Pain physician最新文献

{"title":"Comparison Between Multimedia and Written Informed Consent for Lumbar Transforaminal Epidural Steroid Injection: A Randomized Controlled Pilot Trial.","authors":"Sunmin Kim, Nam Woo Kim, Francis Nahm, Eun Joo Choi, Pyung Bok Lee","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Informed consent is a crucial ethical and legal requirement in medical practice to ensure that patients understand the risks, benefits, and alternatives of medical procedures. Recent advances in multimedia technology have facilitated the exploration of multimedia consent, aiming to enhance patient understanding and satisfaction. Ascertaining that patients have full comprehension of the procedures before opting to undergo them is especially important now that instances of such procedures as lumbar transforaminal epidural steroid injections (TESIs) are increasing.</p><p><strong>Objectives: </strong>To determine the effectiveness of multimedia consent forms for lumbar transforaminal steroid injections.</p><p><strong>Study design: </strong>Randomized clinical trial.</p><p><strong>Setting: </strong>Outpatient multidisciplinary pain medicine center of a tertiary hospital.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted with 30 patients who received lumbar TESIs for lumbar radiculopathy. Patients were randomly assigned to either the multimedia consent group (Group M) or the conventional paper consent group (Group C). This study evaluated patients' comprehension of the procedure, their anxiety levels (using the State-Trait Anxiety Inventory short form), and the patients' post-procedure satisfaction.</p><p><strong>Results: </strong>Group M showed significantly greater understanding of the procedure and reported lower levels of anxiety than did Group C (P = 0.041; P = 0.03). However, there were no statistically significant differences in post-procedure satisfaction between the groups (P = 0.25). These findings suggest that multimedia consent can effectively improve patient comprehension and reduce anxiety without significantly affecting patient satisfaction.</p><p><strong>Limitations: </strong>First, the limited sample size of 30 patients restricts the applicability of our findings to a wider population, suggesting a need for larger studies to better assess the effects of multimedia consent. Second, conducting the study in a single hospital might have introduced bias. Multicenter research may provide a more diverse and accurate evaluation of the efficacy of multimedia consent.</p><p><strong>Conclusion: </strong>This pilot study contributes to the growing evidence supporting the use of multimedia consent to enhance patient understanding and reduce anxiety, marking a promising direction for improving informed consent practices for less invasive procedures, such as lumbar TESIs. Further research is required to fully explore the benefits and limitations of multimedia consent forms in various medical settings.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"529-535"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771195","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":"Nucleus Pulposus Allograft Supplementation in Patients with Lumbar Discogenic Pain: Initial 6-month Outcomes from a Prospective Clinical Pilot Study.","authors":"Douglas P Beall, Timothy T Davis, Kasra Amirdelfan, Ramana K Naidu, Michael J DePalma, Shrif Costandi, Jacob W Fleming, Edward S Yoon, Timothy Ganey, Jon E Block, Nagy Mekhail","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Preventing disc degeneration remains a clinical challenge; patients experiencing chronic lumbar discogenic pain have limited treatment options. Minimally invasive intradiscal procedures such as allogeneic nucleus pulposus (NP) injection have the potential to fill the treatment gap between failed conservative care and spine surgery.</p><p><strong>Objectives: </strong>Our study sought to evaluate the magnitude and durability of improvement in back function in patients with chronic lumbar discogenic pain followed for 6 months after a single intradiscal injection of minimally manipulated, off-the-shelf processed NP allograft (VIA Disc NP®, VIVEX Biologics, Inc.) at up to 2 vertebral levels.</p><p><strong>Study design: </strong>Single-arm, prospective, multicenter, pilot study.</p><p><strong>Setting: </strong>Academic and private practice outpatient clinics.</p><p><strong>Methods: </strong>A total of 29 patients with symptomatic lumbar discogenic pain refractory to conservative care who had a back function score of  40-80 points on the Oswestry Disability Index (ODI), ≥ 6 on an 11-point back pain Numeric Rating Scale (NRS-11) and corresponding imaging evidence of disc degeneration were enrolled. A single dose, intradiscal injection of approximately 100 mg of NP allograft mixed with sterile saline was administered to the affected level or levels.