The sympathetic nervous system has been implicated in the maintenance of numerous pain syndromes. Interruption of sympathetic pathways has been widely applied to relieve pain. Neurolytic sympathetic block is often well tolerated, because numbness and motor weakness are uncommon and neuritis rarely develops. The classic targets for sympatholysis are the stellate or cervicothoracic ganglion for facial and upper extremity pain, celiac plexus for abdominal pin, and lumbar sympathetic chain for lower extremity pain. In addition, the thoracic ganglion is occasionally blocked for the treatment of hyperhidrosis and of pain emanating from the pleura and esophagus. The recognition of the clinical utility of cervical epidural nerve block in the management of head, face, neck, shoulder, and upper extremity pain has brought the technique into the mainstream of contemporary pain management practice. Lumbar epidural nerve block has great utility in the management of a variety of acute, chronic, and cancer-related pain syndromes. The nerve root sleeve is particularly accessible to precise local anesthetic blocks. Segmental information gained from such nerve root blocks can be helpful in sorting out confusing patterns of referred pain to the limbs. The pathway for insertion of spinal needles must be planned so as to avoid damaging neural structures. Spinal nerve roots are particularly delicate structures and do not take kindly to being impaled.
Celiac Plexus ; Esophagus ; Extremities ; Ganglion Cysts ; Head ; Hyperhidrosis ; Hypesthesia ; Lower Extremity ; Neck ; Needles ; Nerve Block ; Neuritis ; Pain Management ; Pain, Referred ; Pleura ; Shoulder ; Spinal Nerve Roots ; Stellate Ganglion ; Sympathetic Nervous System ; Upper Extremity

Radiofrequency neurotomy of the lumbar medial branch, via a caudal approach, is a representative interventional procedure for lumbar zygapophysial joint pain, which can be performed more accurately and easily using a guide needle technique. We experienced a case of burn wound formation along the guide needle trajectory, where heat conduction through the guide needle was suggested to have resulted in the burn wound.
Arthralgia ; Burns* ; Hot Temperature ; Needles* ; Wounds and Injuries*

BACKGROUND: Lumbar plexus block was used not only for the proposal of lower limb surgery, but also for that of pain control in the pain clinic. The aim of our study was to evaluate the motor, sensory function and the anatomic parameters after posterior approach of the lumbar plexus block with the help of a nerve stimulator. METHODS: 30 patients of low back pain radiating to lower extremities were randomized into two groups. We performed the psoas compartment block guided by C-arm fluoroscope. With the pateints in prone position, a 100 mm insulated needle was introduced at the surface of L5 transverse process. Stimulation of femoral nerve was used to optimize the needle placement at the center of lumbar plexus (Dancing Patella). 1% mepivacaine hydrochloride (0.2 ml/kg) solution in group 1 (n=11) and 0.5% mepivacaine hydrochloride (0.2 ml/kg) solution in group 2 (n=19) were then injected. We measured the minimal current, distance of puncture site from midline, distance from skin to transverse process, distance from skin to the point of maximal twitch, and distance from transverse process to the point of maximal twich. Motor and sensory functions were measured at 5, 15, 30, 45, 60, 90 and 120 min after procedure. RESULTS: Anatomical parameters were as follows; distance of puncture site from midline was 42.6 5.6 mm, distance from skin to transverse process was 52.9 +/- 7.0 mm, distance from skin to the point of maximal twitch was 68.8+/-5.6 mm, and distance from transverse process to the point of maximal twich is 15.9+/-3.9 mm. Difference in attenuated motor function(hip adduction, knee extension) was observed between two groups (P<0.05). Hip adduction and knee extension were recovered 60 min after injection in group 1. In group 2, knee extension was attenuated above 2 hours. We observed significant hip flexion attenuation 90 and 120 min (group 1 and group 2, etc) after injection Sensory blockade was recovered 120 min after injection in both groups. CONCLUSIONS: It is suggested that above mentioned anatomical parameters would be useful for the safe blockade. We found that recovery of attenuated hip flexion is crucial for the discharge criteria of ambulating outpatient with the low back pain.
Femoral Nerve ; Hip ; Humans ; Knee ; Low Back Pain ; Lower Extremity ; Lumbosacral Plexus* ; Mepivacaine ; Needles ; Outpatients ; Pain Clinics ; Prone Position ; Punctures ; Sensation ; Skin

