A&A practice
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Traditionally, intrathecal therapy has been used for pain amelioration in cancer patients, but now has indications for nonmalignant chronic pain conditions. Due to its expanding use, it is imperative to understand the risks and management of intrathecal pump implantation. This case illustrates a series of uncommon intrathecal pump complications in a 52-year-old woman with complex regional pain syndrome. Considering the complications outlined in this case, there is a need to conduct retrospective studies and establish guidelines to address when it is optimal to remove a chronically placed catheter as well as the proper technique for removal.
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Selection of anesthetic technique for thigh amputation is complicated by patients' comorbid conditions. The sacral erector spinae plane block (ESPB) is an emerging technique with potential as a primary anesthetic for thigh amputation. ⋯ This instance underscores the necessity for further investigation into the reliability of the sacral ESPB for lower limb surgeries. Until such evidence is established, caution is advised in relying solely on the sacral ESPB for thigh amputations, and consideration of alternative techniques is recommended.
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Diplopia, or double vision, has been listed as a rare adverse effect of intravenous hydromorphone, although there are no case studies or literature documenting this. We detail a case of acute transient diplopia correlated with the use of intraoperative hydromorphone and postoperative hydromorphone patient-controlled analgesia. Although the mechanism for this adverse effect is unknown, there may be risk factors that predispose patients to the potential toxic metabolic effects of hydromorphone. We share the first published case of diplopia as a clinically relevant adverse effect of hydromorphone and propose a potential reason behind this association.
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Case Reports
Basal Cell Carcinoma Formation Within A Spinal Cord Stimulator Surgical Scar: A Case Report.
Implanting neuromodulation devices requires that pain medicine physicians be well-versed in proper surgical technique and postoperative wound management. To be able to identify abnormal wound healing, a basic understanding of normal wound healing is required. When postoperative wounds deviate from expected healing, it is important that pain medicine physicians entertain a broad differential diagnosis, including nonsurgical dermatologic pathology.
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Tethered cord syndrome results from adherence of the conus medullaris to the sacrum and may be associated with high complication rates from neuraxial anesthesia. We present the case of a 32-year-old gravida 2 para 0 patient with a history of lipomyelomeningocele (one of several types of spina bifida) and tethered cord status post repair, residual low-lying conus medullaris, supermorbid obesity (body mass index of 58), and Mallampati IV airway, who underwent successful fluoroscopically guided epidural catheter placement for vaginal delivery. Risks and benefits of epidural catheter utilization and methods of placement are reviewed.