Some pelvic pain syndromes are very resistant to medical treatment. Several studies have demonstrated that sacral neuromodulation, which has been successfully used for the treatment of bladder dysfunction, incontinenc...Some pelvic pain syndromes are very resistant to medical treatment. Several studies have demonstrated that sacral neuromodulation, which has been successfully used for the treatment of bladder dysfunction, incontinence, urinary retention and urinary frequency [1]-[3], can be successfully used for the treatment of chronic pelvic pain [4]-[7]. Several studies have also demonstrated significant involvement of dorsal column pathways in the transmission of visceral pelvic pain [8] and the successful use of spinal cord stimulation for the treatment of chronic pelvic pain [9]. We report three cases of severe chronic pelvic pain that failed conservative treatment modalities. Placement of a combined sacral nerve roots stimulator and a low thoracic spinal cord stimulator resulted in a significant pain relief and improvement in daily life activities. We believe that this combination may help patients suffering from chronic pelvic pain resistant to medical management.展开更多
A 40-years-old female patient with severe right facial pain with a throbbing component along the mandibular division of the trigeminal nerve resistant to medical management. Continuous inferior alveolar nerve block wi...A 40-years-old female patient with severe right facial pain with a throbbing component along the mandibular division of the trigeminal nerve resistant to medical management. Continuous inferior alveolar nerve block with local anesthetics using an indwelling catheter provided a complete pain resolution for the patient for 2 weeks, after which the catheter got infected and was removed. A trial of balloon occlusion of the right internal maxillary artery provided complete resolution of the throbbing component of the patient’s pain. This was followed by permanent embolization with multiple coils.展开更多
In this article we discuss the effect of posture on impedance during the placement of a spinal cord stimulator. Although, according to several studies, there appears not to be a specific and consistent change in imped...In this article we discuss the effect of posture on impedance during the placement of a spinal cord stimulator. Although, according to several studies, there appears not to be a specific and consistent change in impedance with change in posture, we noticed on multiple occasions that if the impedance remains very high during spinal cord stimulator (SCS) lead placement, asking the patient to sit up from the prone position may drop the impedance down. This could be explained by having air around the lead, from using loss of resistance to air technique in finding the epidural space, which moves up when sitting the patient up, or having the lead immersed in epidural fat. Sitting the patient up from the prone position should be tried if the impedance remains very high before aborting the procedure and taking the lead out.展开更多
A 61 year old male patient undergoing gastrectomy under general anesthesia developed severe anaphylactoid shock after 15 minutes from starting 5% albumin infusion. His blood pressure went from 101/67 down to 44/23 wit...A 61 year old male patient undergoing gastrectomy under general anesthesia developed severe anaphylactoid shock after 15 minutes from starting 5% albumin infusion. His blood pressure went from 101/67 down to 44/23 with his heart rate going up from 91 to 99. A total of 1600 mcg of phenylephrine were given without any improvement in the hemo-dynamics. We then gave 50 mcg of Epinephrine to which blood pressure rapidly responded going up to 141/60 (mean 88). Then 15 mg of Dexamethasone were given. Blood pressure remained stable with the mean between 75 and 90, without requiring anymore pressors. 5% albumin is considered among the safer colloids with a risk of anaphylactoid reactions less than gelatins and dextrans and comparable to starches. However, severe life threatening anaphylaxis has been reported with Albumin infusion. With the still ongoing crystalloid colloid debate, with many studies showing no survival benefit with colloid use for volume resuscitation, the risk of severe anaphylactic shock, even with the safer colloids like albumin should drive to a more conservative use of albumin for volume resuscitation, specially under general anesthesia, when recognizing the signs and symptoms of anaphylaxis and the offending agent maybe more challenging.展开更多
文摘Some pelvic pain syndromes are very resistant to medical treatment. Several studies have demonstrated that sacral neuromodulation, which has been successfully used for the treatment of bladder dysfunction, incontinence, urinary retention and urinary frequency [1]-[3], can be successfully used for the treatment of chronic pelvic pain [4]-[7]. Several studies have also demonstrated significant involvement of dorsal column pathways in the transmission of visceral pelvic pain [8] and the successful use of spinal cord stimulation for the treatment of chronic pelvic pain [9]. We report three cases of severe chronic pelvic pain that failed conservative treatment modalities. Placement of a combined sacral nerve roots stimulator and a low thoracic spinal cord stimulator resulted in a significant pain relief and improvement in daily life activities. We believe that this combination may help patients suffering from chronic pelvic pain resistant to medical management.
文摘A 40-years-old female patient with severe right facial pain with a throbbing component along the mandibular division of the trigeminal nerve resistant to medical management. Continuous inferior alveolar nerve block with local anesthetics using an indwelling catheter provided a complete pain resolution for the patient for 2 weeks, after which the catheter got infected and was removed. A trial of balloon occlusion of the right internal maxillary artery provided complete resolution of the throbbing component of the patient’s pain. This was followed by permanent embolization with multiple coils.
文摘In this article we discuss the effect of posture on impedance during the placement of a spinal cord stimulator. Although, according to several studies, there appears not to be a specific and consistent change in impedance with change in posture, we noticed on multiple occasions that if the impedance remains very high during spinal cord stimulator (SCS) lead placement, asking the patient to sit up from the prone position may drop the impedance down. This could be explained by having air around the lead, from using loss of resistance to air technique in finding the epidural space, which moves up when sitting the patient up, or having the lead immersed in epidural fat. Sitting the patient up from the prone position should be tried if the impedance remains very high before aborting the procedure and taking the lead out.
文摘A 61 year old male patient undergoing gastrectomy under general anesthesia developed severe anaphylactoid shock after 15 minutes from starting 5% albumin infusion. His blood pressure went from 101/67 down to 44/23 with his heart rate going up from 91 to 99. A total of 1600 mcg of phenylephrine were given without any improvement in the hemo-dynamics. We then gave 50 mcg of Epinephrine to which blood pressure rapidly responded going up to 141/60 (mean 88). Then 15 mg of Dexamethasone were given. Blood pressure remained stable with the mean between 75 and 90, without requiring anymore pressors. 5% albumin is considered among the safer colloids with a risk of anaphylactoid reactions less than gelatins and dextrans and comparable to starches. However, severe life threatening anaphylaxis has been reported with Albumin infusion. With the still ongoing crystalloid colloid debate, with many studies showing no survival benefit with colloid use for volume resuscitation, the risk of severe anaphylactic shock, even with the safer colloids like albumin should drive to a more conservative use of albumin for volume resuscitation, specially under general anesthesia, when recognizing the signs and symptoms of anaphylaxis and the offending agent maybe more challenging.
