| Propofol y priapismo |
Propofol and priapism. Senthilkumaran S, Shah S, Ganapathysubramanian, Balamurgan N, Thirumalaikolundusubramanian P. Sri Gokulam Hospitals and Research Institute, Salem, TamilNadu, India. Indian J Pharmacol. 2010 Aug;42(4):238-9.Abstract Propofol-induced priapism in a 25-year-old male confirmed by rechallenge is reported for its rarity and to create awareness among practitioners, because propofol is used frequently in India for the induction and maintenance of anesthesia or sedation. The probable mechanisms are highlighted. Because propofol causes low-flow priapism, early alleviation is essential to minimize and/or avert the long-term complications http://www.ijp-online.com/article.asp?issn=0253-7613;year=2010;volume=42;issue=4;spage=238;epage=239;aulast=Senthilkumaran |
| Priapismo - Una complicación rara después de morfina peridural e infusión de bupivacaína |
Priapism--a rare complication following continuous epidural morphine and bupivacaine infusion. Ruan X, Couch JP, Shah RV, Liu H, Wang F, Chiravuri S. 'Physicians', Pain Specialists of Alabama, Mobile, AL 36607, USA. xiuluruan@yahoo.comrPain Physician. 2007 Sep;10(5):707-11.Abstract BACKGROUND: Intraspinal drug delivery (IDD) therapy has been increasingly used in patients with intractable, nonmalignant pain who fail to respond to conventional treatment or can not tolerate systemic opioid therapy due to side effects. By infusing a small amount of analgesics directly into the cerebrospinal fluid (CSF) in close proximity to the receptor sites in the spinal cord, one is able to achieve the spinally mediated analgesia, sparing side effects ffrom systemic opioids. Prior to permanent intraspinal pump implantation, an intraspinal opioid screening trial is required to document the efficacy of intraspinal opioid for analgesia. Although there are a few approaches in conducting such screening trials, a patient-controlled continuous epidural morphine infusion trial, performed in an outpatient setting, is widely accepted by many interventional pain specialists. The major advantage of conducting an outpatient functional opioid infusion trial versus an inpatient trial is that it more closely mimics what the patient does in his or her usual activities of daily living, therefore minimizing the false positive rate of the inpatient screening trial. OBJECTIVE: To describe a rare complication, priapism, observed during an outpatient continuous epidural morphine and bupivacaine infusion trial. CASE REPORT: A 49-year-old male with intractable, chronic low back pain due to diffuse lumbar degenerative disc disease, lumbar spondylosis referred to our clinic for consideration of IDD therapy, after failing to respond to multi-modality pain management including medications, physical therapy with modality, transcutaneous nerve stimulation (TENS), and various interventional procedures. Following a pre-implant psychological evaluation, he was scheduled for the outpatient epidural morphine and bupivacaine infusion trial. A tunneled lumbar epidural a catheter was placed at L3-L4 with the catheter tip advanced to L1 under fluoroscopic guidance. The proximal tip of the catheter was then tunneled, subcutaneously, and connected to a Microject PCEA pump (Codman, Raynham, MA, USA) and reservoir bag containing preservative-free morphine 0.4 mg/mL and bupivacaine 0.016%. The pump was programmed to deliver a basal rate of 0.5 mL/h. The bolus dose was 0.2 mL with a 60-minute lock out interval. The patient was instructed how to use the pump properly before discharging home. Two hours following the initiation of infusion trial, the patient started to experience penile erection. It was initially painless, but became progressively painful and intensified. The unremitting priapism lasted 8 hours, finally resolving 2 to 3 hours after discontinuing the infusion. The patient recovered fully without any sequelae. CONCLUSION: Priapism may occur as a rare complication following epidural morphine administration. This report represents the third case report thus far in the literature revealing priapism induced by epidural morphine administration, yet, it is the only report, to our knowledge, describing priapism occurring in a patient undergoing an outpatient epidural morphine and bupivacaine infusion trial. We believe that epidural morphine, rather than bupivacaine, is responsible for causing priapism in this patient, through a yet to be defined spinal mechanism. http://www.painphysicianjournal.com/2007/september/2007;10;707-711.pdf |
| Analgesia epidural en un niño con enfermedad de células falciformes complicada con dolor abdominal y priapismo |
Epidural analgesia in a child with sickle cell disease complicated by acute abdominal pain and priapism. Labat F, Dubousset AM, Baujard C, Wasier AP, Benhamou D, Cucchiaro G. Département d'Anesthésie et Réanimation, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin Bicêtre, France. Br J Anaesth. 2001 Dec;87(6):935-6.Abstract We describe a case of a 9-yr-old child with sickle cell disease complicated by abdominal vaso-occlusive crisis and priapism. Both complications were successfully treated with a combination of epidural local anesthetics and morphine. http://bja.oxfordjournals.org/content/87/6/935.full.pdf+html |
| Tratamiento del priapismo en un niño con anemia de células falciformes: evolución exitosa con analgesia epidural |
Management of priapism in a child with sickle cell anemia; successful outcome using epidural analgesia. McHardy P, McDonnell C, Lorenzo AJ, Salle JL, Campbell FA. Department of Anesthesia, Hospital for Sick Children, 555 University Avenue, Room 2303, Toronto, Ontario M5G 1X8, Canada. Can J Anaesth. 2007 Aug;54(8):642-5.Abstract PURPOSE: To describe the successful management of priapism secondary to sickle cell anemia in a child using neuraxial analgesia provided via an epidural catheter. CLINICAL FEATURES: A seven-year-old male presented with chest crisis and priapism which, following hemoglobin electrophoresis led to a new diagnosis of sickle cell anemia. Epidural management was attempted as an alternative to surgery after failure of more conventional medical and surgical methods to treat the priapism. The patient's clinical condition improved with this intervention and together with further conservative therapy resulted in complete resolution of the priapism. CONCLUSIONS: Priapism is a well described complication of sickle cell anemia that is painful and difficult to manage. Surgical intervention is the last therapeutic resort and often results in significant long-term morbidity. This case highlights how select cases of priapism can be successfully managed with epidural neuraxial blockade which not only provides superior analgesia for the often painful conservative treatments, but may also per se impart a direct and salutary therapeutic benefit. http://www.springerlink.com/content/v0256374w17n63k1/fulltext.pdf |
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