Publications by authors named "Aaron J Kaye"

32 Publications

Paliperidone 3-Month Injection for Treatment of Schizophrenia: A Narrative Review.

Front Psychiatry 2021 21;12:699748. Epub 2021 Sep 21.

Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, United States.

Given the typical age onset of schizophrenia, there are tremendous economic and social impacts that extend beyond the person and their families. One critical determinant of the diseases' impact is the patient's adherence to antipsychotic drug treatment. Approved in 2015 for the treatment of schizophrenia, paliperidone palmitate (Invega Trinza, a 3-month injection, noted as PP3M) is a second-generation long-acting injectable antipsychotic medication. Among the different formulations offered for palmitate paliperidone, including the 1 and 3-month formulations, the longer duration 3-month formulation was better at preventing relapse in schizophrenic patients. To date, different formulations of palmitate paliperidone that have been studied on relapse episodes of schizophrenia include once-daily extended-release oral paliperidone (ORAL paliperidone), once-monthly paliperidone palmitate (PP1M), and once-every-3-months paliperidone palmitate (PP3M). analyses show that patients who were withdrawn from PP1M paliperidone had the least risk of relapse, followed by patients withdrawn from PP3M and patients withdrawn from ORAL paliperidone. PP3M was better at preventing relapse compared to ORAL paliperidone. The results demonstrated that 50% of patients who were withdrawn from ORAL paliperidone, PP1M, or PP3M remained relapse-free for ~2, 6, and 13 months, respectively. Compared to PP1M, PP3M is just as safe and effective and has the added advantage of increased adherence related to a longer dose interval, decreasing the risk of relapse.
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http://dx.doi.org/10.3389/fpsyt.2021.699748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490677PMC
September 2021

Adjuvant Drugs for Peripheral Nerve Blocks: The Role of Alpha-2 Agonists, Dexamethasone, Midazolam, and Non-steroidal Anti-inflammatory Drugs.

Anesth Pain Med 2021 Jun 4;11(3):e117197. Epub 2021 Jul 4.

Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA.

Adjuvant drugs for peripheral nerve blocks are a promising solution to acute postoperative pain and the transition to chronic pain treatment. Peripheral nerve blocks (PNB) are used in the brachial plexus, lumbar plexus, femoral nerve, sciatic nerve, and many other anatomic locations for site-specific pain relief. However, the duration of action of a PNB is limited without an adjuvant drug. The use of non-opioid adjuvant drugs for single-shot peripheral nerve blocks (sPNB), such as alpha-2 agonists, dexamethasone, midazolam, and non-steroidal anti-inflammatory drugs, can extend the duration of local anesthetics and reduce the dose-dependent adverse effects of local anesthetics. Tramadol is a weak opioid that acts as a central analgesic. It can block voltage-dependent sodium and potassium channels, cause serotonin release, and inhibit norepinephrine reuptake and can also be used as an adjuvant in PNBs. However, tramadol's effectiveness and safety as an adjuvant to local anesthetic for PNB are inconsistent. The effects of the adjuvants on neurotoxicity must be further evaluated with further studies to delineate the safety in their use in PNB. Further research needs to be done. However, the use of adjuvants in PNB can be a way to help control postoperative pain.
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http://dx.doi.org/10.5812/aapm.117197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438706PMC
June 2021

Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate.

Anesth Pain Med 2021 Jun 5;11(3):e117146. Epub 2021 Jul 5.

Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA.

The potential for misuse, overdose, and chronic use has led researchers to look for other methods to decrease opioid consumption in patients with acute and chronic pain states. The use of peripheral nerve blocks for surgery has gained increasing popularity as it minimizes peripheral pain signals from the nociceptors of local tissue sustaining trauma and inflammation from surgery. The individualization of peripheral nerve blocks using adjuvant drugs has the potential to improve patient outcomes and reduce chronic pain. The major limitations of peripheral nerve blocks are their limited duration of action and dose-dependent adverse effects. Adjuvant drugs for peripheral nerve blocks show increasing potential as a solution for postoperative and chronic pain with their synergistic effects to increase the duration of action and decrease the required dosage of local anesthetic. N-methyl-d-aspartate (NMDA) receptor antagonists are a viable option for patients with opioid resistance and neuropathic pain due to their affinity to the neurotransmitter glutamate, which is released when patients experience a noxious stimulus. Neostigmine is a cholinesterase inhibitor that exerts its effect by competitively binding at the active site of acetylcholinesterase, which prevents the hydrolysis of acetylcholine and subsequently retaining acetylcholine at the nerve terminal. Epinephrine, also known as adrenaline, can potentially be used as an adjuvant to accelerate and prolong analgesic effects in digital nerve blocks. The theorized role of sodium bicarbonate in local anesthetic preparations is to increase the pH of the anesthetic. The resulting alkaline solution enables the anesthetic to more readily exist in its un-ionized form, which more efficiently crosses lipid membranes of peripheral nerves. However, more research is needed to show the efficacy of these adjuvants for nerve block prolongation as studies have been either mixed or have small sample sizes.
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http://dx.doi.org/10.5812/aapm.117146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438710PMC
June 2021

Pharmacological Advances in Opioid Therapy: A Review of the Role of Oliceridine in Pain Management.

