Complementary and alternative medicines such as herbal medicines are not currently part of the conventional medical system. As the popularity of and global market for herbal medicine grows among all age groups, with supporting scientific data and clinical trials, specific alternative treatments such as herbal medicine can be reclassified as a practice of conventional medicine. One of the most common conditions for which adults use herbal medicine is pain. However, herbal medicines carry safety concerns and may impact the efficacy of conventional therapies. Unfortunately, mechanisms of action are poorly understood, and their use is unregulated and often underreported to medical professionals. This review aims to compile common and available herbal medicines which can be used as an alternative to or in combination with conventional pain management approaches. Efficacy and safety are assessed through clinical studies on pain relief. Ensuing herb–drug interactions such as cytochrome modulation, additive and synergistic effects, and contraindications are discussed. While self-management has been recognized as part of the overall treatment strategy for patients suffering from chronic pain, it is important for practitioners to be able to also optimize and integrate herbal medicine and, if warranted, other complementary and alternative medicines into their care.
Neuromuscular blocking agents are used during general anesthesia to optimize intubating and surgical conditions. Determining the level of neuromuscular blockade and ensuring adequate reversal are crucial to prevent anesthesia-related postoperative residual weakness and its associated complications. We present a 33-year-old woman who underwent laparoscopic appendectomy. Facial nerve stimulation failed to elicit response to neurostimulation, but subsequent ulnar nerve stimulation showed train-of-four count of 4 without fade in the adductor pollicis muscle. It was later determined that the patient recently received botulinum toxin treatment. Facial nerve stimulation is not a reliable method for neuromuscular blockade monitoring.
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