Articles: pain-management.
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Recent advances in the application of regional anesthesia to the care of patients undergoing shoulder surgery are discussed. New techniques for the management of postoperative pain are highlighted, with an emphasis on interscalene patient-controlled analgesia and suprascapular block. ⋯ Intraoperative hypotension and bradycardia caused by activation of the Bezold-Jarisch reflex is considered. The ongoing debate regarding the use of paresthesia versus nerve-stimulator techniques is examined.
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Objectives. Recent technical improvements in implanted stimulation devices, in particular the development of programmable, multicontact devices, have facilitated their clinical application in the management of pain. If the capabilities of these devices are to be used to full advantage, adjustment after implantation demands a major investment of time and effort. ⋯ Results and Conclusions. Our patient-interactive computerized system has proven to be safe and effective clinically in adjusting implanted spinal cord stimulators. It offers advantages of data standardization and quality control, as well as delivery of novel pulse sequences and protocols to assess the treatment of pain and neurological disorders by electrical stimulation devices.
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Groin pain in the soccer athlete is a common problem accounting for 5% of soccer injuries. Groin distribution has proved to be the most common cause of groin pain. Other causes are direct trauma, ostetis pubis, muscle injuries, fractures, bursitis, hip problems, and hernia and referred pain. Soccer players with groin pain present a complex management problem that is discussed.
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IEEE Trans Rehabil Eng · Sep 1998
Case ReportsTheoretical performance and clinical evaluation of transverse tripolar spinal cord stimulation.
A new type of spinal cord stimulation electrode, providing contact combinations with a transverse orientation, is presented. Electrodes were implanted in the cervical area (C4-C5) of two chronic pain patients and the stimulation results were subsequently simulated with a computer model consisting of a volume conductor model and active nerve fiber models. ⋯ The (a)symmetry of paresthesia could largely be affected in a predictable way by the selection of contact combinations as well. The transverse tripolar combination was shown to give a higher selectivity of paresthesia than monopolar and longitudinal dipolar combinations, at the cost of an increased current (more than twice).
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Case Reports
Chronic pain management--upper visceral malignancies coeliac plexus block with CT scanning--a case report.
Coeliac plexus block has been described more than seventy years ago and is widely used for chronic pain management in upper visceral malignancies. The technique described here is a posterior approach using CT scan guidance with absolute ethyl alcohol. A case illustration of a patient with carcinoma of pancreas managed with coeliac plexus block for pain control is presented.