Dramatic effect in passive ROM exercise under sedation in a patient with intractable complex regional pain syndrome (type I)
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Abstract Rationale: Complex regional pain syndrome (CRPS) usually occurs after trauma and surgery but can also occur spontaneously. There are various known pathophysiology and treatment protocols for CRPS. However, there is no established treatment guideline. Although physical therapy is known as the first line treatment for CRPS, performing physical therapy is difficult due to severe pain. This case reports the first case with positive effect of physical therapy under sedation that allowed early physical therapy. Patient concerns: A 19-year old female had her right elbow area slightly hit by someone else, after which it began to swell and become more painful. Active and passive range of motion (ROM) of the right upper extremity gradually decreased through 3 months, and pain and edema worsened. Diagnoses: She had allodynia, nonpitting edema, temperature asymmetry, and trophic change in fingernails in the right upper extremity, which met the diagnostic criteria for CRPS. In the 3-phase bone scan, which is a specific tool to diagnose CRPS, there was trace uptake increase in the right elbow and wrist, indicating possibility of CRPS. Interventions: Despite conventional treatments such as pharmacologic and interventional therapies, neither pain nor edema subsided. Pain was so severe that it was impossible to apply physical therapy. Therefore, the patient underwent passive ROM exercise in the right upper extremity under sedation for 30 minutes, which was relatively easier due to decreased pain. After 2 days of passive ROM exercise under sedation, the patient was able to receive passive ROM exercise twice daily without sedation for 18 days. Outcomes: After 20 days of passive ROM exercise, including 2 days of passive ROM exercise under sedation, the circumference of her right hand decreased by 5 cm, wrist 2 cm, and elbow 6 cm compared to the initial measurement. Numeric pain rating scale improved from 9 to 3, and her manual muscle test marked fair plus from trace, Jebsen–Taylor hand function test score 43 from 0. Lessons: This case suggests that passive ROM exercise under sedation may be a successful alternative as a treatment when exercise, currently known as a treatment to CRPS, is impossible.Complex regional pain syndrome(CRPS) is a disorder characterized by an intractable, disabling pain of the affected limb. It is triggered by various injuries and is often resistant to standard therapy. We report a young soldier with CRPS of the right hand sustained from an electrical injury, who had improvement in resting pain with Zoledronic acid. In this report, we discuss the therapeutic options and the role of bisphosphonates in CRPS.
Zoledronic Acid
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Background/Purpose: complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, a surgery, a stroke or a heart attack. The pain is out of proportion to the severity of the initial injury. CRPS is uncommon, and its cause isn’t clearly understood.
Stroke
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This chapter contains sections titled: Minimal sedation Moderate sedation Deep sedation General anesthesia Evaluation of the patient from the standpoint of sedation and analgesia Monitoring Drugs used in sedation and analgesia Antidotes for drugs used in sedation and a nalgesia Considerations during sedation and analgesia Further reading
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This study aimed to determine the success rate of sedation-free upper gastrointestinal (GI) endoscopy and evaluate the cost-effectiveness of this drug-free approach.The study included patients who underwent gastroscopy between February 2020 and December 2022. Demographic information such as age and gender, along with clinical data including whether the procedure was performed with sedation and the patients' tolerance status, were recorded. Statistical analysis revealed no significant difference between the sedation and sedation-free groups in terms of procedural success. Interestingly, a notable cost difference of 43% was observed between the two groups, with the sedation-free group demonstrating higher cost-effectiveness. Despite the nearly 50% higher cost associated with administering sedation, there was no significant disparity in the successful completion of the procedure between the two groups. The findings of this study indicate that sedation-free upper GI endoscopy can achieve comparable success rates to the sedation-assisted approach. Moreover, the cost-effectiveness analysis highlights the economic advantage of the drug-free alternative, given the substantial cost reduction observed in the sedation-free group. This study underscores the feasibility of implementing sedation-free procedures as a cost-effective and successful option for upper GI endoscopy
Upper gastrointestinal endoscopy
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Introduction: Complex regional pain syndrome (CRPS) also known as reflex sympathetic dystrophy (RSD) and causalgia is a disorder of a body region, usually of the extremities that is characterized by pain, swelling, limited range of motion. It frequently begins following an injury, surgery, or vascular event such as a stroke. Vitamin C has been proposed to prevent the incidence of complex regional pain syndrome (CRPS).Aim and Objectives: The aim of this study was to assess the efficacy of vitamin C prophylaxis in the prevention of Complex regional pain syndrome (CRPS) Complex regional pain syndrome (CRPS) in patients after distal end radius fractures.Materials and Methods: This prospective and randomized study was conducted on 126 patients from August 2018 to July 2020 in the department of orthopaedics, Govt. Medical College Srinagar. In this study the enrolled patients were evaluated from OPD and emergency department. The enrolled patients were distributed in two groups A (66 patients) and B (60 patients). Patients treated with either conservative or surgical management for distal end radius fractures. In group A patients were given vitamin C with standard therapy and group B patients were given standard therapy alone. In both groups the treatment was given for the period of 3 months.Results: The complex regional pain syndrome (CRPS) was 12.12% in group A and 21.66% in group B. Conclusion: In this study it has been prevailed that daily administration of 500 mg of vitamin C prophylaxis could reduce the development of complex regional pain syndrome (CRPS) in patients after distal end radius fractures.
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Myofascial pain syndrome
Dystrophy
Pain syndrome
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Summary This study examined the relationship between temperament and sedation failure during magnetic resonance imaging (MRI) and computerized tomography (CT). One hundred and two children (aged 3–7 years) who underwent MRI or CT with or without sedation were studied. Demographics, sedatives administered, efficacy of sedation, and adverse events were recorded. Parents completed the Behavioural Style Questionnaire for 3–7 years olds during their wait. Eight children underwent MRI successfully without sedation, 83 were successfully sedated, and 11 procedures were aborted. Children whose sedation failed were less adaptable than children whose sedation was successful ( P =0.04). Children who underwent MRI without sedation were more persistent than children who were sedated ( P =0.05), and more persistent and less active than those whose sedation failed ( P =0.02 and 0.03, respectively). The child's underlying temperament may contribute to sedation outcomes during MRI and CT. A presedation assessment of the child's temperament may therefore assist in decisions regarding sedation.
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Sedation is one of ICU routine treatment, understand the harm to patients caused by deep sedation; by enhancing the ability to regulate the sedation nurse, to help early shallow sedation for goal orientation in the implementation of the program is to reduce sedation, sedation complications, effective means of preventing excessive sedation, is an important measure to promote the development of clinical nursing.
Key words:
Nurses; Conscious sedation; Deep sedation; Sedation
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