ABSTRACT
PURPOSE OF REVIEW: The purpose of this review is to summarize the recent literature regarding regional anesthesia (RA) techniques and outcomes for total hip arthroplasty (THA) in the face of changing surgical techniques and perioperative considerations. RECENT FINDINGS: Based on large meta-analyses, peripheral nerve blocks are indicated for THA. Each block has its own risks and benefits and data for outcomes for particular techniques are limited. New surgical techniques, improved use of multimodal analgesia, and improved ultrasound guided regional anesthetics lead to better pain control for patients undergoing THA with less associated risks. Block selection continues to be influenced by provider comfort, surgical approach, patient anatomy, and postoperative goals. Head-to-head studies of particular nerve blocks are warranted.
ABSTRACT
Modern anesthetic management for foot and ankle surgery includes a variety of anesthesia techniques including general anesthesia, neuraxial anesthesia, or MAC in combination with peripheral nerve blocks and/or multimodal analgesic agents. The choice of techniques should be tailored to the nature of the procedure, patient comorbidities, anesthesiologist skill level, intensity of anticipated postoperative pain, and surgeon preference.
Subject(s)
Anesthesia , Ankle , Foot , Humans , Foot/surgery , Ankle/surgery , Anesthesia/methods , Orthopedic Procedures/methods , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapySubject(s)
Analgesia, Epidural , Rib Fractures , Tissue Plasminogen Activator , Humans , Rib Fractures/complications , Analgesia, Epidural/methods , Tissue Plasminogen Activator/therapeutic use , Tissue Plasminogen Activator/administration & dosage , Fibrinolytic Agents/therapeutic use , Fibrinolytic Agents/administration & dosage , MaleABSTRACT
Modern anesthetic management for foot and ankle surgery includes a variety of anesthesia techniques including general anesthesia, neuraxial anesthesia, or MAC in combination with peripheral nerve blocks and/or multimodal analgesic agents. The choice of techniques should be tailored to the nature of the procedure, patient comorbidities, anesthesiologist skill level, intensity of anticipated postoperative pain, and surgeon preference.
Subject(s)
Anesthesia , Ankle , Anesthesia/methods , Ankle/surgery , Humans , Pain, Postoperative/drug therapy , Pain, Postoperative/prevention & controlABSTRACT
Postoperative pain following thoracic surgery presents a significant challenge, and multiple factors complicate recovery and pain management for this population. Considerable comorbidities often exist in thoracic surgical patients, further limiting therapeutic options. Elements of nociceptive and neuropathic pain may contribute greatly to patient discomfort. There is no single pharmaceutical agent or route of administration that addresses every individual contributor to pain, and thus treatment regimens should be multimodal and tailored to the patient and procedure. This article outlines systemic agents, regional techniques and attendant complications, etiologies of pain following thoracic procedures, and the development and treatment of chronic pain.
Subject(s)
Pain Management/methods , Pain, Postoperative/therapy , Thoracic Surgical Procedures/adverse effects , HumansABSTRACT
In order to facilitate genetic study of the opportunistic bacterial pathogen Pseudomonas aeruginosa, we isolated a conditional, temperature-sensitive plasmid origin of replication. We mutagenized the popular Pseudomonas stabilizing fragment from pRO1610 in vitro using the Taq thermostable DNA polymerase in a polymerase chain reaction (PCR). Out of approximately 23,000 potential clones, 48 temperature-sensitive mutants were isolated. One mutant was further characterized and the origin of replication was designated as mSF(ts1). The mutations that resulted in a temperature-sensitive phenotype in mSF(ts1) were localized to the 1.2 kb of minimum sequence required for replication in P. aeruginosa. The DNA sequence analysis revealed two mutations within the coding sequence of the Replication control (Rep) protein. Growth of P. aeruginosa carrying the temperature-sensitive plasmid at the non-permissive temperature of 42 degrees C resulted in loss of the plasmid by greater than 99.9999% of the cells after 16 h of growth. In order to facilitate its utilization, the mSF(ts1) was converted into a genetic cassette flanked by mirrored restriction endonuclease digestion sites of a pUC1918 derivative. We demonstrate utilization of the mSF(ts1) for genetic studies involving complementation and regeneration of a mutant in P. aeruginosa research.