Prevention and treatment of neurological complications of the upper extremity following local anesthesia

154 Background: Neurological complications such as chemotherapy-induced peripheral neuropathy (CIPN) and neuropathic pain are frequent side-effects of neurotoxic chemotherapy agents. An increasing survival rate and frequent administration of adjuvant chemotherapy treatments involving neurotoxic agents makes it imperative that accurate diagnosis, prevention and treatment of these neurological complications be implemented to minimize the burden experienced by patients undergoing these treatments. Methods: To determine the potential use of pharmaceuticals, nutraceuticals and herbal medicines as adjuvants in cancer treatments a critical literature review was conducted by electronic and manual search on nine databases. These include PubMed, the Cochrane Library, Science Direct, Scopus, EMBASE, MEDLINE, Google Scholar and two Chinese databases CNKI and CINAHL. Thirty studies were selected for pharmaceutical agents, twenty-four studies for nutraceuticals and thirty-four studies for herbal medical trials. Seven acupuncture trials were also identified in relation to CIPN management. Data was collated and organised into chemotherapy drugs, agent’s trialled, number of participants, results and recommendations. Results: For pharmaceutical agents, amifostine has possible ototoxicity protection for children in cisplatin and duloxetine as a treatment option for pain. For nutraceuticals, vitamin E was found to have protective abilities for cisplatin ototoxicity, omega 3 fatty acids for taxane administration and vitamin B6 and lipoic acid for oxaliplatin CIPN. In herbal medicine, Goshajinkigan showed great promise for oxaliplatin-IPN protection. Vitamin B12 deficiencies have also been found to increase the onset and severity of CIPN. Conclusions: Currently, no pharmaceutical, nutraceutical or complementary agent has been found to be completely beneficial in preventing or treating CIPN. It is suggested clinicians identify the best option from the research to assist patients in both possible prevention and treatment of CIPN. In addition, research has found that a vitamin B12 deficiency may potentiate moderate to severe CIPN presentation and testing of this vitamin is suggested.

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Comparison of the Effects of Epidural Anesthesia and Local Anesthesia in Lumbar Transforaminal Endoscopic Surgery

January 2018 - Pain Physician ◽

10.36076/ppj/2016.19.e1001 ◽

2016 ◽

Vol 7;19 (7;9) ◽

pp. E1001-E1004

Author(s):

Zihai Ding

Keyword(s):

Patient Satisfaction ◽

Local Anesthesia ◽

Epidural Anesthesia ◽

Nerve Root ◽

Neurological Complications ◽

Foot Drop ◽

Postoperative Patient ◽

X Ray ◽

Anesthesia Group ◽

Significant Difference

Background: Percutaneous endoscopic lumbar discectomy (PELD) is a standard technique for the treatment of lumbar disc hernia. Thus far, most surgeons have recommended local anesthesia. However, in clinical practice, some patients experience pain and are unable to cooperate with the surgery during intervertebral foramen hemp expansion. The use of general anesthesia may create a greater risk of complications because of nerve root anomalies; thus, intraoperative neurophysiological monitoring should be utilized. Reports regarding the use of epidural anesthesia are few in comparison. Objective: To investigate the risks and contingency plans of epidural anesthesia in lumbar transforaminal endoscopic surgery. Study Design: A retrospective analysis of all lumbar transforaminal endoscopic surgeries performed from 2010 to 2014. Setting: Kanghua hospital. Methods: Patients treated with local and epidural anesthesia were divided into 2 groups. In local anesthesia group (A) and local anesthesia group (B), 0.5% lidocaine and 0.25% ropivacaine was administered, respectively. The incidences of complications, including urological complications, in each surgical group as well as Oswestry disability idex (ODI) improvement rates, postoperative patient satisfaction rates, and x-ray exposure times were assessed. Results: From 2010 to 2014, there were 286 cases of lumbar transforaminal endoscopic surgeries, 121 cases utilizing local anesthesia and 165 cases utilizing epidural anesthesia. In cases in which neurological complications occurred after surgery, 15 cases involved nerve root numbness, including one case of foot drop and 2 cases of cerebrospinal leakage in the local anesthesia group, which accounted for 12.4% of group A. However, in the epidural anesthesia group, which accounted for 9.70% of group B, there were 16 cases of nerve root numbness, including 2 cases of foot drop and 2 cases of cerebrospinal leakage. No significant difference was detected in the incidence of neurological complications between the 2 groups (P > 0.05). The ODI improvement rates were 86.0% in the local anesthesia group and 85.4% in the epidural anesthesia group (P > 0.05). The average x-ray exposure times were 14.7 seconds and 16 seconds in the local anesthesia group and epidural anesthesia group, respectively (P > 0.05). The postoperative patient satisfaction rates were 73.6% and 91% in the local anesthesia group and epidural anesthesia group, respectively (P < 0.001). Limitations: This was a single-blind study, and the complications observed were related to the learning curve; all these factors may lead to biases. Conclusions: Epidural anesthesia in transforaminal lumbar surgery is feasible and safe, and no significant difference in neurological complications was observed between the epidural anesthesia and the local anesthesia groups. However, for the patients concerned, the postoperative patient satisfaction rate was significantly greater in the epidural anesthesia group. It is noteworthy that the x-ray exposure times of the groups were not significantly different. Key words: Epidural anesthesia, transforaminal lumbar surgery, neurological complications, cerebrospinal leak

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Neurological disorders associated with Covid-19 (literature review)

Medical Science And Education Of Ural ◽

10.36361/1814-8999-2020-21-4-140-144 ◽

2020 ◽

Vol 21 (4) ◽

pp. 140-144

Author(s):

M. A. Ahmet’yanov ◽

◽

O. A. Kicherova ◽

L. I. Reikhert ◽

M. V. Deeva ◽

...

