Pain physician
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Entrapment neuropathies of the fibular nerve and its branches are often underdiagnosed due to the lack of reliable diagnosis using clinical examination and electrophysiologic evaluation. Most fibular nerve compressions may be classified into 2 broad categories: (a) mechanical causes, which occur at fibrous or fibro-osseous tunnels, and (b) dynamic causes related to nerve injury during specific limb positioning. Foot drop resulting from weakness of the dorsiflexor muscles of the foot is a relatively uncommon presentation and closely related to L5 neuropathy caused by a disc herniation. ⋯ Knowledge of normal MRI anatomy of the nerves in the knee and leg is essential for the precise assessment of the presence of peripheral entrapment conditions that may produce painless or painful drop foot. In conclusion, we stress the importance of preoperative anatomic mapping of entrapment neuropathies to minimize neurological complications. Key words: Foot drop, fibular nerve, ganglion cyst, proximal tibiofibular jointFoot drop, fibular nerve, ganglion cyst, proximal tibiofibular joint.
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Randomized Controlled Trial
Analgesic Effect of Nalbuphine When Added to Intravenous Regional Anesthesia: A Randomized Control Trial.
Different adjuvant drugs are currently added to lidocaine for intravenous regional anesthesia (IVRA) to decrease tourniquet and postoperative pain. ⋯ Nalbuphine decreases early tourniquet and postoperative pain after IVRA and delays the need for analgesic rescue. In addition, nalbuphine accelerates the onset and prolongs the recovery time for both sensory and motor blocks with no significant adverse events. However, it has no effect on postoperative cortisol levels.Key words: Intravenous, regional anesthesia, lidocaine, nalbuphine, pain, postoperative.
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Observational Study
Cervical Interlaminar Epidural Injections at High Doses Do Not Increase Optic Nerve Sheath Diameter on a Long-Term Basis.
Cervical epidural injection (CEI) is widely performed on patients with pain originating from the cervical spine. Studies have shown a good relationship between the optic nerve sheath diameter (ONSD) and the intracranial pressure (ICP). ⋯ Registered in the Clinical Research Information Service of the Korea National Institute of Health, registration number: KCT0001487. Key words: Analgesic techniques, epidural block, intracranial pressure, optic nerve sheath diameter, ultrasonography Analgesic techniques, epidural block, intracranial pressure, optic nerve sheath diameter, ultrasonography.
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Review Case Reports
What's Tramadol Got to Do with It? A Case Report of Rebound Hypoglycemia, a Reappraisal and Review of Potential Mechanisms.
Tramadol has gained traction as an analgesic of choice among pain practicing physicians. However some concerns regarding a previously unlabeled adverse reaction - hypoglycemia - have cast it in a dim light. Prior reports have noted an associated risk of hospitalization for hypoglycemia after tramadol use, but whether tramadol is the main causal agent is poorly understood and the underlying mechanisms are not well delineated. We present a unique case of rebound hypoglycemia as a variation of the theme of tramadol's adverse effect profile in a patient with type 1 diabetes mellitus, and reappraise potential mechanisms underlying this underappreciated phenomenon. ⋯ The clinical scenario described is a case of rebound hypoglycemia after tramadol use in a patient with type-1 diabetes naïve to opioid analgesics. The episodes of hypoglycemia aligned perfectly with the anticipated pharmacodynamic and pharmacokinetic properties of tramadol. The specificity and temporality of events after tramadol use in this patient fulfilled causality criteria. Tramadol may cause rebound hypoglycemia in patients via interference of the intrinsic euglycemia-restoration pathways and a blunted autonomic counter-regulatory response to antecedent hypoglycemia. Its use must be tempered by this underappreciated adverse effect profile.Key words: Tramadol, hypoglycemia, sacroiliac joint arthritis, type 1 diabetes mellitus, serotonin uptake inhibitors, glutamate receptor 4.
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Anterior cingulotomy for chronic pain aims to modulate patients' attention or emotional reaction to pain rather than to modulate pain intensity. ⋯ Despite decreased utilization in recent years, anterior cingulotomy is an effective neurosurgical intervention in the treatment of pain and carries little risk of permanent or serious adverse effects.Key words: Anterior cingulotomy, chronic pain, stereotaxis, systematic review, pain, cingulate gyrus, cingulotomy, intractable pain.