Pain physician最新文献

{"title":"A 24% Decline in the Utilization of Epidural Procedure Visits for Chronic Spinal Pain Management in the Medicare Population from 2019 to 2022: Updated Analysis of the Effect of Multiple Factors.","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Vidyasagar Pampati, Alan D Kaye, Alaa Abd-Elsayed, Amol Soin, Devi E Nampiaparampil, Nebojsa Nick Knezevic, Christopher G Gharibo, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The analysis of epidural procedure utilization has revealed several notable trends over recent years. Utilization increased significantly until 2004, then rose minimally until 2011, followed by gradual declines up to 2019 in the Medicare population. The COVID-19 pandemic led to a marked 19% decline in usage from 2019 to 2020. Additionally, recent studies of interventional pain management techniques showed a 28.9% reduction in use from 2019 to 2022, leading to an average annual decline of 10.9%.</p><p><strong>Objective: </strong>The present investigation aims to provide an updated evaluation of epidural procedure usage for chronic pain management in the U.S. Medicare population.</p><p><strong>Study design: </strong>A retrospective cohort study examining utilization patterns and variables for epidural injections in the fee-for-service (FFS) Medicare population in the U.S. from 2000 to 2022.</p><p><strong>Methods: </strong>Data was obtained from the Centers for Medicare & Medicaid Services (CMS) master database, specifically using the physician/supplier procedure summary for 2000-2022. Episodes or procedure visits were defined as one per region using primary codes only, while services included all procedure levels and any add-on codes.</p><p><strong>Results: </strong>Between 2000 and 2010, epidural episodes rose by 6.7% annually but then declined by 3% each year from 2010 to 2019. The COVID-19 pandemic led to a 19.3% reduction in procedures from 2019 to 2020, followed by a partial recovery of 5.5% in 2021, then another 10.9% drop in 2022. During 2019-2022, lumbar interlaminar and caudal procedures decreased by 26.9%, while cervical/thoracic interlaminar procedures declined by 24.2%. By 2022, transforaminal procedures surpassed interlaminar procedures, reversing the trend from 2000.</p><p><strong>Limitations: </strong>This analysis includes data only through 2022 and is limited to the FFS Medicare population; it does not account for Medicare Advantage Plan enrollees, who made up nearly half of Medicare participants by 2022. Additionally, the study is subject to limitations inherent in retrospective claims data analysis.</p><p><strong>Conclusion: </strong>This two-decade analysis indicates significant shifts in epidural procedure utilization, with steady increases until 2010, followed by a general decline affected by COVID-19 and other contributing factors. An approximate 24% decline in epidural procedure visits for chronic spinal pain management was noted from 2019 to 2022.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E983-E994"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pectoralis I and Serratus Anterior Plane Block Analgesia for Bilateral Mastectomy: A Case Series.","authors":"Kinjal M Patel, Kiana D de Guzman, Keri Cronin, Noud van Helmond, Sandeep Krishnan, Ludmil Mitrev, Keyur C Trivedi, Ronak G Desai","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Poorly controlled acute breast surgery postoperative pain is associated with delayed recovery, increased morbidity, impaired quality of life, and prolonged opioid use during and after hospitalization. Recently, ultrasound-guided pectoralis nerve (PECS) I block and serratus anterior plane (SAP) block, together or individually, have emerged as a potential method to relieve pain, decrease opioid requirements, and improve patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study was to assess if the addition of a PECS I/SAP block in patients undergoing bilateral mastectomies provides more effective perioperative analgesia compared to standard analgesia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective case series.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Tertiary academic medical center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For patients undergoing breast cancer surgery, different approaches to analgesia by anesthesiologists at our institution provided an opportunity to compare patients who received a PECS I/SAP block to patients who received standard peri- and postoperative pain control from May 1, 2019 through November 30, 2020. Adult women who had bilateral mastectomy and reconstruction with tissue expanders for breast cancer were included. Bilateral PECS I/SAP blocks were performed with 60 mL 0.25% bupivacaine and 266 mg liposomal bupivacaine. The standard analgesia group had a balanced general anesthetic with volatile anesthetic, opioids (fentanyl or hydromorphone), and muscle relaxant. The postoperative analgesic regimen was similar in both groups. Pain scores (Numeric rating Scale) and opioid consumption (converted to oral morphine milligram equivalent [MME]) intraoperatively, and on postop day (POD) 0 up to POD 3 were collected. Length of stay data were collected as a