Postoperative pain management and acupuncture: a case report of meniscal cyst excision by ProQuest


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                                                                                                                                  Case report

                                                                                                       style acupuncture. Our patient was trea-
Postoperative pain management and                                                                      ted by use of eight points unilateral,
                                                                                                       connected      in    pairs    (ST36,SP10,
acupuncture: a case report of meniscal cyst                                                            BL39,GB34, ST34,SP9, BL38,KI10)
                                                                                                       with electrical stimulation at about
excision                                                                                               25 minutes at 80 Hz/2 Hz at the highest
                                                                                                       tolerable intensity.
Nikiforos Galanis, Chara Stavraka, Triantafyllia Boutsiadou,                                              The needles we used (Wujiang Shen Li
                                                                                                       Medical & Healthmaterial Co., Ltd) were
John M Kirkos, George Kapetanos                                                                        sterile, disposable, with 0.2560.25 mm
                                                                                                       gauge and inserted at a depth of 1–1.5
We report a case of pain management after a meniscal cyst excision, with the use of                    cun perpendicularly.
electroacupuncture (EA). There are a few reports which indicate that postoperative pain                   Acupuncture treatment consisted of
management is prerequisite for the patient’s optimal recovery, but surveys in the UK and the USA       three sessions per week for two weeks
have identified an unacceptable prevalence of poor pain control after surgery, which might increase    followed by four additional sessions, once a
the risk of a chronic pain state. The conventional treatment of postoperative pain includes systemic   week, to maintain the acupuncture results.
medications such as opioids, non-steroidal anti-inflammatory drugs and other non-opioid agents. In        After the first session the patient
our case, the rehabilitation lasted for 6 months without significant benefit. After that period our    responded to the therapy and two ses-
patient was treated with EA. By the end of the first EA session the relief of pain was notable and     sions later the pain was sufficiently
after a course of 10 treatments the patient reported complete relief of the symptoms with no           reduced (at about level 2). By the comple-
recurrence during a 2 year follow up period. In conclusion, this might indicate that EA could be       tion of acupuncture sessions the patient
useful for postoperative pain management.                                                              reported no further discomfort. After two
                                                                                                       years follow-up period the patient
                                                                                                       reported no recurrence.
CASE HISTORY                                          Routine blood and urine examination
A 62-year-old woman was admitted to our            showed no abnormalities. x Rays and MRI
hospital reporting pain varying in severity        were ordered due to suspicion of either:            DISCUSSION
from 6 to 8, registered using 0–10 point           (1) any kind of mass as a lipoma or                 A meniscal cyst is a cystic lesion of the
numerical rating scale. The pain had started       synovial sarcoma, (2) any kind of menis-            meniscus, varying in prevalence from 1–
gradually 3 months ago and was located in          cal cyst such as parameniscal or synovial           2%3 4 to 7–8%5 6 according to arthroscopic
the lateral aspect of the head of left fibula.     cyst.                                               and surgical findings. Meniscal cysts can
She described it as dull, aching and also             No abnormalities were detected in the            be divided into three categories: intrame-
cramping with radiation in the distribution        x ray. MRI revealed a parameniscal cyst             niscal, parameniscal and synovial cysts.
of the L5 dermatome. Nocturnal pain was            with no serious meniscal lesion. Two days           Parameniscal cysts are more common in
                                                   later our patient underwent a minimal               comparison to intrameniscal and synovial
reported whilst the patient stated its
                                                   invasive excision. The cyst was removed             cysts.7
aggravation during walking and remission
                                                   and the histopathological examination                  A number of theories regarding the
when resting. Following her GP’s prescrip-
                                                   confirmed the diagnosis.                            aetiology of meniscal cysts have been
tion she was under pharmacological treat-
                                                      The patient followed the conventional            proposed. The most widely accepted
ment with systemic medication such as
                                                   physiotherapy and pharmacological1 2                theory describes that meniscal cysts ori-
paracetamol and non-steroidal anti-inflam-
                                                   pain control for 3 months. After that               ginate from the extrusion of synovial fluid
matory drugs for the last 3 months with no
                                                   time the patient reported similar discom-           through an adjacent meniscal tear.6 8–12
                                                   fort as preoperatively. The pain initially             Pain that deteriorates by activity is the
   The patient’s medical history included                                                              main clinical symptom accompanying
seasonal allergic asthma under treatment           intermittent, gradually became constant
                                                   and its intensity sometimes reached 8 out           meniscal cysts. In our case, the severity
with desloratadine. Routine gynaecologi-                                                               of pain was affecting the quality of her
cal examination had recently revealed a            of 10 (0–10 pain scale) with additional
                                                   accompanying symptoms such as numb-                 life. Large meniscal cysts usually appear as
unilocular ovarian cyst, 3 cm in size with                                                             painful palpable masses along the ante-
benign characteristics, requiring no treat-        ness, pins and needles. The physical
                                                   examination, the postoperative MRI and              rolateral aspect of the knee joint, whereas
ment. The patient also suffered from                                                                   small ones can also be asymptomatic.8 13
chronic hepatitis C, with alanine amino-           the electromyogram did not reveal any
                                                   abnormalities. Being disappointed about   
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