1/26. The treatment of reflex sympathetic dystrophy in a 9 year-old boy with long standing symptoms.reflex sympathetic dystrophy is an uncommonly reported entity in children and it continues to be underdiagnosed. Compared with adult, childhood reflex sympathetic dystrophy is of unknown etiology and has a better prognosis. The most common therapy in children is progressive mobilization supported by antiphlogistic, analgesic drugs, psychological and physical therapy. We report an interesting case of reflex sympathetic dystrophy of the left knee joint of a nine years old child with symptoms insisting more than four years and recalcitrant to the above treatments. The use of intravenous regional anaesthesia with lidocaine 0.5% and methylprednisolone was successful. No other reports seem to exist on the use of lidocaine 0.5% and methylprednisolone for the therapy of reflex sympathetic dystrophy in children. The treatment is simple, safe and well tolerated by children. Psychological factors should not be underestimated. early diagnosis and aggressive therapy are important factors for the full recovery of the patients.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/26. deep brain stimulation of the centre median-parafascicular complex in patients with movement disorders.The centre median-parafascicular (CM-Pf) complex of the thalamus is considered to be a possible target for deep brain stimulation (DBS) in patients with movement disorders. In a prospective study on the effect of CM-Pf DBS versus somatosensory thalamic DBS on chronic neuropathic pain, three of 12 patients had additional movement disorders. Bifocal quadripolar electrodes were implanted by computed tomography guided stereotactic surgery under local anaesthesia contralaterally to the side of the pain for test stimulation. Two of the three patients with movement disorders had permanent implantation of CM-Pf electrodes. During test stimulation of the left CM-Pf complex for several days, a 67 year old woman received no benefit with respect to the neuropathic pain, but the choreoathetotic movements of her right foot ceased. As the pain syndrome was not improved, she decided not to have permanent implantation. A 74 year old man with postzoster neuralgia and allodynia enjoyed excellent relief from his pain with chronic CM-Pf DBS. In addition, improvement in the tremor at rest was noted. A 72 year old man had sustained reduction in his stump dyskinesias. Further evaluation of the possible role of the "forgotten" central and medial thalamic nuclei in the treatment of movement disorders may be warranted.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/26. Two cases of medically and surgically intractable SUNCT: a reason for caution and an argument for a central mechanism.We report two cases of SUNCT that demonstrate the medically and surgically refractory nature of this disorder and support the hypothesis that the causative 'lesion' lies within the central nervous system. After both patients had failed medical therapies, the first underwent a glycerol rhizotomy, gammaknife radiosurgery and microvascular decompression of the trigeminal nerve. The second patient underwent gammaknife radiosurgery of the trigeminal root exit zone and two microvascular decompression surgeries. Neither patient benefited from these procedures. Currently, the first patient suffers from anaesthesia dolorosa and the second patient from unilateral deafness, chronic vertigo and dysequilibrium as a result of surgical trauma. These cases of SUNCT highlight the uncertainty regarding the role of surgery given the potential for significant morbidity. These cases also suggest that SUNCT originates and may be maintained from within the CNS and this central locus explains why SUNCT is not typically amenable to interventions aimed at the peripheral portion of the trigeminal nerve.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/26. Excruciating perineal pain after intravenous dexamethasone.We describe two cases of unexpected perineal pain immediately after intravenous injection of fentanyl and dexamethasone (100 microg and 8 mg respectively) during induction of general anaesthesia. In both cases the pain was immediate (onset within 30 seconds), severe, localized to the genital region and of shooting and burning character No other clinical signs or symptoms were observed in either case and both patients made an uneventful recovery without neurological sequelae. We review the existing literature on perineal pain as an adverse effect of intravenous corticosteroid esters and recommend their administration either in diluted form or after induction of general anaesthesia.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
