RESUMEN
An exceptional case of long-standing central pain temporarily relieved by a focal stroke in the primary somatosensory area is reported. This case highlights the focal nature of central pain mechanisms and the possible value of selective subparietal leukotomies in the management of central pain.
Asunto(s)
Infarto Cerebral/fisiopatología , Vértebras Cervicales , Terapia por Estimulación Eléctrica , Microdiálisis/efectos adversos , Neuralgia/fisiopatología , Neuralgia/terapia , Dolor Intratable/fisiopatología , Radiculopatía/fisiopatología , Corteza Somatosensorial/lesiones , Trastornos Somatosensoriales/terapia , Compresión de la Médula Espinal/fisiopatología , Osteofitosis Vertebral/complicaciones , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Quistes Aracnoideos/fisiopatología , Quistes Aracnoideos/cirugía , Cateterismo/efectos adversos , Infarto Cerebral/etiología , Terapia Combinada , Resistencia a Medicamentos , Femenino , Humanos , Enfermedad Iatrogénica , Persona de Mediana Edad , Relajantes Musculares Centrales/uso terapéutico , Neuralgia/tratamiento farmacológico , Dolor Intratable/tratamiento farmacológico , Dolor Intratable/terapia , Radiculopatía/etiología , Corteza Somatosensorial/fisiopatología , Trastornos Somatosensoriales/tratamiento farmacológico , Médula Espinal/fisiopatología , Compresión de la Médula Espinal/etiología , Osteofitosis Vertebral/cirugía , Vértebras TorácicasRESUMEN
Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP. All patients having HYP reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the medical care costs. The postoperative convalescence was significantly improved after HYP and full return to social or professional activity was significantly shortened. We conclude that HYP is a very efficient technique providing physiological, psychological and economic benefits to the patient.