Erector spine plane block as postoperative rescue analgesia in thoracic surgery

2020 ◽  
Vol 106 (5) ◽  
pp. 388-391
Author(s):  
Marco Rispoli ◽  
Roberta Tamburri ◽  
Moana Rossella Nespoli ◽  
Marianna Esposito ◽  
Dario Maria Mattiacci ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Rating Scale ◽  
Dynamic Assessment ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Numeric Rating Scale ◽  
Forced Expiratory Volume ◽  
Gas Analysis ◽  
Rescue Analgesia ◽  
Surgical Ward

Objective: Erector spine plane block (ESPB) is a newly defined regional anesthesia technique performed by injection of local anesthetic beneath the erector spine muscle. We tested ESPB as a regional rescue analgesia bedside technique to be performed in the thoracic surgical ward, reporting a 7-patient case series. Methods: We report our experience in rescue analgesia after thoracic surgery. During the postoperative stay, numeric rating scale (NRS) score >3 and inability to perform physiotherapy or effective cough due to postoperative pain represented the criteria for proposing rescue analgesia with ESPB. NRS at rest and during movements was recorded; blood gas analysis and spirometry were performed to evaluate PaO2/FiO2 (P/F), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) before ESPB execution. After performing the ESPB, static and dynamic NRS, P/F, and FVC and FEV1 were recorded at 40 minutes and 80 minutes. Results: NRS had a reduction at rest and in dynamic assessment. The P/F did not improve but spirometric measures improved. FVC had a relevant improvement only after 80 minutes; FEV1 was increased after 40 minutes. Conclusion: The use of ESPB as postoperative rescue analgesia can offer several advantages due to effective rescue analgesia and safety that makes it easy to perform in the thoracic surgical ward or in an outpatient clinic setting.

scholarly journals Serratus anterior plane block in modified radical mastectomy surgery: a case series

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Madonna Damayanthie Datu ◽  
Jokevin Prasetyadhi
Keyword(s):  
Side Effects ◽  
Rating Scale ◽  
Case Series ◽  
Radical Mastectomy ◽  
Numeric Rating Scale ◽  
Breast Pain ◽  
Modified Radical Mastectomy ◽  
Serratus Anterior ◽  
Rescue Analgesia ◽  
Anterior Plane

Abstract Background Postoperative breast pain may lead to poorer outcome if left untreated. Common analgesia modalities for postoperative breast pain include opioids and regional anesthesia. However, both of these modalities can cause significant side effects or complications. Serratus anterior plane (SAP) block is a new procedure that is relatively easier to perform and safer, compared with other modalities. Previous studies have reported its usefulness in reducing the need for both intraoperative and postoperative opioids. Case We reported 2 patients that underwent SAP block combined with general anesthesia in modified radical mastectomy (MRM). Patient 2 was given rescue analgesia during the intraoperative period. The administration of postoperative opioids did not exceed 24 h in both patients. Pain assessment using numeric rating scale (NRS) showed minimal postoperative pain. No side effects were found during 24-h monitoring period. Conclusion SAP block can be used as one of the modalities in managing the pain of MRM surgery.

The efficacy of transcatheter arterial embolization for knee pain on patients with knee osteoarthritis: A case series

2021 ◽  
pp. 1-6
Author(s):  
Kun Yung Kim ◽  
Gi-Wook Kim
Keyword(s):  
Conservative Treatment ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Transcatheter Arterial Embolization ◽  
Rating Scale ◽  
Case Series ◽  
Arterial Embolization ◽  
Numeric Rating Scale ◽  
Knee Oa ◽  
Before And After

BACKGROUND: Knee osteoarthritis (OA) is accompanied by inflammation and angiogenesis. Modifying angiogenesis through transcatheter arterial embolization (TAE) can be a potential treatment for knee OA. OBJECTIVE: We subjected five OA knees in three patients to TAE and report the results of our post-treatment observations. CASE DESCRIPTION: Three patients that had experienced knee pain for a minimum of one year prior to the study, and whose pain had persisted despite conservative treatment, were included in this study. Patients more often chose conservative treatment over surgical treatment. Pain and functional scales were evaluated before, immediately, and 1 month after TAE using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). TAE was performed by an experienced interventional radiologist. The average values of NRS evaluated before and after 5 TAEs were 5.2 before TAE, 3 immediately after TAE, and 3.6 after 1 month of TAE, and the average values of WOMAC were 52, 38.4, and 36.4, respectively. There were no major adverse effects. CONCLUSION: The examined cases support the conclusion that TAE is an effective treatment for patients with knee OA. Substantial pain relief and WOMAC improvement were observed both immediately and one month after TAE.

