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British Journal of Anaesthesia Apr 2021Rebound pain is a common, yet under-recognised acute increase in pain severity after a peripheral nerve block (PNB) has receded, typically manifesting within 24 h after...
BACKGROUND
Rebound pain is a common, yet under-recognised acute increase in pain severity after a peripheral nerve block (PNB) has receded, typically manifesting within 24 h after the block was performed. This retrospective cohort study investigated the incidence and factors associated with rebound pain in patients who received a PNB for ambulatory surgery.
METHODS
Ambulatory surgery patients who received a preoperative PNB between March 2017 and February 2019 were included. Rebound pain was defined as the transition from well-controlled pain (numerical rating scale [NRS] ≤3) while the block is working to severe pain (NRS ≥7) within 24 h of block performance. Patient, surgical, and anaesthetic factors were analysed for association with rebound pain by univariate, multivariable, and machine learning methods.
RESULTS
Four hundred and eighty-two (49.6%) of 972 included patients experienced rebound pain as per the definition. Multivariable analysis showed that the factors independently associated with rebound pain were younger age (odds ratio [OR] 0.98; 95% confidence interval [CI] 0.97-0.99), female gender (OR 1.52 [1.15-2.02]), surgery involving bone (OR 1.82 [1.38-2.40]), and absence of perioperative i.v. dexamethasone (OR 1.78 [1.12-2.83]). Despite a high incidence of rebound pain, there were high rates of patient satisfaction (83.2%) and return to daily activities (96.5%).
CONCLUSIONS
Rebound pain occurred in half of the patients and showed independent associations with age, female gender, bone surgery, and absence of intraoperative use of i.v. dexamethasone. Until further research is available, clinicians should continue to use preventative strategies, especially for patients at higher risk of experiencing rebound pain.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Autonomic Nerve Block; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Peripheral Nerves; Retrospective Studies; Young Adult
PubMed: 33390261
DOI: 10.1016/j.bja.2020.10.035 -
Cold Spring Harbor Perspectives in... Mar 2015Although the ultrastructure of peripheral nerves has been known for nearly 200 years, the developmental origins and functional roles of all five main components of these... (Review)
Review
Although the ultrastructure of peripheral nerves has been known for nearly 200 years, the developmental origins and functional roles of all five main components of these specialized nervous system conduits are still poorly understood. One of these understudied nerve elements, the perineurium, is a component of the blood-nerve barrier and is essential for protecting axons and their associated Schwann cells from ionic flux, toxins, and infection. However, until recently, it was thought that this vital nerve tissue was derived from the mesoderm and simply served a structural/barrier function with no other influence on the development, maintenance, or regeneration of peripheral nerves. Recent work in zebrafish using in vivo time-lapse imaging, genetic manipulation, and laser axotomy is shedding light on the origin and roles of this previously ignored glial nerve component and is changing how we view development of the nervous system.
Topics: Animals; Nerve Regeneration; Neuroglia; Peripheral Nerves
PubMed: 25818566
DOI: 10.1101/cshperspect.a020511 -
Ugeskrift For Laeger Nov 2022Rebound pain is a severe post-surgical pain which occurs after the resolution of peripheral nerve blocks. Current literature suggests that rebound pain affects around... (Review)
Review
Rebound pain is a severe post-surgical pain which occurs after the resolution of peripheral nerve blocks. Current literature suggests that rebound pain affects around 50% of those receiving a peripheral nerve block. Possible interventions constitute patient education, bridging analgesia from the resolution of the nerve block, multimodal analgesic regimes, block adjuvants, or continuous pain catheters. Factors such as low age, female gender, bone surgery, and absence of IV dexamethasone are likely to be associated with rebound pain, as argued in this review.
Topics: Female; Humans; Anesthesia, Conduction; Pain Management; Analgesia; Pain, Postoperative; Peripheral Nerves
PubMed: 36426833
DOI: No ID Found -
Biofabrication Sep 2022Electroceuticals provide promising opportunities for peripheral nerve regeneration, in terms of modulating the extensive endogenous tissue repair mechanisms between... (Review)
Review
Electroceuticals provide promising opportunities for peripheral nerve regeneration, in terms of modulating the extensive endogenous tissue repair mechanisms between neural cell body, axons and target muscles. However, great challenges remain to deliver effective and controllable electroceuticals via bioelectronic implantable device. In this review, the modern fabrication methods of bioelectronic conduit for bridging critical nerve gaps after nerve injury are summarized, with regard to conductive materials and core manufacturing process. In addition, to deliver versatile electrical stimulation, the integration of implantable bioelectronic device is discussed, including wireless energy harvesters, actuators and sensors. Moreover, a comprehensive insight of beneficial mechanisms is presented, including up-to-dateand clinical evidence. By integrating conductive biomaterials, 3D engineering manufacturing process and bioelectronic platform to deliver versatile electroceuticals, the modern biofabrication enables comprehensive biomimetic therapies for neural tissue engineering and regeneration in the new era.
