Pain physician
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Epidural injections are among the most commonly performed procedures for managing low back and lower extremity pain. Pinto et al and Chou et al previously performed systematic reviews and meta-analyses, which, along with a recent update from Oliveira et al showing the lack of effectiveness of epidural steroid injections in managing lumbar disc herniation, spinal stenosis, and radiculopathy. In contrast to these papers, multiple other systematic reviews and meta-analyses have supported the effectiveness and use of epidural injections utilizing fluoroscopically guided techniques. A major flaw in the review can be related to attributing active-controlled trials to placebo-controlled trials. The assumption that local anesthetics do not provide sustained benefit, despite extensive evidence that local anesthetics provide long-term relief, similar to a combination of local anesthetic with steroids is flawed. ⋯ A comparative systematic review and meta-analysis of the Cochrane Review of randomized controlled trials (RCTs) of epidural injections in managing chronic low back and lower extremity pain with sciatica or lumbar radiculopathy yielded different results. This review, based on the evidence derived from placebo-controlled trials and active-controlled trials showed Level I, or strong evidence, at one and 3 months and Level II at 6 and 12 months. This review once again emphasizes the importance of the allocation of studies to placebo-control and active-control groups, utilizing standards of practice with inclusion of only the studies performed under fluoroscopic guidance.
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Radiofrequency thermocoagulation (RFT) of the trigeminal ganglion is an excellent treatment option for medically intractable trigeminal neuralgia. However, this procedure can manifest abrupt changes in cardiovascular responses. With abrupt cardiovascular changes, a sudden trigeminocardiac reflex can occur during RFT of the trigeminal ganglion. ⋯ FO puncturing, electrical stimulation, and thermal heating demonstrated an abrupt increase in heart rate and mean arterial pressure. The incidence of sudden bradycardia during RFT of the trigeminal ganglion was 25%. Most cases of bradycardia were observed during FO puncturing.
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The optimal analgesia for video-assisted thoracoscopic surgery (VATS) is still unknown. ⋯ EA and PVB have certain advantages in analgesia, but the incidence of postoperative pruritus after EA is higher. At the same time, considering the risk of coagulation and puncture complications, PVB may be a better choice.
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Randomized Controlled Trial
Ultrasound-Guided Erector Spinae Block Versus Ultrasound-Guided Thoracic Paravertebral Block for Pain Relief in Patients With Acute Thoracic Herpes Zoster: A Randomized Controlled Trial.
Severe acute pain is a significant risk factor for postherpetic neuralgia (PHN). The importance of early management in alleviating zoster pain cannot be overstated. ⋯ Both ESB and PVB were effective in controlling acute pain and persistent herpetic pain after 6 months (which was evident by lower NRS for pain and doses of pregabalin and acetaminophen), but ESB is safer (no reported pneumothorax and hypotension).
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Randomized Controlled Trial
Comparison of Intravascular Uptake and Technical Ease Between Anteroposterior and Oblique Views During Lumbar Medial Branch Block.
Inadvertent intravascular injection of local anesthetics can lead to false-negative results following lumbar medial branch block (MBB) performed to diagnose facet joint origin pain. A previous study demonstrated that the type of approach method could affect the incidence of intravascular injections and technical ease of the procedure. ⋯ The overall incidence rate of intravascular injection during lumbar MBB showed nearly 20% in both approach methods groups. The OB approach and left side MBBs were associated with a longer total procedure time and a higher radiation dose.