Pain physician最新文献

Background: The popularity of tattoos has increased significantly, particularly among younger demographics. However, the implications of tattoos on medical procedures, such as spinal or epidural anesthesia, are not well established. There is a need to understand the potential risks and complications associated with administering anesthesia through tattooed skin.

Objectives: This narrative review aims to explore the principles of tattooing, the composition of tattoo pigments, the immune response to tattoos, the complications arising from tattoos, and the impact of tattoos on spinal or epidural anesthesia.

Study design: A comprehensive literature review was conducted to gather information on the interaction between tattoos and anesthesia. The review included studies that examined the effects of tattoos on anesthesia outcomes and patient safety.

Setting: The review spans both clinical and research environments, focusing on the interactions of tattooed skin and anesthesia administration, particularly in regions where tattoos are prevalent.

Methods: Relevant databases were searched for studies discussing the relationship between tattoos and anesthesia. The analysis included examination of tattoo pigments, immune responses, and the potential for complications during the administration of anesthesia through tattooed skin.

Results: The review found that tattoos could lead to various complications, including infections, allergic reactions, and skin lesions. The presence of tattoos does not preclude the use of spinal or epidural anesthesia but may necessitate modifications in anesthetic technique. The pigments used in tattoos, especially organic compounds, can potentially cause neurotoxic reactions if introduced into the spinal canal. Additionally, tattoos may interfere with the body's immune response, leading to localized inflammation and potential nerve injury.

Limitations: The review is limited by the scarcity of studies specifically addressing the interactions between tattoos and anesthesia. The variability in tattoo pigments and individual patient responses further complicates the establishment of standardized guidelines.

Conclusions: While tattoos present potential risks when considering spinal or epidural anesthesia, they do not absolutely contraindicate these procedures. Anesthesia providers should be aware of the possible complications and adapt their practices accordingly. These adjustments may include selecting alternative puncture sites, using caution with MRI and high-frequency electrosurgery, and obtaining detailed information about the tattoo's pigment composition. Further research is needed to establish clear guidelines and to better understand the long-term implications of tattoos on anesthesia safety and efficacy.

Background: The formulation of opioid medications is becoming increasingly common among hospitalized patients, due to the need for pain control or sedation during procedures. This phenomenon represents the possibility of an increase in adverse events, as demonstrated by monitoring through the Adverse Event Reporting System (FAERS). The importance of tools that unify information search and provide easy access for physicians is becoming more evident. Thus, it is essential to assess the medical needs for information when using technological tools that can support clinical practice.

Objective: To characterize the main pharmacological and pharmaceutical needs of critical care physicians for the management of adult patients when administering sedative and/or opioid analgesic medications.

Study design: A cross-sectional study.

Setting: A tertiary care setting in Bogotá and Chía, Colombia from October 1 through December 31, 2022.

Methods: Surveys were collected through Google Forms. The surveys were directed to physicians from Clinica Universidad de La Sabana and Clínia Nueva de Bogotá. These physicians perform sedation and analgesia procedures on adult patients in critical care services, including emergency departments, hospitalization units, surgical rooms, and adult intensive care units.

Results: Ninety-five percent of the respondents considered the use of technological tools necessary for support during their workday. Most respondents reported that these tools were helpful for information searches regarding dose adjustments of sedatives and opioid analgesics, especially in cases of renal disease, dose calculations for rotation, and titration of opioids.

Limitations: Designed for academic purposes, the survey identified 4 key areas requiring improvement: pharmacological knowledge, patient safety monitoring, specialized administration techniques, and practical application of knowledge during the administration of medication. The survey was conducted under the constraints of time and resources, limiting the sample to 2 institutions based on accessibility and feasibility.

Conclusions: The study highlights the need for the development of technological tools to support medical services in the safe use of sedative and opioid analgesic medications. The evaluation of specific pharmacological and pharmaceutical knowledge related to this group of medications is crucial.

