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Query: UMLS:C0030193 (pain)
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This series describes the outcome of diagnostic block at the coracoid process's common origin of the biceps brachii short head and coracobrachialis for anterior shoulder pain and cervical myofascial pain syndrome in six patients. All showed significant tenderness over the tip of the coracoid process. All underwent diagnostic injection with Marcaine at the coracoid process, followed by therapeutic injection with Marcaine and DepoMedrol. All reported complete relief of pain after local injection. Enthesitis at the coracoid process needs to be considered as a causative or contributing factor in patients presenting with shoulder and neck symptoms. No study was found in the literature describing this association. Whether tendonitis of the common origin is a primary cause or result of chronic neck and shoulder dysfunction remains to be established.
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PMID:Enthesitis of biceps brachii short head and coracobrachialis at the coracoid process: a generator of shoulder and neck pain. 1582 85

The infusion pain pump has been a valuable addition to postoperative pain management in plastic and reconstructive surgery. Concerns have been raised regarding the potential ischemic or infectious complications of placing a catheter beneath the operative site for infusion of local anesthesia (+/- epinephrine). The purpose of this review is to document our experience with this form of postoperative pain control in plastic surgical procedures. Thirty-six consecutive transverse rectus abdominis muscle (TRAM) flap breast reconstruction patients were reviewed and included in the series (16 left, 10 right, and 10 bilateral). The average age was 52 years, and 4 patients had a simultaneous symmetry procedure. The cohort was divided into those with a postoperative pain pump versus those without a pain pump. Data points queried included type, route, and amount of narcotic administered per day in the postoperative period, as well as complications. All patients received patient-controlled analgesia (PCA) (morphine, n = 34; meperidine (Demerol, Sanofi-Synthelabo), n = 1; hydromorphone hydrochloride (Dilaudid, Abbott Pharmaceutical) n = 1). The pain pump was used in 16 patients (bupivacaine (Marcaine, AstraZeneca, n = 16). It was typically infused starting postoperatively at a rate of 4 mL/d and discontinued on postoperative day 2. Supplemental intravenous narcotics were required in 12% (n = 2/16) of patients with a pain pump versus 35% (n = 7/20) in those patients without a pain pump. There were no significant differences in the average number of days the PCA was used (1.8 days with a pain pump versus 2.2 without), and patients with the pain pump started postoperative medications slightly earlier (1.8 versus 2.0 days). PCA requirements were significantly lower in those patients with the pain pump. The average days to discharge for patients with a pain pump were 3.4 compared with 4.7 days in those patients without the pain pump. There were no differences in donor-site or breast complications. The postoperative pain pump has been useful in reducing the intravenous narcotic requirements and length of stay in patients following TRAM flap breast reconstruction. There were no flap, donor-site, or implant complications related to the presence of the catheter. Cost-effectiveness and patient satisfaction data would be interesting.
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PMID:Use of the infusion pain pump following transverse rectus abdominis muscle flap breast reconstruction. 1583 7

