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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Brachial plexus injury is a typical complication after median sternotomy. A prospective study was performed on 1000 consecutive patients to determine whether preventive actions, including lower position and least possible opening of the sternal retractor, help to reduce the complication rate. Twenty-seven patients were observed with postoperative brachial plexus injury. Nerve conduction measurements and electromyography were performed. Patients without preparation of the internal mammary artery had a complication rate of less than 1%, whereas the complication rate of those patients with preparation of the internal mammary artery was as high as 10.6%. The main symptoms were continuous pain and motor and sensory disturbances. Most frequent were lesions corresponding to the roots C8-T1. Six patients had Horner's syndrome; three had ptosis only with no other signs of Horner's syndrome. Symptoms persisted in eight patients more than 3 months after the operation, and one patient still had intractable pain. Increasing use of internal mammary artery grafts in coronary artery bypass demands measures to protect the brachial plexus.
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PMID:Brachial plexus injury after cardiac surgery. The role of internal mammary artery preparation: a prospective study on 1000 consecutive patients. 168 32

Surgery on the shoulder often causes severe pain and, therefore, requires high doses of opiates. As postoperative pain is frequently treated inadequately, it is desirable to seek alternatives for providing effective analgesia. In a prospective study we examined the efficacy of balanced anesthesia consisting of general anesthesia combined with interscalene brachial plexus blockade for intra- and postoperative analgesia for operations on the shoulder. METHODS. Using the technique described by Winnie, interscalene block (ISB) was performed in 100 awake patients. After location of the brachial plexus by means of a peripheral nerve stimulator, we injected 40 ml bupivacaine 0.375%, after which general anesthesia (GA) was induced. At three predetermined points in time (recovery room, 8 h, and 24 h after the end of surgery), pain was evaluated by a visual analogue scale ranging from 0 to 10 and the extent of sensory blockade was tested by the pinprick method. The results of the pain scores and individual demands for analgesics were compared with a group of 22 patients who received only GA. Both groups were comparable in age, sex, and type of surgical procedure. RESULTS. We noted technical failure of the ISB in 8% of our patients. Side effects such as Horner's syndrome (18%), phrenic nerve paralysis (10%), and recurrent laryngeal nerve block (1%) were only temporarily observed during the action of the local anesthetics. During the surgical procedure, the group with ISB received a mean dose of 0.13 +/- 0.07 mg fentanyl versus 0.29 +/- 0.08 mg in the GA group (P less than 0.01) with equipotent doses of volatile anesthetics (1.0 to 1.5 MAC enflurane). Postoperative pain occurred for the first time in 39% of the patients given ISB later than 12 h after the end of surgery (average 8.7 +/- 5.9 h). In contrast, 95% of the patients with GA complained of pain in the recovery room. Pain measurement by the analogue scale clearly demonstrated the advantages of balanced anesthesia directly and 8 h after the operation (P less than 0.01). Even 24 h after the end of the surgical procedure the patients had better pain relief (P less than 0.05) in spite of the decreasing effect of the ISB. These significant differences led to the following results for postoperative treatment: 35% of the patients with ISB did not require additional analgesics during the first 24-h period after surgery, whereas 95% of those with GA requested analgesia. Only 32% of the ISB patients required opioids versus 86% with GA. The average duration of stay in the recovery room was reduced by 25% in the group with ISB (86 vs 134 min). In a final assessment, 84% of the patients were satisfied with the balanced anesthesia and only 5% were disappointed with the method. CONCLUSION. The combination of ISB and GA allows a reduction in intraoperative doses of opiates and facilitates postoperative pain management. Because of the low incidence of side effects, the lack of complications, and the high degree of patient acceptance, we recommend this type of balanced anesthesia for patients undergoing shoulder surgery.
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PMID:[The combination of general anesthesia and interscalene block in shoulder surgery]. 174 12

