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pearl
1
Pulsed radiofrequency stimulation of the suprascapular nerve improves pain and range of motion in those with adhesive capsulitis.
Wu YT, Ho CW, Chen YL et al. Ultrasound-Guided Pulsed Radiofrequency Stimulation of the Suprascapular Nerve for Adhesive Capsulitis: A Prospective, Randomized, Controlled Trial. Anesth. Analg. 2014 Sep 1;119(3):686-92.
  Daniel Jolley
pearl
1
Peri-operative melatonin may cause small reductions in pre-operative anxiety and post-operative pain.
Andersen LP, Werner MU, Rosenberg J et al. A systematic review of peri-operative melatonin. Anaesthesia. 2014 Oct 1; 69 (10): 1163-71.
  Daniel Jolley
pearl
1
Periarticular infiltration with ropivacaine and ketorolac provides equivalent and likely superior post-op analgesia to intrathecal morphine after THA.
Kuchálik J, Granath B, Ljunggren A et al. Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia. Br J Anaesth. 2013 Nov 1;111(5):793-9.
  Daniel Jolley
comment
1
Despite the statistical significance of this finding, I question the clinical significance and appropriateness – especially in the context of ongoing questions regarding the safety of HES solutions and given there are alternative interventions also shown to reduce symptomatic hypotension in this setting.
Mercier FJ, Diemunsch P, Ducloy-Bouthors AS et al. 6% Hydroxyethyl starch (130/0.4) vs Ringer's lactate preloading before spinal anaesthesia for Caesarean delivery: the randomized, double-blind, multicentre CAESAR trial‡ Br J Anaesth. 2014 Sep 1; 113 (3): 459-67.
  Daniel Jolley
pearl
1
Hydroxylethyl starch preload before spinal caesarean section significantly reduces symptomatic hypotension when compared with Ringer's lactate.
Mercier FJ, Diemunsch P, Ducloy-Bouthors AS et al. 6% Hydroxyethyl starch (130/0.4) vs Ringer's lactate preloading before spinal anaesthesia for Caesarean delivery: the randomized, double-blind, multicentre CAESAR trial‡ Br J Anaesth. 2014 Sep 1; 113 (3): 459-67.
  Daniel Jolley
pearl
1
Nitrous oxide exposure increases DNA damage which may be associated with increased risk of wound infection after colorectal surgery.
Chen Y, Liu X, Cheng CH et al. Leukocyte DNA damage and wound infection after nitrous oxide administration: a randomized controlled trial. Anesthesiology. 2013 Jun 1;118(6):1322-31.
  Daniel Jolley
pearl
1
Continuous interscalene block offers analgesic benefits up to 1 week after shoulder surgery when compared with either single-shot block or GA alone.
Salviz EA, Xu D, Frulla A et al. Continuous interscalene block in patients having outpatient rotator cuff repair surgery: a prospective randomized trial. Anesth. Analg. 2013 Dec 1;117(6):1485-92.
  Daniel Jolley
pearl
1
TAP blocks may offer some small analgesic benefit after caesarean section at 6h and 12h, but not 24h, in patients also receiving intrathecal morphine.
Singh S, Dhir S, Marmai K et al. Efficacy of ultrasound-guided transversus abdominis plane blocks for post-cesarean delivery analgesia: a double-blind, dose-comparison, placebo-controlled randomized trial. Int J Obstet Anesth. 2013 Jul 1;22(3):188-93.
  Daniel Jolley
pearl
1
Perineural dexamethasone may significantly increase the duration of analgesia after regional blockade, though without dose-response effect.
Albrecht E, Kern C, Kirkham KR. A systematic review and meta-analysis of perineural dexamethasone for peripheral nerve blocks. Anaesthesia. 2015 Jan 1; 70 (1): 71-83.
  Daniel Jolley
summary
1
Despite frequent incidence of hypotension, no cases of stroke were observed in this audit of 4,169 shoulder surgeries performed in the beach-chair position. Notably though, 97% of the cases were performed under brachial plexus block with intravenous sedation rather than a general or relaxant technique.
The authors estimate the upper limit incidence of stroke in the sitting position under regional anaesthesia as 1 in 1,429 (0.07%).
Yadeau JT, Casciano M, Liu SS et al. Stroke, regional anesthesia in the sitting position, and hypotension: a review of 4169 ambulatory surgery patients. Reg Anesth Pain Med. 2011 Sep 1;36(5):430-5.
  Daniel Jolley