Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2004
Biography Historical ArticleLabat Lecture 2004: Regional anesthesia risks--from Labat to tort reform.
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Reg Anesth Pain Med · Mar 2004
Editorial Comment Historical ArticleBirth of an idea: the epidural blood patch.
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Reg Anesth Pain Med · Mar 2004
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia after total-hip arthroplasty: Comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block. a prospective, randomized, double-blind study.
The authors compared the analgesic effects and quality of rehabilitation of three analgesic techniques after total-hip arthroplasty in a double-blind, randomized trial. ⋯ PCA is an efficient and safe analgesia technique. FNB and PCB should not be used routinely after total-hip arthroplasty.
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Reg Anesth Pain Med · Mar 2004
Case ReportsConversion disorder mimicking Dejerine-Roussy syndrome (thalamic stroke) after spinal cord stimulation.
Dejerine-Roussy syndrome is a complex of various signs and symptoms in patients suffering from central thalamic pain, usually secondary to a vascular etiology. We describe a patient presenting with the potentially devastating signs and symptoms of thalamic stroke, at least temporally related to spinal cord stimulator implantation. The etiology of the patient's affliction was subsequently revealed to be a conversion disorder. Case report A 37-year-old woman presented for spinal cord stimulation as treatment of her brachial plexopathy after failure of conservative therapy. Before implantation, she underwent a clinical interview with a psychologist and psychometric testing. No psychological pathology was detected. Trial and permanent implantation of the cervical stimulator lead and pulse generator were uneventful. Eleven days after receiving the permanent implant, the patient experienced right-sided hemicorporal numbness and burning dysesthesia. The patient was admitted, and a diagnosis of Dejerine-Roussy syndrome (thalamic stroke) was made. She was discharged, and her symptomatology waxed and waned over a period of weeks. The patient was subsequently admitted for psychiatric evaluation because of anxiety attacks. During her protracted admission, her psychiatrists strongly suspected a conversion disorder. The stimulator was removed, and the patient received supportive care only. Within 6 months, sensory symptoms and all motor deficits had completely resolved. ⋯ Despite careful preoperative evaluation, latent psychosocial issues may limit the effectiveness of spinal cord stimulation. We present a case of conversion disorder masquerading as Dejerine-Roussy syndrome after spinal cord stimulation. The implications of the failure of preoperative psychological evaluation and screening to avert implantation are discussed.