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Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Source Type: journals

Table of contentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Source Type: journals

Ultrasonography in pain medicine: A welcomed addition to fluoroscopy and other imaging techniquesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Recently, a growing interest has become evident in the field of ultrasonography in pain medicine (USPM) with the expansion of ultrasound (US) applications. This is obvious when considering the plethora of published reports as well as presentations from national and international meetings. This has prompted the creation of a special interest group in USPM within the American Society of Regional Anesthesia and Pain Medicine.
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Samer Narouze Source Type: journals

Ultrasound-guided peripheral nerve block in chronic pain managementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The objective of this current review is to summarize the anatomy, existing techniques, and literature on a few selected peripheral nerve blocks published to date in chronic pain management.
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Rachael K. Seib, Philip W.H. Peng Source Type: journals

Ultrasound-guided transversus abdominus plan block for the management of abdominal pain: An alternative to differential epidural blockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The abdominal wall consists of three muscle layers—the external oblique, the internal oblique, and the transversus abdominus—and their associated fascial sheaths. The neuronal afferents course through the neurofascial plane between the internal and the transversus abdominus muscles—the “transversus abdominus plane” (TAP). The TAP block is used to produce a dermatomal sensory block of the lower six thoracic and upper lumbar abdominal afferents. It was shown to be effective in providing postoperative analgesia after various lower abdominal procedures, mainly radical prostatectomy, large bowel resections, and gyneco...
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Loran Mounir Soliman, Samer Narouze Source Type: journals

Review of ultrasound-guided peripheral nerve stimulationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: There is minimal literature at present to suggest that peripheral nerve stimulation systems should be placed using US or other minimally invasive image-guided techniques. As an emerging technique, significant further research will be required to guide future use.
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Marc A. Huntoon, Abram H. Burgher Source Type: journals

Ultrasound-guided third occipital nerve and cervical medial branch nerve blocksEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Chronic neck pain following whiplash injury is caused by cervical zygapophysial joints in up to 50% of patients. Diagnostic blocks of nerves supplying the joints are mandatory to diagnose zygapophysial joint pain and are usually done under fluoroscopic (or CT) control. Ultrasound (US) guidance may be a very useful alternative to block the nerves supplying the cervical facet joints lower than C2. In contrast to fluoroscopy or CT, in most patients, the cervical medial branches can be visualized by US. One exception is the nerve at the level of C7, where the superimposed layer of soft tissue does not allow visualizing this sm...
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Andreas Siegenthaler, Samer Narouze, Urs Eichenberger Source Type: journals

Ultrasound-guided cervical facet intra-articular injectionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The prevalence of facet joint involvement in chronic neck pain has been reported to be from 35% to 55%, making it an important target of interventional pain therapy. The facet joint and capsule also have been shown to contain nociceptive elements, suggesting that it may be an independent pain generator.Although cervical medial branch block is easier to perform and is the appropriate diagnostic test to predict the response to radiofrequency neurotomy, cervical facet intra-articular injection has also been implemented in the diagnosis and treatment of facet joint-mediated pain.The use of ultrasound (US) imaging to facilitate...
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Samer Narouze, Amaresh Vydyanathan Source Type: journals

Ultrasound-guided cervical transforaminal injection and selective nerve root blockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Traditionally, cervical transforaminal injections have been performed under fluoroscopic guidance. Real-time fluoroscopy with contrast injection is necessary to minimize intra-arterial injections. But even with strict guidelines, multiple instances of inadvertent intra-arterial injections with resultant spinal cord injury have been reported. This has led some practitioners to question the use of this procedure and whether the benefits outweigh the risks.The use of ultrasound (US) imaging to facilitate nerve blocks has increased recently. US allows visualization of soft tissues, as well as nerves and vessels, and also permi...
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Samer Narouze, Amaresh Vydyanathan Source Type: journals

Ultrasound-guided thoracic paravertebral blockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Thoracic paravertebral block produces ipsilateral somatic and sympathetic nerve blockade in multiple contiguous thoracic dermatomes above and below the site of injection, which is effective in treating acute and chronic pain of unilateral origin from the chest or abdomen. It is frequently performed using surface anatomical landmarks and loss of resistance. Recent advances in ultrasound (US) technology and image-processing capabilities of US machines have made it possible to image the thoracic paravertebral space, which may offer several advantages when used for paravertebral injections. US is noninvasive, safe, simple to u...
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Manoj K. Karmakar Source Type: journals

