Management of lower limb complex regional pain syndrome type 1: an evaluation of percutaneous radiofrequency thermal lumbar sympathectomy versus phenol lumbar sympathetic neurolysis--a pilot study

BACKGROUND

Complex regional pain syndrome type 1 can be difficult to treat. The purpose of this study was to compare the safety and efficacy of two therapeutic options: percutaneous radiofrequency thermal lumbar sympathectomy and lumbar sympathetic neurolysis.

METHODS

We randomized 20 patients to receive percutaneous radiofrequency lumbar sympathectomy or lumbar sympathetic neurolysis with phenol 7% in lower limb complex regional pain syndrome type 1. The study end points were pain relief and side effects.

RESULTS

Within each group, there were statistically significant reductions from baseline in various pain scores after the procedure. However, there was no statistically significant difference in mean pain scores between the groups.

CONCLUSIONS

Based on this pilot study, radiofrequency lumbar sympathectomy may be comparable to phenol lumbar sympathectomy. A larger trial is required to confirm these findings.

Potassium homeostasis during & after cardiopulmonary bypass

Potassium homeostasis was studied in 30 patients undergoing cardiac surgery by employing cardiopulmonary bypass (CPB) and moderate hypothermia, and using morphine, N2O, relaxant anaesthesia. There was a trend for hypokalemia, and for maintaining a K+ level of 4-4.5 mmol/l, K+ infusion was required during CPB (9.017 mmol/m2 BSA/h). K+ infusion required in the post-operative period was considerably less (1.532 mmol/m2 BSA/h). There was no significant difference in the K+ levels of patients receiving preoperative diuretic therapy, as compared to those not receiving such therapy. Potassium requirement was significantly higher in patients under-going CABG and valvular heart disease, as compared to congenital heart disease. The mean urinary loss of K+ during bypass was found to be 2.95 mmol/m2 BSA/h, which was only 32 per cent of that required to be infused (9.017 mmol/m2 BSA/h). The mean excretion of K+ in the post operative period was significantly higher (4.53 mmol/m2 BSA/h) than K+ required to be infused during this period (1.532 mmol/m2 BSA/h).

Management of massive air embolism during open heart surgery

Two patients in whom a massive bolus of air was introduced into the arterial circuit and ascending aorta during valve replacement and in whom the recovery was complete are presented. The technical details of the management of this serious accident are described.

Intensive care in rabies therapy. Clinical observations

Seven patients in India with dog-bite rabies were treated by intensive therapy. Hypoxia was prevented by intermittent positive-pressure ventilation facilitated by muscle relaxants and sedatives. Other measures, included maintenance of nutrition, correction of fluid/electrolyte and acid/base balances, antiviral agents, immunological stimulation, and intensive nursing care by immunised volunteer staff. The patients survived for from 1 to 17 days after the onset of clinical disease. When survival was prolonged (i.e., more than 2-4 days) by intensive care, the disease had diverse and serious effects, including fluctuations in temperature and blood-pressure, cardiac arrhythmia, and diabetes insipidus. Although none of the patients survived, advances in the use of this technique raised hopes that it may eventually be possible to save some patients.

Accidental intravenous injection of cetrimide. A case report

An unusual case of cetrimide toxicity, probably the first of its kind to be recorded, is reported. It occurred after accidental intravenous injection in an infant and the management is discussed. Cardiac arrest, muscle paralysis, haemolysis and other complications were successfully treated.