Botulinum toxin is a neurotoxin that has been widely used in chronic pain for the treatment of mu... more Botulinum toxin is a neurotoxin that has been widely used in chronic pain for the treatment of multiple conditions with a component of localized muscle spasm. Recent studies suggest that botulinum toxin is effective in the treatment of neuropathic pain syndromes such as postherpetic neuralgia or painful scars. We searched the PubMed and OvidSP databases. We also included cross-referencing bibliographies from primary and review articles. In this descriptive review, we evaluate the usefulness, safety, and potential pathophysiological mechanism of botulinum toxin type A for treatment of painful disorders with neuropathic component such as postherpetic neuralgia, diabetic neuropathy, or trigeminal neuralgia. On the basis of the analysis of the reports published in the literature, it would seem that fractioned peripheral subcutaneous and perineural injections of botulinum toxin type A may be useful for the treatment of various chronic pain conditions with neuropathic component.
Background: Neuromodulation is an effective and reversible treatment option for chronic intractab... more Background: Neuromodulation is an effective and reversible treatment option for chronic intractable pain. Spinal cord stimulation (SCS) represents a field of application of neuromodulation and is known to be effective for several conditions including complex regional pain syndrome (CRPS), failed back surgery syndrome (FBSS), and chronic leg and back pain. SCS has some technical limitations that can be bypassed through retrograde neuromodulation. Objective: To examine the safety and efficacy of retrograde neuromodulation in consecutive patients with neuropathic pain in the perineum or lower limb. Study Design: Prospective chart review analyzing one year of retrograde stimulation in our department. Methods: We present a series of 10 patients who underwent retrograde neuromodulation at the University General Hospital of Valencia (Spain). We analyzed the variables that can improve the outcome and help physicians choose retrograde neuromodulation. Results: Seven of 10 patients had an eff...
Approximately 6% to 8% of lumbar pain cases, whether associated with radicular pain or not, may b... more Approximately 6% to 8% of lumbar pain cases, whether associated with radicular pain or not, may be attributed to the presence of piriformis muscle syndrome. Available treatments, among others, include pharmacotherapy, physical therapy, and injections of different substances into the muscle. Various methods have been used to confirm correct needle placement during these procedures, including electromyography (EMG), fluoroscopy, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography (US) has now become a widely used technique and therefore may be an attractive alternative for needle guidance when injecting this muscle. The objective of this study was to assess the reliability of US in piriformis injection of patients with piriformis syndrome. Feasibility study; 10 patients with piriformis muscle syndrome were injected with botulinum toxin A using a US-guided procedure. Then patients were administered 2 mL iodinated contrast and were then transferred to the CT s...
BACKGROUND Approximately 6% to 8% of lumbar pain cases, whether associated with radicular pain or... more BACKGROUND Approximately 6% to 8% of lumbar pain cases, whether associated with radicular pain or not, may be attributed to the presence of piriformis muscle syndrome. Available treatments, among others, include pharmacotherapy, physical therapy, and injections of different substances into the muscle. Various methods have been used to confirm correct needle placement during these procedures, including electromyography (EMG), fluoroscopy, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography (US) has now become a widely used technique and therefore may be an attractive alternative for needle guidance when injecting this muscle. OBJECTIVE The objective of this study was to assess the reliability of US in piriformis injection of patients with piriformis syndrome. STUDY DESIGN Feasibility study; 10 patients with piriformis muscle syndrome were injected with botulinum toxin A using a US-guided procedure. Then patients were administered 2 mL iodinated contrast and...
