Articles: surgery.
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Intrathecal morphine (ITM) is commonly used for the treatment of cancer pain. There is reluctance for its use in France to treat chronic noncancer pain. In order to appreciate its popularity, efficacy, dose escalation with time, and long-term tolerance, we carried out a retrospective study in the neurosurgery departments of university teaching hospitals in France involved in intrathecal drug therapy. ⋯ Side effects imputable to morphine included; constipation, somnolence, decreased libido, weight gain, amenorrhoea, vomiting, nightmares, and itching. No development of tolerance or addiction were recorded. We conclude that in well selected cases ITM should be considered as a possible therapeutic option in the treatment of intractable chronic benign pain.
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Computed tomography (CT) scanning is the gold standard for displaying and visualizing complex anatomic structures such as the calcaneus, pelvis, and spine, etc. In orthopedic surgery CT scanning is unfortunately not available in the OR where it would be highly effective if scans could be done prior to wound closure. The reasons are high costs, need for constructional changes in the OR, and additional staff (radiologic technologist), etc. ⋯ Since February 2001 we have been able to use the ISO C(3D) in our hospital and meanwhile we have scanned 442 surgical sites including the calcaneus, cervical spine, and acetabulum, etc. The intraoperative scans revealed fracture gaps and steps, unsatisfactory fragment alignment, or incorrectly positioned implants, leading to an overall revision rate of 7.3%The ISO C(3D) is a first step towards a new future for bone visualization. The next steps will bring an increase in scan area and resolution, and the high-contrast pictures will be replaced by ones very similar to modern CT slices showing certain soft tissue structures.
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Intraoperative neurophysiologic monitoring provides useful information on the functional status of the nervous system. This review focuses on recently published data concerning the impact of monitoring on patient outcome. ⋯ Brain monitoring facilitates anesthetic drug administration. An increasing number of neurosurgical procedures will require some form of intraoperative neurophysiologic monitoring to achieve higher degrees of safety and accuracy. In many instances, the data derived from monitoring will guide and influence surgical decisions. In this context, neurophysiologic monitoring should be regarded as interventional.
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The objective of this paper is to assess the outcome of implanted multiple thoracolumbar lead spinal cord stimulation (SCS) in mechanical back pain without prior spinal surgery. These results are compared with intrathecal opioid drug delivery (ITDD). An anonymous third party patient questionnaire study of pain relief, function and psychosocial quality of life measures (recorded on 11-point numerical rating scales) for 12 patients with SCS and 13 with ITDD was used. ⋯ The majority of psychosocial quality of life measures were significantly more improved in the ITDD group compared with the SCS group (p < 0.05). We conclude that multiple-lead SCS improves mechanical back pain in patients unresponsive to more conservative measures. However, ITDD provides significantly more improved quality of life measures, with a trend towards greater pain reduction than SCS.
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The purpose of this review is to present the most important recent studies into the clinical use of peripheral nerve blocks for anesthesia and postoperative analgesia of the lower limb surgery. ⋯ Introduction of new methods and techniques are increasing and improving the use of lower peripheral nerve blocks. These techniques are gaining interest after the important increase of the lower molecular weigh heparins.