secondary outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty patients were included (n = 17 PECS I/SAP block; n = 23 standard analgesia). Baseline characteristics were similar between groups; most patients in the PECS I/SAP block (93%) and standard analgesia (96%) groups were discharged on POD 1 or 2. Intra-operative opioid requirements were lower in the PECS I/SAP block vs the standard analgesia group (median 56 MME, interquartile range [IQR] 44-62 vs median 65 MME, IQR 63-83, respectively, P = 0.002). Opioid requirements were similar in the block group compared to the standard analgesia group from POD 0 to POD 2. Pain scores from POD 0 to POD2, postanesthesia care unit length of stay, and hospital length of stay were also similar between the PECS I/SAP block and standard analgesia group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The retrospective nature of this study and its reliance on medical records are limitations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The PECS I/SAP block may potentially reduce pain in patients having breast surgery for cancer by providing analgesia to the lateral and anterior chest wall. While this analysis showed a reduction in int","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1117-E1122"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Epidural Volume Extension Using Low-Dose Sufentanil Combined with Low-Concentration Ropivacaine on Visceral Pain During Cesarean Sections: A Randomized Trial.","authors":"Jin Wang, Feng Xia, Li-Ying Wang, Li-Zhong Wang, Xiang-Yang Chang, Zhi-Yu Meng, Chang-Na Wei","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Visceral pain is common in cesarean sections conducted under combined spinal-epidural anesthesia (CSE). Epidural volume extension (EVE) is a technique for enhancing the effect of intrathecal blocks by inducing epidural fluid boluses in the CSE. Whether EVE that uses different drugs can reduce visceral pain during cesarean sections is rarely studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;In this study, we compared the effect of EVE that used low-dose sufentanil, either alone or combined with low-concentration ropivacaine, on visceral pain during cesarean sections under CSE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A prospective, randomized controlled study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study was performed in the Jiaxing University Affiliated Women and Children Hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We randomly allocated 100 healthy patients to 4 groups to receive spinal hyperbaric bupivacaine followed by EVE with 10 mL of 0.9% saline (Group NS), 10 mL of 0.15% ropivacaine (Group R), 10 mL of 10 mu-g sufentanil (Group S), or a combination of 10 mL of 0.15% ropivacaine and 10 mu-g sufentanil (Group RS) through the epidural catheter 15 minutes thereafter. The primary outcome was the incidence of visceral pain. Each occurrence of visceral pain during the procedure was recorded. Every patient's pain level was evaluated on the visual analog scale (VAS). The consumption of sufentanil during patient-controlled intravenous analgesia (PCIA) and patient satisfaction scores under anesthesia were recorded within 48 hours after surgery. Maximum sensory block levels, segmental increases after EVE, time for sensory regression to the tenth thoracic dermatome (T10), and time for motor recovery to modified Bromage 0 were compared among each group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Visceral pain occurred in 60% (15/25), 56% (14/25), 24% (6/25) and 12% (3/25) of patients in the NS, R, S, and RS groups, respectively. The incidence of visceral pain was significantly lower in the RS group than in the NS or R groups (P &lt; 0.05) but not significantly different from the S group. The S and RS groups have significantly lower VAS scores compared to the NS and R groups (P &lt; 0.05). Sufentanil consumption during PCIA in the R and RS groups was significantly lower than in the NS group. Patients' overall intraoperative satisfaction scores were significantly higher in the S and RS groups than in the NS or R groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This study has limitations in its sample size, time point of EVE implementation, absence of laboratory indicators, and lack of assessment of postoperative visceral pain, necessitating future studies to address these issues.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;EVE at 15 minutes after spinal anesthesia with a 10 mL combination of low-dose sufentanil (10 mu-g) and low-concentration (0.15%) ropivacaine can effectively reduce the incidence and severity of visceral pain in cesarean sections under CSE. At the sa","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1065-E1071"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Effect of Trigeminal Neuralgia Treated With Percutaneous Balloon Compression by Machine Learning-based Modeling of Radiomic Morphological Features.","authors":"Ji Wu, Keyu Chen, Hao Mei, Yuankun Cai, Lei Shen, Jingyi Yang, Dongyuan Xu, Songshan Chai, Nanxiang Xiong","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Trigeminal neuralgia (TN) is defined as spontaneous pain in the region of