Pain practice : the official journal of World Institute of Pain
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Ziconotide is a nonopioid analgesic currently indicated as monotherapy, but frequently used in combination with opioids, for the management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted and who are intolerant of, or whose pain is, refractory to other treatments. There is a paucity of information regarding ziconotide use in patients with complex regional pain syndrome (CRPS). Seven cases in which IT ziconotide was used in patients with CRPS were analyzed. ⋯ Adverse events included urinary retention, depression, anxiety, and hallucinations. Adverse events generally resolved spontaneously, with treatment, or with ziconotide discontinuation/dose reduction. Although further studies are required, ziconotide holds promise as an effective treatment for CRPS.
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Four cases of ischemic injury have been reported in patients undergoing orthopedic surgery in the upright position. We describe the use of cerebral oximetry as a monitor of the adequacy of cerebral perfusion in a 63-year-old woman who underwent arthroscopic rotator cuff surgery in a beach chair under general anesthesia. ⋯ When spontaneous ventilation resumed, an increase in end-tidal carbon dioxide was accompanied by an increase in S(ct)O(2). Cerebral oximetry may prove useful as a guide monitor and manage nonsupine patients.
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The aim of the present work was to measure the pain threshold in hypertensive patients with a new auto-algometry method. ⋯ The data obtained from this study indicate that the auto-algometer as described here can detect hypoalgesia associated with hypertension.