Drezotomy in the management of post brachial plexus injury neuropathic pain: Preliminary results

Abstract

Objective To share our experience of DREZOTOMY in the management of post brachial plexus injury neuropathic pain. Method Records of patients with severe neuropathic pain following brachial plexus injury who underwent microsurgical C4-T1 DREZOTOMY were analyzed. Pain relief in the immediate postoperative period, 6 weeks and 6 months was analyzed. Results Total of 7 patients from July 2010 to May 2013 were included in the study. Mean age was 41.1 (26?63). There were 6 male and 1 female patients. Five patients had right-sided pain and 2 had left sided dysesthetic pain. All patients had intractable pain not relieved by medications and was affecting their activities of daily living (ADL's). After psychological counseling and detailed analysis cervical laminectomy and DREZOTOMY was performed. Findings were that the posterior rootlets were absent from the DREZ, arachnoid over the area was dull and multiple microcysts were present. Pain relief was assessed in the immediate postoperative period and later. Control of pain was graded as absence or minimal pain, requiring minimal or no analgesics in 3 patients (VAS 0 OR 1), moderate pain as requiring atypical analgesics in 4 patients (VAS 3?4). Pain control at 6 weeks follow up was good for 2 and moderate for 2 patients. At 6 months showed good pain relief in 2 patients and moderate for 2. Conclusion Patients whose ADL'S are affected by such pain, microsurgical DREZOTOMY can provide good relief thereby helping them to get back to a better quality of life post trauma.

Changes in microRNA expression in the brachial plexus avulsion model of neuropathic pain

“…The plantar surface of the paw was stimulated with a series of ascending force von Frey monofilaments. The threshold was taken as the lowest force that evoked a brisk withdrawal response to one of five repetitive stimuli ( 7 ). A withdrawal response was considered valid only when the paw was completely removed from the platform.…”

“…The pain could be experienced as burning or a feeling of compression. Pain after BPA is resistant to most traditional pain relief treatments ( 7 ) due to a lack of understanding of the cellular or molecular mechanisms in the occurrence and development of pain ( 8 , 9 ).…”