</p><p><strong>Results: </strong>The average ODI and NRS-11 improvements between baseline and 6-months postprocedure were 54.8% (95% CI, 41.3-68.3) and 52.9% (95% CI, 34.7-71.1) respectively (P < 0.001). A minimal clinically important difference of ≥ 30% improvement over baseline was achieved in 79% (22 of 28) and 68% (19 of 28) of patients for ODI and NRS-11, respectively. At 6-months postprocedure, 64% (18 of 28) of patients had an NRS-11 score ≥ 3.</p><p><strong>Limitations: </strong>This pilot study did not employ a concurrent control group and the clinical follow-up was limited to 6 months.</p><p><strong>Conclusions: </strong>These pilot findings demonstrate the feasibility of treating patients with symptomatic lumbar disc degeneration with a single intradiscal injection of allogeneic NP to provide significant and durable improvements in back function and pain.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E865-E871"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771306","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":"Spinal Cord Stimulator Complication Rates: A Single-Institution, 22-Year Study (1999-2021).","authors":"Johnson S Ho, Michael Glicksman, Kyle Kang, Emily X Zhang, Anh T Phung, Alexandra Thérond, Alexandra C Fonseca, Evgeny Bulat, Michael E Schatman, Alan D Kaye, Jamal Hasoon, Cyrus Yazdi, Jatinder Gill, Qing Ruan, Christopher L Robinson, Thomas Simopoulos","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Since the initial introduction in 1967 of spinal cord stimulation (SCS) in the field of neuromodulation, SCS has been utilized to treat a multitude of chronic pain disorders refractory to both conservative and surgical management. Although efficacious when indicated, SCS has associated risks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The goals of this study are to explore the trend of rates of SCS complications in 2 approximately equally sized cohorts (1999-2015 and 2016-2021) within a single institution over a 22-year period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;A tertiary care academic hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective chart review with pre-existing institutional review board approval was performed on 2 cohorts, one comprising 257 patients between 2016 and 2021 and the other comprising 262 patients between 1999 and 2015, who underwent percutaneous SCS implantation provided by 2 experienced interventional chronic pain specialists. The patients' demographics and complications were recorded in the REDCAP database. Data were collected on complications of both the biological (allergic/foreign-body reactions, dural puncture/leaks, infections, pain over implantation site, poor wound healing, skin erosions, neurological injuries, and subcutaneous/epidural hematomas) and device-related (electrical leaks, inadequate pain coverage, lead fractures, lead migrations, ligamentum flavum stimulation, recharging/battery failures, and unwanted stimulation) varieties. The chart review included records that started 6 months prior to SCS placement and ended at a period of at least one year of follow-up after placement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the patients studied between 2016 and 2021, the mean age was 58.5 ± 13.0 years, with men representing 46.3% and women 53.7% of the patients studied. Of those studied between 1999 and 2015, the mean age was 50.6 +/- 12.3 years, with men representing 42.4% of the patients and women 57.6%. The overall complication rates were 14.0% (36/257) and 38.9% (102/262) for 2016-2021 and 1999-2015, respectively. The rate of biological complications was nearly 3 times lower in the 2016-2021 group than in the 1999-2015 group (4.3% [11/257] vs 12.2% [32/262], P &lt; 0.001). In the 1999-2015 group, the leading biological complication was infection, the rate of which decreased in the 2016-2021 group (3.4% [9/262] vs 1.9% [5/257], P &lt; 0.42). The rate of device complications was nearly 3 times lower in the 2016-2021 group than in the 1999-2015 group (9.7% [25/257] vs. 26.7% [70/262], P &lt; 0.0001). The leading device complication was inadequate pain coverage (12.2% [32/262] vs 7.4% [19/257], P &lt; 0.08). No serious neurological injury or death occurred in either cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Limitations were inherent to this study's design, since it was a retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E909-E917"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771317","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":"Comment on \"The Safety and Effectiveness of Orthobiologic Injections for Discogenic Chronic Low Back Pain: A Multicenter Prospective, Crossover, Randomized Controlled Trial with 