Pain physician
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Randomized Controlled Trial
Use of Bilateral Rectus Sheath Blocks in Open Umbilical Hernia Repair.
In recent years, the rectus sheath block (RSB) has become increasingly prevalent in laparoscopic surgery. However, there is currently no definitive research on its use in the open repair of umbilical hernias with cirrhotic ascites. ⋯ US-guided RSBs are an efficient method of anesthesia for open umbilical hernia repair in patients diagnosed with cirrhosis. This technique not only provides precise anesthesia and appropriate analgesia but also results in a low incidence of postoperative nausea and vomiting.
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Spinal cord stimulator (SCS) surgeries, whether performed using the open or percutaneous approach, are becoming increasingly common for a range of neuropathic pain conditions, including post-laminectomy syndrome and complex regional pain syndrome. However, there is limited knowledge regarding the factors linked to same-day discharge patterns following SCS. ⋯ These results can be used to help determine hospital bed needs post-SCS surgery. Future research should focus on identifying the specific reasons certain demographic and geographic factors might influence same-day discharge rates. Our study provides important insights into the factors associated with same-day discharge rates post open and percutaneous SCS implant and highlights the need for patient-centered, evidence-based approaches to health care delivery.
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Assessing the 3-dimensional (3D) relationship between critical anatomical structures and the surgical channel can help select percutaneous endoscopic lumbar discectomy (PELD) approaches, especially at the L5/S1 level. However, previous evaluation methods for PELD were mainly assessed using 2-dimensional (2D) medical images, making the understanding of the 3D relationship of lumbosacral structures difficult. Artificial intelligence based on automated magnetic resonance (MR) image segmentation has the benefit of 3D reconstruction of medical images. ⋯ We developed an artificial intelligence-based automated MR image segmentation method, which effectively segmented lumbosacral structures (e.g., L5 vertebrae bone, S1 vertebrae bone, disc, lumbosacral nerve, iliac bone, and skin) simultaneously on MR images, and could be used to construct a 3D model of lumbosacral structures for choosing an appropriate approach of PELD at the L5/S1 level.
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Infrapatellar neuropathy arises from traumatic, iatrogenic, or compression injury to the infrapatellar branch (IB) of the saphenous nerve. The risk of infrapatellar neuropathy has been shown to depend on the IB's anatomical course. The infrapatellar branch of the saphenous nerve (ISBN) has been discovered to take varying courses, and the IB can emerge directly from the femoral nerve. The variety of the IBSN's courses and the prevalence of cases involving the infrapatellar branch of the femoral nerve (IBFN) call the uniform IB course described in textbooks into question. ⋯ Infrapatellar innervation can emerge from the saphenous nerve, the femoral nerve, or a combination of both, and the origin of the innervation determines the clinical risk for infrapatellar neuropathy. While innervation from the IBSN may lead to compression at the subsartorial course, distal sartorial penetration, and the crossing of the medial femoral epicondyle, innervation from the IBFN carries reduced anatomical risk for infrapatellar neuropathy.
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Chronic low back pain is widely prevalent, and there are a range of conditions that may result in the low back pain. In general, treatment of low back pain starts with conservative management such as medications, physical therapy, and home exercise regimens. If conservative measures fail, a range of interventional techniques can be employed to manage back pain. An uncommonly recognized cause of back pain is Bertolotti's syndrome which is a result of back pain due to lumbosacral transitional vertebrae (LSTV). LSTV is a congenital abnormality either characterized by the lumbarization of the sacrum where the first sacral bone fails to fuse with the rest of the sacrum or the sacralization of the lumbar spine where the L5 vertebra fuses with the sacrum creating a longer sacrum. In many cases, the condition can be recognized by imaging techniques such as an x-ray, computed tomography, or magnetic resonance imaging. ⋯ Our stepwise approach to diagnosing and managing the pain resulting from Bertolotti's syndrome is an effective method of treatment for the condition.