Anesthesiology and Pain Medicine
Volume:1 Issue: 3, Mar 2012

One of the major problems in surgery is intraoperative bleeding which reduces visibility in the operative field. An important task for an anesthetist during head and neck surgery is to improve intraoperative visibility. The purpose of this study was to compare the amount of bleeding using different doses of oral metoprolol during three common types of nasal operation; rhinoplasty, septoplasty and functional endoscopic sinus surgery, as this is one of the complications during head and neck surgery.Patients and In a randomized, controlled, open clinical trial, 88 patients who were candidates for nasal operations were studied. Patients entering the study were divided into four groups and randomly assigned to receive 50 mg metoprolol a night before the operation, 50 mg metoprolol on the day of operation, 50 mg metoprolol on the night and on the day of operation, or a placebo. Following the patient’s preparation on the operating table and after intubation, systolic and diastolic blood pressures were measured in a non-invasive oscillometric way, and their pulse rate was recorded simultaneously. All the data were recorded during the surgery as well. Bleeding was measured by the quality scale proposed by Formme and Boezaart. There was a statistical significance between using metoprolol and the amount of intraoperative bleeding. All patients who received metoprolol the night before surgery and on the day of surgery had slight bleeding during the surgery. In addition, there was a statistical significance between patients’ agitation levels and the time they received metoprolol. Decreases in both systolic blood pressure and heart rate to less than 60 beats per minute reduces intraoperative bleeding. These rates can be achieved by using beta-blocker drugs. In this study, using a double-dose of metoprolol significantly reduced intraoperative bleeding and improved the quality of the operative field. It also reduced patients’ agitation in the recovery room..

Whiplash patients regard cervicogenic headache (CEH) as the most burdensome symptom of their condition. Sufferers experience a significant degree of disability from headache, associated neck pain and disability, and sleep disturbance. Lateral C1/2 joint pulsed radiofrequency (PRF) treatment has been shown to produce significant relief from headache in patients with CEH. The objective of this retrospective questionnaire study of 45 consecutive whiplash patients with CEH who had undergone antero-lateral atlantoaxial joint pulsed radiofrequency treatment (AA PRF) was to evaluate the treatment’s long-term effects on pain-related disability and health-related quality of life.Patients and Four questionnaires were sent to all 45 patients who had undergone AA PRF:1) The short form-36 (SF-36); 2) The neck disability index (NDI); 3) The medical outcome scale-sleep scale (MOS-SS); 4) The headache impact test-6 (HIT-6).All 45 patients received AA PRF under fluoroscopic guidance. PRF treatment was conducted at 45 V with a pulsed frequency of 4 Hz and a pulsed width of 10 ms for 4 minutes. Patients who responded to the procedure reported lower pain scores at 2, 6, and 12 months of follow-up compared to nonresponders. More important, patients reported marked improvements in headache impact (P < 0.01), neck-disability scores (P < 0.01), awakening due to headache (P < 0.01), and sleep problems (9-item; P < 0.05) on the MOS-SS. Responders to the procedure also reported a significantly higher health-related quality of life in terms of bodily pain (P < 0.05) and health change (P < 0.01) on the SF-36. In light of the inherent limitations of our retrospective study, AA PRF treatment can only be tentatively viewed as a promising treatment modality for whiplash patients with CEH and is subject to validation in future studies..

