A&A practice
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Case Reports
Inappropriate Defibrillator Shocks During Cervical Medial Branch Radiofrequency Ablation: A Case Report.
A 52-year-old woman with a history of cervical spondylosis, nonischemic dilated cardiomyopathy, and complete heart block with implantation of a cardiac resynchronization therapy defibrillator (Inogen XR, Boston Scientific, Natick, MA) underwent bilateral fluoroscopy-guided radiofrequency ablation of the medial branch nerves at C4, C5, and C6 levels at an ambulatory surgery center. After completion of the seemingly routine procedure, several alerts, including 1 inappropriate shock, were received via Boston Scientific's remote monitoring system. Tracings also showed that pacing inhibition occurred. When performing radiofrequency ablation in patients with a cardiac implantable electronic device, it is imperative to follow published best practice recommendations to minimize the risk of adverse events.
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The pericapsular nerve group (PENG) block targets articular branches of the obturator, accessory obturator, and femoral nerves. This block has mostly been used to reduce pain caused by hip fractures. A catheter inserted in the plane between the iliopsoas muscle and iliopubic eminence can extend the analgesic duration. We describe the use of this block for successful pain relief of 10 patients with hip fracture (intertrochanteric, subtrochanteric, neck of femur) scheduled for surgery and continuing analgesia in the postoperative period with a catheter inserted in the musculofascial plane as described above.
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Case Reports
A Case Report of Peripheral Nerve Stimulation for Acute Neuropathic Pain in Guillain-Barre Syndrome.
Guillain-Barre syndrome (GBS) is a peripheral demyelinating neuromuscular disorder occasionally associated with pharmacologically refractory neuropathic pain. We present a case of acute neuropathic pain in a 22-year-old man with GBS managed with percutaneous peripheral nerve stimulation (PNS). ⋯ Analgesic and anxiolytic medications were reduced by 33% on the first day and by 78% on day 21. PNS is a minimally invasive, nonpharmacologic modality for treating acute neuropathic pain in GBS patients.
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We report the case of a patient with a right-sided L4 synovial cyst, which had been causing significant pain, who had a successful transfacet epidural steroid injection to rupture the cyst. Using fluoroscopy, the needle was advanced through the right L4 facet joint and the cyst was ruptured using saline. ⋯ Repeat magnetic resonance imaging (MRI) done 2 years later showed no recurrence of the cyst. We discuss the role of transfacet epidural steroid injection in synovial cysts treatment.
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Case Reports
Takotsubo Cardiomyopathy in a Coronavirus Disease-2019-Positive Patient: A Case Report.
Coronavirus disease 2019 (COVID-19) has a high incidence of cardiac involvement, commonly described as a new-onset cardiomyopathy. In this report, we describe a patient with a new manifestation of cardiac involvement in the setting of a COVID-19 diagnosis: that of takotsubo cardiomyopathy.