Sensory Paresthesia Research Articles

The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach. A prospective study of 1,000 consecutive patients.

The present study was performed at the Crystal Clinic Surgery Center, an outpatient free-standing surgicenter specializing in orthopedic surgery, to determine the incidence of both neurologic and vascular sequelae associated with exclusive use of a transarterial approach to axillary brachial plexus block in order to assess the technique's safety and efficacy. The prospective consecutive study involved 1,000 adult patients scheduled for surgery using axillary brachial plexus block. The transarterial approach was performed on all patients using a medium-bevel 24-gauge Jelco 1-5-inch needle. Data tabulated included the incidence of neurovascular complications and the outcome of successful axillary brachial plexus anesthesia. Two patients presented with a sensory paresthesia (0.2%) in the distribution of the ulnar nerve and the musculocutaneous nerve that most likely occurred during supplementation of an incomplete block. Three patients presented with upper-arm myalgias (0.3%) related to tourniquet injury. After the operation, two patients developed reflex sympathetic dystrophy, which responded to stellate ganglion blocks. Vascular complications, including transient arterial spasm in 10 of 996 (1%), unintentional intravascular injection in 2 of 996 (0.2%), and small (0-2 cm) hematoma formation in 2 of 996 (0.2%), were recognized but did not require any intervention other than close observation. The study revealed a complete block in 88.8% of cases, an incomplete block requiring supplemental local anesthesia in 10% of cases, and a complete block failure in 1.2%. This study demonstrated the safety and efficacy of the transarterial technique in achieving brachial plexus block.

Arthroscopic treatment of chronic synovitis of the ankle

Arthroscopic synovectomy is a valuable tool in treating synovitis of the knee joint. We have identified a group of patients who benefit from ankle synovectomy. To determine the indications and long-term results of arthroscopic synovectomy of the ankle, we evaluated the history, preoperative examination, roentgenograms, and operative data of patients who underwent this procedure and had a minimum of 2 years of follow-up. Sixteen patients who underwent arthroscopic ankle synovectomy were identified. Sprains and inversion-type injuries were common in this young patient group. All had failed conservative therapy. Operative findings revealed hypertrophic synovium in all cases. Good or excellent results were obtained in 75% of patients, using a subjective and functional evaluation scale. Complications were one deep infection, one superficial infection, and one temporary sensory paresthesia. Chronic synovitis, or anterior soft-tissue impingement, was responsive to arthroscopic treatment and results did not deteriorate over time.

Diabetic Radiculoneuropathy: Clinical patterns of sensory loss and distal paresthesias

Diabetic Radiculoneuropathy: Clinical patterns of sensory loss and distal paresthesias

Brain stimulation for pain control.

Three areas of the brain have been used for stimulation to control chronic pain. Stimulation of the primary sensory relay nuclei of the thalamus (VPM, VPL) and internal capsule reduce pain by activating large nonpain sensory neurons which produce sensory paresthesias and inhibition of small pain fibers. The third area is the paraventricular gray matter-an area that apparently modulates pain input. Stimulation of this area reduces pain for hours with short periods of stimulation with little or no side effects. Chronic stimulation intermittently over a period of up to three years shows no tendency to tolerance, habitutation, electrode isolation, loss of effectiveness, or tissue destruction.