[Lumbar sympathetic block for ischemic leg pain management secondary to systemic lupus erythematosus: a case report]

Ischaemic pain counts among the most difficult to treat pains in palliative care. Ischemic pain is frequently severe, and usually resistant to available analgesics. Treatment of this condition is difficult, especially when the condition is inoperable. A 36-year-old woman with the diagnosis of systemic lupus erythematosus with severe ischemic pain in the lower leg due to vascular problems presented to Akhtar Hospital. The patient was arranged for lumbar sympathetic block which was performed in two stages with one week interval. In the procedure, a long needle with No.22 gauge and the length of 15 cm was used. Under view of fluoroscopy guide, 10 cc marcaine 0.125% was injected. In the second stage, 5 cc of marcaine 0.25% and 5 cc of phenol 0.6% were used. Pain improvement was observed immediately after neurolytic lumbar sympathetic block. Three-month follow up period revealed improvement of quality of life. Lumbar sympathetic block is considered as a safe and useful technique. Clinically, the technique is effective for pain relief in patients who develop lower leg pain due to vasculitis.

[Intra-articular hyaluronic acid injections Vs. dextrose prolotherapy in the treatment of osteoarthritic knee pain]

Conservative treatment needs to be tried prior to surgical treatment of knee osteoarthritis. This study was designed to evaluate the short-term effects of dextrose prolotherapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections. In this double blind clinical trial, 100 patients, aged 40-70 years, with complaints of knee pain lasting >3 months were recruited in Akhtar hospital during the years 2010 to 2011. The patients met the criteria proposed by the American College of Rheumatology [ACR] for knee osteoarthritis. 50 patients in hyaluronic acid group received five 2 ml injections of hyaluronic acid [Synocrom Forte[R] 1%] weekly and 50 patients in dextrose prolotherapy group received three 2 ml bimonthly injections of 25% dextrose. The patients were evaluated before and after treatment in terms of pain and functionality using the Knee injury and Osteoarthritis Outcome Score [KOOS] self-questionnaire. The patients were followed up for 12 weeks and were examined 12 weeks after the injections by an observer unaware of group assignments. The data were recorded for statistical analysis. The mean age of the patients was 60.6 +/- 8.2 years. No significant differences were found between the two groups with respect to pre- and post-treatment KOOS scores. The scores showed significant improvements in all items following treatment in both groups [P<0.001]. It seems that intra-articular injections of 25% dextrose prolotherapy could be as effective as hyaluronic acid injections for the treatment of knee pain due to OA

Acute respiratory failure as a rare complication of celiac plexus block in a patient with adenocarcinoma of the Ampulla of Vater

Celiac and splanchnic plexus blocks are considered as terminal approaches for pain control in end stage pancreatic cancer. It may be done temporarily [using local anesthetics] or as a permanent act [using alcohol and/or phenol]. Like every other interventional procedure, celiac plexus block has its own potential complications and hazards among them pneumothorax and ARDS are very rare. In this case report we present an end stage patient with adenocarcinoma of ampulla of Vater with involvement of both abdomen and thorax who presented with severe intractable abdominal pain. Bilateral celiac plexus block in this patient resulted in left side pneumothorax and subsequent development of ARDS. We discuss the rare complications of celiac plexus block as well