the trigeminal nerve that seriously affects a patient's quality of life. Percutaneous balloon compression of the trigeminal ganglion is a simple and reproducible surgical procedure that reduces the incidence of TN, but the postoperative outcome is poor in some patients, with it being ineffective or TN recurring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To establish a machine learning-based clinical imaging nomogram to predict the recurrence of trigeminal neuralgia in patients treated with percutaneous balloon compression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The clinical data of 209 patients with TN treated with percutaneous balloon compression at Zhongnan Hospital of Wuhan University from January 2017 through August 2023 were retrospectively collected and randomized into training and validation cohorts. All imaging histologic morphological features were extracted from the intraoperative x-ray balloon region using 3D slicer software. The relationship among clinical factors, least absolute shrinkage and selection operator, and 4 machine learning predictions of the patient's TN prognosis were analyzed using a one-way analysis of clinical factors. A prediction model was constructed using receiver operating characteristics curve analysis. The performance of the clinical imaging histogram of patients' TN prognoses was evaluated using a receiver operating characteristics curve and decision curve analysis. The model was finally validated using a validation cohort and a receiver operating characteristics curve.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The training group included 149 patients; 16 morphology-related imaging histological features were extracted for analysis. After one-way logistic regression analysis, least absolute shrinkage and selection operator analysis incorporated original_shape_Elongation, original_shape_MajorAxisLength, original_shape_flatness morphology-related imaging histologic features, gender, and affected side to give a total of 6 predictors. The final results were obtained for gender, affected side, and MajorAxisLength. Finally, 4 machine learning receiver operating characteristics curves for random forest tree, support vector machine, generalized linear model, and extreme gradient boosting models were obtained for the clinical and imaging features of gender, affected side, drug, original_shape_MajorAxisLength, and original_shape_flatness. The areas under the receiver operating characteristics curves were 0.990, 0.993, 0.990, and 0.986, respectively. Finally, predictive column maps of affected side, gender, original_shape_flatness, and MajorAxisLength were constructed using the support vector machine method, and the area under the receiver operating characteristics curve of the model was 0.99, which suggests that the model had good predictive ability. Decision curve analysis  and cali","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1105-E1116"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Evidence-Based Guidelines for Implantable Peripheral Nerve Stimulation (PNS) in the Management of Chronic Pain: From the American Society Of Interventional Pain Physicians (ASIPP).","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Amol Soin, Alan D Kaye, Adam M Kaye, Daneshvari R Solanki, Grant H Chen, Devi Nampiaparampil, Nebojsa Nick Knezevic, Paul Christo, Alexander Bautista, Jay Karri, Shalini Shah, Standiford Helm Ii, Annu Navani, Bradley W Wargo, Christopher G Gharibo, David Rosenblum, Komal Luthra, Kunj G Patel, Saba Javed, Warren Reuland, Mayank Gupta, Alaa Abd-Elsayed, Gerard Limerick, Ramarao Pasupuleti, Gary Schwartz, Matthew Chung, Konstantin V Slavin, Vidyasagar Pampati, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Peripheral nerve stimulation (PNS) has been used for over 50 years to treat chronic pain by delivering electrical pulses through small electrodes placed near targeted peripheral nerves those outside the brain and spinal cord. Early PNS systems often required invasive neurosurgical procedures. However, since 2015, the Food and Drug Administration (FDA) approved percutaneously implanted PNS leads and neurostimulators  offering a much less invasive, non-opioid option for managing recalcitrant chronic pain. The following FDA-cleared PNS systems are commercially available in the United States for the management of chronic, intractable pain:•    Freedom® Peripheral Nerve Stimulator (PNS) System (Curonix LLC, 2017) •    StimRouter® Neuromodulation System (Bioness, now Bioventus, 2015)•    SPRINT® PNS System (SPR® Therapeutics, Inc., 2016) •    Nalu™ Neurostimulation System (Nalu Medical Inc., 2019)•    ReActiv8® Implantable Neurostimulation System (Mainstay Medical Limited, 2020) The American Society of Interventional Pain Physicians (ASIPP) has published evidence-based consensus guidelines for the application of PNS systems in managing chronic pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The guidelines aim to provide evidence-based recommendations for the utilization of peripheral nerve stimulation (PNS) in the management of moderate to severe chronic pain. These guidelines exclude field stimulation, or sacral nerve stimulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A multidisciplinary panel of experts in various medical and pharmaceutical fields, convened by ASIPP, reviewed the evidence, considered patient perspectives, and formulated recommendations for implantable peripheral nerve stimulation in chronic pain management. The methodology included developing key questions with evidence-based statements and recommendations. The grading of evidence and recommendations followed a modified approach described by ASIPP, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method, and the Agency for Healthcare Research and Quality (AHRQ) strength of recommendations methods. The evidence review includes existing guidelines, systematic reviews, comprehensive reviews, randomized controlled trials (RCTs), and observational studies on the effectiveness and safety of implantable peripheral nerve stimulation in managing chronic pain. The quality of published studies was assessed using appropriate instruments for systematic reviews, RCTs, and observational studies.In the development of consensus statements and guidelines, we used a modified Delphi technique, which has been described to minimize bias related to group interactions. Panelists without a primary conflict of interest voted to approve specific guideline statements. Each panelist could suggest edits to the guideline statement wording and could suggest additional qualifying remarks or comments as to the implementation of the guideline in clinical practice to achie","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 S9","pages":"S115-S191"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Nomogram Model for Predicting Postherpetic Neuralgia in Patients with Herpes Zoster: A Prospective Study.","authors":"Hui-Min Hu, Peng Mao, Xing Liu, Yuan-Jing Zhang, Chen Li, Yi Zhang, Yi-Fan Li, Bi-Fa Fan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Herpes zoster (HZ) and postherpetic neuralgia (PHN) have a negative effect on patients. A simple and practical PHN prediction model is lacking.</p><p><strong>Objective: </strong>We aimed to investigate risk factors associated with PHN in patients with HZ and develop a predictive model.</p><p><strong>Study design: </strong>A prospective observational study.</p><p><strong>Setting: </strong>This study was conducted at the Department of Pain Management, China-Japan Friendship Hospital in Beijing, People's Republic of China, spanning from August 2020 through March 2022.</p><p><strong>Methods: </strong>Clinical data of 174 patients with HZ were recorded using a case report form. The patients underwent a 3-month follow-up, which included both in-person visits and telephone follow-ups. Patients were categorized into either a PHN or non-PHN group based on the diagnosis  of PHN. Multiple logistic regression analysis was used to identify the predictors of PHN occuring in patients with HZ. Subsequently, a nomogram model was developed to estimate the likelihood of PHN. To validate the prediction model's accuracy, calibration curves, the C-index, and receiver operating characteristic (ROC) curves were utilized.</p><p><strong>Results: </strong>In this study, a total of 174 patients were divided into 2 groups: the PHN Group, consisting of 52 patients, and the non-PHN Group, consisting of 122 patients based on the follow-up results. Multiple logistic regression analysis revealed 5 significant risk factors for PHN, including being a woman, being more than 50 years old, having prodromal phase pain, having a large rash area, and having great pain severity during the acute phase. The model's performance was excellent, with an area under the ROC curve of 0.81 and a close alignment between the calibration curve and the actual data, signifying high accuracy. The model's accuracy and net benefit were maximized when predicting a prevalence between 6% and 92%.</p><p><strong>Limitations: </strong>Our study was conducted at a single center and had a limited sample size.</p><p><strong>Conclusions: </strong>The incidence of PHN is influenced by factors such as being a woman, being more than 50 years old, having prodromal phase pain, having a large rash area, and having great pain severity during the acute stage. The prediction model developed in this study effectively forecasts the occurrence of PHN using these 5 risk factors, making it a valuable tool for clinical practice.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E843-E850"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Double-blind Trial of 5% Dextrose Versus Corticosteroid Hydrodissection for Meralgia Paresthetica.","authors":"Hailin Xu, Xiaochen Shi, Jiaan Zhu, Guicheng Li, Ling Bai","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided 5% dextrose (D5W) hydrodissection provides  favorable outcomes for treating peripheral entrapment neuropathies; its safety is well recognized. However, clinical evidence regarding the use of D5W hydrodissection for meralgia paresthetica (MP) is limited. Although corticosteroids are the most common injectates, the possible adverse effects are a big concern.</p><p><strong>Objective: </strong>To compare the efficacy and safety of ultrasound-guided D5W hydrodissection compared to corticosteroid hydrodissection in patients with MP during a 6-month follow-up period.