1/54. Anaesthetic management for a left pneumonectomy in a child with bronchopleural fistula.The anaesthetic management of a left pneumonectomy in a 18-month-old girl with a bronchopleural fistula is described. An ordinary tracheal tube was slit at the bevel to ensure upper lobe ventilation on right endobronchial intubation. A combination of a bronchial blocker, endobronchial intubation with a slit tube, and nerve blocks for these manoeuvres was used. Pain relief by a thoracic epidural block ensured good physiotherapy and a comfortable postoperative period.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/54. Severe incisional pain and long thoracic nerve injury after port-access minimally invasive mitral valve surgery.The authors describe the occurrence of severe postoperative pain and long thoracic nerve injury after Port-Access minimally invasive mitral valve surgery. The potential for these events and the impact on postoperative hospitalization and rehabilitation are emphasized.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
3/54. Intraspinal haematoma following lumbar epidural anaesthesia in a neonate.A neonate with chromosomal 9 abnormality and omphalocele received a lumbar epidural catheter after laparotomy. Several attempts were needed to establish this catheter. Bleeding occurred from the operative wound after surgery. Using an epidural infusion with ropivacaine 0.1% for 48 h postoperative pain relief was sufficient. Four days after epidural catheter removal, dysfunction of the sacral parasympathetic nerves was noted. Motor and sensor function of the lower limbs were unaffected. magnetic resonance imaging showed a localized intraspinal haematoma in the lower lumbar region.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/54. Percutaneous radiofrequency lesioning of sensory branches of the obturator and femoral nerves for the treatment of hip joint pain.BACKGROUND AND OBJECTIVES: The sensory innervation of the hip joint includes the sensory articular branches of the obturator and femoral nerves. In this report, we retrospectively evaluated 14 cases in which hip joint pain was treated by percutaneous radiofrequency lesioning of sensory branches of obturator and/or femoral nerves. methods: Fourteen patients who had hip joint pain and underwent percutaneous radiofrequency lesioning of sensory branches of obturator and/or femoral nerves were studied. In all cases, intra-articular hip joint block or articular branch block of obturator nerve with local anesthesia was transiently effective. Radiofrequency lesioning was performed at 75 degrees C to 80 degrees C for 90 seconds using an RFG-3B generator and Sluijter-Mehta cannulae kit (Radionics, Burlington, MA) for the obturator nerve in 9 patients and for both the obturator and femoral nerves in 5 patients. To assess pain intensity, a visual analog scale (VAS) was used. RESULTS: The VAS scores before and after the radiofrequency lesioning were 6.8 /- 0.9 and 2.7 /- 1.3, respectively. Twelve patients (86%) reported at least 50% relief of pain for 1 to 11 months. There were no side effects or motor weakness observed. CONCLUSIONS: Percutaneous radiofrequency lesioning of sensory branches of the obturator and femoral nerves is an alternative treatment in patients with hip joint pain, especially in those where operation is not applicable.- - - - - - - - - - ranking = 11keywords = nerve (Clic here for more details about this article) |
5/54. Neuropathic complications of mandibular implant surgery: review and case presentations.Injuries to trigeminal nerves during endosseous implant placement in the posterior mandible appear to occur acutely in approximately 5-15 of cases, with permanent neurosensory disorder resulting in approximately 8%. Nerve lateralization holds even higher risks from epineurial damage or ischaemic stretching. Neuropathy from implant compression and drill punctures can result in neuroma formation of all types, and in some cases precipitate centralized pain syndrome. Two patterns of clinical neuropathy are seen to result; hypoaesthesias with impaired sensory function, often seen with phantom pain, and hyperaesthesias with minimal sensory impairment but presence of much-evoked pain phenomena. The clinician must differentiate, through careful patient questioning and stimulus-response testing, those patients who are undergoing satisfactory spontaneous nerve recovery from those who are developing dysfunctional or dysaesthetic syndromes. Acute nerve injuries are treated with fixture and nerve decompression and combined with supportive anti-inflammatory, narcotic and anti-convulsant therapy. Surgical exploration, neuroma resection and microsurgical repair, with or without nerve grafting, are indicated when unsatisfactory spontaneous sensory return has been demonstrated, and in the presence of function impairment and intractable pain.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