Pain around the eye can be caused by local ophthalmic disorders or by disease of other structures sharing trigeminal nerve sensory innervation. In general, most ocular causes for pain also cause the eye to be red, thus alerting the examiner to the focality of the problem. However, conditions like eyestrain, intermittent angleclosure glaucoma or neovascular glaucoma, and low-grade intraocular inflammation can be painful and not be associated with obvious redness. Ocular signs and symptoms also occur with numerous other causes of headache. Double vision in association with periocular pain can result from orbital lesions, isolated cranial neuropathies, and cavernous sinus lesions. Pupillary abnormalities like Horner's syndrome may result from a variety of painful conditions, including cluster headache, parasellar neoplasms or aneurysms, internal carotid dissection or occlusion, and Tolosa-Hunt syndrome. Pain with a dilated and unreactive pupil may reflect a benign condition like Adie's syndrome or ophthalmoplegic migraine, or it may herald the presence of a life-threatening posterior communicating artery aneurysm. Headache and transient visual loss can be manifestations of classic migraine, or be symptoms of ocular hypoperfusion from ipsilateral internal carotid occlusion or increased intracranial pressure from pseudotumor cerebri. In a young patient, head pain with a fixed visual deficit may result from optic neuritis, in an older adult, temporal arteritis may be the culprit. Ophthalmologic aspects of headache thus encompass problems that range from simple and benign to complex and formidable.
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PMID:Ophthalmologic aspects of headache. 202 Feb 23

The personal experience with cluster headache in 108 patients is reported. Significant clinical findings included a clear male predominance, with a male/female prevalence ratio of 4.7/1, the persistent homolateral character of pain during the attacks, seen in 100% of cases, and the tendency to repeat the attacks on the same side (96%). The cluster headache predominated during spring and the painful crisis, in our experience, had a clear nocturnal predominance. Regarding the signs and symptoms accompanying pain, our series was similar to those in the international literature, except for a smaller prevalence of Horner's sign in our cases. The association with tenderness of the carotid territory ipsilateral to pain is reported here for the first time. The importance of a correct anamnesis of all parameters associated with pain is emphasized in the present study, as in many patients only a detailed investigation permits an adequate clinical definition.
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PMID:[Cluster headache. A clinical study]. 205 6

High thoracic epidural anesthesia was administered by anesthetists in 20 patients undergoing submuscular breast augmentation. An average of 12 ml of 2% lidocaine was instilled after sedation with midazolam, 2-6 mg. The augmentation procedure averaged 90 minutes. In 3 patients, the block developed more rapidly on one side than the other, but soon became symmetrical in all; additional subcutaneous infiltration of lidocaine was necessary in 1 patient because of infraclavicular pain; ephedrine, 10 mg was needed in 2 patients to treat hypotension (greater than 20% decrease in blood pressure). Three patients felt infraclavicular pressure; 1 had a brief sensation of breathlessness; 3 had nasal stuffiness from Horner's syndrome associated with the block; none developed headache, back pain, or paresthesias; and 3 had postoperative nausea. The average time from the end of the procedure to patient discharge was 96 minutes. In this limited series, high thoracic epidural anesthesia for submuscular breast augmentation was extremely satisfactory.
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PMID:Early experience with high thoracic epidural anesthesia in outpatient submuscular breast augmentation. 202 43

Endoscopic transthoracic electrocautery of the sympathetic chain has been the preferred treatment for palmar or axillary hyperhidrosis in this unit since 1980. A retrospective study was carried out of the first 112 patients with case material derived from a postal questionnaire, chart review and outpatient assessment. Eighty-five patients undergoing bilateral transthoracic electrocautery who replied to the questionnaire (76 per cent response rate) form the basis of this study. There were 65 females and 20 males with a mean age of 24.3 years (range 15-40 years). The hands alone were affected in 20 patients (24 per cent), the axillae alone in 17 (20 per cent) and both areas in 48 (56 per cent). Mean hospital stay was 3.1 days (range 1-7 days). Outcome was assessed by 92 per cent of patients immediately after operation as 'very much improved' or 'moderately improved', and this assessment persisted in 85 per cent after a mean follow-up of 43 months (range 3-95 months). Cosmetic results were rated as satisfactory by 95 per cent. Apart from pain after operation, morbidity was limited to transient Horner's syndrome in three patients, surgical emphysema in three, and pneumothorax requiring a chest drain in one. A repeat procedure was needed in one patient because of an inadequate first operation. Some compensatory hyperhidrosis occurred in 54 (64 per cent) patients. As a minimally invasive procedure, endoscopic transthoracic electrocautery should be considered the treatment of choice for palmar and axillary hyperhidrosis.
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PMID:Endoscopic transthoracic electrocautery of the sympathetic chain for palmar and axillary hyperhidrosis. 227 33

