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Pain Reports Jun 2024Postoperative rebound pain after peripheral nerve block increases patient suffering and delays recovery after surgery.
INTRODUCTION
Postoperative rebound pain after peripheral nerve block increases patient suffering and delays recovery after surgery.
OBJECTIVES
We tested whether the 5HT-3 receptor antagonist and α7nAChR agonist tropisetron could prevent postoperative rebound pain.
METHODS
A total of 115 patients were randomized to receive 5-mg/5-mL tropisetron or the same volume of normal saline. Pain intensity was measured with the numerical rating scale of pain (NRS). Rebound pain was defined as a change from mild pain (NRS ≤ 3) measured in the postanesthesia care unit to severe pain (NRS ≥ 7) within 24 hours after peripheral nerve blockade. Logistic regression was used to identify relevant factors associated with postoperative rebound pain.
RESULTS
Tropisetron did not affect the NRS score or the incidence of rebound pain after peripheral nerve block. Logistic regression revealed that preoperative pain, bone surgery, and length of incision were risk factors for postoperative rebound pain, and patient-controlled analgesia was protective against postoperative rebound pain.
CONCLUSION
Tropisetron does not affect the incidence of rebound pain after peripheral nerve block. Patients at high risk of postoperative rebound pain should be identified for appropriate management. Registration site: www.chictr.org.cn (ChiCTR2300069994).
PubMed: 38756786
DOI: 10.1097/PR9.0000000000001163 -
International Journal of Surgery Case... May 2024Ganglioneuromas are benign neurogenic tumors that arise from the sympathetic ganglia. They are less aggressive compared to the more immature neuroblastomas and...
INTRODUCTION
Ganglioneuromas are benign neurogenic tumors that arise from the sympathetic ganglia. They are less aggressive compared to the more immature neuroblastomas and ganglioneuroblastomas but can grow to exert mass effect on surrounding tissues.
PRESENTATION OF CASE
A 7 years old girl who presented with progressive quadriplegia for 4 months. On examination, she had a right supra-clavicular mass with reduced power in the right hand than the left. Power in the lower limbs was also reduced with hyper-reflexia, clonus and Babinski positive. Laboratory investigations were unremarkable and Chest X-Ray showed a widened mediastinum. Magnetic Resonance Imaging (MRI) scan revealed an extra-medullary spinal tumor at C6/C7 extending laterally on the right through the C6/7 neuro-foramen to the para-spinal tissue and brachial plexus. A C6/7 laminectomy with Spinal cord decompression by partial resection of the tumor was done. Histology of the resected tissue showed ganglioneuroma.
DISCUSSION
The presentation of Ganglioneuromas is usually asymptomatic until they are huge enough to exert mass effect on surrounding tissue. Most are located in the posterior mediastinum, retro-peritoneum and neck. Due to this, it may be very challenging to achieve total resection especially when they surround major vessels or nerves. A multi-disciplinary approach is needed for the best surgical outcomes but this is not always realized in our setting.
CONCLUSION
In resource limited settings, more collaboration and training is needed to realize appropriate management of complex surgical conditions. Although complications are not uncommon, total surgical excision is necessary to prevent recurrence and progression of Ganglioneuromas.
PubMed: 38754158
DOI: 10.1016/j.ijscr.2024.109756 -
JPMA. the Journal of the Pakistan... Apr 2024Soft tissue swellings on the forearm can present with a range of clinical and histopathological diagnosis. Ancient Schawanoma is a rare benign condition that can develop...
Soft tissue swellings on the forearm can present with a range of clinical and histopathological diagnosis. Ancient Schawanoma is a rare benign condition that can develop over the flexor surface of the forearm as a cystic swelling and can involve the median or the ulnar nerve. However, the presentation of this condition on the extensor surface with involvement of the radial nerve is an extremely uncommon diagnosis. A 69 year old female presented at the outpatient department with a swelling on the extensor aspect of her right forearm for the past 2 years. Ultrasound examination showed a mixed cystic solid mass and MRI report revealed a complex predominantly cystic mass in the extensor compartment of the forearm, measuring 4.3 x 5.3 x 7.2 cm size. After obtaining informed consent, the patient was operated under tourniquet control and the mass was removed sparing the radial nerve that was adherent to its capsule. The final histopathological report confirmed the diagnosis as Ancient Schawanoma.