Pain Ther 2021 Sep 4. Epub 2021 Sep 4.

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Problems with the treatment of acute pain may arise when a patient is opioid-tolerant, such as those on chronic therapy with opioids or opiate replacement therapy, those who misuse opioids, and those who are in recovery. While some of the adverse effects of opioid medications are well known, it is also important to recognize the roles of tolerance and hyperalgesia. Oliceridine can target and modulate a novel μ-receptor pathway. The G protein-biased agonism of oliceridine allows for effective re-sensitization and desensitization of the mu-opioid receptor, which decreases the formation of opioid tolerance in patients. Oliceridine has been demonstrated to be an effective and relatively safe intravenous analgesic for the treatment of postoperative pain and is generally well tolerated with a favorable side effect profile when compared to morphine. As the prevalence of pain increases, it is becoming increasingly important to find safe and effective analgesics.
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http://dx.doi.org/10.1007/s40122-021-00313-5DOI Listing
September 2021

A Comprehensive Review of Novel Interventional Techniques for Chronic Pain: Spinal Stenosis and Degenerative Disc Disease-MILD Percutaneous Image Guided Lumbar Decompression, Vertiflex Interspinous Spacer, MinuteMan G3 Interspinous-Interlaminar Fusion.

Adv Ther 2021 09 14;38(9):4628-4645. Epub 2021 Aug 14.

Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA.

Spinal stenosis is the compression of nerve roots by bone or soft tissue secondary to the narrowing of the spinal canal, lateral recesses, or intervertebral foramina. Spinal stenosis may have acquired or congenital origins. Most cases are acquired and caused by hypertrophy of the ligamentum flavum, enlarged osteophytes, degenerative arthritis, disk herniations, and various systemic illnesses. The ligamentum flavum (LF) is a highly specialized elastic ligament that connects the laminae of the spine and fuses them to the facet joint capsules. There are a number of treatment options available for spinal stenosis. Implants and surgical interventions have grown in popularity recently, and a number of these have been shown to have varying efficacy, including the minimally invasive lumbar decompression (MILD), Vertiflex, Coflex Interlaminar Stabilization, and MinuteMan G3 procedures. Minimally invasive lumbar decompression (MILD) is a minimally invasive outpatient procedure to treat spinal stenosis related to hypertrophied ligamentum flavum. The Superion Interspinous Spacer, also known as Vertiflex, is a titanium implant that is delivered percutaneously to relieve back pain caused by lumbar spinal stenosis. The MinuteMan is a minimally invasive, interspinous-interlaminar fusion device planned for the temporary fixation of the thoracic, lumbar, and sacral spine, which eventually results in bony fusion. Based on our review of the available current scientific literature, the novel interventions for symptomatic lumbar spinal stenosis, such as the MILD procedure and the Superion interspinous spacer, generally appear to be safe and effective. There is a possibility in the future that these interventions could disrupt current treatment algorithms for lumbar spinal stenosis.
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http://dx.doi.org/10.1007/s12325-021-01875-8DOI Listing
September 2021

Peripheral Nerve Stimulation: A Review of Techniques and Clinical Efficacy.

Pain Ther 2021 Jul 31. Epub 2021 Jul 31.

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Chronic pain is a common source of morbidity in many patient populations worldwide. There are growing concerns about the potential side effects of currently prescribed medications and a continued need for effective treatment. Related to these concerns, peripheral nerve stimulation has been regaining popularity as a potential treatment modality. Peripheral nerve stimulation components include helically coiled electrical leads, which direct an applied current to afferent neurons providing sensory innervation to the painful area. In theory, the applied current to the peripheral nerve will alter the large-diameter myelinated afferent nerve fibers, which interfere with the central processing of pain signals through small-diameter afferent fibers at the level of the spinal cord. Multiple studies have shown success in the use of peripheral nerve stimulation for acute post-surgical pain for orthopedic surgery, including post total knee arthroplasty and anterior cruciate ligament surgery, and chronic knee pain. Many studies have investigated the utility of peripheral nerve stimulation for the management of chronic shoulder pain. Peripheral nerve stimulation also serves as one of the potential non-pharmacologic therapies to treat back pain along with physical therapy, application of transcutaneous electrical neurostimulation unit, radiofrequency ablation, epidural steroid injections, permanently implanted neurostimulators, and surgery. Studies regarding back pain treatment have shown that peripheral nerve stimulation led to significant improvement in all pain and quality-of-life measures and a reduction in the use of opioids. Further studies are needed as the long-term risks and benefits of peripheral nerve stimulation have not been well studied as most information available on the effectiveness of peripheral nerve stimulation is based on shorter-term improvements in chronic pain.
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http://dx.doi.org/10.1007/s40122-021-00298-1DOI Listing
July 2021

Novel Interventional Techniques for Chronic Pain with Minimally Invasive Arthrodesis of the Sacroiliac Joint: (INSITE, iFuse, Tricor, Rialto, and others).

