Ultrasound-guided hydrodissection of the superficial peroneal nerve for chronic neuropathic pain: a war veteran's story.

Aim: This case report presents the application of ultrasound-guided hydrodissection of the superficial peroneal nerve to treat chronic refractory neuropathic pain, rated by the patient with an average intensity of 6/10 on the numerical rating scale. Materials & methods: Under ultrasound guidance, the nerve was identified compressed by a herniation of the peroneus brevis. An in-plane hydrodissection was performed using a solution of 10 ml of ropivacaine and methylprednisolone until the epineurium was entirely separated from the surrounding tissue. Results: At the 2-month follow-up, the patient reported a decrease of pain, which he rated a 2/10 on the numerical rating scale. At this point, night-time episodes of moderate pain persisted. The procedure was repeated and at the 6-month follow-up, the patient remained pain free. Conclusion: This case report suggests that consecutive ultrasound-guided hydrodissection techniques might be a valuable option in the treatment of superficial peroneal nerve entrapment neuropathy.

Peripheral neuropathic pain is a debilitating pain condition. Management can be challenging and clinicians often rely on oral medications and surgical options. This case report presents the treatment of a case of longstanding, moderate-to-severe superficial peroneal nerve entrapment neuropathy due to a grenade explosion, with consecutive nerve hydrodissection using a solution containing an anesthetic and a corticosteroid. Immediately after the second procedure and at the 6-month follow-up the patient reported near-total relief.

Impact of Labor Epidural Analgesia on Maternal Satisfaction and Childbirth Expectations in a Tertiary Care Center in Portugal: A Prospective Study.

INTRODUCTION: In the current century, increasing importance has been given to the opinions, expectations and experiences of women using healthcare services. The fulfillment of expectations is determined by satisfaction. This study aims to analyze both expectations and satisfaction during childbirth regarding labor epidural analgesia among parturients, with a focus on myths. MATERIAL AND METHODS: A prospective observational study was conducted in parturients at the Centro Hospitalar Universitário Lisboa Norte - Santa Maria Hospital in Lisbon, Portugal, applying a questionnaire to 317 random women. SPSS v22.0 was used for data analysis. RESULTS: Three hundred questionnaires were returned, from women with a mean age of 31. Among the respondents, 46.3% had a college degree and 64% were employed, 46% were primiparas and only 14% had a previous anesthesiology appointment for childbirth purposes. The overall degree of satisfaction surrounding the birth experience was good/excellent for 87% of women. Labor epidural analgesia was performed on 96% of all patients, with an excellent/good outcome for 82.1% and a higher than expected results for 40.7% of them. Regarding the myths, 52.5% believed that epidural analgesia imposes a dose limit and 58.9% that it often causes permanent back pain. The level of education was significantly associated with some myths (p < 0.05), since women with a higher level of education do not believe most of them. DISCUSSION: This study supports the need for an evaluation of the current information that women have about labor epidural analgesia/childbirth. Women's individual needs can be met by multidisciplinary teams including Anesthesiology specialists. CONCLUSION: Maternal satisfaction with childbirth and analgesia is a complex and dynamic process that includes and is not limited to the relief of pain.

Introdução: As opiniões, expectativas e experiências das mulheres que utilizam os serviços de saúde têm vindo a alcançar crescente importância. O cumprimento das expectativas é determinado pela satisfação. Este estudo tem como objetivo analisar as expectativas e satisfação das mulheres durante o trabalho de parto em relação à analgesia epidural, com foco principal nos mitos. Material e Métodos: Foi realizado um estudo observacional e prospetivo em grávidas do Centro Hospitalar Universitário Lisboa Norte - Santa Maria Hospital, em Lisboa, Portugal, através da aplicação aleatória de um questionário a 317 mulheres. Foi utilizado o programa SPSS v.22 para análise estatística. Resultados: Foram obtidos 300 questionários, provenientes de mulheres com idade média de 31 anos. Entre as grávidas que responderam ao questionário, 46,3% possuíam diploma universitário e 64% estavam empregadas. Apenas 14% tiveram consulta prévia de Anestesiologia. O grau de satisfação em torno da experiência do parto foi bom/excelente para 87% das mulheres. A analgesia epidural foi realizada em 96% das grávidas, tendo 82,1% considerado a analgesia excelente e 40,7% avaliado como superior ao esperado. Em relação aos mitos, 52,5% acreditam que a técnica epidural apresenta uma dose limite e 58,9% consideram que a técnica acarreta dor permanente nas costas. O nível de escolaridade mostrou-se significativamente associado a alguns mitos (p < 0,05), uma vez que as mulheres com maior grau de escolaridade não acreditam na maioria destes. Discussão: Este estudo demonstra a necessidade da avaliação da informação que as mulheres possuem sobre a analgesia do trabalho de parto. As necessidades individuais devem ser geridas por equipas multidisciplinares que incluamanestesiologistas. Conclusão: A satisfação materna com o parto e respetiva analgesia é um processo complexo e dinâmico, que inclui e não se limita ao alívio da dor.

Erector spinae plane block and altered hemostasis: is it a safe option? -a case series.

BACKGRUOND: We described 5 cases of uneventful administration of the erector spinae plane (ESP) block to patients with altered hemostasis. CASE: Five patients were admitted to the intensive care unit with altered hemostasis, defined by the activated partial thromboplastin time ratio or internatinal normalized ratio exceeding 1.5 times the normal value; platelet count equal to or below 80000/µl; or use of anticoagulation therapy. A multimodal analgesic regimen was used for all patients, which proved unsatisfactory and limited successful ventilator weaning, until the administration of the ESP block. Effective analgesia was observed in all patients, with at least 70% reduction in numeric pain scale scores and 83% reduction in opioid consumption, which enabled successful ventilator weaning. No neurologic or hemorrhagic complications were recorded during daily surveillance over 5 days. CONCLUSIONS: The ESP block may be a suitable regional analgesia technique for patients with altered hemostasis. Further studies are needed to support this finding.