A 21-year-old white man in otherwise excellent general health was referred for a painful, progressive, facial eruption with associated fever, malaise, and cervicofacial lymphadenopathy. The patient reported that a vesicular eruption progressed from the left side of his face to also involve the right side of his face over the 48 hours preceding his clinic visit. He also reported some lesions in his throat and the back of his mouth causing pain and difficulty swallowing. Four to 7 days before presentation to us, the patient noted exposure to his girlfriend's cold sore. Additionally, he complained of a personal history of cold sores, but had no recent outbreaks. Physical examination revealed a somewhat ill man with numerous vesicles and donut-shaped, 2-4 mm, crusted erosions predominantly on the left side of the bearded facial skin. There were fewer, but similar-appearing lesions, on the right-bearded skin. The lesions appeared folliculocentric (Figure). Cervical and submandibular lymphadenopathy was present. Oral exam showed shallow erosions on the tonsillar pillars and soft palate. Genital examination was normal. The remainder of the physical exam was unremarkable. A Tzanck smear of vesicular lesions was positive for balloon cells and many multinucleated giant cells with nuclear molding. A viral culture was performed which, in several days, came back positive for herpes simplex virus. The complete blood cell count documented a white blood cell count of 8000/mm3 with 82.6% neutrophils and 9.0% lymphocytes. Based on the clinical presentation and the positive Tzanck smear, the patient was diagnosed with herpes simplex barbae, most likely spread by shaving. The patient was started on acyclovir 200 mg p.o. five times daily for 10 days. Oxycodone 5 mg in addition to acetaminophen 325 mg (Percocet; Endo Pharmaceuticals, Chadds Ford, PA) was prescribed for pain relief. A 1:1:1 suspension of viscous lidocaine (Xylocaine; AstraZeneca Pharmaceuticals LP, Wilmington, DE), diphenhydramine (Benadryl; Pfizer Inc., New York, NY), and attapulgite (Kaopectate; Pfizer Inc., New York, NY) was given as a swish and spit to relieve the oral discomfort. Good hygiene, no skin-to-skin contact with others, and no further shaving to prevent autoinoculation were stressed. He was advised to discard his old razor.
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PMID:Case study: inoculation herpes barbae. 1589 Dec 58

This prospective study was designed to determine the prevalence of lumbar facet joint pain in a consecutive series of patients with chronic low back pain treated at an interventional, multidisciplinary private pain management practice utilizing double diagnostic blocks, to determine the prevalence of false positive rate of uncontrolled facet joint blocks, and to determine the relationship of clinical features of responders and non-responders to double diagnostic blocks. One hundred and twenty patients with low back pain with or without lower extremity pain were selected. The procedure consisted of diagnostic blocks using lidocaine and bupivacaine on separate occasions, usually two weeks apart. Each facet joint nerve was infiltrated with either 0.4 to 0.6 ml of 1% lidocaine (Xylocaine(R)) or 1% lidocaine (Xylocaine(R)) and 0.25% bupivacaine (Marcaine(R)). A definite response was defined as substantial with at least 75% relief of pain in the symptomatic area following local anesthetic block. Confirmatory blocks using bupivacaine 0.25% were performed at the same levels as the first injection if definite relief was obtained. The response to bupivacaine blocks which lasted longer than the lidocaine blocks was accepted as a positive response. All blocks were performed under fluoroscopic guidance. Eighty-one patients (67.5%) reported a definite response to lidocaine blocks. Confirmatory blocks with bupivacaine were performed in all 81 patients with 54 patients, i.e. 45% of total sample or 66.6% of lidocaine positive group reporting definite response with a false positive rate of 41%. Prevalence and relationship of pain referral pattern in patients with and without facet joint pain confirmed by double blocks showed no significant correlation. We found no relationship between the history, physical findings, age, gender, trauma, duration of pain, and diagnostic blocks. However, history of previous surgery showed a negative correlation as only 29% of the patients after previous surgery were positive in contrast to 51% of the nonsurgical population. The results of this study echo previous concerns of reliability of uncontrolled single blocks, history, and clinical features. This study demonstrated that the facet joint is a source of pain in 45% of the patients suffering with chronic low back pain in an interventional pain management setting in a private practice.
Pain Physician 1999 Oct
PMID:Prevalence of lumbar facet joint pain in chronic low back pain. 1690 17

