Pain physician最新文献

{"title":"Comment on \"Effect of Epidural Volume Extension Using Low-Dose Sufentanil Combined with Low-Concentration Ropivacaine on Visceral Pain During Cesarean Sections: A Randomized Trial\".","authors":"Fei Gao, Dingping Zhou, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E231-E232"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764555","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":"Resiliency is a Predictor of Clinical Outcomes in a Chronic Pain Cohort.","authors":"Gilbert S Chandler Iii, Phillip R Worts, Farnaz Solatikia, Philippe R Gaillard, Alexis M Rojas, Heather A Flynn","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Multidimensional strategies to improve pain have advanced the understanding of pain and pain treatment, yet the examination of biopsychosocial factors and associated treatments within pain management has not reached the mainstream.</p><p><strong>Objective: </strong>The objective of this study was to explore whether psychological variables added to routinely collected medical information were associated with clinical outcomes and the need for additional treatments after an initial chronic pain intervention.</p><p><strong>Study design: </strong>This prospective, observational study recruited patients during their initial pain management visits and followed them until they returned to the clinic for additional pain management.</p><p><strong>Setting: </strong>A private, multispecialty orthopedic clinic in Tallahassee, Florida.</p><p><strong>Methods: </strong>Patients were seeking treatment for their chronic pain. They completed a series of psychological evaluations, including the Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder Scale 7 (GAD-7), Avoidance-Endurance Questionnaire (AEQ), and Connor-Davidson Resilience Scale 10 (CD-RISC-10), in addition to answering lifestyle/behavioral questions. Chart reviews were performed at least one year from the patients' initial visits to understand the response to initial treatment and subsequent clinical management of their pain conditions.</p><p><strong>Results: </strong>One hundred fifty-two patients completed the full assessment, and 118 returned at least once to the clinic for continued medical care and were included in the models. A previous history of opioid use at the initial visit was a significant positive predictor of change in pain (P = 0.049). The CD-RISC-10 score was a significant negative predictor of the need for additional treatment at the patient's follow-up visit (P = 0.040). Thirteen percent of the cohort reported at least moderate symptoms of anxiety, and 26% of the cohort reported at least moderate symptoms of depression.</p><p><strong>Limitations: </strong>The limitations of this study were a lack of quantified opioid use and a reliance on self-reported measures.</p><p><strong>Conclusion: </strong>The inclusion of a resiliency measure along with established psychological instruments appears to add clinical value when managing patients with chronic pain. This study adds to the growing body of evidence that depicts resiliency as an important predictor of clinical outcomes.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E173-E182"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764670","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":"In Response to Comment on \"Computed-Tomography-guided Percutaneous Bilateral Neurolytic Celiac Plexus Block with Alcohol for Upper Abdominal Visceral Cancer Pain\".","authors":"Huda F Ghazaly","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E229"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764665","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":"Influence of Lumbar Epidural Steroid Injection on Osteoporosis and Denosumab Treatment.","authors":"Jun-Han Kim, Jeong-Mo Koo, Dong-Eun Shin, Tae-Keun Ahn","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Lumbar epidural steroid injections (ESIs) are commonly used to alleviate pain associated with lumbar disorders. However, administering steroids to patients with osteoporosis may lead to a decline in bone mineral density (BMD) and increase fracture risk. While various steroids are utilized in ESIs, limited research exists on their effect on BMD.</p><p><strong>Objectives: </strong>This study aimed to analyze the effect of dexamethasone-based ESI therapy on osteoporosis in patients receiving or not receiving denosumab, utilizing real-world clinical data.</p><p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Setting: </strong>A university hospital orthopedic department.