Articles: peripheral-nerve-injuries.
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Anesthesia and analgesia · Oct 2000
Randomized Controlled Trial Clinical TrialMemantine (a N-methyl-D-aspartate receptor antagonist) in the treatment of neuropathic pain after amputation or surgery: a randomized, double-blinded, cross-over study.
Evidence has accumulated that the N:-methyl-D-aspartate receptor system plays a role in continuous and particularly, in stimulus-evoked pain after nerve injury. We examined, in a randomized, double-blinded, cross-over fashion, the analgesic effect of memantine (a N:-methyl-D-aspartate receptor antagonist) in a group of patients with chronic pain after surgery. We randomized 19 patients to receive either memantine or placebo in the first 5-wk treatment period. A washout period of 4 wks was followed by another 5-wk treatment period with the opposite drug. The dosage of drug was increased from 5 to 20 mg/d. Pain was recorded daily, with the use of a 0-10 numeric rating scale. Before and at the end of each treatment period, pain and sensitivity were also assessed by using the McGill Pain Questionnaire, allodynia to touch, brush and cold, wind-up-like pain, and thresholds to mechanical stimuli (pressure and von Frey hair). A total of 15 patients (12 amputees and three patients with other nerve injuries) completed the study. There was no difference between memantine and placebo on any of the outcome measures. We conclude that memantine at a dosage of 20 mg/d does not reduce spontaneous or evoked pain in patients with nerve injury pain. ⋯ In a randomized, double-blinded and cross-over study, the analgesic effect of memantine (a drug which reduces the excitability of sensitized neurons in the dorsal horn) was examined in 19 patients with chronic pain after nerve injury.
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Peripheral nerve injuries can result from mechanical, thermal, chemical, congenital, or pathological etiologies. Failure to restore these damaged nerves can lead to the loss of muscle function, impaired sensation, and painful neuropathies. Current surgical strategies for the repair of critical nerves involve the transfer of normal donor nerve from an uninjured body location. ⋯ Semin. Surg. Oncol. 19:312-318, 2000.
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J Reconstr Microsurg · Oct 2000
Microsurgical management of old injuries of the peripheral nerve and brachial plexus.
A prospective study was carried out in patients suffering from old peripheral nerve and brachial plexus injuries to attempt to validate that functional improvement was possible after microsurgical management. Fifty patients underwent operative procedures, of whom 35 were peripheral-nerve injury cases, from 1.2 to 50 years after injury, and 15 were brachial-plexus injury cases, from 1.2 to 12 years after injury. The patients were treated by external and interfascicular neurolysis and/or autogenous nerve grafts. ⋯ Statistical analysis of recruitment 1 year after surgery demonstrated the appearance of or significant voluntary muscle activity in 45 percent of the muscles. Intraoperative electrophysiologic findings after external and interfascicular neurolysis confirmed that the viability of nerve tissue is of longer duration than previously considered. This study suggests that the use of microsurgical techniques results in the functional improvement of patients suffering from old injuries of the peripheral nerve and brachial plexus.
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Clin. Orthop. Relat. Res. · Jul 2000
Neurovascular injuries in type III humeral supracondylar fractures in children.
Clinical and radiographic records of 210 consecutive children treated for Type III extension humeral supracondylar fractures during a 66-month period were reviewed retrospectively to determine (1) the incidence of neural and vascular injuries associated with this fracture; (2) the frequency of the type of nerve injured; and (3) the relationship of fracture displacement to neural and vascular compromise. Forty patients (19.1%) had neural compromise, vascular compromise, or both. Nerve injuries occurred in 13.3% of patients, combined nerve and vascular compromise occurred in 2.9%, and vascular compromise occurred in 2.9% of patients. ⋯ Posterolateral fracture displacement was correlated with median nerve and vascular compromise. Posteromedial fracture displacement strongly correlated with radial nerve injury. Recognition of fracture displacement pattern provides a guide to clinical examination to assess associated neural injury, in particular, the anterior interosseous nerve, which may be difficult to evaluate in a child who is uncooperative.
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Peripheral nerve injury has been shown to result in sympathetic fibre sprouting around dorsal root ganglia (DRG) neurons. It has been suggested that this anomalous sympathetic fibre innervation of the DRG plays a role in neuropathic pain. Other studies have suggested an interaction between sympathetic and sensory fibres more peripherally. ⋯ It is noteworthy that, although, by week 6 post-MN lesions, SP-IR fibre reinnervation of the lower lip was occurring, the DbetaH-IR fibres still were present in the upper dermis. Quantification revealed that the migration and branching of the DbetaH-IR fibres into the upper dermis occurred gradually and was most significant at 4 weeks post-MN lesions, as demonstrated by the fact that the DbetaH-IR fibres were found 169.6 +/- 91.4 microm away from the surface of the skin compared with 407.1 +/- 78.4 microm away in sham-operated animals. These findings suggest that the ectopic innervation of the upper dermis by sympathetic fibres may be important in the genesis of neuropathic pain through the interactions of sympathetic and SP-containing sensory fibres.