Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2004
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia after total-hip arthroplasty: Comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block. a prospective, randomized, double-blind study.
The authors compared the analgesic effects and quality of rehabilitation of three analgesic techniques after total-hip arthroplasty in a double-blind, randomized trial. ⋯ PCA is an efficient and safe analgesia technique. FNB and PCB should not be used routinely after total-hip arthroplasty.
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Reg Anesth Pain Med · Mar 2004
Case ReportsConversion disorder mimicking Dejerine-Roussy syndrome (thalamic stroke) after spinal cord stimulation.
Dejerine-Roussy syndrome is a complex of various signs and symptoms in patients suffering from central thalamic pain, usually secondary to a vascular etiology. We describe a patient presenting with the potentially devastating signs and symptoms of thalamic stroke, at least temporally related to spinal cord stimulator implantation. The etiology of the patient's affliction was subsequently revealed to be a conversion disorder. Case report A 37-year-old woman presented for spinal cord stimulation as treatment of her brachial plexopathy after failure of conservative therapy. Before implantation, she underwent a clinical interview with a psychologist and psychometric testing. No psychological pathology was detected. Trial and permanent implantation of the cervical stimulator lead and pulse generator were uneventful. Eleven days after receiving the permanent implant, the patient experienced right-sided hemicorporal numbness and burning dysesthesia. The patient was admitted, and a diagnosis of Dejerine-Roussy syndrome (thalamic stroke) was made. She was discharged, and her symptomatology waxed and waned over a period of weeks. The patient was subsequently admitted for psychiatric evaluation because of anxiety attacks. During her protracted admission, her psychiatrists strongly suspected a conversion disorder. The stimulator was removed, and the patient received supportive care only. Within 6 months, sensory symptoms and all motor deficits had completely resolved. ⋯ Despite careful preoperative evaluation, latent psychosocial issues may limit the effectiveness of spinal cord stimulation. We present a case of conversion disorder masquerading as Dejerine-Roussy syndrome after spinal cord stimulation. The implications of the failure of preoperative psychological evaluation and screening to avert implantation are discussed.
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Reg Anesth Pain Med · Mar 2004
Case ReportsAn unusual case of painful phantom-limb sensations during regional anesthesia.
The objective of this article is to describe a late-onset phantom-limb pain during a continuous analgesic popliteal nerve block after foot surgery and its alleviation and recurrence when stopping and resuming the local anesthetic infusion. ⋯ This observation suggests that phantom-limb pain can be of late-onset and might occur during a continuous infusion of low-concentration local anesthetic responsible only for an analgesic block, as shown by the fact that only thermal and pinprick sensations, known to depend on Adelta-fibers and C-fibers, were altered. Therefore, this case contradicts the usual belief that a profound block is necessary to elicit phantom-limb pain.
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Ultrasound is a novel method of nerve localization but its use for lower extremity blocks appears limited with only reports for femoral 3-in-1 blocks. We report a case series of popliteal sciatic nerve blocks using ultrasound guidance to illustrate the clinical usefulness of this technology. ⋯ Our preliminary experience suggests that ultrasound localization of the sciatic nerve in the popliteal fossa is a simple and reliable procedure. It helps guide block needle placement and assess local anesthetic spread pattern at the time of injection.
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Reg Anesth Pain Med · Mar 2004
Thoracic epidural catheter insertion using the caudal approach assisted with an electrical nerve stimulator in young children.
We evaluated whether thoracic epidural catheter placement using the caudal approach and assisted with an electrical stimulator could be performed in young children. ⋯ Electrical stimulation reliably indicated the location of the catheter tip. This technique for thoracic epidural catheter insertion was easy to perform and could be used in young children.