Current Issue : October - December Volume : 2014 Issue Number : 4 Articles : 6 Articles
Background. The aim of this report was to evaluate the clinical profile and previous management of patients with uncontrolled\nneuropathic pain who were referred to pain clinics. Methods.We included adult patients with uncontrolled pain who had a score of\n?4 in theDN4 questionnaire. In addition to sociodemographic and clinical data, we evaluated pain levels using a visual analog scale\nas well as anxiety, depression, sleep, disability, and treatment satisfaction employing validated tools. Results. A total of 755 patients\nwere included in the study.The patients were predominantly referred to pain clinics by traumatologists (34.3%) and primary care\nphysicians (16.7%).Themost common diagnoses were radiculopathy (43%) and pain of oncological origin (14.3%).Themajor cause\nfor uncontrolled pain was suboptimal treatment (88%). Fifty-three percent of the patients were depressed, 43% had clinical anxiety,\n50% rated their overall health as bad or very bad, and 45% noted that their disease was severely or extremely interfering with\ntheir daily activities. Conclusions. Our results showed that uncontrolled neuropathic pain is a common phenomenon among the\nspecialties that address these clinical entities and, regardless of its etiology, uncontrolled pain is associated with a dramatic impact\non patient well-being....
The use of perioperative epidural anesthesia-analgesia may confer many benefits including superior postoperative analgesia,\ndecreased morbidity, and improvement in patient-centered outcomes. We will review our group�s work on perioperative epidural\nanesthesia-analgesia on patient outcomes and discuss future research in this area...
Despite the fact that coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass (CPB) prolongs life and\nreduces symptoms in patients with severe coronary artery diseases, these benefits are accompanied by increased risks. Morbidity\nassociatedwith cardiopulmonary bypass can be attributed to the generalized inflammatory response induced by blood-xenosurfaces\ninteractions during extracorporeal circulation and the ischemia/reperfusion implications, including exacerbated inflammatory\nresponse resembling the systemic inflammatory response syndrome (SIRS). The use of specific anesthetic agents with antiinflammatory\nactivity can modulate the deleterious inflammatory response. Consequently, anti-inflammatory anesthetics may\naccelerate postoperative recovery and better outcomes than classical anesthetics. It is known that the stress response to surgery\ncan be attenuated by sympatholytic effects caused by activation of central (????-)2-adrenergic receptor, leading to reductions in blood\npressure and heart rate, and more recently, that they can have anti-inflammatory properties. This paper discusses the clinical\nsignificance of the dexmedetomidine use, a selective (????-)2-adrenergic agonist, as a coadjuvant in general anesthesia. Actually,\ndexmedetomidine use is not in anesthetic routine, but this drug can be considered a particularly promising agent in perioperative\nmultiple organ protection....
We report a patient who developed paraplegia caused by a spinal epidural hematoma after removal of an epidural catheter,\nwhich resolved spontaneously. A 60-year-old woman underwent thoracoscopic partial resection of the left lung under general\nanesthesia combined with epidural anesthesia. She neither was coagulopathic nor had received anticoagulants. Paraplegia occurred\n40 minutes after removal of the epidural catheter on the first postoperative day. Magnetic resonance images revealed a spinal\nepidural hematoma. Surgery was not required as the paraplegia gradually improved until, within 1 hour, it had completely resolved.\nHypoesthesia had completely resolved by the third postoperative day....
Trigeminal neuralgia is the most common neuralgia. Its therapeutic approach is challenging as the first line treatment often does\nnot help, or even causes intolerable side effects. The aim of our randomized double blind, placebo controlled, crossover study was\nto investigate in a prospective way the effect of lidocaine in patients with trigeminal neuralgia. Twenty patients met our inclusion\ncriteria and completed the study. Each patient underwent fourweekly sessions, two ofwhichwerewith lidocaine (5mgs/kg) and two\nwith placebo infusions administered over 60 minutes. Intravenous lidocaine was superior regarding the reduction of the intensity\nof pain, the allodynia, and the hyperalgesia compared to placebo. Moreover, contrary to placebo, lidocaine managed to maintain\nits therapeutic results for the first 24 hours after intravenous infusion. Although, intravenous lidocaine is not a first line treatment,\nwhen first line medications fail to help, pain specialists may try it as an add-on treatment. This trial is registered with NCT01955967....
Purpose. To evaluate the analgesic efficacy of 0.5% propacaine hydrochloride as topical anesthesia during phacoemulsification\nsurgery. Methods. Intraoperative pain intensity was assessed using a 5-category verbal rating scale during each of three surgical\nstages. Pain scores from each surgical stage and total pain scores were compared for the factors of patient age, gender, cataract\nlaterality, and type. Results. In comparison of cataract type subgroups, the mean total pain scores and mean stage 2 pain scores in\nboth white mature cataract (WMC) and corticonuclear plus posterior subcapsular cataract (CN + PSC) groups were significantly\nhigher than in the PSC-only (PSC) group (???? < 0.05). Conclusion. Phacoemulsification with topical anesthesia is not a completely\npainless procedure. Pain intensity varies with cataract type and stage of surgery....
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