12 Months Follow-up\".","authors":"Merve Sekizkardes, Savas Sencan, Serdar Kokar, Osman Hakan Gunduz","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E966-E967"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771093","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":"Composite Treatment Response from a Prospective, Multi-Center Study (US-nPower) Evaluating a Miniature Spinal Cord Stimulator for the Management of Chronic, Intractable Pain.","authors":"Mehul J Desai, Tejal Raju, Cheanny Ung, Sailesh Arulkumar, Leonardo Kapural, Mayank Gupta, Kasra Amirdelfan, David Rosenfeld, Aaron Calodney, Dawood Sayed, Ajay Antony, Sean Li, Ramana K Naidu, Joel Ackerman, Robert Ball, Michael Fishman, Peter Staats, Gary Heit, Shilpa Kottalgi, James Makous","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Measures of therapeutic efficacy in pain studies have historically focused on pain scores, such as the Visual Analog Scale (VAS) or the Numeric Rating Scale. However, pain scores capture a univariate measure of a multivariate condition present in patients with chronic pain, where the pain condition can affect activities of daily living, sleep, quality of life, and mood. Hence, examining composite endpoints, which incorporate outcomes from multiple facets of pain, may allow investigators to better assess improvements in chronic pain patients with various new treatments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This trial was designed to evaluate the performance of the Nalu™ Neurostimulation System (Nalu Medical, Inc.), a miniature implanted pulse generator (micro-IPG), in the treatment of low-back pain and leg pain with spinal cord stimulation therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This was a prospective, single arm, multicenter, open-label, postmarket study that followed patients for 90 days postimplantation of the Nalu Neurostimulation System.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Patients were recruited from, and treated at, 15 US-based comprehensive pain centers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with chronic, intractable, neuropathic pain of the back and/or leg(s), with a VAS pain score of at least 6 at the time of screening, were included. The micro-IPG was implanted per standard clinical practice. Patient-reported outcomes (PROs), including VAS pain scores, Oswestry Disability Index (ODI), Beck Depression Inventory, quality-of-life metric (EQ-5D-5L), Patient Global Impression of Change (PGIC), and sleep disturbance Patient-reported Outcomes Measurement Information System (PROMIS) were recorded. Literature-based minimal clinically important differences (MCIDs) were used to define the MCID responder rates as well as a composite endpoint analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ninety-four percent (94%) of the study patients reached the MCID in at least 2 of the PROs. Five out of 6 PROs demonstrated a responder rate of &gt; 75%. Forty-nine percent (49%) of the patients were holistic responders, meaning they responded in each of the 6 outcome measures under consideration. Overall VAS pain scores reached the MCID in 86% of the patients. PGIC demonstrated the largest MCID responder rate: 100%. The ODI score reached the MCID in 94% of the patients; the BDI score reached the MCID rate in 84% of the patients; the EQ-5D-5L score reached the MCID in 77% of the patients; and the PROMIS score reached the MCID in 67% of the patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;While this was a multicenter, prospective study, it was also a single arm, nonrandomized trial. The 35 study patients were only followed for 90 days post micro-IPG implant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In the face of improving spinal cord stimulation pain outcomes, composite PROs are likely to become more common in evaluating therapeutic response. Resp","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E881-E889"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771197","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":"Percutaneous Kyphoplasty Alleviates Pain Occurring Distal to the Fracture Area Caused by Stage I and II Kümmell Disease.","authors":"Yuye Zhang, Wenhong Yang, Wenxiang Tang, Xiaomei Song, Jun Hua, Yongming Sun, Xiaozhong Zhou, Fanguo Lin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Kümmell disease (KD)-a rare and relatively complex spinal condition-is a type of posttraumatic osteoporotic vertebral compression fracture manifesting as a delayed collapse of a vertebral body. Although most patients with KD present with pain in the fracture area, some present with pain in the rib region or distal lumbosacral region, without pain in the fracture area, which poses challenges for diagnosing and treating KD.