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Excellent Pain Relief (excellent + pain_relief)
Selected AbstractsCatheter Tip Granuloma Associated with Sacral Region Intrathecal Drug AdministrationNEUROMODULATION, Issue 4 2003Fernandez Julius MD Abstract Spinal cord compression from catheter tip granulomatous masses following intrathecal drug administration may produce devastating permanent neurologic deficits. Some authors have advocated intrathecal catheter placement below the conus medullaris to avoid the possibility of spinal cord involvement. Multiple cases of catheter tip granulomas in the thoracolumbar region have been reported. We present a unique case of a sacral region catheter tip inflammatory mass producing permanent neurologic deficits. A 71-year-old white male with a diagnosis of failed back surgery syndrome was referred to the senior author for evaluation. After more extensive conservative therapy, including spinal cord stimulation, failed to yield adequate pain relief, he was offered implantation of an intrathecal pump for opioid administration. Excellent pain relief was achieved in the postoperative period; however, three years after implantation, he presented with progressive saddle anesthesia and bowel/bladder incontinence. Magnetic resonance imaging demonstrated a space occupying lesion associated with the catheter tip. The patient underwent emergent second level complete sacral laminectomy with partial resection of an intradural extra-axial mass and removal of intrathecal catheter. At discharge, the patient had no restoration of neurologic function. Histologic examination of the mass confirmed a sterile inflammatory mass. It has been suggested that intrathecal catheters be placed below the conus medullaris to avoid the possibility of spinal cord involvement. We present an unusual case documenting devastating permanent neurologic deficits from a catheter tip granuloma in the sacral region. [source] Ultrasound-guided ulnar nerve catheter placement in the forearm for postoperative pain relief and physiotherapyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009M. LURF Consistent identification of peripheral nerves as well as placement of catheters for post-operative pain relief is possible with the aid of ultrasound. By blocking a single nerve rather than the entire extremity, pain can be eliminated without impairing motor function of the entire extremity, providing greater patient comfort. This report describes a case in which ultrasound-guided ulnar nerve catheter placement was performed in the forearm for post-operative pain relief following arthrolysis and tenolysis of the fifth finger. The ulnar nerve catheter allowed for excellent pain relief and completely painless physiotherapy without impairing motor function of the operated finger. [source] Dextrose 5% in water: fluid medium for maintaining electrical stimulation of peripheral nerves during stimulating catheter placementACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2005B. C. H. Tsui It is well documented that a higher electrical current is required to elicit a motor response following a normal saline (NS) injection during the placement of stimulating catheters for peripheral nerve block. We present three cases of continuous brachial plexus catheter placement in which Dextrose 5% in water (D5W) was used to dilate the perineural space instead of NS. Three brachial plexus blocks (two interscalene and one axillary) were performed in three different patients for pain relief. In each case, an insulated needle was advanced towards the brachial plexus. A corresponding motor response was elicited with a current less than 0.5 mA after needle repositioning. A stimulating catheter was advanced with ease after 3,5 ml of D5W was injected to dilate the perineural space. A corresponding motor response was maintained when the current applied to the stimulating catheter was less than 0.5 mA. Local anesthetic was then injected and the motor response immediately ceased. All blocks were successful and provided excellent pain relief with the continuous infusion of local anesthetics. [source] Spinal cord stimulation with percutaneous leads after loss of coverage with implanted surgical leadNEUROMODULATION, Issue 2 2010Alexander E. Yakovlev MD Objective:, This case report presents an application of percutaneous spinal cord stimulation to a patient with complex regional pain syndrome type 1 involving the bilateral lower extremities with loss of coverage with surgical lead. Measurements:, The patient underwent an uneventful spinal cord stimulator trial with percutaneous placement of two temporal eight-electrode epidural leads (Medtronic Inc, Minneapolis, MN, USA) to level T11. Results:, Upon experiencing excellent pain relief over the next three days, the patient was implanted with permanent leads and rechargeable generator four weeks later and reported sustained pain relief. Conclusion:, Percutaneous spinal cord stimulation offers an alternative treatment option for the patient with loss of coverage with surgical lead. [source] Peripheral Nerve Stimulation in Treatment of Intractable Postherpetic NeuralgiaNEUROMODULATION, Issue 4 2007Alexander E. Yakovlev MD ABSTRACT Objective., This case report presents an application of peripheral nerve stimulation to a patient with intractable postherpetic neuralgia that conventional treatment failed to ameliorate. Methods., The patient underwent an uneventful peripheral nerve stimulator trial with placement of two temporal eight-electrode percutaneous leads (Octrode leads, Advanced Neuromodulation Systems, Plano, TX, USA) into the right subscapular and right paraspinal area of the upper thoracic region. Results., Upon experiencing excellent pain relief over the next two weeks, the patient underwent implantation of permanent leads two weeks later and reported sustained pain relief. Conclusion. Peripheral nerve stimulation offers an alternative treatment option for intractable pain associated with postherpetic neuralgia, especially for elderly patients where treatment options are limited due to existing comorbidities. Further studies are warranted. [source] Use of Spinal Cord Stimulation in the Treatment of Phantom Limb Pain: Case Series and Review of the LiteraturePAIN PRACTICE, Issue 5 2010Ashwin Viswanathan MD Abstract Introduction: Despite technical advances in spinal cord stimulation (SCS), there is a paucity of recent literature regarding SCS for phantom limb pain. Methods: Between January 2003 and May 2008, four patients at M.D. Anderson Cancer Center underwent SCS for intractable phantom limb pain. A retrospective chart review was performed to assess outcomes and complications. A PubMed search was performed to review previously published series regarding the efficacy of SCS for phantom limb pain. Results: Postoperatively, all patients subjectively reported excellent pain relief (>80%). Patients were all followed with the Brief Pain Inventory. Patients 1 to 3 each reported a two-point decrease in their usual amount of pain using the numerical rating scale. Patient 4's numerical pain scale was unchanged. When using an 11-point scale to assess other symptomology along 10 dimensions, patients 1 to 3 demonstrated a decrease in their total symptom score by 13, 14, and 4 points, respectively. Patient 4 reported an increase by 5 points in his total symptom score. With regard to complications, patient 2 developed an allergic dermatitis to the generator requiring revision with a polyfluoroethylene (GorTex) pouch. Patient 3 developed a surgical site infection after an implantable pulse generator change. Patients 2 to 4 were very satisfied with their stimulator and would choose to undergo implantation again, with patient 1 having an equivocal response. Conclusions: For selected patients who have not obtained adequate relief with medical management, SCS for phantom limb pain can prove an effective intervention.,, [source] Postoperative pain relief using thoracic epidural analgesia: outstanding success and disappointing failuresANAESTHESIA, Issue 1 2001G. A. McLeod Six hundred and forty patients received epidural analgesia for postoperative pain relief following major surgery in the 6-year period 1993,1998. Although satisfactory pain relief was achieved in over two-thirds of patients for a median duration of 44 h after surgery, one-fifth of patients (133 individuals) still experienced poor pain relief. Almost one out of three patients (194 individuals) had a problem with their epidural. Eighty-three patients (13%) suffered a technical failure and 84 (13%) patients had their epidurals removed at night time when pain-free because of pressure on beds. Seven patients had their epidural replaced and subsequently experienced excellent pain relief for a median of 77 h. Lack of resources prevented a further 480 patients from receiving the potential benefits of epidural analgesia. These results would suggest that the practical problems of delivering an epidural service far outweigh any differences in drug regimens or modes of delivery of epidural solutions. [source] | ||||||||||