Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2002
Targeted methylprednisolone acetate/hyaluronidase/clonidine injection after diagnostic epiduroscopy for chronic sciatica: a prospective, 1-year follow-up study.
It has been claimed that epiduroscopy offers an ideal combination of diagnostic and therapeutic interventions in one session. We prospectively evaluated whether abnormalities at the lumbar level as diagnosed by magnetic resonance imaging (MRI) are confirmed by epiduroscopy, and assessed if targeted epidural injection of medication alleviates sciatic pain. ⋯ Epiduroscopy is of value in the diagnosis of spinal root pathology. In sciatica, adhesions unreported by MRI can be identified. Targeted epidural medication, administered near the compromised spinal nerve, results in substantial and prolonged pain relief.
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Reg Anesth Pain Med · Jul 2002
Case ReportsSeizures after epidural blood patch with undiagnosed subdural hematoma.
We present a case of new-onset seizures in a parturient who received an epidural blood patch (EBP) in the presence of an undiagnosed cerebral subdural hematoma. We review the relevant literature and examine the implications for management. ⋯ We believe that the subdural hematoma and not the EBP was the cause of the seizures. Earlier recognition of confusion and fatigue as a postictal state may have led to earlier diagnosis of the hematoma. Our experience suggests that EBP be avoided in the setting of subdural hematoma.
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Reg Anesth Pain Med · Jul 2002
The epidural fibrous sheath: a guide for the replacement of a spinal cord stimulation electrode.
During spinal cord stimulation there is sometimes a need to replace defective leads. Percutaneous lead replacement by recannulating the epidural space and "steering" the new lead to the prior location is sometimes very difficult, resulting in diminished analgesia. Since fibrous deposits are known to form around epidural catheters and epidural obstructions have been noted with other techniques, we have inserted the new lead through the well-dissected opening in the interspinal ligament. We will report the results of our case series. ⋯ Foreign bodies in the epidural space lead to fibrous deposits. Spinal cord stimulation, when those deposits form a sheath, the sheath is useful for lead revision. The procedure, if meticulously performed, has a high success rate.
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Reg Anesth Pain Med · Jul 2002
Expression of neuron-associated tumor necrosis factor alpha in the brain is increased during persistent pain.
Evidence implicates the pleiotropic cytokine tumor necrosis factor alpha (TNFalpha) in the pathogenesis of persistent pain. The present study employs a chronic constriction injury (CCI) model of neuropathic pain to examine TNFalpha production in the central nervous system (CNS) and in the periphery in this pain model. ⋯ The increases in TNFalpha within regions of the brain and spinal cord that are associated with adrenergic neuron function, as well as with modulation of pain perception, and the time course and distribution of the increases in TNFalpha accumulation support a neuromodulatory role for TNFalpha within the CNS in the development and maintenance of neuropathic pain.