Psychopharmacology bulletin最新文献

{"title":"Going Virtual During a Pandemic: An Academic Psychiatry Department's Experience with Telepsychiatry.","authors":"Sagar V Parikh, Danielle S Taubman, Mary Grambeau, Rena A Menke, Mary C Blazek, Jennifer Sullivan, Jennifer Severe, Paresh D Patel, Gregory W Dalack","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The novel coronavirus pandemic (COVID-19) led healthcare providers, including mental health providers, across the U.S. to swiftly shift to telemedicine.</p><p><strong>Objectives: </strong>This shift gave our Department of Psychiatry a chance to better understand key challenges and opportunities vis-à-vis virtual mental healthcare. We aimed to obtain provider feedback on the use of telepsychiatry and to learn from the provider perspective about patient experiences with video visits. This information will be used to inform the telemedicine strategy at a systems level within our psychiatry department, our academic health system, as well as the field of telemedicine as a whole.</p><p><strong>Design and sample: </strong>A 22-item online questionnaire comprising 16 quantitative and six qualitative items was distributed to providers currently using video visits to provide care.</p><p><strong>Results: </strong>A total of 89 mental health providers completed the questionnaire. Outcomes demonstrated that while providers perceive challenges associated with virtual care (e.g., fatigue, technology-related issues, and age-related concerns), they also recognize a number of benefits to themselves and their patients (e.g., convenience and increased access). Overall, provider satisfaction, comfort, and willingness to use telepsychiatry was high.</p><p><strong>Conclusions: </strong>The vast majority of providers adapted quickly to the use of virtual platforms; many endorse advantages that suggest virtual care will continue to be a modality they provide in the future, post-COVID-19. It will be important to continue to evaluate aspects of virtual care that may limit clinical assessments and to optimize use to improve access, convenience, and cost-efficiency of mental healthcare delivery.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"51 1","pages":"59-68"},"PeriodicalIF":0.0,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063128/pdf/PB-51-1-59.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38827277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Effects of Recreational and Medical Cannabis.","authors":"Ivan Urits,&nbsp;Karina Charipova,&nbsp;Kyle Gress,&nbsp;Nathan Li,&nbsp;Amnon A Berger,&nbsp;Elyse M Cornett,&nbsp;Hisham Kassem,&nbsp;Anh L Ngo,&nbsp;Alan D Kaye,&nbsp;Omar Viswanath","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose of review: </strong>This comprehensive review discusses the adverse effects known today about marijuana, for either medical or recreational use. It reviews the role of cannabis in the treatment of chronic pain, cognitive and neurological adverse effects, special cases and addiction.</p><p><strong>Recent findings: </strong>Cannabinoids work through the endocannabinoids system and inhibit the release of GABA and glutamate in the brain, impact neuromodulation, as well as dopamine, acetylcholine and norepinephrine release. They affect reward, learning and pain. The use of cannabis is increasing nationally and world-wide for both recreational and medicinal purposes, however, there is relatively only low quality evidence to the efficacy and adverse effects of this. Cannabis and its derivatives may be used for treatment of chronic pain. They are via CB1 receptors that are thought to modulate nociceptive signals in the brain. CB2 receptors in the DRG likely affect pain integration in the afferent pathways, and peripherally CB2 also affects noradrenergic pathways influencing pain. A large proportion of users may see more than 50% of chronic pain alleviation compared with placebo. Cannabis affects cognition, most notably executive function, memory and attention, and may deteriorate the boundary between emotional and executive processing. Cannabis impairs memory in the short run, which become more significant with chronic use, and may also be accompanied by poorer effort, slower processing and impacted attention. It is generally believed that long-term use and earlier age are risk factor for neurocognitive deficits; neuroimaging studies have shown reduced hippocampal volume and density. Executive functions and memory are worse in adolescent users versus adults. Cannabis addiction is different and likely less common than other addictive substances, but up to 10% of users meet criteria for lifetime cannabis dependence. Addiction patterns may be linked to genetic and epigenetic differences. It is still unclear whether abstinence reverses patterns of addiction, and more research is required into this topic.