Optimal dose of prophylactic intravenous ephedrine for spinal-induced hypotension during cesarean section

The objective of this study was to compare the efficacy of 10, 15, and 20mg bolus doses of prophylactic IV ephedrine for prevention of maternal hypotension associated with spinal anesthesia for cesarean section. A prospective, quasi experimental study. The study was conducted at Department of Anesthesiology and Intensive Care, Shalamar Hospital Lahore [Pakistan], and was completed in six months period from January to June 2008. Ninety parturients of ASA grade I and II, receiving spinal anesthesia for elective C-section were included in this study. They were randomly divided into three groups. Group-I received lOmg, Group-II 15mg, and Group-Ill 20mg prophylactic IV ephedrine immediately after administration of spinal anesthesia. Intra operative hemodynamic changes were recorded and the data were analyzed. Incidence of hypotension was significantly higher in Group-I parturients receiving a lOmg prophylactic dose of ephedrine than in Group-II and Group-Ill parturients receiving 15mg or 20mg of ephedrine respectively [53.3% versus 13.3% and 3.3% respectively]. There was however, a significantly higher incidence of reactive hypertension in Group-II parturients [46.7%]. 15mg bolus dose of prophylactic IV ephedrine can effectively prevent spinal induced maternal hypotension during cesarean section without adverse effects like reactive hypertension

Contralateral limb weakness after intrathecal chemical neurolysis for cancer pain

The treatment of cancer pain encompasses both pharmacological and interventional techniques. In certain situations, patients may have intractable pain despite use of optimal doses of oral or parenteral analgesics. Interventional procedures, like intrathecal chemical neurolysis [ICN], play an important role in the management of such intractable cancer pains. The goal is to achieve segmental block that is purely sensory, without causing any motor weakness in the patient. Potential problems related to ICN include inadequate pain control with the progression of tumour size, short duration of effect, lower limb weakness on the ipsilateral side and rectal or bladder sphincter dysfunction. We present a case report in which the patient developed unexpected weakness of contralateral limb after ICN for management of cancer pain

Management of refractory secondary glossopharyngeal neuralgia with percutaneous radiofrequency thermocoagulation

Glossopharyngeal neuralgia [GN] can present as an orofacial pain syndrome in which there are repeated episodes of intractable pain in the tongue, throat, tonsils and ears. Primary GN is idiopathic, whereas secondary GN has some identifiable cause like tumor invasion that leads to constant irritation of the nerve. Current therapies include pharmacological management, nerve blocks, decompression surgery, and neuromodulation by either medications or pulsed mode radiofrequency. Radiofrequency lesioning of the glossopharyngeal nerve is a minimally invasive technique, which can effectively manage the pain in such patients. Here, we report a case in which secondary GN due to invasive tongue tumor, unresponsive to pulsed mode radiofrequency treatment, was treated with radiofrequency thermocoagulation [RFT]