Pain physician
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Studies of radiofrequency ablation (RFA) of genicular nerves have reportedly significantly decreased pain up to 3 months post ablation, but no longer term effects have been reported. We performed an analysis of long-term pain relief of 31 RFA procedures of the genicular nerves to analyze the degree of pain relief past 3 months, culminating at 6 months. ⋯ Based on patient interviews and data collection, RFA of genicular nerves can supply on average greater than 60% pain relief in our patient population for as long as 6 months.Key words: Osteoarthritis, knee osteoarthritis, chronic knee pain, radiofrequency ablation, nerve ablation, genicular nerves, long-term pain relief.
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Of all the postsurgical pain conditions, thoracotomy pain poses a particular therapeutic challenge in terms of its prevalence, severity, and ensuing postoperative morbidity. Multiple pain generators contribute to the severity of post-thoracotomy pain, and therefore a multimodal analgesic therapy is considered to be a necessary strategy. Along with opioids, thoracic epidural analgesia, and paravertebral blocks, N-Methyl-D-Aspartate (NMDA) receptor antagonists such as ketamine have been used as adjuvants to improve analgesia. ⋯ The majority of randomized controlled trials reviewed show no role for ketamine in attenuating or preventing post-thoracotomy pain syndrome at variable follow-up lengths. Therefore, additional research is warranted with consideration of risk factors and long-term follow-up for chronic post-thoracotomy pain though the evidence for benefit appears clear for acute post-thoracotomy pain.Key words: Ketamine, postoperative, thoracotomy pain, post thoracotomy pain syndrome, neuropathic pain.
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Review Case Reports
Transforaminal Endoscopic Decompression for a Giant Epidural Gas-Containing Pseudocyst: A Case Report and Literature Review.
The isolated epidural gas-containing pseudocyst is an uncommon pathogenic factor for severe pain of the lower limb as a result of nerve root compression. After reviewing these rare cases reported in the literature, we found that the name, pathogenesis, and treatment strategy of this pathology remained controversial. The most common treatment is conservative treatment or percutaneous aspiration which might result inpoor pain relief and high recurrence rates. ⋯ Due to the great advances in endoscopic techniques and equipment, it is easier to perform lumbar surgery through the endoscope. With this first case of percutaneous endoscopic treatment for the symptomatic epidural gas-containing pseudocyst reported in this study, we believe that this surgical method provides an option to treat this rare condition because it provides sufficient decompression, has a low recurrence rate, and is minimally invasive. Key words: Endoscopic surgery, pseudocyst, epidural gas, intraspinal gas, radiulopathy.
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Case Reports
Pulsed Radiofrequency Ablation of Pudendal Nerve for Treatment of a Case of Refractory Pelvic Pain.
Pudendal neuralgia (PN) is a result of pudendal nerve entrapment or injury, also called "Alcock syndrome." Pain that develops is often chronic, and at times debilitating. If conservative measures fail, invasive treatment modalities can be considered. The goal of this case report is to add to a small body of literature that a pulsed radiofrequency (PRF) ablation can be effectively used to treat PN and to show that high resolution MR neurography imaging can be used to detect pudendal neuropathy.
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Full-endoscopic interlaminar discectomy (FEID) is widely applied for the treatment of lumbar disc herniation (LDH) and satisfactory short-term outcomes have been achieved. However, the long-term evaluation for this technique is still lacking, especially the comparison between FEID and microendoscopic discectomy (MED). ⋯ The application of FEID achieved similar satisfactory long-term clinical outcomes for the surgical treatment of LDH as MED. However, compared with MED, FEID exhibits advantages including less operation time, shorter hospital stay, and faster postoperative recovery.Key words: Lumbar disc herniation, full-endoscopic interlaminar discectomy, microendoscopic disectomy, long-term.