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Anaesthesiology

This category is dedicated to the advancement of research in all topics related to Anaesthesia and Intensive Care.

An Evidence-Based Algorithm for the Treatment of Neuropathic Pain

Nanna B. Finnerup, MD; Marit Otto, MD; Troels S. Jensen, MD, PhD; Søren H. Sindrup, MD, PhD

Abstract


Objective: The purpose of this article is to discuss an evidence-based algorithm that can be implemented by the primary care physician in his/her daily clinical practice for the treatment of patients with neuropathic pain conditions.
Method: A treatment algorithm for neuropathic pain was formulated on the basis of a review of 105 high-quality, randomized, placebo-controlled clinical trials. The number needed to treat (NNT) and number needed to harm (NNH) were used to compare the safety and effectiveness of current treatments for neuropathic pain syndromes. Most of the clinical trials reviewed in the analysis assessed tricyclic antidepressants (TCAs) and antiepileptic drugs (AEDs).
Results: TCAs had the lowest NNT followed by opioids and AEDs, such as gabapentin and pregabalin. The nature of the retrospective calculation of the NNT and NNH involves obvious limitations because of the pooling of studies with different experimental designs and outcomes.
Conclusion: Patients presenting with neuropathic pain are becoming a more frequent occurrence for the primary care physician as the population ages. Evidence-based treatment options allow for the most efficient and effective pharmacotherapy regimen to be implemented.

Read more: An Evidence-Based Algorithm for the Treatment of Neuropathic Pain

Alternative Treatments for Wounds: Leeches, Maggots, and Bees

Karen M. Dente, MA, MD
Introduction

The recalcitrant nature and complexity of chronic wounds continue to challenge health practitioners in the field, with many of the standard treatment options often failing to provide good outcomes. Chronic wounds are often infected with bacteria resistant to antibiotics, compounding the problem. Some alternative biologic forms of treatment have been used and are gaining recognition; they include apitherapy (application of honey), maggots, and leeches. In addition to other wound-promoting actions, they all seem to show efficacy against bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA).
Honey -- A Topical Treatment for Wounds

Read more: Alternative Treatments for Wounds: Leeches, Maggots, and Bees

Appendectomy During Pregnancy Increases Risk for Adverse Fetal Outcomes

News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MD
Appendectomy for suspected appendicitis during pregnancy increased risk for adverse fetal outcomes even when the appendix was normal, according to the results of a retrospective analysis reported in the October issue of the American College of Surgeons.

Read more: Appendectomy During Pregnancy Increases Risk for Adverse Fetal Outcomes

GAO report confirms payment disparity between Medicare and commercial payments

GAO report confirms payment disparity between Medicare and commercial payments for anesthesia services

The U.S. Government Accountability Office (GAO) has just released its long-awaited report comparing Medicare and commercial payment rates for anesthesia services.  The GAO concludes that Medicare anesthesia payments are 67 percent lower than average commercial payments.

Read more: GAO report confirms payment disparity between Medicare and commercial payments

Trends in Chronic Pain Management Malpractice Claims

Dr. Derek LiauDerek W. Liau, M.D., is an R3 Resident,
Department of Anesthesiology,
University of Washington School of Medicine, Seattle, Washington.


A 70-year-old woman with chronic thoracic back pain had an epidural local/steroid injection in the T-spine region. The block was uneventful, but 10 minutes later she complained of increased back pain and shortness of breath. The initial diagnosis was “nerve root irritation.” She was discharged but later went to the emergency room where she was seen by the anesthesiologist. A CT scan showed no change from the pre-block CT scan and she was admitted to the neurological service. An MRI later found a hematoma in the T-spine area. After three subsequent surgeries for evacuation of the hematoma and progressive paraplegia, she died within a week of her last surgery. A suit was filed against the anesthesiologist. Upon further review of her medical records, it was noted that she was instructed to stop taking her outpatient anticoagulant four days prior to the epidural injection. She claimed to have complied, but the records indicated that she had continued to take the anticoagulant up until the time of the injection. Was the anesthesiologist liable or negligent? Are complications such as these becoming more common in chronic pain management?

Read more: Trends in Chronic Pain Management Malpractice Claims

2006 Distinguished Service Award: Carl C. Hug, Jr., M.D., Ph.D.

Dr. Orin F. GuidryOrin F. Guidry, M.D.
Immediate Past President
Carl C. Hug, Jr., M.D., Ph.D.

Several months ago, I was at a social function for anesthesiologists, and I had an opportunity to interject into the conversation that I read an interesting article in a British journal. It is not often that I have the opportunity to appear well read and erudite. One of the anesthesiologists in the group expressed a great deal of interest in the article and asked me to e-mail him a copy. Nothing unusual about this exchange except for me knowing about an interesting article.

Read more: 2006 Distinguished Service Award: Carl C. Hug, Jr., M.D., Ph.D.

Acute Pain Management : A New Area of Liability for Anesthesiologists

Dr. Mariko BirdMariko Bird, M.D., is an R4 resident,
Department of Anesthesiology,
University of Washington, Seattle, Washington.

A 71-year-old obese female smoker with hypertension and diabetes underwent a total knee replacement under epidural anesthesia with intravenous sedation. Postoperatively an epidural infusion (bupivacaine 0.25 percent and fentanyl 2 mcg/ml) was started at 10 ml/hr. She was discharged to a ward without any continuous monitors and with vital signs to be taken every hour for four hours and every four hours thereafter. Several hours later, she was in severe pain for which the anesthesiologist administered 100 mcg fentanyl and 10 ml of 0.25 percent bupivacaine via the epidural. Three hours later, the patient was still complaining of pain, and the epidural concentration was increased to bupivacaine 0.375 percent with 3 mcg/ml of fentanyl and the infusion rate was increased to 15 ml/hr. Two and one-half hours later, the anesthesiologist ordered hydromorphone (2mg IM) due to continuing pain. About four hours later, she was given another 2 mg of IM hydromorphone. Her level of arousal and vitals were not assessed for four more hours until she was found unresponsive and pulseless. CPR was initiated, but the patient suffered severe brain damage. A lawsuit was settled for $135,000 against the anesthesiologist and $15,000 against the hospital.

Read more: Acute Pain Management : A New Area of Liability for Anesthesiologists

Professional Liability Insurance for Anesthesiologists: Yearly Survey of Premiums

Dr. Karen B. DominoKaren B. Domino, M.D., M.P.H., Chair
Committee on Professional Liability
The ASA Committee on Professional Liability has again conducted a survey of medical liability insurance companies to assess trends in liability insurance for anesthesiologists. Thirty-five medical liability insurers throughout the United States participated in the 2007 survey. We collected data concerning distributions of policy limits and premium amounts for a mature $1 million/$3 million policy in the various states in which these carriers provide coverage. In addition we surveyed trends in premiums, moratoriums and comparative costs for specialists in chronic pain management.

Read more: Professional Liability Insurance for Anesthesiologists: Yearly Survey of Premiums

ASA speaks out against new requirement of “tamper resistant” Medicaid prescription pads

Effective October 1, Medicaid prescriptions must be written on tamper-resistant prescription forms. This policy change was slipped into military funding legislation that recently became law.

Read more: ASA speaks out against new requirement of “tamper resistant” Medicaid prescription pads

Tumescent Anesthesia

By Dr. ramaz Mitaishvili
The tumescent technique can reduce bruising, pain and swelling after surgery.
Blood loss is minimized and there is a lower chance to need a blood transfusion
after surgery. Anesthesia solution is injected into the planned regions for fat
sculpting.

Read more: Tumescent Anesthesia

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