The results of a study of 62 patients with 69 dissections of the extracranial internal carotid artery are presented. Mean age at the time of diagnosis was 43 years, with a preponderance of men over women. The patients were followed up for a mean period of 41 months. In 6 cases regarded as being "traumatic" in origin, the outcome was similar to that of "spontaneous" dissection. The most significant associated factors seemed to be migraine (34 per cent), on-going treatment with oestrogens and progestogens (48 per cent of women) and fibromuscular dysplasia (21 per cent). The clinical features consisted of local signs (isolated in 8 cases), signs of ischaemia (isolated in 9 cases) or both together. There were 35 established cerebral vascular accidents and 2 cases of ischaemic optic neuritis with blindness, responsible for invalidating sequelae in 31 per cent of the patients. The most frequent local signs were suggestive hemicrania, cervical pain, Horner syndrome and tinnitus. The initial angiography showed occlusion in one quarter of the cases and stenosis in 70 per cent. Stenosis was usually located in the second infrapetrosal half of the artery and had the most favourable angiographic prognosis.
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PMID:[Dissection of the extracranial internal carotid artery. 62 cases]. 213 49

Interpleural analgesia has been successfully used for pain relief after cholecystectomy, renal surgery, breast surgery and thoracotomy. Little has been reported about side effects and complications. This article summarizes available information about adverse events collected from the literature. The survey comprises a total of 703 cases. Pneumothorax was the most frequently registered complication followed by signs of systemic toxicity and pleural effusion. Horner's syndrome, pleural infections and catheter rupture have also been reported.
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PMID:Side effects and complications related to interpleural analgesia: an update. 214 54

We present a case of a 47-year-old female who was followed for 7 months with complaints of musculoskeletal pain involving the shoulder and scapula until she presented to the emergency department with Horner's syndrome and was diagnosed as having a superior pulmonary sulcus tumor. A review of the literature shows that although such tumors are a frequent cause of Horner's syndrome there are numerous other benign as well as malignant causes of Horner's syndrome. The differential diagnosis can be significantly narrowed by a knowledge of the anatomy and a careful physical examination. We present the anatomy, pathophysiology, differential diagnosis, and evaluation of patients who present to the emergency department with Horner's syndrome.
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PMID:Horner's syndrome in the emergency department. 225 13

Acupuncture has been practiced in the treatment of many diseases in Japan. "Okibari" is one of the procedures in acupuncture treatment: a fine stainless steel or silver needle is inserted into the subcutaneous tissue through the skin, to remain in the subcutaneous tissue. A 57-year-old pharmacist was knocked down by a motorcycle in 1971, since then moderate weakness of left extremities and stiffness of muscles have remained as sequelae. She was consequently treated with acupuncture. Many small needles were inserted permanently in the nuchal, occipital and other areas of the body ten to twelve years before she developed gradual clumsiness and dysesthesia in her right hand in 1984. When she was admitted for the first time in 1985, neurological examination revealed left Horner's syndrome and diminished deep sensation in her right extremities with pseudo-athetosis of her right hand, along with spastic paresis of left extremities and right carpal tunnel syndrome. An old needle which had strayed into left dorsal medulla was considered to be responsible for these symptoms. In 1988 loss of pain and temperature sensation in the right side of her body below the shoulder, and diminished deep sensation of left extremities were appended, and weakness of her left extremities became aggravated. Pseudo-athetosis of her right hand was seen less prominently. In plain X-ray films many needle shadows were visualized. On CT scan needle shadows could be seen also in the left dorsal medulla, right cerebellum and in the subarachnoid space of left dorsal C1-C2 level.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Acupuncture needles, straying in the central nervous system and presenting neurological signs and symptoms]. 227 62


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