Supraorbital neuralgia has been identified as an infrequent cause of headache that may prove very difficult to control pharmacologically. Peripheral nerve stimulation using electrodes to stimulate the nerve segmentally responsible for the zone of pain may constitute a management alternative in such cases. We present the case of a patient with headache because of posttraumatic supraorbital neuralgia, refractory to medical treatment, with good analgesic control after peripheral nerve stimulation. Peripheral nerve stimulation may be considered a safe, reversible treatment for patients with headache secondary to supraorbital neuralgia who respond poorly to pharmacological treatment, thus avoiding irreversible alternatives such as surgery.
Oculocardiac reflex-peHbulbar block or opioid-relaxant anaesthesiaTo the Editor: The Oculocardiac reflex (OCR) can be induced by traction on the extraocular muscles. It usually manifests as bradycardia, nodal rhythm, ectopic beats, ventricular fibrillation and asystole. The reported incidence of OCR during general anaesthesia (GA) varies from 56 -67%. 1,5 This study was designed to compare the effects of peribulbar block (LA) and opioid-relaxant anaesthesia on the incidence of OCR in 30 patients undergoing surgery for retinal detachment. Traction of 400 g was applied to all extraocular muscles using a sprhag balance.Patients in group I underwent surgery using peribulbar block. In group II patients received conventional opioid-relaxant anaesthesia. Intraoperative monitoring included SpO2, PETCO2, heart rate, and arterial pressure every 5 rain. The ECG, lead II, was recorded prior to anaesthesia, and during and after traction of each extraocular muscle. OCR was considered positive if there was 10% decrease in heart rate. Analysis was with chi-square and student's t test.There was a decrease in heart rate following traction on the rectus muscles (P < 0.0005) and oblique muscles (P < 0.005) during GA (Table ). The maximum change in heart rate was observed for inferior rectus. There was no decrease in heart rate, using local anaesthesia, for muscle. There were no alterations in arterial pressure under LA or GA. The incidence of dysrhythmias was 20% under GA and 6.67% under LA. These results demonstrate that the incidence of OCR during GA (63.3%) is higher than during LA (14.4%).
Spinal tumors are infrequent, but pose great difficulties for the management and control of the pain they cause. The utility of the spinal route as an early approach for the provision of adequate analgesia seems clear. However, it also appears to lose efficacy with time, and dose incrementing and/or the addition of drugs that enhance the analgesic action of morphine are not always effective. In such selected cases, the intraventricular route may constitute a useful alternative, allowing improved symptoms control with lower morphine doses, and the use of the system previously implanted for intrathecal spinal infusion.
review two cases of pneumocephalus: one subarachnoid and the other epidural. Iatrogenic pneumocephalus is an uncommon complication observed after using the 'loss-of-resistance'
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