Topics: Biocompatible Materials; Nerve Regeneration; Nerve Tissue; Peripheral Nerves; Tissue Engineering
PubMed: 35995036
DOI: 10.1088/1758-5090/ac8baa -
The British Journal of Radiology Jan 2023High resolution ultrasound (US) and magnetic resonance (MR) neurography are both imaging modalities that are commonly used for assessing peripheral nerves including the... (Review)
Review
High resolution ultrasound (US) and magnetic resonance (MR) neurography are both imaging modalities that are commonly used for assessing peripheral nerves including the sural nerve (SN). The SN is a cutaneous sensory nerve which innervates the lateral ankle and foot to the base of the fifth metatarsal. It is formed by contributing nerves from the tibial and common peroneal nerves with six patterns and multiple subtypes described in literature. In addition to the SN being a cutaneous sensory nerve, the superficial location enables the nerve to be easily biopsied and harvested for a nerve graft, as well as increasing the susceptibility to traumatic injury. As with any peripheral nerves, pathologies such as peripheral nerve sheath tumors and neuropathies can also affect the SN. By utilizing a high frequency probe in US and high-resolution MR neurography, the SN can be easily identified even with the multiple variations given the standard distal course. US and MRI are also useful in determining pathology of the SN given the specific image findings that are seen with peripheral nerves. In this review, we evaluate the normal imaging anatomy of the SN and discuss common pathologies identified on imaging.
Topics: Humans; Sural Nerve; Peroneal Nerve; Ankle; Lower Extremity; Ankle Joint; Magnetic Resonance Imaging
PubMed: 36039944
DOI: 10.1259/bjr.20220336 -
F1000Research 2019Magnetic resonance imaging (MRI) has been used extensively in revealing pathological changes in the central nervous system. However, to date, MRI is very much... (Review)
Review
Magnetic resonance imaging (MRI) has been used extensively in revealing pathological changes in the central nervous system. However, to date, MRI is very much underutilized in evaluating the peripheral nervous system (PNS). This underutilization is generally due to two perceived weaknesses in MRI: first, the need for very high resolution to image the small structures within the peripheral nerves to visualize morphological changes; second, the lack of normative data in MRI of the PNS and this makes reliable interpretation of the data difficult. This article reviews current state-of-the-art capabilities in MRI of human peripheral nerves. It aims to identify areas where progress has been made and those that still require further improvement. In particular, with many new therapies on the horizon, this review addresses how MRI can be used to provide non-invasive and objective biomarkers in the evaluation of peripheral neuropathies. Although a number of techniques are available in diagnosing and tracking pathologies in the PNS, those techniques typically target the distal peripheral nerves, and distal nerves may be completely degenerated during the patient's first clinic visit. These techniques may also not be able to access the proximal nerves deeply embedded in the tissue. Peripheral nerve MRI would be an alternative to circumvent these problems. In order to address the pressing clinical needs, this review closes with a clinical protocol at 3T that will allow high-resolution, high-contrast, quantitative MRI of the proximal peripheral nerves.
Topics: Humans; Magnetic Resonance Imaging; Peripheral Nerves; Peripheral Nervous System Diseases
PubMed: 31700612
DOI: 10.12688/f1000research.19695.1 -
PloS One 2021Clinical comparisons do not usually take laterality into account and thus may report erroneous or misleading data. The concept of laterality, well evaluated in brain and...
BACKGROUND AND PURPOSE
Clinical comparisons do not usually take laterality into account and thus may report erroneous or misleading data. The concept of laterality, well evaluated in brain and motor systems, may also apply at the level of peripheral nerves. Therefore, we sought to evaluate the extent to which we could observe an effect of laterality in MRI-collected white matter indices of the sciatic nerve and its two branches (tibial and fibular).
MATERIALS AND METHODS
We enrolled 17 healthy persons and performed peripheral nerve diffusion weighted imaging (DWI) and magnetization transfer imaging (MTI) of the sciatic, tibial and fibular nerve. Participants were scanned bilaterally, and findings were divided into ipsilateral and contralateral nerve fibers relative to self-reporting of hand dominance. Generalized estimating equation modeling was used to evaluate nerve fiber differences between ipsilateral and contralateral legs while controlling for confounding variables. All findings controlled for age, sex and number of scans performed.
RESULTS
A main effect of laterality was found in radial, axial, and mean diffusivity for the tibial nerve. Axial diffusivity was found to be lateralized in the sciatic nerve. When evaluating mean MTR, a main effect of laterality was found for each nerve division. A main effect of sex was found in the tibial and fibular nerve fiber bundles.
CONCLUSION
For the evaluation of nerve measures using DWI and MTI, in either healthy or disease states, consideration of underlying biological metrics of laterality in peripheral nerve fiber characteristics need to considered for data analysis. Integrating knowledge regarding biological laterality of peripheral nerve microstructure may be applied to improve how we diagnosis pain disorders, how we track patients' recovery and how we forecast pain chronification.
