Articles: nerve-block.
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This prospective study was designed to determine the prevalence of lumbar facet joint pain in a consecutive series of patients with chronic low back pain treated at an interventional, multidisciplinary private pain management practice utilizing double diagnostic blocks, to determine the prevalence of false positive rate of uncontrolled facet joint blocks, and to determine the relationship of clinical features of responders and non-responders to double diagnostic blocks. One hundred and twenty patients with low back pain with or without lower extremity pain were selected. The procedure consisted of diagnostic blocks using lidocaine and bupivacaine on separate occasions, usually two weeks apart. ⋯ However, history of previous surgery showed a negative correlation as only 29% of the patients after previous surgery were positive in contrast to 51% of the nonsurgical population. The results of this study echo previous concerns of reliability of uncontrolled single blocks, history, and clinical features. This study demonstrated that the facet joint is a source of pain in 45% of the patients suffering with chronic low back pain in an interventional pain management setting in a private practice.
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Chronic neck pain, headache, and arm pain are some of the most common patient complaints confronting today's health care provider. Chronic neck pain is reported to be a frequency symptom in 34% of the general population with 14% of the general population reporting neck pain that lasted for more than 6 months. The magnitude of the problem is demonstrated by increase of cervical spine surgery by 45% and cervical fusion by 70% over a ten year period from 1979 through 1988. ⋯ Neural blockade in the cervical spine, though introduced in 1912, lagged behind that of the lumbar spine. At the present time, neural blockade is an extremely popular tool for diagnostic purposes in evaluation of neck pain, even though it has not developed a definitive role in the management of chronic neck pain and associated syndromes. The object of this review is to focus on various aspects of neural blockade in the management of chronic neck pain and associated syndromes including its rationale, clinical effectiveness, indications, and complications.
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Middle East J Anaesthesiol · Oct 1999
ReviewHaemostasis-altering drugs and central neuraxial block.
The purpose of this article is to review the literature concerning the use of epidural and spinal anaesthesia in patient receiving haemostasis-altering drugs, and to provide clear guidelines concerning the safe use of those anaesthetic in this category of patients. ⋯ Central neuraxial block should be avoided in fully anticoagulated patients. In partially anticoagulated patient, strict delays should be respected according to the pharmacology of the anticoagulants used, before institution of the central neuraxial block. Manipulation of epidural catheters should not be done unless the level of anticoagulation is low.