Vulvodynia is a complex and multifactorial clinical condition with severe pain that occurs in the... more Vulvodynia is a complex and multifactorial clinical condition with severe pain that occurs in the absence of visible infectious, inflammatory, neoplastic, or neurological findings. A 35-year-old woman with 3 years of dysesthetic vulvodynia tried conventional and interventional medical treatment with inadequate relief. She was offered peripheral subcutaneous vulvar field stimulation and underwent implantation of two vulvar subcutaneous electrodes. At 15 days after treatment and during 1-year follow-up, the patient scored 1 out of 15 on Friedrich scale, 1 out of 10 on the visual analog scale, and 1 out of 10 on the tampon test. The patient no longer requires oral medication. Stimulation with subcutaneous electrodes provided relief from vulvodynia to a patient in whom all previous therapeutic approaches had failed.
We analysed the expression of aquaporins 1 and 5 and its relation with tidal volume in a model of... more We analysed the expression of aquaporins 1 and 5 and its relation with tidal volume in a model of ventilator-induced lung injury. 42 rats were used. Six non-ventilated animals were sacrificed (group C). The remaining rats were ventilated for 2 hours with different tidal volumes (group 7 ML with 7 ml Kg(-1) , group 20ML with 20 ml kg(-1) ) and a respiratory rate of 90 bpm. Lung oedema was measured and the expression of AQP1 and AQP5 was determined by western immunoblotting and measurement of mRNA. Lung oedema and alveolar-capillary membrane permeability were significantly increased in the animals of group 20ML compared to the control group. AQP1 expression was decreased in groups 7ML and 20ML compared to group C. Mechanical ventilation with high tidal volume causes lung injury and oedema, increasing lung permeability. In ventilated rats with high tidal volume the pulmonary expression of AQP1 decreases. This article is protected by copyright. All rights reserved.
In recent years, there has been a considerable increase in the number of procedures carried out u... more In recent years, there has been a considerable increase in the number of procedures carried out under regional anesthesia. The techniques used can be associated with a number of complications, which should be understood so that they can be recognized and managed appropriately. The overall incidence of reported complications associated with these techniques is low and therefore, with currently available data, we can only have an approximate idea of their incidence. The objective of this study is to systematically describe the complications that may arise from the use of neuraxial and peripheral regional anesthesia techniques.
Botulinum toxin is a neurotoxin that has been widely used in chronic pain for the treatment of mu... more Botulinum toxin is a neurotoxin that has been widely used in chronic pain for the treatment of multiple conditions with a component of localized muscle spasm. Recent studies suggest that botulinum toxin is effective in the treatment of neuropathic pain syndromes such as postherpetic neuralgia or painful scars. We searched the PubMed and OvidSP databases. We also included cross-referencing bibliographies from primary and review articles. In this descriptive review, we evaluate the usefulness, safety, and potential pathophysiological mechanism of botulinum toxin type A for treatment of painful disorders with neuropathic component such as postherpetic neuralgia, diabetic neuropathy, or trigeminal neuralgia. On the basis of the analysis of the reports published in the literature, it would seem that fractioned peripheral subcutaneous and perineural injections of botulinum toxin type A may be useful for the treatment of various chronic pain conditions with neuropathic component.
Background: Neuromodulation is an effective and reversible treatment option for chronic intractab... more Background: Neuromodulation is an effective and reversible treatment option for chronic intractable pain. Spinal cord stimulation (SCS) represents a field of application of neuromodulation and is known to be effective for several conditions including complex regional pain syndrome (CRPS), failed back surgery syndrome (FBSS), and chronic leg and back pain. SCS has some technical limitations that can be bypassed through retrograde neuromodulation. Objective: To examine the safety and efficacy of retrograde neuromodulation in consecutive patients with neuropathic pain in the perineum or lower limb. Study Design: Prospective chart review analyzing one year of retrograde stimulation in our department. Methods: We present a series of 10 patients who underwent retrograde neuromodulation at the University General Hospital of Valencia (Spain). We analyzed the variables that can improve the outcome and help physicians choose retrograde neuromodulation. Results: Seven of 10 patients had an eff...
