RESUMEN
Supraclavicular nerve block is the most popular regional anesthesia approach for upper limb surgery. It also predispose some complications because of the adjacent neurovascular structures such as pleura, recurrent laryngeal and phrenic nerve, supraclavicular vessels, and spinal cord structures. The widespread use of ultrasound for peripheral nerve blocks has reduced the incidence of these complications. We aimed to present a case of brain edema developed after ultrasound-guided supraclavicular block which was not reported in the literature before. A 25 years old, American Society of Anesthesia (ASA) score I, male patient was admitted to our clinic to perform the replacement of external fixator with an internal fixator. The ultrasound guidance supraclavicular nerve block was performed. After the block, we observed disorientation, blurring in consciousness, paleness, tachycardia, hypertension and tachypnea. Upon this, we performed induction for general anesthesia and intubation. After the onset of myoclonic epileptic seizure, he was re-intubated in the recovery room. Bilateral cerebral parenchyma was edematous, the sulci were faint and venous structures were prominent on the brain computerized tomography. Because of magnetic resonance imaging (MRI) finding that restricted diffusion which was compatible with cortical-subcortical acute ischemia, mannitol, dexamethasone and furosamid were started as anti-edema treatment. On the third day in intensive care unit, the patient was extubated because of improvement in consciousness and marked decrease in brain swelling on the control radiologic imaging. It should be kept in mind that brain edema secondary to local anesthetic systemic toxicity (LAST) may develop as a complication after brachial plexus blocks. KEY WORDS: Brain Edema, Epileptic Seizure, Supraclavicular Nerve Block, Ultrasound.
Asunto(s)
Bloqueo del Plexo Braquial , Edema Encefálico , Ultrasonografía Intervencional/efectos adversos , Adulto , Anestésicos Locales/efectos adversos , Bloqueo del Plexo Braquial/efectos adversos , Edema Encefálico/diagnóstico por imagen , Edema Encefálico/etiología , Edema Encefálico/terapia , Humanos , MasculinoRESUMEN
BACKGROUND: The configuration of a nerve block catheter may affect the local anesthetic spread in epidural analgesia and continuous peripheral nerve blocks. This prospective and randomized study aims to compare the multi-orifice nerve block catheter with an end-hole catheter in ultrasound-guided continuous infraclavicular brachial plexus block (BPB) in terms of providing postoperative analgesia for the orthopedic upper limb surgery below the shoulder. The primary outcome measure was mean pain scores. Secondary outcome measures were the consumption of rescue analgesic and the amount of local anesthetics delivered by a Patient-Controlled Analgesia (PCA) device. METHODS: A total of 58 adult patients who underwent orthopedic upper limb surgery below the shoulder were randomly assigned into two groups: group end-hole catheter (EHC) (n=31) and group multi-orifice catheter (MOC) (n=27). All patients received a single-shot infraclavicular BPB using 100 mg lidocaine 2% and 75 mg bupivacaine 0.5% administrated through a Tuohy needle. Then, a multi-orifice (triple-hole) nerve catheter was placed in the group MOC and an end-hole (one-hole) catheter in the group EHC at the same location. Bupivacaine 0.125% was infused through the catheters via PCA (infusion rate: 2 mlh-1, automated regular bolus: 5 mlh-1, patient-controlled bolus: 3 ml, lock-out time: 1 hour, 4 hours limit: 40 ml). Pain intensity was evaluated using a visual analogue scale (VAS). RESULTS: Mean VAS scores were higher in group EHC than group MOC in the first postoperative day (p=0.001). Mean rescue analgesic consumption, the number of bolus demand on PCA, PCA bolus demand dose, and total PCA dose were higher in group EHC than group MOC during the first postoperative day (p<0.05). CONCLUSION: It is concluded that the use of MHC is more effective than EHC for continuous infraclavicular brachial plexus blocks in providing postoperative pain relief during the first 24 hours.
