P R Health Sci J
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Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the central and/or peripheral nervous systems, including infection, trauma, metabolic abnormalities, and nerve compression, and is typically accompanied by hyperalgesia and allodynia. Neuropathic pain can be mild to excruciating, debilitating, difficult to manage, cause depression, decrease the quality of life, require extremity amputations, and has a variety of clinical symptoms. It effects up to 5% of the population, 70% of patients with advanced cancer and inflammatory pathologies, and 95% of patients with spinal cord injuries. ⋯ Alternative treatments to pharmacology include peripheral or neuraxial nerve blockade, and implanted cortical or spinal cord stimulators. However, the great need remains for development of new and more effective approaches to reducing neuropathic pain. This review examines various approaches currently used for treatment of neuropathic pain and potential new and more effective approaches.
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Lumbar discectomy is the most common surgical procedure performed in the United States for patients having back and leg symptoms. The vast majority of the procedures are elective and are performed under general anesthesia. ⋯ The use of Dexmedetomidine was discussed with the patient, explaining the advantage of motor and sensory testing during the surgery and immediate patient feedback. Awake laminotomy and discectomy could be performed as an ambulatory procedure, since the use of Dexmedetomidine as the main anesthetic represents a safe and convenient alternative to general anesthesia in this patient with lumbar disc herniation.