ABSTRACT
An epidural hematoma is a rare but devastating complication after interventional pain procedures. The etiology is multifactorial, including anatomical variations, inherited coagulation disorders, and consumption of anticoagulants or antiplatelet substances. Specifically, in regard to platelet aggregation, the consumption of herbal medicine is often forgotten as a potential cause for coagulation profile disorders, potentially leading to an epidural hematoma. We present the case of a patient who developed an epidural hematoma after a cervical epidural block, most likely associated with daily "red clover" consumption.
Subject(s)
Hematoma, Epidural, Spinal , Humans , Hematoma, Epidural, Spinal/etiology , Injections, Epidural/adverse effects , Trifolium/adverse effectsABSTRACT
BACKGROUND: The suprascapular nerve block is frequently implemented to treat chronic shoulder pain. Although effective the nerve blockade provides only a short-term relief, and more compelling apaproaches have been investigated. Pulsed radiofrequency (pRF) has been anecdotally reported as safe and reliable method. However, formal efficacy study has not been published. Ostensibly evidence-based validation of a new method is necessary for both scholastic and practical purposes. METHODS: This study was designed as a randomized active placebo-control double-blind trial. Because of encountered difficulties in recruitment and high rate of dropout, the study was redesigned as to allow a smaller sample size and statistical analyses were performed utilizing the last observation carry forward method. Lidocaine injections alone or with combination of the pRF were performed. Participants were followed up during 6 months, and multiple subjective and objective outcome variables were recorded. RESULTS: Thirteen of 22 participants completed 6 months follow-up. Dropout rate was higher in the lidocaine group. A significant linear trend (P < 0.05) for improvement on the numeric rating scale, Shoulder Pain and Disability Index and Constant-Murley score was observed in the pRF group, but not in the lidocaine group. Patients in the pRF group were on average more satisfied than the lidocaine group at 1 month (P = 0.041) and at 3 months (P = 0.035). DISCUSSION: Considering limitations of the study design and statistics, it seems plausible to attribute better results in the pRF group to unique properties of this physical modality.
Subject(s)
Pulsed Radiofrequency Treatment/methods , Shoulder Pain/therapy , Aged , Anesthetics, Local/therapeutic use , Chronic Pain/therapy , Double-Blind Method , Female , Humans , Lidocaine/therapeutic use , Male , Nerve Block , Patient Satisfaction , Treatment OutcomeABSTRACT
We report the successful use of low-dose ketamine infusion for treating a severe episode of painful myoclonus in the lower extremities, associated with opioid-induced hyperalgesia (OIH), in a patient who was receiving long-term, high dose intrathecal hydromorphone therapy. A low-dose ketamine infusion immediately relieved the painful myoclonus. It also enabled a reduction in the intrathecal opioid dosage leading to a resolution of the acute symptoms attributed to OIH.
Subject(s)
Hyperalgesia/drug therapy , Ketamine/administration & dosage , Myoclonus/drug therapy , Analgesics, Opioid/therapeutic use , Humans , Hydromorphone/therapeutic use , Hyperalgesia/chemically induced , Hyperalgesia/complications , Infusions, Intravenous , Ketamine/therapeutic use , Male , Middle Aged , Myoclonus/complications , Pain/drug therapyABSTRACT
Limb amputation is a leading cause of pain and disability. Limb amputation can be associated with a myriad of symptoms, including phantom limb sensation, phantom limb pain, and stump pain. Treatment of phantom limb pain and stump pain, remains difficult, therefore optimal management must include a multidisciplinary approach. This case report describes the use of ultrasound for diagnosis and successful management, of persistent stump-neuroma pain, using pulsed radiofrequency ablation.
Subject(s)
Amputation Stumps/physiopathology , Catheter Ablation/methods , Neuroma/complications , Pain/etiology , Pain/surgery , Postoperative Complications/physiopathology , Humans , Male , Middle Aged , Neuroma/diagnostic imaging , Pain Measurement , UltrasonographyABSTRACT
Spinal epidural hematoma is a rare and devastating complication of epidural catheter removal in an anticoagulated patient. The diagnosis could be quite challenging, especially in patients with preexisting neurological deficits. A 35-year-old patient with remote spinal cord injury and T4 level paraplegia developed a spinal epidural hematoma on the 7th postoperative day. The hematoma developed after epidural catheter removal with concurrent administration of unfractionated heparin.
Subject(s)
Anesthesia, Epidural/adverse effects , Hematoma, Epidural, Spinal/etiology , Hematoma, Epidural, Spinal/therapy , Paraplegia/complications , Adult , Anticoagulants/adverse effects , Catheterization/adverse effects , Epidural Space/pathology , Fibrinogen/metabolism , Hematoma, Epidural, Spinal/pathology , Heparin/adverse effects , Humans , Magnetic Resonance Imaging , Male , Platelet Count , Urinary Bladder, Neurogenic/surgeryABSTRACT
Las técnicas combinadas espinales epidurales se han convertido en una alternativa a las intervenciones neuroaxiales tradicionales, fusionando las ventajas del bloqueo subaracnoideo con la flexibilidad de la técnica epidural, utilizandose tanto en alivio del dolor en el trabajo de parto como en cesáarea electiva o urgente. El uso de las mismas se ha introducido en población de alto riesgo. En esta serie de casos describimos el uso de técnicas combinadas espinales epidurales en la población materna críticamente enferma y discutiendo además los beneficios y los problemas potenciales y reales con el uso de las mismas.
