Painregional

This article is a review of the current recommendations relating to this group of patients and outlines the approach to management of acute pain in the opioid tolerant patient by anaesthetists in the hospital setting.Acute pain management for opioid tolerant patients – October 28, 2011

Spinal anaesthesia is appropriate for shorter procedures, whereas general anaesthesia in combination with a regional technique is generally used for procedures over two hours. Ankle block and sciatic nerve block at the
knee provide effective perioperative analgesia and both are described in detail.
Anaesthesia for Foot and Ankle Surgery – June 1, 2008

The ankle block is a safe and effective method for obtaining anaesthesia and analgesia of the foot for surgical procedures on bones and soft tissues.Ankle Blocks – June 1, 1999

An axillary block is the most commonly performed variety of brachial plexus block. The landmarks are easy to identify and it is associated with fewer complications than other approaches to the brachial plexus. The technique may be used to provide anaesthesia for a variety of surgical procedures on the hand and forearm. Although in some patients the block may extend above the elbow it does not do this reliably.Axillary Brachial Plexus Block – June 1, 1995

Caudal anaesthesia has been used for many years and is the easiest and safest approach to the epidural space. When correctly performed there is little danger of either the spinal cord or dura being damaged. It is used to provide peri- and postoperative analgesia in adults and children. It may be the sole anaesthetic for some procedures, or it may be combined with general anaesthesia.Caudal Epidural Anaesthesia – June 1, 1998

Digital nerve blockade is simple and easy to perform and provides useful analgesia for a variety of minor surgical procedures. The technique is essentially the same for fingers and toes.Digital Nerve Block – June 1, 2003

Epidural anaesthesia is a central neuraxial block technique with many applications. Improvements in equipment, drugs and technique have made it a popular and versatile anaesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anaesthetic, as an analgesic adjuvant to general anaesthesia, and for postoperative analgesia in procedures involving the lower limbs, perineum, pelvis, abdomen and thorax. Epidural Anaesthesia – June 1, 2001

Interscalene block is the most proximal approach to the brachial plexus and is the most suitable block for proximal procedures on the arm or shoulder. The block is a paravertebral approach at the level of the cervical roots in the neck and can provide both brachial and cervical nerve blocks. The areas supplied by C8 and T1 nerve roots may prove difficult to block and this approach is therefore less suitable for surgery on the hand. Supplementary block of the ulnar nerve can provide the necessary analgesia for hand surgery.Interscalene Brachial Plexus Block – December 1, 1998

The administration of intravenous local anaesthetic in an isolated limb by means of an ischaemic cuff is a simple and effective technique, with a low incidence of failure and high degree of safety. Intravenous Regonal Anaesthesia – Bier’s Block – December 1, 2002

Local anaesthesia may be employed in hernia operations, either on its own or combined with general anaesthesia. The choice of technique will be influenced not only by local resources and skills, but also by patient preference.Local Anaesthesia for Inguinal and Femoral Hernia Repair – June 1, 2004

This article focuses on the basic structure and function of local anaesthetics. Learning will be improved by trying to answer the questions posed in the text before moving on. More detail can be found in the “Further reading” section at the end.Local Anaesthetic Pharmacology – December 1, 2008

The purpose of this review is to suggest methods of relieving acute postoperative pain. It will discuss how the use of peripherally-acting drugs (such as the non-steroidal anti-inflammatory drugs, centrally-acting agents (such as opioids) and local anaesthetics can achieve this. Guidelines are offered for pain relief in children and the elderly.Management of Postoperative Pain – June 1, 1997

This article reproduces the AAGBI’s recommendations for managment of LA toxicty, including guidance on the use of Intralipid infusionsManagement of severe local anaesthetic toxicity – December 1, 2009

The purpose of this article is to provide a detailed, step by step description of how to safely and reliably perform nerve blocks for surgery and pain relief on the lower limb, for
the non-specialist anaesthetic practitioner. It covers femoral nerve blockade, lumbar plexus blockade using the inguinal paravascular approach and sciatic nerve blockade. No description is given of more distal blocks, since the majority of the limb is readily anaesthetised with the techniques described and as a group they are relatively simple, reliable and commonly used.
Nerve Blocks for Anaesthesia and Analgesia of the Lower Limb – June 1, 2000

Caudal anaesthesia (CA) is epidural anaesthesia of the cauda equina roots in the sacral canal, accessed through the sacral hiatus. CA is a common paediatric regional technique that is quick to learn and easy to perform, with high success and low complication rates.Paediatric Caudal Anaesthesia – December 1, 2010