Asunto(s)
Analgesia , Bloqueo del Plexo Braquial , Catéteres , Dolor Postoperatorio , Extremidad Superior/cirugía , Adulto , Analgesia/instrumentación , Analgesia/métodos , Bloqueo del Plexo Braquial/instrumentación , Bloqueo del Plexo Braquial/métodos , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/prevención & controlRESUMEN
Background/aim: Degenerative disc disease (DDD) is one of the main causes of lower back pain. In this study, we evaluate the efficacy of percutaneous intradiscal GelStix administration in patients with discogenic pain due to lumbar DDD who were unresponsive to conservative methods. Materials and methods: A total of 29 patients were included in the study, which took place between 2013 and 2017. Sedation was performed in the prone position in the operating room, and a C-arm was located so as to provide a lateral view of the surgical field. A 22-G, 3.5-inch needle was inserted into the center of the disc under fluoroscopy guidance, and a percutaneous intradiscal GelStix implantation was performed. All patients were evaluated using the Oswestry Disability Index (ODI) and a visual analogue scale (VAS) before and after treatment, and using the Patient Satisfaction Scale at 12 months following treatment. Results: The mean VAS scores were 7.14 ± 0.64 at baseline and 2.48 ± 0.63 at 12 months (P < 0.001). The mean ODI scores were 28.14 ± 1.81 at baseline and 17.35 ± 0.67 at 12 months (P < 0.001). There was a statistically significant decrease in the VAS and ODI scores before and after treatment. A total of 86.2% of the patients rated the procedure as very good or good at 12 months. Conclusion: Our study results suggest that GelStix treatment is useful in pain relief in patients with DDD from the first month of treatment.
Asunto(s)
Hidrogeles/uso terapéutico , Degeneración del Disco Intervertebral/terapia , Vértebras Lumbares , Femenino , Fluoroscopía , Humanos , Hidrogeles/administración & dosificación , Disco Intervertebral/cirugía , Degeneración del Disco Intervertebral/cirugía , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Resultado del TratamientoRESUMEN
Background/aim: Minimally invasive procedures have been increasingly used for the treatment of herniated discs. Nonsurgical interventions minimize the secondary damage to other tissues and shorten the length of hospital stay by avoiding general anesthesia. Possible complications are thermal injuries, root injury, discitis, endplate damage, dural injury, meningitis, infection, increase in pain, and muscle spasm. We aimed to evaluate the efficacy of percutaneous decompression therapy by using intradiscal navigable electrodes on pain and functional movement index in patients with herniated nucleus pulposus (HNP). Materials and methods: A total of 209 patients with protrusive lumbar disc herniation underwent percutaneous ablation decompression treatment using an intradiscal routable electrode (L-Disq) in our pain clinic. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were recorded at the beginning and at the 1st, 3rd, 6th, and 12th months after treatment. Patient satisfaction was evaluated at the 12th month by a patient satisfaction scale (PSS). Results: When compared to initial values, VAS and ODI scores showed statistically significant improvement at the 1st, 3rd, 6th, and 12th months (P < 0.001). Mean VAS scores were 7.28 and 3.03 points (P < 0.001) while mean ODI scores were 32.46 and 20.48 points (P < 0.001) at the beginning and at the 12th month, respectively. Satisfaction rate of all patients was 81%. We also attempted to treat the existing annular fissure using an ablation method and we believe that treating the herniated disc together with the fissure in the same session increased our success rate. Conclusion: With clinical evidence, we suggest that L-Disq may be considered as an appropriate option with a low risk of complications in pain management in cases of lumbar disc herniation that are resistant to conservative methods.
Asunto(s)
Dolor de Espalda/cirugía , Descompresión Quirúrgica , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/patología , Manejo del Dolor , Adulto , Anciano , Dolor de Espalda/etiología , Dolor de Espalda/fisiopatología , Descompresión Quirúrgica/instrumentación , Femenino , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/fisiopatología , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Resultado del Tratamiento , Escala Visual AnalógicaRESUMEN
Background/aim: We aimed to compare the effectivity of percutaneous disc coagulation therapy (PDCT) and navigable ablation decompression treatment (L-DISQ) in patients who were diagnosed with cervical disc herniation. Materials and methods: Visual analog scale (VAS) and Neck Pain Index (NPI) scores were recorded initially and at the 1st, 3rd, 6th, and 12th months after the procedures. Patient Satisfaction Scale (PSS) scores were recorded 12 months after the procedures Results: Mean VAS scores were 7.55 and 3.1 points in the PDCT group and 7.6 and 3.00 points in the L-DISQ group; mean NPI scores were 34.2 and 20.75 points in the PDCT group and and 34.1 and 20.4 points in the L-DISQ group initially and at the 12th month. When compared between months, there was a significant decrease in time-dependent VAS and NPI scores in both PDCT and L-DISQ groups (P = 0.001). Some complications included esophageal, vascular, and neural injuries; hoarseness; Horner syndrome; infections; dural puncture; and muscle spasm. The only difference between groups was the rate of cervical spasm within 1 month after the procedure: 75% in the PDCT group and 15% in the L-DISQ group. Conclusion: The diameter of the canal of the cervical vertebrae is narrower than of the lumbar and thoracic regions; therefore, the smaller part of the disc may be sufficient to create clinical signs. The response to decompression therapies is faster in the case of cervical percutaneous procedures that are performed correctly. Proper patient selection and practitioner's experience are important in the treatment success
