Spinal cord stimulation for a patient with neuropathic pain related to congenital syringomyelia

No abstract available.

Postmastectomy Pain: A Cross-sectional Study of Prevalence, Pain Characteristics, and Effects on Quality of Life / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Postmastectomy pain syndrome (PMPS) is defined as a chronic (continuing for 3 or more months) neuropathic pain affecting the axilla, medial arm, breast, and chest wall after breast cancer surgery. The prevalence of PMPS has been reported to range from 20% to 68%. In this study, we aimed to determine the prevalence of PMPS among mastectomy patients, the severity of neuropathic pain in these patients, risk factors that contribute to pain becoming chronic, and the effect of PMPS on life quality.</p><p><b>METHODS</b>This cross-sectional study was approved by the Sakarya University, Medical Faculty Ethical Council and included 146 patients ranging in age from 18 to 85 years who visited the pain clinic, general surgery clinic, and oncology clinic and had breast surgery between 2012 and 2014. Patients were divided into two groups according to whether they met PMPS criteria: pain at axilla, arm, shoulder, chest wall, scar tissue, or breast at least 3 months after breast surgery. All patients gave informed consent prior to entry into the study. Patient medical records were collected, and pain and quality of life were evaluated by the visual analog scale (VAS) for pain, a short form of the McGill Pain Questionnaire (SF-MPQ), douleur neuropathique-4 (DN-4), and SF-36.</p><p><b>RESULTS</b>Patient mean age was 55.2 ± 11.8 years (33.0-83.0 years). PMPS prevalence was 36%. Mean scores on the VAS, SF-MPQ, and DN-4 in PMPS patients were 1.76 ± 2.38 (0-10), 1.73 ± 1.54 (0-5), and 1.64 ± 2.31 (0-8), respectively. Of these patients, 31 (23.7%) had neuropathic pain characteristics, and 12 (9.2%) had phantom pain according to the DN-4 survey. Patients who had modified radical mastectomy were significantly more likely to develop PMPS than patients who had breast-protective surgery (P = 0.028). Only 2 (2.4%) of PMPS patients had received proper treatment (anticonvulsants or opioids).</p><p><b>CONCLUSIONS</b>PMPS seriously impacts patients' emotional situation, daily activities, and social relationships and is a major economic burden for health systems. We conclude that the rate of PMPS among patients receiving breast cancer surgery in Turkey is 64.1% and that challenges to the proper treatment of these patients deserve further investigation.</p>

Comparison of Postoperative Analgesic Efficacy of Caudal Block versus Dorsal Penile Nerve Block with Levobupivacaine for Circumcision in Children

BACKGROUND: Circumcision is a painful intervention frequently performed in pediatric surgery. We aim to compare the efficacy of caudal block versus dorsal penile block (DPNB) under general anesthesia for children undergoing circumcision. METHODS: This study was performed between July 1, 2009 and October 16, 2009. Fifty male children American Society of Anesthesiolgists physical status classification I, aged between 3 and 12 were included in this randomized, prospective, comparative study. Anesthetic techniques were standardized for all children. Patients were randomized into 2 groups. Using 0.25% 0.5 ml/kg levobupivacain, we performed DPNB for Group 1 and caudal block for Group 2. Postoperative analgesia was evaluated for six hours with the Flacc Pain Scale for five categories; (F) Face, (L) Legs, (A) Activity, (C) Cry, and (C) Consolability. For every child, supplemental analgesic amounts, times, and probable local or systemic complications were recorded. RESULTS: No significant difference between the groups (P > 0.05) was found in mean age, body weight, anesthesia duration, FLACC pain, and sedation scores (P > 0.05). However, on subsequent measurements, a significant decrease of pain and sedation scores was noted in both the DPNB group and the caudal block group (P < 0.001). No major complication was found when using either technique. CONCLUSIONS: DPNB and caudal block provided similar postoperative analgesic effects without major complications for children under general anesthesia.

Caudal epidural block in children and infants: retrospective analysis of 2088 cases

Regional anesthesia is usually preferred as caudal block via the epidural space. However, the number of large-scale studies including pediatric caudal blocks is small. The objective of this study was to evaluate complications and side effects of local anesthetics and adjuvant drugs. Retrospective, descriptive study of cases occurring during the period December 2007 to October 2009. Of 4815 medical records were screened, 2088 pediatric cases were identified and included in this study. As a local anesthetic, we preferred mostly levobupivacaine in 1669 [79.9%] patients and bupivacaine in 419 [20.1%] patients. As adjuvant drug, we preferred mostly morphine [41 patients], fentanyl [7 patients] and adrenaline [6 patients] in 54 [2.5%] patients. For general anesthesia induction, we preferred mostly propofol [1996 patients, 94.2%]; for maintenance, sevoflurane [1 773 patients, 84.9%]. For airway control, we preferred mostly the ProSeal laryngeal mask [PLMA], in 1008 [48.2%] patients. One thousand six hundred five [76.9%] patients were from outpatient clinics and 483 [23.1%] patients were from inpatient clinics. No permanent complication was encountered after caudal blocks. We conclude that caudal epidural blocks are a safe and effective method for subumbilical daycase pediatric surgeries when performed by anesthetists

A Case of Pneumothorax after Phrenic Nerve Block with Guidance of a Nerve Stimulator

Hiccups have more than 100 etiologies. The most common etiology has gastrointestinal origins, related mainly to gastric distention and gastroesophageal reflux disease. Intractable hiccups are rare but may present as a severe symptom of various diseases. Hiccups are mostly treated with non-invasive or pharmacological therapies. If these therapies fail, invasive methods should be used. Here, we present a patient on whom we performed a blockage of the phrenic nerve with the guidance of a nerve stimulator. The patient also had pneumothorax as a complication. Three hours after intervention, a tube thoracostomy was performed. One week later, the patient was cured and discharged from the hospital. In conclusion, a stimulator provides the benefit of localizing the phrenic nerve, which leads to diaphragmatic contractions. Patients with thin necks have more risk of pneumothorax during phrenic nerve location.

Comparison of Postoperative Analgesic Efficacy of Caudal Block versus Dorsal Penile Nerve Block with Levobupivacaine for Circumcision in Children

BACKGROUND: Circumcision is a painful intervention frequently performed in pediatric surgery. We aim to compare the efficacy of caudal block versus dorsal penile block (DPNB) under general anesthesia for children undergoing circumcision. METHODS: This study was performed between July 1, 2009 and October 16, 2009. Fifty male children American Society of Anesthesiolgists physical status classification I, aged between 3 and 12 were included in this randomized, prospective, comparative study. Anesthetic techniques were standardized for all children. Patients were randomized into 2 groups. Using 0.25% 0.5 ml/kg levobupivacain, we performed DPNB for Group 1 and caudal block for Group 2. Postoperative analgesia was evaluated for six hours with the Flacc Pain Scale for five categories; (F) Face, (L) Legs, (A) Activity, (C) Cry, and (C) Consolability. For every child, supplemental analgesic amounts, times, and probable local or systemic complications were recorded. RESULTS: No significant difference between the groups (P > 0.05) was found in mean age, body weight, anesthesia duration, FLACC pain, and sedation scores (P > 0.05). However, on subsequent measurements, a significant decrease of pain and sedation scores was noted in both the DPNB group and the caudal block group (P < 0.001). No major complication was found when using either technique. CONCLUSIONS: DPNB and caudal block provided similar postoperative analgesic effects without major complications for children under general anesthesia.