</p><p><strong>Summary: </strong>Cannabis use has become more abundant for both medical and recreational use. It carries likely benefits in the form of analgesia, anti-emesis and improved appetite in chronic patients. The evidence reviewing adverse effects of this use are still limited, however, exiting data points to a clear link with neurocognitive deterioration, backed by loss of brain volume and density. Addiction is likely complex and variable, and no good data exists to support treatment at this point. It is becoming clear that use in earlier ages carries a higher risk for long-term deficits. As with any other drug, these risks should be considered alongside benefits prior to a decision on cannabis use.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"51 1","pages":"94-109"},"PeriodicalIF":0.0,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063125/pdf/PB-51-1-94.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38839792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Black Book of Psychotropic Dosing and Monitoring.","authors":"Charles DeBattista,&nbsp;Alan F Schatzberg","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"51 1","pages":"8-58"},"PeriodicalIF":0.0,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063126/pdf/PB-51-1-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38827276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Omics-Based Biomarkers on the Fluvoxamine's Steady-State Concentration, Efficacy and Safety in Patients with Affective Disorders Comorbid with Alcohol Use Disorder.","authors":"M S Zastrozhin, VYu Skryabin, VYu Smirnov, A K Zastrozhina, E V Kaverina, D A Klepikov, E A Grishina, K A Ryzhikova, I V Bure, E A Bryun, D A Sychev","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Fluvoxamine is commonly administered to patients with recurrent depressive disorder. Some of these patients do not show adequate response to the therapy with fluvoxamine, whereas many of them experience dose-dependent adverse drug reactions. Previous research revealed that CYP2D6 is involved in the metabolism of fluvoxamine, the activity of which is highly dependent on the polymorphism of the gene encoding it.</p><p><strong>Objective: </strong>The objective of this study was to investigate the effect of polymorphisms of the CYP3A4, CYP2C9, CYP3A5, ABCB1, CYP2C19, SCL6A4, and 5-HTR2A genes on the concentration/dose indicator of fluvoxamine and on the CYP3A expression level obtained by measuring the miR-27b plasma concentration levels in patients suffering from a recurrent depressive disorder.</p><p><strong>Material and methods: </strong>Our study included 105 patients with recurrent depressive disorder (average age - 37.5 ± 13.2 years). The treatment regimen included fluvoxamine in an average daily dose of 117.6 ± 44.3 mg per week. Therapy efficacy was assessed using the international psychometric scales. Therapy safety was assessed using the UKU Side-Effect Rating Scale. For genotyping and estimation of the microRNA (miRNA) plasma levels, we performed the real-time polymerase chain reaction. The activity of CYP3A was evaluated using the HPLC-MS/MS method by the content of the endogenous substrate of the given isoenzyme and its metabolite in urine (6b-HC/cortisol). Therapeutic drug monitoring has been performed using HPLC-MS/MS.</p><p><strong>Results: </strong>Our study didn't reveal any statistically significant results in terms of the treatment efficacy and safety of the therapy. We also didn't reveal a statistical significance for the concentration/dose indicator of fluvoxamine in patients with different genotypes. Analysis of the results of the pharmacotranscriptomic part of the study didn't demonstrate the statistically significant difference in the miR-27b plasma levels in patients with different genotypes. At the same time, correlation analysis didn't reveal a statistically significant relationship between the fluvoxamine efficacy profile evaluated by changes in HAMD scale scores and the miR-27b plasma concentration: r_s = -0.012, p = 0.63. Also, we didn't reveal the correlation between the miRNA concentration and safety profile: rs = -0.175, p = 0.30. In addition, we didn't reveal the relationship between the CYP3A enzymatic activity and the miR-27b plasma concentration: r_s = -0.197, p < 0.32. However, the difference in the CYP3A enzymatic activity in carriers of AG and GG genotypes of the 6986A > G polymorphism of CYP3A5 gene has been revealed: (AG) 4.72 [1.18; 8.45] vs (GG) 9.23 [5.12; 15.53], p-value = 0.23.