University of Louisville School of Medicine,USA
Dr Aurel Neamtu has completed his MD followed by a PhD at the Iuliu Hatieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. Later he has completed an anesthesiology residency at the University of Louisville School of Medicine, and a pain fellowship at Washington University in St. Louis. Since 2004 he has served as faculty member in the Department of Anesthesiology at the University of Louisville SOM. His more recent interest is in ultrasound guided procedures, both for acute and chronic pain. Dr. Neamtu has published 12 peer reviewed papers and more than 30 abstracts and posters.
For the purpose of this presentation, the term “painful peripheral neuropathy” is used to mean the neuropathic pain conditions associated with most peripheral neuropathies, with the exception of trigeminal neuralgia, which is unique in terms of its clinical presentation and management. Over the past decade, diabetic polyneuropathy and postherpetic neuralgia have been the target of most treatment trials (1–3), with HIV sensory neuropathy, carpal-tunnel syndrome, and alcoholic polyneuropathy being less rigorously studied (4-6). The first comprehensive guidelines on pharmacological treatment of neuropathic pain published in 2006 (7) provide algorithms for medical management of most peripheral neuropathies. However, in this presentation the focus will be mostly on invasive management of painful peripheral neuropathies. Starting from a case presentation of a patient with posttraumatic saphenous peripheral neuropathy, the role of ultrasound guided procedures combined with older methods of neurolytic blocks will be discussed. Ultrasound guided procedures allow physicians to use real time images to deliver the local anesthetics, neurolytic substances, or perform radiofrequency ablations more accurately at the target of choice. In this way, potential complications that resulted in quasi abandonment of some older techniques could be reconsidered.