Ugeskrift for laeger
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Ugeskrift for laeger · Jan 2011
[Regional anaesthesia may be used in selected acute compartment syndrome patients].
Acute compartment syndrome (ACS) is a serious condition which, if not treated promptly, can cause severe disability or even death. Regional anaesthesia (epidural analgesia or peripheral nerve blocks) is increasingly used in postoperative pain management in orthopaedic surgery, but has been presumed to mask the symptoms of ACS. We present a short review of the current literature relating regional anaesthesia to a delayed diagnosis of ACS and find no convincing evidence that regional anaesthesia is unsafe in patients with a high risk of ACS.
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Herpes zoster (HZ) and post-herpetic neuralgia (PHN) are frequently occurring diseases in elderly and in immuno-compromised persons. The live attenuated HZ vaccine boosts an existing immune response, so that the already established varicella-zoster virus infection is kept latent. ⋯ However, the clinical efficacy of the vaccine is best studied in people aged = 60 years. The vaccine has so far not shown any serious side-effects.
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Ugeskrift for laeger · Jan 2011
Review[Herpes zoster: clinical manifestation, diagnosis and treatment].
Herpes zoster (HZ) is a painful vesicular rash localized to one dermatome. Post-herpetic neuralgia (PHN) is persistent pain three months after the rash started. In recent years several Cochrane reviews and clinical studies on how to treat HZ and PHN have been published. These studies show that early recognition and treatment can reduce acute symptoms, that antiviral therapy and corticosteroids shorten the acute illness period, that opioids and anticonvulsants have effect on acute HZ pain and, finally, that tricyclic antidepressants, opioids and anticonvulsants all have proven efficiency in PHN therapy.
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Ugeskrift for laeger · Jan 2011
[Intravenous administration of lipids in poisoning caused by local analgesics].
To draw attention to the use of intravenous lipids in the treatment of cardiac arrests caused by overdosage of lipophilic drugs. Case reports and animal studies have shown beneficial use of lipids in severe intoxication. The literature is reviewed. ⋯ Lipids have a place in the treatment of severe cardiac events caused by local analgesics for regional anaesthesia. Lipids should be readily available when regional anaesthesia is performed. National guidelines should be prepared. Lipids may also be an option in the treatment of intoxication with other lipophilic drugs.
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Multiple mechanisms are responsible for persistent postherniotomy pain, including preoperative pain hypersensitivity, other chronic pain states and intraoperative nerve injury. Currently, the primary preventive techniques are intraoperative nerve identification/sparing in open surgery or use of laparoscopic surgery with non-fixed mesh. The choice between pharmacological intervention and re-exploration is debatable. A centralisation of the Danish patients with regard to evaluation and treatment is proposed.