BackgroundThe active involvement of anesthesiologists in chronic pain management has been associated with an increase in the number of related medical dispute cases.MethodsUsing the Korean Society of Anesthesiologists Legislation Committee database covering case files from July 2009 to June 2016, we explored injuries and liability characteristics in a subset of cases involving chronic pain management.ResultsDuring the study period, 58 cases were eligible for final analysis. There were 27 cases related to complex regional pain syndrome (CRPS), many of them involving problems with financial compensation (24/27, 88.9%). The CRPS cases showed male dominance (22 males, 5 females). In a disproportionately large number of these cases, the causative injury occurred during military training (n = 5). Two cases were associated with noninvasive pain managements, and 29 cases with invasive procedures. Of the latter group, procedures involving the spine (both neuraxial and non-neuraxial procedures) resulted in more severe complications than other procedures (P = 0.007). Seven of the patients who underwent invasive procedures died. The most common type of invasive procedures were lumbosacral procedures (16/29, 55.2%). More specifically, the most common damaging events were inadvertent intravascular or intrathecal injection of local anesthetics (n = 6).ConclusionsSeveral characteristics of medical disputes related to chronic pain management were identified: the prevalence of injury benefit claims in CRPS patients, higher severity of complications in procedures performed at the spine or cervical region, and the preventability of inadvertent intravascular or intrathecal injection of local anesthetics.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Green discoloration of the urine after propofol administration is a rare clinical phenomenon. Although the exact incidence of propofol-induced green urine is not known, the reported incidence is thought to be less than 1%. In most reported cases of propofol-induced green urine, the clinical effects were benign and reversible. However, many clinicians are unfamiliar with this rare side effect of propofol. Here, we present the case of a patient who showed green urine following two-staged repair of a thoracoabdominal aortic aneurysm with propofol infusion. His urine had a normal yellowish color after the first operation, but appeared green immediately after the second surgery. Because propofol is a commonly used sedative agent, knowing that green urine can be attributed to propofol administration and that its clinical effect is mostly benign will help clinicians with patient management, as such knowledge will also reduce unnecessary concerns and laboratory tests. Propofol is a commonly used sedative agent for induction and maintenance of general anesthesia and for sedation in the intensive care unit (ICU). However, urine discoloration after propofol infusion and its clinical association is not widely known to clinicians because of its rare occurrence. Although the exact incidence of propofol-induced green urine is unknown, reported incidence is suggested to be less than 1%.There have been only a few previous reports of this green discoloration of urine after propofol administration [1][2][3][4][5][6][7][8][9][10][11]. We experienced a 27-year-old man who showed green urine after two-staged repair of a thoraco-abdominal aortic aneurysm. His urine color was normal yellowish color after the first infusion of propofol, but appeared green immediately after the second surgery with propofol administration. We report this case with a review of the relevant literature. the ICU and transferred to the general ward on postoperative day 2. During the time interval between the first and second operations, his systolic blood pressure and heart rate were controlled at 90 to 100 mmHg and around 90 bpm, respectively, with intermittent infusion of intravenous esmolol (50 g/kg/min) and/or nicardipine (1 g/kg/min). Intravenous famotidine, codein, and warfarin were also used occasionally. CASE REPORTHe was on oral carvedilol and losartan. During this time, the intraoperative and postoperative urine was normal yellowish.Seven days later, open repair of an abdominal aortic aneurysm was performed under the same TIVA technique. The intraoperative anesthetic and hemodynamic management was similar to that during the Bentall operation. Total anesthesia time was 4 hours and 42 minutes, with total propofol dosage of 2,100 mg. During this abdomin...

Erythromelalgia is often refractory and resistant to many forms of treatment. Numerous therapeutic options have been tried, but effective treatment remains elusive. The sympathetic nervous system has been involved in various painful conditions of neuropathic, vascular, and visceral origin. Sympathetic block is helpful in making a diagnosis and managing pain. We report a case of excellent pain relief after lumbar sympathetic pulsed radiofrequency treatment in a patient with primary erythromelalgia of the lower extremities. This case suggests the viability of pulsed radiofrequency treatment in patients with erythromelalgia.