Pain physician
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Randomized Controlled Trial
Effect of 3 Different Doses of Intrathecal Dexmedetomidine (2.5µg, 5µg, and 10 µg) on Subarachnoid Block Characteristics: A Prospective Randomized Double Blind Dose-Response Trial.
The extended analgesic efficacy of intrathecal dexmedetomidine (ITD) has been investigated in a few clinical trials; however, there is a lack of conclusive evidence upon its ideal dosage. ⋯ The addition of 10 µg compared with 2.5 µg or 5µg ITD to 0.5% hyperbaric bupivacaine is associated with significantly earlier onset of sensory and motor block as well as prolonged duration of sensory block, motor block, analgesia, and DA with a comparable adverse effect profile.
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Review Case Reports
Thoracic Nerve Root Entrapment by Intrathecal Catheter Coiling: Case Report and Review of the Literature.
Intrathecal catheter placement has long-term therapeutic benefits in the management of chronic, intractable pain. Despite the diverse clinical applicability and rising prevalence of implantable drug delivery systems in pain medicine, the spectrum of complications associated with intrathecal catheterization remains largely understudied and underreported in the literature. ⋯ This case demonstrates that any existing loops in the intrathecal catheter during initial implantation should be immediately re-addressed, as they can precipitate nerve root entrapment and irritation. Reduction of the loop or extrication of the catheter should be attempted under continuous fluoroscopic guidance to prevent further neurosurgical morbidity.
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Randomized Controlled Trial Comparative Study
False Loss of Resistance in Cervical Epidural Injection: The Loss of Resistance Technique Compared with the Epidrum Guidance in Locating Epidural Space.
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Comparative Study
What is the Correlation Between Facet Joint Radiofrequency Outcome and Response to Comparative Medial Branch Blocks?
Facet joint pain is a common cause of low back pain. There are no physical exam findings that provide a reliable diagnosis. Diagnosis is made by medial branch block injections (MBB). Once the source of pain has been determined, radiofrequency neurotomy (RFN) can be performed. Previous studies have shown that RFN reduces level of pain and improves function. No study has tried to correlate MBB results with outcomes after RFN. ⋯ Patients had improved disability scores and decreased pain after RFN. No correlation was seen between results on MBB and pain relief after RFN. It is still unclear how many medial branch blocks are needed and the criteria for MBB results before proceeding to RFN.
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Randomized Controlled Trial
Effect of Adding Calcitonin to Translaminar Epidural Steroid in Degenerative Lumbar Spinal Canal Stenosis.
Spinal canal stenosis is one of the most common causes of low back pain and disability. Its management varies from surgical to conservative, and the indications for ideal management are not clearly defined. ⋯ Adding calcitonin to epidural steroid and local anesthetic injection seems to be more effective than epidural steroid and local anesthesia alone in management of spinal canal stenosis regarding increased walking distance, better Oswestry scale, diminished pain intensity and perception of paresthesia, and less analgesic consumption, all the above mentioned benefits continued up to one year. So, epidural calcitonin may be considered as a new therapeutic modality in the management of pain in spinal canal stenosis.