5/26. Intra-ureteric capsaicin in loin pain haematuria syndrome: efficacy and complications.OBJECTIVE: To evaluate the safety and efficacy of intra-ureteric capsaicin for loin pain haematuria syndrome (LPHS). patients AND methods: In an open prospective pilot study, four middle-aged patients (three women and one man) with LPHS resistant to therapies such as splanchnic nerve block, psychological treatment or renal autotransplantation (one) were assessed. An intra-ureteric infusion of capsaicin (30 mg/100 mL of 30% alcohol in saline) for 30 min with bladder irrigation was administered under general anaesthesia, with a subsequent intravenous patient-controlled narcotic analgesic pump for pain control. Double-concentration capsaicin was used for second infusions, if necessary when the response to the earlier infusion was inadequate or incomplete. RESULTS: The first patient had experienced reduced pain levels for the first 3 months only, with no benefit from the subsequent treatments with higher doses of capsaicin (60 mg). The second patient with recurrent pain in an autotransplanted kidney had no benefit from either a 30 or 60 mg capsaicin infusion a month apart, but developed a fibrotic stricture at the transplant pelvi-ureteric junction, requiring pyelocystoplasty. The third patient with concurrent depression had no benefit from a 30-mg infusion of capsaicin. The fourth patient experienced no pain relief from a 30 mg infusion of capsaicin but developed proteinuria secondary to mesangial proliferative glomerulonephritis, ureteric inflammation needing stenting within 7 days of treatment and subsequently nephrectomy for a nonfunctioning kidney at 3 months. CONCLUSION: Intra-ureteric capsaicin was neither effective nor safe in LPHS; the contribution of the alcohol diluent cannot be excluded.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/26. Dorsal penile nerve block.BACKGROUND: The dorsal penile nerve block (DPNB) is a common form of regional anaesthesia for circumcisions in children. The safety of this block has been questioned following several case reports of potentially serious complications. methods: We performed a retrospective review of all the incidents related to the conduct of this block in our institution over a period of 53 months. RESULTS: A total of 3909 circumcisions were performed under DPNB and nine incidents were recorded. This included two cases of bleeding from the prepuce, two urethral injuries, three haematomas and two drug errors. Two cases required further surgical intervention but all of the patients recovered with no apparent long-term sequelae. CONCLUSIONS: We feel that the DPNB is a safe technique for circumcisions in infants and children.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/26. Congenital trigeminal anaesthesia.Two patients with congenital trigeminal nerve anaesthesia are described. The first (male, aged 14 years) had an isolated unilateral loss of sensation in all three divisions of the trigeminal nerve with no other abnormalities. The second patient (male, aged 3 years 6 months) had bilateral loss of sensation in all three divisions of the trigeminal nerve, associated with other neurological abnormalities. No explanation for their abnormalities was found. The Rosenberg classification of congenital trigeminal anaesthesia is discussed with reference to these patients and also with reference to the developmental biology of the trigeminal nerve.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
8/26. The impact of regional anaesthesia on outcome: a patient's perspective.Peripheral nerve catheters are being used increasingly to manage acute pain. Whilst acknowledged as effective, their broader implications for patient outcome are less clear. In this case report, we describe the way in which not only was the pain management of an ischaemic leg successful via a sciatic nerve catheter, but decision-making around this strategy affected outcome.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
9/26. Vertical patellar dislocation: a case report.Dislocation of the patella around the vertical axis is rare. Previous reports suggest reduction requires general anaesthesia and occasionally open reduction is necessary. We describe a case of dislocation of the patella around its vertical axis with impaction in the intercondylar notch of the femur following minor trauma. Successful reduction was achieved without the need for general anaesthesia.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
10/26. Development of bilateral herpes zoster following thoracoscopic splanchnicectomy.A 39-year-old female presented for elective bilateral thoracoscopic splanchnicectomy for chronic severe visceral pain. Surgery and anaesthesia were uneventful and she gained good symptomatic relief. Postoperative recovery was complicated by the development on day four of bilateral herpes zoster at the T8 dermatome level. This was treated immediately with oral acyclovir. She subsequently developed severe post-herpetic neuralgia requiring the recommencement of gabapentin and amitriptyline. Further benefit was gained from a course of calcitonin. This case report examines the possible causative factors in the development of post-surgical herpes zoster.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
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