Articles: pain-clinics.
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Interlaminar cervical epidural steroid injections (ic-ESI) are safe and effective treatment options for the management of acute and chronic radiculopathy, spinal stenosis, and other causes of neck pain not responding to more conservative measures. However, the procedure inherently lends itself to possible spinal cord injury (SCI). Though reports of such events have been documented, the clinical presentation of patients with needle puncture SCI varies. ⋯ Though most cases of devastating outcomes, such as hemiplegia and death, have been reported during cervical transforaminal epidural injections and rarely with ic-ESI, it is important to understand the symptoms and potential pitfalls of performing any cervical epidural injection. Cervical epidural malpractice claims are uncommon, but exceed those of steroid blocks at all the levels combined, demonstrating the need for improved awareness of potential complications in ic-ESI. Here, we will describe an unusual presentation of a spinal cord injection during an ic-ESI procedure.
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The current retrospective study was completed with the aim to identify demographic characteristics and clinical predictors (if any) of the patients discharged from our pain clinic due to breach in narcotic use contract (BNUC). ⋯ In 2011-2012, our pain clinic discharged 1-in-16 patients due to breach in narcotic use contract.
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Patients over the age of 65 represent 15% of Canada's population and one-third of patients undergoing surgery. Older surgical patients often have lasting disability following "minor" ambulatory procedures. This study sought to explore the postoperative experience of ambulatory surgery, as described by older surgical patients and their caregivers. ⋯ Patients and caregivers ardently described real challenges during convalescence. Ambulatory care facilities should prepare this specific demographic of patients and caregivers for the post-discharge experience. Paramount for participants was the need for clear communication and a commitment to ongoing support following discharge. The trial on which this analysis was based was registered with Clinical Trials.gov (NCT01382251).
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Minerva anestesiologica · Oct 2014
ReviewPharmacological and clinical differences among transmucosal fentanyl formulations for the treatment of breakthrough cancer pain. A review article.
Breakthrough pain (BTP) is highly prevalent (59.2%) in chronic cancer patients and normally needs rescue treatments' with opioids when pain flares up. Transmucosal oral/nasal fentanyl formulations are commonly used in clinical practice. The different methods of release influence the pharmacokinetics and clinical properties of these formulations. ⋯ In parallel, we report the differences in delivery systems, bioavailability, maximum plasma concentration (Cmax), plasma half-life, and time to reach Cmax (tmax). Considerable variability emerged between formulations. This suggests some considerations on the choice of the fentanyl formulation in the light of the BTP features in each clinical case.
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Acta Anaesthesiol Scand · Oct 2014
Pain management following the Nuss procedure: a survey of practice and review.
Pectus excavatum is the most common congenital chest wall deformity. The Nuss procedure is frequently used for surgical correction and this technique has been associated with severe and prolonged post-operative pain. At the present time, the optimal analgesic strategy for managing patients following this procedure has not been determined. ⋯ Post-operative pain management following the Nuss procedure is variable and poorly characterized. Clinical trials or large observational registries comparing the safety and efficacy of primary modalities and long-term outcomes are needed to enable evidence-based decision-making for the management of these patients.