The Spirits of Pain and Suffering
Robert S. Holzman in Anesthesia and the Classics, 2022
Anesthesia is broadly considered to be the provision of pain relief, unconsciousness and motionlessness during surgery. Most surgical anesthetics are general anesthetics, but anesthetic techniques are much more extensive than that. They include regional (nerve block) anesthesia, the provision of pain relief through the use of local anesthetic blocking major nerves to the arms or legs, as well as spinal or epidural anesthesia, blocking spinal nerves, typically for obstetrical pain relief or extremity surgery. Pain treatment specialists perform specific nerve blocks for the treatment of cancer pain, trauma, inflammatory diseases, headache and other disorders that can be treated with such blocks. They will also employ multi-modal analgesic medications because of their expert understanding of the various kinds of nerves and neurotransmitters involved in different modalities of pain – the lancinating pain of trauma, the sharp, twinging of peripheral neuropathies such as diabetic neuropathy, and the burning of complex regional pain syndromes. Critical Care Medicine, a melting pot of medical specialties such as anesthesiology, surgery, pulmonary medicine and pediatrics, began in the back of the Recovery Room (now called the Post Anesthesia Care Unit, or PACU) with anesthesiologists, as specialists in cardiopulmonary support and mechanical ventilation.
Procedures for pediatric pain management
Harald Breivik, William I Campbell, Michael K Nicholas in Clinical Pain Management, 2008
Neuraxial spread of solution in the epidural space allows relatively extensive analgesia for a given dose of analgesic. The toxicity of LA means that dose limits must be strictly observed and so neuraxial analgesia has distinct advantages, especially in the very young. The duration of action of epidural LA is relatively extended in comparison with peripheral nerve block and intrathecal block, but does not exceed four hours even with the longest acting drugs. Catheters can easily be placed into the epidural space and considerable experience has been gained of prolonged epidural analgesia by infusion of local anesthetic. The duration of action of single-shot caudal or lumbar epidurals can be extended by drugs with an additive neuraxial effect, e.g. opioids, clonidine, or ketamine.
Botulinum toxin in the management of focal hyperhidrosis
Anthony V. Benedetto in Botulinum Toxins in Clinical Aesthetic Practice, 2017
Nerve blocks are effective and can be performed in the office69,79–81; however, with the much simpler technique of ice and pressure described below, nerve blocks are not often used. The palm is innervated by three nerves, median, ulnar, and radial nerves. All can be anesthetized at the level of the wrist using 1% or 2% lidocaine (Figure 9.8). Risks of a nerve block include infiltration of the nerve with subsequent nerve injury and vascular puncture. In addition, temporary hand weakness after the nerve blocks may limit the patients’ activities and ability to have both hands treated at one session. A 30 G 0.5-inch needle should be used to minimize any nerve trauma. Approximately 2 cc of 1% or 2% lidocaine is injected around each of the nerves. If the patient feels any unusual tingling or sensation during the injection, the needle should be withdrawn slightly. Twenty minutes or more may be necessary for the full effect to develop. If the anesthesia is not complete, other techniques may also be used (Table 9.7).
Effects of Dexamethasone on Bupivacaine-Induced Peripheral Nerve Injection Injury in the Rat Sciatic Model
Published in Journal of Investigative Surgery, 2021
Mehmet Selim Çömez, Yakup Borazan, Tümay Özgür, Cafer Tayer İşler, Mustafa Cellat, Mehmet Güvenç, Muhammed Enes Altuğ
Regional anesthesia gains popularity with potential benefits of improved analgesia, decreased nausea and vomiting and increased patient satisfaction.1 Peripheral nerve blocks are one of the regional anesthesia methods with increasing popularity. Intraneural local anesthetic injectionisone of the important complications of the peripheral nerve block technique.2 Local anesthetics are related to increased inflammatory response, altered nerve permeability, and myotoxicity.3 Among local anesthetics, bupivacaine is an amid-type local anesthetic and is used widely in the regional anesthesia and has toxic effects on neurons.4,5 Bupivacaine may trigger apoptosis through a dose-dependent pattern by impairing the mitochondrial membrane and activating caspase-3 and other products.6
Postoperative analgesic effect of dexmedetomidine combined with TPVB applied to open gastrectomy for gastric cancer
Published in Immunopharmacology and Immunotoxicology, 2023
Weilan Wan, Zhiqi Hou, Qiuying Qiu
Afterwards, ultrasound-guided TPVB was performed by an experienced anesthesiologist that was blind to the group allocation. In brief, the patient was in lateral position, and the 8–9 spinous processes of thoracic vertebrae were determined first. Before puncture, 1% lidocaine was used for local infiltration anesthesia. The puncture point was 3 cm beside the upper edge of spinous process. In-plane puncture technique was used to puncture into thoracic paravertebral space. No blood and cerebrospinal fluid were drawn back. The catheter was implanted 2.5 cm and fixed. Fifteen milliliters 0.5% RO with 2 mL dexmedetomidine (1 μg/kg) was injected paravertebrally to the patients in RD group under ultrasound guidance. Patients in the RO group received 15 mL RO (0.5%) and 2 mL normal saline. The anesthetic effect was tested to determine that nerve block was successful.
Occipital osteomylelitis and epidural abscess after occipital nerve block: A case report
Published in Canadian Journal of Pain, 2018
Sean D. Christie, Nelofar Kureshi, Ian Beauprie, Renn O. Holness
Occipital nerve block is a common diagnostic and therapeutic tool used in the course of occipital neuralgia, and injections are commonly performed by both family physicians and specialists. Ultrasound-guided approaches are superior to landmark techniques for favorable outcome with occipital nerve block.11 The greater occipital nerve (GON) provides cutaneous innervation to the posterior scalp, whereas the lesser occipital nerve supplies scalp sensation lateral to the GON to the posterior auricle. In patients with occipital neuralgia, the GON may be blocked alone or with the lesser occipital nerve for peripheral nerve block. Local anesthetics including lidocaine, mepivacaine, and bupivacaine may be injected as monotherapy or as combinations. Corticosteroids may be added for patients who do not respond to infiltration with local anesthetic only.
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