Articles: treatment.
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Ambulatory surgery is now one of the major areas of surgical and anesthetic practice, with up to 70% of procedures performed in the ambulatory setting. This review focuses on some of the recent studies performed in day case anesthesia. ⋯ Careful patient selection can minimize perioperative events. The concept of multimodal analgesic and antiemetic therapy, in combination with newer anesthetic drugs, help expand the field of ambulatory surgery.
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To assess the effectiveness of the lidocaine patch 5% (Lidoderm), a targeted peripheral analgesic, in reducing pain intensity/interference with quality of life (QOL) among patients with postherpetic neuralgia (PHN). ⋯ Based on results of previous randomized, controlled trials and the current study, designed to gauge response in the clinical practice setting, the lidocaine patch 5% should be considered a first-line therapy, alone or in combination with other agents, for PHN due to its efficacy, safety, minimal systemic side effects and drug interactions, and ease of administration. Although the lidocaine patch 5% was equally effective in longstanding PHN, it would appear prudent to begin therapy as early in the course of PHN as possible.
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Many treatment options are available for the management of cancer pain including drugs, local excision, radiation, brachytherapy, and nerve blocks. Percutaneous radiofrequency ablation has been used to treat painful neurologic and bone lesions and thus could potentially be used to treat cancer pain in other sites. Two superficial subcutaneous metastatic nodules were treated with percutaneous radiofrequency ablation. The patient received significant pain relief and improved quality of life.
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J Stroke Cerebrovasc Dis · Nov 2002
International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial.
Endovascular detachable coil treatment is being increasingly used as an alternative to craniotomy and clipping for some ruptured intracranial aneurysms, although the relative benefits of these two approaches have yet to be established. We undertook a randomized, multicenter trial to compare the safety and efficacy of endovascular coiling with standard neurosurgical clipping for such aneurysms judged to be suitable for both treatments. We enrolled 2143 patients with ruptured intracranial aneurysms and randomly assigned them to neurosurgical clipping (n = 1070) or endovascular treatment by detachable platinum coils (n = 1073). ⋯ The risk of rebleeding from the ruptured aneurysm after 1 year was two per 1276 and zero per 1081 patient-years for patients allocated endovascular and neurosurgical treatment, respectively. In patients with a ruptured intracranial aneurysm, for which endovascular coiling and neurosurgical clipping are therapeutic options, the outcome in terms of survival free of disability at 1 year is significantly better with endovascular coiling. The data available to date suggest that the long-term risks of further bleeding from the treated aneurysm are low with either therapy, although somewhat more frequent with endovascular coiling.
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The herpes zoster rash occurs when a dormant varicella zoster virus reactivates in dorsal root and cranial nerve ganglia. Pain that persists in the region where this rash occurred after the cutaneous lesions have healed is termed postherpetic neuralgia (PHN). A wide variety of therapies has been used with varying degrees of success to prevent the occurrence of PHN and to reduce pain with established PHN. ⋯ Several classes of drugs are effective in attenuating the pain and hyperalgesia caused by PHN, but no single drug leads to the complete relief of symptoms. Additional research is needed to improve treatment strategies and define the role of invasive pain management techniques in cases where PHN is associated with intractable pain.