Chronic abdominal, groin, and perineal pain of visceral origin
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
Neurolysis by percutaneous injection or surgical resection have been described. The most positive results are those of Gillespie73 who reported on 175 women diagnosed with IC treated with laser obliteration of the vesicoureteric plexus bilaterally. One hundred and twelve patients reported complete relief and 58 partial relief following the procedure. Two-year follow-up in 45 patients in the “complete relief” group demonstrated no recurrence of symptoms. Considered a last resort, surgery in the form of supravesical diversions or cystectomy has also received mixed reports of efficacy. For example, Peeker et al.74 reported excellent results in patients with classic (ulcerative) IC and poor results in nonulcerative IC. Webster et al.75 reported that only two of their 14 patients treated surgically with urinary diversion and cystourethrectomy had symptom resolution, and Baskin and Tanagho80 have reported on patients with continued bladder pain despite the absence of a bladder.
Hands
Tor Wo Chiu in Stone’s Plastic Surgery Facts, 2018
Common indications for open surgery include the following: Revisional surgery/recurrenceAcute burns (see ‘burns’) due to direct injury, reperfusion, over-resuscitation, etc.Other surgery planned, e.g.Opponensplasty.Synovectomy – generally not needed except those with florid disease such as rheumatoid and amyloid.CTS associated with acute fracture.Neurolysis is of little benefit with risks of scarring and further tethering; it will usually need to be combined with other procedures to reduce adhesions, e.g. vein wrap, muscle flaps, steroids or early motion.
Nerve blocks: chemical and physical neurolytic agents
Nigel Sykes, Michael I Bennett, Chun-Su Yuan in Clinical Pain Management, 2008
Complications following neurolysis include motor paralysis, sensory disturbance, autonomic disturbance, and minor problems such as pain on injection (Table 17.9). No controlled data exist regarding the use of intrathecal neurolysis, so it is difficult to estimate the exact incidence of these complications. However, complications are likely to be reduced by accurate needle placement using image intensification where appropriate. The higher concentrations of alcohol, 50 percent and above, are more likely to cause motor paralysis. Dysesthetic pains such as neuralgias are infrequent after injection. After intrathecal neurolysis, an area of numbness may replace the painful area. Some patients may find this distressing.
Meralgia paresthetica: finding an effective cure
Published in Postgraduate Medicine, 2020
Two surgical interventions may be used in MP: Neurolysis and Neurectomy, but both have their advantages. In neurolysis, the surgeon tries to release the nerve from compression along its course. There are some challenges with this approach, most notably the variable course of the nerve and the location of the compression. One of the most common methods is threefold; the first is to sever the inguinal ligament overlying the LFCN, then to cut the iliac fascia underlying the nerve, and last to cut distally along the thigh fascia for each division [52–55]. Success rate following this procedures varies with reports ranging from as low as 60% to as high as 99% [46] with most studies reporting an average of 80% success rate [52–55]. Although the success rate is not very high, this approach carries the main advantages of no sensory loss following the procedures due to preserving the nerve.
Peroneal neuropathy and bariatric surgery: untying the knot
Published in International Journal of Neuroscience, 2020
Mohamad Y. Fares, Zakia Dimassi, Jawad Fares, Umayya Musharrafieh
Therapeutic modalities for this condition should be specific to each individual case. However, two approaches have been proposed as the best choice for therapy: a conservative approach and a surgical approach [21]. The conservative approach includes physical therapy, and vitamin and nutrition supplementation to replenish any vitamin deficiencies [23]. In the case where symptoms remain persistent, surgery can be done to relieve pain and improve outcomes [16,22]. Surgical techniques and time of intervention differ according to the nature of the presenting case. Neurolysis often yields the best outcome when compared to other surgical techniques. End-to-end suture repair is considered preferable to graft repair, and shorter grafts provide better outcomes [36]. That being said, one should not delay treatment since the probability of irreversible neurological damage increases with time [21].
Practice patterns for the treatment of acute proximal hamstring ruptures
Published in The Physician and Sportsmedicine, 2020
Nicholas Pasic, J. Robert Giffin, Ryan M. Degen
The approach respondents took to the sciatic nerve was consistent with current literature. The majority performed neurolysis only if symptoms were present pre-operatively. However, respondents felt that on average only 18% of patients presented with sciatic nerve symptoms. This rate is higher than a previous study by Subbu et al. that reported sciatic nerve symptoms in 11% of patients, but lower than the rate reported by Wilson et al. who reported that ~28% of patients with acute ruptures had sciatic nerve-related symptoms [15,20]. In the latter study, they advocate that nerve symptoms are likely under-recognized, with symptoms presenting in a variety of ways with a mix of motor weakness, sensory changes and neuropathic pain [20]. This illustrates the importance of a thorough pre-operative physical exam documenting sciatic nerve function.
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