scholarly journals Epidural blockade in thoracic surgery: a case report

2020 ◽  
Vol 14 (4) ◽  
pp. 224-227
Author(s):  
Vasiliy A. Zhikharev ◽  
A. S. Bushuev ◽  
V. F. Larin ◽  
V. A. Koryachkin
Keyword(s):  
Chest Trauma ◽  
Pain Syndrome ◽  
Epidural Injection ◽  
Multimodal Analgesia ◽  
Severe Trauma ◽  
Pulmonary Complications ◽  
Epidural Puncture ◽  
Epidural Catheterization ◽  
Bilateral Fracture ◽  
The Right

This report presents a clinical case of the treatment of pain syndrome in isolated chest trauma following an accident of a patient with liver cirrhosis and hypocoagulation syndrome who sustained bilateral fracture of the ribs (II, III, IV, V, and VI ribs on the right and II, III, IV, V, and VI ribs on the left), fracture of the sternum body in the middle third, bilateral hemopneumothorax, and contusion of both lungs. From the initial hours, fentanyl, which was administered intravenously in a complex of multimodal analgesia, was used for anesthesia. However, adequate pain control was not achieved. Against the background of pain syndrome, the patient developed impaired consciousness and respiratory failure. Epidural puncture and catheterization with an epidural injection of ropivacaine were performed, which relieved the pain syndrome and helped prevent pulmonary complications. The present case highlights the need for an individual assessment of the riskbenefit ratio of the use of epidural catheterization in patients with coagulopathy. Conclusion: The use of epidural analgesia for chest trauma in patients with moderate coagulopathy made it possible to initiate effective analgesia and reduce the risk of respiratory complications, which ultimately ensured a favorable outcome of severe trauma.

Management of rib fractures

2019 ◽  
Vol 80 (10) ◽  
pp. C146-C149
Author(s):  
Zachary Jeffery ◽  
Matthew Everson ◽  
Suzanne Carty
Keyword(s):  
High Risk ◽  
Hospital Admission ◽  
Chest Trauma ◽  
Anaesthetic Techniques ◽  
Multimodal Analgesia ◽  
Pulmonary Complications ◽  
Rib Fractures ◽  
Erector Spinae ◽  
Junior Doctors ◽  
Careful Assessment

Rib fractures are a common reason for hospital admission and are associated with significant morbidity and mortality. This article discusses the management of simple rib fractures and provides practical guidance for junior doctors involved in the care of these patients. Careful assessment to identify patients at high risk of complications is essential and calculation of a rib fracture score can aid management decisions. Pain from rib fractures can be severe and requires multimodal analgesia started promptly and proactively on hospital admission. This may include the use of regional anaesthetic techniques such as thoracic epidurals and erector spinae blocks for patients with significant chest trauma or those at high risk of pulmonary complications.

scholarly journals Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Punit Pruthi ◽  
Pramod Arora ◽  
Manoj Mittal ◽  
Anugrah Nair ◽  
Waqia Sultana
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Inflammatory Arthritis ◽  
Young Male ◽  
Pain Syndrome ◽  
Poor Response ◽  
History Of ◽  
Diagnostic Modalities ◽  
Musculoskeletal Ultrasonography ◽  
The Right

Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient’s symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized.

scholarly journals Incentive spirometry to prevent pulmonary complications after chest trauma: a retrospective observational study

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Hisashi Dote ◽  
Yohichiro Homma ◽  
Masaaki Sakuraya ◽  
Hiraku Funakoshi ◽  
Shigeru Tanaka ◽  
...  
Keyword(s):  
Observational Study ◽  
Chest Trauma ◽  
Pulmonary Complications ◽  
Retrospective Observational Study ◽  
Incentive Spirometry

Iatrogenic hydrohemothorax during percutaneous nephrolithotomy: A case report

2021 ◽  
Vol 1 (2) ◽  
pp. 079-082
Author(s):  
Tae Yeon Kim ◽  
Kyu Nam Kim ◽  
Lee Kwang Hyun ◽  
Bo Seok Kwon ◽  
Jo Hyung Jun
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Vital Signs ◽  
Pulmonary Complications ◽  
Fluid Retention ◽  
Air Bubbles ◽  
Close Cooperation ◽  
The Right ◽  
Pleural Injury ◽  
Routine Chest

