Role of regional anesthesia and analgesia in the opioid epidemic

Lee, Bradley H.; Kumar, Kanupriya; Wu, E.; Wu, Christopher L.

doi:10.1136/rapm-2018-100102

Cited by 10 publications

(8 citation statements)

References 30 publications

(16 reference statements)

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“…1,18,19 Furthermore, the ongoing opioid crisis has demonstrated the need for increased utilization of regional techniques for opioid minimization. 20,21 After stingray envenomation, pain typically reaches its peak within 30 to 90 min of injury and can last 48 h if untreated. 22 Long-acting local anesthetics such as bupivacaine or ropivacaine could offer analgesic benefit during this time period.…”

Section: Discussionmentioning

confidence: 99%

Regional Anesthesia for Symptomatic Treatment of Stingray Envenomation

DeYoung

Hughey

Miller

et al. 2021

Wilderness & Environmental Medicine

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Stingray envenomation is common in coastal regions around the world and may result in intense pain that can be challenging to manage. Described therapies involve hot water immersion and potentially other options such as opioid and nonopioid analgesics, removal of the foreign body, wound debridement, antibiotics for secondary infection, and tetanus toxoid. However, for some patients, this may not be enough. Peripheral nerve blockade is a frequently used perioperative analgesic technique, but it has rarely been described in the management of stingray envenomation. Here, we report a case of stingray envenomation in an otherwise healthy 36-y-old male with pain refractory to traditional therapies. After admission for pain control, the patient received an ultrasound-guided sciatic popliteal nerve block. Upon completion of the peripheral nerve block, the patient reported rapid and complete resolution of the intense pain, which did not return thereafter.

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Section: Discussionmentioning

confidence: 99%

Regional Anesthesia for Symptomatic Treatment of Stingray Envenomation

DeYoung

Hughey

Miller

et al. 2021

Wilderness & Environmental Medicine

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“…From a public health perspective, the innovation and creativity inherent to implementing regional methods into the acute pain setting play a large role in mitigating the propagation of opioid dependency in the U.S. [ 21 ]. Developing alternative strategies like this one is integral to this process.…”

Section: Discussionmentioning

confidence: 99%

Localizing the Pain: Continuous Paravertebral Nerve Blockade in a Patient with Acute Pancreatitis

2021

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Patient: Female, 41-year-old Final Diagnosis: Pancreatitis Symptoms: Abdominal pain • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Anesthesiology Objective: Unusual or unexpected effect of treatment Background: Acute pancreatitis is the leading gastrointestinal cause of hospitalization in the United States. The associated pain, for which opioids are commonly prescribed, can result in complications of respiratory dysfunction secondary to impaired abdominal wall movement. Paravertebral nerve blockade has shown substantial efficacy in treatment of abdominal and thoracic pain, but its utility for pancreatitis pain and role in reducing hospital length of stay and narcotic use has not been well studied. Case Report: A 41-year-old woman with longstanding history of recurrent pancreatitis controlled with celiac plexus blocks and oxycodone was admitted for severe left upper quadrant abdominal pain. The patient was admitted, made NPO, and started on IV morphine. She underwent a left-sided T12-L1 paravertebral single shot injection and catheter placement, and experienced immediate relief. A Marcaine infusion was continued for 3 days and the patient required no additional narcotics while the catheter was in place. On hospital day 6, the catheter was removed and the patient was discharged. Conclusions: Our case illustrates the successful use of continuous thoracic paravertebral nerve blockade in a patient with pancreatitis. This intervention resulted in a significant reduction in narcotic requirements. As the number of hospitalizations and mean cost for acute pancreatitis has increased over the years despite an in-house mortality decrease, targeting cost reduction via length of stay reductions is key. Optimizing pain management in these patients is one way in which we can reduce LOS and thereby cost. We believe paravertebral nerve blockade is a viable analgesic option worth exploring in this patient population.

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“…34,142,143 Therefore, in this population, it may be prudent to consider utilizing strategies such as multimodal analgesia and regional anesthesia techniques that can improve analgesia while limiting opioid consumption until more research is conducted. 147…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Cannabis and Cannabinoids in the Perioperative Period

Lee

Sideris

Ladha

et al. 2023

Anesthesia &Amp; Analgesia

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Cannabis use is increasingly common, and with a growing number of jurisdictions implementing legalization frameworks, it is likely that providers will encounter more patients who use cannabis. Therefore, it is important for providers to understand the implications of cannabis use and practical considerations for the perioperative period. Cannabis affects multiple organ systems and may influence intraoperative anesthesia, as well as postoperative pain management. The effects of cannabis and key anesthetic considerations are reviewed here.

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Role of regional anesthesia and analgesia in the opioid epidemic

Cited by 10 publications

References 30 publications

Regional Anesthesia for Symptomatic Treatment of Stingray Envenomation

Regional Anesthesia for Symptomatic Treatment of Stingray Envenomation

Localizing the Pain: Continuous Paravertebral Nerve Blockade in a Patient with Acute Pancreatitis

Cannabis and Cannabinoids in the Perioperative Period

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