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Biomedical subjects

R B Patt

Publications and source records attributed to R B Patt.

At least 19 recordsLinked to original sources
PubMed1996

Psoas sheath chemical neurolysis for management of intractable leg pain from metastatic liposarcoma.

CASE REPORT: A 56-year-old man with widely metastatic liposarcoma, after left Tower extremity amputation, complained of severe right lower extremity pain. Trials of systemic opioids had resulted in poor pain control while introducing intolerable dose-limiting side effects. METHODS AND RESULTS: Initial inpatient management consisted of a lumbar epidural infusion of a dilute local anesthetic and preservative-free morphine. This provided satisfactory relief but was discontinued because of recrudescence of phantom limb pain. A lumbar epidural infusion of preservative-free morphine sulfate was associated with poor pain relief, central nervous system (CNS) side effects, and severe urinary retention resulting in acute renal failure. A repeated trial of parental opioids provided marginal pain relief with persistent CNS side effects. Chemical neurolysis of the lumbar plexus was performed with 10 ml of 10% aqueous phenol injected into the psoas muscle sheath. The pain gradually resolved over a 2-day period without apparent side effects. Motor function was preserved, pain was resolved, and as systemic opioids were reduced, cognitive function and overall well-being were improved.

Amputation, Surgical↗
PubMed1995

Subarachnoid neurolytic block under general anesthesia in a 3-year-old with neuroblastoma.

CASE REPORT: A 3-year-old boy with neuroblastoma complained of severe pain in the left lower extremity. Pharmacologic management had previously been attempted, but severe pain continued, and further upward titration was complicated by sedative effects. METHODS AND RESULTS: Because the focus of treatment had become the controlling of pain, a lumbosacral subarachnoid neurolytic block was performed under general anesthesia. One-time neurolysis was more acceptable to the family than a procedure like epidural analgesia, that requires greater management. Contrast medium was used to monitor the spread of the neurolytic. An epidural catheter was inserted during the neurolytic block procedure for possible future use. The short-term results were good--pain reports and opioid doses decreased greatly, although with increased incontinence. The boy had new abdominal distention and pain 5 days after neurolysis. Opioid doses and sedatives were increased. He died 3 days later.

Anesthesia, General↗
PubMed1994

The benzodiazepines as adjuvant analgesics.

There has been long-standing debate regarding whether benzodiazepines possess analgesic properties that are independent of their effects on mood and alertness. A careful review of the literature reveals insufficient evidence to support the contention that the benzodiazepines have meaningful analgesic properties in most clinical circumstances. Treatment with the benzodiazepines may reduce complaints of pain, but this seems to be an indirect effect related to their psychotropic properties, such as alleviation of anxiety and, in selected cases, depression. In the absence of definitive data, clinical experience suggests a potential role for treatment with benzodiazepines for acute muscle spasm, concomitant chronic pain and anxiety, and lancinating neropathic pain, in which case clonazepam and alprazolam may be the agents of choice. They should probably not be considered as first-line choices even for the above indications, since potential benefits must be considered in the context of potential for the development of cognitive impairment, physical and psychological dependence, worsening depression, overdose, and other side effects.

Adjuvants, Pharmaceutic↗
PubMed1994

The neuroleptics as adjuvant analgesics.

The role of neuroleptic drugs as adjuvant analgesics has been a subject of longstanding controversy. Despite frequent claims of efficacy, evidence from controlled trials supports neither claims of intrinsic analgesic properties nor the routine use of the neuroleptics as a means to reliably induce clinically useful analgesia. Methotrimeprazine is unique in that there is evidence for reliable dose-related analgesia that is comparable to opioid-mediated analgesia, although routine use is not recommended. Despite probable interaction with opioid receptors, there is insufficient evidence to support a role for the butyrophenone category of neuroleptics as adjuvant analgesics. Limited trials of the neuroleptics may be considered for pain that has been unresponsive to more conventional pharmacologic approaches, especially when associated with headache, nerve injury, or psychological distress. The neuroleptics have an important role in the symptomatic management of agitation, delirium, and nausea, particularly in patients with cancer.

Analgesics↗
PubMed1994

Pharmacotherapy for cancer pain: an anaesthesiologist's viewpoint.

Cancer pain is prevalent and undertreated despite the availability of therapeutic options that, taken together are highly effective, economical and safe. Improved understanding of the pharmacology of chronically-administered opioids has resulted in reduced concerns about addiction and an increased emphasis on their use. The anaesthetist may play a pivotal role in cancer pain management by the provision of nerve blocks and other interventions, but, to be a truly effective consultant, must also be expert in all aspects of pharmacotherapy. A rationale for the development of pharmacologic expertise together with a review of assessment and pharmacologic management of cancer pain are provided.

Analgesics↗
PubMed1994

Spinal neurolysis for cancer pain: indications and recent results.

Effective control of cancer pain can now be achieved in a high proportion of patients with rigorously applied pharmacologic treatment, reducing the need for more demanding invasive procedures. Ten to thirty percent of patients will, however, require some form of more aggressive management, ranging from the parenteral and spinal administration of opioids to neurodestructive procedures. Intrathecal neurolysis is a time-tested procedure that, although used less frequently than in the past, still has important indications. Guidelines for patient selection and results of a recent clinical series are presented here.

Clinical Protocols↗
PubMed1992

Transdermal fentanyl for chronic cancer pain: detailed case reports and the influence of confounding factors.

Patients were entered into an open label study to evaluate the efficacy of transdermal fentanyl as an analgesic for chronic cancer pain. The clinical course of 3 patients is described as well as an emphasis on the apparent influence of confounding factors, i.e., factors unique to each patient that appeared to affect that individual's analgesic requirements. Our anecdotal clinical experience suggests that transdermal fentanyl is an acceptable, efficacious, and safe means of pharmacologic management for patients with chronic cancer pain. Our results reinforce the concept that cancer pain is a dynamic, multiply determined process and that, as a result, the effects of a single intervention are difficult to analyze.

Administration, Cutaneous↗