Background: Percutaneous nephrolithotomy (PNL) is a widely used surgical method for renal stone management. However, it can be associated with several complications. Case: We report an acute hemothorax during PNL in 57-year-old male patient with a stone. After observing air bubbles at the diaphragm on the laparoscopic screen, we considered pulmonary complications. A chest radiograph demonstrated a shade that measured 130 mm wide and 70 mm long and fluid retention on the right side of the chest. During drainage of 200 ml of blood through a chest tube, the patient’s vital signs became unstable. After the patient received hydration and intravenous injection of vasopressor, his vital signs stabilized. Conclusions: Pulmonary complications due to pleural injury during PNL can result in death, but the complications can be managed by early diagnosis and treatment. Close cooperation between surgeon and anesthesiologist and routine chest radiographs after PNL can reduce the pulmonary complications.

scholarly journals Treatment of Type 1 Complex Regional Pain Syndrome in 14 Years Old Child

2014 ◽  
Vol 21 (4) ◽  
pp. 79-82
Author(s):  
V. N Merkulov ◽  
A. I Dorokhin ◽  
A. I Krupatkin ◽  
M. V Merkulov ◽  
M. A Avakova
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Hand Injury ◽  
Psychological Status ◽  
Interventional Treatment ◽  
Bolus Administration ◽  
Right Hand ◽  
Foot Injury ◽  
The Right

Case report on 14 years old girl with type 1 complex regional pain syndrome (CRPS) is presented. At first admission in 5.5 months after right hand injury and development of type 1 CRPS, paravasal sympathectomy on the right upper extremity was performed. Complete elimination of pain syndrome and restoration of the extremity function was achieved. Five and a half months after discharge the left foot and in 3 weeks later the right hand were injured. In both cases injuries were accompanied by pronounced CRPS clinical picture. At second admission in 6 weeks after foot injury interventional treatment with placement of catheters next to nerve trunks and bolus administration of antibiotics was performed for 1 week and enabled to achieve remission of the disease. It was noted that not only hypersymphaticotony but also psychological status of a patient were important for the disease development.

scholarly journals Pain Assessment: Subjectivity, Objectivity, and the Use of Neurotechnology Part One: Practical and Ethical Issues

2010 ◽  
Vol 4;13 (4;7) ◽  
pp. 305-315 ◽  
Author(s):  
James Giordano
Keyword(s):  
Pain Assessment ◽  
Subjective Experience ◽  
Ethical Issues ◽  
Social Issues ◽  
Clinical Care ◽  
Pain Syndrome ◽  
Objective Evaluation ◽  
Pain Patient ◽  
Key Words Pain ◽  
The Right

The pain clinician is confronted with the formidable task of objectifying the subjective phenomenon of pain so as to determine the right treatments for both the pain syndrome and the patient in whom the pathology is expressed. However, the experience of pain — and its expression — remains enigmatic. Can currently available evaluative tools, questionnaires, and scales actually provide adequately objective information about the experiential dimensions of pain? Can, or will, current and future iterations of biotechnology — whether used singularly or in combination (with other technologies as well as observational-behavioral methods) — afford objective validation of pain? And what of the clinical, ethical, legal and social issues that arise in and from the use — and potential misuse — of these approaches? Subsequent trajectories of clinical care depend upon the findings gained through the use of these techniques and their inappropriate employment – or misinterpretation of the results they provide — can lead to misdiagnoses and incorrect treatment. This essay is the first of a two-part series that explicates how the intellectual tasks of knowing about pain and the assessment of its experience and expression in the pain patient are constituent to the moral responsibility of pain medicine. Herein, we discuss the problem of pain and its expression, and those methods, techniques, and technologies available to bridge the gap between subjective experience and objective evaluation. We address how these assessment approaches are fundamental to apprehend both pain as an objective, neurological event, and its impact upon the subjective experience, existence, and expectations of the person in pain. In this way, we argue that the right use of technology — together with inter-subjectivity, compassion, and insight — can sustain the good of pain care as both a therapeutic and moral enterprise. Key words: pain, assessment, neurotechnology, biotechnology, neuroethics, medicine

scholarly journals Club cell protein 16 and cytokeratin fragment 21-1 as early predictors of pulmonary complications in polytraumatized patients with severe chest trauma

