Abstract：
BACKGROUND:A growing body of evidence indicates that the use of regional anesthesia offers advantages over general anesthesia, not only in terms of reducing complications but also regarding resource utilization and patient satisfaction. Because of the paucity of data on the nationwide adoption of regional anesthesia techniques, we aimed to elucidate trends in the use of neuraxial anesthesia (NA) and peripheral nerve blocks (PNBs) in orthopedic surgeries. METHODS:We extracted data from N = 959,257 (Premier Perspective database; 2006-2013) total hip and knee arthroplasties (THA, TKA) and assessed NA/PNB use by a 2-year period, stratified by demographics and hospital factors. Cochran-Armitage trend tests assessed significance of trends. RESULTS:Comparing 2006-2007 with 2012-2013, NA utilization decreased slightly from 21.7% to 19.7% for THA patients; this was 24.7% to 21.3% for TKA patients (with the main drop between 2012 and 2013). Conversely, PNB utilization increased from 6.5% to 8.7% for THA patients and 10.3% to 20.4% for TKA patients (all P < 0.001). These general trends did not change when stratified by patient demographics, whereas stratification by hospital factors did show differences: the highest NA utilization was seen in rural, nonteaching, and small hospitals, whereas the highest PNB utilization was seen in large and teaching hospitals. CONCLUSIONS:Our findings provide important insight into the dynamics of the adoption of regional anesthetic techniques. Whereas PNB utilization is significantly increasing, overall, NA and PNBs are performed in the minority of cases. With accumulating evidence in favor of regional anesthesia, promoting the use of NA and a further increase in PNB utilization could have far-reaching medical and economic implications.
journal_name
Reg Anesth Pain Medjournal_title
Regional anesthesia and pain medicineauthors
Cozowicz C,Poeran J,Zubizarreta N,Mazumdar M,Memtsoudis SGdoi
10.1097/AAP.0000000000000342subject
Has Abstractpub_date
2016-01-01 00:00:00pages
43-9issue
1eissn
1098-7339issn
1532-8651journal_volume
41pub_type
杂志文章abstract：BACKGROUND AND OBJECTIVES:The posterior approach to performing a continuous brachial plexus block at the level of the nerve roots has been described using traditional superficial landmarks. We describe an ultrasound-guided approach for the placement of a continuous interscalene brachial plexus catheter at the level of ...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1016/AAP.0b013e3181933a53
更新日期：2009-01-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Poorly controlled postoperative pain is strongly associated with the development of chronic pain. We aimed to investigate the effect of topical morphine (in 1 of 3 doses: 5, 10, or 15 mg) on acute and chronic neuropathic pain after modified radical mastectomy for cancer breast. METHODS:In thi...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章,随机对照试验
doi：10.1097/AAP.0000000000000496
更新日期：2016-11-01 00:00:00
abstract：INTRODUCTION:Diabetes may affect the duration of nerve block after regional anesthesia. This study aimed to compare the durations of sensory and motor block in diabetes versus non-diabetes patients after lower limb nerve block and delineate any sex-based differences in the duration of sensory and motor blocks of both d...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1136/rapm-2019-100609
更新日期：2019-07-12 00:00:00
abstract：BACKGROUND AND OBJECTIVE:We present an unusual complication of epidural analgesia used to facilitate postoperative pain relief while allowing mobilization of the patient. CASE REPORT:A 65-year-old woman with a history of chronic obstructive pulmonary disease, atherosclerotic cardiovascular disease, chronic renal failu...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1053/rapm.2001.22993
更新日期：2001-05-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Shortening the onset time of sensory block is a practical goal to improve the quality of epidural anesthesia. The addition of fentanyl to a local anesthetic solution is widely used during epidural anesthesia. This randomized double-blind study examined the onset time of sensory block during ep...
