Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Dec 2024
Anatomical study of the innervation of the posterior elbow joint capsule: implications for ultrasound-guided peripheral nerve block and radiofrequency ablation procedures.
Ultrasound-guided peripheral nerve block and radiofrequency ablation have been developed for pain management in various joints including the hip, knee and shoulder, but not the elbow. Precise three-dimensional (3D) localization of the articular branches and landmarks visible on ultrasound are needed. The objectives of this anatomical study were to determine the presence, course, frequency, landmarks and areas innervated by the articular branches supplying the posterior elbow joint. ⋯ The 3D data of the articular branches supplying the posterior elbow joint provide an anatomical basis for the development of peripheral nerve block and radiofrequency ablation protocols to treat elbow joint pain. Further anatomical and clinical studies are necessary to identify target sites and evaluate the proposed landmarks in vivo.
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Reg Anesth Pain Med · Dec 2024
Review Case ReportsIntrathecal baclofen pump in pregnancy: case report, literature review, and management considerations.
Baclofen, a gamma-aminobutyric acid receptor type B agonist in the central nervous system, is the first-line medication among central nervous system modulating agents for the treatment of neurogenic muscle spasticity. While baclofen is most often administered enterally, patients with severe spasticity may be candidates for baclofen delivered by intrathecal pump. Currently, there are only nine studies reporting on the use of intrathecal baclofen (ITB) during pregnancy and childbirth. ⋯ Our case, alongside the existing literature on ITB during pregnancy, suggests that ITB therapy in pregnancy poses a low risk of teratogenicity and infant withdrawal seizures; however, larger, controlled studies are necessary to make those conclusions with confidence. Healthcare providers caring for pregnant ITB patients should be cognizant of the potential for such patients to require increased doses of ITB during pregnancy to achieve adequate symptom control.