Serratus anterior plane (SAP) block for Acute Thoracic Herpes Zoster: Introduction: The concomitant inflammation of the peripheral nerve and skin damage is supposed to be responsible for the acute pain in patients with herpes zoster (HZ). The area affected by the disease can be extremely painful, and pain tends to be exacerbated by any movement or contact. Epidural, intrathecal, and sympathetic nerve blocks have been used in the treatment of pain caused by HZ and postherpetic neuralgia. The recently described pectoral nerve (Pecs) and serratus anterior plane (SAP) blocks are easy and reliable methods for thoracic wall block. The SAP block primarily the thoracic intercostal nerves and to provide anterior hemithorax as arising from the anterior axillary line to the sternum, the posterior hemithorax as being from the posterior axillary line to the spinous processes of the vertebra, and the lateral hemithorax as the area in between the other two. Here we describe the use of ultrasound (US)-guided SAP block to treat acute, severe zoster-associated …show more content…
Localization of the pain was consistent from the T4 to T5dermatome (on the right anterior, lateral and posterior chest wall). He described the pain as severe stabbing and lancinating with a numeric rating scale (NRS) of 8/10. The patient also reported sleep disturbances due to the pain, which had begun 20 day earlier but had aggravated within the last 1 week. He had a 3-year history of taking anticoagulants for the management of arterial fibrillation. At our pain clinic we prescribed tramadol and low dose pregabalin, but they failed to provide pain relief. The anticoagulants contraindicated a possible epidural or paravertebral block because of unwanted and potentialy catastrophic associated sideeffect. Thus, we determined the patient was a good candidate for US-guided SAP
The common conditions they treat include the adhesive capsulitis or 'frozen shoulder ', acromioclavicular joint impingement or shoulder impingement, bursitis, concussion, degenerative disk disease, degenerative joint disease/
aricella-zoster virus (VZV) is a ubiquitous human alpha- herpesvirus, which causes varicella (chicken pox) and herpes zoster (shingles). Varicella results from primary VZV infec- tion; it is a common childhood illness associated with fever and a generalized pruritic vesicular rash. As is characteristic of the alphaherpesviruses, VZV establishes latency in cells of the dorsal root ganglia after primary infection. Herpes zoster is a localized, painful, vesicular rash involving one or adjacent der- matomes and caused by VZV reactivation. The incidence of herpes zoster increases with age or immunosuppression.
Individual who have immunocompromised show early display of the herpes zoster infection for those who are not immunocompromised. The management of HIV/AIDS or other immunocompromising diseases may also contribute to herpes zoster development. For example, one of the most powerful risk factors for herpes zoster infection is the use of systemic corticosteroids, which are part of the standard management of most autoimmune diseases. Despite the increased risk of herpes zoster associated with immunosuppression, 70% to 80% of patients hospitalized for this condition are
Genital Herpes is a disease that is sexually transmitted, and is in the form of wart like bumps. This disease is very common and highly contagious. This form of herpes nationwide is affecting 45 million people from ages 12 and older. Genital Herpes and other forms of herpes originated from early chimpanzees, and rodent like chipmunks. Once the disease is entered through the skin, it can become inactive and just stay there.
These techniques are; full-endoscopic posterior foraminotomy versus microsurgical anterior decompression and fusion (Sebastian et al., 2008). The latter is commonly used in case the patient has a radicular arm pain which led to the cervical disc herniation. The former is used as the alternative for the latter when the lateral localization of the patient's pathology. An experiment was carried out on one hundred and seventy-five individuals who had undergone full-endoscopic posterior or a microsurgical anterior cervical discectomy. After the surgery had been conducted, the researchers found that 87.4% of the patients had no more arm pain while only 9.2% reported some occasional pain.