</p><p><strong>Study design: </strong>A prospective, randomized double-blind, controlled trial.</p><p><strong>Setting: </strong>Outpatient clinic at a university hospital.</p><p><strong>Methods: </strong>A total of 56 patients with MP were randomly allocated to either a D5W or steroid group in a 1:1 ratio. The patients received one session of ultrasound-guided perineural injection therapy of 10 mL D5W or a corticosteroid solution (1 mL compound betamethasone [1 mL: betamethasone sodium phosphate 5 mg and betamethasone dipropionate 2 mg] mixed with 5 mL 2% lidocaine and 4 mL 0.9% saline).The primary outcomes were Visual Analog Scale (VAS) scores for MP (pain and paresthesia) and global quality of life. The secondary outcomes included self-reported successful clinical response and injection adverse effects. Evaluations were conducted at pretreatment and at one, 3, 4 and 6 months posttreatment.</p><p><strong>Results: </strong>All patients completed the study. Compared with baseline, both groups exhibited reductions in VAS scores for MP and global quality of life at all follow-up time points, with statistical differences at 3, 4, and 6 months in the D5W group (P < 0.05), as well as those at one, 3, and 4 months in the steroid group (P < 0.05). The D5W group exhibited greater improvement than the steroid group in VAS scores for MP and global quality of life at 4 and 6 months (P < 0.05), and demostrated a more successful clinical response at 6 months (P < 0.05). No adverse effects were reported in the D5W group during the study period, while 6 patients in the steroid group reported an adverse effect.</p><p><strong>Limitations: </strong>A longer follow-up period is necessary; the exact mechanism of D5W is not clear.</p><p><strong>Conclusions: </strong>Ultrasound-guided perineural injection therapy of D5W is more beneficial than corticosteroid injection for MP at 4 to 6 months posttreatment. Additionally, D5W displays a better safety profile than corticosteroid. Thus, we suggest D5W as a more suitable injectate for patients with MP.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E835-E842"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Hydromorphone Compared to Morphine for Postoperative Analgesia: A Systematic Review and Meta-analysis.","authors":"Yihang Li, Xinying Yue, Shuang Liang, Fei Ren, Qulian Guo, Wangyuan Zou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Because of its side effects, a morphine replacement has been searched for in the field of postoperative analgesia. Hydromorphone is a derivative of morphine with no active metabolites.</p><p><strong>Objectives: </strong>We conducted a meta-analysis of hydromorphone and morphine to compare their clinical effects in postoperative analgesia.</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>The methodological quality of the studies included in this meta-analysis was assessed according to the Cochrane risk-of-bias tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were used to evaluate the quality of evidence and recommendation grade for inclusion of randomized controlled trials. The primary outcome was postoperative pain score. Secondary outcomes were severe sedation, nausea, vomiting, and pruritus. The meta-analysis was performed using RevMan 5.4 (The Nordic Cochrane Centre for The Cochrane Collaboration).</p><p><strong>Results: </strong>Eight randomized controlled trials comprising 833 patients were found. There was no significant difference in pain scores between the hydromorphone and morphine groups at any measured postoperative time point: 8 hours (mean difference [MD] = -0.42; 95%CI, -2.08 to 1.24; P = 0.62); 12 hours (MD = -0.19; 95%CI, -0.62 to 0.24; P = 0.39); 24 hours (MD = -0.22; 95%CI, -0.54 to 0.09; P = 0.17); 36 hours (MD = 0.01; 95%CI, -0.67 to 0.69; P = 0.98) and 48 hours (MD = -0.14; 95%CI, -1.25 to 0.96; P = 0.80). There was no significant difference in the incidence of nausea and vomiting at 24 hours postoperative. The incidence of pruritus at 24 hours postoperative was lower in the hydromorphone group (relative risk = 0.24; 95%CI, 0.09 to 0.66; P = 0.005).</p><p><strong>Limitations: </strong>The perioperative multimodal analgesia measures were varying in the included studies, such as different medication doses. The sample size was small for some outcomes and high heterogeneity was observed.</p><p><strong>Conclusions: </strong>There was no significant statistical difference in postoperative analgesic effect between hydromorphone and morphine, as well as side effects, including severe sedation, nausea, and vomiting at 24 hours postoperative. However, the incidence of pruritus was lower in the hydromorphone group at 24 hours postoperative.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"469-478"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose Equivalence of Remimazolam and Propofol for Loss of Consciousness in Pediatric Patients: A Randomized Clinical Trial.","authors":"Yang Shen, Ying Sun, Yan-Ting Wang, Zhe-Zhe Peng, Jie Bai, Ji-Jian Zheng, Ma-Zhong Zhang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam and propofol can be used interchangeably for general anesthesia. However, no dosing recommendations exist for the intravenous bolus administration of remimazolam during general anesthesia induction in pediatric patients. Determining the appropriate dose for anesthesia induction in pediatric patients is crucial for safe and effective surgical procedures.