Background: Current standards of practice recommend performing the cervical medial branch block (MBB) and applying the subsequent radiofrequency ablation (RFA) electrode via anterior-posterior (AP) and lateral fluoroscopic views. The lateral views of the lower cervical segment are frequently hindered by patients' anatomical factors and prevent the accurate and safe placement of the RFA needle.

Objective: The goal of this technical modification is to introduce and standardize an oblique angle view using fluoroscopy to enable more accurate placement of the MBB needle and RFA needle electrode in the cervical facet joint.

Study design: The technical modification was developed using a cadaveric skeletal model. Then, in an actual patient, this additional oblique view was tested in an RFA procedure for a cervical facet joint.

Setting: This protocol was produced at a single musculoskeletal and interventional spine center.

Methods: A team of interventional pain specialists developed a step-by-step technique that utilized a 50-degree ipsilateral fluoroscopic view, in addition to AP and lateral views, by simulating a cervical facet joint RFA in a cadaveric skeletal model. The technique was then tested in an actual patient's cervical facet joint RFA procedure.

Results: The team successfully developed a technique to confirm placement of the RFA needle electrode at the articular pillar to denervate the medial branch for treating pain in the cervical facet joint. This technique allows for the clear visualization of the needle RFA electrode to overcome patient factors that can obscure the electrode, including physiological aspects such as short neck and shoulder musculature.

Limitations: A potential disadvantage of this technical modification is the additional radiation exposure, which is caused by the addition of an oblique view.

Conclusions: Our technical modification of an oblique angle view enables clear visualization, thus increasing the accuracy and potentially the safety of RFA needle electrode placement in lower cervical facet joint RFA over those of the conventional approach.

Background: Anesthesia through neuroaxial approaches is an effective option for lower abdominal surgeries, but postdural puncture headache (PDPH) is often an adverse effect of this procedure.

Objectives: Evaluation of the effect of bilateral bi-level greater occipital nerve blocks (GONB) on the severity of PDPH and its effect on patients' quality of life.

Study design: Randomized controlled trial.

Setting: Department of Anesthesia, ICU and Pain, Faculty of Medicine, Benha University in conjunction with multiple private centers, Cairo, Arab Republic of Egypt.

Methods: A total of 180 patients with PDHP were evaluated using the Numeric Rating Scale (NRS-11) to assess pain in an upright position and the 36-Item Short-form Survey Instrument (SF-36) was used to assess the effect of PDPH on quality of life. Patients were randomly divided into an intramuscular group and received an intramuscular injection. Other injection location groups were distal (DG), proximal (PG), and bilevel (BG). All groups received bilateral GONB using 2 mL of lidocaine 2% mixed with 2 mL of dexamethasone. Pain scores were evaluated at 24 hours postprocedure. At one month pain and SF-36 scores were recorded. The success rate was defined as the frequency of pain-free (NRS-11 < 4) among the trial patients. Recurrent cases received bilevel GONB and nonresponsive patients received an epidural blood patch.

Results: At 24 hours postprocedure, 82.8% of the total patients and all BG patients were pain-free. NRS-11 pain scores were significantly lower in BG patients than patients in other groups; 7 patients required an epidural blood patch. At one month, 114 total patients (63.3%) had a zero pain score and 95.6% of BG patients were pain-free; the BG patients had significantly lower pain scores than the other groups. Also, SF-36 scores were improved in all patients with significantly higher scores in the BG and PG groups compared to the other groups. Twenty-seven total patients had recurrent PDPH; intramuscular  injection patients had a significantly higher frequency of recurrent PDPH and shorter pain-free duration. The success rate of bilevel GONB management for recurrent PDPH was 81.5%.

Limitations: The limitations of this trial are two-fold: missing of blocking the other occipital nerves and omission of blocking at the recently defined area of the three main occipital nerves communicate.

Conclusion: Bilevel GONB provided was superior to single level blocks and intramuscular injection with no 24 hour postprocedure failure, a low recurrence rate, and totally negated the need for an epidural blood patch; it also significantly improved patients' quality of life. Bilevel GONB is an efficient first-line therapy for recurrent PDPH.