Pain physician
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Comparative Study
Comparison of 3 Anesthetic Methods for Percutaneous Transforaminal Endoscopic Discectomy: A Prospective Study.
Percutaneous transforaminal endoscopic discectomy (PTED) under local anesthesia (LA) is growing popular in recent years because of its safety, effectiveness and increased patient demands for minimally invasive procedures. To avoid neural injuries, local anesthesia that can keep the patient conscious is recommended. However, many patients complain about the severe pain during surgery. Epidural anesthesia (EA) is an alternative choice. We put forward an anesthetic method that combined preemptive analgesia (PA) and local anesthesia. ⋯ Percutaneous transforaminal endoscopic discectomy (PTED), local anesthesia, epidural anesthesia, preemptive analgesia, morphine, ropivacaine, pain management, visual analog scale (VAS), Oswestry Back Pain Disability Index (ODI).
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Osteoarthritis of the hip joint is a common cause of pain and disability. Patients not responding to conservative management often cannot undergo joint replacement due to the presence of multiple comorbidities, while some other patients prefer to postpone surgery as long as possible. Radiofrequency denervation of articular branches of the femoral and obturator nerves, which supply innervation of the joint, is a novel technique to reduce hip joint pain. Previous studies reported positive results after application of continuous radiofrequency to the target nerves; however, this approach carries the potential risk of neuritis and neuroma formation. Pulsed radiofrequency (PRF) is a safer alternative to continuous radiofrequency not creating necrosis but a complex neuromodulatory effect on target nerves. There is no published evidence of PRF efficacy after 3 month follow-up. ⋯ Hip joint pain, pulsed radiofrequency, obturator nerve, femoral nerve, interventional pain management, radiofrequency.
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Meta Analysis
Prevalence of Recurrent Herniation Following Percutaneous Endoscopic Lumbar Discectomy: A Meta-Analysis.
Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgery for the treatment of lumbar disc herniation (LDH) with a smaller incision, decreased damage to soft tissues, faster recovery, and fewer postoperative complications. However, the exactly epidemiological prevalence of recurrent herniation after PELD remains unclear. ⋯ Percutaneous endoscopic lumbar discectomy, prevalence, recurrent herniation, meta-analysis.
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Randomized Controlled Trial
Transforaminal vs Interlaminar Epidural Steroid Injection for Acute-Phase Shingles: A Randomized, Prospective Trial.
The acute phase of shingles is characterized by severe pain, and one of the complications of shingles known as postherpetic neuralgia (PHN) is associated with prolonged pain. Although factors predicting the development of PHN, as well as its preventative measures, have been investigated, there is no single treatment effective for PHN. Some studies showed effectiveness of epidural injection to alleviate pain associated with acute-phase shingles. In these studies, epidural injection was performed by interlaminar (IL) approach. However, transforaminal (TF) approach may be more effective as it enables injection of steroids and local anesthetics closer to the dorsal root ganglion where inflammation primarily occurs. There have not been any studies comparing the analgesic effects of epidural injection approaches for pain associated with acute-phase shingles. ⋯ Shingles epidural steroid injection interlaminar approach; transforaminal approach, fluoroscopic, postherpetic neuralgia, VAS, SF-36.
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Interferon regulatory factor 8 (IRF8), which is induced by peripheral nerve injury (PNI), plays a key role in activating spinal microglia to release inflammatory cytokines in a p38-dependent way, thereafter results in formation of central sensitization. Pulsed radiofrequency (PRF) on dorsal root ganglion (DRG) alleviates neuropathic pain and inhibits the microglial activation in chronic constriction injury (CCI) rats. However, the consequences of PRF on spinal IRF8 of CCI rats remains unknown. ⋯ Neuropathic pain, pulsed radiofrequency, dorsal root ganglion, microglia, p38MAPK, Interferon regulatory factor 8, chronic constriction injury of sciatic nerve.