RESUMEN
Delayed pneumothorax may occur after subclavian vein catheterization and results from slow accumulation of air in the pleural space. Thus initial postinsertion chest x-rays may not detect this complication. The addition of positive pressure ventilation for general anaesthesia may make this complication life threatening. We report three cases and the literature is surveyed.
Asunto(s)
Cateterismo/efectos adversos , Neumotórax/etiología , Respiración con Presión Positiva/efectos adversos , Vena Subclavia , Anciano , Anestesia General/métodos , Femenino , Humanos , Persona de Mediana Edad , Factores de TiempoRESUMEN
Headaches are among the most common pain syndromes encountered in clinical practice. Of these headaches, 70%-80% are ultimately diagnosed as tension type headaches (TTH). Most patients suffering from TTH will experience improvement when treated with traditional modalities, including tricyclic antidepressants, nonsteroidal antiinflammatory agents, and cognitive therapies. Unfortunately, not all patients respond to the traditional modalities. We wish to report 48 patients suffering from pain secondary to intractable TTH who failed to respond to traditional treatment modalities and were treated with cervical steroid epidural nerve blocks (CSENB). The average number of CSENB performed per patient was four. Average pain score prior to CSENB was 4.8. Six weeks following CSENB, the average pain score was 0.95. At 3 months follow-up, the VAS score was 0.35. These results suggest that CSENB may appear to provide effective relief of pain to some patients with intractable TTH.
Asunto(s)
Analgesia Epidural/métodos , Cefalea/terapia , Bloqueo Nervioso/métodos , Dolor Intratable/terapia , Cuidados Paliativos/métodos , Bupivacaína , Estudios de Seguimiento , Cefalea/complicaciones , Humanos , Metilprednisolona , Dolor Intratable/etiologíaRESUMEN
A 33-yr-old, 42-kg female, with extensive hepatic metastatic disease with intractable pain unresponsive to narcotic analgesics, nonsteroidal antiinflammatory drugs, and tricyclic antidepressants, is presented. Management of this patient's intractable pain with local anesthetics administered via a tunneled intrapleural catheter is discussed. Tunneling techniques are described. The patient continued to experience excellent pain relief at 6 wk follow-up.
Asunto(s)
Catéteres de Permanencia , Bloqueo Nervioso/métodos , Dolor Intratable/tratamiento farmacológico , Adulto , Bupivacaína/administración & dosificación , Bupivacaína/uso terapéutico , Femenino , Humanos , Inyecciones , Neoplasias Hepáticas/fisiopatología , Neoplasias Hepáticas/secundario , PleuraRESUMEN
Relapsing polychondritis is a rare disease of unknown etiology characterized pathologically by degeneration of the chondrocyte and replacement with fibrous connective tissue. The following case report presents the pain management of a 34-yr-old man suffering from intractable pain secondary to relapsing polychondritis. Systemic narcotic analgesics, adjunctive drugs, and peripheral nerve blocks with local anesthetic and steroid failed to adequately control the patient's pain. Thoracic epidural morphine was used to provide excellent relief of pain. Factors in the selection of an implantable narcotic delivery system as well as practical considerations including tolerance and potential side effects of intraspinal narcotics are discussed. Ethical issues surrounding the chronic use of intraspinal narcotics in the setting of chronic benign pain are also discussed.