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Techniques in regional anesthesia & pain management最新文献

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Regenerative medicine modalities for nondiscal spinal disorders 非椎间盘性脊柱疾病的再生医学模式
Pub Date : 2015-01-01 DOI: 10.1053/j.trap.2016.09.009
Steve M. Aydin DO

Regenerative medicine has demonstrated to have significant positive clinical outcomes. Its applications to multiple conditions, and potential for a healing result has caused some patients to seek out regenerative treatment options rather than considering surgical interventions once other conservative and interventional options have not been successful. In particular to the spine, much of the literature and attention has been on discogenic pain in the spine, followed by sacroiliac joint pain or syndrome. The applications of regenerative medicine in the peripheral joints, ligaments, tendons, and muscles can certainly be paralleled to many of the conditions and syndromes in the spine. Limited data and research are available; however, this is the cause for further research to be conducted.

再生医学已被证明具有显著的积极临床结果。它在多种情况下的应用,以及潜在的愈合结果,导致一些患者寻求再生治疗选择,而不是考虑手术干预,一旦其他保守和介入性选择没有成功。特别是脊柱,许多文献和注意力都集中在脊柱的椎间盘源性疼痛,其次是骶髂关节疼痛或综合征。再生医学在周围关节、韧带、肌腱和肌肉的应用当然可以与脊柱的许多情况和综合征相提并论。可用的数据和研究有限;然而,这是需要进行进一步研究的原因。
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引用次数: 0
Regenerative medicine techniques in the management of chronic tendinopathy 再生医学技术在慢性肌腱病治疗中的应用
Pub Date : 2015-01-01 DOI: 10.1053/j.trap.2016.09.013
Enrique Galang MD , George C. Chang Chien DO , Agnes Stogicza MD, FIPP, CIPS , Andrea Trescot MD, DABIPP, FIPP

Tendinopathy is characterized by failure of the normal tendon repair mechanism, and is a common malady that leads to chronic pain. Although pain relief is an important goal in treating the patient with tendinopathy, modalities that are intended to decrease pain in the short term do not address the underlying tissue disorder. As no current gold standard exists in the treatment of tendinopathy, physicians face a unique challenge in treating this common pathology. Regenerative medicine applications in pain medicine aim to address this unique challenge.

肌腱病的特征是正常肌腱修复机制的失败,是一种导致慢性疼痛的常见疾病。虽然缓解疼痛是治疗肌腱病变患者的一个重要目标,但旨在短期内减轻疼痛的治疗方式并不能解决潜在的组织紊乱。由于目前没有治疗肌腱病变的黄金标准,医生在治疗这种常见病理时面临着独特的挑战。再生医学在疼痛医学中的应用旨在解决这一独特的挑战。
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引用次数: 0
Basic science of regenerative biology and application to regenerative medicine: Past, present, and future 再生生物学的基础科学及其在再生医学中的应用:过去、现在和未来
Pub Date : 2015-01-01 DOI: 10.1053/j.trap.2016.09.001
David B. Harrell PhD, DABRM, FRIPH, FAARM

The concept of tissue regeneration is ancient; the earliest known written reference to it is found in Hesiod’s Theogony. Prometheus’ liver regenerated after being consumed. This type of tissue regeneration is known as regenerative hypertrophy. Regenerative biology advanced significantly in the 18th and 19th centuries and it was during this period that the first reference to the term “stem cell” was recorded; however, the term was used significantly differently than the definition it contains today (a clonal entity able to self-renew and displays asymmetric division). Although the history of regenerative medicine, regenerative biology, and tissue regeneration is ancient, significant findings have occurred in the 18th and 19th centuries, and recently, after a period of neglect, many findings of these time frames have resurfaced and changed the way the field experts understand regenerating tissue. This translates itself into regenerative medicine regarding how to think about the technologies available to the clinician practicing regenerative medicine. That is, basic science should guide the clinical use of available methods and tools used. The tools themselves (eg, cellular therapy) are not synonymous with the practice of regenerative medicine. Rather they are tools in the arsenal of the practicing physician. The goal of this article is to provide an overview of the history of regenerative biology and medicine, the progression of the basic science of regenerative biology, and to include discussions that are focused on translating the basic science of regenerative biology into regenerative medicine. This is not a structured and comprehensive review of all the history and aspects of regenerative biology and regenerative medicine, but merely incorporates several key points to provide evidence of the topics discussed in this article.

