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Kindlin-1 Regulates Astrocyte Activation and Pain Sensitivity in Rats With Neuropathic Pain
Background and Objectives Astrocyte activation has been implicated in the pathogenesis of neuropathic pain, but the involvement of kindlin-1 in astrocyte activation and neuropathic pain has not yet been illustrated. Using a chronic constriction injury (CCI) rat model of neuropathic pain, we investigated the expression levels of kindlin-1 during neuropathic pain and the influences of kindlin-1 on regulating pain sensitivity. Methods Neuropathic pain was induced in rats by CCI of the sciatic nerve. Rats were randomly assigned to 4 groups: sham operation, CCI, CCI + kindlin-1 short hairpin RNA (shRNA), and CCI + kindlin-...
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Chronic and Interventional Pain: Original Article Source Type: research

Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists
Conclusions Evidence supports the use of ketamine for chronic pain, but the level of evidence varies by condition and dose range. Most studies evaluating the efficacy of ketamine were small and uncontrolled and were either unblinded or ineffectively blinded. Adverse effects were few and the rate of serious adverse effects was similar to placebo in most studies, with higher dosages and more frequent infusions associated with greater risks. Larger studies, evaluating a wider variety of conditions, are needed to better quantify efficacy, improve patient selection, refine the therapeutic dose range, determine the effectivene...
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Chronic and Interventional Pain: Special Article Source Type: research

Why Aren't There More Female Pain Medicine Physicians?
Despite a growing awareness about the importance of gender equity and the rising number of women in medicine, women remain persistently underrepresented in pain medicine and anesthesiology. Pain medicine ranks among the bottom quartile of medical specialties in terms of female applicants, female trainees, and proportion of female practitioners. Female pain medicine physicians are also notably disadvantaged compared with their male colleagues in most objective metrics of gender equity, which include financial compensation, career advancement, public recognition, and leadership positions. Increased gender diversity among pai...
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Chronic and Interventional Pain: Daring Discourse Source Type: research

Immunomodulatory Effects of Fentanyl or Dexmedetomidine Hydrochloride Infusion After Allogeneic Heart Transplantation in Mice
Background and Objectives Postoperatively, transplant recipients receive immunosuppressants, as well as sedatives and analgesics. The immunomodulatory effects of these other agents during the induction period following transplantation remain unclear. We aimed to determine whether the agents dexmedetomidine hydrochloride (Dex) and fentanyl (Fen) have immunomodulatory effects during the induction period following heart transplantation (HTx). Methods Fifty mice were used for antinociception tests after administration of Dex and Fen, and T cells from 3 naive animals were used for in vitro lymphocyte transformation test (s...
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Original Articles Source Type: research

The Impact of Spinal Needle Selection on Postdural Puncture Headache: A Meta-Analysis and Metaregression of Randomized Studies
Background and Objectives Potentially broadened indications for spinal anesthesia require increased understanding of the risk factors and prevention measures associated with postdural puncture headache (PDPH). This review is designed to examine the association between spinal needle characteristics and incidence of PDPH. Methods Meta-analysis and metaregression was performed on randomized controlled trials to determine the effect of needle design and gauge on the incidence of PDPH after controlling for patient confounders such as age, sex, and year of publication. Results Fifty-seven randomized controlled trials (n ...
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Original Articles Source Type: research

Microanatomical Nerve Architecture of 6 Mammalian Species: Is Trans-Species Translational Anatomic Extrapolation Valid?
Background and Objectives Various animal models have historically been used to study iatrogenic nerve injury during performance of conduction nerve blocks. Our aims were to compare the microstructures of nerves in commonly used species to those of humans and to explore the validity of the extrapolating these findings to humans. Methods High-resolution, light-microscopic images were obtained from cross sections of sciatic nerves at their bifurcation from fresh rat, rabbit, pig, sheep, dog, and human cadavers. Various microanatomical characteristics were measured and compared between the species. P (Source: Regional Ane...
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Original Articles Source Type: research

Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block: A Single-Center, Prospective, Double-Blind, Randomized Controlled Trial
Background and Objectives Intravenous (IV) dexmedetomidine (DEX) is reported to prolong the analgesic duration after single-shot interscalene brachial plexus block (ISBPB). However, the effective analgesic dose of IV DEX remains undetermined. Therefore, we aimed to elucidate the clinically relevant dose of IV DEX to prolong the analgesic duration of ISBPB. Methods Seventy-two patients scheduled for arthroscopic shoulder surgery received ISBPB with 15 mL of 0.5% ropivacaine with 1:200,000 epinephrine and were randomly assigned to 1 of 4 groups (n = 18, each): (1) IV normal saline (control), (2) IV DEX 0.5 μg/kg (DEX 0...
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Original Articles Source Type: research

Too Deep or Not Too Deep?: A Propensity-Matched Comparison of the Analgesic Effects of a Superficial Versus Deep Serratus Fascial Plane Block for Ambulatory Breast Cancer Surgery
Conclusions The postoperative in-hospital analgesia associated with deep serratus block is as effective (within an acceptable margin) as superficial serratus block following ambulatory breast cancer surgery. These new findings are important to inform both current clinical practices and future prospective studies. (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Original Articles Source Type: research

The Importance of the Saphenous Nerve Block for Analgesia Following Major Ankle Surgery: A Randomized, Controlled, Double-Blind Study
Conclusions The saphenous nerve is an important contributor to postoperative pain after major ankle surgery, with significant clinical pain appearing within 30 minutes after surgery. Clinical Trials Registration This study has been registered at ClinicalTrials.gov, identifier NCT02697955. (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Original Articles Source Type: research

Local Anesthetic Injection Speed and Common Peroneal Nerve Block Duration: A Randomized Controlled Trial in Healthy Volunteers
Conclusions Injection speed of LA in the range of 12 to 1800 mL/h did not affect common peroneal nerve block duration. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02801799. (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Original Articles Source Type: research

Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists
Conclusions Evidence supports the use of ketamine for acute pain in a variety of contexts, including as a stand-alone treatment, as an adjunct to opioids, and, to a lesser extent, as an intranasal formulation. Contraindications for acute pain are similar to those for chronic pain, partly based on the observation that the dosage ranges are similar. Larger studies evaluating different acute pain conditions are needed to enhance patient selection, determine the effectiveness of nonparenteral ketamine alternatives, define optimal treatment parameters, and develop protocols optimizing safety and access to care. (Source: Regio...
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Special Article Source Type: research

Low-Dose Ketamine for Acute Pain Management: A Timely Nudge Toward Multimodal Analgesia
No abstract available (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - June 23, 2018 Category: Anesthesiology Tags: Editorial Source Type: research

Documentation of the Tenting Effect
No abstract available (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - April 18, 2018 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

Reply to Dr Tran et al
No abstract available (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - April 18, 2018 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

Hospitals Marketing Opioid-Sparing Analgesia to Patients Is in Patients' Best Interests
No abstract available (Source: Regional Anesthesia and Pain Medicine)
Source: Regional Anesthesia and Pain Medicine - April 18, 2018 Category: Anesthesiology Tags: Letters to the Editor Source Type: research