The Clinical journal of pain
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Randomized Controlled Trial Clinical Trial
Effect of eutectic mixture of local anesthetics (EMLA) for pain relief during suprapubic aspiration in young infants: a randomized, controlled trial.
The purpose of this study was to determine whether a eutectic mixture of local anesthetics (EMLA) cream reduce the pain experienced by newborns and young infants undergoing suprapubic aspiration (SPA). ⋯ Newborns and infants undergoing SPA experience pain during the procedure. Application of EMLA cream 1 hour before SPA is effective in reducing the pain associated with SPA. In situations in which an SPA is not emergent, strong consideration should be given to the use of EMLA.
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Numerous potential complications are associated with the use of programmable intrathecal (IT) drug delivery systems. Radiation is often assumed to cause dysfunctions of the programmable IT device. However, radiation-induced failure of this device and limits of dose exposure have not clinically documented. ⋯ Estimated cumulative doses to the pump were in the range of 28.5 to 36 Gy when the alarm occurred after 20 daily treatments. The IT pump itself exposed to this high-dose radiation did not pose any risk to the patient or the environment. This is the first case description about the pump malfunction secondary to clinical radiotherapy, which is very useful to physicians who manage the pain and radiotherapy for cancer patients.
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To assess the local and referred pain areas and pain characteristics evoked from temporalis muscle trigger points (TrPs) in chronic tension-type headache (CTTH). ⋯ In CTTH patients, the evoked local and referred pain from active TrPs in the temporalis muscle and its sensory characteristics shared similar patterns as their habitual headache pain. Local and referred pain from active TrPs in the temporalis muscles may constitute one of the sources contributing to the pain profile of CTTH.
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To present different aspects and advantages of the laparoscopic approach to the pelvic nerves aimed at treating intractable pelvic neuralgia. ⋯ Laparoscopic approach to the pelvic nerves opens new possibilities for the diagnosis and treatment of pelvic neuralgia, and offers new curative surgical techniques.
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Clinical Trial
Intrathecal treatment in cancer patients unresponsive to multiple trials of systemic opioids.
The aim of this study was to evaluate the clinical response to a combination of intrathecal morphine and levobupivacaine in advanced cancer patients who were highly opioid-tolerant, being previously treated with multiple opioid trials unsuccessfully. Initial intrathecal morphine dose was calculated from the previous opioid consumption using a morphine oral-intrathecal ratio of 100:1. Then, doses of both drugs were modified during the treatment according to the clinical needs and balanced with adverse effects. ⋯ Early complications included mild bleeding in 2 patients, without consequences, headache in 4 patients, bladder catheterization in 6 patients, reoperation for bleeding or changes of catheter position in 4 patients, unrelated death in 1 patient, and stroke in another 1. Late complications included local infection in 2 patients, and discontinuation of intrathecal therapy due to spinal compression. In patients who had received multiple trial of opioids and routes of administration, the intrathecal treatment started with an oral-intrathecal morphine conversion ratio of 100:1, and local anesthetics at the most convenient clinical doses provided a long-term improvement of analgesia, with a decrease in adverse effects and opioid consumption until death.