Keyword(s):

Nervous System ◽

Literature Review ◽

Healthcare System ◽

Neurological Disorders ◽

Neurological Complications ◽

Pathological Conditions ◽

Prevention And Treatment ◽

Coronavirus Infection ◽

Human Nervous System

The pandemic of the new SARS-CoV2, that started at the beginning of 2020, caused a catastrophic increase in morbidity and mortality in early 2020 and posed a number of challenges for healthcare system. Primarily, this concerns the study of the effect on different organs and systems, that new virus can exhibit. This knowledge further can serve as a key to the development of effective methods for the prevention and treatment of COVID-19 associated pathological conditions. The objectives of this review include the analysis of neurological complications caused by the new coronavirus infection and the determination of the possible mechanisms of the virus’s effect on the human nervous system.

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Current and Future Treatment Considerations in the Management of Aneurysmal Subarachnoid Hemorrhage

Journal of Pharmacy Practice ◽

10.1177/0897190010372334 ◽

2010 ◽

Vol 23 (5) ◽

pp. 408-424 ◽

Cited By ~ 4

Author(s):

Denise H. Rhoney ◽

Karen McAllen ◽

Xi Liu-DeRyke

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Supportive Therapy ◽

Neurological Complications ◽

Stunned Myocardium ◽

Medical Complications ◽

Pharmacological Management ◽

Quality Literature ◽

Prevention And Treatment ◽

Treatment Considerations

Aneurysmal subarachnoid hemorrhage (aSAH) is a type of hemorrhagic stroke that can cause significant morbidity and mortality. Although guidelines have been published to help direct the care of these patients, there is insufficient quality literature regarding the medical and pharmacological management of patients with aSAH. Treatment is divided into 3 categories: supportive therapy, prevention of complications, and treatment of complications. There are numerous pharmacological therapies that are targeted at prevention and treatment of the neurological and medical complications that may arise. Rebleeding, hydrocephalus, cerebral vasospasm, and seizures are the most common neurological complications while the most common medical complications include hyponatremia, pulmonary edema, cardiac arrhythmias, neurogenic stunned myocardium, fever, anemia, infection, hyperglycemia, and venous thromboembolism. Risk factors, clinical presentation, diagnosis, pathophysiology, as well as initial management, prevention, and treatment of complications will be the focus of this discussion.

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Patient management with diabetes mellitus in outpatient practice: prevention and treatment of vascular and neurological complications

Consilium Medicum ◽

10.26442/20751753.2019.4.190325 ◽

2019 ◽

Vol 21 (4) ◽

pp. 45-49

Author(s):

Tatiana E. Morozova ◽

◽

Natalia A. Konyshko ◽

Keyword(s):

Diabetes Mellitus ◽

Patient Management ◽

Neurological Complications ◽

Prevention And Treatment ◽

Outpatient Practice

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Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption

Hand ◽

10.1177/1558944719843635 ◽

2019 ◽

Vol 15 (4) ◽

pp. 447-455

Author(s):

Yehuda Chocron ◽

Albaraa Aljerian ◽

Stephanie Thibaudeau

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Upper Extremity ◽

Local Anesthesia ◽

Pain Reduction ◽

Opioid Consumption ◽

Health Concern ◽

Specific Patient ◽

Nerve Decompression ◽

Prescription Practices

Background: Opioid abuse is a major health concern in North America. Data have shown an alarming increase in opioid-related deaths and complications, which has shed light on current prescription practices across many specialties, including hand surgery. To that end, we sought to conduct a focused literature review to determine the available modalities to decrease postoperative pain and opioid consumption following upper-extremity nerve decompression procedures, taking advantage of the homogeneity and inherent pain pathways of this specific patient cohort. Methods: A systematic review of the literature was conducted. Primary studies evaluating perioperative and intraoperative modalities for postoperative pain reduction and analgesic consumption following upper-extremity nerve decompression procedures under local anesthesia were included. Studies implementing modalities requiring non–hand surgeon expertise (ie, intravenous sedation), as well as studies that include non–nerve decompression procedures, were excluded. Results: A total of 1478 studies were identified, and 9 studies were included after full-text review. Six studies evaluated intraoperative and 3 studies evaluated preoperative and postoperative modalities. Successful interventions included buffered anesthetic, the use of hyaluronidase, and varying techniques and mixtures for anesthetic administration. No successful preoperative or postoperative modalities were identified. Conclusion: Despite data reporting on the dangers associated with current opioid prescription practices, evidence-based modalities to decrease postoperative pain and opioid consumption are limited in general. Several intraoperative modalities do exist, and nonopioid oral analgesics, standardized opioid protocols, and reduced postoperative prescriptions can be used. Large randomized controlled trials evaluating perioperative modalities for pain reduction are needed to further address this issue.

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