Brian M. Block

Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery : a meta-analysis

Background:Perioperative central neuraxial analgesia may improve outcome after coronary artery bypass surgery due to attenuation of stress response and superior analgesia. Methods:MEDLINE and other databases were searched for randomized controlled trials in patients undergoing coronary artery bypass surgery with cardiopulmonary bypass who were randomized to either general anesthesia (GA) versus general anesthesia–thoracic epidural analgesia (TEA) or general anesthesia–intrathecal analgesia (IT). Results:Fifteen trials enrolling 1,178 patients were included for TEA analysis. TEA did not affect incidences of mortality (0.7% TEA vs. 0.3% GA) or myocardial infarction (2.3% TEA vs. 3.4% GA). TEA significantly reduced the risk of dysrhythmias with an odds ratio of 0.52, pulmonary complications with an odds ratio of 0.41, and time to tracheal extubation by 4.5 h and reduced analog pain scores at rest by 7.8 mm and with activity by 11.6 mm. Seventeen trials enrolling 668 patients were included for IT analysis. IT had no significant effect on incidences of mortality (0.3% IT vs. 0.6% GA), myocardial infarction (3.9% IT vs. 5.7% GA), dysrhythmias (24.8% vs. 29.1%), nausea/vomiting (31.3% vs. 28.5%), or time to tracheal extubation (10.4 h IT vs. 10.9 h GA). IT modestly decreased systemic morphine use by 11 mg and decreased pain scores by 16 mm. IT significantly increased the incidence of pruritus (10% vs. 2.5%). Conclusions:There were no differences in the rates of mortality or myocardial infarction after coronary artery bypass grafting with central neuraxial analgesia. There were associated improvements in faster time until tracheal extubation, decreased pulmonary complications and cardiac dysrhythmias, and reduced pain scores.

The lucent cleft, a new radiographic sign of cervical disc injury or disease

Moderately severe neck injury or disease may be associated with negative routine radiographs. Three cases are presented which show small, smooth, lucent clefts adjacent to the vertebral body end-plate anteriorly, seen only on the extension lateral view. This was the only radiographic sign of cervical injury or disease. An explanation of the finding is given and it is distinguished from the well known vacuum phenomena of disc degeneration.

An imaging review of sacroiliac joint injection under computed tomography guidance.

b a c j t w s n o u i hronic low-back pain is a common disease that is also the most common and expensive cause f disability. Low-back pain has multiple generaors, such as vertebral bone pain, spondylosis and facet syndrome,” and the intervertebral discs. Aditionally, the sacroiliac joint (SIJ) may be a pain enerator in approximately 30% of patients with hronic low-back pain and buttock pain1-3 and also nflammatory spondyloarthropathy. However, SIJ ain is easily overlooked, and the exact contribuion of SIJ pain can be difficult to determine.1,2 The njection of local anesthetic directly into the joint an be useful in the diagnosis and treatment of SIJ ain (arthralgia). This injection can be performed y use of surface landmarks alone or with fluorocopic, ultrasound, or CT guidance. We discuss a ase of SIJ injection that was possible only with CT uidance. We also discuss the potential usefulness f CT guidance.