Rheumatol Ther 2021 Sep 30;8(3):1061-1072. Epub 2021 Jul 30.

Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA.

Acute and chronic pain are public health issues that clinicians have been battling for years. Opioid medications have been a treatment option for both chronic and acute pain; however, they can cause unwanted complications and are a major contributor to our present opioid epidemic. The sacroiliac (SI) joint is a common cause of both acute and chronic low back pain. It affects about 15-25% of patients with axial low back pain, and up to 40% of patients with ongoing pain following lumbar fusion. Recent advances in the treatment of SI joint pain have led to the development of a wide variety of SI joint fusion devices. These fusion devices seek to stabilize the joints themselves in order that they become immobile and, in theory, can no longer be a source for pain. This is a minimally invasive procedure aimed to address chronic pain without subjecting patients to lengthy surgery or medications, including opioids with the potential for addiction and abuse. Minimally invasive SI fusion can be performed by a lateral approach (i.e., iFuse, Tricor) or posterior approach (i.e., CornerLoc, LinQ, Rialto). The posterior approach requires the patient to be in the prone position but allows for less disruption of muscles with entry. More data are necessary to determine which fusion system may be best for a particular patient. SI fusion devices are a promising way of treating chronic lower back pain related to the SI joint. This narrative review will discuss various types of SI fusion devices, and their potential use in terms of their safety and efficacy.
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http://dx.doi.org/10.1007/s40744-021-00350-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380604PMC
September 2021

Brexpiprazole for the Treatment of Schizophrenia and Major Depressive Disorder: A Comprehensive Review of Pharmacological Considerations in Clinical Practice.

Psychopharmacol Bull 2021 Mar;51(2):69-95

Edinoff, MD, Wu, MD, Odisho, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Maxey, BS, Ren, BS, Leethy, BS, Louisiana State University Shreveport School of Medicine. Girma, MD, Alan D. Kaye, MD, PhD, Mychaskiw, DO, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Jessica S. Kaye, Adam M. Kaye, PharmD, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Aaron J. Kaye, MD, Medical University of South Carolina, Department of Anesthesiology, Charleston, SC. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA.

Mood and psychotic disorders are a group of illnesses that affect behavior and cognition. Schizophrenia is characterized by positive symptoms, such as delusions and hallucinations, as well as negative symptoms. Major depressive disorder (MDD) is a mood disorder that affects the patient's emotions, energy, and motivation. Brexpiprazole works as a partial agonist at serotonin 5-hydroxytryptamine1A and dopamine D2 receptors and an antagonist at serotonin 5-hydroxytryptamine2A. Schizophrenia and MDD have a wide range of risk factors, both biological and environmental. Third generation antipsychotics, which include brexpiprazole, are the latest group of drugs to reach the market, demonstrating efficacy and tolerability. Patients with acute schizophrenia have responded well to brexpiprazole. In this regard, in patients who have MDD plus anxiety symptoms, brexpiprazole can be effective as an adjunctive therapy and can reduce anxiety symptoms. In summary, brexpiprazole has proved to be an effective alternative to typical or first and second-generation atypical antipsychotics.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146559PMC
March 2021

Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review.

Cardiol Ther 2021 Jun 11;10(1):111-140. Epub 2021 Mar 11.

Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Purpose Of Review: Chronic venous insufficiency is found to some extent in a large proportion of the world's population, especially in the elderly and obese. Despite its prevalence, little research has been pursued into this pathology when compared to similarly common conditions. Pain is often the presenting symptom of chronic venous insufficiency and has significant deleterious effects on quality of life. This manuscript will describe the development of pain in chronic venous insufficiency, and will also review both traditional methods of pain management and novel advances in both medical and surgical therapy for this disease.

Recent Findings: Pain in chronic venous insufficiency is a common complication which remains poorly correlated in recent studies with the clinically observable extent of disease. Although lifestyle modification remains the foundation of treatment for pain associated with chronic venous sufficiency, compression devices and various pharmacologic agents have emerged as safe and effective treatments for pain in these patients. In patients for whom these measures are insufficient, recently developed minimally invasive vascular surgical techniques have been shown to reduce postsurgical complications and recovery time, although additional research is necessary to characterize long-term outcomes of these procedures. This review discusses the latest findings concerning the pathophysiology of pain in chronic venous insufficiency, conservative and medical management, and surgical strategies for pain relief, including minimally invasive treatment strategies.
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http://dx.doi.org/10.1007/s40119-021-00213-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126535PMC
June 2021

A Comprehensive Review of Alternative Therapies for the Management of Chronic Pain Patients: Acupuncture, Tai Chi, Osteopathic Manipulative Medicine, and Chiropractic Care.