组织再生的概念是古老的;已知最早的书面记载是在赫西奥德的《神学家》中。普罗米修斯的肝脏在被吃掉后再生。这种类型的组织再生被称为再生肥厚。再生生物学在18世纪和19世纪取得了重大进展,正是在这一时期,“干细胞”一词第一次被记录下来;然而,该术语的使用与今天的定义(能够自我更新并显示不对称分裂的克隆实体)有很大不同。虽然再生医学、再生生物学和组织再生的历史是古老的,但重要的发现发生在18世纪和19世纪,最近,经过一段时间的忽视,这些时间框架的许多发现重新浮出水面,改变了该领域专家对再生组织的理解方式。这就转化为再生医学关于如何考虑临床医生可获得的再生医学技术。也就是说,基础科学应该指导临床使用可用的方法和工具。这些工具本身(如细胞疗法)并不是再生医学实践的同义词。相反,它们是执业医师武器库中的工具。本文的目的是概述再生生物学和医学的历史,再生生物学基础科学的进展,并包括关于将再生生物学基础科学转化为再生医学的讨论。这并不是对再生生物学和再生医学的所有历史和方面的结构化和全面的回顾,而只是结合了几个关键点来为本文所讨论的主题提供证据。
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引用次数: 2
Everything old is new again: New developments in prolotherapy 一切旧的都是新的:前驱疗法的新发展
Pub Date : 2015-01-01 DOI: 10.1053/j.trap.2016.09.003
Andrea Trescot MD, DABIPP, FIPP

Prolotherapy, or fibroproliferative therapy, is a regenerative injection therapy, first popularized in the 1940s and 1950s. Unfortunately, the combination of “better” surgical techniques and a series of high-profile medical catastrophes by poorly trained providers relegated the technique into the “fringe” arena. However, recent recognition of the failure of surgical interventions, combined with better technology and a burgeoning interest in the continuum of regenerative injection options, has renewed the interest and research into this “old” technique.

前驱疗法,或纤维增殖疗法,是一种再生注射疗法,在20世纪40年代和50年代首次普及。不幸的是,“更好”的外科技术和一系列由缺乏训练的提供者造成的引人注目的医疗灾难的结合,使这项技术沦落为“边缘”舞台。然而,最近认识到手术干预的失败,结合更好的技术和对再生注射选择连续性的蓬勃发展的兴趣,重新燃起了对这种“旧”技术的兴趣和研究。
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引用次数: 7
Bone marrow concentrate and platelet-rich plasma acquisition and preparation: Why technique matters 骨髓浓缩物和富血小板血浆的获取和制备:为什么技术很重要
Pub Date : 2015-01-01 DOI: 10.1053/j.trap.2016.09.004
Matthew B. Murphy PhD , Jessica A. Terrazas BS , Don A. Buford MD, RDMS

Current best practices in regenerative medicine use cell and platelet preparations derived from a patient׳s blood or bone marrow aspirate, concentrated at the point of care, and returned to the patient during a single surgical or clinical event. As a field in its infancy, there is great confusion among many physicians, patients, regulatory agencies, and the media about what these therapies represent, their safety and efficacy, and how they are properly administered. Advances in bone marrow aspiration technique and concentration technologies have resulted in consistent significant increases in mesenchymal stem cell content in pursuit of threshold or minimum progenitor concentrations for successful outcomes described by clinical studies treating bone and soft tissues. This report reviews current preclinical and clinical data on the acquisition, processing, and administration techniques of platelet-rich plasma and bone marrow concentrate while discussing the regulatory environment around these and other cellular and regenerative medicine products.

