Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome: A Case Report

Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain.

The effects on Apgar scores and neonatal outcomes of switching from a combination of phenylephrine and ephedrine to phenylephrine alone as a prophylactic vasopressor during spinal anesthesia for cesarean section / 대한마취과학회지

BACKGROUND: Ephedrine, unlike phenylephrine, has a dose-related propensity to depress fetal pH during spinal anesthesia during cesarean section. A low arterial umbilical cord pH has a strong association with neonatal mortality and morbidity. The purpose of this retrospective study was to investigate influences of vasopressor change on Apgar scores and adverse neonatal outcomes in cesarean section. METHODS: In obstetric anesthesia, we changed the prophylactic vasopressor from a combination of phenylephrine and ephedrine to phenylephrine alone in 2000. We evaluated the impact of vasopressor change on Apgar scores (1 and 5 min), incidence of Apgar score < 7 (1 and 5 min), neonatal seizure, continuous positive airway pressure (CPAP), intermittent positive pressure ventilation (IPPV), intraventricular hemorrhage (IVH), periventricular leucomalacia (PVL), and hypoxic ischemic encephalopathy (HIE) in low-risk elective cesarean sections during a period when the combination of phenylephrine and ephedrine was used (2008-2009, two years) and the period of phenylephrine use alone (2011-2012, two years). RESULTS: There were no differences in Apgar scores (1 and 5 min), the incidence of 5 min Apgar score < 7, neonatal seizure, CPAP, IPPV, IVH, PVL, and HIE between the two time periods. However, the incidence of 1 min Apgar < 7 was decreased during the period of phenylephrine use compared with the period of phenylephrine and ephedrine use (P = 0.002). CONCLUSIONS: Conversion from a combination of phenylephrine and ephedrine to phenylephrine alone as a prophylactic anti-hypotensive drug during spinal anesthesia for cesarean section in low-risk pregnancy may be associated with a significant decrease in the incidence of 1 min Apgar < 7.

The effects of epidural analgesia on maternal fever and neonatal outcomes

BACKGROUND: In low-risk women at term, epidemiologic studies have shown that fever in nulliparous parturients during labor is related to epidural use. Moreover, effects of fever associated with epidural analgesia on adverse neonatal outcomes have been debated. The purpose of this study is to evaluate the influence of epidural analgesia on intrapartum fever, neonatal outcomes in deliveries including nulliparity and multiparity. METHODS: We retrospectively investigated normal full-term spontaneous deliveries during 2012. Of 3,858 mother-infant pairs, 3,179 (82%) parturients received and 679 (18%) parturients did not receive epidural analgesia during labor. We regarded intrapartum fever greater than 37.5degrees C, and the parturients with fever were treated with intravenous propacetamol. We divided the study population according to labor epidural analgesia use and, fever and compared the incidence of fever and neonatal outcomes. RESULTS: Incidence of fever was higher in the epidural group compared with the no epidural group (21 vs. 5%). The number of babies with a 1 min Apgar < 7 was lower in the no epidural with no fever group, and neonatal seizure was more frequent in the epidural with fever group compared with the no epidural without fever group, no epidural with fever group, and the epidural without fever group. CONCLUSIONS: Incidence of fever was increased in the epidural analgesia group. Adverse neonatal outcomes were more frequent in the epidural with fever group. No conclusion whether the epidural analgesia cause neonatal adverse outcomes can be drawn due to confounding factors.

Intravascular migration of a previously functioning epidural catheter / 대한마취과학회지

No abstract available.

Cardiac arrests in placenta accreta patient during emergency cesarean section: A case report

We report the case of a patient who suffered two events of sudden cardiac arrests separately. Sudden onset of dyspnea and cardiac arrests occurred during cesarean section in a 35-year-old woman who delivered premature baby. Instant chest compression and epinephrine 1 mg was administered. She was diagnosed to have a placenta previa totalis with bleeding preoperatively and placenta accreta was noted intraoperatively. Cesarean hysterectomy was performed due to excessive hemorrhage associated with uterine atony. Another cardiac arrests occurred during hysterectomy. After instant successful resuscitation, she recovered her heart rhythm and transferred to tertiary hospital safely. She was discharged about two months later without any major physical or neurocognitive deficits.