Topics: Humans; Female; Aged; Radial Nerve; Magnetic Resonance Imaging; Radial Neuropathy; Forearm; Ultrasonography
PubMed: 38751285
DOI: 10.47391/JPMA.9610 -
PloS One 2024The brachial plexus is a set of nerves that innervate the upper extremity and may become injured during the birthing process through an injury known as Neonatal Brachial...
The brachial plexus is a set of nerves that innervate the upper extremity and may become injured during the birthing process through an injury known as Neonatal Brachial Plexus Palsy. Studying the mechanisms of these injuries on infant cadavers is challenging due to the justifiable sensitivity surrounding testing. Thus, these specimens are generally unavailable to be used to investigate variations in brachial plexus injury mechanisms. Finite Element Models are an alternative way to investigate the response of the neonatal brachial plexus to loading. Finite Element Models allow a virtual representation of the neonatal brachial plexus to be developed and analyzed with dimensions and mechanical properties determined from experimental studies. Using ABAQUS software, a two-dimensional brachial plexus model was created to analyze how stresses and strains develop within the brachial plexus. The main objectives of this study were (1) to develop a model of the brachial plexus and validate it against previous literature, and (2) to analyze the effect of stress on the nerve roots based on variations in the angles between the nerve roots and the spinal cord. The predicted stress for C5 and C6 was calculated as 0.246 MPa and 0.250 MPa, respectively. C5 and C6 nerve roots experience the highest stress and the largest displacement in comparison to the lower nerve roots, which correlates with clinical patterns of injury. Even small (+/- 3 and 6 degrees) variations in nerve root angle significantly impacted the stress at the proximal nerve root. This model is the first step towards developing a complete three-dimensional model of the neonatal brachial plexus to provide the opportunity to more accurately assess the effect of the birth process on the stretch within the brachial plexus and the impact of biological variations in structure and properties on the risk of Neonatal Brachial Plexus Palsy.
Topics: Brachial Plexus; Finite Element Analysis; Humans; Infant, Newborn; Stress, Mechanical; Biomechanical Phenomena
PubMed: 38743738
DOI: 10.1371/journal.pone.0303511 -
Local and Regional Anesthesia 2024Rebound pain after regional anesthesia, a common phenomenon when the analgesic effect wears off, has been recognized in the last a few years. The aim of this study is to...
PURPOSE
Rebound pain after regional anesthesia, a common phenomenon when the analgesic effect wears off, has been recognized in the last a few years. The aim of this study is to analyze the status and tendency of this area in a macroscopic perspective.
METHODS
Bibliometric analysis is the primary methodology of this study. Literature retrieval was conducted in Web of Science (WoS) Core Collection. WoS, Excel, VOSviewer and CiteSpace were employed to do the analyses and visualization. Parameters were analyzed, such as publications, citations, journals, and keywords, etc.
RESULTS
In total, 70 articles in the past 10 years were identified eligible. Most articles (14 pieces) were published in 2021, followed by 2022 and 2023 with 13 articles. Researchers come from 134 institutions and 20 countries. Huang Jung-Taek, Hallym College, and USA are the most productive author, institution and country, respectively. The articles were mainly published on the top journals of anesthesiology, orthopedics and surgery. The topic of these articles is primarily about the clinical issues of rebound pain. Peripheral nerve block, brachial plexus block and femoral nerve block are the activist keywords in the area, while perioperative management, fracture surgery and outcome may become hotpots in the next years.
CONCLUSION
Our results show that the study of rebound pain after regional anesthesia starts relatively late and is in upward tendency, future studies can focus on the perioperative management and outcomes of fracture patients, and the definition and mechanism of rebound pain after regional anesthesia.
