RESUMEN
A 33 year-old female at 38 weeks gestation with a history of Complex Regional Pain Syndrome (CRPS) Type 1 of the upper extremities, diagnosed 13 years prior to this admission, was scheduled for an elective cesarean section (C-Section). She refused neuraxial anesthesia and requested general anesthesia. This abstract discusses the general anesthesia steps taken to pre-empt recurrence of CRPS symptoms.
Asunto(s)
Anestesia General , Cesárea , Distrofia Simpática Refleja/prevención & control , Prevención Secundaria , Adulto , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Embarazo , Distrofia Simpática Refleja/complicacionesRESUMEN
OBJECTIVES: This study compares the effects of constant current (CC) and constant voltage (CV) spinal cord stimulation (SCS) at various frequencies and intensities on standard nociceptive measurements in rats, the visceromotor reflex (VMR) and neuronal activity, during noxious visceral and somatic stimuli. MATERIALS AND METHODS: Abdominal muscle electromyographic activity changes were measured to indicate VMR, and extracellular activity of L6-S2 spinal neurons was recorded during somatic (pinching) and noxious visceral stimulation (colorectal distension [CRD], 60 mmHg) in anesthetized rats. A stimulating (unipolar ball) electrode at L2-L3 delivered CC- or CV-SCS at varied frequencies and intensities. RESULTS: CC-SCS reduced VMR evoked by CRD significantly more than CV-SCS (p < 0.05). For neuronal activity, high-frequency CC-SCS (40 and 100 Hz) and CV-SCS (100 Hz) effectively reduced intraspinal somatic nociceptive transmission more than low-frequency SCS (2 Hz). No significant differences were observed between the effects of CC- and CV-SCS on spontaneous activity and nociceptive responses of spinal neurons to noxious CRD following short- (five to ten minutes) or long-term (20-30 min) SCS. CONCLUSIONS: Although high-frequency CC- and CV-SCS may be more useful for the management of somatic pain, CC-SCS may be more effective for treating complex pain systems like visceral hypersensitivity.
Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Dolor Nociceptivo/terapia , Nociceptores/fisiología , Médula Espinal/fisiología , Potenciales de Acción/fisiología , Animales , Colon/inervación , Modelos Animales de Enfermedad , Electromiografía , Laminectomía , Masculino , Inhibición Neural/fisiología , Neuronas/fisiología , Dolor Nociceptivo/etiología , Estimulación Física/efectos adversos , Ratas , Ratas Sprague-Dawley , Médula Espinal/citología , Aferentes VisceralesRESUMEN
Sacroiliac joint pain is one of the most common causes of low back pain in pregnant women. We present a case of a 30-year-old G2P1 at 20 weeks gestation presenting with intractable low back pain refractory to conservative management. History and physical examination revealed sacroiliac joint as the pain generator. We elected to do an ultrasound-guided sacroiliac joint injection that significantly abated her pain. This article aims to review the diagnosis, pathophysiology, and treatment approaches to adequately manage sacroiliac joint pain in pregnant women.