Asunto(s)
Vértebras Cervicales/cirugía , Discectomía Percutánea , Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/cirugía , Disco Intervertebral/cirugía , Coagulación con Láser , Adulto , Discectomía Percutánea/efectos adversos , Discectomía Percutánea/métodos , Discectomía Percutánea/estadística & datos numéricos , Femenino , Humanos , Coagulación con Láser/efectos adversos , Coagulación con Láser/métodos , Coagulación con Láser/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Dolor de Cuello , Dolor Postoperatorio , Estudios Retrospectivos , Escala Visual Analógica , Adulto JovenRESUMEN
Background/aim: We aimed to compare the results of the treatment of the patients with failed back surgery syndrome (FBSS) by mechanical lysis and steroid hylase injection via epiduroscopy due to their stabilization status and to detect the effect of pathological diagnostic markers on prognosis and ongoing treatment protocol. Materials and methods: Eighty-two patients with FBSS symptoms were included. Two groups were composed as group I (stabilized) and group II (nonstabilized). All patients were evaluated using the oswestry disability index (ODI) and visual analogue scale (VAS) scores before and after treatment at 1, 3, 6, and 12 months and using the patient satisfaction scale at 12 months following treatment. Epidural scar tissue visual and mechanical signs were also recorded. Results: Mean VAS scores were 7.8 and 3.28 points in group I (P < 0.001) and 7.51 and 2.74 points in group II (P < 0.001) at the beginning and at 12 months, respectively. Mean ODI scores were 34.05 and 22.16 points in group I (P < 0.001) and 30.74 and 19.46 points in group II (P < 0.001) at the beginning and at 12 months. VAS and ODI scores decreased significantly in both groups, but were more significant in the nonstabilized group (P < 0.001). Moderate or severe fibrous tissue was observed in 86.58% of the patients and patient satisfaction scores were very good or good in 78.06% of the patients. During the procedure, a dura rupture developed in four patients in the stabilization group and in two patients in the nonstabilization group; however, none of these patients developed a spinal headache and no significant permanent complication arose. Conclusion: We suggest that epidural adhesiolysis, hyaluronidase, and steroid injection in patients with FBSS chronic low back pain and/or radicular symptoms may give reliable information about the quality of life, accuracy of diagnosis, and the possible course of the present findings and may be more effective in nonstabilized patients
Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/cirugía , Hialuronoglucosaminidasa/uso terapéutico , Adherencias Tisulares/terapia , Adulto , Estudios de Cohortes , Femenino , Humanos , Dolor de la Región Lumbar/terapia , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/efectos adversos , Dolor Postoperatorio/terapia , Reoperación , Adherencias Tisulares/etiología , Resultado del TratamientoRESUMEN
Aims: Although there have been many studies about lumbar and cervical ablation procedures, few studies have been performed in the thoracic region. To evaluate the clinical results of a percutaneous disc decompression device in patients with radicular symptoms and/or dorsal pain due to thoracic disc herniation. Methods: Eleven patients with thoracic disc herniation and/or degenerative discs (all in T10-T11, or T11-T12 levels) who did not respond to conservative treatments were undergoing ablation and compression procedures. Pain and radicular symptoms consistent with the thoracolumbar region were confirmed via abnormal magnetic resonance imaging findings after detailed anamnesis and physical examination. All patients were evaluated before and 1, 3, 6, and 12 months after treatment using the visual analog scale score. The patient satisfaction scale was used to evaluate the level of patient satisfaction at the end of the treatment at 12 months. Results: The median visual analog scale score was 7.00±0.45 points before treatment and 2.73±0.65 points at 12 months post-procedure and were statistically significant (p<0.001). The results of pairwise comparisons using the Bonferroni Corrected Wilcoxon Signed-Rank test showed that there were statistically significant differences. The mean visual analog scale score at the beginning (7.00±0.45) was significantly higher than the mean score of other months. Postoperative improvement was significant with a 99% confidence interval. No complications that may cause permanent damage occurred. Conclusion: Percutaneous disc decompression is an effective and safe procedure to treat pain caused by lower thoracic intervertebral disc disease, which did not respond to conservative treatments.