PURPOSE: The Swedish Interactive Thresholding Algorithm (SITA) strategies is a new diagnostic tool of Humphrey automatic perimetry and has been reported to reduce testing time without loss of useful diagnostic information. To test the usefulness of this new diagnostic method, we compared the SITA and full threshold diagnostic method, which had been used previously. METHODS: Forty six patients (46 eyes) who were followed up for glucoma or ocular hypertension were in this study. Autoperimetry was performed using both SITA and full threshold strategies. RESULTS: The SITA showed shorter testing time (7.74+/-1.25 min) than the full threshold (14.4+2.43 min). There were significant differences between the full threshold MD (-8.06+8.11 dB) and SITA MD (-7.45 +/-8.32 dB), as well as full threshold PSD (4.47+/-2.50 dB) and SITA PSD (3.67+/-2.56 dB), when compared with data of greater than -12 dB MD respectively(p<0.05). Two cases showed changed diagnosis in GHT. CONCLUSIONS: SITA is a good test method with short test time. However, changing from full threshold to the SITA method should be reconsidered due to variation in the amount of field defect depending on the damage progression and the possibility of changes in diagnosis.
Diagnosis ; Glaucoma* ; Humans ; Ocular Hypertension ; Visual Field Tests

The utilization of transforaminal epidural steroid injections (TFESIs), an elective diagnostic and therapeutic spinal procedure, has risen dramatically over the past decade. The transforaminal technique uses a needle that approaches the posterolateral aspect of the intervertebral foramen. Despite the superiority of the transforaminal route, transforaminal blocks have been associated with devastating neurological complications, particularly paraplegia. Since the radiological target advocated for transforaminal injections matches the superoanterior portion of the foramen, it comes as no surprise that this approach renders radiculomedullary arteries vulnerable to injury. The author uses retrograde interlaminar ventral epidural steroid injection with catheters to obtain a theoretically advantageous placement of epidural corticosteroid. Epidurography of such injections does demonstrate that this approach more frequently achieves coverage of both the putative disc source of nerve irritation and of the affected segmental nerve.
Arteries ; Catheters ; Needles ; Nerve Block ; Paraplegia ; Spinal Cord

BACKGROUND: Patients without genuine zygapophysial joint pain exhibit a positive response to uncontrolled diagnostic blocks. We determined the false positive rate of single uncontrolled diagnostic zygapophysial joint block in patients with chronic back pain. METHOD: Thirty-five patients with chronic lower back pain were studied prospectively. All patients underwent a series of medial branch of dorsal rami blocks with lidocaine and bupivacaine starting at the symptomatic level to a maximum of three levels or until the pain was abolished. RESULTS: All patients proceeded with the injections. 16 patients (45%) had a definite or greater response to the initial lidocaine injection at one or more levels but only 5 (14%) had a 50% or greater response to a confirmatory injection of 0.5% bupivacaine. Using the confirmatory blocks as the criterion standard, the false positive rate of uncontrolled diagnostic blocks was 37% and the positive predictive value was only 31%. CONCLUSION: Uncontrolled diagnostic blocks may be unreliable for the diagnosis of lumbar zygapophysial joint pain.
Arthralgia ; Back Pain ; Bupivacaine ; Diagnosis ; Humans ; Joints ; Lidocaine ; Low Back Pain ; Prospective Studies

Succinylcholine induced hyperkalemia has been reported in many neurologic disorders including subarachnoid hemorrhage. The purpose of this study was to evaluate suceinylcholine induced-hyperkalemia in twenty ruptured cerebral aneuryam patients undergoing general anesthesia for repair of the cerebral aneurysm. Serum potassium levels were measured after induction of anesthesia, but before succinylcholine, and 1, 5 and 10 min after administration of succinylcholine. Serum potassium levels were continuously increased until 10 min after euccinylcholine administration. The increments of serum potassium above 1.0mEq/L were observed in 5 of 9 patients with loss of consciousnesa A relationship between the loss of consciousness and hyperkalemic response after succinylcholine was suggested.
Anesthesia ; Anesthesia, General ; Humans ; Hyperkalemia ; Intracranial Aneurysm* ; Nervous System Diseases ; Potassium* ; Subarachnoid Hemorrhage ; Succinylcholine* ; Unconsciousness