journal_title：Regional anesthesia and pain medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1053/rapm.2001.27852
更新日期：2001-11-01 00:00:00
abstract：OBJECTIVE:Postdural puncture headache (PDPH) is an uncommon sequel of lumbar puncture in children. When conservative treatment with bed rest, hydration, and caffeine are ineffective, epidural blood patches are recommended and are generally effective. The purpose of this report was to highlight that when lumbar epidural...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1097/AAP.0000000000000562
更新日期：2017-03-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Multimodal analgesic clinical pathways for joint replacement patients often include perineural catheters, but long-term adherence to these pathways has not yet been investigated. Our primary aim was to determine adherence rate to a knee arthroplasty clinical pathway for patients undergoing sta...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1097/AAP.0000000000000588
更新日期：2017-05-01 00:00:00
abstract：OBJECTIVE:We present a case of reappearance of spinal anesthesia despite the use of plain (isobaric) lidocaine and without an associated cough or Valsalva maneuver. CASE REPORT:A 66-year-old man had spinal anesthesia for knee arthroscopy. Two hours after the induction of spinal anesthesia and after the patient's motor...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1016/j.rapm.2007.11.007
更新日期：2008-05-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Ultrasound-guided regional anesthesia is a rapidly growing field. There exists little information regarding the competencies involved with such a practice. The objective of this exploratory study was to characterize the behavior of novices as they undertook the challenges of learning a new tec...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1016/j.rapm.2006.11.006
更新日期：2007-03-01 00:00:00
abstract：:Although interscalene brachial plexus block (ISB) remains the gold standard for analgesia after shoulder surgery, the inherent risks of ipsilateral phrenic nerve block and hemidiaphragmatic paralysis (HDP) limit its use in patients with preexisting pulmonary compromise. In a previous Daring Discourse (2017), our resea...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1136/rapm-2019-100908
更新日期：2019-09-20 00:00:00
abstract：BACKGROUND AND OBJECTIVE:The study goal was to compare the effect of epinephrine in different doses on pulmonary gas exchange in a rat model of bupivacaine-induced cardiac depression. METHODS:Twenty-four adult male Sprague-Dawley rats were divided into 4 groups (n = 6), and each group received a bupivacaine infusion (...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1097/AAP.0000000000000541
更新日期：2017-05-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Glomangiomas are rare, vascular tumors consisting of an afferent artery, arteriovenous canal, neuro-reticular elements, collagen, and efferent veins, and are most often located in the soft tissue of the upper extremities. We describe how the use of ultrasound-guided nerve blockade altered the ...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1016/j.rapm.2007.10.003
更新日期：2008-01-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:S(-)-Bupivacaine has the pharmacotoxicological advantage over its antipode and racemate. The interaction with lipid membranes was compared between S(-)-, R(+)- and racemic bupivacaine. METHODS:The bupivacaine-induced changes in membrane property were determined by turbidity and fluorescence p...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1016/j.rapm.2007.05.011
更新日期：2008-07-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Conflicting definitions concerning the exact location of the lumbar plexus have been proposed. The present study was carried out to detect anatomical variants regarding the topographical relation between the lumbar plexus and the psoas major muscle as well as lumbar plexus anatomy at the L4-L5...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1016/j.rapm.2007.07.016
更新日期：2008-03-01 00:00:00
abstract：:Pain patients can be difficult. They can provoke negative feelings of frustration and anger among clinicians and damage the doctor-patient relationship. This article helps practitioners to identify those pain patients who would be prone to difficult behavior and sheds light on some of the reasons behind the behavior t...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章,评审
doi：10.1016/j.rapm.2004.11.005
更新日期：2005-03-01 00:00:00
abstract：:Contemporary nonmalignant pain treatment algorithms commence with conservative non-invasive strategies, later progressing from minimally invasive interventions to invasive techniques or implantable devices. The most commonly used implantable devices are spinal cord stimulation (SCS) systems or targeted drug delivery (...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1136/rapm-2019-100859
更新日期：2020-01-12 00:00:00
abstract：BACKGROUND AND OBJECTIVES:A sublingual sufentanil tablet is being developed as a potential alternative to intravenous (IV) opioids for the management of postoperative pain. The objective of these studies was to evaluate the pharmacokinetics, efficacy, and safety of sublingual sufentanil tablets for postoperative pain m...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章,随机对照试验
doi：10.1097/AAP.0b013e3182791157
更新日期：2013-03-01 00:00:00
abstract：:Potassium (K+) channels form the largest family of ion channels with more than 70 such genes identified in the human genome. They are organized in 3 superfamilies according to their predicted membrane topology: (1) subunits with 6 membrane-spanning segments and 1-pore domain, (2) subunits with 2 membrane-spanning segm...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章,评审
doi：10.1016/j.rapm.2004.12.001
更新日期：2005-05-01 00:00:00
abstract：BACKGROUND:Given the steep learning curve for neuraxial and peripheral nerve blocks, utilization of general anesthesia may increase as new house staff begin their residency programs. We sought to determine whether "July effect" affects the utilization of neuraxial anesthesia, peripheral nerve blocks, and opioid prescri...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1136/rapm-2020-101318
更新日期：2020-05-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Peripherally administered opioids, e.g., intra-articular morphine, exert their analgesic action on local opioid receptors. The present study investigated the safety and efficacy of intrabursal oxycodone and bupivacaine in comparison with bupivacaine infiltration and interscalene brachial plexu...