Adv Ther 2021 01 12;38(1):76-89. Epub 2020 Nov 12.

Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.

Introduction: Non-pharmacologic alternative therapies for pain have been around for a long time, some for hundreds of years. They have been used throughout history to treat many issues.

Recent Findings: Currently, alternative medicine is most frequently used to treat musculoskeletal pain, and between 59 and 90% of patients utilizing alternative therapies for chronic pain claimed they were helpful and can serve as an effective adjunctive for the treatment of chronic pain. Some examples of alternative therapies that will be discussed in this review include acupuncture, tai chi, osteopathic manipulation, and chiropractic care. Acupuncture, traditionally a Chinese practice, is becoming more popular across the world to attempt to relieve pain. It involves the placement of thin needles at various points in the body. The efficacy of acupuncture for pain is heavily debated. More research and discussion are necessary to determine the exact role it plays in the treatment of chronic pain. Tai chi is also a traditional Chinese practice that is often used as a form of meditation and for potential health benefits. Tai chi involves a series of complex movements such as squatting combined with deep breathing to achieve relaxation and pain reduction. Osteopathic manipulative treatment (OMT) is a technique used by both osteopathic physicians (DO) as well as other health professionals to manage a wide range of conditions in any given patient. The technique involves utilization and manipulation of the musculoskeletal system to achieve potential health benefits. OMT has been used as therapy for many issues but is commonly used for pain conditions. Alternative therapies may serve as an effective adjunctive treatment modality for the management of chronic pain conditions. There has been a tremendous amount of research dictating the effectiveness of alternative therapies for chronic pain management. The purpose of this review is to provide a comprehensive evidence-based update of alternative therapy used for the management of chronic pain conditions.
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http://dx.doi.org/10.1007/s12325-020-01554-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854390PMC
January 2021

Neuropathic Pain and Sickle Cell Disease: a Review of Pharmacologic Management.

Curr Pain Headache Rep 2020 Jul 24;24(9):52. Epub 2020 Jul 24.

Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Purpose Of Review: Sickle cell disease (SCD) remains among the most common and severe monogenic disorders present in the world today. Although sickle cell pain has been traditionally characterized as nociceptive, a significant portion of sickle cell patients has reported neuropathic pain symptoms. Our review article will discuss clinical aspects of SCD-related neuropathic pain, epidemiology of neuropathic pain among individuals with SCD, pain mechanisms, and current and future potential pharmacological interventions.

Recent Findings: Neuropathic pain in SCD is a complicated condition that often has a lifelong and significant negative impact on life; therefore, improved pain management is considered a significant and unmet need. Neuropathic pain mechanisms are heterogeneous, and the difficulty in determining their individual contribution to specific pain types may contribute to poor treatment outcomes in this population. Our review article outlines several pharmacological modalities which may be employed to treat neuropathic pain in SCD patients.
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http://dx.doi.org/10.1007/s11916-020-00885-5DOI Listing
July 2020

PECS, serratus plane, erector spinae, and paravertebral blocks: A comprehensive review.

Best Pract Res Clin Anaesthesiol 2019 Dec 17;33(4):573-581. Epub 2019 Jul 17.

Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., 70112, New Orleans, LA, USA. Electronic address:

Thoracic planar blocks represent a novel and rapidly expanding facet of regional anesthesia. These recently described techniques represent the potential for excellent analgesia, enhanced technical safety profiles, and reduced physiological side effects versus traditional techniques in thoracic anesthesia. Regional techniques, particularly those described in this review, have potential implications for mitigation of surgical pathophysiological neurohumoral changes. In the present investigation, we describe the history, common indications, technique, and limitations of pectoral nerves (PECS), serratus plane, erector spinae plane, and thoracic paravertebral plane blocks. In summary, these techniques provide excellent analgesia and merit consideration in thoracic surgery.
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http://dx.doi.org/10.1016/j.bpa.2019.07.003DOI Listing
December 2019

The role of regional anesthesia in the propagation of cancer: A comprehensive review.

Best Pract Res Clin Anaesthesiol 2019 Dec 31;33(4):507-522. Epub 2019 Jul 31.

Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA. Electronic address:

New cancer incidences worldwide will eclipse 18 million in 2019, with nearly 10 million cancer-related deaths. It is estimated that in the United States, almost 40% of individuals will be diagnosed with cancer in their lifetime. Surgical resection of primary tumors remains a cornerstone of cancer treatment; however, the surgical process can trigger an immune-suppressing sympathetic response, which promotes tumor growth of any residual cancerous cells post surgery. Regional and local anesthesia have become staples of anesthesia and analgesia during and after surgery. Recently, much evidence in the form of retrospective and prospective studies has come to light regarding the protective, antitumor properties of anesthetic and analgesic agents across a wide variety of cancers and patient demographics. It is believed that by blocking afferent pain signals, the body does not mount the sympathetic response that contributes to the perpetuation of disease after surgical treatment. This review, therefore, investigates these studies as they pertain to the treatment and outcomes of cancers treated surgically to elucidate the role of regional anesthesia in the propagation of cancer.
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http://dx.doi.org/10.1016/j.bpa.2019.07.004DOI Listing
December 2019

Regional Anesthesia in Patients on Anticoagulation Therapies-Evidence-Based Recommendations.

