Vol 2-3 Commentary

Commentary: Prevalence and Characteristics of Chronic Pain among Patients in Portuguese Primary Care Units

Filipe Antunes

Physical and Rehabilitation Medicine department & Chronic Pain Unit, Hospital de Braga, Sete fontes-São Victor, Braga, Portugal

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Vol 2-3 Commentary

What if pain in fibromyalgia is primarily due to increased muscle tension?

Robert S Katz1*, Frank Leavitt2, Ben J Small3

1Section of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA

2Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA

3Department of Rheumatology, Northwestern Memorial Hospital, Chicago, IL, USA

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Vol 2-3 Mini Review

Mini Review of An Opioid-Sparing Protocol for the Management of Patients Undergoing Laparoscopic Sleeve Gastrectomy

Jay Suggs*, Garrett G. Perry

Crestwood Medical Center, One Hospital Drive, Huntsville, AL, USA

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Vol 2-3 Review Article

Quadratus Lumborum Block for Post Caesarean Delivery Analgesia: A Review

Anudeep Jafra1, Jeetinder Kaur Makkar1*, Nidhi Bhatia1, Narinder Pal Singh2

1Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India

2Department of Anaesthesia, MMIMSR, MM (DU), Mullana-Ambala, India

Caesarean delivery is one of the commonest surgical procedures being performed world-wide, and with it comes the burden for management of acute post-operative pain in parturient. A number of modalities including neuraxial opioids, intravenous drugs and truncal nerve blocks are available to control acute postsurgical pain. Quadratus lumborum block has recently been emerged as a modality for pain relief following caesarean delivery. This review highlights the anatomical aspects, mechanism of action of block, relevant literature search and future directions for use of quadratus lumborum block in parturient undergoing caesarean delivery.

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Vol 2-3 Commentary

Commentary: Perioperative Pregabalin and Intraoperative Lidocaine Infusion to Reduce Persistent Neuropathic Pain After Breast Cancer Surgery: A Multicenter, Factorial, Randomized, Controlled Pilot Trial

Elad Dana1,2*, James S. Khan3

1Department of Anesthesia, Intensive Care and Pain Medicine, Meir Medical Center, Kfar Saba, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel

2Department of Anesthesia and Pain Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada

3Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada

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Vol 2-3 Mini Review

Air Leak in COVID-19 Patients

Jonathan Nieves*, Tarig S. Elhakim, Valentina Rojas Ortiz, Gabriell Silva, Robert Hernandez, Jose Gascon

Department of Internal Medicine, Kendall Regional Medical Center, Miami, Florida, USA

COVID-19 has been associated with multiple complications including Acute Respiratory Distress Syndrome (ARDS), thrombo-embolism, and septic shock. A rare complication is a Spontaneous pneumomediastinum (SPM), pneumothorax (PNX), and subcutaneous emphysema (SCE) unrelated to positive pressure ventilation. These complications can become life threatening if a large amount of air is present and cannot escape to the neck or retroperitoneum causing obstructive shock or tension pneumothorax. Studies suggest that the cytokine storm in COVID-19 can result in diffuse alveolar injury, which can result in the alveolar wall being vulnerable to rupture. It is also speculated that the cause of the alveolar rupture is due to the diffuse alveolar damage resulting in air leak to the mediastinum. A recent case series of COVID19 autopsies have identified the microthrombi formation and the mononuclear response that leads to diffuse alveolar damage. In addition, recent studies have shown that COVID 19 infected patients are associated with worse clinical outcomes and increase intra and postoperative pulmonary complications and mortality risk. Meaning that patients with SPM had a higher chance of intubation and a higher chance of death. For anesthesiologists, the preoperative evaluation and risk assessment have always been a crucial step in determining whether it is safe to take a patient for surgery. Studies have shown that patients who test positive for COVID 19 are associated with worse clinical outcomes and increase postoperative complications and mortality. Obtaining accurate information, using clinical judgement and having open communication with surgeons may help reduce these risks.

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