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All Journal Jurnal Anestesiologi Indonesia Journal of Anaesthesia and Pain Academic Hospital Journal
Nur Azza, Kamala Kan
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health

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Tunneled Epidural Analgesia for Refractory Scrotal Cancer Pain: A Case-Based Evaluation of Therapeutic Efficacy Nur Azza, Kamala Kan; Tomo, Wahyu Kartiko; Darwito, Darwito; Puspitasari, Ika; Mahmud, Mahmud; Widyastuti, Yunita
Academic Hospital Journal Vol 7, No 2 (2025)
Publisher : Rumah Sakit Akademik Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ahj.v7i2.109434

Abstract

Background: Scrotal Squamous Cell Carcinoma (SCC) is a rare malignancy. Although SCC typically demonstrates slow progression, in advanced stages with significant size, it can cause considerable pain due to mass effect and local tissue invasion. The management of cancer-related pain encompasses a wide spectrum of approaches, ranging from pharmacologic to surgical interventions. In cases where patients become intolerant to the side effects of pharmacologic therapies and adequate pain relief cannot be achieved, while surgical options are either not feasible, interventional pain management may offer an effective alternative. Tunneled Epidural Analgesia represents one such interventional technique that can be considered for refractory pain. This case report aims to evaluate the efficacy of tunneled epidural analgesia administration in managing intractable pain associated with advanced scrotal SCC.Materials and methods: This case report is structured according to the CARE (Case Report) guideline. The study was conducted at UGM Academic Hospital, where the patient received evaluation and treatment.Case: A 65-year-old male diagnosed with SCC presented experiencing refractory cancer pain. Despite receiving conventional analgesic therapy, he experienced no significant pain relief and developed adverse effects. Pain management was subsequently escalated to an interventional approach using a bupivacaine 0.125% and fentanyl 25 mcg administered via a tunneled epidural drug delivery system. This intervention resulted in effective pain control, enabling him to do daily activities. With this modality, the pain remained well managed, although occasional breakthrough pain occurred, which was successfully managed with 1% lidocaine as a rescue analgesic.Conclusion: Tunneled epidural analgesia using a combination of opioid and bupivacaine has demonstrated effectiveness in the management of refractory scrotal cancer pain.
Interlaminar Cervical Epidural Non-Particulate Steroid Injection for Acute Cervical Radicular Pain: A Case Study of Clinical Effectiveness Nur Azza, Kamala Kan; Susianti, Noor Alia; Mahmud, Mahmud; Nathania, Caroline Evanthe
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.73464

Abstract

Background: Cervical radicular pain is pain that arises in the upper extremities caused by ectopic activities of afferent nociceptive or radix medulla spinalis. The pain intervention which can be done is interlaminar cervical epidural steroid injection (ICESI), transforaminal epidural steroid injection (TFSI), thermal radio frequency (TRF), pulse radio frequency (PRF), spinal cord stimulation (SCS), or surgery. Each modalities have different benefits and side effects. The success of ICESI is still debatable. This case report aimed to evaluate the success of ICESI for cervical radicular pain.Case: A woman, 71 years old, suffered from neck pain with radicular pain along the arm, until the palm, thumbs, and index finger on both right and left sides. The patient reported persistent pain predominantly in the palms, with an intensity of 7 out of 10 on the numeric rating scale (NRS). She felt the pain for 2 months, and it wasn’t relieved with pharmacotherapy and physiotherapy. The cervical magnetic resonance imaging (MRI) showed entrapment at the radix C6. The patient was advised to undergo an operative procedure, but the patient refused it and was offered an ICESI.Discussion: The ICESI approach has been proven to be effective in managing acute cervical radicular pain. By delivering corticosteroids into the epidural space, ICESI reduces inflammation around the affected nerve roots, leading to significant pain relief and improved functional outcomes, and allows for a broader spread of medication across multiple levels.Conclusion: ICESI is effective for cervical radicular pain.
A Comprehensive Review of Complex Regional Pain Syndrome: Diagnostic Challenges and Therapeutic Innovations Nur Azza, Kamala Kan; Mahmud, Mahmud; Susianti, Noor Alia; Widyastuti, Yunita; Puspitasari, Ika; Nathania, Caroline Evanthe
Journal of Anaesthesia and Pain Vol. 7 No. 1 (2026): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Complex regional pain syndrome (CRPS) is a medical condition marked by disturbances in motor, sensory, and autonomic functions in the affected extremities, which may occur with or without trauma. The prevalence of CRPS is approximately 2–5% in adults, with a higher incidence in females. Annually, CRPS affects between 5.4 and 26.2 individuals per 100,000 population. The diagnosis of CRPS presents a significant clinical challenge, as its symptoms often mimic those of other conditions, frequently leading to misdiagnosis. A thorough understanding of CRPS and its diagnostic criteria is crucial for clinicians, as accurate diagnosis directly affects treatment selection and outcomes. An effective management approach should encompass the four foundational pillars of CRPS therapy, i.e., education and information for the patients, pain management including both pharmacologic and pain intervention approaches, vocational and physical rehabilitation, and psychological interventions. A comprehensive and individualized treatment strategy is crucial to achieving optimal outcomes. When inadequately treated, CRPS can have profound effects on the physical, emotional, social, and quality-of-life (QoL) aspects, as well as the financial well-being, of both patients and their families. Given the relatively high prevalence of CRPS, the diagnostic complexity, and the broad implications for patient care and QoL, a thorough review of the existing knowledge and treatment strategies for CRPS is warranted. This review aims to provide clinicians with the latest information on diagnosing and managing CRPS, thereby supporting timely and effective clinical decision-making. Accurate diagnosis and appropriate therapy are expected to yield positive outcomes for the patients and their families.
Co-Authors Darwito, Darwito Ika Puspitasari Mahmud Mahmud Nathania, Caroline Evanthe Susianti, Noor Alia Tomo, Wahyu Kartiko Yunita Widyastuti