Ultrasound-guided zygapophysial nerve and joint injectionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Diagnostic and therapeutic lumbar zygapophysial (facet) nerve and joint interventions are probably the most commonly performed injections in pain management, and routine fluoroscopy guidance is required. Imaging is necessary to ensure precise needle position and to exclude an intravascular injection. Because the procedure is considered a low-risk intervention, use of ultrasound (US) guidance is thought to be an attractive alternative to fluoroscopy mainly because the former renders no ionizing radiation to the patient and medical personnel. In addition US-guided procedures are essentially “office-based” and do not requ...
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Michael Gofeld Source Type: journals

Ultrasound guidance for periradicular injections in the lumbar spine: A review articleEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Periradicular infiltrations in the lumbar spine are an established procedure in the management of pain. These injections are preferentially performed as computed tomography or fluoroscopically controlled interventions. Ultrasound (US) imaging is also applicable for lumbar periradicular injections. It requires a systematic proceeding, knowledge in US imaging techniques of the lumbar paravertebral region, and practice in handling a transducer in combination with a needle. In our experience, lumbar spinal periradicular infiltrations are feasible in most patients.
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Klaus Galiano, Alois Albert Obwegeser, Hannes Gruber Source Type: journals

Ultrasound-guided caudal and sacroiliac joint injectionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Caudal epidural steroid injection and sacroiliac joint injection are two very commonly employed interventions at any pain clinic. These injections are traditionally performed under fluoroscopic guidance, but recently the use of ultrasound (US) guidance has been reported. We will review the relevant anatomy, sonoanatomy, and the US-guided technique.
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Amaresh Vydyanathan, Samer Narouze Source Type: journals

Ultrasound for central neuraxial blocksEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Recent advances in ultrasound (US) imaging have significantly improved our understanding of spinal sonoanatomy. Today, US imaging has been used to assist or guide central neuraxial blocks, and it appears to be a promising alternative to traditional landmark-based technique. US is noninvasive, safe, simple to use, can be quickly performed, does not involve exposure to radiation, provides real-time images, and is free from adverse effects. Currently, the majority of the outcome data are from its application in the lumbar region. A scout (prepuncture) scan allows the operator to preview the spinal anatomy, identify the midlin...
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Manoj K. Karmakar Source Type: journals

Ultrasound-guided interventional procedures for chronic pelvic painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Chronic pelvic pain refers to noncyclical pain localized to the pelvic region for longer than 6 months. There can be numerous causes for pelvic pain excluding visceral pathology. Familiarity with disorders of peripheral nerve and musculoskeletal structures may assist in diagnosis and therapy. This review focuses on three pelvic pain syndromes mediated by somatic nerves: the “border nerve syndrome” (consisting of the ilioinguinal, iliohypogastric, and genitofemoral nerves), the piriformis syndrome, and pudendal neuralgia.Various approaches have been described to block these nerves, ranging from simple blind techniques t...
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Geoff A. Bellingham, Philip W.H. Peng Source Type: journals

Ultrasound-guided trigger point injectionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Myofascial trigger point injections are frequently indicated for myofascial pain syndrome and are performed as blind procedures. Although these injections are usually safe and effective, complications resulting in pneumothorax, epidural abscess, skeletal muscle toxicity, and intrathecal injection been reported. Avoiding the risk of radiation, ultrasonography provides real-time visualization of soft tissue, bone, cartilage, and foreign body, and may be used to guide injections.The clinical manifestation of myofascial pain syndrome and trigger points will be presented. A review of the etiology and identification of trigger p...
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: David Chim, Peter H. Cheng Source Type: journals

Ultrasound-guided shoulder joint injectionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Subacromial bursa (SAB) and glenohumeral joint (GHJ) injections are commonly performed for shoulder pain and dysfunction. For patients with rotator cuff or impingement syndromes, the SAB injection may provide temporary relief of pain and increase shoulder mobility, as well as help confirm the diagnosis. Likewise, for patients with calcific tendonitis or arthritis of the GHJ, injection of the GHJ may be therapeutic.Although these procedures are usually performed “blindly” without image guidance, inadvertent extra-articular injections have been frequently reported; therefore, many practitioners use fluoroscopy for confir...
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Peter H. Cheng, James G. Modir, Helen J. Kim, Samer Narouze Source Type: journals