</p><p><strong>Methods: </strong>A retrospective review was conducted, incorporating patients who underwent denosumab therapy alongside ESIs for pain alleviation from January 2018 through April 2022. Eligibility criteria included patients with a minimum follow-up period of 12 months. Forty patients who had received an ESI and denosumab treatment were enrolled in Group One. Similarly, 35 patients who had only received an ESI (Group 2) and 33 patients who underwent denosumab treatment alone (Group 3) were enrolled and analyzed. Statistical analysis was performed using analysis of variance (ANOVA) to compare patient age, gender, lumbar and  hip BMD, difference in lumbar and hip BMD at postinjection one year, serum vitamin D, calcium, phosphorus levels, and one-year cumulative steroid dosage.</p><p><strong>Results: </strong>In terms of patient demographics, the mean age of Group One was 71.73 (± 9.59) years, Group 2 was 70.00 (± 9.82) years, and Group 3 was 71.18 (± 5.64) years. The ANOVA analysis revealed no significant differences among groups. The BMD analysis showed that the lumbar BMD in Group One was 0.811 g/cm2, Group 2 was 0.831 g/cm2, and Group 3 was 0.822 g/cm2. Hip BMD in Group One was 0.696 g/cm2, Group 2 was 0.711 g/cm2, and Group 3 was 0.668 g/cm2. The change in BMD values showed that in Group One, lumbar BMD increased by 0.0411 g/cm2 compared to baseline, a 5.06% increase, while hip BMD increased by 0.0047 g/cm2, a 0.68% increase. In Group 2, lumbar BMD decreased by -0.0307 g/cm2, a 3.7% decrease, and hip BMD decreased by -0.036 g/cm2, a 5.02% decrease. In Group 3, lumbar BMD increased by 0.056 g/cm2, a 6.77% increase, while hip BMD increased by 0.005 g/cm2, a 0.69% increase.</p><p><strong>Limitations: </strong>The number of patients recruited was relatively small and limited to specific age groups. Study design was retrospective.</p><p><strong>Conclusion: </strong>Lumbar ESIs with dexamethasone reduce BMD in elderly patients with osteoporosis. However, when denosumab is administered alongside dexamethasone-based ESIs, the steroid does not significantly affect the decline of BMD.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E183-E189"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764666","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":"Ultrasound-Guided Stellate Ganglion Block for the Treatment of Chronic Migraine in Adults: Study Protocol for a Randomized, Open-Label, Blinded Endpoint Trial.","authors":"Lu Liu, Zhe Sun, Lei Jiang, Fang Luo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic migraine (CM) is a recurring disorder with a relatively poor prognosis. Microinvasive and nonpharmacological therapies are essential for refractory patients with this condition. To date, only nonrandomized trials have reported the efficacy of the stellate ganglion block (SGB) for CM patients. Whether a combination of SGB and drug therapy is an optimal treatment for CM patients must still be confirmed with randomized controlled studies utilizing standardized oral medications as a control.</p><p><strong>Objective: </strong>To assess the efficacy and safety of the repeated administration of SGBs over a 4-week period on the basis of standardized oral medications for reducing the severity and number of migraine episodes during the course of a 6-month trial in CM patients for whom prophylactic treatment has failed. The aim of this study was to provide more effective nonpharmacological therapies.</p><p><strong>Study design: </strong>A prospective, randomized, open-label, blinded endpoint trial.</p><p><strong>Setting: </strong>A pain clinic in Beijing, China.</p><p><strong>Methods: </strong>CM patients from 18 to 65 years of age will be enrolled. Patients unresponsive to migraine prophylaxis will be randomly assigned to receive either SGB with standardized drug therapy (SGB group) or standardized drug therapy alone (drug group) in an effort to determine the efficacy of SGBs for the treatment of CM.</p><p><strong>Results: </strong>The efficacy and safety of the SGB as a CM treatment will be compared to those of the SGB in combination with drug therapy. Differences in pain relief and functional improvement will be assessed. The primary outcome is the change in mean monthly (defined as a 4-week time span) migraine days during the 6-month follow-up period following the patients' first SGB treatment. Secondly, analgesic medication requirements, quality-of-life assessments, and any SGB complications will also be addressed during the 6-month follow-up period.