic paravertebral block, the multi-injection intertransverse process block provided non-inferior analgesia within 30 min in the recovery room and recovery quality at 24 hours following major breast cancer surgery in females.
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Reg Anesth Pain Med · Mar 2023
Randomized Controlled TrialRandomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision.
Optimal analgesia for circumcision is still debated. The dorsal penile nerve block has been shown to be superior to topical and caudal analgesia. Recently, the ultrasound-guided pudendal nerve block (group pudendal) has been popularized. This randomized, blinded clinical trial compared group pudendal with ultrasound-guided dorsal penile nerve block (group penile) under general anesthesia for pediatric circumcision. ⋯ Both ultrasound-guided blocks, performed under general anesthesia, provide equivalent postoperative analgesia for pediatric circumcision as evidenced by low pain scores and opioid consumption. Surgeon satisfaction was higher in the pudendal group.