Preventive Analgesia with Pregabalin in Neuropathic Pain from "Failed Back Surgery Syndrome": Assessment of Sleep Quality and Disability.

OBJECTIVE: Pregabalin group (PGB) is an antiepileptic used to treat neuropathic pain. We evaluated analgesic efficacy and safety for postoperative/chronic pain, disability, and sleep quality in patients who underwent spine surgery administered with PGB, or not, during the presurgical and postsurgical periods. DESIGN: Retrospective cohort study of 60 patients (two groups with 30 patients) with full information on 50 (29 with PGB and 21 without PGB). Ten patients were dismissed as information was lacking. The PGB group (P) (29 patients) received 75 mg/12 hours before surgery, 150 mg 10 hours after surgery, and 150 mg/12 hours 3 days after surgery. The control group (C; 21 patients) took no PGB. METHODS: Neuropathic pain was assessed before surgery, and 2 and 6 months later using visual analog scales (VAS), DN4, disability (Oswestry), and sleep quality. No serious adverse events occurred with PGB. RESULTS: The median VAS pain score at rest was lower in the PGB group at 2 months postsurgery (1 vs 2, P = 0.032), as was the median DN4 score (0 vs 3, P = 0.032) and the median Oswestry disability index (ODI: 12 vs 18, P = 0.001). At 6 months postsurgery, pain scores were also lower in the PGB group for VAS (0 vs 4, P = 0.001), DN4 score (0 vs 4, P = 0.001) and the ODI (10 vs 24, P = 0.001). Improvement in the functionality and sleep quality of the PGB group was noteworthy (P = 0.018). CONCLUSIONS: PGB has analgesic/antihyperalgesic effects on postoperative neuropathic pain after surgery for lumbar disc hernia. Our findings show that this benefit increases with time.

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Venous anomalies encountered in aortoiliac surgery.

Reconstructive procedures of the aortoiliac system are extremely common. Aside from ruptured aneurysms, most severe intraoperative hemorrhage is due to venous injuries. The ability to recognize and manage venous anomalies is essential. This article presents a review of major venous anomalies including (1) transposition of the inferior vena cava, (2) double vena cava, (3) retroaortic left renal vein, (4) circumaortic renal collar, and (5) preaortic iliac venous confluence. Embryologic development, operative recognition, and techniques of operative management are discussed. A case report is presented in which an anomaly similar to a preaortic iliac confluence was discovered during aortic reconstruction for a ruptured abdominal aortic aneurysm. This case differs from previously reported cases of preaortic iliac confluence in that the right common iliac vein persisted in its course anterior to the right common iliac artery.

The diagnosis of deep venous thrombosis. Fallibility of clinical symptoms and signs.

One hundred twenty-four patients, with 133 involved extremities having the clinical diagnosis of deep venous thrombosis of the lower extremity, were studied by phleborheography and phlebography. Seventy-two limbs were proved to have deep venous thrombosis and 61 to have no evidence of thrombi in the deep veins. Classic symptoms of muscle pain and muscle tenderness, swelling, and the presence of a positive Homans sign obtained by dorsiflexion of the foot were found to occur with approximately equal frequency in those limbs with and without deep venous thrombosis.

Phleborheographic technique for diagnosing deep venous thrombosis of the lower extremities.

There has been further experience with a new plethysmographic technique for diagnosing deep venous thrombosis of the lower extremity. Now called phleborheography, this technique is highly practical and noninvasive and can be conveniently performed in the laboratory, at the bedside or in the office of the physician by a technician. Interpretation of the permanent tracing may be learned by a physician in a short period of time. Since development of a new specifically designed instrument, the accuracy of the test is approximately 96 per cent when correlatewith phlebography.