Epidural and spinal analgesia are two types of regional analgesia. With epidural analgesia, an indwelling catheter is directed into the epidural space,

and the patient receives a continuous infusion or multiple injections of local anesthetic. Spinal injections are usually single injections into the intrathecal space. A combination of epidural and spinal analgesia, known as a walking GDC-0994 epidural, also is available. This technique combines the rapid pain relief from the spinal regional block with the constant and consistent effects from the epidural block. It allows sufficient motor function for patients to ambulate. Complications with regional analgesia are uncommon, but may include postdural puncture headache. Rare serious complications include neurologic injury, epidural hematoma, or deep epidural infection. Regional analgesia increases the risk of instrument-assisted vaginal

delivery, and family physicians should understand the contraindications and risks of complications. Continuous labor support (e.g., doula), systemic opioid analgesia, pudendal blocks, water immersion, sterile water injections into the lumbosacral spine, self-taught hypnosis, and acupuncture are other options for pain management during labor. (Am Fam Physician. 2012;85(5):447-454. Copyright (C) 2012 American Academy of Family Physicians.)”
“Purpose: To evaluate differences in the serum concentrations of cell adhesion molecules (CAMs) after retroperitoneal GSK1210151A laparoscopic and conventional open radical nephrectomies for localized renal-cell carcinoma (RCC).

Patients and Methods: A total of 62 patients with stage T1N0M0 RCC were randomized Epigenetics inhibitor to either a retroperitoneal laparoscopic radical nephrectomy group

(n = 31) or an open group (n = 31). Serum levels of soluble cluster of differentiation 44 splice variant 6 (sCD44v6), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble epithelial cadherin (sE-cadherin) were determined independently by enzyme linked immunosorbent assay (ELISA) preoperatively, and on postoperative days 1 and 5. In addition, follow-up results were compared.

Results: On postoperative day 1, sCD44v6, sICAM-1, and sVCAM-1 levels increased significantly compared with preoperative levels in both groups (P < 0.05). sE-cadherin levels decreased compared with preoperative levels in both groups without statistically significant differences (P > 0.05). sCD44v6 levels in the retro-laparoscopy group were significantly higher than in the open group (P < 0.05), while sICAM-1, sVCAM-1, and sE-cadherin levels showed no statistically significant differences between both groups (P > 0.05). On postoperative day 5, all parameters in both groups were similar to preoperative values (P > 0.05). Follow-up ranged from 7 to 18 months postoperatively in all 62 patients, with a 100% cancer-specific survival rate in each group.