Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2024
Fluoroscopy-guided high-intensity focused ultrasound ablation of the lumbar medial branch nerves: dose escalation study and comparison with radiofrequency ablation in a porcine model.
Radiofrequency ablation (RFA) is a common method for alleviating chronic back pain by targeting and ablating of facet joint sensory nerves. High-intensity focused ultrasound (HIFU) is an emerging, non-invasive, image-guided technology capable of providing thermal tissue ablation. While HIFU shows promise as a potentially superior option for ablating sensory nerves, its efficacy needs validation and comparison with existing methods. ⋯ These findings suggest that HIFU may be more effective than RFA in inducing thermal necrosis of the nerve.
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Reg Anesth Pain Med · Mar 2024
First evidence of a biomarker-based dose-response relationship in chronic pain using physiological closed-loop spinal cord stimulation.
In spinal cord stimulation (SCS) therapy, electricity is the medication delivered to the spinal cord for pain relief. In contrast to conventional medication where dose is determined by desired therapeutic plasma concentration, there is lack of equivalent means of determining dose delivery in SCS. In open-loop (OL) SCS, due to the dynamic nature of the epidural space, the activating electric field delivered is inconsistent at the level of the dorsal columns. Recent Food and Drug Administration guidance suggests accurate and consistent therapy delivered using physiologic closed-loop control (PCLC) devices can minimize underdosage or overdosage and enhance medical care. PCLC-based evoked compound action potential (ECAP)-controlled technology provides the ability to prescribe a precise stimulation dose unique to each patient, continuously measure neural activation, and objectively inform SCS therapy optimization. ⋯ Higher dose, more time over ECAP threshold, and higher accuracy are associated with better outcomes across patients. There is potential to optimize individual patient outcomes based on unique objective measurable electrophysiological inputs.
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Reg Anesth Pain Med · Mar 2024
Prospective evaluation of the safety of ultrasound-guided cervical medial branch blocks using the in-plane technique.
While fluoroscopic guidance is currently the imaging standard for cervical medial branch blocks (CMBBs), ultrasound guidance (USG) offers several potential safety advantages such as real-time needle visualization and the ability to detect and avoid critical soft tissue vascular or neural structures. However, no large-scale trials have examined the safety of USG for CMBB. ⋯ When performed using an in-plane technique by experienced operators, USG CMBB was found to be safe, with rare minor immediate complications and no further adverse event reported in the following 2 weeks.
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Reg Anesth Pain Med · Mar 2024
Multimodal pain management and postoperative outcomes in inpatient and outpatient shoulder arthroplasties: a population-based study.
Multimodal analgesia has been associated with reduced opioid utilization, opioid-related complications, and improved recovery in various orthopedic surgeries; however, large sample size data is lacking for shoulder surgery. ⋯ Multimodal analgesia is associated with reductions in opioid charges-specifically inpatient setting-but not various other outcomes.