RESUMO
Qutenza is a high potency capsaicin topical patch which has been recommended for the treatment of peripheral neuropathic pain. The aim of this study was to assess our selected patients' response to Qutenza application. All patients had their dynamic pain score recorded prior to application and were asked to fill in a standardised questionnaire for three months post application. Patients were also asked to document any changes to the character of their pain, changes in sleep, activities of daily living and mood as well as any changes to their medication usage. 21 patients had Qutenza applied in a 5 month period. 17 patients completed the questionnaire in a 5 month period. We found that the mean overall reduction in pain score at 3 months was 32.7%. 8 of our patients (47%) reported improved sleep, activities of daily living and mood. 6 patients (35%) reported a reduction in medication use, while 7 (41%) reported an improvement in the character of their pain.
Assuntos
Analgésicos/administração & dosagem , Capsaicina/administração & dosagem , Dor Crônica/tratamento farmacológico , Neuralgia/tratamento farmacológico , Adesivo Transdérmico , Atividades Cotidianas , Dor Crônica/diagnóstico , Humanos , Neuralgia/diagnóstico , Medição da Dor , Sono/efeitos dos fármacos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
A 38-year-old wheelchair-bound primigravida with transverse myelitis presented at 38 weeks of gestation for elective caesarean section. Transverse myelitis, which is characterised by bilateral inflammation of the spinal cord and myelin destruction, is associated with myopathy, autonomic dysreflexia and pulmonary aspiration. Regional anaesthesia was contraindicated in this case as the patient had undergone two previous lumbar spinal fusion procedures. Rocuronium 1.2 mg/kg was used to facilitate rapid intubating conditions. The caesarean section proceeded uneventfully, but even after administration of neostigmine the patient exhibited prolonged neuromuscular blockade. After 3 h and 15 min sugammadex was obtained to reverse neuromuscular blockade; the drug was not stocked in our hospital. Sugammadex 4 mg/kg resulted in complete reversal of blockade after 2 min. We believe that myopathy associated with transverse myelitis led to the prolonged duration of action of rocuronium. Sugammadex is a relatively new drug with few reported side effects. In this case it was used to reverse neuromuscular blockade and prevented prolonged postoperative ventilatory support.
Assuntos
Androstanóis/antagonistas & inibidores , Mielite Transversa/complicações , Bloqueio Neuromuscular/efeitos adversos , Fármacos Neuromusculares não Despolarizantes/antagonistas & inibidores , Complicações na Gravidez/terapia , gama-Ciclodextrinas/uso terapêutico , Adulto , Androstanóis/efeitos adversos , Anestesia Geral , Anestesia Obstétrica , Cesárea , Feminino , Humanos , Recém-Nascido , Masculino , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , Paralisia/complicações , Gravidez , Rocurônio , SugammadexRESUMO
We report the case of a 35-year-old lady who presented with a 6-day history of a postural headache following an uncomplicated epidural catheter insertion. Meningitis was initially suspected and a neurology review was obtained. CT and MRI brain revealed features suggestive of meningitis. However these radiological features are also consistent with post dural puncture headache (PDPH). This case highlights the under reported and possible misleading radiographical features of PDPH.
