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Biomedical subjects

Richard W Rosenquist

Publications and source records attributed to Richard W Rosenquist.

14 recordsLinked to original sources
PubMed2004

Applying the ASRA guidelines to the use of low-molecular-weight heparin thromboprophylaxis in major orthopedic surgery.

Although low-molecular-weight heparin (LMWH) is a widely used form of thromboprophylaxis in orthopedic surgery, concerns remain over the concomitant use of regional anesthesia (RA)/postoperative regional analgesia (PRA) stemming from reports in the 1990s of spinal hematoma associated with this combination. One of the objectives of the Second American Society of Regional Anesthesia (ASRA) Consensus Conference was to address the safety of LMWH in combination with neuraxial anesthesia. The guidelines are designed in part to help orthopedic surgeons already using or contemplating the use of LMWH prophylaxis to avoid or minimize potential complications arising from its use with RA/PRA. Clinicians should consult the ASRA guidelines for recommendations on total daily dose, timing of the first postoperative dose, and dose schedule for anticoagulants used in conjunction with RA/PRA.

Analgesia↗
PubMed2003

Long-term outcomes during treatment of chronic pain with intrathecal clonidine or clonidine/opioid combinations.

To evaluate the effectiveness of intrathecal clonidine or clonidine/opioid admixture for the treatment of chronic pain states, a retrospective chart audit of 15 patients seen by the Pain Medicine and Neurosurgical Services was performed. Subjects included 9 men and 6 women aged 26-86 years. Diagnoses included complex regional pain syndrome, neuropathic pain, and cancer pain. All patients received a trial of single-shot and/or short-term infusion of clonidine. Those reporting a significant reduction in pain, or at least 50% reduction in their visual analog scale (VAS), received long-term therapy. Intrathecal clonidine as a single-shot dose, infusion, or as intrathecal polytherapy did not improve VAS scales from pre-treatment values in 5 patients. Ten patients reported significant pain relief or >50% decrease in VAS scores with the initial trial and received long-term therapy. Two received clonidine alone for 7-11 months before the therapy failed; others failed after just a few days. Seven of eight initially responded to clonidine alone (75-950 microg/day) before failing and requiring a second drug. Three received hydromorphone (200-8000 microg/day) and four morphine (0.15-15 mg/day) with clonidine. Four patients then failed 2-drug therapy (duration 6-21 months). Two continue with intrathecal clonidine/hydromorphone (duration 19-29 months) and 1 with clonidine/morphine (duration 21 months). After initiation of intrathecal clonidine, one patient reported good relief with clonidine/morphine until his death 5 months later. In this population, intrathecal clonidine was of limited utility for most patients. It may be of benefit for subset(s) of patients, but in our experience, duration of relief is typically <18 months.

Adult↗
PubMed2003

An indication for continuous cervical paravertebral block (posterior approach to the interscalene space).

We present a patient who required perioperative analgesia with continuous nerve block for shoulder disarticulation, for whom the only approach possible to the brachial plexus was from posterior. A 51-yr-old woman was suffering from intractable upper extremity pain and dysfunction as a result of severe lymphedema after metastatic spread of breast cancer to the axilla. Her pain was poorly controlled despite aggressive treatment with oral, systemic, and intrathecal opiates. She presented for amputation of her arm as a last resort for management of pain. In order to provide optimal postoperative analgesia, continuous peripheral nerve block was selected in consultation with the patient, and due to anatomic disfigurement and tumor invasion, a continuous cervical paravertebral block was placed preoperatively and shoulder disarticulation was performed using a combined regional/general anesthesia technique. The patient had an uneventful recovery without pain for the 6 postoperative days that the catheter was in place and 0.25% bupivacaine was infused at 5 mL/h. Because of anatomic considerations, which precluded the use of all other approaches to the brachial plexus, the posterior cervical paravertebral approach provided an effective means of pain control in this difficult clinical situation.

Anesthesia, General↗
PubMedDate not supplied

Ganglionic local opioid application (GLOA) for treatment of chronic headache and facial pain.

