Alternative Implantation Site of Intrathecal Pump in the Submuscular Plane of the Pectoralis Major Muscle: A Case Report.

An intrathecal drug delivery system (IDDS) has been widely utilized in the management of chronic pain and spasticity when oral pharmacologic agents are deemed ineffective. Typically, intrathecal pumps are implanted in the abdominal region; however, previous case reports have described nontraditional pump implantation sites, such as anterior thigh, gluteal region, and iliac fossa. Adding to the growing literature of alternative implantation sites, this case report discusses the implantation of the pump into the submuscular plane of the pectoralis major muscle and reviews the advantages and disadvantages of this location.

Mental Nerve Blocks for Lip Brachytherapy: A Case Report.

High dose rate interstitial brachytherapy is a commonly performed procedure for carcinoma of the lower lip. Placement of the brachytherapy catheters can be painful and may require monitored anesthesia care or general anesthesia. We present the use of bilateral mental nerve blocks with minimal sedation to facilitate placement of brachytherapy catheters.

Case report: bilateral tunneled epidural catheters to prevent unilateral analgesia for cancer-related pain.

OBJECTIVE: Unilateral analgesia often occurs with epidural analgesia. Traditional methods of troubleshooting this problem can be insufficient in obtaining adequate pain relief in a timely manner for terminal cancer patients. This case report demonstrates a safe and effective solution which can be utilized in these circumstances. CASE REPORT: A 55-year-old female with stage IV pancreatic cancer and life expectancy of a few weeks presented to the interventional pain clinic with intractable sacral pain. The decision to place an epidural catheter and external pump for analgesia was made. An epidural catheter placed at the L5-S1 level showed contrast spread only along the right nerve roots and a test dose produced only right-sided analgesia. Suspecting compartmentalization of the epidural space, a second left-sided epidural catheter was placed and bilateral analgesia was achieved by using both catheters. This dual catheter technique gave the patient effective bilateral analgesia until she passed away several weeks later. CONCLUSION: The bilateral epidural catheter technique is safe and effective in patients who present with persistent unilateral epidural analgesia despite exhausting traditional solutions.