</p><p><strong>Limitations: </strong>Neither the investigators nor the patients were blinded to treatment allocation. Additionally, this is a short-term follow-up study.</p><p><strong>Conclusions: </strong>This study is a randomized controlled trial with a relatively large sample size to demonstrate the potential benefits of combined SGBs and drug therapy for CM patients. In the short term, this combined therapy will likely optimize CM treatment management. Further research will be needed to assess the efficacy of this treatment as a long-term therapeutic option.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"117-126"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764677","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":"Technique Considerations to Improve Efficacy in Sacroiliac Radiofrequency Ablation.","authors":"Joshua B Lewis, Sayed E Wahezi, Ugur Yener, Alan D Kaye, Marco Lawandy, Suwannika Palee, Joseph D Fortin","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic low back pain is a global health burden with significant health care costs. Accurate diagnosis and treatment are often complicated due to its multifactorial nature. The sacroiliac joint has been identified as a major source of lower back pain, especially among the elderly and individuals with a history of lumbar fusion surgery. Conservative treatments frequently fall short in providing relief, leading to the exploration of alternative interventions such as sacroiliac joint radiofrequency ablation (RFA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We aimed to demonstrate a novel approach for sacroiliac joint RFA based on new ex vivo evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Development of a novel methodology integrating ex vivo evidence and clinical approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Academic health care institution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Current radiofrequency methods, such as conventional RFA, water-cooled RFA, and cryoneurolysis, involve 2 main needle placement strategies: the palisading and the strip lesioning techniques. Additionally, the periforaminal/intraforaminal lesion technique, performed with fluoroscopy, visualizes the dorsal sacral foramina by adjusting the beam according to sacral tilt while the patient is prone. Targeting the lateral borders of the S1-S3 foramina, the technique aims to reach described lateral branch neural locations. Needle placement focuses on the lateral borders of the posterior sacral foramina, spaced one mm to 10 mm from the foraminal border, often following a clock face analogy. Protruding electrode RFA needles are recommended because of their demonstrated larger lesion width. After directing the needles to the lateral border of the S1-S3 posterior sacral foramina and then medially into the foramen, a lateral projection confirms proper needle placement beyond the posterior sacral ridge. Sensory-motor testing follows, with 0.5 mL of iohexol 180 administered to assess vascular flow and minimize contrast medium migration. Subsequently, 0.5 mL of lidocaine 2% is given for ablation anesthesia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This technique achieves an estimated 95% needle approximation of the lateral branches, enhancing neural ablation efficacy by optimizing needle tip positioning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitation: &lt;/strong&gt;Our technique faces challenges as lesion success rates decrease with distance from the foramen.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Adipose interference is minimized when a protruding electrode RFA needle is used within a posterior sacral foramen; neural approximation may be enhanced by giving 2% lidocaine prior to ablation. Considerable gaps in knowledge still exist despite advances in our understanding of the effect of tissue on RFA. Thorough research aimed at refining RFA procedures is essential to ensuring the best feasible patient care and sustainable pain relief. For sacroiliac joint RFA, perineural lateral branch ablation is a viable option that","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E23-E29"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190100","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":"Effects of Kilohertz Frequency on Paresthesia Perception Thresholds in Spinal Cord Stimulation.","authors":"Kas Amirdelfan, David Provenzano, Cong Yu, Paul Verrills, Ricardo Vallejo, Maged Guirguis, Jordan Tate, Kerry Bradley","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Paresthesia-based spinal cord stimulation (SCS) depends upon dorsal column (DC) fiber activation to engage pain-relieving neural mechanisms. However, the mechanisms for 10-kHz paresthesia-free SCS have not been fully elucidated. Preclinical work has shown selective drive of inhibitory dorsal horn neurons, while other hypotheses suggest that DC fibers may be activated. To provide clinical data for guiding mechanism work, we analyzed paresthesia perception thresholds (PPT) over a range of low to high kHz frequency and compared those values to the stimulation parameters from the therapeutic 10-kHz SCS programs used by patients.