</p><p><strong>Objective: </strong>We aimed to explore whether percutaneous kyphoplasty can alleviate pain distal to the fracture area caused by either Stage I or Stage II KD.</p><p><strong>Study design: </strong>A retrospective study.</p><p><strong>Setting: </strong>This study was conducted at a university-affiliated hospital.</p><p><strong>Methods: </strong>We conducted a retrospective analysis on patients with Stage I or Stage II KD who underwent surgical treatment in our hospital from December 2021 through October 2023. All patients were accompanied by pain distal to the fracture area (i.e., pain in the rib region or the distal lumbosacral region). All patients underwent percutaneous kyphoplasty. Postoperative follow-up thoracic or lumbar x-rays confirmed polymethylmethacrylate diffusion and vertebral reduction. Pain distal to the fracture area and functional impairment were evaluated at presurgery and at postsurgery one day, one week, and one month. In addition, the anterior, middle, and posterior vertebral heights and the Cobb angle were measured at pre- and postsurgery.</p><p><strong>Results: </strong>A total of 42 patients were enrolled; 39 (92.9%) were women. Their average age was 73.48 ± 8.81 years. The fracture segments with KD and pain distal to the fracture area were as follows: T7 (9 cases, 21.4%); T10 (9 cases, 21.4%); and T8 (8 cases, 19.0%). The common location of pain distal to the fracture area was the rib region (30 cases, 71.4%). The preoperative Visual Analog Scale score of pain distal to the fracture area and the Oswestry Disability Index scores were significantly higher than those at postsurgery one day, one week, and one month. The heights of the anterior, middle, and posterior edges of the vertebrae on x-ray were significantly higher postoperatively than preoperatively. The Cobb angle of the fractured vertebrae was also higher postoperatively than preoperatively.</p><p><strong>Limitations: </strong>Our study was conducted at a single center; single-center studies may introduce bias. Our study also had a relatively short follow-up time.</p><p><strong>Conclusion: </strong>Patients with Stage I or Stage II KD may experience pain distal to the fracture area, which may effectively be alleviated by percutaneous kyphoplasty.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E829-E834"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771308","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":"The Quadrant Localization Technique for Percutaneous Balloon Compression Surgery is Beneficial for Patients with Classic Trigeminal Neuralgia: A Retrospective Study.","authors":"Yuchen Tian, Yanmeng Tan, Wei Gao, Lin Yang, Wei Zhang, Xinghua Jiang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The Hartel anterior approach is a commonly used puncture method in percutaneous balloon compression (PBC) surgery. However, anatomical variations along the puncture path, and visual errors on x-ray 2-dimensional imaging, may increase the difficulty of a successful first attempt. Our clinical practice has shown that employing the quadrant localization technique to plan puncture points and angles can enhance the puncture success rate.</p><p><strong>Objectives: </strong>We will demonstrate that the quadrant localization technique increases the success rate of the first puncture of the foramen ovale and the initial placement of the balloon catheter, thereby improving the efficiency of PBC surgery.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>A single center, tertiary general hospital.</p><p><strong>Methods: </strong>This study included a total of 371 patients with classic trigeminal neuralgia who underwent PBC surgery from January 2019 through May 2023. All patients received general anesthesia and underwent PBC surgery under radiographic guidance. In total, 170 patients underwent a puncture using the quadrant localization technique (Group Q), and 201 underwent a puncture using the conventional Hartel anterior approach (Group P).</p><p><strong>Results: </strong>Group Q demonstrated higher success rates for the first puncture and insertion of the balloon catheter, along with a lower total radiographic radiation dose, shorter surgical duration, and shorter hospital stay (P < 0.05). However, there were no significant differences in PBC success rates or the incidence of puncture-related side effects and complications between the 2 groups (P > 0.05).</p><p><strong>Limitations: </strong>This study lacked information on long-term complications and pain recurrence rates. Also, single-center results may be influenced by institution-specific practices and physician-related biases.</p><p><strong>Conclusion: </strong>In PBC surgery, the quadrant localization technique improves efficiency and reduces hospital stay compared with the conventional Hartel anterior approach, without increasing the risk of complications.