ABSTRACT
BACKGROUND: The location and the number of lumbar sympathetic ganglia (LSG) vary between individuals. The aim of this study was to determine the appropriate level for a lumbar sympathetic ganglion block (LSGB), corresponding to the level at which the LSG principally aggregate. METHODS: Seventy-four consecutive subjects, including 31 women and 31 men, underwent LSGB either on the left (n = 31) or the right side (n = 43). The primary site of needle entry was randomly selected at the L3 or L4 vertebra. A total of less than 1 ml of radio opaque dye with 4% lidocaine was injected, taking caution not to traverse beyond the level of one vertebral body. The procedure was considered responsive when the skin temperature increased by more than 1℃ within 5 minutes. RESULTS: The median responsive level was significantly different between the left (lower third of the L4 body) and right (lower margin of the L3 body) sides (P = 0.021). However, there was no significant difference in the values between men and women. The overall median responsive level was the upper third of the L4 body. The mean responsive level did not correlate with height or BMI. There were no complications on short-term follow-up. CONCLUSIONS: Selection of the primary target in the left lower third of the L4 vertebral body and the right lower margin of the L3 vertebral body may reduce the number of needle insertions and the volume of agents used in conventional or neurolytic LSGB and radiofrequency thermocoagulation.
Subject(s)
Female , Humans , Male , Electrocoagulation , Follow-Up Studies , Ganglia, Sympathetic , Lidocaine , Needles , Skin Temperature , SpineABSTRACT
BACKGROUND: Insomnia is becoming increasingly recognized as a clinically important symptom in patients with chronic low back pain (CLBP). In this retrospective study, we have determined risk factors associated with clinical insomnia in CLBP patients in a university hospital in Korea. METHODS: Data from four-hundred and eighty one CLBP patients was analyzed in this study. The Insomnia Severity Index (ISI) was used to determine the presence of clinical insomnia (ISI score > or = 15). Patients' demographics and pain-related factors were evaluated by logistic regression analysis to identify risk factors of clinical insomnia in CLBP. RESULTS: It was found that 43% of patients reported mild to severe insomnia after the development of back pain. In addition, 20% of patients met the criteria for clinically significant insomnia (ISI score > or = 15). In a stepwise multivariate analysis, high pain intensity, the presence of comorbid musculoskeletal pain and neuropathic pain components, and high level of depression were strongly associated with clinical insomnia in CLBP. Among these factors, the presence of comorbid musculoskeletal pain other than back pain was the strongest determinant, with the highest odds ratio of 8.074 (95% CI 4.250 to 15.339) for predicting clinical insomnia. CONCLUSIONS: Insomnia should be addressed as an integral part of pain management in CLBP patients with these risk factors, especially in patients suffering from CLBP with comorbid musculoskeletal pain.
Subject(s)
Humans , Back Pain , Demography , Depression , Korea , Logistic Models , Low Back Pain , Multivariate Analysis , Musculoskeletal Pain , Neuralgia , Odds Ratio , Pain Management , Retrospective Studies , Risk Factors , Sleep Initiation and Maintenance DisordersABSTRACT
Calcification of the cardiac chambers is among the challenges associated with reoperative cardiac surgeries by increasing the risk of systemic embolization. We experienced a case of an unexpected detected mass by intraoperative transesophageal echocardiography during weaning from cardiopulmonary bypass in a patient undergoing trido mitral and tricuspid valve replacement surgery. The surgically removed mass was identified as calcified tissue. This case shows the importance of careful echocardiographic evaluation of the left heart in patients undergoing repeat valve surgery given their greater potential for embolic sources.