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      Success with neurotropin in treating pediatric lower extremity pain induced by spinal cord injury after epidural anesthesia

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          Abstract

          Spinal cord injury (SCI) complicated by epidural anesthesia, though rare, can result in neuropathic pain. However, the treatment for this kind of life-altering injury remains a challenge. A 7-year-old girl was referred with dyskinesia and severe pain in her right lower extremity due to an accidental SCI following lumbar puncture. After treatment with analgesics such as gabapentin, mecobalamin, and dexamethasone/methylprednisolone for 1 week, the myodynamia had improved, but progressive pain persisted. After treatment with neurotropin, a gradual decrease in visual analog scale score from 7 to 0 was observed. We herein first describe that neurotropin produced sustained relief of pain induced by SCI. This case suggests that neurotropin might be a promising drug in treating pediatric neuropathic pain caused by SCI.

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          Most cited references 20

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          Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review.

          A 27-year-old woman developed severe adhesive arachnoiditis after an obstetric spinal anaesthetic with bupivacaine and fentanyl, complicated by back pain and headache. No other precipitating cause could be identified. She presented one week postpartum with communicating hydrocephalus and syringomyelia and underwent ventriculoperitoneal shunting and foramen magnum decompression. Two months later, she developed rapid, progressive paraplegia and sphincter dysfunction. Attempted treatments included exploratory laminectomy, external drainage of the syrinx and intravenous steroids, but these were unsuccessful and the patient remains significantly disabled 21 months later. We discuss the pathophysiology of adhesive arachnoiditis following central neuraxial anaesthesia and possible causative factors, including contamination of the injectate, intrathecal blood and local anaesthetic neurotoxicity, with reference to other published cases. In the absence of more conclusive data, practitioners of central neuraxial anaesthesia can only continue to ensure meticulous, aseptic, atraumatic technique and avoid all potential sources of contamination. It seems appropriate to discuss with patients the possibility of delayed, permanent neurological deficit while taking informed consent.
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            Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury: An Update.

            To update a systematic review of published research on pharmacotherapy for pain post-spinal cord injury (SCI).
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              Case report: neurological complications associated with epidural analgesia in children: a report of 4 cases of ambiguous etiologies.

              The safety and utility of pediatric epidural analgesia is well established, but the risk of permanent neurological injury is unknown and largely must be extrapolated from adult literature. In this article we present a series of 4 cases of longterm or permanent neurologic complications associated with epidural analgesia. Possible mechanisms of injury and implications for practice are discussed.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                06 June 2017
                : 10
                : 1391-1394
                Affiliations
                [1 ]Department of Pain Clinic
                [2 ]Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang
                [3 ]Department of Pain Clinic, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
                Author notes
                Correspondence: Yong Zhang, Department of Pain Clinic, The First Affiliated Hospital of Nanchang University, 17 Yongwaizhen Street, Nanchang 330006, Jiangxi, People’s Republic of China, Email zy830226@ 123456163.com
                [*]

                These authors contributed equally to this work

                Article
                jpr-10-1391
                10.2147/JPR.S135037
                5476653
                © 2017 Zhu et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Case Report

                Anesthesiology & Pain management

                children, spinal cord injury, neurotropin, pain

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