Pain, particularly phantom limb pain (PLP), is highly prevalent in landmine victims. These victims, often poor and rural, have much to lose from injury and disability. Relief agencies such as the Red Cross are ill equipped to deal with pain problems, and specialist pain relief organizations such as Douleur Sans Fronti̬res have limited resources.Pain and Rehabilitation from Landmine Injuries РJune 1, 2000

Pain in sickle cell disease (SCD) presents unique challenges for patients, families, and health care professionals. Pain is the most frequent problem experienced by people with SCD. It has profound effects upon comfort and function in work, school, play and social relationships.Pain in Sickle Cell Disease – June 1, 1999

Understanding pain physiology is very important in countering it. From what is known it is clear that pain perception involves transduction, transmission, and modulation. Both facilitators and inhibitors are involved. The body response to painful stimuli may be helpful or counter-productive. Better knowledge allows both artificial modulation of pain and suppression of harmful reflex response.Pain Physiology – December 1, 2008

Penile block has been widely used for circumcision. Complications include inadequate block or, rarely, ischaemia. Techniques vary from injection below the symphysis pubis to ring block of the shaft.Penile Block – June 1, 1993

Antiplatelet drugs, such as aspirin and clopidogrel, are widely used in primary and secondary care and are very commonly encountered in the perioperative setting. In this article we explore the specific uses of antiplatelet drugs, their mechanisms of action and possible consequences of their discontinuation. Perioperative Management of Antiplatelet Drugs – December 1, 2010

PDPH has the potential to cause considerable morbidity and is a complication that should not to be treated lightly. PDPH is usually a self-limiting process. If left untreated, 75% resolve within the first week and 88% resolve by 6 weeks. PDPH continues to be a common morbidity despite several innovations in equipment and techniques used for spinal (subarachnoid) and epidural (extradural) anaesthesia.Post Dural Puncture Headache – June 1, 2008

PHN is defined as pain arising or persisting in areas affected by herpes zoster at least three months after the healing of the skin lesions. The early recognition and treatment of herpes zoster prevents viral replication, relieves the acute pain and may reduce the complications of the disease of which PHN is the most feared.Post-herpetic Neuralgia – June 1, 2001

Regional blocks at the wrist are easy to perform and are useful for a number of situations, such as supplementing arm blocks and Bier’s blocks, minor surgery or dressings on the hand and fingers, repairing hand trauma, pain relief – for example burns to the hand or fingers.Regional Blocks at the Wrist – December 1, 2000

At least a million people in India suffer unrelieved cancer pain. The number of people suffering other chronic pain conditions is anyone’s guess. India is not alone. The situation is common to most of the developing world.Relief From Chronic Pain When Resources Are Limited – December 1, 2002

Spinal anaesthesia is induced by injecting small amounts of local anaesthetic into the cerebro-spinal fluid (CSF). The injection is usually made in the lumbar spine below the level at which the spinal cord ends (L2). Spinal anaesthesia is easy to perform and has the potential to provide excellent operating conditions for surgery below the umbilicus. Spinal Anaesthesia – a Practical Guide – December 1, 2000

Spinal anaesthesia has the advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anaesthetic. In the following article the factors that influence how the local anaesthetic spreads within the CSF, determining the extent of the block, are discussed. Spinal Anaesthesia – Assessment of Block – June 1, 2007

Regional anaesthesia, although popular in certain centres in developing countries, is generally poorly accepted in these areas as a reliable, economical means for providing operative anaesthesia. Failure of single-injection spinal anaesthetic techniques to achieve richly deserved popularity is difficult to understand given the obvious advantages with which such simple, straightforward, effective, safe and even inexpensive techniques are associated.Spinal Anaesthesia in Developing Countries – December 1, 1993

This article will detail the factors that determine how local anaesthetic spreads within the CSF, therefore determining the extent of the block.Spinal Anaesthetic Spread – December 1, 2007

Pethidine (meperidine) is a synthetic phenylpiperidine derivative opioid agent with local anaesthetic and anticholinergic properties, and high lipid solubility. It is presented as a 5% solution (50mg/ml), which is slightly hyperbaric with respect to cerebrospinal fluid (specific gravity 1.026). These properties make it an ideal agent to use for subarachnoid anaesthesia if local anaesthetic agents are not readily available.Subarachnoid Saddle Block Using Pethidine – December 1, 1998

Rectus sheath analgesia is a safe and reliable alternative to other techniques such as epidural catheters. Where the equipment or technical expertise is not available for ultrasound placed catheters, the surgeon can site bilateral catheters at the beginning or end of a laparotomy. Surgically Placed Rectus Sheath Catheters – December 1, 2010