Articles: pain-management.
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JNMA J Nepal Med Assoc · Feb 2024
Case ReportsRecurrent Idiopathic Granulomatous Mastitis: A Case Report.
Idiopathic granulomatous mastitis is a rare benign breast disease of unknown aetiology mostly presenting as a breast abscess but not responding to usual conservative management with incision and drainage and frequently mimics breast cancer. We present a case 31-year-old female presented with complaints of right breast pain and redness who was initially diagnosed and treated as a case of breast abscess with repeated incision and drainage and antibiotics but did not improve. Later histopathology revealed granuloma with giant cell reaction and the patient was given a trial of steroids which showed no improvement. Wide local excision with a long course of broad-spectrum antibiotics was performed which led into remission. This case report highlights the importance of considering idiopathic granulomatous mastitis as differentials in non-responding breast abscesses. Histopathology for diagnosis and trial of wide local excision with a long course of broad-spectrum antibiotics as treatment may be done for management. ⋯ antibiotics; case reports; granuloma; mastitis.
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JNMA J Nepal Med Assoc · Feb 2024
Case ReportsIncarcerated Littre's Umbilical Hernia: A Case Report.
Littre's hernia is an extremely rare type of hernia which has Meckel's diverticulum as its content. A 63-year-old male, presented to the emergency department with chief complaints of swelling and pain around the umbilicus. The patient was diagnosed with an incarcerated umbilical hernia. Following the emergency laparotomy, the intraoperative finding depicted an umbilical Littre's hernia. The patient underwent open Meckel's diverticulectomy with mesh repair. Preoperative diagnosis of Littre's hernia is unlikely due to its low incidence and lack of specific radiological and clinical findings, but the role of computed tomography scan and ultrasound are important in differentiating between strangulated or incarcerated bowel and omentum and in guiding the urgency of operative management. ⋯ case reports; hernia; Meckel diverticulum.
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A Spigelian hernia is a hernia through the Spigelian fascia which are difficult to diagnose as they do not present with a subcutaneous swelling and can be dangerous as there is a high risk of incarceration. We report a case of a 51-year-old female who presented to our surgical unit with epigastric pain for 5 days. She was diagnosed with Spigelian hernia with esophagitis and antral gastritis with the help of a computed tomography scan and upper gastrointestinal endoscopy. The diagnosis was confirmed on diagnostic laparoscopy and transabdominal preperitoneal repair of the defect was performed using prolene mesh. Her post-operative period was uneventful. Spigelian hernias are rare and patients can present with atypical symptoms as in this case. Thus, imaging plays a vital role in diagnosis. Management is surgical and has good outcomes. ⋯ case reports; rectus abdominis; ventral hernia.
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Randomized Controlled Trial
Evaluation of basal rate infusion in intravenous patient-controlled analgesia for post-cesarean section pain management: A randomized pilot study.
Administering opioids via intravenous patient-controlled analgesia is a prevalent approach for managing postoperative pain. Nevertheless, due to concerns about opioid-related side effects and the potential for opioid tolerance, there is a growing emphasis on adopting opioid-sparing techniques for postoperative pain management. We aimed to investigate the effect of adding a basal rate infusion in fentanyl-based IVA following a cesarean section (CS). ⋯ The inclusion of a basal fentanyl infusion in the IVA protocol did not provide any advantages over an IVA devoid of a basal rate infusion in managing acute pain following CS.
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Reg Anesth Pain Med · Feb 2024
ReviewMethodological and statistical characteristics of meta-analyses on spinal cord stimulation for chronic pain: a systematic review.
A growing number of meta-analyses (MA) have investigated the use of spinal cord stimulation (SCS) as a treatment modality for chronic pain. The quality of these MAs has not been assessed by validated appraisal tools. ⋯ CRD42023431155.