Techniques in Regional Anesthesia & Pain Management RSS feed: Current Issue. Techniques in Regional Anesthesia and Pain Management is a journal unlike any in the specialty. The concept underlying the publication is to combine the timeliness of a quarterly journal with the illustrative aspects of a procedure oriented atlas. Exact techniques are well-illustrated, giving precise drug dosages and helpful clinical pearls. In addition, common complications of regional anesthesia and pain management procedures and their appropriate treatments are described. New and Forthcoming Issues: January Pain and Rehabilitation Steven Stanos April Headaches: Diagnosis and Treatment Brian McGeeney http://www.techreganesth.org/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Techniques in Regional Anesthesia & Pain Management1084-208X154October 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.techreganesth.org/article/PIIS1084208X11001042/abstract?rss=yesEditorial Board10.1053/S1084-208X(11)00104-2Techniques in Regional Anesthesia & Pain Management 15, 4 (2011)2011-10-01Techniques in Regional Anesthesia & Pain Management2011-10-01154S1084-208X(11)X0005-8iihttp://www.techreganesth.org/article/PIIS1084208X11001054/abstract?rss=yesTable of contents10.1053/S1084-208X(11)00105-4Techniques in Regional Anesthesia & Pain Management 15, 4 (2011)2011-10-01Techniques in Regional Anesthesia & Pain Management2011-10-01154S1084-208X(11)X0005-8iiiihttp://www.techreganesth.org/article/PIIS1084208X11000747/abstract?rss=yes An essential component of cancer treatment and management is effective pain control, which is vital to the preservation of functioning, quality of life, and potentially survival time. Unfortunately, not all patients with chronic cancer-related pain can be controlled with comprehensive medical management and it is important to consider other modalities of treatment, including intrathecal (IT) therapy for these patients. The indications for IT therapy in patients suffering from chronic pain resulting from cancer or the treatment of cancer are explored here. Generally, IT therapy is indicated for patients with greater than 3 months of life expectancy who have continuing neuropathic and/or somatic/visceral pain despite an optimized pharmacologic treatment regimen or who experience intolerable side effects from medications. In these refractory patients, IT therapy can provide targeted, effective analgesia with fewer adverse effects, leading to quality-of-life--enhancing pain relief. Indications for intrathecal therapy in cancer patientsJacqueline Lozano, Oscar A. de Leon-Casasola10.1053/j.trap.2011.10.002Techniques in Regional Anesthesia & Pain Management 15, 4 (2011)2011-10-01Techniques in Regional Anesthesia & Pain Management2011-10-01154S1084-208X(11)X0005-8147149http://www.techreganesth.org/article/PIIS1084208X11000929/abstract?rss=yes The epidural trial is an integral part of the success of an intrathecal pump treatment. As described in this article, it will allow the practitioner to test for the best site for catheter placement, drugs to combine in the therapeutic regimen, and to get an idea of the doses per day to utilize of each of the drugs to be used. The trial is usually used for 1-2 weeks to allow for enough time to make all the appropriate changes to guarantee a high probability of success with intrathecal therapy. The epidural trialHemadevi Chenthilmurugan, Marchyarn Mahathanaruk, Oscar A. de Leon-Casasola10.1053/j.trap.2011.10.003Techniques in Regional Anesthesia & Pain Management 15, 4 (2011)2011-10-01Techniques in Regional Anesthesia & Pain Management2011-10-01154S1084-208X(11)X0005-8150154http://www.techreganesth.org/article/PIIS1084208X11000930/abstract?rss=yes The use of intrathecal therapy is associated with increase quality of analgesia and a decrease in side effects in patients who have not tolerated oral pharmacological therapy AND have had a successful epidural trial. Steps to achieve a high degree of success are delineated in this article, including ideal catheter tip position, indication and use of medications for the infusion, rate of infusion, etc. Moreover, recommendations to follow before and after a myelogram through the pump are given. Implementing and managing intrathecal pumpsOscar A. de Leon-Casasola10.1053/j.trap.2011.10.004Techniques in Regional Anesthesia & Pain Management 15, 4 (2011)2011-10-01Techniques in Regional Anesthesia & Pain Management2011-10-01154S1084-208X(11)X0005-8155157http://www.techreganesth.org/article/PIIS1084208X11000954/abstract?rss=yes Perioperative complications associated with the implantation of intrathecal pumps can be significantly decreased through the use of a preoperative, intraoperative and postoperative protocols. This article describes the steps to be followed to limit the side effects and complications that may be associated with this procedure. Intrathecal pump implantation techniquesJulie A. Sparlin, Oscar A. de Leon-Casasola10.1053/j.trap.2011.10.006Techniques in Regional Anesthesia & Pain Management 15, 4 (2011)2011-10-01Techniques in Regional Anesthesia & Pain Management2011-10-01154S1084-208X(11)X0005-8158161http://www.techreganesth.org/article/PIIS1084208X11000735/abstract?rss=yes Cancer and its treatments often result in complex combinations of nociceptive and neuropathic pain. Comprehensive pharmacologic management with opioids and antineuropathic medications can result in adequate pain control in a vast majority of patients. For patients who fail oral pharmacotherapy, intrathecal drug delivery systems can be used to treat pain from a localized source. When considering a patient for trial and possible implementation of an intrathecal drug delivery system, the risks associated with this invasive therapy must be weighed against the benefits and presented to the patient. Complications of intrathecal drug delivery systemsJames M. Hitt, Oscar A. de Leon-Casasola10.1053/j.trap.2011.10.001Techniques in Regional Anesthesia & Pain Management 15, 4 (2011)2011-10-01Techniques in Regional Anesthesia & Pain Management2011-10-01154S1084-208X(11)X0005-8162166http://www.techreganesth.org/article/PIIS1084208X11000942/abstract?rss=yes Because of the relative lack of placebo and dose-ranging studies regarding the initiation and titration of intrathecal (IT) therapy, the Polyanalgesic Consensus Conference (2007) yielded recommendations regarding the management of pain by IT drug delivery. Expert opinion is valuable; however, further consideration might be given to the established literature on the subject. Conclusions of the Polyanalgesic Consensus Conference (2007) were reviewed in light of existing literature. Of note, few published data exist to determine hydromorphone equianalgesic doses or maximum IT dose, the risk of spinal cord lesion secondary to bupivacaine, the suitability of ziconotide as a first-line agent, and the practicality of computed tomography-myelography for diagnosis of granuloma at the IT catheter tip. Common practices are not necessarily supported by established data. Nevertheless, continuous IT infusion has established itself as a powerful, effective, and safe modality for the treatment of pain in selected individuals who cannot tolerate or find relief with noninvasive analgesic techniques. A critique of the latest consensus panel for intrathecal therapyMatthew Peer, Oscar A. de Leon-Casasola10.1053/j.trap.2011.10.005Techniques in Regional Anesthesia & Pain Management 15, 4 (2011)2011-10-01Techniques in Regional Anesthesia & Pain Management2011-10-01154S1084-208X(11)X0005-8167171