</p><p><strong>Objective: </strong>The goal of this study was to provide clinically relevant stimulation parameters for translational mechanism work.</p><p><strong>Study design: </strong>Retrospective chart review of technical data collected during baseline evaluation from two prospective clinical studies.</p><p><strong>Setting: </strong>Acute outpatient follow-up.</p><p><strong>Methods: </strong>Data were extracted from study files of enrolled patients who had used fully implanted SCS for at least 3 months with leads positioned in the epidural space at the T8-T11 vertebral levels to treat their chronic intractable back and/or leg pain. PPTs had been measured using a bipole program at 10 kHz at pulse width (PW) = 30 µs, and at 50 Hz, 500 Hz, 1 kHz, and 5 kHz at PW = 80 µs. Therapeutic stimulation amplitudes for 10 kHz at 30 µs were obtained from patients' IPG log files at the time of study enrollment.</p><p><strong>Results: </strong>PPTs were obtained from 23 patients with failed back surgery syndrome (11 M/ 12 F; 60 ± 15 years old). PPTs at PW = 80 µs were PPT (50 Hz) = 7.9 (5.7 - 9.7) mA, PPT (500 Hz) = 7.0 (5.2 - 9.1) mA, PPT(1 kHz) = 7.0 (5.5 --8.5) mA, and PPT (5 kHz) = 6.1 (4.1- 7.9) mA; all higher frequencies had statistically significantly lower PPTs than PPT(50 Hz at 80 µs). For 10 kHz at 30 µs, the PPT was higher than 15 mA for 13 (56%) of the subjects; for the remaining 44%, the PPT =  8.3  ± 4.0 mA was statistically significantly larger than the therapeutic stimulation pulse amplitudes = 2.4 ± 0.4 mA.</p><p><strong>Limitations: </strong>Retrospective chart review, small number of patients.</p><p><strong>Conclusions: </strong>Therapeutic 10-kHz SCS uses stimulation amplitudes far lower than the PPT, providing evidence that therapeutic 10-kHz SCS does not activate dorsal column axons.  Additionally, the PPT decreases with increasing kHz frequency, suggesting that a presumed asynchronous pattern of activation from kHz stimulation does not raise the threshold at which sensation occurs.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E81-E91"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190121","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":"In Response to Comment on \"A Novel Sequential Percutaneous Radiofrequency Treatment Strategy for Drug-refractory Trigeminal Neuralgia: A Propensity Score-matched Study\".","authors":"Hao Ren, Fang Luo","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E104"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190133","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":"Association Between 25-hydroxyvitamin D Status and New Vertebral Fractures Post Percutaneous Vertebral Augmentation in Patients During Postmenopause: A Retrospective Case-control Study.","authors":"Shu-Bao Zhang, Jin Yang, Hao-Wei Xu, Yu-Yang Yi, Chang-Xu Ren, Xiao-Yong Ge, Xin-Yue Fang, Wei Pan, Shan-Jin Wang","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Serum 25-hydroxyvitamin D (25[OH]D) deficiency causes osteoporosis and increases muscle weakness, which worsens the risk of falls and osteoporotic vertebral fractures. However, the effect of a lower serum 25(OH)D level on new vertebral fractures, including osteoporotic vertebral refractures and cascade vertebral fractures post percutaneous vertebral augmentation in patients during postmenopause has not been reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to investigate the relationship between serum 25(OH)D and the risk of osteoporotic vertebral refractures and cascade vertebral fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective case-control study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study took place at the Department of Spinal Surgery at a hospital affiliated with a medical university.