Articles: nerve-block.
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Facet or zygapophysial joint blocks are used extensively in the evaluation of chronic spinal pain. However, there is a continuing debate about the value and validity of facet joint blocks in the diagnosis of chronic spinal pain. The value of diagnostic facet joint injections may have been overlooked in the medical literature. ⋯ The diagnostic accuracy of controlled local anesthetic facet joint blocks is high in the diagnosis of chronic spinal pain.
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The purpose of this review is to present recent research into the clinical use of regional anaesthesia techniques in ambulatory surgery. Further, to put into an ambulatory perspective some of the issues recently discussed on the basis and practice of regional anaesthesia in general. ⋯ Loco-regional techniques are well suited for ambulatory surgery due to less postoperative nausea and pain and possibly less cognitive dysfunction. The different techniques are continuously being refined in order to provide fast discharge readiness, while still maintaining the benefits.
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In this review, emphasis is placed on adjuvant drugs that are already in clinical use. The list of adjuvants studied during the review period includes adrenaline, clonidine, ketamine, neostigmine, nondepolarizing muscle relaxants, and nonsteroidal antiinflammatory drugs. Some future aspects are considered in a couple of experimental studies on slow-release local anaesthetic formulations. ⋯ Adrenaline and opioids may be regarded as the best investigated and most important adjuvants in regional anaesthesia. Other drugs, such as clonidine and neostigmine, may prolong analgesia in various regional anaesthetic techniques, but possible side effects may limit their clinical application. Further development is needed concerning extra-long acting analgesic formulations.
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Interventional pain management dates back to the origins of neural blockade and regional analgesia. Over the years, it evolved into a distinct specialty with the application of interventional techniques beyond those of simple neural blockade. The first therapeutic nerve block in pain management was described in 1899 by Tuffer. ⋯ Diagnostic blockade in pain management was pioneered by von Gaza with the use of procaine for determining the pathways of obscure pain. Interventional pain management has entered into the modern era in the twenty-first century, driven by contributions from pioneers including Bonica, Winnie, Raj, Racz, Bogduk, and others. This historical review examines the origins of interventional pain management, its pathophysiologic basis, the role of precision diagnostic interventional techniques, therapeutic interventional techniques, and the future of interventional pain management.
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Radiofrequency heat lesioning has been advocated to prolong the duration of therapeutic effect of lumbar sympathetic block in Complex Region Pain Syndrome (CRPS) of the lower extremity. Prior to radiofrequency lesioning of the lumbar sympathetic trunk, sensory and motor stimulation may be used to verify that the active needle tip is not adjacent to a spinal nerve to avoid unwanted neural injury. However, the value of sensory stimulation to aid in precise needle positioning at the desired target remains controversial. ⋯ Motor stimulation did not occur up to the maximum voltage tested (2.0 V at 2 Hz) Sensory stimulation of the lumbar sympathetic trunk may be used to aid in localization of the active tip of the radiofrequency needle, in preparation for lesioning. A dermatomal sensory pattern was observed, suggesting that afferent sensory fibers travel in the lumbar sympathetic trunk. The implications of this observation for understanding the mechanism of CRPS-related pain are discussed.