Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of the prostate.

BACKGROUND AND OBJECTIVES: Superior hypogastric plexus block has been used to treat cancer pain of the pelvis. METHODS: A patient with severe chronic nonmalignant penile pain after transurethral resection of the prostate underwent a single superior hypogastric plexus block with local anesthetic and steroid. The patient was also started on medications that treat neuropathic pain a few hours after the procedure was finished. RESULTS: The superior hypogastric plexus block resulted in complete pain relief immediately after the procedure. The pain relief continued at 1, 2, 4, and 8 months follow up. CONCLUSIONS: In this case of severe penile pain the superior hypogastric plexus block was useful diagnostically and therapeutically.

Therapeutic drugs for neuropathic pain.

Neuropathic pain is common and may be resistant to usual doses of analgesic medications. However, an improved understanding of the pathophysiology of neuropathic pain and a growing number of adjuvant medications that are useful for the treatment of neuropathic pain provide renewed hope for clinicians and their patients. It is useful to classify adjuvant analgesic drugs into two broad categories. Membrane stabilizing agents, which include the anticonvulsants, antiarrhythmics and probably corticosteroids, may act by blocking sodium channels on damaged neural membranes. Medications that enhance dorsal horn inhibition, which include the antidepressants and some anticonvulsants, may augment biogenic amine or GABAergic mechanisms in the dorsal horn of the spinal cord. Current evidence regarding efficacy generally does not support the use of one agent over another and selection of a particular agent may depend in part on the expected side effects or experience with a given drug. For maximum analgesic effect, more than one agent may be necessary and to improve therapy and minimize side effects, medications generally should be started at lower doses and titrated slowly to effect. Although labor-intensive, this strategy may improve compliance and optimize patient care.

Postoperative Guillain-Barré syndrome, arachnoiditis, and epidural analgesia.

BACKGROUND AND OBJECTIVES: A 58-year-old man developed progressive neurologic symptoms following a surgical procedure and postoperative epidural analgesia. METHODS: Neurologic evaluation, magnetic resonance imaging, computed tomography, and electromyography indicated the presence of both arachnoiditis and Guillain-Barré syndrome. The patient was treated with plasmapheresis and methylprednisone. RESULTS: The patient began to show clinical and electromyographic recovery but was lost to follow-up after his transfer to a rehabilitation facility. CONCLUSIONS: Anesthesiologists should be aware of the possible postoperative occurrence of rare neurologic disorders, both in patients who have received epidural analgesia and in those who have not, but they should not be deterred from using epidural analgesia by this isolated case.