Meningitis after invasive treatment of the trigeminal ganglion: two case reports and a review of the literature.

OBJECTIVES: The objective of this case is to report the rare complication of a meningitis after an invasive treatment of the trigeminal ganglion. METHODS: In this case report, two cases of meningitis due to oral streptococci are reported and a review of literature is presented. RESULTS AND DISCUSSION: This complication should be recognized as early as possible to prevent deterioration of the situation. Meningitis must be suspected when a patient reports headache and fever within days after an invasive treatment of the trigeminal ganglion.

[Pain treatment following knee and hip replacement surgery]. / Pijnbehandeling na heup- of knievervangende operatie.

OBJECTIVE: To gain insight into the outcomes of postoperative pain treatment using patient-controlled intravenous analgesia (PCIA) with morphine and oral analgesics after total hip or knee arthroplasty (THA or TKA). DESIGN: Prospective observational study. METHOD: In 2006-2007, 154 THA and 110 TKA patients who underwent arthroplasty at the Medical Centre Alkmaar were included in this study. Postoperative pain treatment consisted of a PCIA pump with morphine and oral analgesics. Primary endpoints were effectiveness of pain treatment and the incidence of side effects. RESULTS: After THA, 65% of the patients had an acceptable pain score at rest on the day of surgery (day 0), increasing to >95% from 2 days after the operation onwards. On day 1, 43% had an acceptable pain score during movement, increasing to >90% from day 2 onwards. On day 0, nausea occurred in 24% and vomiting in 25% of patients; on day 1, these figures were 21% and 29% respectively. After TKA, 45% of the patients had acceptable pain at rest on day 0, increasing to >or=95% from day 3 onwards. On day 1, pain during movement was acceptable in 24% of the patients, increasing to 80% on day 4. On day 0 following TKA nausea occurred in 37% and vomiting in 39% of patients; on day 1, these figures were 26% and 23%, respectively. CONCLUSION: In view of the somewhat disappointing effectiveness and the side effects of a PCIA pump with morphine and oral analgesics, adjustments in the treatment of pain following THA and TKA are required. The greatest improvement can be realised on the day of surgery and the first postoperative day.

1. Trigeminal neuralgia.

Trigeminal neuralgia is a common cause of facial pain. It has a significant impact on the quality of life and the socioeconomic functioning of the patient. The aim of this review is to provide recommendations for medical management of trigeminal neuralgia based on current evidence. Based upon the analyses of the literature combined with experience in pain management, symptoms, assessment, differential diagnosis, and treatment possibilities of trigeminal neuralgia are described and discussed. Recommendations for pain management are given and are displayed in a clinical practice algorithm. Treatment should be multidisciplinary. Various treatment options and their risks should be discussed with the patient. The first treatment of choice is carbamazepine or oxcarbazepine. In younger patients, the first choice of invasive treatment is probably microvascular decompression. For elderly patients, radiofrequency treatment of Gasserian ganglion is recommended and the technique is described in detail.