Spinal Cord Stimulation for the Treatment of Intractable Pain from Failed Back Surgery Syndrome

Introduction: Failed back surgery syndrome (FBSS) is a debilitating chronic neuropathic pain condition, affecting approximately 10–40% of patients after lumbosacral spine surgery. Treatment of FBSS is challenging as conservative therapies and repeat surgery often fail in providing adequate pain relief. Spinal cord stimulation (SCS) has been proven to be a successful therapeutic option in FBSS patients. Case Report: A 23 year-old male presented with persistent low back pain and bilateral radicular pain after spinal surgery. He was also wheelchair-bound because of his severe pain. Conservative treatment with oral analgesics and interventional pain procedures were unsuccessful in improving his pain. Subsequently, we performed a permanent implantation of epidural leads for SCS after a successful trial of SCS. He reported good coverage of pain without complications after the procedure. Three months after surgery, and after intensive physiotherapy and rehabilitation, he could walk and return to work. Conclusion: We describe our first successful case of treating intractable pain from FBSS in a patient after implantation of SCS leads in our institution

A Randomised Controlled Trial Evaluating the Efficacy of a Nurse Controlled Analgesia (NCA) Protocol in Post Anaesthesia Care Unit (PACU)

Introduction: The purpose of this trial was to determine the efficacy of a Nurse Controlled Analgesia (NCA) protocol in reducing the time taken to achieve a satisfactory postoperative pain score. The safety aspects of the NCA protocol were also evaluated. Method: 120 patients undergoing major surgery were randomised into 2 groups – NCA group and the doctor administered analgesia group (DRA). Nurses in the Post Anaesthestic Care Area (PACU) administered analgesia based on a protocol whereas analgesia was titrated at the discretion of the doctor in the DRA group. Effective pain control was measured by the time taken to obtain first dose of analgesia and the time taken to achieve either a pain score of less than 4/10 or if the patient refused further analgesia. Results: Patients received their first dose of morphine faster in the NCA group compared to DRA group, 6.7 minutes versus 9.5 minutes respectively (p= 0.037). Time taken to achieve a pain score of less than 4 was shorter in the doctor group although this was not significant. Complication rates were not different in both groups. Conclusion: Nurse administered analgesia based on a protocol can provide pain relief for patients in the postoperative period as effectively and safely as doctor administered analgesia