目前再生医学的最佳实践使用从患者的血液或骨髓抽吸中提取的细胞和血小板制剂,在护理点浓缩,并在单次手术或临床事件中返回患者。作为一个刚刚起步的领域,许多医生、患者、监管机构和媒体对这些疗法代表什么、它们的安全性和有效性,以及如何正确使用这些疗法存在很大的困惑。骨髓抽吸技术和浓缩技术的进步导致间充质干细胞含量持续显著增加,以追求阈值或最低祖细胞浓度,以达到治疗骨和软组织的临床研究所描述的成功结果。本报告回顾了目前关于富血小板血浆和骨髓浓缩物的获取、处理和给药技术的临床前和临床数据,同时讨论了围绕这些和其他细胞和再生医学产品的监管环境。
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引用次数: 10
Role of intra-articular platelet-rich plasma in sacroiliac joint pain 关节内富血小板血浆在骶髂关节疼痛中的作用
Pub Date : 2015-01-01 DOI: 10.1053/j.trap.2016.09.010
Annu Navani MD , Deepak Gupta BA, MS-II

The goal of this case review is to evaluate safety and efficacy with the use of intra-articular platelet-rich plasma (PRP) in patients with sacroiliac (SI) joint (SIJ) pain. The secondary outcomes include additional medical treatments, hospitalization, and surgery. SIJ pain contributes significantly to the social and economic burden due to its long-standing and debilitating course. Current treatments include either interventional procedures with transient benefits or invasive surgical options. PRP has been used clinically in various settings for its anti-inflammatory and tissue repair properties attributed to growth factors. Ten patients with chronic SIJ pain who tried and failed conservative treatments were administered a single injection of 4 mm autologous PRP into the joint under fluoroscopic guidance after careful clinical and imaging evaluation. The patients were followed up at 1, 3, 6, and 12 months postinjection and primary and secondary outcomes were recorded. Verbal analog scale score for pain of all patients decreased more than 50% and their function increased for the period of 12 months. None of the patients presented to the hospital or clinic or received any treatments or surgery after the PRP injection. There were no adverse reactions, side effects, or complications. PRP presents as a promising option based on our preliminary observation. Larger, well-designed randomized controlled trials are warranted to understand the full breath of the efficacy, risks, and complications from the use of PRP for SIJ pain.

本病例回顾的目的是评估关节内富血小板血浆(PRP)治疗骶髂(SI)关节(SIJ)疼痛的安全性和有效性。次要结果包括额外的药物治疗、住院和手术。由于其长期和衰弱的过程,SIJ疼痛对社会和经济负担作出了重大贡献。目前的治疗方法包括具有短暂疗效的介入性手术或侵入性手术。PRP已用于临床各种设置,其抗炎和组织修复特性归因于生长因子。10例经保守治疗失败的慢性SIJ疼痛患者,在仔细的临床和影像学评估后,在透视引导下向关节内单次注射4mm自体PRP。分别于注射后1、3、6、12个月对患者进行随访,记录主要和次要结局。在12个月的时间里,所有患者的疼痛言语模拟量表评分下降50%以上,功能增强。在PRP注射后,没有患者到医院或诊所就诊,也没有接受任何治疗或手术。没有不良反应、副作用或并发症。根据我们的初步观察,PRP是一个很有前途的选择。为了全面了解PRP治疗SIJ疼痛的疗效、风险和并发症,有必要进行规模更大、设计良好的随机对照试验。
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引用次数: 10
Regenerative medicine: Invigorating pain management practice 再生医学:充满活力的疼痛管理实践
Pub Date : 2015-01-01 DOI: 10.1053/j.trap.2016.10.008
Dmitri Souzdalnitski MD, PhD (Guest Editor)
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引用次数: 2
FMii: Table of Contents FMii:目录
Pub Date : 2015-01-01 DOI: 10.1053/S1084-208X(16)30031-3
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引用次数: 0
The adductor canal catheter and interspace between the popliteal artery and the posterior capsule of the knee for total knee arthroplasty 全膝关节置换术中腘动脉与膝关节后囊间的内收管导管和间隙
Pub Date : 2014-10-01 DOI: 10.1053/j.trap.2015.10.011
Clint E. Elliott MD, Salman Thobhani MD

