RESUMEN
An inevitable side effect of iliac crest bone graft harvesting is postoperative pain at the donor site. Bupivacaine hydrochloride is a long-acting local anesthetic that is clinically effective for approximately 8 hours. The present study was undertaken to assess postoperative pain relief with locally injected bupivacaine at the iliac crest bone graft harvest site. Pain relief with locally injected bupivacaine or saline at the iliac bone harvest site using an indwelling catheter was studied in 13 patients in a prospective, double-blind, crossover study. Twelve patients had cervical diskectomy and arthrodesis with autograft and one patient had a triple arthrodesis of the foot. There were no statistically significant differences between patients given bupivacaine and patients given saline with respect to pain relief ratings and hip-pain ratings at rest and motion during the first 24-hour postoperative period and the second 24-hour postoperative period (Mann-Whitney test). The single diabetic patient who had a triple arthrodesis developed a wound infection at the catheter placement site. The number of patients was too small to draw conclusions about the differences in pain-medication requirements between patients undergoing single versus multiple diskectomies and fusions. In view of the lack of improvement in pain relief and the risk of infection, local administration of bupivacaine at the iliac bone harvest site is not recommended in its present form for postoperative analgesia.
Asunto(s)
Anestésicos Locales/uso terapéutico , Bupivacaína/uso terapéutico , Ilion/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Trasplante Óseo , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Ilion/trasplante , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Estudios ProspectivosRESUMEN
Brainstem auditory evoked potential (BAEP) and visual evoked potential (VEP) studies were undertaken in 8 patients with chronic cervical pain associated with auditory and visual symptoms of more than 6 months duration. The purpose of the study was to ascertain possible central abnormalities, including posterior cervical sympathetic syndrome (Barre-Lieou syndrome), in their auditory and/or visual pathways. Patients who had been treated surgically for cervical pain were excluded from the study group. All patients had normal cervical radiographs and electromyographic findings. Six also had normal CT scans and myelograms. A criterion of the study was that abnormal results would be considered significant only if ophthalmological and/or otolaryngological work-ups failed to reveal an underlying organic abnormality. The TECA-TE 42 was used throughout the study, as well as the international Ten-Twenty System of Electrode Placement. The results showed no abnormalities in the latency, amplitude, or waveform morphology of the evoked potentials. BAEP and VEP studies do not appear to reveal central abnormalities of the auditory and visual pathways in this group of patients. However, in view of the small number of patients included in the study, no conclusions can be made with certainty and the study is continuing.
Asunto(s)
Vértebras Cervicales , Potenciales Evocados Auditivos , Potenciales Evocados Visuales , Dolor/fisiopatología , Adulto , Tronco Encefálico/fisiopatología , Mareo/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Visión/fisiopatologíaRESUMEN
This report reviews the results of the first 2 1/2 years of a comprehensive multidisciplinary inpatient-outpatient treatment program for patients with chronic pain. Functional data indicate a 33 1/3% rate of return to work or involvement in work training programs, while self-report data indicate a 50% improvement rate. Future directions for research are suggested.
Asunto(s)
Manejo del Dolor , Grupo de Atención al Paciente , Adulto , Anciano , Enfermedad Crónica , Emociones , Femenino , Estudios de Seguimiento , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Dolor/psicología , Rehabilitación Vocacional , Conducta Social , Encuestas y CuestionariosRESUMEN
The management of iatrogenic drug dependence in individuals with pain can be more difficult than the treatment of the pain itself. In addition to a multidisciplinary approach to the treatment of a patient with chronic pain, there is a need for a rapid, safe, and effective method of detoxification from opiate use. Clonidine HCl, a nonopiate, has been found, in this case presentation, to be a valuable option.
Asunto(s)
Clonidina/uso terapéutico , Meperidina/efectos adversos , Dolor/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Adulto , Terapia Combinada , Esquema de Medicación , Femenino , Humanos , Meperidina/uso terapéuticoRESUMEN
Chronic pain is a leading health care problem with a wide range of physical and psychosocial outcomes. This report reviews the key intake findings of the first 227 patients admitted to a comprehensive inpatient/outpatient program for the treatment of chronic pain. Key trends in the data which suggest the different presentations of the chronic pain syndrome are highlighted and indications for future research are given.