Interventional Pain Medicine and Neuromodulation
Volume:1 Issue: 1, 2021 Dec

In the new modern world, technology has a remarkable role in human life and affects all aspects of it. Indeed, the need for rapid counteractions, especially in medical requirements, can lead to interesting innovations. Telemedicine was disregarded for being an unwieldy, unreliable, and unaffordable technology. Rapidly evolving telecommunications and information technologies have provided a solid foundation for telemedicine as a feasible, dependable, and useful technology. Telemedicine has been conceived as an integrated system of healthcare delivery that employs telecommunications and computer technology as a substitute for faceto- face contact between provider and client. It has the potential for ameliorating seemingly intractable problems in healthcare such as limited access to care among segments in the population, especially the geographically disadvantaged, uneven quality of care, and cost of inflation. Its true merit has yet to be determined by systematic empirical studies. In another survey, the authors defined telemedicine as a branch of e-health, which works by communication networks and delivers healthcare and medical educations from remote locations. The main aim of telemedicine is to overcome the improper distribution of human and fundamental resources. Telemedicine could be considered from the viewpoint of two basic conditions: (1) as an alternative way for emergency services in remote locations and (2) it is a better option rather than conventional health services; for example, teleradiology for rural hospitals. It can result in appropriate availability of health services and acceptable efficiency. However, this aspect of medicine was considered in the late 1990, and then, developing countries have a long way for research about it. 

Meany factors lead to myocardial infarction in a pregnant woman, resulting in the increasing prevalence of women with cardiac diseases during pregnancy. There are special considerations for anesthetic care under this condition. This report presents a 40- year-old woman admitted for emergent cesarean section due to acute myocardial infraction (AMI). Providing safe and balanced anesthesia while managing cardiac events was challenging; however, it was performed in accordance with standard anesthesiologic rules. 

The neural plexus exists in different parts of the body. The sacral plexus is the lowest neural network in the body that is responsible for sensory and motor innervation to a large part of the body. The sacral plexus or sacral nerve roots may be damaged by diseases, such as disc herniation, spinal canal stenosis, and cancer or iatrogenic injuries during surgery or interventional pain procedures (open spinal surgeries, hip surgeries, percutaneous endoscopic disc decompression, trans-sacral epiduroscopic laser decompression, …). Patients with sacral nerve damage may experience a variety of symptoms, including low back pain radiating to the legs, sensory disturbance in the buttocks or legs, motor weakness in the legs, bladder or bowel dysfunction (urinary retention/ incontinence, defecation’s problems), or sexual dysfunction. Therefore, complete familiarity with the anatomy of the sacral plexus is very important. In this article, we tried to review the anatomy of the sacral plexus and sensory or motor innervations of each terminal branch of the sacral plexus. Also, the clinical importance of these nerves in the development of pain syndromes and diagnostic and therapeutic methods for damage to the terminal branches of the sacral plexus were investigated. 

The most frequent illnesses characterized by the gradual malfunctioning of brain neurons are neurodegenerative disorders (NDs). Genetic mutations and a range of biological processes can produce NDs. Alzheimer’s disease (AD), Parkinson’s disease (PD), and Multiple Sclerosis (MS) are all related to oxidative stress (OS). Reduced brain activity has become a greater health threat with a growing elderly population. It causes some pathophysiological alterations and is an important risk factor for a range of neurodegenerative illnesses. An increase in reactive oxygen species (ROS) can cause neuronal cell death, and it is thus essential to control ROS levels to maintain normal neuronal activity. Synthetic medicines are often used to treat neurological disorders; however, harmful effects have been reported. Multiple bodies of research have shown the effectiveness of polyphenols in the treatment of various NDs due to their negligible side effects. This review article describes the neuroprotection effects of polyphenols such as resveratrol, epigallocatechin-3-gallate, curcumin, and quercetin, as well as the signaling pathways and immune response controls through polyphenols.

This study aimed to compare the effect of dexamethasone and ketorolac on pain control in elective foot surgery.

Forty patients visiting Akhtar and Imam Hossein Hospital for lower limb orthopedic surgery were selected. They were randomly divided into two groups: (1) dexamethasone, and (2) ketorolac. The dexamethasone group received eight mg dexamethasone intravenously. Also, 90 mg ketorolac was infused in one liter of normal saline serum for 24 hours for the ketorolac group. Before injection and 2, 4, and 6 hours after the injection, pain control was measured employing the Visual Analog Scale (VAS) score. Corresponding data were then analyzed using the independent t-test.

The conclusions revealed that in two and four hours after injection, there was a significant difference between the two groups in the amount of VAS score. That is, the pain was weaker in the ketorolac group than in the dexamethasone group. The findings additionally proved that there was no statistically important difference in pain levels between the two groups six hours after injection.

Overall, according to the results of the research, it can be settled that ketorolac is a better drug in foot surgery pain control than dexamethasone. 

Guidelines recommend the use of regional anesthesia for patients with COVID-19, when possible. Interscalene block (ISB) is the standard care for analgesia of shoulder surgery. Hemidiaphragmatic paresis due to phrenic nerve block is expected in ISB but is usually well-compensated. We present a patient with pulmonary involvement of COVID-19 candidate for the surgery of shoulder dislocation under ISB who experienced respiratory failure after the block.

A 36-year-old female patient with COVID-19 developed a shoulder dislocation following a seizure. Relocating the joint was successfully attempted under intravenous sedation and ultrasound-guided ISB. The patient developed respiratory distress due to hemidiaphragmatic paresis after the block. She was managed using a continuous positive airway pressure (CPAP) mask for 48 hours until the pulmonary condition improved.

Anesthetists should prepare themselves to replace ISB with diaphragm-sparing blocks or apply techniques to reduce the chance of hemidiaphragmatic paresis after ISB in patients with COVID-19.