Pain physician
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Randomized Controlled Trial
The Effect of Erector Spinae Plane Blockade on Prevention of Postherpetic Neuralgia in Elderly Patients: A Randomized Double-blind Placebo-controlled Trial.
Postherpetic neuralgia (PHN) is the most common chronic complication following the onset of herpes zoster (HZ). Both the incidence of HZ and the proportion of patients with HZ who develop PHN rise with age. Ultrasound-guided erector spinae plane blockade (ESPB) has been reported to relieve neuropathic pain and PHN in elderly patients, but no randomized controlled trials have been conducted regarding the effect of ESPB on elderly patients with HZ in the acute or subacute phases. ⋯ For elderly patients suffering acute or subacute HZ, ESPB reduces the incidence of PHN at 12 weeks after treatment; it also decreases the occurrence of neuropathic pain, sleep disturbance, and anxiety/depression.
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Several minimally invasive nonsurgical treatments have been widely applied for plantar fasciitis (PF). To date, controversy still exists regarding the effectiveness of these approaches for treating PF. ⋯ The MSN treatment should be recommended as the best therapy, followed by BTA in the gastrocnemius and BTA. CS and PRP are common medications that remain valuable in clinical practice. PEP can be performed after the injection of medication.
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Evidence suggests that a significant proportion of terminal cancer patients have uncontrolled or inadequately controlled pain when using the World Health Organization (WHO) analgesic ladder approach. The use of interventional techniques has proven to reduce pain that is refractory to conventional methods. However, despite the use of well-established techniques (e.g., intrathecal drug delivery, celiac plexus blocks, etc), nonneuraxial, catheter-based techniques remain underutilized. ⋯ Nonneuraxial, catheter-based techniques have the potential to play a significant role in the treatment of terminal cancer pain. Despite limited data, initial findings indicate that nonneuraxial, catheter-based techniques have the potential to bridge the gap between single shot interventions and surgical implanted devices by providing an effective, continuous therapy, with a lower risk profile.
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Post-dural puncture headache (PDPH), or spinal headache, is the most common serious complication resulting from iatrogenic puncture of the dura during epidural or spinal anesthesia and cerebrospinal fluid (CSF) leak in pregnant women. ⋯ Exposure to opioids for any reason after the diagnosis of unintentional dural puncture is not associated with a reduced risk of PDPH and does not decrease the need for therapeutic EBP.
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Randomized Controlled Trial
Effects of Intravenous Dexmedetomidine Versus Lidocaine on Postoperative Pain, Analgesic Consumption and Functional Recovery After Abdominal Gynecological Surgery: A Randomized Placebo-controlled Double Blind Study.
The management of acute postoperative pain remains challenging, and the search for adjuvants to reduce opioid use continues. ⋯ Dexmedetomidine and lidocaine could be useful adjuvants for analgesia after abdominal surgery. Lidocaine significantly reduced postoperative opioid consumption, while dexmedetomidine prevented early postoperative nausea. However, hypotension and the need for vasopressors was common with both agents, especially with dexmedetomidine.