Pain practice : the official journal of World Institute of Pain
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Comparative Study Controlled Clinical Trial
The relation between epinephrine concentration and the anesthetic effect of lidocaine iontophoresis.
We assessed the effect of epinephrine at various concentrations on the anesthetic effect during lidocaine iontophoresis. A solution of 2% lidocaine with epinephrine in concentration of 1:80,000, 1:160,000, 1:320,000, 2% lidocaine plain and normal saline control was delivered to the medial antecubital skin for 10 minutes by iontophoresis with 1.0 mA of direct current. The pinprick test and the von Frey test were conducted to evaluate anesthetic effect. ⋯ The pressure pain thresholds (PPT) and the touch thresholds (TT) were significantly elevated in groups with 1:80,000 and 1:160,000 epinephrine compared with the baseline values. No significant elevations in the PPT and TT values were observed in the other groups. The present study revealed that the anesthetic effect was significantly enhanced in an epinephrine dose-related manner and the anesthetic effect of 2% lidocaine with 1:160,000 epinephrine was equivalent to the same anesthetic with 1:80,000 epinephrine.
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Randomized Controlled Trial
Treatment of ischemic pain in patients suffering from peripheral vasculopathy with transdermal buprenorphine plus epidural morphine with ropivacaine vs. epidural morphine with ropivacaine.
This study compared the efficacy and safety of buprenorphine transdermal delivery system with peridural infusion of morphine and ropivacaine to peridural infusion alone for the control of ischemic pain in patients suffering from peripheral vasculopathy. ⋯ Transdermal buprenorphine use resulted in significant pain relief with excellent patient satisfaction, which may translate into improvement in mood and quality of life.
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Case Reports
Successful treatment of lumbar discogenic pain using intradiscal biacuplasty in previously discectomized disc.
Discogenic back pain is frequently present in patients after discectomy. Here, we describe a case of young woman, previously discectomized, who was treated by a novel annuloplasty procedure, intradiscal biacuplasty (IDB). ⋯ Oswestry scale showed functional improvement from 52%, or severe disability, to 14%, or minimal disability, and the SF-36 physical function scale score changed from 55 to 95. IDB may be an effective treatment for patients with discogenic pain from previously discectomized discs.
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The administration of epidural and spinal clonidine has demonstrated an antinociceptive effect in animals and humans. For that reason, its spinal administration has been proposed as an adjuvant in chronic pain management. However, there is limited information about its possible neurotoxic effect after its continuous neuraxial administration. ⋯ These findings showed that continuous intrathecal administration of clonidine did not produce evidence of histological neurotoxicity; therefore it is possible that continuous administration of intrathecal clonidine might be a safe option for treatment of chronic intractable pain; however, further investigations are necessary for evaluating diverse doses and periods of time, and to define its possible behavioral effects.