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Regional anesthesia and ischemic pain: go with the flow.

The launch of a new section on acute pain in this journal [1], followed by the formation of a new Special Interest Group on this topic by the academy [2], have helped break down compartmental thinking separating acute pain medicine and the management of long-term or recurrent painful conditions. The physiological circumstance of ischemia lies at the crossroads between acute and chronic pain, offering an opportunity for mutually beneficial crosstalk between those who primarily focus upon acute vs chronic pain.

Ischemia can befall any organ to produce deleterious, disastrous, or even fatal consequences. Cardiac ischemia responds to thoracic epidural analgesia, which has been applied perioperatively during cardiac surgery as well as chronically in the treatment of outpatients with angina [3]. Chronic symptomatic ischemia of the spine and lumbar nerve roots, i.e., neurogenic claudication of the lower extremities as seen in spinal stenosis, is less responsive to epidural analgesia. Since the invention of this technique by Bier in 1908, deliberate tourniquet ischemia of an extremity has been combined with instillation of local anesthetic …