Low back disorder is the most common problem in the entire spinal axis. About two-thirds of adults suffer from low back pain (LBP) at some time. Pain generators in the lumbar spine include the annulus of the disc, the posterior longitudinal ligament, a portion of the dural membrane, the facet joints, the spinal nerve roots and ganglia, and the associated paravertebral muscle fascia. There is no doubt that the facet joint is a potential source of chronic LBP. Facet joints are true synovial joints that have a joint space, hyaline cartilage surfaces, a synovial membrane, and a fibrous capsule. Two medial branches of the dorsal rami innervate the facet joints. If conservative measures fail in the treatment of facet joint pain, pulsed radiofrequency (PRF) of the medial branches can be administered. The aim of this observational study was to evaluate the efficacy of PRF in the treatment of lumbar chronic facet joint pain.Patients and In this prospective observational study, we selected 300 patients who suffered from lumbar facet joint pain, were referred to the Pain Therapy Department, and underwent PRF treatment of the lumbar medial branches. We analyzed patients with facet joint pain that was unresponsive to conventional treatment, with a positive response to diagnostic medial branch block, who underwent PRF of the lumbar area for 18 months at San Giovanni Hospital of Rome. Three hundred patients were eligible for the study. After 1 month, 62% of patients (186 patients) reported good pain relief [95% confidence interval (CI) 0.53, 0.7]; 8.6% (26 patients) reported excellent pain relief (95% CI 0.07-0.09); 20. 4% (61 patients) reported poor pain relief (95% CI 0.18-0.22), and 9% (27 patients) reported no pain relief (95% CI 0.08-0.099). The average pain numeric rating scale (NRS) score before the procedure was 6 (range 4-9), decreasing to 2 after the procedure (range 0-4). SF-36 physical and mental parameters improved significantly after the treatment [≥ 1 standard deviation (SD)]. Results after 6 months were similar to those obtained after 1 month. This study suggests that PRF treatment of the lumbar medial branches provides good pain relief for at least 6 months in 70% of patients who suffer from lumbar facet joint pain..

Caudal analgesia is commonly employed to provide excellent intra- and postoperative analgesia for primary hypospadias repair in children. Several additives to local anesthetics are commonly employed to increase the block duration, although these have uncertain benefits. This study investigated whether, in caudal analgesia with levobupivacaine 0.25%, the addition of S (+)-ketamine, clonidine, or both agents combined, would prolong postoperative analgesia in patients undergoing primary hypospadias repair.Patients and We conducted a retrospective chart analysis for all patients who underwent hypospadias repair with caudal analgesia over a consecutive 3-period at this institution. The study examined four patient groups, classified according to the analgesia used:1) No additive, levobupivacaine alone2) Levobupivacaine and S (+)-ketamine3) Levobupivacaine and clonidine4) Levobupivacaine, S (+)-ketamine, and clonidinePrimary outcome measures were as follows: time to the first postoperative request for analgesia, total first 24-hour postoperative analgesia, and time to hospital discharge. The 87 patients included had a mean ± SD age of 21.4 ± 13.5 months and weight of 11.9 ± 2.4 kg. The median doses of levobupivacaine, S (+)-ketamine, and clonidine were 0.7 mg/kg (range, 0.4–1.3), 0.5 mg/kg (0.2–1.1), and 1.8 μg/kg (0.8–2.3), respectively. The addition of S(+)-ketamine, clonidine, or both did not increase the time to first oral analgesia request. Neither did it reduce the total first 24-hour postoperative analgesia requirements or alter hospital discharge time. However, the additive drugs in combination did increase postoperative sedation. The addition of S (+)-ketamine or clonidine to levobupivacaine 0.25% in caudal analgesia for hypospadias repair appears to be of no benefit. However, use of the additives in combination increased postoperative sedation..

Effective control of postoperative pain remains one of the most important and pressing issues in the field of surgery and has a significant impact on our health care system. In too many patients, pain is treated inadequately, causing them needless suffering and they can develop complications as an indirect consequence of pain. Analgesic modalities, if properly applied, can prevent or at least minimize this needless suffering and these complications. The aim of this study was to compare the efficacy of continuous infusions of local anesthetic drugs by paravertebral and epidural routes in controlling postoperative pain in patients undergoing hip surgeries.Patients and The study involved 60 patients who were undergoing hip surgery under the subarachnoid block. They were randomly divided into 2 groups of 30 patients. Group I (paravertebral group) received a single dose of spinal anesthesia with 2.5 mL 0.5% bupivacaine (heavy) + a continuous infusion of 0.125% bupivacaine at 5 mL/h in the paravertebral space. Group II (epidural group) received a single dose of spinal anesthesia with 0.5% bupivacaine (heavy) + a continuous infusion of 0.125% bupivacaine at a rate of 5 mL/hr in the epidural space for 48 hours in the postoperative period. Visual analogue scale (VAS) score, vital statistics, rescue analgesia, and procedure time were compared with the corresponding times between the 2 groups by student’s t-test and repeated measures ANOVA with post hoc Bonferroni. P < 0.05 was considered significant. There were no statistically significant differences between the 2 groups regarding mean pain score in the first 48 hours. Mean arterial pressure was significantly lower in the epidural group compared with the paravertebral group from 2 hours after start of the infusion until 48 hrs. Regional anesthesia procedure time was significantly longer in the epidural group (P < 0.001). There was no significant difference between the 2 groups regarding frequency of postoperative complications and catheter-related problems. The results of our study indicate that for patients who are scheduled for hip surgery, both continuous paravertebral and continuous epidural analgesia are effective in controlling postoperative pain but that the former has several crucial advantages..