journal_title：Regional anesthesia and pain medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s1098-7339(98)90030-x
更新日期：1998-09-01 00:00:00
abstract：OBJECTIVE:We report a case of perioperative management of a single-ventricle patient with Fontan-associated liver disease undergoing hepatectomy. CASE REPORT:A 12-year-old boy with Fontan circulation was scheduled for partial hepatectomy to remove a liver mass in segment 6. He received stent implantation to relieve co...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1097/AAP.0000000000000316
更新日期：2015-11-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Continuous brachial plexus blocks at the interscalene level are associated with known diaphragm dysfunction from phrenic nerve paresis. More distal blocks along the brachial plexus may provide postsurgical analgesia while potentially having less effect on diaphragm function. Continuous intersc...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章,随机对照试验
doi：10.1097/AAP.0000000000000578
更新日期：2017-05-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:A common analgesic technique for total knee arthroplasty (TKA) is to inject local anesthetic into the periarticular tissue during surgery, known as local infiltration analgesia (LIA). Since the solution used typically contains a large amount of local anesthetic, concerns arise about exceeding ...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1136/rapm-2018-100043
更新日期：2019-01-11 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Hematoma is typically cited as one mechanism of nerve injury following axillary block. However, documented cases of this are lacking. METHODS:A healthy 38-year-old man was scheduled for surgical removal of a tumor of the hand. A transarterial axillary block was performed with a 22-gauge short...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：
更新日期：1999-05-01 00:00:00
abstract：:This study aimed to describe the anatomical distribution of dye injected in the erector spinae plane (ESP) in a porcine living model, which could aid to reveal factors potentially relevant to the unexplained clinical effects of the ESP block. Six pigs received 0.6 mL/kg of 0.25% new methylene blue at the level of the ...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1136/rapm-2019-100964
更新日期：2020-03-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:The duration of nerve block is longer in streptozotocin (STZ)-induced diabetic rats for all local anesthetics (with and without adjuvants) compared with normal rats. Perioperative glycemic control is currently practiced to reduce adverse events in many at-risk patients, especially in diabetic ...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1097/AAP.0b013e31826742fd
更新日期：2012-11-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:We tested the hypothesis that an opioid-free local anesthetic alone is able to provide comparable analgesia to the opioid supplemented epidural application of local anesthetics using thoracic epidural catheters after major abdominal surgery. METHODS:In a prospective, randomized, and double-bl...
journal_title：Regional anesthesia and pain medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1053/rapm.2002.32583
更新日期：2002-07-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Peripheral nerve stimulation (PNS) is analgesic for some lower extremity neuropathic pain syndromes. PNS currently involves open surgical placement of electrode(s). Increasingly, ultrasound guidance is used for perioperative neural block. Minimally invasive placement of PNS electrodes for lowe...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1016/j.rapm.2008.04.007
更新日期：2008-11-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Amputations of the lower extremity remain a common procedure in a high-risk population. Perioperative morbidity and mortality reach as high as 14.1% in below-knee amputations. We aimed to determine whether regional, or neuraxial, anesthesia, when compared with general anesthesia (GA), would be...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1097/AAP.0000000000000687
更新日期：2018-01-01 00:00:00
abstract：:The progression of sensory blockade in the hand following a forearm Bier block with ropivacaine is currently unknown. The hands of 10 healthy adult human subjects were anesthetized with ropivacaine, and their sensitivities to cold and touch were tested until the completion of anesthesia. On average, insensitivity to c...
journal_title：Regional anesthesia and pain medicine
pub_type： 杂志文章
doi：10.1097/AAP.0b013e31820d42ed
更新日期：2011-03-01 00:00:00
