This review article discusses the current role of ultrasound in interventional spine practice as both a diagnostic tool and as a modality for image guidance with procedures. Epidemiology of spine pain, the emergence of ultrasound, advantages and disadvantages of ultrasound in comparison to other image modalities are discussed. Recent selected published articles pertaining to the role of ultrasound in the guidance of spinal interventional procedures are reviewed. The potential for the use of ultrasound with spine procedures is discussed as well as further evaluation of its cost-effectiveness, accuracy, safety, and efficacy when compared to the current standards of practice.
Hyperactivity of N-methyl-D-aspartate (NMDA) receptors may be one of the factors in the genesis of neuropathic pain (NP). Ketamine is a dissociative anesthetic and analgesic that is the most potent NMDA receptor antagonist currently available for human use. There is a growing body of literature for three decades suggesting efficacy of subanaesthetic doses of ketamine in the treatment of NP, particularly the pain in complex regional pain syndromes. The primary limitations of ketamine use are secondary to psychotomimetic and, to a lesser extent, sympathetic activation. The purpose of this article is to review the history, pharmacology, pharmacodynamics, clinical benefits, and limitations of ketamine for treatment of NP. Methods of administration and management of adverse effects are highlighted based on the clinical experience of the authors.
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