3-14 Cover• Stocki and colleagues (A Randomized Controlled Trial of the Efficacy and Respiratory Effects of Patient-Controlled Intravenous Remifentanil Analgesia and Patient-Controlled Epidural Analgesia in Laboring Women) prospectively demonstrated that labor analgesia from parturient-controlled remifentanil infusions is inferior to labor epidural analgesia.  Liu and colleagues (A Comparison of Remifentanil Parturient-Controlled Intravenous Analgesia with Epidural Analgesia: A Meta-Analysis of Randomized Controlled Trials) reached the same conclusion in their meta-analysis of parturient-controlled remifentanil infusions.  As Birnbach and Ranasinghe note in their accompanying editorial, parturients who are not candidates for epidural analgesia “have to make the best of an imperfect situation.”

• The relationship between labor epidural analgesia and intrapartum fever is well established. Sharma and colleagues (A Randomized Trial of the Effects of Antibiotic Prophylaxis on Epidural-Related Fever in Labor) demonstrated that antibiotics do not decrease the incidence of fever after labor epidural analgesia.  As Goetzl (Epidural Fever in Obstetric Patients: It’s a Hot Topic) notes in her accompanying editorial, the study “provides very strong evidence against an infectious etiology for epidural fever in obstetric patients.”

• In a retrospective study of 1285 children who received continuous postoperative anesthesia after surgery at the Children’s Hospital of Philadelphia, Gurnaney and colleagues (Ambulatory Continuous Peripheral Nerve Blocks in Children and Adolescents: A Longitudinal 8-Year Single Center Study) failed to find a single case of neurologic deficit.  As noted in the accompanying editorial by Krane and Polaner (The Safety and Effectiveness of Continuous Peripheral Nerve Blockade in Children), this retrospective study adds to other large studies demonstrating the safety or continuous infusions of local anesthesia in children after outpatient surgery.

• The common teaching in regional anesthesia is that intraneural needle placement can be distinguished from perineural placement by the current required to elicit a motor response. In a pig model of brachial plexus block Wiesmann and colleagues (Minimal Current Intensity to Elicit an Evoked Motor Response Cannot Discern Between Needle-Nerve Contact and Intraneural Needle Insertion) convincingly demonstrated that current cannot reliably distinguish between intraneural and perineural needle placement.

• Patients with HIV often develop neuropathic pain from the nucleoside reverse transcriptase inhibitors (NTRIs) used to treat HIV. In a rat model of NTRI-associated neuropathic pain, Huang and colleagues (Mechanical Allodynia Induced by Nucleoside Reverse Transcriptase Inhibitor Is Suppressed by p55TNFSR Mediated by Herpes Simplex Virus Vector Through the SDF1 alpha/CXCR4 System in Rats) suppressed mechanical allodynia by administering p55TNF, soluble TNF alpha receptor, to the DRG using a nonreplicating herpes simplex virus.

On the Cover

Our parturient is contemplative about the poppy plant. She sits high atop a giant serpent reflective of both the somatic (barbed spine) and visceral (unrelenting coils) pain of labor, seemingly unreachable and beyond our capacity to treat. What at first appears to be butterflies are under closer scrutiny the gray matter cross sections of the spinal cord encircling the figure, just out of reach and beyond our conquest. One of them has fully matured into a cherub, a promise of salvation, though it is yet blindfolded, hence compromised. The fainting couch on which she languishes in combination with the umbrella allude to the piperidine and phenyl rings respectively of synthetic opiates. Lastly, hidden in the folds of her gown are the classic and all-too-familiar context-sensitive half-times of fentanyl and its congeners (shown in the inset).