Curr Pain Headache Rep 2019 Jul 29;23(9):67. Epub 2019 Jul 29.

Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.

Purpose Of Review: Anticoagulant use among patients is prevalent and increasing. It is important for anesthesiologists to be aware of patients on anticoagulants while performing regional anesthesia.

Recent Findings: In recent years, the FDA has approved many new anticoagulants. With new drugs coming to the market, new side effect profiles should be considered when treating patients, especially when using regional anesthesia. Both ASRA and European agencies have laid out recommendations regarding anticoagulant use and neuraxial/regional techniques. Regarding newer anticoagulants, the guidelines for discontinuation prior to neuraxial injection are based on pharmacokinetics, including half-life duration for each drug. While each clinical scenario requires an individualized approach, general guidelines can serve as a starting point to help with anesthetic planning and potentially improve patient safety in this evolving field.
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http://dx.doi.org/10.1007/s11916-019-0805-xDOI Listing
July 2019

Regional Nerve Blocks-Best Practice Strategies for Reduction in Complications and Comprehensive Review.

Curr Pain Headache Rep 2019 May 23;23(6):43. Epub 2019 May 23.

Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave, New Orleans, LA, 70112, USA.

Purpose Of Review: Understanding the etiologies of the complications associated with regional anesthesia and implementing methods to reduce their occurrence provides an opportunity to foster safer practices in the delivery of regional anesthesia.

Recent Findings: Neurologic injuries following peripheral nerve block (PNB) and neuraxial blocks are rare, with most being transient. However, long-lasting and devastating sequelae can occur with regional anesthesia. Risk factors for neurologic injury following PNB include type of block, injection in the presence of deep sedation or general anesthesia, presence of existing neuropathy, mechanical trauma from the needle, pressure injury, intraneural injection, neuronal ischemia, iatrogenic injury related to surgery, and local anesthetic neurotoxicity. The present investigation discusses regional blocks, complications of regional blocks, risk factors, site-specific limitations, specific complications and how to prevent them from happening, avoiding complications in regional anesthesia, and the future of regional anesthesia.
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http://dx.doi.org/10.1007/s11916-019-0782-0DOI Listing
May 2019

Pharmacogenomics, precision medicine, and implications for anesthesia care.

Best Pract Res Clin Anaesthesiol 2018 Jun 6;32(2):61-81. Epub 2018 Aug 6.

Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. Electronic address:

The study of how individual genetic differences, known as polymorphisms, change the pharmacokinetics and pharmacodynamics of drugs is called pharmacogenomics. As the field of pharmacogenetics grows and continues to identify genetic polymorphisms, it is promising that the unmet need in this patient population may soon be addressed with personalized drug therapy based on the patient's genetic composition. Although encouraging, pharmacogenomic testing is underutilized in the United States and is often not covered by insurance companies. This manuscript describes the current state of precision medicine as it relates to perioperative care and how preoperative genomic analysis can help improve patient outcomes. This investigation also outlines future directions in this important and evolving field.
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http://dx.doi.org/10.1016/j.bpa.2018.07.001DOI Listing
June 2018

Pulmonary vasodilators: Latest evidence and outcomes in the perioperative setting.

Best Pract Res Clin Anaesthesiol 2018 Jun 3;32(2):237-250. Epub 2018 Jul 3.

Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA. Electronic address:

Numerous conditions give rise to pulmonary arterial hypertension (PAH), with most of them being idiopathic. Signs and symptoms are generally difficult to recognize initially because they present as nonspecific and typically are mistaken for age-related physiological processes or alternate medical conditions. Many advances have been made toward PAH-specific therapies that have led to advanced clinical management of the disease. The present investigation describes new pulmonary vasodilator agents that are currently available or under development that could impact perioperative management. The 6-min walk test is the gold standard in assessing the efficacy of any pulmonary hypertension treatment, and the only drug to show any mortality benefit in pulmonary hypertension is epoprostenol. The present investigation also describes the latest evidence on using these medications in the perioperative period, including clinical trials and practice guidelines. Future direction for research and clinical management of pulmonary hypertension is described.
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http://dx.doi.org/10.1016/j.bpa.2018.06.006DOI Listing
June 2018

Perioperative implications of common and newer psychotropic medications used in clinical practice.

Best Pract Res Clin Anaesthesiol 2018 Jun 2;32(2):187-202. Epub 2018 Jul 2.

Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA. Electronic address:

Psychotropic medications are widely prescribed by clinicians as both primary therapy for a variety of psychiatric and neurodegenerative diseases and as adjunctive analgesics for use in the perioperative period. It is critical to understand various modes of action, drug-drug interactions, side effects, and clinical implications. Health care providers must understand how these medications interact with anesthetics, as well as other drugs used in perioperative care. We review relevant psychiatric and neurodegenerative diseases, psychotropic medications used to treat them, and how these medications interact with anesthetics and drugs used in perioperative care. We will also discuss emerging psychotropic drugs and the challenges they may create during the perioperative period. Future direction of investigation into the role of these drugs during the perioperative period and implications is also discussed.
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http://dx.doi.org/10.1016/j.bpa.2018.06.002DOI Listing
June 2018

New opioid receptor modulators and agonists.

Best Pract Res Clin Anaesthesiol 2018 Jun 2;32(2):125-136. Epub 2018 Jul 2.

Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, PO Box 208051, New Haven, CT, 06520, USA. Electronic address:

There has been significant research to develop an ideal synthetic opioid. Opioids with variable properties possessing efficacy and with reduced side effects have been synthesized when compared to previously used agents. An opioid modulator is a drug that can produce both agonistic and antagonistic effects by binding to different opioid receptors and therefore cannot be classified as one or the other alone. These compounds can differ in their structures while still possessing opioid-mediated actions. This review will discuss TRV130 receptor modulators and other novel opioid receptor modulators, including Mitragyna "Kratom," Ignavine, Salvinorin-A, DPI-289, UFP-505, LP1, SKF-10,047, Cebranopadol, Naltrexone-14-O-sulfate, and Naloxegol. In summary, the structural elucidation of opioid receptors, allosteric modulation of opioid receptors, new opioid modulators and agonists, the employment of optogenetics, optopharmacology, and next-generation sequencing of opioid receptor genes and related functionality should create exciting new avenues for research and therapeutic development to treat conditions including pain, opioid abuse, and addiction.
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http://dx.doi.org/10.1016/j.bpa.2018.06.009DOI Listing
June 2018

Stem Cell Therapy for Osteonecrosis of the Femoral Head: Current Trends and Comprehensive Review.

Curr Pain Headache Rep 2018 May 3;22(6):41. Epub 2018 May 3.

Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, B6/319 CSC, 600 Highland Ave, Madison, WI, 53792-3272, USA.

Purpose Of Review: Osteonecrosis of the femoral head (ONFH) is a common and frequently occurring disease. It is caused by interruption of blood supply with different etiologies. ONFH leads to degeneration and necrosis of the subchondral bone of the femoral head and eventually collapse of the femoral head. ONFH has a high disability rate, seriously affecting the quality of living of patients, and often involves middle-aged and younger people.

Recent Findings: In recent years, the technology and understanding of stem cells and regenerative medicine have been developing rapidly. Numerous studies have reported successful results in the treatment of ONFH by stem cell transplantation. Thus, stem cell transplantation is expected to serve as a new method in the treatment of ONFH. In the present report, therefore, we evaluated current techniques and outcomes utilizing stem cells in the treatment of ONFH. A computer-based online search of PubMed and Cochrane Library databases between January 2006 and June 2017 was performed to search related articles using the keywords of "treatment, stem cell, osteonecrosis of the femoral head" in English language. Literature related to the treatment of ONFH was selected. Our search obtained a total of 161 articles, but only 9 articles met our inclusion criteria and were included in our report. The present review reveals that cell technology has demonstrated good evidence in the treatment of ONFH. However, this technology needs additional in-depth study to better explore and appreciate more ideal ways to overcome difficulties associated with source of cells.
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http://dx.doi.org/10.1007/s11916-018-0700-xDOI Listing
May 2018

Preoperative Assessment for Ambulatory Surgery.

Curr Pain Headache Rep 2017 Aug 31;21(10):43. Epub 2017 Aug 31.

Department of Anesthesiology, Louisiana School of Medicine, New Orleans, LA, USA.

Purpose Of Review: Ambulatory surgery has grown in recent decades in volume and represents a significant number of anesthetics delivered throughout the USA. Preoperative anesthetic assessment in the ambulatory setting has become important because patients with numerous complex comorbidities are now commonplace in this arena. Disease states involving the lungs, the heart, the kidneys, and subpopulations including those who are obese and the elderly commonly receive anesthetics in an ambulatory setting.

Recent Findings: This review presents key aspects of current thinking with regard to preoperative assessment and considerations for different critical disease states and subpopulations that are now being managed under ambulatory surgery. Same day surgery centers require patient safety, and expectations are high for patient satisfaction. Advancements in surgical and anesthetic technique have allowed for more complex patients to partake in ambulatory surgery. Anesthesiologists must be familiar with guidelines, state-of-the-art pain management, and standards of preoperative patient evaluation to accurately stratify patient risk and to advocate for patient safety.
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http://dx.doi.org/10.1007/s11916-017-0643-7DOI Listing
August 2017

Challenges and Limitations to Treating ADHD in Incarcerated Populations.

