Pain Management..

### Pain Management Techniques

Which of the following is the most common microbe that grows in cultures of infected intrathecal pump wounds?

(A) Pseudomonas species

(B) Escherichia coli

(C) Staphylococcus aureus

(D) Staphylococcus epidermidis

(E) None of the above

(D)

• A. Pseudomonas species grew in 3% of infected wound cultures.

• B. Escherichia coli is probably among the unknown or not reported 20% or the multiple or other species (7%).

• C. and D. Staphylococcus species grew in cultures of infected sites 59% of the time. Most reports did not specify whether the cultured Staphylococcus organisms were S aureus or S epidermidis. However one study specifically emphasized S epidermidis, which arises from the skin of the patient or operating room personnel, as the most likely culprit. No growth took place in 9% of the infected-wound cultures. No positive fungal cultures were reported.

You think a patient has developed an intrathecal catheter-tip inflammatory mass. What signs and symptoms would support this finding?

(A) Diminishing analgesic effects

(B) Pain that mimics nerve root compression

(C) Pain that mimics cholecystitis

(D) A and B

(E) A, B, and C

(E)

1. Subtle prodromal signs and symptoms during early growth of a catheter-tip mass include decreasing analgesic effects (loss of previously satisfactory pain relief) and unusual increase in the patient's underlying pain. Another occurrence was that patient required unusually frequent or high dose escalations to obtain analgesia. In certain instances, dose increases and large drug boluses reduced the patient's pain only temporarily or to a lesser degree than previous experiences predicted.

2. Catheter-tip masses in the lumbar region sometimes simulated nerve root compression from a herniated intervertebral disc or spinal stenosis.

3. When the catheter tip is located in the thoracic region, early signs and symptoms of an extra-axial inflammatory mass sometimes included thoracic radicular pain that stimulated intercostal neuralgia or cholecystitis.

Gradual, insidious neurologic deterioration weeks or months after the appearance of subjective symptoms was the most common clinical course before the onset of myelopathy or cauda equina syndrome.

Myelopathy is a term that means that there is something wrong with the spinal cord itself. This is usually a later stage of cervical spine disease, and is often first detected as difficulty while walking because of generalized weakness or problems with balance and coordination. This type of process occurs most commonly in the elderly, who can have many ...

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