Background. The application of additive manufacturing (3D printing) has been recently expanded to various medical fields. The new technique named loss of guide wire resistance (LOGR) was developed via 3D printing for the detection of epidural space using a guide wire instead of air or saline used in the loss of resistance (LOR) technique. Methods. The prototype model of epidural space finder consists of a polyactic acid (PLA) or a resin. It was manufactured with 3D printing. Biocompatibility test (eluate and sterility tests) was performed in both products. The advantage of the newly developed device was compared with conventional loss of resistance (LOR) technique in a porcine model. Results. Eluate and sterility tests revealed that the PLA was more biocompatible than the resin. The LOGR technique facilitated rapid access to epidural space compared with the LOR technique (41.64 ± 32.18 vs. 92.28 ± 61.46 seconds, N = 14, p=0.0102, paired sample t-test), without any differences in success rate (87.5%). Conclusion. We conclude that LOGR technique is comparable to LOR technique to access the epidural space, although the advantage of either technique in terms of complications such as dural puncture or epidural hematoma is unknown. We demonstrated the potential benefit of 3D printer for the development of a new medical device for anesthesia.
Opioid-induced hyperalgesia is characterized by an increased pain response to noxious stimuli despite increased use of opioid medications. Here, we report the case of a 43-year-old woman diagnosed with post-laminectomy syndrome who presented with an increasing pain score following a morphine infusion via an implanted intrathecal drug delivery device. Her pain improved after reducing opioid doses and the administration of intravenous ketamine infusion therapy. Thus, the early suspicion of opioid-induced hyperalgesia is essential for patients with increasing pain refractory to augmented doses of opioid medications.
We successfully performed cervical spinal cord stimulator (SCS) surgery in a 27-year-old man with complex regional pain syndrome to control intractable pain. The SCS trial was performed twice to adjust the SCS coverage region. After permanent implantation surgery, the patient developed Horner’s syndrome when the region near the C4 spinal dorsal root was stimulated. However, Horner’s syndrome disappeared after changing the stimulation leads. This case report suggests that cervical SCS can be associated with superior cervical ganglion stimulation.
An implantable intrathecal drug delivery system (IDDS) could be used for various malignant or non-malignant chronic pain [1]. Even though the IDDS insertion is an invasive procedure that makes a direct conduit into the central nervous system for analgesics delivery, the use of IDDS is increasingly popular because it is very effective in treating chronic intractable pain and is supported by multiple studies [2,3]. We report on the case of a patient who had a clear discharge from a suspected cerebral spinal fluid (CSF) leakage through a lumbar wound after intrathecal morphine pump removal surgery. It was an uncertain case of CSF leakage because the patient did not suffer from a headache. Finally, the clear discharge was successfully resolved by a single epidural blood patch.
CASE REPORTA 55 year-old man had a post herpetic neuralgia (PHN) affecting the right shoulder and arm for 10 years. He experienced piercing, severe burning pain (visual analogue scale[VAS] 8/10) that was not easily managed by various medications such as oxycodone, morphine, fentanyl transdermal patch, milnacipran, and pregabalin. Pain interventions such as stellate ganglion block, cervical epidural block, and brachial plexus block were performed multiple times. Those procedures only relieved his pain for a few brief moments.Eight years ago, a spinal cord stimulator was implanted on his cervical spinal cord area though it did not successfully relieve the pain (Fig. 1). An intrathecal morphine pump insertion was performed to control the intractable PHN. Other physical examination and laboratory results was unremarkable. His coagulation profiles were within the normal ranges.In the intrathecal morphine trial, his right arm pain was reduced to VAS 5/10 with the injection of 0.3 mg morphine sulfate into the L3-4 interspinous space. A permanent morphine pump was implanted two days later.
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