A Treatment-Based Classification Algorithm to Treat Achilles Tendinopathy: An Exploratory Case Series

2017 ◽  
Vol 26 (3) ◽  
pp. 260-268
Author(s):  
Patti Syvertson ◽  
Emily Dietz ◽  
Monica Matocha ◽  
Janet McMurray ◽  
Russell Baker ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Repeated Measures ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Achilles Tendinopathy ◽  
Global Rating ◽  
Physically Active ◽  
Indirect Treatment

Context:Achilles tendinopathy is relatively common in both the general and athletic populations. The current gold standard for the treatment of Achilles tendinopathy is eccentric exercise, which can be painful and time consuming. While there is limited research on indirect treatment approaches, it has been proposed that tendinopathy patients do respond to indirect approaches in fewer treatments without provoking pain.Objective:To determine the effectiveness of using a treatment-based-classification (TBC) algorithm as a strategy for classifying and treating patients diagnosed with Achilles tendinopathy.Participants:11 subjects (mean age 28.0 ±15.37 y) diagnosed with Achilles tendinopathy.Design:Case series.Setting:Participants were evaluated, diagnosed, and treated at multiple clinics.Main Outcome Measures:Numeric Rating Scale (NRS), Disablement in the Physically Active Scale (DPA Scale), Victorian Institute of Sport Assessment–Achilles (VISA-A), Global Rating of Change (GRC), and Nirschl Phase Rating Scale were recorded to establish baseline scores and evaluate participant progress.Results:A repeated-measures ANOVA was conducted to analyze NRS scores from initial exam to discharge and at 1-mo follow-up. Paired t tests were analyzed to determine the effectiveness of using a TBC algorithm from initial exam to discharge on the DPA Scale and VISA-A. Descriptive statistics were evaluated to determine outcomes as reported on the GRC.Conclusion:The results of this case series provide evidence that using a TBC algorithm can improve function while decreasing pain and disability in Achilles tendinopathy participants.

scholarly journals Transposition of the lateral femoral cutaneous nerve

2019 ◽  
Vol 130 (2) ◽  
pp. 496-501 ◽  
Author(s):  
Amgad Hanna
Keyword(s):  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Meralgia Paresthetica ◽  
Femoral Cutaneous Nerve ◽  
Simple Decompression ◽  
Reoperation Rates ◽  
Numeric Rating

OBJECTIVEMeralgia paresthetica causes pain, burning, and loss of sensation in the anterolateral thigh. Surgical treatment traditionally involves neurolysis or neurectomy of the lateral femoral cutaneous nerve (LFCN). After studying and publishing data on the anatomical feasibility of LFCN transposition, the author presents here the first case series of patients who underwent LFCN transposition.METHODSNineteen patients with meralgia paresthetica were treated in the Department of Neurological Surgery at University of Wisconsin between 2011 and 2016; 4 patients underwent simple decompression, 5 deep decompression, and 10 medial transposition. Data were collected prospectively and analyzed retrospectively. No randomization was performed. The groups were compared in terms of pain scores (based on a numeric rating scale) and reoperation rates.RESULTSThe numeric rating scale scores dropped significantly in the deep-decompression (p = 0.148) and transposition (p < 0.0001) groups at both the 3- and 12-month follow-up. The reoperation rates were significantly lower in the deep-decompression and transposition groups (p = 0.0454) than in the medial transposition group.CONCLUSIONSBoth deep decompression and transposition of the LFCN provide better results than simple decompression. Medial transposition confers the advantage of mobilizing the nerve away from the anterior superior iliac spine, giving it a straighter and more relaxed course in a softer muscle bed.

scholarly journals Genicular Nerve Radiofrequency Ablation for Chronic Knee Pain Using a Three-Tined Electrode: A Technical Description and Case Series

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3344-3349
Author(s):  
Edvin Koshi ◽  
Cole W Cheney ◽  
Beau P Sperry ◽  
Aaron Conger ◽  
Zachary L McCormick
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Vastus Medialis ◽  
The Novel ◽  
Chronic Knee Pain ◽  
Numeric Rating

Abstract Background Genicular nerve radiofrequency ablation (RFA) for the treatment of chronic knee pain has traditionally targeted the superomedial, superolateral, and inferomedial genicular nerves. However, recent cadaveric studies of knee neuroanatomy demonstrate varied locations of these specific nerves as well as additional articular nerves. This work suggests that traditional genicular nerve RFA lesion locations may be inadequate. Objective 1) To describe a novel protocol utilizing a three-tined RFA electrode to target the superomedial (SMGN), superolateral (SLGN), and inferomedial genicular nerves (IMGN), as well as the terminal articular branches of the nerves to the vastus medialis (NVM), intermedius (NVI), and lateralis (NVL). 2) To assess the ability of this technique to reduce chronic knee pain. Methods Case series of consecutive patients with six or more months of refractory knee pain who underwent genicular nerve RFA according to the novel protocol described. Seven discrete RFA lesions were placed to target the SMGN, NVM, NVI, NVL, SLGN, and IGMN. Results Eleven patients underwent RFA, nine with knee osteoarthritis and two postarthroplasty. At one month, 91% (95% CI = 59–100%), 82% (95% CI = 48–98%), and 9% (95% CI = 2–41%), of patients reported ≥50%, ≥80%, and 100% improvement in knee pain on the numeric rating scale, respectively. These results were sustained at six months. There were no complications. Discussion/Conclusions These preliminary data suggest the feasibility and possible effectiveness of genicular nerve RFA using the described novel protocol including a three-tined electrode. Larger-scale studies with comparative groups are warranted.

