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Spinal cord stimulation in vascular insufficiency and phantom pain
SLIDE SESSIONS
s5
CNS stimulation I
PAIl+RELA!TEDEWKEDPWlX?l?IALSAFTERELECPRICAL STIMULATION OF ‘I'HEGASSERIAN GANGLION IN PATT-
WI'IHATYPCAbTRIGE%lINAL RALGIA.G. Kobal', I2, W.H.-M. Raab YU, C. HafT-Ch. Hamburger?, U. Steude Pharmacol y and lBxicolcgy University of Erlangeri-Niirnberg, D8520 Erlangen, Departmentof Neurosurgery,University of Miinchen,U-8000 Miinchen 70, E'FG. Aim of Investigatior!: The purposeof the presentstudy was to prove - -----_;--the analgesiceffect of electricalstimulationof the Gasserianganglion in patients with atypical trigeminalneuralgia by using pain-related evokedpotentials. Methods:Co applied to the nasal mucosa and electricpulses applied to the dental% ulp were used as painful stimuli.The EKG was recorded fran various positionsof the international lo/20 system Interstimulus intervalwas 30-40 sec. Electrodes (connected to a unipolar,multiprogramable neurological pulse generator) were implanted in the Gasserian ganglions of 7 patients suffering fran atypical trigeminal neuralgia.They were investigated before,during,and after therapeutical electricalstimulation. Results:In all patientsa statistically significant(m.01, t-test) reductionof the potentialcanponentNl/P2 was foundduring therapeutical stimulation.After terminationof the stimulationan increase in the potentialamplitudesas well as in the estimatesof painfulintensitywas observed within the same experimentalsession. The latencies of the evokedpotentialswere slightlylongerduringstimulation. Conclusion:In the describedexperimentsit was possibleto establishthe &xiFeffect of the therapeuticalelectrical stimulationof the Gasserianganglionby employingelectrophysiological techniques.
SPINAL CORD STIMULATION IN VASCULAR INSUFFICIENCY AND PHANTOM PAIN. G.P. Novelli*, M. Trapani*, P. Livi*, V. Bartoli* / and Inten(SPON: P. Procacci), Institute of Anesthesiology sive Care, University of Florence, Florence, Italy. Electrical stimulation of spinal cord (SCS) is a well accepted method to assure analgesia; in recent years it has been shown to provoke also an improvement of peripheral circulation. Eleven patients with severe peripheral vascular insufficiency not suitable for reconstructive surgery (stage III and IV) were studeied. Three patients with uncontrollable phantom pain were treated. SCS was performed using Medtronic Itrel unipolar devices totally implanted, locating the electrode in the peridural space at level TB-T12. The maximum follow-up is limited to about one year. Results: Complete pain relief was observed in all patients with phantom pain. Third stage patients (6) obtained a significant analgesia and improve-, ment of tissue perfusion as measured by cutaneous temperature, deep muscular temperature, reactive hyperemia and doppler flowmeter. Fourth stage patients (5) obtained satisfactory analgesia but in 3 of them amputation was unavoidable due to preexisting necrosis or to infections. Conclusion: according to our brief experience, SCS seems to be an effective mean for providing analgesia partly due to an effects on sympathetic system.
s5
CNS stimulation I
PAIl+RELA!TEDEWKEDPWlX?l?IALSAFTERELECPRICAL STIMULATION OF ‘I'HEGASSERIAN GANGLION IN PATT-
WI'IHATYPCAbTRIGE%lINAL RALGIA.G. Kobal', I2, W.H.-M. Raab YU, C. HafT-Ch. Hamburger?, U. Steude Pharmacol y and lBxicolcgy University of Erlangeri-Niirnberg, D8520 Erlangen, Departmentof Neurosurgery,University of Miinchen,U-8000 Miinchen 70, E'FG. Aim of Investigatior!: The purposeof the presentstudy was to prove - -----_;--the analgesiceffect of electricalstimulationof the Gasserianganglion in patients with atypical trigeminalneuralgia by using pain-related evokedpotentials. Methods:Co applied to the nasal mucosa and electricpulses applied to the dental% ulp were used as painful stimuli.The EKG was recorded fran various positionsof the international lo/20 system Interstimulus intervalwas 30-40 sec. Electrodes (connected to a unipolar,multiprogramable neurological pulse generator) were implanted in the Gasserian ganglions of 7 patients suffering fran atypical trigeminal neuralgia.They were investigated before,during,and after therapeutical electricalstimulation. Results:In all patientsa statistically significant(m.01, t-test) reductionof the potentialcanponentNl/P2 was foundduring therapeutical stimulation.After terminationof the stimulationan increase in the potentialamplitudesas well as in the estimatesof painfulintensitywas observed within the same experimentalsession. The latencies of the evokedpotentialswere slightlylongerduringstimulation. Conclusion:In the describedexperimentsit was possibleto establishthe &xiFeffect of the therapeuticalelectrical stimulationof the Gasserianganglionby employingelectrophysiological techniques.
SPINAL CORD STIMULATION IN VASCULAR INSUFFICIENCY AND PHANTOM PAIN. G.P. Novelli*, M. Trapani*, P. Livi*, V. Bartoli* / and Inten(SPON: P. Procacci), Institute of Anesthesiology sive Care, University of Florence, Florence, Italy. Electrical stimulation of spinal cord (SCS) is a well accepted method to assure analgesia; in recent years it has been shown to provoke also an improvement of peripheral circulation. Eleven patients with severe peripheral vascular insufficiency not suitable for reconstructive surgery (stage III and IV) were studeied. Three patients with uncontrollable phantom pain were treated. SCS was performed using Medtronic Itrel unipolar devices totally implanted, locating the electrode in the peridural space at level TB-T12. The maximum follow-up is limited to about one year. Results: Complete pain relief was observed in all patients with phantom pain. Third stage patients (6) obtained a significant analgesia and improve-, ment of tissue perfusion as measured by cutaneous temperature, deep muscular temperature, reactive hyperemia and doppler flowmeter. Fourth stage patients (5) obtained satisfactory analgesia but in 3 of them amputation was unavoidable due to preexisting necrosis or to infections. Conclusion: according to our brief experience, SCS seems to be an effective mean for providing analgesia partly due to an effects on sympathetic system.