A & A case reports
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Persistent postsurgical pain after amputation is common and has a number of proposed risk factors. We describe the management of a patient with persistent pain after a below-the-knee amputation. We used a combination of general, peripheral, and neuraxial anesthesia techniques to control postoperative phantom limb and stump pain in a patient at high risk for developing chronic pain. With preemptive management and mechanism-directed therapies, adequate preoperative and postoperative pain control were achieved in attempts to reduce the risk of chronic phantom limb pain.
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Brachial plexus avulsion is a rare and debilitating condition frequently associated with severe, intractable neuropathic pain. Interventional treatment modalities include dorsal root entry zone lesioning, stellate ganglion blockade, and neuromodulation such as spinal cord stimulation. ⋯ After a successful trial of cervical spinal cord stimulator lead placement, she went on to an uneventful permanent implantation procedure. Spinal cord stimulation is an effective treatment for deafferentation pain and complex regional pain syndrome type II secondary to brachial plexopathy refractory to pharmacotherapy and conventional interventional attempts to modulate pain.
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Involuntary movements in patients with cerebral palsy can interfere with invasive procedures performed under sedation. We present a case of a 58-year-old man with cerebral palsy, who successfully underwent a cardiac catheterization while sedated with IV dexmedetomidine. The patient's involuntary movements were suppressed, which allowed the cardiologist to perform the procedure on an immobile, cooperative patient, all while maintaining patient comfort, stable hemodynamics, as well as adequate oxygenation and ventilation. This novel use of dexmedetomidine might facilitate monitored anesthesia care in patients otherwise requiring general anesthesia.