PubMed: 38742096
DOI: 10.2147/LRA.S455347 -
Surgical Neurology International 2024Schwannomas are benign nerve sheath tumors that can either be sporadic or part of neurofibromatosis type 2 (NF2). Tumors of the brachial plexus (BP) with both supra- and...
BACKGROUND
Schwannomas are benign nerve sheath tumors that can either be sporadic or part of neurofibromatosis type 2 (NF2). Tumors of the brachial plexus (BP) with both supra- and infraclavicular components are uncommon and represent a challenge to complete surgical resection. There are few reports on single clavicular osteotomies for BP exposure; however, there are currently no reports of utilization of a clavicular window for a large schwannoma resection.
CASE DESCRIPTION
We report a case of a patient with a schwannoma spanning the BP roots to the cords, with the majority involving the retro clavicular inferior trunk in the setting of NF2. The patient underwent previous subtotal resection and had postoperative enlargement of the residual mass. A gross total resection was made possible by the creation of a clavicular window to expose the BP. A 2 cm segment piece of the mid-clavicle was removed, allowing for roughly 6 cm of mediolateral exposure through clavicular distraction. This clavicular window facilitated complete exposure of the BP schwannoma underneath the clavicle as well as unobstructed exposure of supraclavicular and infraclavicular tumor. The segment was then refixed with a plate after resection of the tumor.
CONCLUSION
The use of a clavicular window allowed for extensive exposure of the trunks and divisions of the BP to achieve a gross total resection in this case. The clavicular window approach may provide a benefit for optimizing exposure in the setting of lesions involving the trunks and divisions that the clavicle would traditionally obstruct.
PubMed: 38741996
DOI: 10.25259/SNI_824_2023 -
Frontiers in Oncology 2024Radiation-induced brachial plexopathy (RIBP) is one of the most concerning late radiation effects after hypofractionated postmastectomy radiotherapy (HF-PMRT) to the...
INTRODUCTION
Radiation-induced brachial plexopathy (RIBP) is one of the most concerning late radiation effects after hypofractionated postmastectomy radiotherapy (HF-PMRT) to the chest wall and regional lymph nodes. The purpose of this study was to investigate the RIBP events occurring in breast cancer patients after HF-PMRT using intensity-modulated radiation therapy (IMRT) by helical tomotherapy. Furthermore, the dosimetric parameters of the ipsilateral brachial plexus were reported.
MATERIALS AND METHODS
Breast cancer patients who underwent HF-PMRT using the IMRT via HT at our institute were included. In the first cohort, subjective RIBP symptoms were measured using a QuickDASH questionnaire, whereas objective RIBP events were assessed using a comprehensive physical evaluation in the second cohort. The ipsilateral brachial plexus from all eligible patients' treatment plans was contoured, and the dosimetric parameters were explored.
RESULTS
From March 2014 to December 2022, 229 patients were enrolled; 107 and 72 individuals were in the first and second cohorts, respectively. The first cohort's median follow-up period was 27 months, and the second cohort was 31 months. In the first cohort, 80 patients (74.77%) had a normal function, 21 (19.63%) had a mild grade, and 6 (5.61%) had a moderate grade; no severe or very severe RIBP was observed. However, the comprehensive physical evaluation of the second cohort indicated no RIBP events. Dosimetric analysis revealed that the median maximum dose was 44.52, 44.52, and 44.60 Gy; the median mean dose was 33.00, 32.23, and 32.33 Gy; and the median dose at 0.03 cc was 44.33, 44.36, and 44.39 Gy for all patients, patients in the first and second cohort, respectively. Each dosimetric parameter was evaluated, and no statistically significant differences were detected.
CONCLUSION
The absence of RIBP events supports the safety of employing HF-PMRT by HT for the chest wall and all regional lymph nodes. We propose that applying the ICRU Report 83 criteria for IMRT planning, which limit the maximum dose (107% of the prescribed dose) to less than 2% of the planning target volume and exclude the brachial plexus region from the maximal dose area, is a practical way to minimize the risk of RIBP from HF-PMRT.
