post splenic embolization pain

[hbutler at pol.net]

  Can an anesthesiologist locate a place to inject the involved nerve,
possibly using CT guidance?

> --- You wrote:
>   What do you make the neurology of the pain to be?  Dermatomal?
> Visceral?
> Blockable?
> --- end of quote ---
> more info:
> pt. has tried massage, acupuncture, medial nerve blocks, radiofrequency
> ablation, injection of the subcostal scar, Neurontin, opiods,counseling
> and antidepressants. One examiner thought he had a "floating rib' and
> injected it without benefit. There was no hx of rib fxs and CT scan
> shows no chest wall abnormality. he has constant "deep" pain not made
> worse with any manipulation of the abdominal or chest wall.
>
> CT scans (10 months apart) show a stable pattern in which the spleen is
> perfused but there is peri splenic "streaking" around the superior and
> inferior poles. there are no cystic collections or wedge shaped infarcts
> but there is a non homogenous pattern in the mid postero lateral spleen
> that extends out to the diaphragm and abdominal wall. the splenic
> embolization coils are 2-3 cms proximal to the splenic hilum.
>
> I have done splenectomies for persistent pain, infarcts, renewed
> bleeding, continued SIRS,etc. up to 2 weeks out following embolization
> but never one that was this delayed ( i.e. > 3 years).
>
> Would splenectomy be reasonable in this pt?
>
> thanks
> JES
>
>
> John E. Sutton, Jr., M.D. , F.A.C.S
> Professor of Surgery,  Dartmouth Medical School
> Division Chief, Trauma and Acute Surgical Care
> Director of Trauma Services DHMC
> phone: 603-650-8022
> fax :     603-650-8030
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