PLoS ONE ◽  
2017 ◽  
Vol 12 (4) ◽  
pp. e0175303 ◽  
Author(s):  
Lukas L. Negrin ◽  
Gabriel Halat ◽  
Stephan Kettner ◽  
Markus Gregori ◽  
Robin Ristl ◽  
...  
Keyword(s):  
Chest Trauma ◽  
Pulmonary Complications ◽  
Cell Protein ◽  
Club Cell ◽  
Early Predictors

scholarly journals Saphenous nerve entrapment manifested as proximal cruralgia

1997 ◽  
Vol 115 (5) ◽  
pp. 1553-1554 ◽  
Author(s):  
João Neves Camargo Júnior ◽  
Anamarli Nucci
Keyword(s):  
Myofascial Pain ◽  
Femoral Nerve ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Primary Lesion ◽  
Saphenous Nerve ◽  
Medial Aspect ◽  
Correct Treatment ◽  
The Right ◽  
Pain Distribution

A 16 year old boy had continuous pain in the right testis, groin, and the medial aspect of the thigh and knee for 16 months.The onset of symptoms was acute and pain distribution included a retrograde area in relation to the entrapment site. Tinel's sign was the clue for diagnosis. Diagnosis was confirmed at operation and division of the aponeurosis of Hunter's canal relieved the symptoms for three days. A second surgical exploration, proximal to the former one, was performed after five months.The right femoral nerve was found normal. This new operation was therapeutically ineffective. Causes of pain distribution and relapsed pain are discussed. The relapse was attributed to myofascial pain syndrome. This diagnosis should be considered independently of the correct treatment of the primary lesion.

Collapse in a mare during standing sedation with a fatal outcome

2020 ◽  
Vol 8 (1) ◽  
pp. e000829
Author(s):  
Maria Valentina Carrozzo ◽  
Barbara Ambros
Keyword(s):  
Veterinary Medicine ◽  
Epidural Analgesia ◽  
Fatal Outcome ◽  
Epidural Injection ◽  
Total Intravenous Anaesthesia ◽  
Pressure Measurements ◽  
Normal Muscle ◽  
Intravenous Anaesthesia ◽  
The Right ◽  
Caudal Epidural

A 6-year-old 559-kg Canadian Warmblood mare with lacerations over the neck and all four limbs was presented to the Western College Veterinary Medicine. Medical treatment and wound lavage was carried out for 5 days with no clinical improvement. Ultrasonography of the gluteal region showed disruption of normal muscle architecture, predominantly on the right side. A diagnosis of compartmental syndrome was confirmed with intracompartment pressure measurements. Fasciotomy of the semimembranosus and tendinosus muscles was elected. Standing sedation was achieved with intermittent boluses of butorphanol and detomidine, and caudal epidural analgesia was performed with 13 mL of lidocaine 2 per cent. Forty minutes after the epidural injection, the mare became ataxic and fell. The horse was anaesthetised with ketamine and diazepam followed by total intravenous anaesthesia until the effects of the epidural lidocaine were presumed to have resolved. In recovery, the mare was unable to stand. The owner elected humane euthanasia.

scholarly journals Diagnosis of Complex Regional Pain Syndrome I Following Traumatic Axonal Injury of the Corticospinal Tract in a Patient with Mild Traumatic Brain Injury

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 95 ◽  
Author(s):  
Sung Ho Jang ◽  
You Sung Seo
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Complex Regional Pain Syndrome ◽  
Mild Traumatic Brain Injury ◽  
Corticospinal Tract ◽  
Axonal Injury ◽  
Pain Syndrome ◽  
Traumatic Axonal Injury ◽  
Right Hand ◽  
The Right

A 54-year-old male suffered from direct head trauma resulting from a fall while working. At approximately two months after the accident, he began to feel pain (burning sensation) and swelling of the dorsum of the right hand and wrist. He showed the following clinical features among the clinical signs and symptoms of revised diagnostic criteria for complex regional pain syndrome (CRPS): spontaneous pain, mechanical hyperalgesia, vasodilation, skin temperature asymmetries, skin color changes, swelling, motor weakness. No specific lesion was observed on brain MRI taken at ten weeks after onset. Plain X-ray, electromyography, and nerve conduction studies for the right upper extremity detected no abnormality. A three-phase bone scan showed hot uptake in the right wrist in the delayed image. On two-month diffusion tensor tractography, partial tearing of the corticospinal tract (CST) was observed at the subcortical white matter in both hemispheres (much more severe in the left CST). In addition, the fiber number of the right CST was significantly decreased than that of seven normal control subjects. CRPS I of the right hand in this patient appeared to be related to traumatic axonal injury of the left CST following mild traumatic brain injury.

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