Naeem Haider

Thoracic epidural anesthesia and analgesia is a valuable tool in the perioperative period. Successful thoracic epidural catheter placement requires a thorough knowledge of anatomy and its role in the performance of thoracic epidural block. The paramedian approach in the mid-thoracic region (T5-8) makes use of definitive bony landmarks to facilitate successful thoracic epidural space identification. In properly trained hands using

We present a patient who required perioperative analgesia with continuous nerve block for shoulder disarticulation, for whom the only approach possible to the brachial plexus was from posterior. A 51-yr-old woman was suffering from intractable upper extremity pain and dysfunction as a result of severe lymphedema after metastatic spread of breast cancer to the axilla. Her pain was poorly controlled despite aggressive treatment with oral, systemic, and intrathecal opiates. She presented for amputation of her arm as a last resort for management of pain. In order to provide optimal postoperative analgesia, continuous peripheral nerve block was selected in consultation with the patient, and due to anatomic disfigurement and tumor invasion, a continuous cervical paravertebral block was placed preoperatively and shoulder disarticulation was performed using a combined regional/general anesthesia technique. The patient had an uneventful recovery without pain for the 6 postoperative days that the catheter was in place and 0.25% bupivacaine was infused at 5 mL/h. Because of anatomic considerations, which precluded the use of all other approaches to the brachial plexus, the posterior cervical paravertebral approach provided an effective means of pain control in this difficult clinical situation.

▪ Abstract:  We present a patient with intractable neuropathic pain because of radiation-induced transverse myelitis unresponsive to medical treatment. After a successful trial of spinal cord stimulation, a permanent stimulator was implanted. Improvement was noted in verbal pain score, medication usage and function. Spinal cord stimulation may offer a therapeutic option for patients with neuropathic pain resulting from transverse myelitis and should be considered when other treatments fail. ▪