Superior Hypogastric Plexus Block in the Lateral Position: A Case Report.

INTRODUCTION: Patients with severe visceral abdominal or pelvic pain are sometimes candidates for celiac or superior hypogastric block. These blocks are performed in the prone position that is usually very painful for these patients. We introduce another position for these blocks that can be better tolerated. CASE PRESENTATION: We performed the superior hypogastric plexus block in the lateral position in a patient who was suffering from severe abdominal and pelvic pain. The procedure was done under the guide of C-Arm fluoroscopy. After the procedure, the pain score reduced to 2 out of 10 on the 11-point Numeric Rating Scale and the patient was discharged without any complication. CONCLUSIONS: Superior hypogastric plexus block in the lateral position was safe and effective for a patient with severe abdominal and pelvic pain.

Multi-Modal Preemptive Analgesia With Pregabalin, Acetaminophen, Naproxen, and Dextromethorphan in Radical Neck Dissection Surgery: A Randomized Clinical Trial.

BACKGROUND: Preemptive analgesia may be considered as a method not only to alleviate postoperative pain but also to decrease analgesic consumption. Different regimens are suggested, but there is currently no standard. OBJECTIVES: The aim was to measure the efficacy of preemptive analgesia with pregabalin, acetaminophen, naproxen, and dextromethorphan in radical neck dissection surgery for reducing the intensity of pain and morphine consumption. PATIENTS AND METHODS: This study was conducted as a randomized double-blind clinical trial. Eighty adult patients (18 to 60 years of age) under the American society of anesthesiologists (ASA) physical status I and II undergoing elective radical neck dissection were enrolled. Patients were randomized into two groups of 40 with a simple randomization method. The case group received a combination of 15 mg/kg acetaminophen, 2.5 mg/kg pregabalin, 7 mg/kg naproxen, and 0.3 mg/kg dextromethorphan administered orally one hour prior to surgery. Postoperative pain was assessed with the universal pain assessment tool (UPAT) at 0, 2, 4, 6, 12, and 24 hours after surgery. Subjects received morphine based on postoperative pain control protocol. Total administered morphine doses were noted. RESULTS: Postoperative pain rates at 0, 2, 4, 6, 12, and 24 hours after surgery were significantly lower for the case group than the control group (P values = 0.014, 0.003, 0.00, 0.00, and 0.00, respectively). Total morphine doses for the preemptive analgesia group were 45% lower than those of the other group. Side effects were similar for both groups. CONCLUSIONS: A single preoperative oral dose of pregabalin, acetaminophen, dextromethorphan, and naproxen one hour before surgery is an effective method for reducing postoperative pain and morphine consumption in patients undergoing radical neck dissection.

Multiple sclerosis influences on the augmentation of serum Klotho concentration.

We have already shown that the concentration of secreted form of Klotho decreases in the cerebrospinal fluid of patients with relapsing-remitting multiple sclerosis (RRMS). The current study aimed at assessing possible changes in the serum Klotho concentration of MS patients. Participants involved 15 new cases of RRMS patients in the relapse phase, 15 RRMS patients who had been suffering from the disease for more than three years and were under regular treatments (interferon beta-1a) and, finally, 15 non-MS patients who constituted the control group. Beside thorough neurological examinations, demographic and clinical data (e.g. gender, age, duration of disease and expanded disability status scale) were obtained. Serum Klotho concentration was measured using ELISA method. The results showed no statistically meaningful difference between new cases of RRMS (585.56pg/ml±153.99) and control group (556.81pg/ml±120.36; P=0.859). The serum Klotho level, however, was significantly higher in patients with prolonged disease duration (696.94pg/ml±170.52; P=0.037) in comparison with the subjects in the control group. In conclusion, this study showed that serum Klotho concentration tends to be higher in MS patients when compared to control group. This finding might be attributed to treatment of MS patients with immunomodulatory drugs or a compensatory response to enhance CNS regeneration and/or vitamin D biosynthesis. Further studies are required to elucidate the role of Klotho in MS pathophysiology.

Sciatic Nerve Block in Tetanus: A Case Report.

INTRODUCTION: Muscle rigidity and generalized spasm can cause severe pain in patients with tetanus. Administration of high dose sedative or narcotic agents can increase respiratory failure and prolong mechanical ventilation support. CASE PRESENTATION: In this report, ultrasound-guided sciatic nerve block was performed in a 25-year-old patient with tetanus to progress his respiratory drive which was decreased due to high dose sedative administration. This procedure accelerates the weaning process and extubation. CONCLUSIONS: Nerve blocks may be appropriate for the particular patient with tetanus to tolerate the pain, reduce depth of sedation, accelerate extubation and subsequently decrease complications of tetanus relating to long time intubation.