A&A practice
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Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is an uncommon condition classically characterized by chronic abdominal pain, weight loss, and abdominal bruit. Chronic mesenteric ischemia caused by intermittent compression of the celiac artery by the MAL provokes upper abdominal pain that is sympathetically mediated via the celiac plexus. Because it is a diagnosis of exclusion, diagnosis of MALS in the clinical setting is typically challenging. We present an atypical case which highlights the utility of celiac plexus block as both an assistant diagnostic tool and a predictor of surgical outcomes for suspected MALS.
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Severe pain after a hip fracture commonly delays hospital discharge and poses significant nursing problems in patients who are not surgical candidates. We present ultrasound-guided pericapsular hip alcohol neurolysis of the articular branches of the femoral and obturator nerves as a novel approach in the treatment of severe pain after hip fracture. This technique provided excellent pain relief in a 94-year-old patient with intertrochanteric hip fracture until her death 2 months later.
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Case Reports
Transversalis Fascia Plane Block for the Treatment of Chronic Postherniorrhaphy Inguinal Pain: A Case Report.
Chronic neuropathic pain is a well-recognized complication of inguinal hernia repair. We report a 47-year-old man suffering from chronic neuropathic postherniorrhaphy pain. ⋯ We therefore performed transversalis fascia plane block with local anesthetic and steroid that resulted in long-term pain relief. This block has been successfully used in the past for providing postoperative analgesia in the L1 dermatome, but its role in chronic pain is unreported.
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A 37-year-old gravida 5 para 4 with gestational hypertension underwent uneventful repeat cesarean delivery and tubal ligation under combined spinal-epidural anesthesia. On postoperative day 3, she developed a postural headache, unrelieved by caffeine, ibuprofen, and hydration. ⋯ An epidural blood patch was administered, providing immediate and complete relief of her headache and bilateral upper and lower dental pain, which she noted arising concomitantly with her headache. We suspect bilateral traction on cranial nerve V2 and V3, secondary to intracranial hypotension after dural puncture, as the cause of her pain.