Approximately 6% to 8% of lumbar pain cases, whether associated with radicular pain or not, may b... more Approximately 6% to 8% of lumbar pain cases, whether associated with radicular pain or not, may be attributed to the presence of piriformis muscle syndrome. Available treatments, among others, include pharmacotherapy, physical therapy, and injections of different substances into the muscle. Various methods have been used to confirm correct needle placement during these procedures, including electromyography (EMG), fluoroscopy, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography (US) has now become a widely used technique and therefore may be an attractive alternative for needle guidance when injecting this muscle. The objective of this study was to assess the reliability of US in piriformis injection of patients with piriformis syndrome. Feasibility study; 10 patients with piriformis muscle syndrome were injected with botulinum toxin A using a US-guided procedure. Then patients were administered 2 mL iodinated contrast and were then transferred to the CT s...
BACKGROUND Approximately 6% to 8% of lumbar pain cases, whether associated with radicular pain or... more BACKGROUND Approximately 6% to 8% of lumbar pain cases, whether associated with radicular pain or not, may be attributed to the presence of piriformis muscle syndrome. Available treatments, among others, include pharmacotherapy, physical therapy, and injections of different substances into the muscle. Various methods have been used to confirm correct needle placement during these procedures, including electromyography (EMG), fluoroscopy, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography (US) has now become a widely used technique and therefore may be an attractive alternative for needle guidance when injecting this muscle. OBJECTIVE The objective of this study was to assess the reliability of US in piriformis injection of patients with piriformis syndrome. STUDY DESIGN Feasibility study; 10 patients with piriformis muscle syndrome were injected with botulinum toxin A using a US-guided procedure. Then patients were administered 2 mL iodinated contrast and...
Vulvodynia is a complex and multifactorial clinical condition with severe pain that occurs in the... more Vulvodynia is a complex and multifactorial clinical condition with severe pain that occurs in the absence of visible infectious, inflammatory, neoplastic, or neurological findings. A 35-year-old woman with 3 years of dysesthetic vulvodynia tried conventional and interventional medical treatment with inadequate relief. She was offered peripheral subcutaneous vulvar field stimulation and underwent implantation of two vulvar subcutaneous electrodes. At 15 days after treatment and during 1-year follow-up, the patient scored 1 out of 15 on Friedrich scale, 1 out of 10 on the visual analog scale, and 1 out of 10 on the tampon test. The patient no longer requires oral medication. Stimulation with subcutaneous electrodes provided relief from vulvodynia to a patient in whom all previous therapeutic approaches had failed.
We analysed the expression of aquaporins 1 and 5 and its relation with tidal volume in a model of... more We analysed the expression of aquaporins 1 and 5 and its relation with tidal volume in a model of ventilator-induced lung injury. 42 rats were used. Six non-ventilated animals were sacrificed (group C). The remaining rats were ventilated for 2 hours with different tidal volumes (group 7 ML with 7 ml Kg(-1) , group 20ML with 20 ml kg(-1) ) and a respiratory rate of 90 bpm. Lung oedema was measured and the expression of AQP1 and AQP5 was determined by western immunoblotting and measurement of mRNA. Lung oedema and alveolar-capillary membrane permeability were significantly increased in the animals of group 20ML compared to the control group. AQP1 expression was decreased in groups 7ML and 20ML compared to group C. Mechanical ventilation with high tidal volume causes lung injury and oedema, increasing lung permeability. In ventilated rats with high tidal volume the pulmonary expression of AQP1 decreases. This article is protected by copyright. All rights reserved.
In recent years, there has been a considerable increase in the number of procedures carried out u... more In recent years, there has been a considerable increase in the number of procedures carried out under regional anesthesia. The techniques used can be associated with a number of complications, which should be understood so that they can be recognized and managed appropriately. The overall incidence of reported complications associated with these techniques is low and therefore, with currently available data, we can only have an approximate idea of their incidence. The objective of this study is to systematically describe the complications that may arise from the use of neuraxial and peripheral regional anesthesia techniques.
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Papers by Gustavo Fabregat