Abstract:
OBJECTIVES:The majority of intrathecal pumps are implanted by anesthesiologists. Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature. The present case report describes a patient with spinal cord compression as a result of an inflammatory mass and reviews the current literature as to the etiology of inflammatory mass formation. CASE REPORT:A 47-year-old man with intractable neck and arm pain received an intrathecal pump implantation in 2001, at a stable dose of morphine 8 mg and clonidine 40 microg/d. After an injury in late 2001, his dose requirement for intrathecal morphine steadily increased. In May 2002, hydromorphone was substituted for morphine. The concentrations of hydromorphone and clonidine were 12.5 mg/mL and 150 microg/mL, respectively, infusing at 0.3 mL/d. In October 2003, he developed progressive T9 paraparesis. A computed tomography scan with myelogram showed complete blockage of contrast flow at T8-9. Surgical exploration found an intradural-extramedullary mass compressing the spinal cord anteriorly and to the left. Four weeks after surgical removal of the mass, the patient's neurologic function had improved minimally. All the microbiological analyses were negative. Review of the current literature suggests that the development of an inflammatory mass is related to the delivery of the high dose opioids in the intrathecal space. CONCLUSION:Delivery of high-dose intrathecal opioids can result in the formation of an inflammatory mass, leading to poor pain control and neurologic complications. Anesthesiologists should be vigilant as to these complications when managing patients receiving intrathecal pump therapy.
journal_name
Reg Anesth Pain Medjournal_title
Regional anesthesia and pain medicineauthors
Peng P,Massicotte EMdoi
10.1016/j.rapm.2004.01.012subject
Has Abstractpub_date
2004-05-01 00:00:00pages
237-42issue
3eissn
1098-7339issn
1532-8651pii
S1098733904000410journal_volume
29pub_type
杂志文章,评审abstract:BACKGROUND:Interpretation of ultrasound images and knowledge of anatomy are essential skills for ultrasound-guided peripheral nerve blocks. Competency-based educational models promoted by the Accreditation Council for Graduate Medical Education require the development of assessment tools for the achievement of differen...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/AAP.0000000000000236
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:It has recently been proposed that an infraclavicular brachial plexus block (BPB) at the costoclavicular (CC) space may overcome some of the limitations of the lateral sagittal (LS) approach. In this study, we hypothesized that the CC approach will produce faster onset of sensory blockade of t...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0000000000000822
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:We present 2 case reports that illustrate that chronic intrathecal (IT) baclofen administration may be efficacious in treating patients with long-standing complex regional pain syndrome, type I (CRPS I) who have failed treatment with multiple drugs and procedures. CASE REPORTS:Both cases pres...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1053/rapm.2002.29244
更新日期:2002-01-01 00:00:00
abstract::Despite a growing awareness about the importance of gender equity and the rising number of women in medicine, women remain persistently underrepresented in pain medicine and anesthesiology. Pain medicine ranks among the bottom quartile of medical specialties in terms of female applicants, female trainees, and proporti...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,评审
doi:10.1097/AAP.0000000000000774
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Many patients experience moderate to severe postoperative pain. Nitrous oxide (N₂O) exerts analgesia by inhibition of N-methyl-D-aspartate receptors. Ketamine, another N-methyl-D-aspartate receptor antagonist, reduces postoperative opioid consumption and pain. A similar effect of N₂O is plausi...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0000000000000039
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Ivor-Lewis esophagectomy is associated with significant postoperative analgesic requirements and perioperative complications. A dual-epidural technique may improve perioperative outcomes compared with single thoracic epidural analgesia. METHODS:This study identified all cases of Ivor-Lewis esophagectomy ove...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0b013e318276a714
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Cervical medial branch blocks are used to treat patients with chronic neck pain. The aim of this study was to clarify the anatomical aspects of the cervical medial branches to improve the accuracy and safety of radiofrequency denervation. METHODS:Twenty cervical specimens were harvested from ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0000000000000175
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Several types of quadratus lumborum block (QLB) are used for postoperative analgesia and are believed to be effective against both somatic and visceral pain via a local anesthetic (LA) effect in the paravertebral space (PVS). However, it remains unclear whether all QLB techniques result in LA ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0000000000000735
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Stellate ganglion block (SGB) is one treatment option for human trigeminal nerve injury. The aim of this study was to evaluate the effectiveness of cervical sympathetic ganglia blocks (SB) by comparing the recovery of severed nerves in 2 rat models, treated or not treated by SB. METHODS:The i...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1053/rapm.2002.31206
更新日期:2002-05-01 00:00:00
abstract::This article provides a brief overview of earlier work of our group on the peripheral signaling of pain, summarizes more recent studies on the role of opioids in chronic neuropathic pain, and speculates on the future of gene-based therapies as novel strategies to enhance the peripheral modulation of pain. Neurophysiol...
