ABSTRACT
Implantable intrathecal pump is one of the therapeutic options for intractable pain. A 24-year-old male with complex regional pain syndrome was suffering from right lower extremity pain. He had all modalities of treatment including spinal cord stimulator. However, his pain had been worse in the past 6 months. His visual analogue pain scale (VAS) was 8-10 and he could not sit or walk. Only opioid was thought to be effective. Then, intrathecal pump was considered. We estimated the minimal effective dose of spinal morphine before implantation. 0.3 mg of morphine was injected intrathecally as a starting dose. Dosage had been increased up to 0.8 mg in 10 days. His VAS score decreased from 8 to 5. He could sleep without pain and walk with crutch. Therefore, intrathecal pump was inserted. He could tolerate to pain. This case suggests that intrathecal morphine delivery can provide effective treatment for intractable non-malignant pain.
Subject(s)
Humans , Male , Young Adult , Lower Extremity , Morphine , Pain Measurement , Pain, Intractable , Spinal Cord , Stress, PsychologicalABSTRACT
Emergence from anesthesia may be neurologically unsatisfactory. Delayed awakening after general anesthesia is most commonly caused by the effects of anesthetic drugs, but primary central neurologic events (hemorrhage, ischemia, and embolus, etc) that occur during surgery can cause failure to awaken. We experienced a patient whose emergence was delayed from general anesthesia for zygomatic bone savage. The patient had such unexpected focal neurologic abnormalities as left ankle clonus and anisocoria (right dilation). Brain CT revealed acute subdural hematoma as a cause of delayed emergence in the postanesthetic care unit. An emergency craniectomy was performed to evacuate the hematoma, but the patient failed to regain consciousness following surgery. The patient regained consciousness on the 28th postoperative day, and had left hemiparesis and right blindness.
Subject(s)
Humans , Anesthesia , Anesthesia, General , Anesthetics , Anisocoria , Ankle , Blindness , Brain , Consciousness , Embolism , Emergencies , Hematoma , Hematoma, Subdural, Acute , Ischemia , ParesisABSTRACT
Herein is described the successful treatment of complex regional pain syndrome type II with the combination treatment of spinal cord stimulation and radiofrequency thermocoagulation of the lumbar sympathetic ganglion. A 62 years old male patient, suffering from CRPS type II in his left lower extremity, visited our pain clinic. Medication and nerve blockade produced only slight improvement in his symptoms and signs. Therefore, a linear type spinal cord simulator was inserted into the thoracic epidural space, using a non-surgical percutaneous approach, with the cephalad lead located at the T11 level. Two months later, the repositioning of the electrode to the T12 level for more effective pain control, with radiofrequency thermocoagulation of lumbar sympathetic ganglion also performed at the left L2 and 3 levels for the control of trophic change. These resulted in significant pain relief and decreased trophic change, with no complications, after which the patient was able to resume a normal life.
Subject(s)
Humans , Male , Middle Aged , Causalgia , Electrocoagulation , Electrodes , Epidural Space , Ganglia, Sympathetic , Lower Extremity , Nerve Block , Pain Clinics , Spinal Cord Stimulation , Spinal CordABSTRACT
Unilateral brachial plexus injury is a rare complication of thoracoscopic sympathectomy, which is generally considered to be a simple and safe procedure. We report on a 20-year-old female patient who developed persistent pain and weakness of the left arm after thoracoscopic sympathectomy for hyperhidrosis. An electromyographic study revealed evidence of denervation at the C5-C7 level, and a nerve conduction study on the left brachial plexus showed decreased amplitude of the compound muscle action potential of the left musculocutaneous and axillary nerves. The above findings are compatible with left brachial plexopathy, with predominant involvement of the lateral and posterior cord. We suggest that this complication was caused by stretch and/or compression of the left brachial plexus when the arm was hyperabuducted upwards during the operation. Careful attention to positioning by the surgeon and anesthesiologist is needed to prevent this debilitating injury.