Ultrasound-guided injections of the knee and hip jointsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article presents suitable techniques for performing US-guided intra-articular knee and hip injections. With appropriate training, it would be feasible for physicians to incorporate US-guided injections into their clinical practices.
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Peter H. Cheng, Helen J. Kim, Einar Ottestad, Samer Narouze Source Type: journals

Ultrasonography in pain medicine: Future directionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This paper presents examples of potential future directions regarding the applications of ultrasonography in interventional pain management.
Source: Techniques in Regional Anesthesia & Pain Management - July 1, 2009 Category: Anesthesiology Authors: Samer Narouze Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Techniques in Regional Anesthesia & Pain Management - April 1, 2009 Category: Anesthesiology Source Type: journals

Table of ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Techniques in Regional Anesthesia & Pain Management - April 1, 2009 Category: Anesthesiology Source Type: journals

Management of axial back pain: A critical viewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The current issue of Techniques in Regional Anesthesia and Pain Management tackles a controversial topic: axial spine pain from intervertebral disc diseases (IDD) and its management. Although this issue does not address physiotherapeutic management or common surgical interventions for IDD, it focuses more on what pertains to the discipline and practice of Pain Medicine. The first article describes potential pathophysiologic mechanisms of IDD. This is an important contribution because it will help us understand the potential mechanisms by which the interventional procedures, later discussed in this issue, may help patients ...
Source: Techniques in Regional Anesthesia & Pain Management - April 1, 2009 Category: Anesthesiology Authors: Ali Mchaourab, Karen Knight Source Type: journals

Anatomy and pathophysiology of intervertebral disc diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Intervertebral discs provide support and cushioning against mechanical loads. Changes secondary to aging and degeneration lead to loss of this important function. This also sets the stage in some for disc-related pain. Various therapeutic modalities have been attempted with minimal long-term success to alleviate the poorly described disc-related pain. To better understand the pain originating from the disc, this article attempts to explore the anatomy of the disc and the different perturbations that occur following aging and degeneration. There is a great deal of similarity among the discs in different levels. They all con...
Source: Techniques in Regional Anesthesia & Pain Management - April 1, 2009 Category: Anesthesiology Authors: Hariharan Shankar, Jeremy A. Scarlett, Stephen E. Abram Source Type: journals

Discography: Interpretation from a surgeon's perspectiveEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The use of spinal discography has been controversial since its inception. Although its intended common uses and indications have changed over the decades, questions about its reliability and how to interpret results have persisted. As it has evolved from a primary diagnostic tool for spinal disc protrusions in the pre-computed tomography (CT) and pre-magnetic resonance imaging (MRI) eras to a more limited role in evaluating the nature of suspected painful discs, the controversies have continued. Here, the author reviews the historical evolution of spinal discography and recent literature focused on the role of provocative ...
Source: Techniques in Regional Anesthesia & Pain Management - April 1, 2009 Category: Anesthesiology Authors: David J. Hart Source Type: journals

Lumbar discography: Diagnostic role in discogenic painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses the current scientific evidence regarding the use of discography at lumbar spinal levels, describes the technique and associated complications, and explores the controversies surrounding the usefulness of this diagnostic test.
Source: Techniques in Regional Anesthesia & Pain Management - April 1, 2009 Category: Anesthesiology Authors: Carlos A. Pino, Clarence S. Ivie, James P. Rathmell Source Type: journals

Nucleoplasty for disc protrusion: A novel percutaneous decompression techniqueEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Nucleoplasty is an FDA-approved minimally invasive technique for percutaneous decompression of intervertebral disc protrusion. It is indicated for radicular pain, but there are emerging data related to management of discogenic pain. The evolution of minimally invasive spine techniques provides an impetus for pain specialists to ensure the safest and most effective use of these technologies. Due to its relatively recent release, pain management specialists are still exploring its best possible use. In this article, research regarding this technique is summarized and the technique is described. Recent research has been posit...
Source: Techniques in Regional Anesthesia & Pain Management - April 1, 2009 Category: Anesthesiology Authors: Karen Knight, Don M. Woods, Ali Mchaourab Source Type: journals

