Erector Spinae Plane Block for the Treatment of Intractable Pain in a Patient with Pancoast Tumor: A Case Report.

Introduction: The erector spinae plane (ESP) block is a regional anesthetic technique that involves injecting a local anesthetic below the erector spinae muscle in an interfascial plane. Case Presentation: We report a case of a 66-year-old man with cervicothoracic junction pain caused by an advanced Pancoast tumor. The administration of ESP block at the T2-T3 level led to pain relief of more than 50% in this patient after two sessions. Conclusions: Therefore, the application of this method of regional analgesia is both convenient and safe and reduces opioid consumption. Further studies are needed to evaluate the safety and effectiveness of continuous blocks in outpatient settings.

Refractory Complex Regional Pain Syndrome: A Case Report and Review of Literature.

Introduction: Complex regional pain syndrome (CRPS) is characterized by extreme pain in a limb disproportional to the clinical history or physical findings accompanied by the signs of autonomic dysfunction. The pathophysiology of CRPS is obscure, making it challenging to treat. Treatment options include medications, physical therapy, and psychological support. In some cases, surgery or other minimally-invasive procedures such as nerve blocks may be recommended, while several novel treatments, such as ozone therapy, lack sufficient clinical evidence. Case Presentation: A 40-year-old man with CRPS was referred to our clinic with pain in his right arm and left lower leg. The patient had a history of trauma to the ulnar nerve and had undergone a sural to ulnar nerve autograft surgery. After the surgery, the patient's symptoms began, primarily in the right arm. Despite receiving conventional drugs, multiple nerve blocks, and lidocaine patches, the patient's symptoms persisted. In addition, we tried medical ozone for 14 sessions along with ketamine infusion, but these treatments were also ineffective. Conclusions: We emphasize the importance of studying and developing more effective treatments for CRPS and suggest that further randomized clinical trials are needed to determine whether ozone therapy is effective for patients with severe, intractable CRPS symptoms.

The Effects of Opioid Dependency Use on Postoperative Spinal Surgery Outcomes: A Review of the Available Literature.

There is a lack of evidence to support the effectiveness of long-term opioid therapy in patients with chronic, noncancer pain. Despite these findings, opioids continue to be the most commonly prescribed drug to treat chronic back pain and many patients undergoing spinal surgery have trialed opioids before surgery for conservative pain management. Unfortunately, preoperative opioid use has been shown repeatedly in the literature to negatively affect spinal surgery outcomes. In this review article, we identify and summarize the main postoperative associations with preoperative opioid use that have been found in previously published studies by searching on PubMed, Google Scholar, Medline, and ScienceDirect; using keywords: Opioid dependency, postoperative, spinal surgery, specifically (1) increased postoperative chronic opioid use (24 studies); (2) decreased return to work (RTW) rates (8 studies); (3) increased length of hospital stay (LOS) (9 studies); and (4) increased healthcare costs (8 studies). The conclusions from these studies highlight the importance of recognizing patients on opioids preoperatively to effectively risk stratify and identify those who will benefit most from multidisciplinary counseling and guidance.