A&A practice
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Pain following amputation is often poorly controlled despite the use of nerve blocks. We describe a novel pain management approach in a 56-year-old woman with episodes of poorly controlled pain following below-knee amputation despite a multimodal analgesic regimen with continuous sciatic nerve block. Effective analgesia was observed during those episodes when the nerve block catheter was briefly stimulated at low frequency using a nerve stimulator designed for regional anesthesia procedural guidance. This case report explains the utilization and rationale of this hybrid technique of combined peripheral nerve stimulation and locoregional analgesia via perineural nerve block catheters to augment analgesia.
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Kearns Sayre syndrome (KSS) is a rare mitochondrial myopathy that is associated with progressive impaired ventilatory drive, heart block, and peripheral neuropathy. Charcot-Marie-Tooth disease (CMT) is a rare chronic motor and sensory peripheral neuropathy which includes muscle weakness and restrictive pulmonary impairment. ⋯ We report a 52-year-old man diagnosed with variants of KSS and CMT presenting for supraventricular tachycardia (SVT) ablation. This is the first report of successful perioperative management of a general anesthetic in a patient with both KSS and CMT.
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An intrathecal drug delivery system (IDDS) has been widely utilized in the management of chronic pain and spasticity when oral pharmacologic agents are deemed ineffective. Typically, intrathecal pumps are implanted in the abdominal region; however, previous case reports have described nontraditional pump implantation sites, such as anterior thigh, gluteal region, and iliac fossa. Adding to the growing literature of alternative implantation sites, this case report discusses the implantation of the pump into the submuscular plane of the pectoralis major muscle and reviews the advantages and disadvantages of this location.
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Primary leiomyosarcomas of the inferior vena cava (IVC) are rare sarcomas, none of which have been described in literature during a third-trimester pregnancy. Here, we describe the complex care of a patient at 30 weeks of gestation who presented to her obstetrician with shortness of breath and lower extremity swelling. She was found to have a 5.0 × 5.0 × 13 cm heterogeneous mass of her IVC, ultimately diagnosed as a leiomyosarcoma. She underwent a cesarean delivery under combined spinal epidural and a subsequent tumor resection and IVC reconstruction requiring multidisciplinary surgical and anesthetic care.
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Case Reports
Chest Wall Regional Anesthesia for Modified Radical Mastectomy and Axillary Lymph Node Dissection: A Case Report.
Restrictive chest wall disorders impair cardiopulmonary physiology and pose anesthesia-related safety challenges. Regional anesthesia, as the primary anesthetic modality, may mitigate general anesthesia-related risks in such patients presenting for breast cancer surgery. We describe the use of chest wall fascial plane blocks as the primary anesthetic, combined with high-flow humidified nasal oxygen and low-dose propofol sedation, in a patient with complex comorbidities presenting for modified radical mastectomy and axillary lymph node dissection.