Neuropathic component of postoperative pain for predicting post-cesarean chronic pain at three months: a prospective observational study.

BACKGROUND: Recent investigations have showed that cesarean section (CS) might be a cause of chronic pain, with a consequent decrease in quality of life. METHODS: Prospective observational study in a Spanish tertiary hospital. Main outcome measure was to assess early neuropathic characteristics of pain (DN2 score ≥3) one week after CS as a potential risk factor for post-cesarean section chronic pain (PCSCP) at three months. Secondary outcome was to identify other risk factors. Six hundred ten consecutive consenting patients undergoing CS were interviewed preoperatively, at discharge from recovery room and 24 hours postoperatively. Telephone follow-up interviews were conducted one week, three months and twelve months following surgery. RESULTS: We analyzed 597 consecutive patients. The incidence of PCSCP at three and twelve postoperative months were 6.2% and 1% respectively. Subjects with NRS score superior to five on movement one week after CS presented higher incidence of PCSCP (NRS superior to five: 19 [52.2%]; NRS equal or lower to five: 172 [30.9%]; P=0.009). On multivariate analysis neuropathic pain one week after CS was associated with a higher risk of PCSCP (AOR=1.63 [95% CI: 1.26-2.11; P<0.001]). Other identified risk factors for PCSCP were: uterine exteriorization during CS (AOR=3.89 [95% CI: 1.25-12.10; P=0.019]) and a lower gestational age (AOR=0.87 [95% CI: 0.78-0.96; P=0.008]). CONCLUSIONS: Incidence of PCSCP at three and twelve postoperative months was low, 6.2% and 1% respectively. Early neuropathic characteristics of pain after one week measured by neuropathic pain questionnaire, consisting of two questions (DN2)≥3/7 could be used to identify patients at risk for chronic post-surgical pain and develop preventive strategies.

Anesthetic management in neurological disorders: is combined spinal-epidural a suitable option? Case report / Manejo anestésico en trastornos neurológicos: ¿es la anestesia espinal-epidural una alternativa apropiada? Reporte de caso

Abstract Tuberous sclerosis (TSC) is a rare disease with multi-systemic involvement, predominantly neurological. Little evidence exists about the anesthetic management of patients with this disorder, particularly in pregnant women. This article discusses a case of a patient with TSC admitted to our hospital for the delivery of a twin gestation. Twenty-four hours after surgery, the patient presented left-side facial-brachial hypoesthesia and headache. A brain CT revealed a right frontal cortical bleeding tumor, which was diagnosed as glioblastoma multiforme. The patient was discharged 15 days after admission and a neurosurgical approach was suggested.

Resumen La esclerosis tuberosa es una enfermedad poco frecuente asociada con compromiso multisistémico, principalmente neurológico. Es poca la evidencia sobre el manejo anestésico de los pacientes con este trastorno, en particular las mujeres embarazadas. En este artículo presentamos el caso de una paciente con esclerosis tuberosa ingresada en nuestro hospital para el parto de una gestación gemelar. Veinticuatro horas después de la cirugía, la paciente presentó hipoestesia facial y braquial izquierda y cefalea. La tomografía cerebral mostró un tumor cortical sangrante en el lóbulo frontal derecho, diagnosticado como glioblastoma multiforme. La paciente fue dada de alta 15 días después de su ingreso y, con recomendación de manejo por neurocirugía.