Procedimientos intervencionistas guiados con ultrasonido para pacientes con dolor pélvico crónico. Descripción de técnicas y revisión de la literatura
Ultrasound-guided interventional procedures for patients with chronic pelvic pain - a description of techniques and review of literature.
Peng PW, Tumber PS.
Pain Physician. 2008 Mar-Apr;11(2):215-24.
Abstract
Chronic pelvic pain can present in various pain syndromes. In particular, interventional procedure plays an important diagnostic and therapeutic role in 3 types of pelvic pain syndromes: pudendal neuralgia, piriformis syndrome, and "border nerve" syndrome (ilioinguinal, iliohypogastric, and genitofemoral nerve neuropathy). The objective of this review is to discuss the ultrasound-guided approach of the interventional procedures commonly used for these 3 specific chronic pelvic pain syndromes. Piriformis syndrome is an uncommon cause of buttock and leg pain. Some treatment options include the injection of the piriformis muscle with local anesthetic and steroids or the injection of botulinum toxin. Various techniques for piriformis muscle injection have been described. CT scan and EMG-guidance are not widely available to interventional physicians, while fluoroscopy exposes the performers to radiation risk. Ultrasound allows direct visualization and real-time injection of the piriformis muscle. Chronic neuropathic pain arising from the lesion or dysfunction of the ilioinguinal nerve, iliohypograstric nerve, and genitofemoral nerve can be diagnosed and treated by injection to the invloved nerves. However, the existing techniques are confusing and contradictory. Ultrasonography allows visualization of the nerves or the structures important in the identification of the nerves and provides the opportunities for real-time injections. Pudendal neuralgia commonly presents as chronic debilitating pain in the penis, scrotum, labia, perineum, or anorectal region. A pudendal nerve block is crucial for the diagnosis and treatment of pudendal neuralgia. The pudendal nerve is located between the sacrospinous and sacrotuberous ligaments at the level of ischial spine.Ultrasonography, but not the conventional fluoroscopy, allows visualization of the nerve and the surrounding landmark structures. Ultrasound-guided techniques offer many advantages over the conventional techniques. The ultrasound machine is portable and is more readily available to the painspecialist. It prevents patients and healthcare professionals from the exposure to radiation during the procedure. Because it allows the visualization of a wide variety of tissues, it potentially improves the accuracy of the needle placement, as exemplified by various interventional procedures in the pelvic regions aforementioned.
http://www.painphysicianjournal.com/2008/march/2008;11;215-224.pdf
Bloqueo trigeminal guiado con ultrasonido via fosa pterigopalatina: manejo efectivo de neuralgia trigeminal y dolor facial atípico
Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: an effective treatment for trigeminal neuralgia and atypical facial pain.
Nader A, Kendall MC, De Oliveria GS, Chen JQ, Vanderby B, Rosenow JM, Bendok BR.
Author information
Pain Physician. 2013 Sep-Oct;16(5):E537-45.
Abstract
BACKGROUND: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminalnerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. OBJECTIVE: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. SETTING: Academic pain management center. STUDY DESIGN: Prospective case series. METHODS: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. RESULTS: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. LIMITATIONS: Prospective case series. CONCLUSION: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.
http://www.painphysicianjournal.com/2013/september/2013;16;E537-E545.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Ultrasound-guided interventional procedures for patients with chronic pelvic pain - a description of techniques and review of literature.
Peng PW, Tumber PS.
Pain Physician. 2008 Mar-Apr;11(2):215-24.
Abstract
Chronic pelvic pain can present in various pain syndromes. In particular, interventional procedure plays an important diagnostic and therapeutic role in 3 types of pelvic pain syndromes: pudendal neuralgia, piriformis syndrome, and "border nerve" syndrome (ilioinguinal, iliohypogastric, and genitofemoral nerve neuropathy). The objective of this review is to discuss the ultrasound-guided approach of the interventional procedures commonly used for these 3 specific chronic pelvic pain syndromes. Piriformis syndrome is an uncommon cause of buttock and leg pain. Some treatment options include the injection of the piriformis muscle with local anesthetic and steroids or the injection of botulinum toxin. Various techniques for piriformis muscle injection have been described. CT scan and EMG-guidance are not widely available to interventional physicians, while fluoroscopy exposes the performers to radiation risk. Ultrasound allows direct visualization and real-time injection of the piriformis muscle. Chronic neuropathic pain arising from the lesion or dysfunction of the ilioinguinal nerve, iliohypograstric nerve, and genitofemoral nerve can be diagnosed and treated by injection to the invloved nerves. However, the existing techniques are confusing and contradictory. Ultrasonography allows visualization of the nerves or the structures important in the identification of the nerves and provides the opportunities for real-time injections. Pudendal neuralgia commonly presents as chronic debilitating pain in the penis, scrotum, labia, perineum, or anorectal region. A pudendal nerve block is crucial for the diagnosis and treatment of pudendal neuralgia. The pudendal nerve is located between the sacrospinous and sacrotuberous ligaments at the level of ischial spine.Ultrasonography, but not the conventional fluoroscopy, allows visualization of the nerve and the surrounding landmark structures. Ultrasound-guided techniques offer many advantages over the conventional techniques. The ultrasound machine is portable and is more readily available to the painspecialist. It prevents patients and healthcare professionals from the exposure to radiation during the procedure. Because it allows the visualization of a wide variety of tissues, it potentially improves the accuracy of the needle placement, as exemplified by various interventional procedures in the pelvic regions aforementioned.
http://www.painphysicianjournal.com/2008/march/2008;11;215-224.pdf
Bloqueo trigeminal guiado con ultrasonido via fosa pterigopalatina: manejo efectivo de neuralgia trigeminal y dolor facial atípico
Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: an effective treatment for trigeminal neuralgia and atypical facial pain.
Nader A, Kendall MC, De Oliveria GS, Chen JQ, Vanderby B, Rosenow JM, Bendok BR.
Author information
Pain Physician. 2013 Sep-Oct;16(5):E537-45.
Abstract
BACKGROUND: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminalnerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. OBJECTIVE: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. SETTING: Academic pain management center. STUDY DESIGN: Prospective case series. METHODS: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. RESULTS: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. LIMITATIONS: Prospective case series. CONCLUSION: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.
http://www.painphysicianjournal.com/2013/september/2013;16;E537-E545.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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