The perioperative management of cleft palate surgery remains controversial. Early literature supported hospital stays of 2-5 days, but more recent reports have supported 24-hour admissions in carefully screened patients without congenital syndromes. We retrospectively reviewed 65 cleft palate repairs performed by the senior author from August 1992 through November 2003. Procedures included repairs of the soft palate (n = 25), hard palate (n = 4), or combined hard and soft palate (n = 36). All repairs were performed using a Furlow double, opposing Z-plasty technique. Nine patients (14%) had associated congenital syndromes. Prior to January 1995, patients (n = 15) received perioperative antibiotics and local injection of lidocaine with epinephrine prior to incision. The average operative time to first oral feeding was 13 hours, and the average length of stay in this group was 2.4 days. Previous oral surgery literature has demonstrated the reduction of pain, edema, and trismus with the use of dexamethasone. As part of our recent operative protocol, all patients (n = 50) after January 1995 received perioperative antibiotics, local injection of a 50/50 mixture of 1% lidocaine with epinephrine, and 0.5% Marcaine with epinephrine prior to incision and 4 mg of intravenous dexamethasone perioperatively. The average time to first feeding was 7 hours and the average length of stay was 1.1 days. Postoperatively, patients from both groups were maintained on a liquid or soft diet, depending on their age without the use of bottles. There were no differences in the use of antibiotics or pain management between the 2 groups. Patients were assessed by the surgical team for evaluation of the surgical site and oral intake prior to discharge. Patients in the steroid/Marcaine group had earlier oral intake (P < 0.05) and shorter length of stay (P < 0.05). Of those patients receiving dexamethasone and Marcaine, 43/50 (86%) were discharged within 24 hours. Patients requiring longer hospitalization had initially inadequate oral intake. One patient required readmission for dehydration secondary to rotavirus. In conclusion, short-stay cleft palate surgery is safe, given adequate oral intake, competent parents, and a safe home environment.
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PMID:Short-stay cleft palate surgery with intraoperative dexamethasone and marcaine. 1692 86

The present paper comparatively analyzes anesthetic support in 91 patients during a total endoprosthetic operation on the knee joint. All the patients were conventionally divided into 4 groups: (1) those (n=7) in whom the operation had been made under general anesthesia (nitrous oxide, ketamine, seduxen, droperidol, and fentanyl); (2) those (n=36) who had been operated on under epidural anesthesia; (3) those (n=24) who had intraoperatively received spinal (subarachnoidal) anesthesia; (4) those (n=24) whom had been intraoperatively given combined spinal and epidural anesthesia. The study established that the above-mentioned general anesthesia failed to produce a steady-state hemodynamics; the earliest postoperative period being accompanied by a significant pain syndrome, which required the use of narcotic analgesics. In Group 2, due to the specific features of the impact of epidural anesthesia itself on different innervation links (A, B, and C), susceptibility to hypotension and the adequacy of this mode of anesthesia were observed, which required the intraoperative additional administration of narcotic agents to enhance anesthesia. Group 3 was marked by a relative postoperative stability of parameters, but a significant pain syndrome is observed in the earliest postoperative period. The best results were obtained in Group 4 patients undeigone a combined spinal and epidural anesthesia. The component of subarachnoidal (spinal) anesthesia Marcaine Spinal provided a sufficient intraoperative analgesic effect and the component of epidural anesthesia induced virtually no pain syndrome under continuous epidural block.
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PMID:[Comparative assessment of general and regional anesthesia during total endoprosthetic operations on the knee joint]. 1706 83

Chronic severe pain following inguinal hernia repair is a significant post-operative problem. Its exact cause and lack of evidence-based treatment path present problems in the effective management of this surgical complication. We retrospectively reviewed the records of patients diagnosed with chronic pain following open inguinal hernia repair between November 1995 and November 2000, who were under the care of the senior author. Over the five-year period, 146 patients underwent inguinal hernia repair. 88 (60%) had suture repair (darn & modified Bassini's) and 58 (40%) underwent a Lichtenstein mesh repair. Thirteen patients (9%), (3 in suture vs. 10 in mesh group, p = 0.004) developed chronic severe pain. Examination revealed maximal tenderness over the genitofemoral nerve (GF) distribution (n = 5), over the medial end of the scar (n = 3), over the pubic tubercle (n = 1) and in the ilioinguinal nerve distribution (n = 1) No abnormality was detected on clinical examination in the cases of three patients. Treatment involved GF nerve block (n = 5), local injection of Chirocaine and Methylprednisolone acetate into the medial end of the scar (n = 3), Chirocaine and Methylprednisolone acetate into the pubic tubercle (n = 1), ilioinguinal nerve block (n = 1), re-exploration with re-suturing of the mesh (n = 1), and Amitriptyline (n = 2). At a median follow up of 45 months (range: 24-87), 10 (77%) are completely pain free; two (15.4%) had mild pain and one patient still has significant persistent pain. To conclude, chronic severe pain occurred in nine percent of patients following primary open inguinal hernia repair. The majority of patients were successfully treated by therapeutic injection into the point of maximal tenderness.
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PMID:Chronic pain after hernia surgery--an informed consent issue. 1785 38

