Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2014
Case ReportsDyskinesia Caused by Ziconotide-Baclofen Combination in an Adolescent Affected by Cerebral Palsy.
To report on the first case of ziconotide-induced dyskinesia. Ziconotide, a synthetic peptide analogue of the ω-conotoxin MVIIA that blocks selectively N-type voltage-sensitive calcium channels, has been used in intrathecal administration for 30 years. Ziconotide is a drug of choice for chronic pain because of its efficacy and flexibility because it can substitute or complement other intrathecal therapies including morphine or baclofen. Whereas substantial information is available regarding its efficacy, systematic data regarding the safety of ziconotide remain scant. The adverse reactions to ziconotide described so far regard only the coordination and execution of intentional movements. ⋯ An analysis of the signaling pathways of baclofen and ziconotide revealed a possible drug interaction that allowed ziconotide to trigger dyskinesia.
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Reg Anesth Pain Med · Mar 2014
A Prospective Validation of Biplanar Ultrasound Imaging for C5-C6 Cervical Medial Branch Blocks.
Ultrasound (US) guidance offers an alternative to fluoroscopy for medial branch blocks of the upper cervical spine, but it may be less accurate for blocks at the C5 and C6 levels. We hypothesized that a modified technique using biplanar US imaging would facilitate level identification and provide greater accuracy for the lower cervical spine. ⋯ Ultrasound guidance using a biplanar approach is a reliable imaging modality for C5 and C6 medial branch blocks.