ABSTRACT
Trigeminal neuralgia is characterized by recurrent episodes of intense lancinating pain affecting the face localized to the sensory supply areas of the trigeminal nerve. There is a lack of certainty regarding the etiology and pathophysiology of trigeminal neuralgia. The diagnosis of idiopathic typical trigeminal neuralgia requires the absence of clinically evident neurological deficit. Treatment must be individualized to each patient. Various trigeminal neural blockades can be options when medical therapy fails to relieve pain. Neural blockades include peripheral nerve branch blocks and intracranial nerve root or ganglion blocks such as RF thermocoagulation, percutaneous balloon compression and glycerol rhizolysis. Neural blockade with local anesthetics produces temporary effects, but neural blockade with neurolytics like alcohol lasts longer, around one or two years. They are very useful for patients with poor general condition or high risk. RF rhizotomy and balloon compression of trigeminal ganglion are relatively more invasive treatment options, but have more cost effectiveness with less serious complications compared to other surgical procedures. The continuous improvement of neural block techniques is necessary for better treatment of trigeminal neuralgia.
Subject(s)
Humans , Anesthetics, Local , Cost-Benefit Analysis , Electrocoagulation , Ganglion Cysts , Glycerol , Peripheral Nerves , Rhizotomy , Trigeminal Ganglion , Trigeminal Nerve , Trigeminal NeuralgiaABSTRACT
BACKGROUND: Pediatric day surgery shortens the hospital stay, reduces the exposure of nosocomial infections and allows for active parental participation. But pain delays the recovery and it increases the morbidity, including nausea and vomiting, and the maladaptive behavioral changes. This study was conducted to compare the effect of rectally administered paracetamol or diclofenac combined with regional nerve block with the traditional pain control method. METHODS: Two hundred forty one randomly selected pediatric patients were allocated into two groups. The empirical pain relief group (the control group, n = 120) included the patients that received intravenous sulpyrin and/or meperidine postoperatively. The patients in the multimodal preemptive pain relief group (the study group, n = 121) received regional nerve blockade with 0.25% bupivacaine combined with preoperative rectally administered paracetamol 45 mg/kg or diclofenac 1 mg/kg 60 min before surgery for cases that were to undergo lower abdominal surgery. But only paracetamol or diclofenac was rectally administered preoperatively in the other surgical cases. RESULTS: The mean time in the recovery room for the study group was shorter than that for the control group. The postoperative pain was hurts even more in 16.7%, worst in 11.8%, a whole lot in 26.5% and no pain in 27.5% of the control group patients. But the pain was hurts little more only in 11%, a little bit in 10.0% and no pain in 88.9% of the study group patients. The average postoperative VAS score was 0.21 +/- 0.6 in the study group and 8.36 +/- 1.7 in the control group, respectively. Vomiting, nausea and fever were more frequently observed in the control group. CONCLUSIONS: The pain intensity of the children who were treated with rectally administered paracetamol or diclofenac combined with regional nerve block before surgery was significantly decreased as compared to that of the children who were treated with the traditional method.
Subject(s)
Child , Humans , Acetaminophen , Ambulatory Surgical Procedures , Bupivacaine , Cross Infection , Diclofenac , Dipyrone , Fever , Isothiocyanates , Length of Stay , Meperidine , Mongolia , Nausea , Nerve Block , Pain Management , Pain, Postoperative , Parents , Recovery Room , VomitingABSTRACT
@#Objective To investigate the therapeutic efficacy and side effect of regional blockade using diprospan combined with oxycodone and acetaminophen taking orally which called balanced analgesia on severe tension-type headache. Methods 32 patients diagnosed as severe tension-type headache were treated with regional blockade using diprospan mixed with 0.4% lidocaine, combined with oxycodone and acetaminophen. The severity of pain (using numeric rating scales, NRS) and the duration of headache were observed and the side effects were recorded. Results There was a significant decrease in the severity of pain and the duration of headache after treatment compared with those before (P<0.01). No serious side effects were observed. Conclusion The balanced analgesia therapy mainly including regional blockade and oxycodone and acetaminophen can be significantly effective on the severe tension-type headache.