A case of severe hemifacial pain with radiation into the anterior auricular, frontal and temporal areas associated with blurry vision and dizzy spells is presented. The patient's symptoms were temporarily cured by local injection of Xylocaine around the elongated styloid process and were permanently relieved by resection of the abnormally long styloid process. The salient diagnostic and x-ray features of the "symptomatic elongated styloid process" (The Eagle Syndrome) are presented.
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PMID:Hemicrania secondary to elongated styloid process "the Eagle Syndrome". 1789 63

Background. We investigated the efficacy of intra - articular bupivacaine with morphine administration after knee joint arthroscopy.<br /> Material and methods. The present study compared intra- arthicular bupivacaine with intra-arthricular morphine for postoperative analgesia in 56 patients (21 women, 35 men) (age 20-70, mean 39.8) undergoing knee joint arthroscopy.<br /> Intraoperatively, the patients received anaesthesia spinaly (0.5 % Marcaine spinal ASTRA) and immediately following surgery received 10 ml intra-arthricular injection consisting either of 0.5 % bupivacaine (group I), 5 mg morphine + 0.9 % saline (group II).Postoperative analgesia was supporeted by intravenous doses of proefferalgan.<br /> In all patients the visual analogue pain score (VAS), PaO2, systolic blood preassure (SABP), diastolic blood preassure (DABP), heart rate (HR), respiratory rate (f), supplemented analgesia and possible side effects were monitored postoperatively.<br /> Results. Intra-arthricular administration of each solution was well toleratede and non side effects were noted.<br /> There was non significant difference among the two groups in monitored parameters. The mean time of postoperative analgesia was 185,7 +/- 25.3 min for bupivacaine group and 390.3 +/- 35,4 min for morphine group.<br /> Total amount proefferalgan supplamentation was the highest in group I.<br /> Conclusions. Postoperative intra- arthricular injections of bupivacaine and morphine for patients undergoing knee joint arthroscopy can provide a safe and effective analgesia and therefore shound be recommended and widely implamented into the clinical use as a standard procedure.
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PMID:Morphine or bupivacaine in controlling postoperative pain in patients subjected to knee joint arthroscopy. 1803 69

A case of skin injuries due to stings by crown-of-thorns starfish, Acanthaster planci, in a 53-year-old Okinawan woman is reported. She went to a beach to gather shellfish on 8 April 2001 and fell to the ground with her left palm on a crown-of-thorns starfish that happened to be close to her. She hurried to the emergency section of our hospital. An emergency doctor sterilized the wound and administered an antibiotic, an analgesic agent and an injection of a tetanus antitoxin. He tried to remove the remaining spines from the palm with great difficulty. Because swelling and subcutaneous indurations of the left palm had persisted thereafter, oral and topical administration of corticosteroid started on 13 April. Physical examination at the dermatology section revealed approximately 10 stab wounds of the left palm with pus, subcutaneous bleeding and many abrasions around them. X-rays of the left hand showed foreign bodies, 2-10 mm in size, located on the lesions. The patient was treated with a topical injection of 2 mg triamcinolone acetonide (Kenacort-A), diluted fivefold with 1% Xylocaine, once a week. Some of the foreign body granulomatous lesions improved but pain and subcutaneous indurations persisted in most of the lesions. Because the X-ray photographs showed many remaining spines, surgical excision to remove them was performed under local anesthesia 3 months after the injury. All the symptoms improved after the operation. Scanning electron microscopic examination of the spines revealed that their tips had fragile lattice-like structures.
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PMID:Case of skin injuries due to stings by crown-of-thorns starfish (Acanthaster planci). 1834 60


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