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Electron Microscopy of Dural and Arachnoid Disruptions After Subarachnoid Block
Conclusions: Accepted theories of the etiology of PDPH need to be revised. This article marks the first time that arachnoid layer damage has been quantified. Dural fibers tend to have sufficient “memory” to close back the hole created by a spinal needle, whereas arachnoid has diminished capacity to do so. The pathogenesis of PDPH and its resolution algorithm are a far more complex process that involves many more “stages” of development than hitherto imagined. (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - October 23, 2017 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Original Articles Source Type: research

Chronic Poststernotomy Pain: Incidence, Risk Factors, Treatment, Prevention, and the Anesthesiologist's Role
Abstract: Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have sig...
Source: Regional Anesthesia and Pain Medicine - October 23, 2017 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Review Article Source Type: research

Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty: An Evidence-Based Review by the American and European Societies of Regional Anesthesia and Pain Medicine
Abstract: In 2014, the American Society of Regional Anesthesia and Pain Medicine in collaboration with the European Society of Regional Anaesthesia and Pain Therapy convened a group of experts to compare pathways for anesthetic and analgesic management for patients undergoing total knee arthroplasty in North America and Europe and to develop a practice pathway. This review is intended to be an analysis of the current literature to assist individuals and institutions in designing a pathway for total knee arthroplasty that is based on existing evidence and expert recommendation and may be customized according to individual s...
Source: Regional Anesthesia and Pain Medicine - October 23, 2017 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Special Article Source Type: research

Reply to Dr Neal et al
No abstract available (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

Asleep Versus Awake and Standard of Care
No abstract available (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

The Case for Thinking Beyond Classic Randomized Controlled Trial Design: A Response to “Distinguishing Between Efficacy and Real-World Effectiveness”
No abstract available (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

Anterior Approach to the Suprascapular Nerve
No abstract available (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial
Background and Objectives: Truncal blocks have a place within multimodal analgesia techniques in abdominal surgery. The quadratus lumborum block is a new abdominal truncal block used for somatic analgesia of both the upper and lower abdomen. In this prospective, double-blind, randomized study, we aimed to compare quadratus lumborum block and transversus abdominis plane block in pediatric patients undergoing lower abdominal surgery. Methods: Fifty-three children undergoing unilateral inguinal hernia repair or orchiopexy surgery were randomized into 2 groups: transversus abdominis plane block and quadratus lumborum block. A...
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Pediatric Analgesia: Ultrasound Article Source Type: research

The Effect of Ondansetron on Acute Opioid Tolerance in Patients Receiving Intrathecal Opioids Prior to Cesarean Delivery
Conclusions: In patients undergoing cesarean delivery under spinal anesthesia with intrathecal opioids, the administration of ondansetron prior to spinal anesthesia did not significantly affect postoperative pain scores or opioid consumption. Thus, the administration of ondansetron did not have an effect on acute opioid tolerance in our study. (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Obstetric Analgesia: Original Article Source Type: research

Measurement Error of a Simplified Protocol for Quantitative Sensory Tests in Chronic Pain Patients
Conclusions: This study contributes to a standardized QST protocol, and based on the minimal measurement error of 1 single record of PPDT, EPDT, and NWRT, we submit to reduce the testing burden. This would allow saving time, resources, and patient discomfort. (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Chronic and Interventional Pain: Original Articles Source Type: research

Perioperative Patient Beliefs Regarding Potential Effectiveness of Marijuana (Cannabinoids) for Treatment of Pain: A Prospective Population Survey
Conclusions: Patients generally believe that marijuana could be at least somewhat effective for the management of pain and are willing to use cannabinoid compounds for this indication, if prescribed by a physician. (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Chronic and Interventional Pain: Original Articles Source Type: research

Thoracic Epidural Catheter Placement in a Preoperative Block Area Improves Operating Room Efficiency and Decreases Epidural Failure Rate
Background and Objectives: The primary aim of this study was to review the impact of inserting thoracic epidural catheters in a preoperative block room setting on operating room efficiency. Methods: We conducted a retrospective preintervention/postintervention review of thoracic epidurals inserted over a 12-month period. The review included 6 months of data prior to implementation of the regional anesthesia block room and 6 months of data following implementation. The primary outcome measure was anesthesia-controlled operating room time, defined as time from patient arrival to the operating room to time of surgical site s...
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Brief Technical Report Source Type: research

Neuralgic Amyotrophy Attributed Incorrectly to Block-Related Injury: Understanding Errors in Clinical Reasoning
Conclusions: Cognitive bias may lead to errors in clinical reasoning and consequent misdiagnosis. Temporal proximity may falsely implicate regional anesthesia as the causative agent. (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Case Report Source Type: research

Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist
This article in our point-of-care ultrasound (PoCUS) series discusses the benefits of focused cardiac ultrasound (FoCUS) for the regional anesthesiologist and pain specialist. Focused cardiac US is an important tool for all anesthesiologists assessing patients with critical conditions such as shock and cardiac arrest. However, given that ultrasound-guided regional anesthesia is emerging as the new standard of care, there is an expanding role for ultrasound in the perioperative setting for regional anesthesiologists to help improve patient assessment and management. In addition to providing valuable insight into cardiac phy...
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Review Articles Source Type: research

Perioperative Breast Analgesia: A Qualitative Review of Anatomy and Regional Techniques
Abstract: Breast surgery is exceedingly common and may result in significant acute as well as chronic pain. Numerous options exist for the control of perioperative breast pain, including several newly described regional anesthesia techniques, but anesthesiologists have an insufficient understanding of the anatomy of the breast, the anatomic structures disrupted by the various breast surgeries, and the theoretical and experimental evidence supporting the use of the various analgesic options. In this article, we review the anatomy of the breast, common breast surgeries and their potential anatomic sources of pain, and analge...
Source: Regional Anesthesia and Pain Medicine - August 22, 2017 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Review Articles Source Type: research