J Am Acad Psychiatry Law 2016 Dec;44(4):513

Medical University of South Carolina Charleston, SC.

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December 2016

Methadone analgesia in the critically ill.

J Crit Care 2016 12 16;36:295. Epub 2016 Jul 16.

Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, LA 70112. Electronic address:

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http://dx.doi.org/10.1016/j.jcrc.2016.06.036DOI Listing
December 2016

The emerging therapeutic roles of κ-opioid agonists.

J Opioid Manag 2016 May-Jun;12(2):101-7

Associate Professor, Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

The current practice of μ-opioid receptor agonists such as morphine as the primary means of acute and chronic pain relief has several dangerous consequences that limit their effectiveness, including respiratory depression, gastrointestinal motility inhibition, addiction, tolerance, and abuse. Several other opioid receptors, notably the μ-opioid (KOP) receptor, have long been known to play a role in pain relief. Recent discoveries and advancements in laboratory techniques have allowed significant developments of KOP agonists as potential novel therapies for pain relief and other pathological processes. These drugs exhibit none of the classic opioid adverse effects and have displayed pronounced analgesia in several different scenarios. New formulations since 2014 have unveiled increased oral bioavailability, exceptional peripheral versus central selectivity, and a positive safety profile. Continued refinements of established μ-opioid agonist formulations have virtually eliminated the centrally mediated side effects of dysphoria and sedation that limited the applicability of previous KOP agonists. Further research is required to better elucidate the potential of these compounds in pain management, as well as in the mediation or modulation of other complex pathophysiological processes as therapeutic agents.
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http://dx.doi.org/10.5055/jom.2016.0321DOI Listing
September 2016

An Analysis of Responses to Defibrotide in the Pulmonary Vascular Bed of the Cat.

Am J Ther 2016 May-Jun;23(3):e757-65

Departments of 1Anesthesiology, and 2Pharmacology, LSU School of Medicine, Louisiana State University Health Science Center, New Orleans, LA; and 3Stanford University, Palo Alto, CA.

Defibrotide is a polydisperse mixture of single-stranded oligonucleotides with many pharmacologic properties and multiple actions on the vascular endothelium. Responses to defibrotide and other vasodepressor agents were evaluated in the pulmonary vascular bed of the cat under conditions of controlled pulmonary blood flow and constant left atrial pressure. Lobar arterial pressure was increased to a high steady level with the thromboxane A2 analog U-46619. Under increased-tone conditions, defibrotide caused dose-dependent decreases in lobar arterial pressure without altering systemic arterial and left atrial pressures. Responses to defibrotide were significantly attenuated after the administration of the cyclooxygenase inhibitor sodium meclofenamate. Responses to defibrotide were also significantly attenuated after the administration of both the adenosine 1 and 2 receptor antagonists 8-cyclopentyl-1,3-dimethylxanthine and 8-(3-chlorostyryl)caffeine. Responses to defibrotide were not altered after the administration of the vascular selective adenosine triphosphate-sensitive potassium channel blocker U-37883A, or after the administration of the nitric oxide synthase inhibitor L-N-(1-iminoethyl)-ornithine. These data show that defibrotide has significant vasodepressor activity in the pulmonary vascular bed of the cat. They also suggest that pulmonary vasodilator responses to defibrotide are partially dependent on both the activation of the cyclooxygenase enzyme and adenosine 1 and 2 receptor pathways and independent of the activation of adenosine triphosphate-sensitive potassium channels or the synthesis of nitric oxide in the pulmonary vascular bed of the cat.
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http://dx.doi.org/10.1097/MJT.0000000000000010DOI Listing
February 2017

Sleep physiology, abnormal States, and therapeutic interventions.

Ochsner J 2012 ;12(2):122-34

Sleep is essential. Unfortunately, a significant portion of the population experiences altered sleep states that often result in a multitude of health-related issues. The regulation of sleep and sleep-wake cycles is an area of intense research, and many options for treatment are available. The following review summarizes the current understanding of normal and abnormal sleep-related conditions and the available treatment options. All clinicians managing patients must recommend appropriate therapeutic interventions for abnormal sleep states. Clinicians' solid understanding of sleep physiology, abnormal sleep states, and treatments will greatly benefit patients regardless of their disease process.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387837PMC
September 2012

Perioperative management of neurofibromatosis type 1.