Intradiscal electrothermal therapy (IDET) for the treatment of discogenic painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Despite advances in imaging and interventional techniques, discogenic back pain continues to be a diagnostic and management challenge. Practitioners have sought the use of minimally invasive intradiscal thermal therapies for the relief of discogenic low back pain. Different techniques delivering heat to the disc have been developed, collectively known as thermal intradiscal procedures. The main focus of this review is dedicated to the most studied procedure, intradiscal electrothermal therapy (IDET), in the management of discogenic low back pain. Although IDET may be beneficial in a selected population of patients, evidenc...
Source: Techniques in Regional Anesthesia & Pain Management - April 1, 2009 Category: Anesthesiology Authors: Abdallah Kabbara, Salim M. Hayek Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Source Type: journals

Table of ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Source Type: journals

Headache medicine for the pain practitionerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Pain medicine is alive and thriving in the body of work done by many specialties, including anesthesia, rehabilitation medicine, and neurology, among others. Different pain syndromes often have different levels of ownership among the medical specialties, and the complaint of headache tends to reside in the neurology court—or headache medicine to be precise; but all practitioners in the art of pain medicine need to understand this common complaint. Headache often accompanies another pain complaint. With the sensitivity of the trigeminal system, one can easily develop headache spontaneously, or with minimal provocation, in...
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Brian E. McGeeney Source Type: journals

An introduction to headache classificationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Health care providers spend a lot of time with headache patients, where there is worry over secondary causes for headache. But the great majority of time is spent managing patients with primary headache; that, is dysfunction of the pain system in the head itself, such as migraine, and all its presentations. The release of the International Classification of Headache Disorders in 1988 (updated in 2004) was a major advance in headache medicine and neurology, fostering an enormous increase in clinical study, from which treatment decisions are now made and patients benefit. It is worthwhile for pain medicine practitioners to h...
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Brian E. McGeeney Source Type: journals

An introduction to migraine pathophysiologyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The pathophysiology of migraine is a complicated one. What produces aura, pain, and concurrent neurological symptoms is not completely clear. What we do know, however, is that migraine is a primary neurological disorder with effects throughout the body. In this article, we will review basic physiology of headache, characteristics of migraine, and more specifically, what is currently known about its pathophysiology.
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Dyveke Pratt Benoit Source Type: journals

Acute treatment of migraine headacheEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The purpose of this article is to provide practitioners with the tools necessary to diagnose and treat acute migraine. The current diagnostic criteria for migraine are outlined. Pearls to distinguish migraine from the other primary headaches, such as tension-type headache and cluster headache, are provided. The importance of the headache history, plus indications for neuroimaging, are presented. Readers will be taught how to take an effective headache history. General principles of treatment, including appropriate medication selection, medication dosing and route of administration, medication contraindications, drug intera...
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Marisa Chang, Alan M. Rapoport Source Type: journals

Tension-type headacheEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(TTH) is the most common headache encountered, with most people experiencing TTH at some time in their lives. Diagnostic criteria are somewhat vague and nonspecific, with TTH mainly defined by the absence of associated migrainous features. Generally, TTH does not cause impairment, and sufferers can go about their daily lives. TTH can be divided into episodic and chronic, with the chronic variety being much more likely to come to medical attention. Pathophysiology is still largely unknown, and TTH is associated with a greater chance of comorbid anxiety disorders and depression. Treatment involves patient education and cons...
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Brian E. McGeeney Source Type: journals

Daily pharmacologic prophylaxis of episodic migraineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Patients with high frequencies of migraine, high disability or impact from migraine, and frequent users of acute migraine medications merit migraine prophylaxis in the form of daily medication. The choice of migraine-preventive medication is best based on the opportunity to treat multiple concomitant disorders as well as migraine with 1 medication. Migraine-preventive medications, at best, work in approximately half of patients to reduce migraine frequency by about 50%, so careful establishment of expectations with use of headache diaries is crucial for therapeutic success. Treatment should always begin with low doses and ...
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Cynthia C. Bamford, Stewart J. Tepper Source Type: journals

Lifestyle changes, dietary restrictions, and nutraceuticals in migraine preventionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses this practitioner's empiric recommendation for lifestyle changes and graded evidence for dietary changes and nutraceuticals in migraineurs. Alcohol, aspartame, nitrates, and monosodium glutamate are Grade B-rated dietary substances needing restriction, with MSG lacking data specific for migraine. No consensus yet exists on the hierarchy of efficacy for the nutraceuticals. Given the number of patients studied and data consistency or lack thereof regarding efficacy, Petadolex appears to have best proof followed by magnesium > feverfew (no commercially available MIG-99 forms) > riboflavin > coenzyme Q10 > thiotic acid.
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Frederick R. Taylor Source Type: journals