scholarly journals Effects of Korean Medicine Treatment focusing on Acupotomy of headache: A Case Report of Four Patients

2021 ◽  
Vol 42 (3) ◽  
pp. 176-184
Author(s):  
Joohyun Lee ◽  
Hongmin Chu ◽  
Kyungho Kang ◽  
Ju-hyeon Moon ◽  
Jongchul Kim ◽  
...  
Keyword(s):  
Clinical Effect ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Attack Frequency ◽  
Headache Attack ◽  
Positive Clinical Effect ◽  
Headache Impact ◽  
Numeric Rating Scale Score ◽  
Numeric Rating

Background: The aim of this study was to report the effect of acupotomy for patients with headache. Methods: Four patients with headache were treated with acupotomy. The improvement of symptoms was evaluated by numeric rating scale(NRS), Headache impact test-6(HIT-6) and headache attack frequency. Results: The numeric rating scale score and headache attack frequency decreased throughout the treatment period. No side effects were observed during treatment. Conclusion: Acupotomy had shown a positive clinical effect in the treatment of a headache in this case series. Further studies are required for its application on various headache.

scholarly journals Screening Children with a Family History of Central Congenital Hypoventilation Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Hina Emanuel ◽  
Kimberly Rennie ◽  
Kelly Macdonald ◽  
Aravind Yadav ◽  
Ricardo A. Mosquera
Keyword(s):  
Family History ◽  
Genetic Disorder ◽  
Neuropsychological Testing ◽  
Clinical Manifestations ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Cor Pulmonale ◽  
Gas Analysis ◽  
Neuropsychological Evaluations ◽  
Hypoventilation Syndrome

Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder of an autonomic nervous disorder that affects breathing. It is characterized by respiratory insufficiency secondary to insensitivity to hypoxemia and hypercarbia, particularly during sleep leading to persistent apnea. We report four individuals across two generations harboring heterozygous 25 polyalanine repeats mutations (PARMs) in PHOX2B with a varying degree of phenotypic clinical manifestations. Two family members who reported to be “asymptomatic” were subsequently diagnosed with CCHS, based on genetic testing, obtained because of their family history. Genetic studies in the family including a mother and three offsprings revealed in-frame five amino acid PARMs of PHOX2B consistent with CCHS in addition to full clinical assessment. All affected individuals had evidence of hypercapnia on blood gas analysis with PCO2 in the range of 32–70 (mean; 61). Nocturnal polysomnogram revealed evidence of hypoventilation in two individuals (1 offspring and mother) with the end-tidal CO2 median of 54. Magnetic resonance imaging of brain revealed no abnormalities in the brain stem. There was no evidence of cor pulmonale on echocardiograms in all individuals. Neuropsychological testing was conducted on all four patients; two patients (mother and 1 offspring) had normal results, while the other two offspring exhibited some impairments on neuropsychological testing. This case series emphasizes the importance of screening first-degree relatives of individuals with confirmed CCHS to minimize complications associated with long-term ventilatory impairment. It also suggests that some patients with CCHS should undergo neuropsychological evaluations to assess for cognitive weaknesses secondary to their CCHS.

scholarly journals Metformin poisoning treated with high dose insulin dextrose therapy: a case series

2019 ◽  
Vol 26 (1) ◽  
pp. 72-78
Author(s):  
Theodore Young ◽  
Joaquim Cevallos ◽  
James Napier ◽  
Juan Martin-Lazaro
Keyword(s):  
Lactic Acidosis ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Independent Effect ◽  
High Dose ◽  
Blood Gas ◽  
Compassionate Use ◽  
Life Threatening ◽  
Dextrose Infusion

