Pain practice : the official journal of World Institute of Pain
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The neuroselective effects of tourniquet ischemia/compression in healthy volunteers were evaluated using the automated electrodiagnostic sensory Nerve Conduction Threshold (sNCT) test. The sNCT evaluation generates reliable, painless Current Perception Threshold (CPT) measures. Standardized CPT measures using constant alternating current sinusoid waveform stimulus at 3 different frequencies 5 Hz, 250 Hz, and 2 kHz (NeurometerEG CPT/C Neurotron, Inc. ⋯ There were no significant changes in 5 Hz CPT measures. The results of this study demonstrate the ability of the sNCT test to quantify previously described differential neuroselective effects of tourniquet ischemia on sensory nerve function. Demonstration of statistically significant increases in CPT values at 2000 Hz and 250 Hz secondary to tourniquet ischemia, with no change in 5 Hz CPT values, is consistent with the understanding that 2000 Hz sine wave stimuli activate the large myelinated sensory fibers, 250 Hz sine wave stimuli activate small myelinated sensory fibers, and 5 Hz sine wave stimuli activate small unmyelinated sensory fibers.
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Complex Regional Pain Syndrome Type-I (CRPS-I) is a neuropathic pain syndrome resulting from complex pain mechanisms that involve several levels and components of the nervous system. CRPS-I consists of multiple signs, including autonomic dysfunction, in the form of edema, vasomotor changes, motor dysfunctions, muscle spasms, tremors and dystonia, as well as burning pain, hypersensitivity and allodynia that could present in any combination. ⋯ Multiple analgesic modalities have been used to facilitate the rehabilitation program with varying rates of success. The most successful treatment is a multi-disciplinary comprehensive approach, where initial pain control allows for physical and psychological interventions that are believed to be the basis for successful treatment.(1) The pain in CRPS-I may be mediated through the sympathetic nervous system, sympathetic maintained pain (SMP) or sympathetic independent pain (SIP)(2).
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Bupivacaine is a long-acting amide local anesthetic that was introduced to clinical practice in the early 1980s. Since then it has been extensively used for both peripheral blocks as well as neuraxial blockade in concentrations varying from 0.125% to 0.75%. Despite the relatively narrow safety margin, bupivacaine has become the most frequently used local anesthetic in obstetric anesthesia. ⋯ Several studies have failed to show TNS after spinal anesthesia using bupivacaine 0.5% or 0.75%. In the literature there is only 1 case report of TNS after spinal anesthesia using bupivacaine and morphine. The following report describes a case of TNS following spinal anesthesia with bupivacaine 0.75%.
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Facet arthropathy is a common cause of spine-related pain. Typically resulting from spondylosis, trauma, including surgical trauma or post surgical stress is also a significant cause. Radiofrequency thermocoagulation or neurolysis may be an effective modality providing long-term improvement. ⋯ In summary, 85% of cervical and 71% of lumbar RFTC cases had at least a 50% improvement in symptoms for extended periods. RFTC of median branches for facet arthropathy is a safe and efficacious modality with the potential for long-term benefit.
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A CSF leak that persists despite conservative therapy may significantly increase the morbidity associated with implantable intrathecal drug delivery systems. This report presents 2 cases where the application of a subdural blood patch led to the satisfactory resolution of a persistent CSF leak after previous epidural blood patches had failed.