The rapid onset of epidural fentanyl could be used to cover the latency period of epidural marphine, thus potentiating analgesia during anesthesia regression after short acting local anesthetics and possibly extending the morphine analgesia for longer duration. The study was designed to determine whether epidural fentanyl given before epidural morphine improves the quality of intraoperative epidural anesthesia without worsening postoperative analgesia provided by epidural morphine. Epidural anesthesia was established using 2% lidocaine with epinephrine 5 ug/ml. Patients scheduled for study was assigned to two groups (n=20 for each). Group 1 receiving epidural normal saline-control 10 ml, and Group 2 receiving epidural fentanyl 100 ug (10 ug/ml) through epidural catheter after delivery. After uterine repair epidural morphine 10 ml (0.3 mg/ml) was injected through epidural catheter. Patients were surveyed regarding their impression on intraoperative analgesia, nausea and postoperative analgesia, vomiting, pruritis, sedation. No significant difference was found in the two groups for intraoperative analgesia, nausea and vomiting. Postoperatively, visual analogue score for pain, vomiting, pruritis, sedation were similar at 1,2,4,8 hours in the two groups. In conclusion, epidural fentanyl 100 ug after delivery did not improve the intraoperative pain, nausea and early postoperative pain.
Analgesia* ; Anesthesia ; Anesthesia, Epidural ; Anesthetics, Local ; Catheters ; Epinephrine ; Fentanyl* ; Humans ; Latency Period (Psychology) ; Lidocaine ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Vomiting

The rapid onset of epidural fentanyl could be used to cover the latency period of epidural marphine, thus potentiating analgesia during anesthesia regression after short acting local anesthetics and possibly extending the morphine analgesia for longer duration. The study was designed to determine whether epidural fentanyl given before epidural morphine improves the quality of intraoperative epidural anesthesia without worsening postoperative analgesia provided by epidural morphine. Epidural anesthesia was established using 2% lidocaine with epinephrine 5 ug/ml. Patients scheduled for study was assigned to two groups (n=20 for each). Group 1 receiving epidural normal saline-control 10 ml, and Group 2 receiving epidural fentanyl 100 ug (10 ug/ml) through epidural catheter after delivery. After uterine repair epidural morphine 10 ml (0.3 mg/ml) was injected through epidural catheter. Patients were surveyed regarding their impression on intraoperative analgesia, nausea and postoperative analgesia, vomiting, pruritis, sedation. No significant difference was found in the two groups for intraoperative analgesia, nausea and vomiting. Postoperatively, visual analogue score for pain, vomiting, pruritis, sedation were similar at 1,2,4,8 hours in the two groups. In conclusion, epidural fentanyl 100 ug after delivery did not improve the intraoperative pain, nausea and early postoperative pain.
Analgesia* ; Anesthesia ; Anesthesia, Epidural ; Anesthetics, Local ; Catheters ; Epinephrine ; Fentanyl* ; Humans ; Latency Period (Psychology) ; Lidocaine ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Vomiting

Radiofrequency current is simply a tool used to create discrete thermal lesions in neural pathways in order to interrupt transmission. In pain medicine, radiofrequency lesions have been used to interrupt nociceptive pathways at various sites. This is a palliative treatment accompanying complications, so its use should be limited to those patients with cancer pain or chronic non-cancer pain when conservative non-surgical therapies have proven to be ineffective or intoerable. With the development of alternatives such as intrathecal opioid infusion and neuromodulation technologies, the number of patients considered for neuroablative therapy may dwindle. Nevertheless, there is a line of evidence that radiofrequency neurotomy has an important role in the management of trigeminal neuralgia, nerve root avulsion and spinal pain. This article introduces the radiofrequency lesioning as an interventional treatment modality of cervical pain.
Humans ; Neck Pain* ; Neural Pathways ; Palliative Care ; Post-Traumatic Headache ; Radiculopathy ; Trigeminal Neuralgia