This blog’s attempt to ensure practitioners – especially rural or isolated – remain up to date is now scheduled for closure due to general lack of interest. The twitter account continues at @Awareness_Live
A majority of patients have been reported to experience post amputation neuropathic limb pain, with twin components of residual limb pain, and phantom limb pain. Its refractory nature has spurred a variety of physical, psychological, opioid and non-opioid therapies.
With the arrival of improved percutaneous ultrasound-guided fine-wire coiled peripheral nerve stimulation (PNS) leads in proximity to the sciatic and femoral nerves, this randomized study reported significant pain relief and improved disability in patients with chronic neuropathic postamputation pain.
The reversible procedure involved 8 weeks stimulation, but longer term improvements persisted. Further follow-up and study is ongoing for this promising intervention in an often intractable condition.
Two studies compare high flow nasal oxygen (HFNO) with facemask preoxygenation, one in obstetrics. Both reach the same conclusion in that HFNO is inferior to standard facemask preoxygenation.
HFNO, or simply a maximally cranked nasal cannula placed under the facemask have both been shown to increase apnea time and desaturation during difficult intubations but as a stand-alone measure are inadequate to optimize oxygenation prior to anesthesia induction.
Breathing exercises and personal education pre-op rather than booklets reduced post operative pulmonary complications. More studies needed as mortality effect not clearly demonstrated bmj
In other news, myocardial infarction up sixfold in the week after respiratory infection, especially influenza nejm