Ochsner J 2012 ;12(2):111-21

Neurofibromatosis type 1 (neurofibromatosis-1), a relatively common single-gene disorder, is caused by a mutation of the NF1 gene that results in a loss of activity or in a nonfunctional neurofibromin protein. Clinical anesthesiologists may find patients with neurofibromatosis-1 challenging because this condition may affect most organ systems and result in a wide variety of presentations and clinical implications. Current neurofibromatosis-1 research studies include genotype-phenotype correlations, investigation of the pathoetiology behind the different clinical manifestations of neurofibromatosis-1, and the search for treatment options for the different features of the disorder. Neurofibromatosis-1-associated complications of the central nervous, respiratory, cardiovascular, musculoskeletal, and gastrointestinal and genitourinary systems all present various degrees of considerations for anesthesiologists. Additionally, neurofibromatosis-1 has dramatic implications for pregnant women.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387836PMC
September 2012

Pharmacology of cyclooxygenase-2 inhibitors and preemptive analgesia in acute pain management.

Curr Opin Anaesthesiol 2008 Aug;21(4):439-45

Department of Anesthesiology, LSU School of Medicine, New Orleans, Louisiana 70112, USA.

Purpose Of Review: NSAIDs have served as analgesic, antiinflammatory, and antipyretic medicines for over a century. A novel class of NSAIDs, cyclooxygenase-2 inhibitors, was introduced in 1999. All NSAIDs and aspirin inhibit active sites of cyclooxygenase-1 and cyclooxygenase-2. Recent studies have demonstrated an important role of cyclooxygenase-2 inhibitors in the management of acute pain processes.

Recent Findings: There have been many reports related to an 'imbalance theory' suggesting that cyclooxygenase-2 inhibitors create an 'imbalance' between thromboxane and prostacyclin (reduction of prostacyclin), resulting in a prothrombic state; however, these drugs were designed to have improved gastrointestinal safety profiles by being more selective of the cyclooxygenase-2 pathway. Although balance and regulation of hemostasis is influenced in part by the balance of prostacyclin and thromboxane A2, many other substances are involved in thrombosis and include the coagulation cascade, fibrinogen and plasminogen pathways, numerous endogenous substances such as adenosine, nitric oxide, and serotonin.

Summary: On the basis of many human studies, one may conclude that perioperative cyclooxygenase-2 inhibitors, in standard doses, decrease opioid consumption. Future investigations that include different multimodal techniques, for example combining cyclooxygenase-2 inhibitors with regional blocks, may help elucidate and clarify the true benefits of perioperative cyclooxygenase-2 inhibitors in acute pain management strategies.
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http://dx.doi.org/10.1097/ACO.0b013e3283007e8dDOI Listing
August 2008

Arteriovenous malformation, complications, and perioperative anesthetic management.

Middle East J Anaesthesiol 2008 Feb;19(4):737-56

University of Mississippi School of Medicine, Jackson, MS, USA.

Arteriovenous malformations (AVMs) are the most common intracranial vascular malformation, with an estimated occurrence of 1:5000-1:2000 persons. The repair requires careful embolization, often followed by stereotactic radiosurgery and can also include open craniotomy. Preoperatively, patients may be healthy or dramatically unstable, as 30-50% of these cases present with acute cerebral hemorrhage. One of the most important considerations for the anesthesiologist should be attempting to achieve hemodynamic stability in the face of potential increased intracranial pressure and subsequent vulnerability of the tissues to ischemic insult. Knowledge of the risks and hazards of the procedure and collaboration with specialists, including neuroradiologists, critical care physicians, and potentially neurosurgeons, ultimately form the basis for appropriate management. AVM's can lead to potentially fatal ischemic or hemorrhagic complications that may occur in up to 8% of cases. The protection of the airway, adequate monitoring, and maintaining cardiovascular and neurological stability, are critical. Further, in the setting of a radiological suite, peripheral location considerations involving equipment, monitors, and appropriate drugs and sustaining the patient's immobility during the radiological procedures, while managing potential perioperative complications are all essential.
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February 2008

The effect of deep-tissue massage therapy on blood pressure and heart rate.

J Altern Complement Med 2008 Mar;14(2):125-8

Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.

Aim: In the present study, we describe the effects of deep tissue massage on systolic, diastolic, and mean arterial blood pressure.

Materials And Methods: The study involved 263 volunteers (12% males and 88% females), with an average age of 48.5. Overall muscle spasm/muscle strain was described as either moderate or severe for each patient. Baseline blood pressure and heart rate were measured via an automatic blood pressure cuff. Twenty-one (21) different soothing CDs played in the background as the deep tissue massage was performed over the course of the study. The massages were between 45 and 60 minutes in duration. The data were analyzed using analysis of variance with post-hoc Scheffe's F-test.

Results: Results of the present study demonstrated an average systolic pressure reduction of 10.4 mm Hg (p<0.06), a diastolic pressure reduction of 5.3 mm Hg (p<0.04), a mean arterial pressure reduction of 7.0 mm Hg (p<0.47), and an average heart rate reduction of 10.8 beats per minute (p<0.0003), respectively.

Conclusions: Additional scientific research in this area is warranted.
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http://dx.doi.org/10.1089/acm.2007.0665DOI Listing
March 2008
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