Dear Physio members:

I am going to receive a referral of a female who suffers facial
pain/headache status post face lift.  If anyone has experience in
successfuly treating someone like her, please contact me.  I will have more
specific information on her after her initial evaluation.  She had 5
sessions of PT in another clinic and treatments included E-stim, US, etc...
She also had one nerve block.  Sorry for the incomlete picture but I will
be greatly appreciated if you have any comment on this type of care.

Thank you in advance.

Sachiko Komagata, PT
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p.s.  I attached an article I found through Medline search.







Date: 08-Apr-98
Name: T2596_21a000c_
Database: Medline <1995 to April 1998>

Set   Search                                                       Results
---------------------------------------------------------------------------
001   surgical flaps/ae                                                143
002   (facial surgery and pain).ti,ab,sh.                                3
003   from 2 keep 1                                                      1
004   from 2 keep 1                                                      1
005   from 2 keep 3                                                      1


<1>
Unique Identifier
  96015935
Authors
  Lipp M.  Daublander M.  Sebastian M.  Dick W.
Institution
  Klinik fur Anasthesiologie, Johannes Gutenberg-Universitat Mainz.
Title
  [Analgesia-sedation for maxillo-facial surgery with midazolam-pentazocine
  and miazolam-ketamine. Clinical double-blind study of anxiety, analgesia,
  sedation and amnesia]. [German]
Original Title
  Analgosedierungsverfahren fur zahnarztlich-chirurgische Eingriffe mit
  Midazolam/Pentazocin und Midazolam/Ketamin. Klinische Doppelblindstudie zu
  Anxiolyse, Analgesie, Sedierung und Amnesie.
Source
  Anaesthesist.  44(8):566-72, 1995 Aug.
MeSH Subject Headings
  Adult
  Ambulatory Surgical Procedures
  Amnesia/ci [Chemically Induced]
  Analgesia
  *Anesthesia
  *Anesthesia Adjuvants
  *Anesthetics, Dissociative
  Anxiety/pc [Prevention & Control]
  Double-Blind Method
  English Abstract
  *Face/su [Surgery]
  Human
  Hypnotics and Sedatives
  *Ketamine
  *Maxilla/su [Surgery]
  *Midazolam
  *Pentazocine
Abstract
  Ketamine and midazolam, applied as intravenous medication for conscious
  sedation in day-case maxillo-facial surgery, has been proven to be
  superior to pentazocine and midazolam concerning cardiovascular parameters
  and respiratory depression. The aim of this study was to evaluate the
  effects of low-dose ketamine/midazolam on anxiety, analgesia, amnesia and
  subjective feelings. METHODS. 140 out-patients (ASA I) were randomly
  divided into four groups. The double-blind study was prospective. Control
  group: Local anaesthesia (LA), articaine 4% plus epinephrine 1:200,000 (n
  = 35); test group P/M: LA, additional pentazocine 0.40 mg/kg bw and
  midazolam 0.075 mg/kg bw i.v. (n = 35); test group K25/M: LA, additionally
  ketamine 0.25 mg/kg bw and midazolam 0.075 mg/kg bw i.v. (n = 35), test
  group K50/M: LA, additionally ketamine 0.5 mg/kg bw and midazolam 0.075
  mg/kg bw i.v. (n = 35). LA was injected 3 min after application of the
  systemic medication in the test groups or application of a placebo (saline
  0.9%) in the control group. Three further minutes later, operation was
  started. For evaluation questionnaires, visual analogue scales (VAS) and
  the state-trait anxiety inventory (STAI) were used. For testing retrograde
  and anterograde amnesia, acoustic sensations were delivered before
  application of the systemic medication (a Christmas carol) and during
  operation (the German national anthem). RESULTS. The control group and the
  test groups were comparable with regard to biological data, duration of
  operation, applied dosage of local anaesthetics and actual anxiety before
  operation. The patients in all test groups rated intraoperative anxiety as
  mild, in contrast to the control group. Nearly no pain sensation during
  the operation was remembered in all test groups. Retrograde amnesia was
  not found in any group. Complete anterograde amnesia was observed in all
  test groups with respect to the intraoperative sensation, but even in the
  control group 50% of the patients did not remember having heard the
  national anthem. As subjective feelings negative criteria were mainly
  reported in the control group, where as in all test groups positive
  sensations dominated. Dreams were reported mostly after the higher dosage
  of ketamine, but no patient experienced any unpleasant dreams. The
  clinical assessment of the different regimes were excellent for test
  groups P/M and K50/M, modest for the control group and test group K25/M.
  Postoperatively, patients of test group P/M were remarkably sedated, but
  no clinically relevant sedation or motor weakness were observed in the
  other groups. Postoperative pain sensations were rated more intense in all
  test groups than in the control group. In test groups P/M and K25/M an
  increasing pain level was recorded during the postoperative period, with
  the consequence of a higher demand rate for analgesics. CONCLUSIONS.
  Dental surgery can be performed safely with low-dose ketamine/midazolam.
  Compared to pentazocine/midazolam, the higher dosage of ketamine (0.5
  mg/kg bw) showed identical results intraoperatively, but was superior
  during the postoperative period (vigilance), and thus may represent a
  suitable dosage. The lower dosage of ketamine resulted in worse operating
  conditions, but a dosage higher than 0.5 mg/kg bw might lead to
  unconscious sedation and might increase the frequency of unpleasant
  dreams.
Registry Numbers
  0 (Anesthesia Adjuvants).  0 (Anesthetics, Dissociative).  0 (Hypnotics
  and Sedatives).  359-83-1 (Pentazocine).  59467-70-8 (Midazolam). 
  6740-88-1 (Ketamine).