</p><p><strong>Objectives: </strong>The study aimed to determine the median effective dose (ED50) for loss of consciousness (LOC) with remimazolam and propofol in pediatric patients and establish the dose equivalence between these anesthetics.</p><p><strong>Study design: </strong>A prospective, randomized, single-center trial.</p><p><strong>Setting: </strong>A tertiary pediatric hospital in China from January 2023 to July 2023.</p><p><strong>Methods: </strong>Pediatric patients aged 3 to 15 years, undergoing elective surgery under general anesthesia, were included. Patients were randomized to receive either remimazolam (in doses of 0.1, 0.15, 0.2, 0.25, and 0.3 mg/kg-1) or propofol (in doses of 0.75, 1.0, 1.25, and 1.5 mg/kg-1) via intravenous bolus. The primary measure consisted of determining the ED50 for LOC with remimazolam, and the secondary measure consisted of establishing the dose equivalence between remimazolam and propofol.</p><p><strong>Results: </strong>The calculated ED50 for remimazolam was 0.19 mg/kg-1 (95% CI: 0.10-0.35), and that for propofol was 1.11 mg/kg-1 (95% CI: 0.53-2.15). This finding indicates that remimazolam is approximately 5.8 times more potent than propofol.</p><p><strong>Limitations: </strong>In this study, the anesthesiologist could not be blinded to the different appearances of remimazolam and propofol, and the LOC assessment method may have introduced bias. Furthermore, the recommended dose for remimazolam induction was not tested directly within this trial, suggesting a need for further research.</p><p><strong>Conclusions: </strong>Remimazolam demonstrates significantly higher sedative efficacy for pediatric patients than does propofol. An induction dose of 0.34 mg/kg-1 remimazolam could be recommended for general anesthesia induction, considering the safety and effectiveness of a 2 mg/kg-1 dose of propofol.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"521-528"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Injectable Nerve Stimulation Electrode Placed on the Dorsal Root Ganglion Using an Extravertebral Approach: A Feasibility Study in Cadavers.","authors":"Bart Billet, Christian Jessen, Bernhard Moriggl, Derrick Liu, Emily Szabo, Stephan Nieuwoudt, Alaa Abd-Elsayed, Amol Soin, Thomas Fichtner Bendtsen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Dorsal root ganglion stimulation (DRGS) is an established method for treating persistent and severe pain conditions. However, performing DRGS has significant challenges. Current DRGS systems are expensive, hindering accessibility for many patients and health care systems. Additionally, placing DRGS devices requires specialized training in epidural techniques and lead anchoring methods. Technical and financial requirements also limit the clinical applicability and availability of DRGS.</p><p><strong>Objectives: </strong>This study evaluated the feasibility of a new method for rapidly delivering near- DRG stimulation in human cadavers. The method involves a fluoroscopy-guided transforaminal approach using a fully implantable, injectable electrode, and its associated delivery system.</p><p><strong>Study design: </strong>A human cadaver feasibility study.</p><p><strong>Setting: </strong>A cadaver laboratory.</p><p><strong>Methods: </strong>In this study, 3 anesthesiologist pain physicians received training on the injectable electrode device and delivery system using spine phantom models. They then applied the device's associated implantation techniques to 2 adult male cadavers. In the first cadaver, a single injectable electrode was placed near the left L2 lumbar DRG. In the second cadaver, injectable electrodes were placed near the left L1 and L2 DRG levels, and a benchmark DRGS device was installed at the left L1 level using fluoroscopic guidance. A careful anatomical dissection was then performed for each implanted device.</p><p><strong>Results: </strong>The stimulating contacts of the injectable electrodes were accurately positioned within one mm of the DRG at the lumbar L1 and L2 levels in both cadavers. The distances of both the injectable lead and benchmark DRGS device at the L1 level were measured as one mm from the posterior aspect of the DRG.</p><p><strong>Limitations: </strong>The findings of this study are based on anatomical examinations of a limited number of human cadavers and may not fully represent living human anatomy.</p><p><strong>Conclusions: </strong>To our knowledge, this feasibility cadaver study is the first of its kind to examine the accuracy and efficiency of a fluoroscopy-guided transforaminal approach to place injectable electrodes near the DRG. These promising results suggest that this method could be a viable alternative to existing DRGS techniques, warranting further investigation into its clinical potential.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E899-E907"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}