Purpose. We describe the compassionate use of high dose insulin dextrose (HID) for life threatening metformin associated lactic acidosis (MALA) in four patients admitted to intensive care. Methods. Patients presenting with refractory lactic acidosis believed to be secondary to metformin poisoning were included. High dose insulin dextrose at 0.5units/kg/hour was infused in 50% dextrose. Frequent blood gas analysis allowed titration of therapy. All patients also received continuous veno-venous haemofiltration. Results. All four patients recovered to normal or near normal lactate and pH between 10 and 24 hours of therapy. Two patients had significant separation in time between initiation of HID and haemofiltration to suggest an independent effect of HID on improving pH and lactate. All patients had at least one episode of hypoglycaemia below 4.0 mmol/L with the lowest glucose in any patient during therapy being 3.0 mmol/L. All episodes were corrected with a dextrose infusion without sequelae. Conclusions. Our study demonstrates that HID therapy appears to be safe in patients with suspected metformin poisoning. It also appears to work to drive down lactate, improve pH and patients’ clinical condition. Further evidence is required to assess the effectiveness of HID therapy in the context of MALA.

scholarly journals Intrapelvic entrapment of sacral nerve roots by abnormal bundles of the piriformis muscle: description of an extra-spinal cause of sciatica and pudendal neuralgia

2021 ◽  
Author(s):  
Corey Sermer ◽  
Adrienne L K Li ◽  
Gustavo L Fernandes ◽  
Augusta M Ribeiro ◽  
Giancarlo Polesello ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Rating Scale ◽  
Clinical Success ◽  
Case Series ◽  
Laparoscopic Approach ◽  
Numeric Rating Scale ◽  
Piriformis Muscle ◽  
Nerve Roots ◽  
Sacral Nerve ◽  
Sacral Foramina

Abstract Piriformis syndrome is a well-known extra-spinal cause of sciatica characterized by the entrapment of the sciatic nerve by variant bundles of the piriformis muscles in the deep gluteal space. In this case series, we describe the entrapment of intrapelvic portions of the sacral nerve roots by a variant bundle of the piriformis muscle originating medially to the sacral foramina, the surgical technique for the laparoscopic treatment of this condition, and the outcomes of the first eight cases treated with this technique. Five female and three male patients presenting with sciatica, pudendal pain and lower urinary tract symptoms underwent a laparoscopic exploration of the intrapelvic portion of the sacral nerve roots and transection of the abnormal piriformis bundle. Surgical technique is demonstrated in the Supplementary Video. Clinical success was achieved in seven of the eight patients, with a reduction of pain numeric rating scale from 8.5 (±1.2; 7–10) pre-operatively to 2.1 (±2.6; 0–7), 1-year following surgery. In conclusion, entrapment of intrapelvic portions of the sacral nerve roots by variant bundles of the piriformis originating medially to the sacral foramina are an extraspinal cause of sciatica, which can be treated though a laparoscopic approach.

Radiofrequency Thermoablation and Hypofractionated Radiotherapy Combined Treatment for Bone Metastases: A Retrospective Study

2021 ◽  
pp. 1-5
Author(s):  
Antonio Piras ◽  
Luca Boldrini ◽  
Sebastiano Menna ◽  
Antonella Sanfratello ◽  
Andrea D’Aviero ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Bone Metastases ◽  
Rating Scale ◽  
Combined Treatment ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Mean Value ◽  
Second Phase ◽  
Combined Approach ◽  
Radiofrequency Thermoablation

<b><i>Introduction:</i></b> Bone metastases (BMs) are the common cause of cancer-related pain, as approximately 45% of cancer patients suffer from bone pain (BP). Radiotherapy (RT) is well established as BP treatment strategy; also, other approaches have been shown to be effective in this setting. Radiofrequency thermoablation (RFA) in a combined strategy with RT appears to be feasible and effective in the treatment of metastatic BP ensuring a better quality of life. Aim of this retrospective study was to describe a case series of patients with painful osteolytic lesions at risk of fracture treated with the RFA-RT combined approach, analyzing local control and pain control as outcomes. <b><i>Methods:</i></b> Data of all patients with BM treated with combined approach in our center from April 2016 to June 2020 were retrospectively analyzed. Patients underwent RFA followed by cementoplasty on the same day and RT in a second phase. RT dose ranged between 30 and 37.5 Gy in 5/10 fractions. BP was evaluated according to the numeric rating scale (NRS), at the beginning of treatment and at 1, 2, 3, 6, 9, and 12 months from the end of combined treatment. <b><i>Results:</i></b> A total of 27 patients were treated from April 2016 to June 2020 with RFA-RT combined approach. The large majority of patients underwent stereotactic body radiotherapy (SBRT) (23/27). All patients experienced an NRS value decrease &#x3e;2 at 1 month and between the first and second months. NRS mean value reached 0 at 3, 6, 9, and 12 months’ evaluations. <b><i>Discussion/Conclusion:</i></b> The results of this retrospective analysis of patients treated with RFA-RT combined approach for BP support its safety and efficacy in terms of pain reduction. SBRT role in this combined approach has to be investigated in randomized trials.

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