Analgesia for total knee arthroplasty (TKA) is not a new topic; however, some newer approaches to peripheral nerve blocks for control of postoperative pain have been developed. The femoral nerve block plus or minus a sciatic nerve block has been shown to provide effective analgesia, but not without some degree of motor block. The adductor canal block provides analgesia not inferior to a femoral with less motor weakness, and a continuous catheter technique can be used to prolong its effects. Blocking the sciatic nerve has been a subject of controversy, in part because of the motor weakness but also because of the inclusion of the common peroneal nerve, a nerve that can potentially be damaged by TKA. An infiltration of the interspace between the popliteal artery and the capsule of the posterior knee, provides analgesia for the posterior knee without motor effects or common peroneal block. The combination of an adductor canal catheter and an interspace between the popliteal artery and the capsule of the posterior knee provides a balance of effective postoperative analgesia and preservation of motor function, ultimately shortening length of stay following TKA.

全膝关节置换术(TKA)的镇痛并不是一个新课题;然而,周围神经阻滞控制术后疼痛的一些新方法已经被开发出来。股骨神经阻滞加上或减去坐骨神经阻滞已被证明能提供有效的镇痛,但并非没有一定程度的运动阻滞。内收管阻滞的镇痛效果不逊于股动脉阻滞,且运动无力较少,可采用连续导管技术延长其效果。坐骨神经阻滞一直是一个有争议的话题,部分原因是由于运动无力,但也因为腓总神经的阻滞,腓总神经可能被TKA损伤。腘动脉与膝后囊之间的间隙浸润,为膝后提供镇痛,无运动作用或腓总肌阻滞。内收管导管和腘动脉与膝关节后囊之间的间隙的结合提供了有效的术后镇痛和运动功能保存的平衡,最终缩短了TKA后的住院时间。
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引用次数: 15
Ketamine in perioperative analgesia for knee surgeries: Review of evidence from randomized controlled trials 氯胺酮在膝关节手术围手术期镇痛中的应用:随机对照试验证据综述
Pub Date : 2014-10-01 DOI: 10.1053/j.trap.2015.10.012
Dmitri Souzdalnitski MD, PhD , Glenn R. Rech RPh , Aleksandr Naydinskiy BSc , Daria Suzdalnitskaya , Roman V. Isakov , Maged Guirguis MD

Successful perioperative analgesia for knee surgeries results in improved patient satisfaction and promotes successful rehabilitation. However, effective perioperative pain control is commonly a challenging task for knee surgeries. Such surgical procedures as total knee replacement or knee arthroscopy may be accompanied by severe postoperative pain. As opioids and nonsteroidal anti-inflammatory drugs are commonly used, the side effects of these types of medicines are quite common as well, especially in patients with chronic pain, as they are commonly dissatisfied with regular analgesia. Patients with chronic pain tend to have lower tolerance to pain, and be dependent and tolerant to opioids. These patients typically require higher doses of analgesics, which further negatively affect patients’ safety and the overall perioperative experience. Multimodal perioperative analgesia helps to spare opioids and promote successful rehabilitation. Ketamine is a noncompetitive N-Methyl-d-aspartate (NMDA) receptor antagonist that has been used for multimodal perioperative analgesia as an adjunct to opioids and nonsteroidal anti-inflammatory drugs. Despite the significant number of papers evaluating the role of ketamine in perioperative analgesia, the feasibility of ketamine for perioperative pain control in knee surgeries remains a subject of debate. There are only a limited number of high-quality studies on the topic. We used a systematic approach to evaluate randomized controlled trials with perioperative ketamine used for knee surgeries. The majority of the studies confirmed that the utilization of ketamine in perioperative analgesia was associated with lower pain scores, reduced opioid use, improved knee joint mobility, and an increase in patient tolerance for physical therapy and rehabilitation. The techniques for ketamine administration and dosing varied significantly, which may explain the inconsistencies between the reports. In addition, some of the studies, even those of high quality, used nitrous oxide in both the study and control groups. Nitrous oxide has NMDA receptor antagonist properties, as does ketamine. None of the studies reported whether patients were taking methadone, dextromethorphan, memantine, or magnesium sulfate, which are NMDA receptor antagonists too. The concomitant use of NMDA receptor antagonists, other than ketamine, may have interfered with the realization of analgesic effects of ketamine. Although it is largely accepted that NMDA receptor antagonism at the spinal level explains most of the analgesic effects of ketamine, it also interacts at other multiple receptors centrally, including, cholinergic receptors, nicotinic and muscarinic, adrenergic, central NMDA, and non-NMDA glutamate receptors. These influences may potentially explain why patients tr

