Pain medicine : the official journal of the American Academy of Pain Medicine
-
Case Reports
A novel CT-guided transpsoas approach to diagnostic genitofemoral nerve block and ablation.
Inguinal hernia repair is associated with a high incidence of chronic postsurgical pain. This pain may be caused by injury to the iliohypogastric, ilioinguinal, or genitofemoral nerves. It is often difficult to identify the specific source of the pain, in part, because these nerves are derived from overlapping nerve roots and closely colocalize in the area of surgery. It is therefore technically difficult to selectively block these nerves individually proximal to the site of surgical injury. In particular, the genitofemoral nerve is retroperitoneal before entering the inguinal canal, a position that puts anterior approaches to the proximal nerve at risk of transgressing into the peritoneum. We report a computed tomography (CT)-guided transpsoas technique to selectively block the genitofemoral nerve for both diagnostic and therapeutic purposes while avoiding injury to the nearby ureter and intestines. ⋯ CT-guided transpsoas genitofemoral nerve block is a viable option for safely and selectively blocking the genitofemoral nerve for diagnostic or therapeutic purposes proximal to injury caused by inguinal surgery.
-
Randomized Controlled Trial
Double-blinded, placebo-controlled, prospective randomized trial evaluating the efficacy of paravertebral block with and without continuous paravertebral block analgesia in outpatient breast cancer surgery.
Paravertebral block (PVB) is an effective alternative to general anesthesia for breast cancer surgery. Continuous paravertebral block (CPVB) anesthesia may extend postoperative analgesia at home and improve quality of early postoperative recovery of breast cancer patients. ⋯ The current study does not support the routine use of continuous paravertebral catheter anesthesia in patients undergoing operative treatment for breast cancer.
-
Case Reports
Misdiagnosed chronic pelvic pain: pudendal neuralgia responding to a novel use of palmitoylethanolamide.
Pudendal neuralgia is a cause of chronic, disabling, and often intractable perineal pain presenting as burning, tearing, sharp shooting, foreign body sensation, and it is often associated with multiple, perplexing functional symptoms. ⋯ PEA may induce relief of neuropathic pain through an action upon receptors located on the nociceptive pathway as well as a more direct action on mast cells via an ALIA (autocoid local injury antagonism) mechanism. As recently demonstrated in animal models, the present case suggests that PEA could be a valuable pharmacological alternative to the most common drugs (anti-epileptics and antidepressants) used in the treatment of neuropathic pain.
-
To present a technique that better visualizes the needle during interlaminar cervical epidural steroid injection (ICESI) in patients where the lateral view is inadequate. ⋯ Grave complications have been associated with ICESI necessitating impeccable and systematic technique with substantial knowledge of anatomy. Although injection at lower levels is advocated for safety concerns, the needle during lateral view may be obscured by the shoulders in some patients. The "Swimmer's View" position may be attempted when lateral view is insufficient to visualize needle during ICESI.