PubMed: 38741780
DOI: 10.3389/fonc.2024.1392313 -
Journal of ISAKOS : Joint Disorders &... May 2024In this case report a unique instance of delayed isolated anterior branch axillary nerve injury following shoulder dislocation is highlighted. The patient, a 55-year-old...
In this case report a unique instance of delayed isolated anterior branch axillary nerve injury following shoulder dislocation is highlighted. The patient, a 55-year-old manual laborer, presented with severe deltoid wasting and reduced power 18 months post-dislocation, necessitating a specialized treatment approach. The use of axillary nerve neurolysis and an innovative upper trapezius to anterior deltoid transfer via a subacromial path posterior to the clavicle, facilitated by an autologous semitendinosus graft, resulted in significant improvement with 160 degrees of abduction and Grade 4+ power (MRC grading (Medical Research Council) at the 5-year follow-up.
PubMed: 38740266
DOI: 10.1016/j.jisako.2024.05.006 -
Cureus Apr 2024Chemotherapy is part and parcel of the multimodality approach to cancer treatment. Chemoports are frequently used to administer chemotherapy, preventing complications...
INTRODUCTION
Chemotherapy is part and parcel of the multimodality approach to cancer treatment. Chemoports are frequently used to administer chemotherapy, preventing complications associated with the use of peripheral lines. However, chemoports have their own set of complications and can be very debilitating at times. Accurate knowledge and correct technique can help prevent and manage these complications properly.
METHODS
We retrospectively analyzed all patients who underwent chemoport insertion for chemotherapy infusion over three years between July 2020 and June 2023. The patient's profile, type of cancer, the technique of chemoport insertion, complications related to chemoport, and its management were recorded retrospectively from patient records.
RESULTS
The total number of patients in our study was 119. The age group of patients ranged from 13 years to 76 years. Of the 119 patients, 55 had breast cancer, 23 had ovarian cancers, 29 had GI cancers including gastroesophageal junction (GEJ)/ stomach/periampullary/colorectal, and 12 had leukemias. The most common intraoperative complication was catheter tip malposition (9.2%). The most common postoperative complications were infection (7.5%), followed by drug extravasation (5.0%), thrombosis (3.3%), wound dehiscence (2.5%), and skin necrosis (0.8%) in decreasing order of frequency. Serious complications such as hemothorax, pneumothorax, air emboli, brachial plexus injury, and pericardial tamponade, commonly reported in the literature, were not seen in any of our cases.
CONCLUSION
Totally implanted venous access devices (TIVAD)/chemoports are indispensable in the management of cancer patients, especially in patients requiring long duration of infusion and prolonged treatment. Although chemoports are associated with a spectrum of complications, proper technique of implantation and use makes it a safe and reliable tool.
PubMed: 38738137
DOI: 10.7759/cureus.58052 -
BMC Veterinary Research May 2024In the left axilla of a formalin-embalmed adult female cross-breed dog, an unusual course of the axillary artery in relation to the brachial plexus was noted. A part of...
In the left axilla of a formalin-embalmed adult female cross-breed dog, an unusual course of the axillary artery in relation to the brachial plexus was noted. A part of the axillary artery after the origin of the subscapular artery coursed through the loop formed by the contributions of the caudal pectoral and lateral thoracic nerves and then between the median and ulnar nerves. Thus, the common trunk for the latter two nerves was missing. Instead, in the proximal brachium, they communicated with each other in both directions. A communicating branch between the cranial and caudal pectoral nerves forming a nerve loop, ansa pectoralis lacked the axillary artery and was instead traversed by the subscapular artery. This is a variation in the relationship between the axillary artery and brachial plexus in the domestic dog and has not been reported in the literature yet. The axillary artery entrapped by the contributions of the caudal and lateral thoracic nerves may be considered as a risk factor for the neuroarterial compressions with non-specific signs and should be taken into account both in surgery and imaging.
Topics: Animals; Dogs; Axillary Artery; Brachial Plexus; Female; Cadaver; Terminology as Topic
PubMed: 38734622
DOI: 10.1186/s12917-024-04041-8