成功的围手术期镇痛可提高患者满意度并促进成功的康复。然而,有效的围手术期疼痛控制通常是膝关节手术的一个具有挑战性的任务。诸如全膝关节置换术或膝关节镜检查等外科手术可能伴有严重的术后疼痛。由于阿片类药物和非甾体类抗炎药是常用的,这类药物的副作用也很常见,特别是对于慢性疼痛患者,因为他们通常不满意常规镇痛。慢性疼痛患者往往对疼痛的耐受性较低,对阿片类药物有依赖性和耐受性。这些患者通常需要更高剂量的镇痛药,这进一步对患者的安全性和整体围手术期体验产生负面影响。多模式围手术期镇痛有助于节省阿片类药物,促进成功康复。氯胺酮是一种非竞争性n -甲基-d-天冬氨酸(NMDA)受体拮抗剂,作为阿片类药物和非甾体抗炎药的辅助药物,已被用于多模式围手术期镇痛。尽管有大量的论文评价氯胺酮在围手术期镇痛中的作用,但氯胺酮在膝关节手术围手术期疼痛控制中的可行性仍然是一个有争议的话题。关于这一主题的高质量研究数量有限。我们采用了一种系统的方法来评估围手术期氯胺酮用于膝关节手术的随机对照试验。大多数研究证实,氯胺酮在围手术期镇痛中的使用与较低的疼痛评分、减少阿片类药物的使用、改善膝关节活动能力以及增加患者对物理治疗和康复的耐受性有关。氯胺酮的施用技术和剂量差异很大,这可能解释了报告之间的不一致。此外,一些研究,甚至是高质量的研究,在研究组和对照组中都使用了一氧化二氮。氧化亚氮和氯胺酮一样具有NMDA受体拮抗剂的特性。没有研究报告患者是否服用美沙酮、右美沙芬、美金刚或硫酸镁,这些也是NMDA受体拮抗剂。同时使用NMDA受体拮抗剂,而不是氯胺酮,可能会干扰氯胺酮镇痛作用的实现。虽然人们普遍认为氯胺酮在脊髓水平上的NMDA受体拮抗作用解释了氯胺酮的大部分镇痛作用,但它也与其他多个中枢受体相互作用,包括胆碱能受体、烟碱和毒蕈碱受体、肾上腺素能受体、中枢NMDA受体和非NMDA谷氨酸受体。这些影响可能潜在地解释了为什么使用其他NMDA受体拮抗剂治疗的患者使用氯胺酮也有改善。氯胺酮也与椎骨上的阿片受体相互作用,产生椎骨上抗感觉。一些研究没有报告参与者是否阿片类药物naïve或阿片类药物依赖。这可能是镇痛效果的一个重要决定因素,因为阿片类药物依赖患者从氯胺酮中明显受益。没有一项随机对照试验评估氯胺酮对阿片类药物依赖患者的影响。氯胺酮应用于膝关节手术围手术期镇痛的结果差异,至少部分可以用这些发现来解释。
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引用次数: 2
期刊
Techniques in regional anesthesia & pain management
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