Effective Pain Management After Total Hip Arthroplasty in a Sickle Cell Patient Emphasizing Dexamethasone Sodium Phosphate/Methylprednisolone Acetate Administered via a Peripheral Nerve Blockade: A Case Report
We present a case of effective analgesia that lasted for weeks in a young opioid-tolerant female. This was achieved by the administration of glucocorticoids with different durations of action, dexamethasone sodium phosphate/methylprednisolone acetate, via a femoral/lateral femoral cutaneous nerve block placed preoperatively. Postoperatively, the patient’s opioid demand was unchanged from her preoperative baseline. She met all the discharge requirements, including physical therapy targets, on postoperative day 2 and did not have any complications during the hospitalization.
CONCLUSION: To our knowledge, this is the first case report of an HTR associated with anti-Mta . PMID: 31503331 [PubMed - as supplied by publisher]
DiscussionL ‐glutamine has limited high‐quality evidence supporting its use. Although L‐glutamine is FDA approved for the prevention of frequent episodes of VOC pain, only one randomized controlled trial has strong evidence to support this indication. Based on the results of a systematic review, L‐gluta mine may be considered for patients unable to receive hydroxyurea or in addition to hydroxyurea for reduction in VOC and associated pain.
Publication date: Available online 7 September 2019Source: Neuroscience LettersAuthor(s): Shibin Du, Corinna Lin, Yuan-Xiang TaoAbstractSickle cell disease (SCD) is one of the most common severe genetic diseases around the world. A majority of SCD patients experience intense pain, leading to hospitalization, and poor quality of life. Opioids form the bedrock of pain management, but their long-term use is associated with severe side effects including hyperalgesia, tolerance and addiction. Recently, excellent research has shown some new potential mechanisms that underlie SCD-associated pain. This review focused on how transi...
CONCLUSIONS: Moderate to low quality evidence showed neither intravenous magnesium and oral magnesium therapy has an effect on reducing painful crisis, length of hospital stay and changing quality of life in treating sickle cell disease. Therefore, no definitive conclusions can be made regarding its clinical benefit. Further randomized controlled studies, perhaps multicentre, are necessary to establish whether intravenous and oral magnesium therapies have any effect on improving the health of people with sickle cell disease. PMID: 31498421 [PubMed - as supplied by publisher]
Might a virtual reality simulation be a useful adjunct to help pediatric patients with sickle cell disease who are experiencing acute pain from vaso-occlusive crisis?Pediatric Nursing
Everyone who works with me knows that I love joint radiographs, and the wrist is my favorite. It was no surprise when I came on shift that someone exclaimed, "I have an x-ray for you. I bet you will know exactly what it is! This 30-ish-year-old lady came in with atraumatic wrist pain."I did know exactly what it was. My eyes were drawn to the lucent lunate target. The patient was still in the ED, so I went to examine her hand. She had increased pain when I walked my fingers proximally down the metacarpal, which dipped into the carpal space. She was also not a fan of volar flexion or dorsiflexion. It made sense....
Discussion Our study is the first to examine the association between MPQ sensory pain quality descriptors and QST-derived classifications in adults with SCD. Our findings provide the basis for the development of a MPQ subscale with potential as a mechanism-based screening tool for neuropathic pain.
Conclusion: The prevalence of HPV B19 among hospitalized SCD patients at MNH was high. SCD patients with HPV B19 were more likely to present with pain, low neutrophils levels and MCH. HIV infection might be associated with high risk of HPV infection in SCD patients, however this requires further investigation.
CONCLUSION: Opioids suppress cortisol secretion, primarily mediated by direct negative effect on hypothalamus and pituitary gland. Further studies are needed to define the incidence and the clinical significance of opioid-induced adrenal insufficiency, as well as the need for hormone replacement. PMID: 31444021 [PubMed - as supplied by publisher]
CONCLUSION: Thus, our work provides evidence that despite SCA being a chronic inflammatory disease, only genes polymorphisms are not enough to change the outcome of this disease. PMID: 31448710 [PubMed - as supplied by publisher]