A&A practice
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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.
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Patients with end-stage liver disease are often hyponatremic due to multiple physiological processes associated with hepatic failure. For severely hyponatremic patients undergoing liver transplantation, intraoperative management of serum sodium concentration ([Na]s) is challenging. [Na]s tends to increase during transplantation by the administration of fluids with higher sodium concentration than the patient's [Na]s. An overly rapid increase in [Na]s (>1 mEq·L·hour) is difficult to avoid and increases the risk of serious perioperative complications. We report the successful use of intravenous desmopressin to reverse an overly rapid rise in [Na]s during living donor liver transplantation.
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Baastrup disease is a condition where spinous processes form painful pseudoarticulations. We present a patient with midline axial back pain consistent with Baastrup disease confirmed by computed tomography, which revealed degenerative changes along the opposing surfaces of the spinous processes at L1-2 and L2-3. ⋯ She underwent successful interspinous radiofrequency lesioning, which has not been previously described in the literature. At 4 months follow-up, she reported complete pain relief.
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We describe a case of refractory pulseless polymorphic ventricular tachycardia successfully treated with a bolus of propranolol intravenously, followed by an esmolol infusion and extracorporeal life support for 4 days in a 12-year-old boy later diagnosed with catecholaminergic polymorphic ventricular tachycardia. He had an excellent neurological outcome. Genetic testing for mutations associated with cardiac arrhythmias yielded a mutation of the syntrophin α-1 gene. ⋯ A mutation of this gene at a different locus is implicated in rare cases of long-QT syndrome. The patient subsequently underwent left cardiac sympathetic denervation followed by implantable cardiac defibrillator insertion. He remains symptom and arrhythmia free on atenolol.