Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2024
Randomized Controlled TrialInsignificant influence of the intertransverse process block for major breast cancer surgery: a randomized, blinded, placebo-controlled, clinical trial.
The intertransverse process (ITP) block mimics the thoracic paravertebral block and allegedly ameliorates hemithoracic postoperative pain. However, concerning major reconstructive breast cancer surgery the modality has never been tested against placebo in a randomized clinical trial. We aimed to assess the efficacy of the multiple-injection ITP block and hypothesized that the blockade would reduce postoperative opioid consumption. ⋯ Following major reconstructive breast cancer surgery, a preoperative multiple-injection ITP block neither reduces 24-hour opioid consumption postoperatively nor promotes substantial clinical positive outcomes.
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Reg Anesth Pain Med · Jan 2024
Randomized Controlled TrialComparison of the incidence of intravascular injection using the Tuohy and Quincke needles during ultrasound-guided caudal epidural block: a prospective randomized controlled study.
Intravascular injection of a local anesthetic can lead to life-threatening complications, such as deficits in neurological function after caudal epidural block. This study aimed to determine whether the intravascular injection rate of the Tuohy needle is lower than that of the Quincke needle during an ultrasound-guided caudal block. ⋯ The overall incidence of inadvertent intravascular injections during ultrasound-guided caudal block confirmed using DSA was 10.9%. Tuohy needles did not reduce intravascular injection rates during the ultrasound-guided caudal block.
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A cautionary summary of the benefits and potential risks of perineural dexamethasone.
"...there have been no reports of neurotoxicity or complications of any kind attributed to perineural dexamethasone in the nearly 700 patients who have received it in published studies of peripheral nerve blocks ... We must acknowledge that complications in regional anesthesia are rare, and 700 patients are woefully inadequate to declare dexamethasone safe for routine perineural use." (Noss 2014)
Noss concludes that:
- Perineural dexamethasone is probably safe, though conclusive safety evidence is still lacking.
- Systemic effects from IV dex is unlikely to explain the profound block prolongation.
- Prolongation is not enough on its own.
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Reg Anesth Pain Med · Apr 2024
Observational StudyCutaneous sensory block area of the ultrasound-guided subcostal transversus abdominis plane block: an observational study.
The transversus abdominis plane block (TAP) can be applied using different approaches, resulting in varying cutaneous analgesic distributions. This study aimed to assess the cutaneous sensory block area (CSBA) after ultrasound-guided TAP (US-TAP) using the subcostal approach. ⋯ The subcostal US-TAP results in a heterogeneous non-dermatomal CSBA with varying size and distribution across the medial abdominal wall.
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Reg Anesth Pain Med · Sep 2023
Focused ultrasound-induced inhibition of peripheral nerve fibers in an animal model of acute pain.
Moderate-to-severe acute pain is prevalent in many healthcare settings and associated with adverse outcomes. Peripheral nerve blockade using traditional needle-based and local anesthetic-based techniques improves pain outcomes for some patient populations but has shortcomings limiting use. These limitations include its invasiveness, potential for local anesthetic systemic toxicity, risk of infection with an indwelling catheter, and relatively short duration of blockade compared with the period of pain after major injuries. Focused ultrasound is capable of inhibiting the peripheral nervous system and has potential as a pain management tool. However, investigations of its effect on peripheral nerve nociceptive fibers in animal models of acute pain are lacking. In an in vivo acute pain model, we investigated focused ultrasound's effects on behavior and peripheral nerve structure. ⋯ Focused ultrasound, using a distinct parameter set, reversibly inhibits A-delta peripheral nerve nociceptive, motor, and non-nociceptive sensory fiber-mediated behaviors, has a prolonged effect on C nociceptive fiber-mediated behavior, and alters nerve structure. Focused ultrasound may have potential as a peripheral nerve blockade technique for acute pain management. However, further investigation is required to determine C fiber inhibition duration and the significance of nerve structural changes.