The Clinical journal of pain
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Obstructive sleep apnea (OSA) has become an epidemic worldwide, and OSA patients frequently present for surgery. Comorbidities such as cardiovascular disease, diabetes, hypertension, stroke, gastrointestinal disorder, metabolic syndrome, chronic pain, delirium, and pulmonary disorder increase the perioperative risk for OSA patients. ⋯ Management of acute postoperative pain in OSA patient remains complex. A comprehensive strategy is needed to reduce the complications and adverse events related to administration of analgesics and anesthetics.
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Case Reports
Placement of an Intrathecal Catheter Through a Bony Fusion Mass Using 3D Image Guidance: A Case Report.
We describe the 3-dimensional (3D) image-guided placement technique for a lumbar intrathecal catheter through a dorsal fusion mass. This is the first time this technique has been reported. A patient with 6 prior spine surgeries and chronic pain syndrome presented with a challenging large dorsal fusion mass. The use of 3D cone beam computed tomography-based image guidance proved advantageous for the placement of an intrathecal drug delivery system (IDDS). ⋯ This is the first case report using 3D cone beam computed tomography-based image guidance for the placement of an intrathecal catheter through a bony fusion mass. This technique appears to be a viable option for IDDS implantation in patients with difficult anatomy.
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Symptomatic cluster-like headache has been described with some ophthalmological disorders such as glaucoma, orbital myositis, posterior scleritis, enucleation, herpes zoster ophthalmicus, and cataract surgery. ⋯ The surgical technique of cataract removal involves corneal incision, which can trigger the trigeminal-autonomic reflex, a pathophysiological mechanism potentially implicated in idiopathic cluster headache. Differential diagnosis in these cases includes surgical and anesthetic complications.
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Case Reports
Ritodrine for Intractable Uterine Pain Due to Extrapelvic Malignant Tumor Metastases: A Case Report.
Effective pain management is an essential component of cancer treatment as approximately 75% of all cancer patients experience excruciating nociceptive pain even at maximum safe doses of nonsteroidal anti-inflammatory drugs and/or opioids. We report a case where ritodrine hydrochloride effectively controlled refractory pain due to uterine metastases from thymic carcinoma. ⋯ Ritodrine relieved the pain caused by uterine contraction due to metastases and enhanced the quality of life.
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Review
Subcutaneous and Perineural Botulinum Toxin Type A For Neuropathic Pain: A Descriptive Review.
Botulinum toxin is a neurotoxin that has been widely used in chronic pain for the treatment of multiple conditions with a component of localized muscle spasm. Recent studies suggest that botulinum toxin is effective in the treatment of neuropathic pain syndromes such as postherpetic neuralgia or painful scars. ⋯ On the basis of the analysis of the reports published in the literature, it would seem that fractioned peripheral subcutaneous and perineural injections of botulinum toxin type A may be useful for the treatment of various chronic pain conditions with neuropathic component.