Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2004
Case ReportsCervical epidural analgesia via a thoracic approach using nerve stimulation guidance in an adult patient undergoing elbow surgery.
This case report describes the placement of a cervical epidural catheter via the thoracic approach, using nerve stimulation, in a patient undergoing elbow surgery. ⋯ This case report suggests that electrical stimulation may allow one to accurately position epidural catheters in the central neuraxial space to provide reliable, effective analgesia of the upper extremity. This approach might be an alternative way to deliver cervical epidural analgesia for patients undergoing upper extremity surgery.
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Reg Anesth Pain Med · Jul 2004
Case ReportsUltrasound guidance for difficult lateral popliteal catheter insertion in a patient with peripheral vascular disease.
Interest in ultrasound-guided nerve block is increasing, but clinical utility still is being determined. We report a case in which ultrasound imaging aided nerve localization during popliteal block. ⋯ Ultrasound guidance can facilitate lateral popliteal catheter insertion in patients in whom electrolocation has failed.
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Reg Anesth Pain Med · Jul 2004
Case ReportsFemoral nerve injury complicating continuous psoas compartment block.
The objective of this case report is to describe a femoral nerve injury after a psoas compartment block (PCB) and to discuss the probable mechanisms of injury and neuron regeneration. To date, this is the first report of severe femoral nerve injury after PCB. ⋯ Severe nerve injuries after regional anesthesia techniques remain infrequent and probably unreported. Our case report suggests that severe femoral nerve injury should be added to the list of reported complications during PCB. This case report is also encouraging because it shows the possibility of a good recovery after such injury.
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Reg Anesth Pain Med · Jul 2004
Case ReportsCombined spinal-epidural technique for vaginal hysterectomy in a patient with Machado-Joseph disease.
Machado-Joseph disease is a form of progressive spino-cerebellar ataxia with both bulbar and peripheral neurological manifestations. To date, anesthesia for patients affected by this disease has not been described. General anesthesia may be problematic because of the risk of pulmonary aspiration and hypoxia. We describe our experience with the successful use of combined spinal-epidural in a patient with Machado-Joseph Disease (MJD). ⋯ Central neuraxial anesthesia is an option for patients with MJD presenting for lower abdominal and lower extremity operations. Combined spinal-epidural anesthesia confers hemodynamic stability yet allows for augmentation of intraoperative anesthesia and postoperative analgesia.
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Reg Anesth Pain Med · Jul 2004
Case ReportsPiriformis syndrome in a patient after cesarean section under spinal anesthesia.
The diagnosis, pathogenesis, and treatment of piriformis syndrome as a cause of persistent buttock and hip pain after spinal anesthesia are presented in this case report. ⋯ Back pain with radiation into the buttocks after spinal anesthesia is frequently attributed to the spinal procedure itself. However, prolonged sitting and weight bearing in the upright position after cesarean delivery can cause sciatic nerve compression at the sacroiliac joint with concomitant irritation, inflammation, and spasm of the piriformis muscle. Piriformis syndrome is frequently underdiagnosed in the obstetric population. Because the diagnosis of piriformis syndrome is based mainly on clinical signs and symptoms, the clinician must have a high index of suspicion.