Cluster headache and related disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Cluster headache is a well-known primary headache syndrome occurring much less frequently than migraine, with a prevalence of approximately 5/10,000 of the adult population and a strongly male predilection. Cluster headache is the most prevalent of a group of unilateral headache syndromes known as trigeminal autonomic cephalalgias and can be differentiated from migraine by clinical and pathophysiological features. Cluster headache also exhibits a differing therapeutic response to medications when compared with migraine. Cluster attacks are known for their brief intense unilateral excruciating pain with unilateral autonomic...
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Brian E. McGeeney Source Type: journals

Nerve blocks and nerve stimulation in headache disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article summarizes the techniques, proposed mechanisms, and effectiveness of these commonly used anesthetic procedures and electrical stimulation procedures for head pain conditions. There are unfortunately few controlled studies of nerve blockade and neurostimulation, so, despite numerous positive reports of their usefulness, firm evidence for these procedures is lacking. There is therefore a serious need for randomized, blinded, sham-controlled studies of the nerve block and nerve stimulation procedures which have been reported as potentially helpful for headache and facial pain disorders.
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Morris Levin Source Type: journals

Behavioral management of headacheEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Most clinicians agree that biobehavioral factors are important considerations in the assessment and treatment of patients with headache. A biobehavioral model underscores the need to abandon a traditional organic vs psychogenic explanation to account for the development and maintenance of head pain. Conditions that control pain symptoms may become multidimensional because they involve cognitive, emotional, and behavioral factors as well as biological processes. The interplay of these variables becomes an even more important treatment issue should the frequency of a patient's headaches increase, if there is increased disabi...
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Randall E. Weeks Source Type: journals

Secondary headache: concepts and examplesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Many disorders herald their onset or presence with headache. Of particular concern are those disorders that do not present with signs and symptoms that quickly point to an underlying etiology, and may present with headache as a first or sole symptom. New headache has a very wide differential, as opposed to chronic recurrent headache. Early identification of secondary headache is made easier by identifying those at higher risk of secondary headache, based on their background along with features of the presentation, such as new onset headache, thunderclap onset headache, and headache presentations in those over 50 years old....
Source: Techniques in Regional Anesthesia & Pain Management - January 1, 2009 Category: Anesthesiology Authors: Brian E. McGeeney Source Type: journals

Editorial boardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Techniques in Regional Anesthesia & Pain Management - October 1, 2008 Category: Anesthesiology Source Type: journals

Table of contentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Techniques in Regional Anesthesia & Pain Management - October 1, 2008 Category: Anesthesiology Source Type: journals

Does regional anaesthesia improve outcome? Facts and dreamsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Perioperative regional anesthesia and analgesia have been shown to attenuate perioperative pathophysiology, provide optimal postoperative analgesia, and possibly improve patient outcomes. Obvious benefits, such as the quality of postoperative analgesia and the decrease in hospital stay or in hospital costs, are easy to demonstrate, but proof that regional anesthesia improves the outcome from surgery is still lacking. Many old studies were inconclusive with methodological weaknesses. So, there is some controversy surrounding the efficacy of these techniques in improving patient outcomes.
Source: Techniques in Regional Anesthesia & Pain Management - October 1, 2008 Category: Anesthesiology Authors: Xavier Capdevila, Olivier Choquet Source Type: journals

Regional anesthesia and patient outcomes: evidence-based medicineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Despite some reticence on the part of both surgical and anesthesiology colleagues, the use of regional anesthesia and analgesia does provide improvement in patient outcomes. Although the majority of available data has examined the effect of epidural anesthesia and analgesia on patient outcomes, an increasing number of studies recently have investigated the effect of peripheral regional techniques (both single-shot and continuous) on outcomes. Overall, the data suggest that the perioperative use of regional anesthesia and analgesia may improve both major (e.g., mortality, major morbidity) and minor (patient-reported) outcom...
Source: Techniques in Regional Anesthesia & Pain Management - October 1, 2008 Category: Anesthesiology Authors: Vineesh Mathur, E. David Bravos, Cristianna Vallera, Christopher L. Wu Source Type: journals

