Neuromodulation : journal of the International Neuromodulation Society
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Objective. The outcomes of different modes of TENS (transcutaneous electrical nerve stimulation) in relieving experimental heat and cold pain were studied. Materials and methods. Three modes of stimulation, conventional, burst, and high rate frequency modulation (HRFM) including placebo, were trancutaneously applied to 20 right handed healthy volunteers (10 males and 10 females). Stimulation was carried out using two pad electrodes placed over the median nerve for 120 s in each case. ⋯ Conclusions. All modes of stimulation statistically decreased both heat and cold pain when compared to placebo. HRFM was the most effective mode of TENS. It might be worthwhile to test the patterns of stimulation in chronic pain patients.
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The paper describes an original method of endoluminal electrical stimulation of the stomach developed by authors. The aim of the study was to compare two types of electrical stimulation: low frequency (LF) and high frequency (HF) in human patients. Twenty-three patients with postoperative gastroparesis (after abdominal surgery) were involved in the study and randomized into two groups. ⋯ Symptoms score decreased on the consecutive days of pacing from 8.3 to 3.8, 1.3, to 0.9 in the LF group and from 8.2 to 3.1, 1.0, to 0 in the HF group. We conclude that HF is more effective than LF in the treatment of postoperative gastroparetic human patients. No adverse effects of HF and LF were observed in this study.
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The performance of cathode-anode configurations in a cuff electrode to stimulate a single fascicle in a nerve trunk has been investigated theoretically. A three-dimensional volume conductor model of a nerve trunk with four fascicles in a cuff electrode and a model of myelinated nerve fiber stimulation were used to calculate the recruitment of 15 m fibers in each fascicle. The effect of a monopole, a transverse bipole (anode opposite the cathode), and a narrow transverse tripole (guarded cathode) in selectively stimulating 15 m fibers in each fascicle has been quantified and presented as recruitment curves. ⋯ As compared to monopolar and longitudinal tripolar stimulation, the slope of the recruitment curves in transverse bipolar stimulation is reduced considerably, thus allowing improved fine tuning of nerve (and thus force) recruitment. Another advantage of this method is a minimal number of cable connections to the cuff electrode. The cost of the improved selectivity is an increased stimulation current.
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Spinal cord compression from catheter tip granulomatous masses following intrathecal drug administration may produce devastating permanent neurologic deficits. Some authors have advocated intrathecal catheter placement below the conus medullaris to avoid the possibility of spinal cord involvement. Multiple cases of catheter tip granulomas in the thoracolumbar region have been reported. ⋯ Histologic examination of the mass confirmed a sterile inflammatory mass. It has been suggested that intrathecal catheters be placed below the conus medullaris to avoid the possibility of spinal cord involvement. We present an unusual case documenting devastating permanent neurologic deficits from a catheter tip granuloma in the sacral region.
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Percutaneous epidural neuroplasty (lysis of epidural adhesions, epidural application of hypertonic saline) is an interventional technique for the management of pain due to spinal disorders. Epidural neuroplasty is found to be effective in removing fibrous tissue occurring in the epidural space for various reasons, however, the procedure may be prone to serious complications. We present here our retrospectively collected complications and precautions of complications of epidural neuroplasty in 250 patients. ⋯ Possible known complications include bending of the tip of the introducer needle, shearing/tearing of the catheter, misplacement of the catheter, inadvertent blockage of the catheter or catheter tip, migration of the catheter, hypotension, respiratory depression, urinary and/or fecal incontinence, urinary hesitancy, sexual dysfunction, paresthesia, epidural abscess, and meningitis. We found the following complications in our series: the tips of the introducer needle were bent in 12 patients; catheter sheaths were torn during withdrawal through the needle in three patients; 39 patients had bleeding or aspiration of blood from the epidural space; eight patients had their catheters migrate into an epidural vein; one patient's catheter migrated into the prevertebral space during the procedure; there were dural punctures in 11 patients; there were catheter blockages in six patients during consecutive applications of neuroplasty; hypotension was seen during and after drug injections in 12 patients, there was hypotension in one patient; three patients had migration and penetration of their catheters into the dura after placement and in consecutive days; 25 patients experienced numbness in dermatomal areas of the upper and lower extremities depending the level of the procedure; and there were eight infections at the entry site of the catheter, three epidural abscesses, and two patients with meningitis. In order to prevent complications such as those seen, epidural neuroplasty procedures must be performed in well-equipped centers by experienced hands.