</p><p><strong>Conclusion: </strong>Thus, the effect of genetic polymorphism of the CYP3A4, CYP2C9, CYP2C9, CYP3A5, ABCB1, CYP2C19, CYP2C19, CYP2C19, SCL6A4, 5-HTR2A gene on the ","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"51 1","pages":"69-80"},"PeriodicalIF":0.0,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063127/pdf/PB-51-1-69.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38827278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Review of Slipping Rib Syndrome: Treatment and Management.","authors":"Kyle Gress, Karina Charipova, Hisham Kassem, Amnon A Berger, Elyse M Cornett, Jamal Hasoon, Ruben Schwartz, Alan D Kaye, Omar Viswanath, Ivan Urits","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose of review: </strong>This is a comprehensive review and update on advances in the understanding and treatment of slipping rib syndrome. It covers the physiology and pathophysiology at the basis of the syndrome, epidemiology and clinical presentation as well as diagnosis. It goes on to review the available literature to provide description and comparison of the available methods for alleviation.</p><p><strong>Recent findings: </strong>Slipping rib syndrome stems from irritation of intercostal nerves. It is caused by slipping of the costal cartilage and the resulting displacement of a false rib and pinning underneath the adjacent superior rib and nerve irritation. It is rare and spans genders and ages; most evidence about epidemiology is conflicting and mostly anecdotal. Risk factors include trauma and high intensity athletic activity. Presentation is of a sudden onset of pain with jerking motion; the pain can be localized, radiating or diffuse visceral. It is often alleviated by positions that offload the impinged nerve. Diagnosis is clinical, and can be aided by Hooking maneuver and dynamic ultrasound. Definitive diagnosis is with pain relief on nerve block, visualization of altered anatomy during surgery and relief after surgical correction. Initial treatment includes rest, ice and NSAIDs, as well as screening for co-morbid conditions, as well as local symptomatic relief. Injection therapy with local anesthetics and steroids can provide a diagnosis as well as symptomatic relief. Surgical correction remains the definitive treatment.</p><p><strong>Summary: </strong>Slipping rib syndrome is a rare cause of chest pain that could be perceived as local or diffuse pain. Diagnosis is initially clinical and can be confirmed with nerve blocks and surgical visualization. Initial treatment is symptomatic and anti-inflammatory, and definitive treatment remains surgical. More recently, advanced surgical options have paved way for cure for previously hard to treat patients.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"189-196"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901126/pdf/PB-50-4S1-189.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Electrical Spinal Cord Stimulation with Neuromodulating Medications: A Systematic Review.","authors":"Weston Case Nadherny,&nbsp;Kenneth Fiala,&nbsp;Ivan Urits,&nbsp;Omar Viswanath,&nbsp;Alaa Abd-Elsayed","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain is a prevalent and debilitating problem for millions of people and spinal cord stimulation (SCS) is one option for treatment. It has been shown to have membrane stabilizing properties and is often used in conjunction with medications that are also believed to offer pain control through membrane stabilization.</p><p><strong>Objective: </strong>The goal of this review is to analyze the effects of SCS combined with medications to evaluate for augmentative therapeutic effect.</p><p><strong>Setting: </strong>Systematic review.</p><p><strong>Methods: </strong>A systematic computerized search of the literature was conducted using PubMed, the Cochrane Library, and EMBASE for articles published in English.</p><p><strong>Results: </strong>We report three articles that discuss the potential for augmentative effects of medication in combination with SCS. Located articles related primarily to SCS combined with Gabapentin, TCA, or SNRI.</p><p><strong>Limitations: </strong>The limited number of articles reflects a need for more investigation in this area.</p><p><strong>Conclusion: </strong>Based on the suspected mechanisms for SCS and neuromodulating medications, there is reason to believe adding these medical therapies may enhance the effects of SCS.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"67-73"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901128/pdf/PB-50-4S1-67.