Faculty Bibliography

The fascia iliaca nerve block provides excellent postoperative pain relief after knee surgery. It is easy to perform, needle insertion is not directly next to nerves or vessels, and it is associated with minimal side effects. Instructive case reports as well as a description and discussion of the technique are presented.

Complex regional pain syndromes (CRPS) are challenging neuropathic pain states quite difficult to comprehend and treat. Although not yet fully understood, advances are being made in the knowledge of the mechanisms involved with CRPS. Patients often present with incapacitating pain and loss of function. Patients suffering from these disorders need to have treatment plans tailored to their individual problems. A comprehensive diagnostic evaluation and early and aggressive therapeutic interventions are imperative. The therapeutic approach often calls for a combination of treatments. Medications such as antiepileptics, opioids, antidepressants, and topical agents along with a rehabilitation medicine program can help a major portion of patients suffering from these disorders. Implantable devices can aid those patients with CRPS. While progress is being made in treating patients with CRPS, it is important to remember that the goals of care are always to: 1) perform a comprehensive diagnostic evaluation, 2) be prompt and aggressive in treatment interventions, 3) assess and reassess the patient's clinical and psychological status, 4) be consistently supportive, and 5) strive for the maximal amount of pain relief and functional improvement. In this review article, the current knowledge of the epidemiology, pathophysiology, diagnostic, and treatment methodologies of CRPS are discussed to provide the pain practitioner with essential and up-to-date guidelines for the management of CRPS.

The author discusses state-of-the-art technology for patient monitoring in office-based anesthesia. New technology includes bispectral index monitoring to evaluate the depth of anesthesia, signal extraction for more accurate oxygen saturation monitoring, and online S-T segment analysis for monitoring multiple electrocardiographic leads.

Since significant pain can adversely affect multiple organ systems, many anesthesiologists believe that effective pain control can decrease perioperative and post-trauma morbidity. To achieve the goal of attenuating the physiological stress response associated with trauma, modalities such as patient-controlled analgesia, epidural infusions and peripheral nerve blocks are being utilized. This article will review the physiological response to pain, the new strategies and techniques for providing pain relief, and recent literature that evaluates the effect of the newer pain modalities on perioperative morbidity.