6/54. Sympathetic activity-mediated neuropathic facial pain following simple tooth extraction: a case report.This is a report of a case of sympathetic activity-mediated neuropathic facial pain induced by a traumatic trigeminal nerve injury and by varicella zoster virus infection, following a simple tooth extraction. The patient had undergone extraction of the right lower third molar at a local dental clinic, and soon after the tooth extraction, she became aware of spontaneous pain in the right ear, right temporal region, and in the tooth socket. At our initial examination 30 days after the tooth extraction, the healing of the tooth socket was normal; however, the patient had a tingling and burning sensation (dysesthesia) and spontaneous pain of the right lower lip and the right temporal region, both of which were exacerbated by non-noxious stimuli (allodynia). The patient also showed paralysis of the marginal mandibular branch of the facial nerve, taste dysfunction, and increased varicella zoster serum titers. A diagnostic stellate ganglion block (SGB) 45 days after the tooth extraction using one percent lidocaine markedly alleviated the dysesthesia and allodynia. These symptoms are characteristic of neuropathic pain with sympathetic interaction. The patient was successfully treated with SGB and a tricyclic antidepressant.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
7/54. Innovation and surgical techniques: endoscopic resection of cervical branchiogenic cysts.The recent advent of endoscopic procedures has compelled both plastic and neck and head surgeons to reconsider the conventional methods by which the excision of cervical congenital cystic is classically achieved.An endoscopic approach for excision of the cervical congenital cystic is described. This procedure is anatomically safe and can be made with minimal morbidity through a small transcervical incision.Both specific instruments and solid anatomical knowledge are necessary to perform a safe and efficient cystic endoscopic excision.The essential surgical steps are as follows: 1. Minimal incision placed in natural cervical wrinkle over the dome of the cyst; 2. Intracystic or extracystic dissection; 3. Identification and protection of the sternocleidomastoid muscle, spinal nerve, hypoglossi nerve, and posterior belly of digastric muscle; 4. Careful dissection of the posterior surface of the cyst, avoiding injury on the carotid vessels and internal jugular vein.Eight patients were operated on with this technique and they were very pleased with postoperative comfort and aesthetic results. Inconspicuous scars and no complications were registered.With advanced endoscopic instruments and the development of new surgical technique and surgeon experience, the endoscopic surgery can be the method of choice in cervical excision of branchiogenic cysts.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
8/54. Bilateral continuous paravertebral catheters for reduction mammoplasty.Surgical procedures of the breast can result in significant postoperative pain. Paravertebral nerve blocks have been used successfully in the management of analgesia after breast surgery but are limited by a single injection. This report describes the use of bilateral paravertebral catheters to provide extended analgesia for reduction mammoplasty. A 48-year-old female underwent bilateral paravertebral catheter placement at thoracic level 3 and local anesthetic injections followed by general anesthesia for elective reduction mammoplasty. She reported no pain following the operation and required no supplemental opioids for pain management during her overnight recovery. This case demonstrates a method for extended bilateral thoracic analgesia. The technique may offer an alternative to traditional outpatient analgesics for reduction mammoplasty.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/54. Continuous mandibular nerve block for pain relief. A report of two cases.PURPOSE: mandibular nerve block allows surgery to be performed on the mandible. However, pain in the postoperative period needs to be treated with opioids or non-steroidal anti-inflammatory agents which have undesirable side effects. We examine the feasibility of continuous mandibular nerve block with 0.25% bupivacaine top-ups using a catheter for intraoperative and postoperative pain relief in two patients with a fracture of the mandible. methods: Using the lateral extraoral approach, the mandibular nerve was approached with an 18-gauge indwelling iv cannula in two patients undergoing repair of a fractured mandible under general anesthesia. After removing the needle, an 18-gauge epidural catheter was inserted into the cannula which was then removed. The catheter was tunnelled subcutaneously to emerge at the lateral aspect of the forehead. Two to 4 mL bupivacaine 0.25% were injected on a 12-hr basis and the catheter was kept in place for seven days. RESULTS: Both patients had excellent pain relief and no parenteral or oral analgesics were required throughout the postoperative period. No side effects were noted. CONCLUSIONS: Continuous mandibular nerve block with 2-4 mL 0.25% bupivacaine top-ups injected twice a day through a catheter provides excellent pain relief in patients with a fracture of the mandible. This method may have implications for the management of pain of other etiology in the mandibular region.- - - - - - - - - - ranking = 8keywords = nerve (Clic here for more details about this article) |
10/54. Pulsed radiofrequency as a treatment for groin pain and orchialgia.Inguinal and testicular pain are challenging problems for which no reliable, standardized treatment exists. We report 3 patients with groin pain or orchialgia who were treated with pulsed radiofrequency of the nerves innervating these areas. All 3 patients reported complete pain relief at their 6-month follow-up visits. The techniques and settings used for the nerve blocks and radiofrequency procedures are explained in detail, along with a brief synopsis of the rationale for using it. Randomized, placebo-controlled studies are needed to better assess the efficacy of this procedure and identify eligible candidates.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
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