A&A practice
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Case Reports
Continuous Intrathecal Morphine Infusion for Pain Management in a Polytrauma Patient: A Case Report.
Polytrauma patients are at high risk for neurologic complications as a result of the primary mechanism of their trauma and/or delirium caused by subsequent pain, sedatives and analgesic exposure, sleep disturbances, infections, metabolic derangements, organ dysfunctions, withdrawal syndromes, or other factors. The high prevalence of delirium within trauma intensive care units increases risks for both patients and providers and is associated with worsened patient outcomes. This case report explains the rationale and utilization of continuous intrathecal morphine administration to improve pain control while reducing and eliminating intravenous (IV) analgesics and sedatives to enable wakefulness in a polytrauma patient with refractory agitated delirium.
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Case Reports
First Bite Syndrome Relief With Trigeminal Nerve Branch Block and Ablation: A Case Report.
First bite syndrome (FBS) is intense facial pain at the first bite of each meal. Currently, no guidelines exist for treating FBS, although botulinum toxin injection has shown benefit. ⋯ Our treatment may have disrupted somatic sensory input from the parotid carried by the auriculotemporal nerve or lesioned the otic ganglion resulting in decreased parasympathetic hyperactivation. Further studies are warranted to evaluate the use of this procedure for FBS.
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Neuromuscular blocking agents are used during general anesthesia to optimize intubating and surgical conditions. Determining the level of neuromuscular blockade and ensuring adequate reversal are crucial to prevent anesthesia-related postoperative residual weakness and its associated complications. ⋯ It was later determined that the patient recently received botulinum toxin treatment. Facial nerve stimulation is not a reliable method for neuromuscular blockade monitoring.