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively analyzed clinical data from patients during postmenopause aged &gt;= 50 years who underwent percutaneous vertebral augmentation. The patients were categorized into a nonrefracture group, an osteoporotic vertebral refractures group, and a cascade vertebral fractures group. Univariate and multivariate logistic regression analysis models were employed to assess the effect of 25(OH)D on osteoporotic vertebral refractures and cascade vertebral fractures, while a receiver operating characteristic curve was used to evaluate its predictive value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 528 patients were included in this study. Of these, 163 patients (30.9%) developed new vertebral fractures, with 124 (23.5%) classified as osteoporotic vertebral refractures and 39 (7.4%) as cascade vertebral fractures. The 25(OH)D levels were significantly lower in the new vertebral fracture group. Multivariate logistic regression analysis confirmed that an increase in 25(OH)D levels was protective against osteoporotic vertebral refractures occuring, including cascade vertebral fractures post percutaneous vertebral augmentation, even after adjusting for other potential confounding factors. A Pearson correlation analysis indicated a close relationship between vitamin D levels and L3 paraspinal muscle density and L3 bone mineral density in the enrolled patients with osteoporotic vertebral fractures (P &lt; 0.05). A receiver operating characteristic curve analysis indicated an area under the curve of 0.751 for 25(OH)D levels in predicting the risk of osteoporotic vertebral refractures (cut-off value, 27.5 ng/mL; sensitivity, 62.74%; specificity, 72.60%; P = 0.001) and 0.831 for cascade vertebral fractures (cut-off value, 19.5 ng/mL, sensitivity, 56.41%; specificity, 97.53%; P = 0.001), respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This retrospective study was conducted at a single center with a limited number of patients during postmenopause who had prior percutaneous vertebral augmentation,  especially those that developed recurrent fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E31-E41"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189991","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 Placebo-Controlled Randomized Trial Comparing Oral Midazolam, Dexmedetomidine, and Gabapentin on Prophylaxis of Emergence Agitation After Sevoflurane Anesthesia in Adenotonsillectomy.","authors":"Mohammad Fouad Algyar, Ahmed Mohammed Abdelghany, Sherif Kamal Arafa, Amir Abouzkry Elsayed","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Sevoflurane causes emergence agitation (EA) in up to 80% of pediatric patients.</p><p><strong>Objectives: </strong>Using midazolam, dexmedetomidine (DEX), and gabapentin, this work aimed to assess the prophylactic effect of oral premedication on EA incidence experienced by pediatric patients during recovery from sevoflurane anesthesia.</p><p><strong>Study design: </strong>Randomized controlled trial.</p><p><strong>Setting: </strong>Kafrelsheikh University, Kafrelsheikh, Egypt.</p><p><strong>Methods: </strong>This study was performed on 240 men and women aged 3 to 10 years who were scheduled for adenotonsillectomy. Patients were randomized into 4 equal-sized groups. Thirty minutes before general anesthesia, oral premedication was applied in the form an apple-flavored sugary fluid plus 0.5 mg/kg of midazolam in Group M, 4 µg/kg of DEX in Group D, 10 mg/kg of gabapentin in Group G, or no drugs whatsoever in Group P (placebo).</p><p><strong>Results: </strong>The incidence of EA was reduced more greatly in the M, D, and G groups than in the P group, and the D group's incidence of EA was lower than that of the M or G groups. The severity of EA exhibited a more significant reduction in the M, D, and G groups than in Group P. Similarly, the time until extubation was more prolonged in the M, D, and G groups than it was in the P group. Hemodynamics measurements were significantly lower in Groups M, D, and G than in Group P, and the D group had a lower hemodynamics measurement than did the M or G groups. Sedation scores were greater in the D and G groups than in the P group, and the D group had a higher sedation score than did Group M.</p><p><strong>Limitations: </strong>This study used a small sample, took place at a single center, and had a short follow-up period.</p><p><strong>Conclusion: </strong>Premedication using oral midazolam, DEX, or gabapentin reduced the incidence of EA, and DEX provided the best sedation and hemodynamics of all.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"31-38"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190019","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}