Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2015
Case ReportsWorsening of Neurologic Symptoms After Spinal Anesthesia in Two Patients With Spinal Stenosis.
Spinal stenosis has been proposed as a previously unrecognized risk factor for neurologic complications after neuraxial techniques. ⋯ We conclude that, until the relative contribution of patient and surgical (eg, positioning, retractors, hypotension) factors is known, the decision to perform neuraxial blockade in patients with severe symptoms of neuroclaudication or recently progressive symptomatic spinal stenosis should be made cautiously. Avoidance of spinal anesthesia is suggested for any procedure with prolonged lordotic positioning or any position that might cause a compromise of the spinal canal because subarachnoid block may contribute to any deterioration suffered by the patient.
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Reg Anesth Pain Med · Sep 2015
Case ReportsA Novel Modified Retrocrural Approach for Celiac Plexus Block: The Single-Needle Retroaortic Technique.
For patients with pain from upper abdominal malignancies, celiac plexus neurolysis can provide an effective means of pain control. However, there are instances when traditionally described percutaneous approaches may not be technically feasible. ⋯ We present 4 cases of patients with pain from upper abdominal malignancies in whom we performed celiac plexus neurolysis using a novel single-needle retroaortic approach. All 4 patients had significant pain relief and no significant adverse effects from the retroaortic approach.
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Reg Anesth Pain Med · Sep 2015
Case ReportsRotational Thromboelastometry-Guided Hemostatic Therapy for Management of Cerebrospinal Fluid Catheter in Patients Undergoing Endovascular Aortic Repair.
Central neuraxial techniques are typically avoided in patients with underlying coagulopathy or abnormal coagulation tests. Vertebral canal hematoma is a rare but devastating complication of those procedures. Although the sensitivity and specificity of standard laboratory tests in predicting this event are rather poor or unknown, these tests are commonly used to allow or advise against the insertion of an epidural or spinal catheter. Furthermore, the role of viscoelastic point-of-care tests, which are widely used to monitor coagulation in the perioperative setting, is unexplored. ⋯ Thromboelastometry proved useful to guide hemostatic therapy before subarachnoid catheter placement and extraction in a patient with severe coagulopathy when standard coagulation tests were of less benefit.
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Reg Anesth Pain Med · Sep 2015
Case ReportsPercutaneous Rupture of a Symptomatic Facet Joint Synovial Cyst Using 2-Needle Distention.
This case report calls attention to an alternative approach for management of a symptomatic facet joint synovial cyst. We describe a patient with a symptomatic facet joint synovial cyst who failed an attempted percutaneous rupture using a single-needle technique. This patient was subsequently successfully managed with percutaneous rupture using a 2-needle technique. ⋯ Percutaneous rupture of a symptomatic facet joint synovial cyst using a single-needle technique has been validated as an efficacious form of management. In a select group of patients who fail single-needle percutaneous rupture, a 2-needle approach for percutaneous facet cyst rupture may be considered as an option for management.