journal_title:Regional anesthesia and pain medicine
pub_type:
doi:10.1097/AAP.0b013e31823b145f
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:We describe a new therapeutic modality for sacroiliac joint syndrome that represents an alternative to other treatment modalities. We report on four cases of sacroiliac joint syndrome with severe pain. METHODS:Three patients had undergone operative treatment of the lumbar spine and one patien...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/s1098-7339(99)90170-0
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Recent clinical trials suggest that subfascial (sometimes termed subepineural) injections result in faster block onset and success compared with conventional techniques. This prospective, randomized, observer-blinded study measured and compared the 3-dimensional spread pattern and volume of pe...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0b013e31826af511
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:In this study, we examined the consistency, rapidity, and reproducibility of the ABCDE technique for diaphragm identification. Operators using this method place the probe at the Anterior axillary line, watch for Breathing (lung sliding), and then move the probe Caudally to identify the Diaphra...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0000000000000718
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Robotic and hand-assisted laparoscopic nephrectomies are often associated with moderate to severe postoperative pain. The aim of the current study was to investigate the analgesic efficacy of the transmuscular quadratus lumborum (TQL) block for patients undergoing robotic or hand-assisted laparoscopic nephre...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1136/rapm-2020-101745
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Long-acting nociceptive-selective regional anesthesia has remained an elusive clinical goal. We aspired to identify a novel compound that would produce nociceptive-selective regional anesthesia through the transient receptor potential vanilloid 1 (TRPV1) channels. METHODS:We designed and synth...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1136/rapm-2019-101057
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Third occipital nerve block (TONB) is commonly used in the diagnosis and treatment of upper neck pain and cervicogenic headaches. Although fluoroscopy is the current imaging standard for TONB, ultrasound (US) guidance offers a promising, radiation-free alternative. In this randomized, observer-blinded trial,...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0b013e31828b25bc
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Mexiletine is an oral sodium channel antagonist that has been reported to be effective in a variety of neuropathic pain syndromes. However, recent reports question the efficacy of oral mexiletine in neuropathic pain. The objectives of this study were to examine the effect of oral mexiletine on...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1053/rapm.2000.8583
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVE:Postdural puncture headache (PDPH) is an uncommon sequel of lumbar puncture in children. When conservative treatment with bed rest, hydration, and caffeine are ineffective, epidural blood patches are recommended and are generally effective. The purpose of this report was to highlight that when lumbar epidural...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0000000000000562
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Quadratus lumborum (QL) block is a new regional analgesic technique for upper and lower abdominal surgeries as part of a multimodal analgesic regime. It has also been reported to relieve pain after total hip arthroplasty (THA). In this prospective, randomized, double-blind study, we compared Q...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1136/rapm-2019-100804
更新日期:2019-10-25 00:00:00
abstract:OBJECTIVE:Our objective was to describe the first reported use of an axillary brachial plexus block to treat the entrapment of a transradial artery catheter due to vasospasm. CASE REPORT:A 42-year-old man undergoing transradial arterial cardiac catheterization suffered arterial vasospasm causing the catheter to become...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0000000000000595
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVE:We present a case of intense herpes zoster-related pain and itching in the ophthalmic division of the trigeminal nerve (V1). Successful pain and itch management was achieved after insertion of a high thoracic epidural catheter with a continuous infusion of bupivacaine and clonidine. CASE REPORT:A 73-year-old...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/s1098-7339(03)00182-2
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Subarachnoid blocks are considered routine anesthetic procedures important in the daily practices of most anesthesiologists. However, few data exist regarding modern failure rates or quality-compromising behaviors. METHODS:Sixty adult patients having orthopedic surgery under spinal anesthesia were enrolled ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0b013e3182030863
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Multimodal analgesia protocols have shortened hospitalizations after total joint arthroplasty. It is unclear whether individual components of these protocols are associated with respiratory depression during phase I postanesthesia recovery. OBJECTIVES:To test the hypothesis that sedating analgesics used in ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0000000000000257
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Epinephrine, 25 microg and 200 microg, has been found to prolong the duration of intrathecal labor analgesia when added to an opioid. In our hospital we use the standard epidural mixture, prepared by the pharmacist, containing epinephrine 1:800,000; i.e., 1.25 microg/mL for both spinal and epi...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1053/rapm.2001.24406
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Postoperative pain is the expected but nonetheless undesirable byproduct of all surgical procedures. Humanitarian concerns and recent quasi-governmental regulations have heightened awareness about the importance of treating postoperative pain. This guideline builds upon the foundation created ...
journal_title:Regional anesthesia and pain medicine
pub_type: 指南,杂志文章
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更新日期:2003-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The benefit of adding sciatic nerve block (SNB) to femoral nerve block to improve analgesia after total knee arthroplasty (TKA) is uncertain. We hypothesized that the effective duration of single-injection SNB is too short to improve postoperative analgesia and that this contributes to conflic...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
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更新日期:2014-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Conflicting definitions concerning the exact location of the lumbar plexus have been proposed. The present study was carried out to detect anatomical variants regarding the topographical relation between the lumbar plexus and the psoas major muscle as well as lumbar plexus anatomy at the L4-L5...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/j.rapm.2007.07.016
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Arthroscopic anterior cruciate ligament (ACL) reconstruction of the knee is a painful procedure requiring intensive postoperative pain management. This prospective study investigates analgesic quality after a femoral block as compared with intra-articular injection of local anesthetic. METHOD...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2003-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:A common analgesic technique for total knee arthroplasty (TKA) is to inject local anesthetic into the periarticular tissue during surgery, known as local infiltration analgesia (LIA). Since the solution used typically contains a large amount of local anesthetic, concerns arise about exceeding ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1136/rapm-2018-100043
更新日期:2019-01-11 00:00:00
abstract:BACKGROUND:Detailed description of the tasks anesthetists undertake during the performance of a complex procedure, such as ultrasound-guided peripheral nerve blockade, allows elements that are vulnerable to human error to be identified. We have applied 3 task analysis tools to one such procedure, namely, ultrasound-gui...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0b013e318228d1c0
更新日期:2011-09-01 00:00:00