Peripheral Nerve Stimulation of the Lesser Occipital and Greater Auricular Nerve for Post Herpetic Neuralgia in a Case of Ramsay Hunt Syndrome: Case Report.

Background: Post-herpetic neuralgia (PHN) is a painful condition that presents after herpes zoster reactivation in the peripheral and central nervous system. When medical treatment fails, options are limited, and patients may suffer with chronic pain indefinitely. Case Presentation: We present the case of a gentleman with a 3-year history of PHN in the distribution of the right lesser occipital and greater auricular nerves that failed to respond to medical treatment. He underwent a trial of neuromodulation, and post-operative pain scores improved by 80%, and at 60 days post-operatively his average pain score was 0 out of 10. Conclusions: PNS is an effective and safe option for the treatment of chronic pain, and we present a report of successful treatment of PHN in a particularly difficult anatomic distribution. PNS of the lesser occipital and greater auricular nerves is a novel treatment for PHN and shows promise as an effective, safe therapy when other treatment fails.

Interventional Treatment Modalities for Chronic Abdominal and Pelvic Visceral Pain.

PURPOSE OF REVIEW: Chronic abdominal and pelvic visceral pain is an oftentimes difficult to treat pain condition that requires a multidisciplinary approach. This article specifically reviews the interventional treatment options for pain resulting from visceral abdominal and pelvic pain. RECENT FINDINGS: Sympathetic nerve blocks are the main interventional option for the treatment of chronic abdominal and pelvic visceral pain. Initially, nerve blocks are performed, and subsequently, neurolytic injections (alcohol or phenol) are longer term options. This review describes different techniques for sympathetic blockade. Neuromodulation is a potential option via dorsal column stimulation or dorsal root ganglion stimulation. Finally, intrathecal drug delivery is sometimes appropriate for refractory cases. This paper will review interventional options for the treatment of chronic abdominal and pelvic visceral pain.

Anesthetic Errors During Procedures in the United States.

OBJECTIVES: The purpose of this study was to identify the incidence of anesthetic errors per discharges in the United States within these errors, the incidence of death. A secondary aim was to identify any association between the mortality and patient comorbidities. METHODS: A retrospective analysis of the hospitals in the United States using the Nationwide Inpatient Sample (NIS) database during 2007-2014 was performed. The study population consisted of patients who were recorded as inpatient discharges who experienced complications as a result of incorrect anesthetic administration resulting from either an overdose or inappropriate medication administration in the United States. RESULTS: Between 2007 and 2014, a total of 17,116 anesthetic errors were reported. There was a substantial decrease in the total number of these errors over time, from 2483 in 2007 to 1391 in 2014 (44% decrease). There were 131 reported deaths in this cohort (0.77% mortality rate), with 61 mortalities in teaching hospitals (0.86% mortality rate) and 57 in nonteaching hospitals (0.73% mortality rate). During the study period, deaths decreased from 21 in 2007 (0.85% mortality rate) to 11 in 2014 (0.79% mortality rate), corresponding with a 7.1% decrease in the mortality rate. Comorbidities associated with a significant increase in mortality from anesthetic substances included fluid and electrolyte disorders (odds ratio 8.82, 95% confidence interval 5.24-14.83, P < 0.001) and coagulopathies (odds ratio 5.26, 95% confidence interval 2.53-10.93, P < 0.001). CONCLUSIONS: Our study showed that although the incidence of anesthetic errors is small, they do still exist in our hospitals. Certain comorbidities appear to predispose patients to increased risk. The subsets of patients who appear to be at the greatest risk include those with preexisting electrolyte and fluid disorders and coagulopathies.