Stylohyoid pain syndrome—an Australian case series and review

Objectives: (1) To define patient demographics and common symptoms in patients who undergo styloidectomy for stylohyoid pain syndrome (Eagle’s syndrome). (2) To evaluate the effectiveness of styloidectomy in reducing symptoms of Eagle’s syndrome. Methods: Retrospective chart review and prospective case series. We retrospectively gathered demographic data on all patients at a single institution who underwent styloidectomy during a 5-year period. Using a patient symptom survey, we also gathered prospective data on a cohort of these patients presenting during the second half of the timeframe. Results: Thirty-two patients underwent styloidectomy for Eagle’s syndrome between November 2010 and June 2015. Of these patients, 22 (68.8%) were female, 29 (90.6%) were Caucasian, and 10 (31.3%) reported history of tonsillectomy. Mean age was 46.0 years, and mean BMI was 26.1 kg/m2. Nineteen patients completed the prospective survey. Average styloid length was 45.3 mm. Most severe preoperative symptoms were neck pain, otalgia, globus, facial pain, headache, and discomfort with neck turning. Thirteen of 17 individual symptoms demonstrated significant decrease in symptom scores after styloidectomy. Aggregate symptom scores also showed significant decrease postsurgically. Longer styloid length correlated with increased scores for dysphagia and odynophagia but not with conglomerate symptom scores. Conclusions: Patients with Eagle’s syndrome were mostly female, Caucasian, and had near-normal BMI. There is wide variability in presenting symptoms of Eagle’s syndrome, but nearly all demonstrate improvement after styloidectomy. Thus, in appropriately selected patients, styloidectomy can effectively and reliably produce improvement in patient symptoms.

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Interventional pain management techniques for chronic pain

Oxford Textbook of Paediatric Pain ◽

10.1093/med/9780199642656.003.0046 ◽

2013 ◽

pp. 474-485

Author(s):

Navil F. Sethna ◽

Pradeep Dinakar ◽

Karen R. Boretsky

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Case Series ◽

Pain Syndrome ◽

Treatment Modalities ◽

Neuraxial Blockade ◽

Paediatric Case ◽

Injection Techniques ◽

Interventional Pain Management ◽

Management Techniques

As part of multidisciplinary management of paediatric chronic pain, interventional pain management techniques can play an important role when pain is unrelieved by conventional treatment modalities. Many procedures and indications are extrapolated from adult studies, and evidence for long-term efficacy in paediatric populations is limited. Interventions range from injection techniques with local anaesthetic and/or corticosteroids to neuraxial blockade with implanted catheters. Paediatric case series have reported benefit in selected patients with complex regional pain syndrome and cancer-related pain.

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Percutaneous T2 and T3 Radiofrequency Sympathectomy for Complex Regional Pain Syndrome Secondary to Brachial Plexus Injury: A Case Series

The Korean Journal of Pain ◽

10.3344/kjp.2013.26.4.401 ◽

2013 ◽

Vol 26 (4) ◽

pp. 401 ◽

Cited By ~ 3

Author(s):

Chee Kean Chen ◽

Vui Eng Phui ◽

Abd Jalil Nizar ◽

Sow Nam Yeo

Keyword(s):

Brachial Plexus ◽

Complex Regional Pain Syndrome ◽

Brachial Plexus Injury ◽

Case Series ◽

Pain Syndrome

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Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.08.013 ◽

2017 ◽

Vol 17 (1) ◽

pp. 325-329 ◽

Cited By ~ 58

Author(s):

Mauricio Forero ◽

Manikandan Rajarathinam ◽

Sanjib Adhikary ◽

Ki Jinn Chin

Keyword(s):

Pain Management ◽

Thoracic Surgery ◽

Interventional Procedures ◽

Case Series ◽

Pain Syndrome ◽

Erector Spinae ◽

Pain Clinic ◽

Thoracic Vertebrae ◽

Thoracic Pain ◽

Topical Analgesics

AbstractBackground and aimsPost thoracotomy pain syndrome (PTPS) remains a common complication of thoracic surgery with significant impact on patients’ quality of life. Management usually involves a mul¬tidisciplinary approach that includes oral and topical analgesics, performing appropriate interventional techniques, and coordinating additional care such as physiotherapy, psychotherapy and rehabilitation. A variety of interventional procedures have been described to treat PTPS that is inadequately managed with systemic or topical analgesics. Most of these procedures are technically complex and are associated with risks and complications due to the proximity of the targets to neuraxial structures and pleura. The ultrasound-guided erector spinae plane (ESP) block is a novel technique for thoracic analgesia that promises to be a relatively simple and safe alternative to more complex and invasive techniques of neural blockade. We have explored the application of the ESP block in the management of PTPS and report our preliminary experience to illustrate its therapeutic potential.MethodsThe ESP block was performed in a pain clinic setting in a cohort of 7 patients with PTPS following thoracic surgery with lobectomy or pneumonectomy for lung cancer. The blocks were performed with ultrasound guidance by injecting 20–30mL of ropivacaine, with or without steroid, into a fascial plane between the deep surface of erector spinae muscle and the transverse processes of the thoracic vertebrae. This paraspinal tissue plane is distant from the pleura and the neuraxis, thus minimizing the risk of complications associated with injury to these structures. The patients were followed up by telephone one week after each block and reviewed in the clinic 4–6 weeks later to evaluate the analgesic response as well as the need for further injections and modification to the overall analgesic plan.ResultsAll the patients had excellent immediate pain relief following each ESP block, and 4 out of the 7 patients experienced prolonged analgesic benefit lasting 2 weeks or more. The ESP blocks were combined with optimization of multimodal analgesia, resulting in significant improvement in the pain experience in all patients. No complications related to the blocks were seen.ConclusionThe results observed in this case series indicate that the ESP block may be a valuable therapeutic option in the management of PTPS. Its immediate analgesic efficacy provides patients with temporary symptomatic relief while other aspects of chronic pain management are optimized, and it may also often confer prolonged analgesia.ImplicationsThe relative simplicity and safety of the ESP block offer advantages over other interventional procedures for thoracic pain; there are few contraindications, the risk of serious complications (apart from local anesthetic systemic toxicity) is minimal, and it can be performed in an outpatient clinicsetting. This, combined with the immediate and profound analgesia that follows the block, makes it an attractive option in the management of intractable chronic thoracic pain. The ESP block may also be applied to management of acute pain management following thoracotomy or thoracic trauma (e.g. rib fractures), with similar analgesic benefits expected. Further studies to validate our observations are warranted.

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