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Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Thermography may be used in local anesthesia to determine the onset and extent of nerve blocks and spinal/epidural anesthesia procedures.212 Perineural injections of local anesthetic agents such as lidocaine cause a total nerve block as the agent diffuses into the nearby neural tissue. This block affects the sympathetic fibers as well as the sensorimotor fibers, inhibiting the sympathetic vasoconstrictive action over the distribution of the blocked nerve. The warmer thermographic appearance of a successful nerve block in a vasoconstricted hand or foot will show a distinct and sharp-edged delineation (Figure 11.48). Areas supplied by other unaffected nerves will remain cool.213 This thermographic appearance may precede the sensory blockade by a few minutes. More proximal areas supplied by the blocked nerve may show less distinct and lower amplitude thermal changes. If epinephrine is added to the anesthetic to make the block last longer, the injection site may appear cool due to local adrenergic vasoconstriction.
Screening and Pharmacological Management of Neuropathic Pain
Published in Suvardhan Kanchi, Rajasekhar Chokkareddy, Mashallah Rezakazemi, Smart Nanodevices for Point-of-Care Applications, 2022
Manu Sharma, Ranju Soni, Kakarla Raghava Reddy, Veera Sadhu, Raghavendra V. Kulkarni
The nerve block technique involves a procedure designed to interfere with neural conduction to diminish or hamper pain. Both afferents as well as efferent conduction may be interrupted. Local anesthetics are the most commonly injected substance for nerve blocks and the effect is prolonged on the addition of a corticosteroid. Nerve block techniques have been classified into four categories, i.e. diagnostic, prognostic, prophylactic, and therapeutic nerve block. Diagnostic nerve blocks can define more clearly the anatomical etiology of the pain and help in distinguishing peripheral and central pain syndromes. Prognostic nerve blocks are performed to help to predict response to a procedure that may have a greater duration of action than a nerve block with a local anesthetic. On the other hand, prophylactic nerve blocks or preemptive analgesia are techniques employed to prevent the development of significant pain following surgery or trauma. Therapeutic nerve blocks may be used to diminish pain and promote functional rehabilitation in combination with physiotherapy during acute or chronic pain syndromes.
Acute postoperative pain management with percutaneous peripheral nerve stimulation: the SPRINT neuromodulation system
Published in Expert Review of Medical Devices, 2021
Rodney A. Gabriel, Brian M. Ilfeld
Multimodal opioid-sparing analgesia pathways are a strategic approach to optimizing pain control in patients undergoing moderate-to-severely painful surgery[1]. One of the key components of a multimodal approach to analgesia is the utilization of regional anesthesia, especially important in the midst of the opioid epidemic within the United States [2,3]. A single injection of perineural local anesthetic produces analgesia for only as long as the duration of action of the local anesthetic – currently a maximum of less than one day. Perineural local anesthetic infusion – a ‘continuous peripheral nerve block’ in which local anesthetic is repeatedly administered to a nerve via a percutaneous catheter – affords potent analgesia in the affected area by providing ongoing blockade of the sensory nerves attributed to pain sensation from the surgery[2]. However, there are major limitations with this current modality: 1) concomitant motor blockade that may negatively affect postoperative rehabilitation and safety; 2) the sense of numbness which can decrease the ability to protect the limb and may be experienced as discomfort; 3) the need to carry an external bulky medication bag and pain pump that are frequently cumbersome; 4) the risk of catheter dislodgement leading to uncontrolled pain; and 5) a typical duration limited to 3–7 days due to an increasing risk of infection and local anesthetic reservoir exhaustion[2]. The latter is especially limiting as the duration of acute pain from some surgical procedures frequently outlasts that of the nerve block. Unlike performing PNS in an outpatient pain procedure setting, anesthesiologists are tasked with providing nerve blocks for surgical patients in a fast-paced perioperative environment; in which, patients check-in for surgery 1–2 hours prior to their scheduled start time. This provides only a small window of time to perform nerve blocks; thus, any new modalities would also need to consider this workflow barrier. A newer regional anesthesia modality for managing acute postoperative pain is peripheral nerve stimulation (PNS)[4]. In the following review, we discuss the SPRINT (SPR Therapeutics, Cleveland, OH) neuromodulation system and how it may be implemented in a fast-paced perioperative environment with the goal to provide long-term postoperative analgesia specifically for surgical patients.