Techniques in regional anesthesia & pain management最新文献

There is a trend in spinal surgery to pursue motion-sparing alternatives to lumbar fusion. This article discusses the indications for lumbar disc arthroplasty. As with most surgical procedures, patient selection is crucial. Carefully selected patients may benefit from this new technology. However, many patients may not be appropriate for disc replacement and will still necessitate a lumbar fusion for treatment of their degenerative disc disease.

Lumbar disc herniations are seen frequently in pain management practices. Specialists are well versed in the nonsurgical treatments for lumbar radiculopathy. Although most disc herniations would resolve without the need for surgery; it should be considered when patients have refractory pain or motor deficit. The following article discusses the surgical treatment for lumbar disc herniation—microdiscectomy. Pertinent literature has been reviewed and the surgical outcomes are highlighted.

In 1985, approximately 50 million people died in the world of which 37.9 million were in developing countries, where cancer was the cause in 10% of the cases. In these developing countries, most cancer resources are destined to curative treatments, which do not always have the best results. Roughly 12.7 million new cases are diagnosed globally each year; without substantial improvement in cancer control, it is predicted that this worldwide annual toll will rise to 21.3 million new cancer cases and 13.1 million deaths by 2030. That is why education, along with rules to facilitate the availability of opioid analgesics and the development of health programs, is one of the basic pillars for implementing a successful palliative care program, which is available for the entire population. Palliative care aims to relieve suffering and improve the quality of life for patients with advanced illnesses and their families through specific knowledge and skills, including communication with patients and family members; management of pain and other symptoms; psychosocial, spiritual, and bereavement support; and coordination of an array of medical and social services.

The prevalence of chronic diseases has been increasing globally and in the region of the Americas. The World Health Organization states that the population older than 60 years has doubled in the last 30 years, and the cost of these diseases to health systems is of immense significance. Neurologic diseases, such as dementia and cerebrovascular disease, as well as chronic obstructive pulmonary disease, significantly deteriorate the quality of life of patients owing to an increase in symptoms that are often not treated. The management of chronic symptoms, which is the basis of palliative care, becomes a major approach to the patient, his or her family, and the system. This article seeks to show the importance of joint work between physicians and palliative care specialists to define the most appropriate management for these patients and optimize quality of life.

Palliative care is an interdisciplinary approach provided to patients and their families when the medical expectation of recovery is negligible. Palliative care does not focus on a single disease. However, it takes into account the integrity of the human being, allowing the patient to improve his or her quality of life and relief from the suffering imposed by adverse medical conditions. The increasing need for a comprehensive approach in health care for patients and families suffering from cancer and noncancer chronic degenerative diseases makes palliative care an indispensable resource in today's society. The current demographic changes and the increased incidence of cancer and chronic diseases is consolidating the practice of palliative care and expanding its frontiers to face new research challenges in areas such as palliative care in children and nonmalignant diseases, public health policy, education in palliative care, and euthanasia.

Cancer pain is often related with suffering. Despite all the efforts and the availability of new drugs, it can be severe and reluctant. The classical World Health Organization (WHO) ladder is based on a fixed treatment model; therefore, it may not fulfill the goal of an adequate pain relief. That is why a more multimodal and mobile regimen, using coadjuvants and interventional therapies could be useful. The present review updates the role of interventional pain management as a part of a comprehensive management, with the celiac plexus block being highlighted, and also gives us a glance for the potential use of ultrasound guidance in this context.

Illnesses that limit life or functioning have the potential to cause significant distress and lead to suffering. Suffering is a subjective and multidimensional experience that results from the person's appraisal of threat and exhaustion of coping resources. Detection and management of suffering in patients who are chronically ill have become of great interest in the last few years as relief from suffering was established as one of palliative care main goals. Psychological, sociocultural, and family issues that contribute to suffering are discussed. Also, assessment strategies and instruments, as well as interventions toward relief from suffering, are described. Therapeutic approaches should be individualized and include issues in the physical, psychological, sociocultural, and spiritual domains to plan for comprehensive interventions suited to the patient's needs and to attain better symptom control. Regarding family suffering, interventions that reinforce the perceived social support, facilitate communication and emotional disclosure, effect on the family's level of cohesion and flexibility, and enable role distribution, resilience, and meaning of the illness as a learning experience will reinforce adaptation and alleviate suffering.

The current problem of land mines is worrying. Large mined territories endanger civilians and military personnel. About 100,000 land mines are scattered today in Colombia, and the mortal victims are growing each day. Land mine injuries result in significant musculoskeletal and abdominal injuries throughout the world. Accurate pain assessment is necessary to effective pain management. However, it is a challenge in polytrauma patients. Although it may be difficult, the initial multimodal analgesic management facilitates early rehabilitation and theoretically may prevent chronic pain progression after a land mine injury.

Phantom limb pain is a type of chronic pain existing in different organs, not just limbs. The incidence is very high in the postamputation period and treatment can be a challenge. The pharmaceutical treatment strategies in addition to psychological rehabilitative strategies and interventional management play a successful role in the management of these patients. For this article, we conducted a review of literature about pain management for phantom limb pain to identify the treatment modalities, which involved interventional pain management, and an algorithmic approach is proposed.