Regional anesthesia and the perioperative period: basis and principlesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Insufficient analgesia and/or opioid-related side effects may hinder the course of the postoperative recovery. Regional anesthesia and/or analgesia (RA) has the ability to provide optimal pain relief with a concomitant reduction of opiate consumption and its side effects. Some other potential advantages of RA have been described, such as the potential to reduce the surgical stress, or the prevention of chronic postoperative pain, which may represent significant benefits and strongly argues for a widespread use of RA.Locoregional techniques should be considered according to the type of the surgery. As surgery is moving towa...
Source: Techniques in Regional Anesthesia & Pain Management - October 1, 2008 Category: Anesthesiology Authors: Marc Beaussier, Arthur Atchabahian, Nicolas Dufeu Source Type: journals

The role of regional anesthesia in patient outcome: orthopedic surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Outcome is defined as “a change in a patient's health status that can be attributed to antecedent health care.” Postoperative pain is a major concern after orthopedic limb surgery. Indeed, pain is exacerbated with motion, particularly after shoulder and knee surgery. From moderate at rest, pain becomes most severe during mobilization. Several studies have shown that regional anesthesia is associated with superior analgesia compared with patient-controlled analgesia morphine. The better postoperative pain control has led to the application of early mobilization, a new trend in modern orthopedics. Other benefits of regio...
Source: Techniques in Regional Anesthesia & Pain Management - October 1, 2008 Category: Anesthesiology Authors: Alain Borgeat Source Type: journals

The role of regional anaesthesia in patient outcome: thoracic and abdominal surgeriesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This review focuses on the establishment and implementation of well-defined, evidence-based clinical pathways in thoracic and abdominal surgeries, to facilitate improved outcomes and avoid complications, enabling rapid recognition and treatment of complications. Ultimately, this will facilitate the recovery process and return to baseline activity. Patients scheduled for either thoracic or abdominal surgery often have compromised cardiopulmonary and metabolic functions before surgery, and the procedure itself may decrease patients' reserve. Postoperative pain acts as an additional insult to body reserve, and regional anesth...
Source: Techniques in Regional Anesthesia & Pain Management - October 1, 2008 Category: Anesthesiology Authors: Avinash Sinha, Franco Carli Source Type: journals

The role of regional anesthesia in patient outcome: ambulatory surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The past 10 years have demonstrated real and dramatic growth in the number and complexity of ambulatory surgeries. The remaining real problems are the postoperative pain and the adverse effects due to systemic opioids promoting hospital readmissions and increasing costs. These events limit the expansion of outpatient surgery. Regional anesthesia techniques such as spinal anesthesia and peripheral nerve blocks are ideal techniques for 1-day hospital admission surgical procedures. It is now fully demonstrated that these techniques allow rapid and complete anesthetic blocks, a limitation of adverse events and unplanned hospit...
Source: Techniques in Regional Anesthesia & Pain Management - October 1, 2008 Category: Anesthesiology Authors: Xavier Capdevila, Matthieu Ponrouch, Didier Morau Source Type: journals

Regional anesthesia and analgesia: prevention of chronic painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Chronic pain after surgery is an area that has been neglected. Though limited in clinical trials, there is reasonable evidence that there are specific risk factors for developing chronic pain after surgery. These patients should be identified preoperatively and followed up very closely by the anesthesiologist during the postoperative period so as to prevent the development of chronic pain. Regional anesthesia and analgesia should be utilized when possible in these surgical cases, and a multimodal approach to controlling the perioperative pain with the goal to prevent spinal cord sensitization should prevent chronic pain an...
Source: Techniques in Regional Anesthesia & Pain Management - October 1, 2008 Category: Anesthesiology Authors: Asokumar Buvanendran Source Type: journals

Does regional anesthesia improve long-term patient outcome?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Events occurring in the perioperative period may have persistent effects beyond discharge from the hospital. The role of regional anesthesia in the improvement of long-term patient outcome has been evaluated in several studies. The goal of this review is to examine how the anesthetic management, particularly regional anesthesia, could influence long-term mortality, cancer recurrence, cognitive dysfunction, persistent chronic pain and rehabilitation in the postoperative period.
Source: Techniques in Regional Anesthesia & Pain Management - October 1, 2008 Category: Anesthesiology Authors: Fernande Lois, Marc De Kock Source Type: journals

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