“Anesthesia” for awake craniotomy is a unique clinical condition that requires the anesthesiologist to provide changing states of sedation and analgesia, to ensure optimal patient comfort without interfering with electrophysiologic monitoring and patient cooperation, and also to manipulate cerebral and systemic hemodynamics while guaranteeing adequate ventilation and patency of airways. Awake craniotomy is not as popular in developing countries as in European countries. This might be due to the lack of information regarding awake craniotomy and its benefits among the neurosurgeons and anesthetists in developing countries. From the economic perspective, this procedure may decrease resource utilization by reducing the use of invasive monitoring, the duration of the operation, and the length of postoperative hospital stay. All these reasons also favor its use in the developing world, where the availability of resources still remains a challenge. In this case report we presented a successful awake craniotomy in patient with a frontal bone mass..

Chronic sacroiliac (SI) joint pain constitutes 16% to 30% of the total prevalence of chronic low back pain, which is commonly unilateral. Apart from conservative management, various interventional pain management procedures have been reported. Intraarticular deposteroid injection has been described as the most evidence-based, but different various radio frequency (RF) procedures have been described with varied success. Conventional bipolar RF is relatively new in the management of SI joint pain. We have successfully managed pain of the SI joint origin.Case Report: A 53-year-old female who presented with unilateral back pain with radiation to the leg was diagnosed with pain from SI joint arthropathy by clinical and diagnostic interventional procedures. She was treated conservatively without any result. Deposteriod gave good but very short-term relief. She underwent a bipolar RF procedure. An RF needle was placed at the L5 medial branch, and 2 were placed on each lateral side of the sacral foramina for the lateral branches of the S1, S2, and S3 nerve roots. Conventional RFwas performed at 80°C for 90 seconds. This case report supports the use of bipolar RF nerve ablation for chronic sacroiliac joint pain that does abate with deposteroid injection. In this patient, the Rt L5 medial branch nerve was ablated using conventional RF technique, followed by conventional bipolar RF nerve ablation for the S1, S2 and S3 lateral branches. We recommend the use of bipolar RF nerve ablation for chronic sacroiliac joint pain that has an inadequate response to deposteroid injection..

Chronic pain following lower-limb amputation is now a well-known neuropathic, chronic-pain syndrome that usually presents as a combination of phantom and stump pain. Controlling these types of neuropathic pain is always complicated and challenging. If pharmacotherapy does not control the patient’s pain, interventional procedures have to be taken. The aim of this study was to evaluate the efficacy of using pulsed radiofrequency (PRF) on the dorsal root ganglia at the L4 and L5 nerve roots to improve phantom pain.Two patients with phantom pain were selected for the study. After a positive response to segmental nerve blockade at the L4 and L5 nerve roots, pulsed radio frequency was performed on the L4 and L5 dorsal root ganglia.Global clinical improvement was good in one patient, with a 40% decrease in pain on the visual analogue scale (VAS) in 6 months, and moderate in the second patient, with a 30% decrease in pain scores in 4 months. PRF of the dorsal root ganglia at the L4 and L5 nerve roots may be an effective therapeutic option for patients with refractory phantom pain.