BACKGROUND AND OBJECTIVES: It has been found that 5% lidocaine with 7.5% dextrose causes irreversible conduction block in animal studies. Our case report subjects allowed us to observe the efficacy of 5% lidocaine for a prolonged analgesia in vivo. METHOD: After performing a diagnostic nerve block with 1% lidocaine, 5% lidocaine with 7.5% dextrose was injected into three patients with trigeminal neuralgia, post-herpetic occipital neuralgia, and intercostal neuralgia, respectively. The patients were followed for one and a half years. Visual Analog Scale (VAS) scores and the side effects were recorded for each patient. RESULTS: One patient received a trigeminal block and one patient received an occipital nerve block. Both patients reported immediate and complete pain relief lasting 14 and 8 months, respectively. One patient, given an intercostal nerve block, received immediate pain relief lasting 5 weeks. None of these patients exhibited any appreciable side effects or complications. CONCLUSIONS: Our observations suggest that 5% lidocaine may be used safely and effectively for the purpose of prolonged analgesia in selected patients with intractable chronic pain syndromes.

Adult↗

PubMedDate not supplied

Continuous inferior mesenteric ganglion block for the control of abdominal pain.

BACKGROUND AND OBJECTIVES: A 71-year-old woman was referred for control of intractable left-sided abdominal pain and constipation caused by stage 2B rectosigmoid colon cancer. She was treated with an intravenous morphine sulfate infusion at 4 mg/h which made her drowsy and lethargic. Because the distal colon is innervated by the inferior mesenteric sympathetic ganglion, it was hypothesized that a continuous block of this ganglion would provide both pain control and increased intestinal motility. METHODS: The patient was placed in a prone position, and a Tuohy needle was placed at an entry site 7 cm lateral to the L3 spinous process. The needle was advanced 2 cm anterior to the L3 vertebral body with fluoroscopic guidance. An 18-gauge indwelling catheter was placed through the needle and a continuous infusion with 0.1% bupivacaine was maintained for 4 days. RESULTS: The patient obtained immediate pain relief and bowel motility. She remained awake and comfortable throughout the duration of therapy. She was discharged home 3 days after stopping the infusion and required a minimal amount of opioids. CONCLUSION: Continuous inferior mesenteric ganglion block may be an option in providing relief for pain caused by distal colon pathology.

Abdominal Pain↗

PubMedDate not supplied

Rectus syndrome. Another cause of upper abdominal pain.

BACKGROUND AND OBJECTIVES: Rectus syndrome is somatic pain originating from the rectus abdominis musculature of the abdomen. However, pain with its associated somatovisceral symptoms such as nausea, vomiting, and anorexia, is called pseudovisceral pain syndrome. It commonly mimics abdominal visceral pain and misleads medical practitioners into establishing a wrong diagnosis and giving inadequate pain management. Owing to its primary somatic origin, a regional rectus nerve block is an efficacious modality for use in differentiating the diagnosis and providing longlasting optimal pain relief. METHODS: Two cases, a 48-year-old man and a 41-year-old woman, were referred for the management of chronic upper abdominal pain consistent with chronic pancreatitis. They underwent rectus block, first to differentiate the diagnosis and then to relieve intractable pain problems with multidisciplinary pain management. RESULTS: Rectus block was performed successfully, and a diagnosis of rectus syndrome was established. These two patients responded to the rectus block immediately and received long-lasting pain relief after repeated rectus blocks in conjunction with pharmacologic and psychological treatment and physiotherapy. CONCLUSION: Rectus syndrome could be another potential cause of chronic intractable upper abdominal pain problem; rectus block provides a simple diagnostic and therapeutic technique to differentiate the diagnosis and treat it adequately.

Abdominal Muscles↗