We report a case of pain management after a meniscal cyst excision, with the use of electroacupuncture (EA). There are a few reports which indicate that postoperative pain management is prerequisite for the patient's optimal recovery, but surveys in the UK and the USA have identified an unacceptable prevalence of poor pain control after surgery, which might increase the risk of a chronic pain state. The conventional treatment of postoperative pain includes systemic medications such as opioids, non-steroidal anti-inflammatory drugs and other non-opioid agents. In our case, the rehabilitation lasted for 6 months without significant benefit. After that period our patient was treated with EA. By the end of the first EA session the relief of pain was notable and after a course of 10 treatments the patient reported complete relief of the symptoms with no recurrence during a 2 year follow up period. In conclusion, this might indicate that EA could be useful for postoperative pain management.
Downloaded from aim.bmj.com on 16 July 2009 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 improvement. 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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