Stellate-ganglion block (SGB) is a commonly performed procedure for the treatment of numerous conditions, including upper-extremity complex regional pain syndromes and arterial insufficiency. The appropriate response to SGB includes ipsilateral Horner’s syndrome and temperature elevation of affected extremity. Contralateral and bilateral Horner’s syndrome following SGB are rarely seen, with only six prior cases reported. We describe a case of a 47-year-old female with right-hand pain secondary to Raynaud’s phenomenon who underwent SGB with subsequent contralateral Horner’s syndrome and review the literature of this rare phenomenon.
Background: To date, there is limited research on whether the various types of mandatory usage of prescription drug monitoring programs (PDMP) have any effects on prescribing patterns, drug usage, patient care, and drug diversion (8-10). Within the United States (US), there is wide variation in individual states’ requirements for the usage of PDMPs. Objective: The objective of this study was to determine whether mandatory prescriber review of a PDMP prior to each issuance of a controlled substance resulted in a reduction in the total number of controlled substance prescriptions dispensed. Study Design: A retrospective review of the State of Wisconsin’s PDMP controlled substance database from April 2015 to March 2019 was performed. The evaluation compared the number of prescriptions among individual drug classes (opioids, benzodiazepines, stimulants) dispensed throughout the state before and after April 1st, 2017, when implementation of a state law mandating the review of the PDMP during each patient encounter prior to issuing a prescription for a controlled substance took effect. Setting: Research was conducted using Wisconsin’s PDMP controlled substance database from April 2015 to March 2019. During this time, controlled substance policy has come to the forefront of the nation due to issues with an opioid epidemic. Methods: Descriptive analysis was used to express data as n and % for categorical data and average ± standard deviation for numerical data. Before- and after-prescription totals were analyzed using a paired t test and Levene’s test for equality of variances. The P value was considered significant at a level ≤ .05. Limitations: Limitations to this study included its retrospective design, focus on a single US state, and possible unforeseen contributors to cause and effect. Results: Prior to the enforcement of the state’s mandatory PDMP legislation, an average of 844,314 controlled substance prescriptions were written monthly. Following the implementation of the law, the average monthly total prescriptions written within the state decreased to 708,063. This was an average monthly reduction of 136,251 prescriptions written or 16.1%. Statistically significant reductions were also seen in opioid and benzodiazepine subgroups (23.0%, 16.3%). Conclusion: Our study suggests that state-enforced mandatory usage of a PDMP, which records all controlled substance prescriptions filled by a pharmacy such as opioids, benzodiazepines, amphetamines, etc. at every encounter prior to prescribing any controlled substance, can provide for a significant reduction in controlled substance prescriptions, specifically opioids and benzodiazepines. Key words: Prescription drug monitoring program, opioids, mandatory usage, benzodiazepines, Wisconsin
Background: Previous studies have demonstrated Ketamine to induced apoptosis in various cellular lines. Ketamine is commonly utilized during total intravenous anesthesia in patients undergoing brachytherapy for prostate cancer. The primary aim of this study was to determine if concomitant ketamine exposure during prostate brachytherapy improved outcomes evaluate through follow prostate specific antigen (PSA) levels. Methods: A retrospective analysis of 91 prostate brachytherapy performed at our institution from 2014-2016 was done identifying 31 procedures in which ketamine was administered during the procedure. Measured outcomes were the comparison reduction of PSA levels at 1 month, 6 months, and 12 months post procedural visits. Results: No statistical significant reduction in the prostatic specific antigen or the corresponding percent reduction of PSA levels were demonstrated between ketamine and non-ketamine exposed patient undergoing prostate brachytherapy. Conclusions: Concomitant ketamine exposure does not appear to enhance the therapeutic effect of prostate brachytherapy. When comparing the overall percent reduction of PSA levels between the two groups (ketamine exposed/ no exposure), the ketamine patients did have greater decrease in PSA levels, but was not statistically significant. With the limitation of our retrospective analysis, further double blinded prospective trials may be warranted.
Developing a broad differential for chronic back pain is important in terms of work-up, and eventual treatment. We present a case of a sixty-nine-year old male with chronic back pain, failing multiple treatments and medications, which were eventually diagnosed with non-obstructing renal calculi. We believe it is imperative that pain management physicians are cognizant of small stone syndrome, and that they widen their differential to include rarer causes of back pain when treatment modalities prove ineffective. As demonstrated by our case, ineffective treatment, unneeded procedures, and poor patient satisfaction, may result when a broad differential is not utilized.
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