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Evidence Based Review of Epidurolysis for the Management of Epidural Adhesions.","authors":"Ivan Urits,&nbsp;Ruben H Schwartz,&nbsp;Joseph Brinkman,&nbsp;Lukas Foster,&nbsp;Paulo Miro,&nbsp;Amnon A Berger,&nbsp;Hisham Kassem,&nbsp;Alan D Kaye,&nbsp;Laxmaiah Manchikanti,&nbsp;Omar Viswanath","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review presents epidurolysis as a procedure to alleviate pain and disability from epidural adhesions. It reviews novel and groundbreaking evidence, describing the background, indications, benefits and adverse events from this procedure in an effort to provide healthcare experts with the data required to decide on an intervention for their patients.</p><p><strong>Recent findings: </strong>Epidural adhesions (EA) or epidural fibrosis (EF) is defined as non-physiologic scar formation secondary to a local inflammatory reaction provoked by tissue trauma in the epidural space. Often, it is a sequelae of surgical spine intervention or instrumentation. The cost associated with chronic post-operative back pain has been reported to be up to nearly $12,500 dollars per year; this, coupled with the increasing prevalence of chronic lower back pain and the subsequent increase in surgical management of back pain, renders EF a significant cost and morbidity in the U.S. Though risk factors leading to the development of EA are not well established, epidural fibrosis has been reported to be the culprit in up to 46% of cases of Failed Back Surgery Syndrome (FBSS), a chronic pain condition found in up to 20-54% of patients who receive back surgery. Moreover, EF has also been associated with lumbar radiculopathy after lumbar disc surgery. Epidurolysis is defined as the mechanical dissolution of epidural fibrotic scar tissue for persistent axial spine or radicular pain due to epidural fibrosis that is refractory to conservative therapy Endoscopic lysis of adhesions is a procedural technique which has been shown to improve chronic back pain in one-third to one-half of patients with clinically symptomatic fibrous adhesions. Here we review some of the novel evidence that supports this procedure in EA and FBSS.</p><p><strong>Summary: </strong>The literature concerning epidurolysis in the management of epidural adhesions is insufficient. Prospective studies, including randomized controlled trials and observational studies, have suggested epidurolysis to be effective in terms of pain reduction, functional improvement, and patient satisfaction scores. Observational studies report epidurolysis as a well-tolerated, safe procedure. Current evidence suggests that epidurolysis may be used as an effective treatment modality for epidural adhesions. Nonetheless, further high quality randomized controlled studies assessing the safety and efficacy of epidurolysis in the management of epidural adhesions is needed.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"74-90"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901122/pdf/PB-50-4S1-74.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional Approaches to Pain and Spasticity Related to Cerebral Palsy.","authors":"Jacquelin Peck, Ivan Urits, Hisham Kassem, Christopher Lee, Wilton Robinson, Elyse M Cornett, Amnon A Berger, Jared Herman, Jai Won Jung, Alan D Kaye, Omar Viswanath","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review will cover seminal and emerging evidence on interventional therapy chronic pain in cerebral palsy (CP). It will cover the background and burden of disease, present the current options, and then weigh the evidence that is available to support interventional therapy and the current indications.</p><p><strong>Recent findings: </strong>CP is a permanent posture and movement disorder from in-utero brain development defects with a 3-4/1,000 incidence in the US. The cost of care for each child is estimated at $921,000. Pain in CP is attributed to musculoskeletal deformities, spasticity, increased muscle tone, dislocations, and GI dysfunction. First-line treatments include physical and occupational therapy and oral pharmacological agents; however, a significant amount of patients remain refractory to these and require further therapy. Injection therapy includes botulinum toxin A (BTA) injections and intrathecal baclofen. BTA injections were shown to control chronic pain effectively and are FDA approved for spastic pain; intra-thecal baclofen, in contrast, was only shown to improve comfort and quality of life with a focus on the pain. Surgical intervention includes selection dorsal rhizotomy (SDR). It may increase range of motion and quality of life and reduce spasticity and pain; however, most evidence is anecdotal, and more research is required.