RESUMEN
A 39-year-old woman with juvenile idiopathic arthritis complicated by nonuremic calciphylaxis presented for pain management of bilateral lower extremity wounds requiring frequent dressing changes. Bilateral single-shot femoral nerve blocks using liposomal bupivacaine and 0.25% bupivacaine were performed. The patient reported decreased pain scores and had reduced opioid use for 72 hours postblock. Repeat, bilateral single-shot femoral nerve blocks with liposomal bupivacaine and 0.25% bupivacaine were performed approximately every 72 hours to maintain adequate analgesia. We conclude that off-label use of liposomal bupivacaine in femoral nerve blocks results in prolonged block duration without adverse effects or tachyphylaxis.
Asunto(s)
Analgesia , Calcifilaxia , Adulto , Femenino , Humanos , Anestésicos Locales/uso terapéutico , Bupivacaína/uso terapéutico , Calcifilaxia/terapia , Nervio Femoral , Bloqueo Nervioso/métodos , Manejo del Dolor/métodosRESUMEN
A 36-year-old man with a history of cervical spinal cord stimulator (SCS) lead placement presented with transient right-sided hemiparesis and diplopia that began 2 days after a coughing episode. Imaging revealed lateral and cranial migration of one of the patient's SCS leads. Deactivation of the SCS resulted in rapid improvement of his nonmotor symptoms but did not resolve his motor deficits. The SCS system was surgically explanted, resulting in resolution of the patient's motor symptoms. The unique neurologic symptomatology demonstrated by this patient is a previously undescribed complication of SCS placement and lead migration.
Asunto(s)
Médula Cervical , Terapia por Estimulación Eléctrica , Masculino , Humanos , Adulto , Diplopía/etiología , Diplopía/terapia , Médula Espinal , Terapia por Estimulación Eléctrica/efectos adversos , CuelloRESUMEN
The occurrence of a postdural puncture headache (PDPH) is a known risk associated with epidural procedures. The primary nonconservative treatment option for PDPH is the performance of an epidural blood patch. This case report describes the use of image guidance for placement of a caudal epidural to treat a PDPH in a postpartum patient. A caudal catheter was placed under real-time guidance and visualization of the deposition of the blood was obtained. By entering via the caudal foramen and utilizing a catheter, manipulations in catheter placement could be performed to adjust deposition of the blood.