Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH) has been a problem for patients following dural puncture. Clinical and laboratory research over the last 30 years has shown that use of smaller-gauge needles, particularly of the pencil-point design, are associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients < 50 years, post-partum, in the event a large-gauge needle puncture is initiated, an epidural blood patch should be performed within 24–48 hours of dural puncture. The optimum volume of blood has been shown to be 12–20 mL for adult patients. Complications caused by autologous epidural blood patching (AEBP) are rare.

Buprenorphine-local anesthetic axillary perivascular brachial plexus block provided postoperative analgesia lasting 3 times longer than local anesthetic block alone and twice as long as buprenorphine given by IM injection plus local anesthetic-only block. This supports the concept of peripherally mediated opioid analgesia by buprenorphine.

Postdural puncture headache (PDPH) has been a problem for patients, following dural puncture, since August Bier reported the first case in 1898. His paper discussed the pathophysiology of low-pressure headache resulting from leakage of cerebrospinal fluid (CSF) from the subarachnoid to the epidural space. Clinical and laboratory research over the last 30 years has shown that use of small-gauge needles, particularly of the pencil-point design, is associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients , for example, age < 50 years, postpartum, large-gauge needle puncture, epidural blood patch should be performed within 24–48 h of dural puncture. The optimum volume of blood has been shown to be 12–20 mL for adult patients. Complications of AEBP are rare.

The results of this study demonstrated that local anesthetic injections are useful for the diagnosis of nonradicular low back pain but may yield false positive results with respect to lumbar facet pain depending upon the technique utilized.

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Chronic sensorimotor distal symmetric polyneuropathy (DPN) is a common neurologic complication of diabetes mellitus. Prevalence of DPN approaches 50% in people living with diabetes, and about 10% of these cases are painful neuropathy. 1,2 Like other symptoms of DPN (loss of reflexes or somatic sensations), ''positive'' symptoms (pain and paresthesias) of DPN have symmetrical distribution and distal-toproximal progression. Nocturnal intensification seems to be another general characteristic of pain in DPN. 2 Otherwise, there is a great variety of individual presentations of this syndrome. Pain may be evoked or spontaneous, persistent or intermittent, and chronic, lasting for years or remitting within 1 year of onset. The persistent, spontaneous pain may be described as superficial or deep, dull, aching, cramp-like, burning, or crushing. The intermittent, chronic pain is frequently perceived as electric-like, shooting, or lancinating. Mechanical allodynia (painful perception of normally nonpainful stimuli) and hyperalgesia (exaggerated pain in response to moderately painful mechanical stimuli) are common types of evoked pain. Paresthesias described in some cases 95

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