</p><p><strong>Summary: </strong>Interventional therapy, including injection and surgical, is the last line of therapy for chronic pain in CP. It extends the possibility of therapy in hard-to-treat individuals; however, more data is required to provide strong evidence to the efficacy of these treatments and guide proper patient selection.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"108-120"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901135/pdf/PB-50-4S1-108.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Update of Adhesive Capsulitis and Minimally Invasive Treatment Options.","authors":"Riki Patel, Ivan Urits, John Wolf, Anu Murthy, Elyse M Cornett, Mark R Jones, Anh L Ngo, Laxmaiah Manchikanti, Alan D Kaye, Omar Viswanath","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Adhesive capsulitis of the shoulder (AC) is characterized by fibrosis and contracture of the glenohumeral joint capsule, resulting in progressive stiffness, pain, and restriction of motion of the shoulder. The prevalence of AC is estimated to be 2-5% of the general population. Patients with AC typically have an insidious onset of pain and can progress to severe limitation of the shoulder leading to significant disability and decreased quality of life.</p><p><strong>Objectives: </strong>The objective of this manuscript is to provide a comprehensive review of AC with a focus on clinical presentation, natural history, pathophysiology, and various treatment modalities.</p><p><strong>Study design: </strong>A review article.</p><p><strong>Setting: </strong>A review of literature.</p><p><strong>Methods: </strong>A search was made on the Pubmed database using the keywords of adhesive capsulitis, frozen shoulder, shoulder capsulitis, arthrofibrosis, shoulder pain, shoulder stiffness.</p><p><strong>Results: </strong>Our search identified numerous studies in order to provide a comprehensive review of the current understanding of the treatment and management of AC.</p><p><strong>Limitations: </strong>There remains limited evidence in literature about the understanding of AC and optimal treatment.</p><p><strong>Conclusion: </strong>AC is an important cause of chronic pain and disability. There is currently no consensus on treatment. Initial treatment modalities revolve around conservative measures as well as aggressive physical therapy. Further treatment options include intraarticular injections, hydro-dilation, nerve blocks, and for more refractory cases, surgical interventions such as arthroscopic capsulotomy.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"91-107"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901130/pdf/PB-50-4S1-91.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Review and Update of the Use of Dexmedetomidine for Regional Blocks.","authors":"Ivan Urits,&nbsp;Celina Guadalupe Virgen,&nbsp;Hamed Alattar,&nbsp;Jai Won Jung,&nbsp;Amnon A Berger,&nbsp;Hisham Kassem,&nbsp;Islam Mohammad Shehata,&nbsp;Amir Elhassan,&nbsp;Alan D Kaye,&nbsp;Omar Viswanath","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose of review: </strong>This evidence-based systematic review will focus on the use of dexmedetomidine and its role as adjuvant anesthetics in regional blocks to help better guide physicians in their practice. This review will cover background and mechanism of dexmedetomidine as well as the use in various regional blocks.</p><p><strong>Recent findings: </strong>Local anesthetics are preferred for nerve blocks over opioids; however, both due come with its own side effects. Local anesthetics may be toxic as they disrupt cell membrane and proteins, but by using adjuvants such as dexmedetomidine, that can prolong sensory and motor blocks can reduce total amount of local anesthetics needed. Dexmedetomidine is an alpha-2-adrenergic agonist used as additive for regional nerve block. It has a relatively low side effect profile and have been researched in various regional blocks (intrathecal, paravertebral, axillary, infraclavicular brachial plexus, interscalene). Dexmedetomidine shows promising results as adjuvant anesthetics in most regional blocks.</p><p><strong>Summary: </strong>Many studies have been done and many show promising results for the use of dexmedetomidine in regional blocks. It may significantly increase in duration of sensory and motor blocks that correlates with lower pain scores and less need of morphine in various regional blocks.</p>","PeriodicalId":21069,"journal":{"name":"Psychopharmacology bulletin","volume":"50 4 Suppl 1","pages":"121-141"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901136/pdf/PB-50-4S1-121.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25405667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}