Maged Guirguis

Trigeminal Nerve Block

Trigeminal neuralgia is characterized by intense electric, shooting, and shock-like pain in the trigeminal nerve distribution on a unilateral side. The most common indication for performing TNB is trigeminal neuralgia refractory to medical treatment. The contraindications for performing TNB include the following: patient refusal, local infection, sepsis, coagulopathy, increased intracranial pressure, allergy to local anesthetics, and uncooperative patient. The classic approach may be utilized to perform a block/radiofrequency ablation at the level of the Gasserian ganglion, ophthalmic division, maxillary division, or mandibular division. The coronoid approach may be utilized for simultaneous maxillary and mandibular nerve block.

The Business of Pain Medicine

The Business of Pain Medicine will explore key concepts surrounding physician practice types and physician compensation models. An array of practice types and compensation models are available to physicians in the healthcare industry today. Physicians may practice independently or seek employment or alignment with a hospital or major health system. Compensation models can range from salary only to production based, value based, or a hybrid based on components of these.

A Rare Case of Transverse Sinus Venous Thrombosis Simulating Postdural Puncture Headache After Cervical Epidural Injection.

Postdural puncture headache (PDPH) is a feared complication related to epidural steroid injections. We report a unique case in which all subjective and objective findings indicated the diagnosis of PDPH. However, the patient failed appropriate conservative and interventional management. Therapeutic failure prompted further investigation to establish the correct diagnosis of cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis is a rare, difficult to diagnose, but potentially lethal disorder with nonspecific and variable clinical presentations, including headache and focal neurological deficits. Performing magnetic resonance imaging and magnetic resonance venogram should be considered early, especially in patients who fail to respond to standard interventions for PDPH.

Continuous Anterior Sciatic Nerve Block: A Case Series

Continuous Anterior Sciatic Nerve Block: A Case Series Sciatic nerve block is classically performed through posterior or lateral approaches. With the increased use of ultrasound, the anterior approach has gained popularity. An anterior approach should be considered in patients after trauma and severe postoperative pain where patient positioning can be challenging. The anatomical landmark techniques can be difficult for anterior approach and cannot always be relied on due to inconsistency in extremely obese population. The presence of large blood vessels in the needle path and increasing use of anticoagulants, call for the use of ultrasound guidance for anterior approach to sciatic nerve