Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities.

Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures.

Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study.

Background: Continuous interscalene blocks provide excellent analgesia after shoulder surgery. Although the safety of the ultrasound-guided in-plane approach has been touted, technical and patient factors can limit this approach. We developed a caudad-to-cephalad out-of-plane approach and hypothesized that it would decrease pain ratings due to better catheter alignment with the brachial plexus compared to the in-plane technique in a randomized, controlled study.

Setting up an acute pain management service.

Successful implementation of an acute pain management service involves a team approach in which team members have clearly defined roles. Clinical protocols are designed to help address common problems and prevent errors. As the complexity of surgery and patients' diseases continues to increase, current knowledge of new analgesic medications, acute pain literature, and skills in regional anesthesia techniques is imperative.

Perioperative pain management for total knee arthroplasty.

Pain management following total knee arthroplasty (TKA) can be challenging. Inadequate pain management following TKA may inhibit rehabilitation, increase morbidity and mortality, decrease patient satisfaction, and lead to chronic persistent postsurgical pain. Traditionally the mainstay of postoperative pain management was opioids; however, the current recommendations to pain management emphasize a multimodal approach and minimizing opioids whenever possible.

Perioperative management of interscalene block in patients with lung disease.

Interscalene nerve block impairs ipsilateral lung function and is relatively contraindicated for patients with lung impairment. We present a case of an 89-year-old female smoker with prior left lung lower lobectomy and mild to moderate lung disease who presented for right shoulder arthroplasty and insisted on regional anesthesia. The patient received a multimodal perioperative regimen that consisted of a continuous interscalene block, acetaminophen, ketorolac, and opioids.

Spinal anesthesia: should everyone receive a urinary catheter?: a randomized, prospective study of patients undergoing total hip arthroplasty.

Background: The objective of this randomized prospective study was to determine whether a urinary catheter is necessary for all patients undergoing total hip arthroplasty under spinal anesthesia.

Methods: Consecutive patients undergoing total hip arthroplasty under spinal anesthesia were randomized to treatment with or without insertion of an indwelling urinary catheter. All patients received spinal anesthesia with 15 to 30 mg of 0.

Fascia lliaca block for analgesia after hip arthroplasty: a randomized double-blind, placebo-controlled trial.

Background And Objectives: Fascia iliaca block (FIB) is often used to treat pain after total hip arthroplasty (THA), despite a lack of randomized trials to evaluate its efficacy for this indication. The objective of this study was to assess the analgesic benefit of FIB after THA. Our primary hypothesis was administration of FIB decreases the intensity of postoperative pain (numeric rating scale [NRS-11] score) compared with sham block (SB) in patients after THA.

Acute pain management in the postanesthesia care unit.

Pain management in the postanesthesia care unit (PACU) is continually evolving, with several new nonopioids expanding the list of available agents. Pain in the PACU is not an inevitable outcome of surgery. With careful planning, multimodal analgesic techniques instituted preoperatively will reduce pain in the PACU.

Preoperative anemia in total joint arthroplasty: is it associated with periprosthetic joint infection?

Background: Anemia is common in patients undergoing total joint arthroplasty (TJA). Numerous studies have associated anemia with increased risk of infection, length of hospital stay, and mortality in surgical populations. However, it is unclear whether and to what degree preoperative anemia in patients undergoing TJA influences postoperative periprosthetic joint infection (PJI) and mortality.

The effect of stimulating versus conventional perineural catheters on postoperative analgesia following ultrasound-guided femoral nerve localization.

Study Objective: To test the hypothesis that, if the femoral nerve is correctly localized using ultrasound (US) guidance, the type of perineural catheter used has no effect on catheter success.

Design: Randomized controlled trial.

Setting: Post-anesthesia care unit of an academic teaching hospital.

Quantifying cardiovascular risks in patients with metabolic syndrome undergoing total joint arthroplasty.

The coexistence of diabetes, hypertension, obesity, and dyslipidemia is defined as metabolic syndrome. Studies show substantial cardiovascular risks among these patients. The risk of patients with metabolic syndrome undergoing total joint arthroplasty (TJA) is unknown.

Multimodal pain management after total joint arthroplasty.

Adequate postoperative pain control in patients who have undergone total joint arthroplasty allows faster rehabilitation and reduces the rate of postoperative complications. Multimodal pain management involves the introduction of adjunctive pain control methods in an attempt to control pain with less reliance on opioids and fewer side effects. Current research suggests that traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and the associated cyclooxygenase type-2 (COX-2) inhibitors improve pain control in most cases.

Challenges in acute pain management.

The management of acute pain remains challenging, with many patients suffering inadequate pain control following surgery. Certain populations are at unique risk for unrelieved pain. Evidence-based approaches taking into account patients' specific needs and problems will likely substantially improve their perioperative experience.

The effect of mixing 1.5% mepivacaine and 0.5% bupivacaine on duration of analgesia and latency of block onset in ultrasound-guided interscalene block.

Background: Short- and long-acting local anesthetics are commonly mixed to achieve nerve blocks with short onset and long duration. However, there is a paucity of data on advantages of such mixtures. We hypothesized that a mixture of mepivacaine and bupivacaine results in a faster onset than does bupivacaine and in a longer duration of blockade than does mepivacaine.

Postoperative pain management techniques in hip and knee arthroplasty.

Adequate control of postoperative pain following hip and knee arthroplasty can be a challenging task fraught with potential complications. Postoperative pain is perceived by the patient via a complex network and a multitude of molecular messengers in both the peripheral and central nervous systems. This allows the physician to modulate pain via an array of medications that act on different sites within the body.

Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis.

Objective: To compare the risk of neonatal and infant adverse outcomes between vacuum and forceps assisted deliveries.

Design: Population based study.

Setting: US linked natality and mortality birth cohort file and the New Jersey linked natality, mortality, and hospital discharge summary birth cohort file.

Fas-mediated neutrophil apoptosis and associated A1 protein expression during systemic inflammation are regulated independently of both tumor necrosis factor receptors.

TNFR-1 (p55) and Fas share a death domain which is critical for apoptosis signaling whereas TNFR-p55 and TNFR-2 (p75) can activate NF-kappaB leading to anti-apoptotic proteins expression such as A1. The purpose of this study was to elucidate the role(s) of TNFR-p55 and TNFR-p75 in Fas-mediated neutrophil apoptosis and A1 expression in a mouse model of endotoxemia. Gene knockout (KO) (p55-/-, p75-/-, p55(-/-)/p75(-/-)) or wild type (WT) mice were injected i.