Articles: patients.
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The role of anesthesia outside the operating room is rapidly expanding and evolving alongside with the advances in interventional neuroradiology. Increasingly complex diagnostic and therapeutic neuroradiological procedures are being performed on sicker patients. This review provides an overview of the principles of anesthetic management and summarizes recent advances in interventional neuroradiology. ⋯ Providing anesthesia in the interventional neuroradiology suite continues to be a challenge to the anesthesiologist. Understanding the anesthetic constraints and complexities and keeping abreast of the current developments in neuroradiology are crucial in ensuring the maximal benefits to and safety of patients.
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Postoperative epidural fibrosis may contribute to between 5% to 60% of the poor surgical outcomes following decompressive surgery. Correlations have been reported between epidural scarring and radicular pain, poor surgical outcomes, and a lack of any form of surgical treatment. The use of spinal endoscopic adhesiolysis in recent years in the management of chronic refractory low back and lower extremity pain has been described. ⋯ Spinal endoscopic adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of patients with chronic low back and lower extremity pain without major adverse effects.
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Multiple studies have documented the incidence of illicit drug use and abuse of opioids. Over the years, several hypotheses have been proposed. Short-acting opioids such as hydrocodone are generally considered to predispose patients to poor pain management, dependency, misuse, or abuse; whereas long-acting opioids such as methadone are thought to provide sustained pain management without dependency or abuse. ⋯ There were no significant differences as to illicit drug use and/or misuse of opioids in patients treated with hydrocodone or methadone. These findings suggest that the use of a long acting opioid formulation by patients with chronic pain does not reduce the risk of drug abuse or improve compliance with medical therapy.
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In recent years, transforaminal epidural injections have emerged as an alternative to interlaminar and caudal epidural steroid injections. The rationale for utilizing transforaminal epidural injections has been described for diagnostic as well as therapeutic purposes. The evidence for lumbar transforaminal epidural steroid injections in managing lumbar nerve root pain is strong, whereas it is moderate in managing cervical nerve root pain. However, these techniques are also associated with rare, but catastrophic, neurologic complications. ⋯ This case report describes vascular injury leading to an infarction of the spinal cord following a thoracolumbar transforaminal epidural steroid injection. Alternative approaches to, or alternatives means of, performing transforaminal injections should be considered to avoid devastating neurological complications.