Some nociceptive afferent input also sprouts into the Lamina II of the dorsal horn of spinal cord (which respond to noxious stimulation).which results in increased neuronal activity, expansion of neuronal receptive field and hyperexcitibility of other region. This process is called central sensitization. Sensitization of dorsal horn neuron is mediated by the increased activity of NMDA receptor and release of glutamate and neurokinins. The stump or phantom pain is evoked by repetitive stimulation of the stump the phenomenon is known as “windup phenomenon” in which there is up regulation of the receptors in the respective
Joint mobilization (JM), such as lateral glides (LAT) and posterior pressures (AP) appears efficacious for non-specific neck pain (NSNP). The neurophysiologic system that modulates pain overlaps with blood pressure (BP) as observed in BP-related hypoalgesia. Nevertheless, evidence is sparse characterizing the cardiovascular response (CR) to LAT or AP in NSNP. Five sets of (10 seconds on and 10 seconds off) AP and LAT have evidently produced disparate cardiovascular responses in pain-free adults. What is indeterminate is whether these procedures, when dispensed in the same minimal regimen, yield comparable or divergent outcomes in patients with NSNP.
NTRODUCTION Spinal anaesthesia is the most common technique in LSCS and several adjuvants have been tried along with local anaesthetic for prolongation postoperative analgesia. (1) And better postoperative analgesia will improve mother child interaction and improved breastfeeding and infant well-being. Regional anaesthesia for LSCS has distinct advantages over General anaesthesia via avoidance of pulmonary aspiration and difficult in ventilation and intubation due to physiological changes of pregnancy and better postoperative analgesia, less neonatal exposure to drugs. Bupivacaine is being more preferred because of its long acting action and more potent, less neurotoxic than lignocaine. Ketamine a phencyclidine derivative anaesthetic agent
Result outcomes were recorded at the end of treatment session i.e. after 2 weeks. Intensity of pain and disability index were taken as baseline values and at the end of 2-week treatment session. RESULTS At the end of treatment session, data analysis showed significant improvement in intensity of pain and disability index in both the groups. However, it was observed that there was higher improvement in VAS score in group A compared to group B. ODI measurements showed a tendency towards a difference in reduction in favor of group
The methods for the study are easy to follow and straightforward. The authors for this study state that there is not substantial evidence through literature to compare these two treatments but from their study you can conclude short term affects are more beneficial for the patient to receive deep friction massage with mobilization exercises to increase their range of motion and decreasing pain short term. This study does not include threats of internal and external validity, confidence in data, or risks and
Why is dating with herpes so stressful? After being diagnosed with herpes, people are worried that they might transfer the virus to their partner. There is a certain kind of stigma surrounding herpes and this is what makes it difficult for people to be open about their medical condition. Fortunately, dating with herpes isn 't as burdensome as some people think. Here is all that you need to know about herpes dating.
In both the cases the SAM block was administered for entirely different indications. But the noteworthy observation in both the cases was the striking reduction in pain and total requirement of analgesia over 24 hours. There are sporadic case reports where an epidural catheter has been left in situ for continuous analgesia.3 In the present cases, in patient following MRM, patient was connected to IV PCA but patient did not take any additional top up. In patient in intensive care unit, the block had to be repeated after 24 hours in view of complaints of pain.
H. L. Mencken once said and I quote, “For every complex problem there is an answer that is clear, simple, and wrong.” Unfortunately, this is often the case when environmental and cultural views are discussed in relation to scientific advancement. I would argue, not only is society a large influence to scientific development but, it also leads to a lack of “actual” knowledge in relation to some subjects. Most often, people are less comfortable with the “unknown.” In addition, we often times require and “explanation” for those things we cannot grasp.
Herpes simplex Herpes or Herpes simplex is a common sexually transmitted disease that any sexually active person can get. Research Goal:What is Herpes? How do we get it? What are the symptoms of it? Is there any cure?
The majority of these blocks are performed with very small-gauge needles; thus, the headache rate is generally < 1%. Opioid-induced pruritus and nausea are seen in roughly 20% to 40% of patients, but these side effects are typically mild, well tolerated, and temporary. Additional serious side effects such as respiratory depression are unusual. Serious complications - These include getting infection, a blood clot, or the wrong drug in the back, all of which could cause paralysis.