Regional Anesthesia for Bilateral Carpal Tunnel Release

Carpal Tunnel Syndrome is the most common nerve entrapment neuropathy with over 60% of diagnosed patients presenting with bilateral median nerve involvement.  Bilateral upper extremity surgery presents unique anesthesia challenges, yet surgeons are increasingly interested in performing simultaneous bilateral carpal tunnel release (BCTR) procedures. Regional anesthesia techniques traditionally employed for unilateral hand procedures are impractical, and general anesthesia is expensive and incurs added risk.  A cost effective and efficient anesthesia plan for BCTR is therefore needed. Objective:  Conduct a literature search to support the administration of an efficient and safe anesthesia technique for BCTR utilizing local infiltration and median nerve block.  Methods: Electronic searches were conducted for current pertinent information published in anesthesia, hand surgery and plastic surgery journals within the past 5 years.  Information gathered was assimilated to make an evidence based recommendation for a BCTR anesthesia technique.  Results: BCTR is a more cost effective and time efficient treatment for bilateral carpal tunnel syndrome than a staged unilateral approach.  Local anesthesia with median nerve block with or without sedation is a cost efficient and safe anesthesia strategy for BCTR

Regional development gaps in Argentina: A multidimensional approach to identify the location of policy priorities

Spatial inequalities within Latin American countries have historically attracted the interest ofacademics, policy-makers, and international agencies. This article aims to provide amultidimensional diagnosis of provincial development gaps in Argentina, in order to identifythe location of policy priorities. Therefore, we built a large database, which covers sevendevelopment dimensions, and applied multivariate analysis techniques to overcome someanalytical limitations of previous studies. Results show the stability of provincial developmentgaps between 2003 and 2013 and some heterogeneity within geographic regions. Instead,cluster analysis offers a better classification of Argentine provinces according to theirdevelopment gaps, which can help the government to prioritize the places wheredevelopment policies are strategic.Fil: Niembro, Andrés Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Universidad Nacional de Río Negro; ArgentinaFil: Sarmiento, Jesica Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Universidad Nacional de Río Negro; Argentin

An Anesthesia Quality Improvement Plan to Improve Postoperative Pain Outcomes after Hysterectomy

An anesthesia quality improvement initiative implemented an evidence-based, preemptive, preventive multimodal analgesic regimen to improve perioperative pain outcomes for women undergoing hysterectomy.  Though statistical significance was not achieved, clinically significant decreases in Post Anesthesia Care Unit (PACU) narcotic usage, pain ratings, time in the PACU, and opioid related side effects were observed.  This analgesic regimen was easily implemented, readily modifiable, and suitable for expansion to multiple surgical populations to supplement customary anesthesia perioperative care