A&A practice
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Split cord malformations are rare spinal dysraphisms in which 2 separate spinal cords are present. Despite its diagnosis in all age groups, split cord malformations are not well described. ⋯ Anesthesiologists may encounter patients with known or unknown split cord malformations without much information to guide clinical decision-making and procedural risks of neuraxial anesthesia. This is the first case to the authors' knowledge of utilizing a caudal epidural injection for pain management in a patient with a diagnosed split cord malformation.
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Case Reports
Blue Rubber Bleb Nevus Syndrome in the Obstetric Patient: A Case Report of Anesthetic Implications and Management.
Blue rubber bleb nevus syndrome (BRBNS) is a rare systemic syndrome characterized by venous malformations usually found in the skin and visceral organs. To date, 11 case reports describing BRBNS during pregnancy have been published. To our knowledge, this is the first report describing intracranial, airway, epidural, and birth canal involvement of venous malformations in the same parturient. Key lessons learned include clinical presentation, workup, team management, and care of obstetric patients with this disorder.
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Complex regional pain syndrome (CRPS) is a chronic condition commonly consisting of allodynia, paresthesias, skin and temperature changes, and motor dysfunction. CRPS is relatively rare and classically develops in a limb after sustaining a traumatic or surgical insult. To date, CRPS developing in a previously uninjured limb after prolonged immobilization has not yet been reported. We describe a 45-year-old man with no known preexisting injury or neuropathy to his upper extremities who developed CRPS of his right wrist and hand after prolonged colorectal surgery.
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Case Reports
Liposomal Bupivacaine for Pediatric Celiac Plexus Block: A Case Report of Refractory Constipation Management.
Liposomal bupivacaine is a long-acting amide local anesthetic with a limited list of indications. At the time of publication, use is limited to field block and surgical wound infiltration and, more recently, interscalene nerve block. ⋯ We present the use of liposomal bupivacaine for pediatric celiac plexus block in a 12-year-old boy suffering from gastrointestinal complications (eg, pain, constipation, and ileus) after bone marrow transplantation. Celiac plexus block utilizing liposomal bupivacaine was successfully used to palliate his pain and to normalize bowel function.
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Vertebral body tethering (VBT) is an innovative surgical technique used to treat juvenile and adolescent idiopathic scoliosis. The optimal anesthetic technique, including the preferred management of postoperative pain, is not known. In this case series, we describe 3 patients with adolescent idiopathic scoliosis who received either continuous erector spinae plane block (ESPB) catheters or intercostal liposomal bupivacaine for postoperative pain management after bilateral VBT via minithoracotomy.