A&A practice
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Case Reports
Airway Management Through a Facial Defect Resulting From Noma (Orofacial Gangrene): A Case Report.
At a rural district hospital in Burundi, a 3-year-old severely malnourished girl with Noma presented to the operating room for placement of a gastrostomy tube. The child had a large left-sided facial defect as well as trismus. ⋯ Given that the hospital has no fiberoptic bronchoscope, direct laryngoscopy and intubation were performed directly through her facial defect. After securing the airway, the surgery proceeded without difficulty.
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The pericapsular nerve group (PENG) block targets articular branches of the obturator, accessory obturator, and femoral nerves. This block has mostly been used to reduce pain caused by hip fractures. A catheter inserted in the plane between the iliopsoas muscle and iliopubic eminence can extend the analgesic duration. We describe the use of this block for successful pain relief of 10 patients with hip fracture (intertrochanteric, subtrochanteric, neck of femur) scheduled for surgery and continuing analgesia in the postoperative period with a catheter inserted in the musculofascial plane as described above.
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Case Reports
Inappropriate Defibrillator Shocks During Cervical Medial Branch Radiofrequency Ablation: A Case Report.
A 52-year-old woman with a history of cervical spondylosis, nonischemic dilated cardiomyopathy, and complete heart block with implantation of a cardiac resynchronization therapy defibrillator (Inogen XR, Boston Scientific, Natick, MA) underwent bilateral fluoroscopy-guided radiofrequency ablation of the medial branch nerves at C4, C5, and C6 levels at an ambulatory surgery center. After completion of the seemingly routine procedure, several alerts, including 1 inappropriate shock, were received via Boston Scientific's remote monitoring system. Tracings also showed that pacing inhibition occurred. When performing radiofrequency ablation in patients with a cardiac implantable electronic device, it is imperative to follow published best practice recommendations to minimize the risk of adverse events.
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Case Reports
A Case Report of Peripheral Nerve Stimulation for Acute Neuropathic Pain in Guillain-Barre Syndrome.
Guillain-Barre syndrome (GBS) is a peripheral demyelinating neuromuscular disorder occasionally associated with pharmacologically refractory neuropathic pain. We present a case of acute neuropathic pain in a 22-year-old man with GBS managed with percutaneous peripheral nerve stimulation (PNS). ⋯ Analgesic and anxiolytic medications were reduced by 33% on the first day and by 78% on day 21. PNS is a minimally invasive, nonpharmacologic modality for treating acute neuropathic pain in GBS patients.
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Case Reports
Pecs Blocks for Chronic Pain: A Case Report of Successful Postmastectomy Pain Syndrome Management.
Mastectomies can be complicated by difficult-to-treat postmastectomy pain syndrome (PMPS) and axillary web syndrome (AWS). We present a case of PMPS and AWS successfully treated with Pecs I and II blocks and trigger point injections. ⋯ This case presents the utility of a multimodal approach for a patient with pain after mastectomy. This case report is the first-time demonstration of Pecs blocks to treat chronic PMPS.