ABSTRACT
AIM:To investigate the effect of intercostals neural blockade(INB)combining with intravenous dexamethasone on postoperative pain,nausea and vomiting and rehabilitation after laparoscopic cholecystectomy(LC).METHODS:Seventy-two patients with ASA I-Ⅱ undergoing LC were randomly divided into three groups with twenty-four patients in each group.Group DI received intravenous dexamethasone infusion before induction combining with INB.Group I only received INB.Group C was control group.Propofol and remifentanil consumption were recorded,postoperative pain and fatigue were assessed according to a pain and fatigue severity score using a subjective analog visual scale(VAS)1,4,12,and 24 h after the surgery.The incidence of postoperative nausea and vomiting,times to first enterocinesia,flatus and hospital discharge were recorded.RESULTS:Propofol and remifentanil consumption,postoperative pain and fatigue scores 4,12,24 h after surgery,the postoperative nausea and vomiting incidences,times to first enterocinesia and flatus,times to hospital discharge were significantly lower in Group DI and I than those in Group C(P
ABSTRACT
OBJECTIVE: The purpose of this study is to determine the efficacy of neural blockades in patients with herniated lumbar disc and lumbar spinal stenosis. METHODS: The authors reviewed 47 patients with low back and radicular pain, treated with epidural and facet block at the departments of anesthesiology and neurosurgery from June 2000 to November 2001. Epidural blockade was performed via transforaminal, translaminar, or transcaudal route. Facet blocks were performed at the corresponding levels, including above and below the reference level, in patients accompanied with facet syndrome. Improvement was evaluated with pre- and post-block visual analogue scale score and follow-up evaluation was performed at the time of first recurrence to the level of pre-block pain. Time to first recurrence was analyzed with Kaplan-Meyer Survival analysis according to disease entity. RESULTS: After one cycle of blockade, effective responses lasting more than 1 month were 64% more than 3 months were 48% of patients. Median time to first recurrence were 21 weeks in patients with herniated lumbar discs, 7 weeks with lumbar spinal stenosis. The former group showed significant pain improvement(p=0.048). CONCLUSION: Despite of relative short-term effect, neural blockade provides substantial pain relief in majority of patients and this lead early and efficient rehabilitation and exercise therapy.
Subject(s)
Humans , Anesthesiology , Exercise Therapy , Follow-Up Studies , Low Back Pain , Neurosurgery , Recurrence , Rehabilitation , Spinal Stenosis , Survival AnalysisABSTRACT
The sympathetic nervous system has been implicated in the maintenance of numerous pain syndromes. Interruption of sympathetic pathways has been widely applied to relieve pain. Neurolytic sympathetic block is often well tolerated, because numbness and motor weakness are uncommon and neuritis rarely develops. The classic targets for sympatholysis are the stellate or cervicothoracic ganglion for facial and upper extremity pain, celiac plexus for abdominal pin, and lumbar sympathetic chain for lower extremity pain. In addition, the thoracic ganglion is occasionally blocked for the treatment of hyperhidrosis and of pain emanating from the pleura and esophagus. The recognition of the clinical utility of cervical epidural nerve block in the management of head, face, neck, shoulder, and upper extremity pain has brought the technique into the mainstream of contemporary pain management practice. Lumbar epidural nerve block has great utility in the management of a variety of acute, chronic, and cancer-related pain syndromes. The nerve root sleeve is particularly accessible to precise local anesthetic blocks. Segmental information gained from such nerve root blocks can be helpful in sorting out confusing patterns of referred pain to the limbs. The pathway for insertion of spinal needles must be planned so as to avoid damaging neural structures. Spinal nerve roots are particularly delicate structures and do not take kindly to being impaled.