Neuromodulation : journal of the International Neuromodulation Society
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Objective. Intrathecal opioid/local anesthetic mixtures are a popular alternative in contemporary treatment of chronic nonmalignant pain. Unfortunately, its use is based solely on retrospective studies or anecdotal reports. ⋯ Addition of bupivacaine to the intrathecal opioid failed to produce significant improvement in pain control. Conclusion. At currently used doses, intrathecal opioid bupivacaine mixtures are not more efficacious in the treatment of chronic nonmalignant pain than opioid alone.
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Objective. This article presents an overview of the use of intrathecal bupivacaine (with and without opioid), focusing on laboratory data and clinical use for chronic pain. Some background on epidural use is included to support the intrathecal literature. ⋯ In addition, outcome studies are needed specifically to differentiate use of intrathecal bupivacaine based on the source and mechanism of pain. Conclusions. While there are few long-term randomized prospective studies at this point, we conclude that intrathecal bupivacaine appears to be a safe and efficacious treatment in both cancer and noncancer pain.
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We modified a commercial indoor rowing machine (Concept 2 Inc., Morrisville, NJ, USA) for a functional electrical stimulation (FES) assisted indoor rowing exercise in which the rowers must repeatedly press the two switches on the handle that stimulate their paralyzed leg muscles. The objective of this study was to automate the delivery of electrical stimulation to prevent potential repetitive strain injuries and to expand the user base to clients with impaired hand function. The modifications for development of the FES rowing machine and clinical trials were all performed in the University of Alberta. ⋯ Two paraplegic users of the older manual control system tested the new automatic controller. The automatic FES controller spent more electrical stimulation per rowing cycle but it did not require repetitive thumb presses, required less concentration, and was preferred by the clients. We conclude FES rowing with the new automatic controller was easier and safer and expanded the user base of the FES rowing exercise to those with affected hand.
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The purpose of the study was to determine if functional electrical stimulation of abdominal muscles (FESAM) could maintain pulmonary ventilation at acceptable levels in individuals with spinal cord injury (SCI) who are unable to breathe spontaneously. This is the first published investigation of this technique in this subject population. This case series study included three individuals with SCI; two were on mechanical ventilation (MV), and one used mechanical ventilation and also had an implanted phrenic nerve stimulator (PNS). ⋯ When oxygenation measured with pulse oximetry dropped to 92% saturation, FESAM was discontinued, and MV or PNS was resumed. This is the first report of achieving successful ventilation in individuals with SCI who have zero tidal volume using FESAM. These preliminary results indicate the clinical potential of FESAM as an additional tool in the armamentarium of supported ventilation.