OBJECTIVE: This report describes the effects of ganglionic local opioid application (GLOA) in patients with chronic headache and persistent idiopathic facial pain. CASE REPORT: We present 2 patients with chronic headaches and 1 patient with persistent idiopathic facial pain who were refractory to medical treatment. These patients responded well to a series of ganglionic local opioid applications (GLOAs) by administration of buprenorphine. The beneficial effect of GLOA was manifested by a decrease in pain intensity, reduction of pain medications, and improvement in quality of life. CONCLUSIONS: These results support the theory of sympathetically mediated pain in the head and face, the presence of opioid receptors on the sympathetic ganglia, and a possible beneficial role of opioids in modulation of this process. To our knowledge, this case series is the first case series in the English literature of the use of GLOA at the stellate ganglion for head-and-face pain.

Adult↗
PubMedDate not supplied

Acute post-surgical pain management: a critical appraisal of current practice, December 2-4, 2005.

The Acute Pain Summit 2005 was convened to critically examine the perceptions of physicians about current methods used to control postoperative pain and to compare those perceptions with the available scientific evidence. Clinicians with expertise in treatment of postsurgical pain were asked to evaluate 10 practice-based statements. The statements were written to reflect areas within the field of acute-pain management, where significant questions remain regarding everyday practice. Each statement made a specific claim about the usefulness of a specific therapy (eg, PCA or epidural analgesia) or the use of pain-control modalities in specific patient populations (eg, epidural analgesia after colon resection). Members of the American Society of Regional Anesthesia and Pain Medicine (ASRA) were asked, via a Web-based survey, to rate their degree of agreement with each of the 10 statements; 22.8% (n = 632) of members responded. In preparation for the pain summit, a panel member independently conducted a literature search and summarized the available evidence relevant to each statement. Summit participants convened in December 2005. The assigned panel member presented the available evidence, and workshop participants then assigned a category for the level of evidence and recommendation for each statement. All participants then voted about each statement by use of the same accept/reject scale used earlier by ASRA members. This manuscript details those opinions and presents a critical analysis of the existing evidence supporting new and emerging techniques used to control postsurgical pain.

Acute Disease↗
PubMedDate not supplied

Postoperative pain guidelines.

BACKGROUND AND OBJECTIVES: Postoperative pain is the expected but nonetheless undesirable byproduct of all surgical procedures. Humanitarian concerns and recent quasi-governmental regulations have heightened awareness about the importance of treating postoperative pain. This guideline builds upon the foundation created by the Agency for Health Care Policy and Research guideline published in 1993, highlights changes that have occurred over the past 10 years, and makes recommendations based on the current scientific evidence. In addition, it takes advantage of the versatile information management inherent in a web-based format to make the information readily available. METHODS: A multidisciplinary group of physicians, dentists, nurses, pharmacists, physical therapists, psychologists, and ethicists from the Veterans Health Administration (VHA) and Department of Defense (DoD) in conjunction with the VHA Office of Quality and Performance and a consultant group developed a postoperative pain algorithm and supporting documentation. The guideline structure and content were determined by a standardized rating of the evidence gleaned from comprehensive electronic searches. RESULTS: An interactive electronic and traditional "paper" guideline with a pre- and postoperative algorithm was developed. A table, which provides a menu of analgesic choices organized by specific operation, was constructed. Preferences for particular analgesic techniques and classes of medications were identified. A postoperative pain interactive pharmacopoeia and printable patient educational materials were also provided. The guideline may be reviewed at the following website: www.oqp.med.va.gov/cpg/cpg.htm. CONCLUSIONS: This postoperative pain guideline provides readily accessible information and evidence-based guidance to a variety of providers. It highlights deficiencies in our understanding of the pain and recovery processes and how they might guide our choices of postoperative analgesic techniques. In combination with the powerful system-wide data collection capabilities of the VHA, there may be improved understanding of what techniques are useful. Finally, it may lead to the development of reliable, individualized analgesic plans for specific surgical procedures that incorporate the full range of pharmacologic and nonpharmacologic techniques.

Algorithms↗
PubMedDate not supplied

Gabapentin.

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Acetates↗