Microwave tumor ablation of vertebral bone metastasis: a case report

Introduction: Thermal ablation by microwave [MWA] has proven efficacy in treatment of primary and metastatic cancers. Soft tissue tumors could be ablated completely using MWA. However, bony tissue metastasis particularly spinal vertebral metastasis ablation has not reported yet

Case presentation: A 50 year old male patient with primary diagnosed colon cancer undergone surgical resection of tumor. Recently, he was diagnosed with metastasis to liver and spinal vertebral bone. He was referred to pain clinic with severe non-radiating back pain. In MRI Imaging, hyperdensity lesions were identified on body of L5 and T12 and in spinal canal of L1 indicating metastatic involvement. Under fluoroscopy guidance, the metastatic tumor was ablated by MWA and the generator was powered to 20 Watt/3 minutes in the temperature control mode. Patient had no low back pain afterward

Conclusion: MWA could be used to ablate vertebral bone metastasis without any complications and with good prognosis

[ effect of bupivacaine 0.5% versus lidocaine 2% injection for pain control in patients after percutaneous nephrolithotomy [PCNL]]

Controlling pain in the post-operative period is still one of the challenging issues for anaesthesiologists as it tremendously helps patients to return to their daily life as soon as possible. In this survey we have tried to compare the efficacy of 0.5% bupivacaine and 2% lidocaine with normal saline for controlling pain after PCNL. In a double blind clinical trial, 60 patients were enrolled being divided into 3 groups. 0.5% Bupivacaine in a dose of 0.5 mg/kg diluted in 20 cc normal saline was injected, into the insertion site and also the tract of the PCNL probe in group one. In our second group, 2% lidocaine [4mg/kg] diluted in 20 cc normal saline, and in the third group, just 20cc NS were injected in the same manner and direction. VAS was measured at 0, 3, 6, 9, 12, 15, and 18 hours post-operatively in order to evaluate pain control. The mean VAS measured 0, 3, and 6 hours post-operatively in the bupivacaine and lidocaine groups was less than the normal saline group [P<0/05]. The average time to injection of the first dose of pethedine was longer in the bupivacaine and lidocaine groups than the normal saline group. [p<0/05]. Injection of 0.5% bupivacaine and 2% lidocaine in the puncture site of PCNL is effective for pain control after PCNL surgery according to our results

[Evaluating the efficacy of extraplural versus epidural analgesia for post-thoracotomy pain]

Thoracotomy is a particularly painful surgery and good pain control is crucial to maximize the ability to cough and breath. The most common methods of post operative pain management are systemic narcotics and epidural administration of local anesthetic agents or narcotics. The purpose of this study was to compare postthoracotomy analgesia of extraplural and epidural catheters. This is a randomized clinical control trial study performed in Alzahra's hospital of medical university of Isfahan. 64 patients were randomized in two groups. In group A, 15cc%0/125 bupivacaine before surgery and in group B, 10cc%0/5 bupivacaine at the end of surgery were injected and repeated every hour post operatively. Visual analog scale in two group collected and compared. VAS in epidural catleter was better than extra plural catheter but this difference is not significant [P<0/05]. No significant respiratory complication was reported in both groups. Due to results this difference is related to position, drainage of chest tube, volume of local anesthetic and type of surgery in the extra plural groups. Because of no significant difference between them we can use this techniques based on experience and preference of anesthesiologist and surgeon

[Complications of ultrasound-guided stellate ganglion block in patients suffering from chronic pain]

Stellate ganglion is a sympathic ganglion in the neck area which by effective blocking a lot of chronic pain syndromes at upper limbs, head, neck and chest can be treated. In this study, results of ultrasound-guided Stellate ganglion block in 44 patients have been reviewed. In this case series, 44 patients candidate for stellate ganglion block due to chronic pain were enrolled. Ultrasound-guided block was performed with bupivacaine 0.5% on level of C-6 tubercle. Successful blockage was diagnosed in the presence of horner syndrome and variation in temperature in two hands. Any Complications were recorded. Among 44 recruited patients, 18 cases were excluded for unsuccessful block. In the 26 remaining patients, a total of 101 Stellate ganglion blocks were performed. Among these, one had hoarseness, and three cases had cough. There was no life threatening side effect, vessel puncture, paresthesia or neuroaxial injection. The use of sonography in order to perform Stellate ganglion block may improve the success rate and reduce the complications attributable to blind needle insertion