Pain physician
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Over the past decade granulomas have been noted to occur at or near the tip of intrathecal catheters used for spinal infusions. The majority of cases involved morphine infusions, although other drugs have been implicated. Granulomas may be asymptomatic or cause significant neurological deficits. ⋯ Intrathecal granulomas were identified in 3% of patients imaged in this series. Eighty percent of the patients were asymptomatic. MRI imaging remains the diagnostic method of choice for most patients, and can be done safely when scans are taken at the level of the catheter tip. Given the low incidence of granulomas with intrathecal catheters, routine imaging to identify granulomas is not warranted.
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The sphenopalatine ganglion block has been utilized over the last century for a wide variety of maladies. This paper provides a brief history of the use of the sphenopalatine ganglion block, a review of the sphenopalatine ganglion anatomy, and the diagnoses which currently warrant its use. The traditional transnasal sphenopalatine ganglion block is described and our modification of the traditional technique is proposed. A case study is described in which sphenopalatine block pain control in a patient with a 20-year history of poorly controlled pain from bilateral herpetic keratitis.
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To demonstrate the effectiveness of Sarapin in prolonging the action of neural blockade with improved pain relief. ⋯ This prospective, double-blind trial of 500 patients undergoing 828 treatments, one time with Sarapin and a subsequent time without, with each patient acting as their own control, showed no significant differences in the pain relief or duration of significant relief with the addition of Sarapin.
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To evaluate the pattern and flow of epidural contrast in fluoroscopically guided lumbar interlaminar steroid injections. ⋯ Thirty six percent of the injections observed in the study revealed ventral contrast flow. Bilateral contrast flow occurred in 16% of the injections. Caudad contrast flow is less than cephalad. The observed contrast flows need to be studied clinically to determine if this can affect clinical outcome.
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To evaluate accuracy of needle placement and flow patterns of fluoroscopically guided caudal epidural injections. ⋯ Caudal epidural injections are ideally performed with fluoroscopic guidance as the gold standard for accurate needle placement. However, this does not assure either targeted delivery or accurate placement of the drug.