Topics: Adolescent; Diffusion Tensor Imaging; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Nerve Fibers; Peripheral Nerves; Young Adult
PubMed: 34914714
DOI: 10.1371/journal.pone.0260256 -
Muscle & Nerve Jan 2023Neuralgic amyotrophy (NA), also referred to as idiopathic brachial plexitis and Parsonage-Turner syndrome, is a peripheral nerve disorder characterized by acute severe... (Review)
Review
Neuralgic amyotrophy (NA), also referred to as idiopathic brachial plexitis and Parsonage-Turner syndrome, is a peripheral nerve disorder characterized by acute severe shoulder pain followed by progressive upper limb weakness and muscle atrophy. While NA is incompletely understood and often difficult to diagnose, early recognition may prevent unnecessary tests and interventions and, in some situations, allow for prompt treatment, which can potentially minimize adverse long-term sequalae. High-resolution ultrasound (HRUS) has become a valuable tool in the diagnosis and evaluation of NA. Pathologic HRUS findings can be grouped into four categories: nerve swelling, swelling with incomplete constriction, swelling with complete constriction, and fascicular entwinement, which may represent a continuum of pathologic processes. Certain ultrasound findings may help predict the likelihood of spontaneous recovery with conservative management versus the need for surgical intervention. We recommend relying heavily on history and physical examination to determine which nerves are clinically affected and should therefore be assessed by HRUS. The nerves most frequently affected by NA are the suprascapular, long thoracic, median and anterior interosseous nerve (AIN) branch, radial and posterior interosseous nerve (PIN) branch, axillary, spinal accessory, and musculocutaneous. When distal upper limb nerves are affected (AIN, PIN, superficial radial nerve), the lesion is almost always located in their respective fascicles within the parent nerve, proximal to its branching point. The purpose of this review is to describe a reproducible, standardized, ultrasonographic approach for evaluating suspected NA, and to share reliable techniques and clinical considerations when imaging commonly affected nerves.
Topics: Humans; Brachial Plexus Neuritis; Peripheral Nerves; Peripheral Nervous System Diseases; Radial Nerve; Constriction, Pathologic; Shoulder Pain
PubMed: 36040106
DOI: 10.1002/mus.27705 -
International Journal of Molecular... Oct 2023Appropriate animal models, mimicking conditions of both health and disease, are needed to understand not only the biology and the physiology of neurons and other cells... (Review)
Review
Appropriate animal models, mimicking conditions of both health and disease, are needed to understand not only the biology and the physiology of neurons and other cells under normal conditions but also under stress conditions, like nerve injuries and neuropathy. In such conditions, understanding how genes and different factors are activated through the well-orchestrated programs in neurons and other related cells is crucial. Knowledge about key players associated with nerve regeneration intended for axonal outgrowth, migration of Schwann cells with respect to suitable substrates, invasion of macrophages, appropriate conditioning of extracellular matrix, activation of fibroblasts, formation of endothelial cells and blood vessels, and activation of other players in healthy and diabetic conditions is relevant. Appropriate physical and chemical attractions and repulsions are needed for an optimal and directed regeneration and are investigated in various nerve injury and repair/reconstruction models using healthy and diabetic rat models with relevant blood glucose levels. Understanding dynamic processes constantly occurring in neuropathies, like diabetic neuropathy, with concomitant degeneration and regeneration, requires advanced technology and bioinformatics for an integrated view of the behavior of different cell types based on genomics, transcriptomics, proteomics, and imaging at different visualization levels. Single-cell-transcriptional profile analysis of different cells may reveal any heterogeneity among key players in peripheral nerves in health and disease.
Topics: Rats; Animals; Endothelial Cells; Rats, Wistar; Peripheral Nerves; Diabetic Neuropathies; Schwann Cells; Nerve Degeneration; Nerve Regeneration; Axons; Peripheral Nerve Injuries; Diabetes Mellitus
PubMed: 37894921
DOI: 10.3390/ijms242015241 -
Basic & Clinical Pharmacology &... Aug 2014Peripheral neuropathy can be caused by medication, and various descriptions have been applied for this condition. In this MiniReview, the term 'drug-induced peripheral... (Review)
Review
Peripheral neuropathy can be caused by medication, and various descriptions have been applied for this condition. In this MiniReview, the term 'drug-induced peripheral neuropathy' (DIPN) is used with the suggested definition: Damage to nerves of the peripheral nervous system caused by a chemical substance used in the treatment, cure, prevention or diagnosis of a disease. Optic neuropathy is included in this definition. A distinction between DIPN and other aetiologies of peripheral neuropathy is often quite difficult and thus, the aim of this MiniReview is to discuss the major agents associated with DIPN.
Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Optic Nerve Diseases; Peripheral Nerves; Peripheral Nervous System Diseases
PubMed: 24786912
DOI: 10.1111/bcpt.12261