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E891-E898"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771319","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":"Percutaneous Endoscopic Resection of Lumbar Discal Cyst.","authors":"Shuai Ding, Guangquan Zhang, Yanzheng Gao, Zhiqiang Hou, Fuqiang Shao","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Discal cysts, an uncommon condition, can replicate the characteristic signs typically linked to a herniated lumbar disc, encompassing discomfort in the lumbar region and neuralgia that extends along the nerve paths, thereby complicating the process of distinguishing the discal cyst from other conditions. Consensus on the treatment of this disease remains elusive, and the best treatment for it is still a matter of controversy. In numerous past reports, this disease has been treated through either open or microscopic surgical approaches.</p><p><strong>Objectives: </strong>The aim of this study is to assess the therapeutic efficacy and safety of a minimally invasive endoscopic surgery technique in the treatment of lumbar discal cysts.</p><p><strong>Study design: </strong>We conducted a retrospective observational analysis.</p><p><strong>Setting: </strong>This research was initiated with a group of patients selected from the Spinal Surgery Unit at the Henan Provincial People's Hospital.</p><p><strong>Methods: </strong>From March 2017 to May 2021, a minimally invasive endoscopic procedure was executed on a cohort of 7 male patients (average age: 30.86 ± 5.24 years), each diagnosed with discal cysts, within our spinal surgery division. The efficacy of the treatment was gauged by pre- and postoperative assessments that used the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Furthermore, the ultimate clinical efficacy of the procedure was appraised in accordance with the revised Macnab criteria.</p><p><strong>Results: </strong>The patients reported a prompt and significant relief of symptoms after the surgical removal of the lumbar disc lesions, with no cases of recurrence noted during the follow-up period. A significant drop was observed in the VAS score for lower limb pain, declining from a preoperative mean of 6.86 ± 1.35 to 1.57 ± 0.53 at the final evaluation (P < 0.05). In tandem with this finding, a marked decrease in the ODI score was noted, with a reduction from 69.14 ± 10.76 before surgery to 10.29 ± 5.59 at the concluding review (P < 0.05). The postoperative VAS and ODI scores collectively pointed toward substantial improvements in patients' conditions. When assessed according to the revised Macnab criteria, the outcomes were distributed as follows: 4 patients (57.1%) achieved excellent results, 2 (28.6%) had very good results, and one (14.3%) had a fair result, totaling 6 patients (85.7%) with satisfactory outcomes. No severe complications or recurrences were identified during the postoperative monitoring phase.</p><p><strong>Limitations: </strong>This observational retrospective study was based on a convenience sampling that involved a limited number of patients.</p><p><strong>Conclusions: </strong>Percutaneous endoscopic resection emerged as a micro-invasive and secure surgical approach for the management of lumbar discal cysts.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E873-E879"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771307","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":"Intravenous Versus Peribulbar Dexmedetomidine as an Adjunct to Local Anesthetics in Strabismus Surgery: A Randomized, Double-blinded Clinical Trial.","authors":"Huda F Ghazaly, Ibrahim E Hassan, Ahmed F Gabr, Taha T Dardeer, Mohamed A Alazhary","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Dexmedetomidine has not been adequately studied as an adjuvant to peribulbar anesthesia in strabismus surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We investigated how different routes of dexmedetomidine administration affect the peribulbar block characteristics in adults undergoing strabismus surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A randomized, double-blind clinical trial. The study was approved by the Institutional Ethics Committee (approval number: 520/3/2021) and registered at ClinicalTrials.gov (NCT05215158).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The trial included 46 patients aged 20-60 years with an American Society of Anesthesiologists Physical Status Classification System of  I or II who were scheduled for unilateral strabismus surgery at a university hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients were randomly assigned to an intravenous dexmedetomidine group (n = 15) who received 50 µg dexmedetomidine in 50 mL normal saline intravenously over 10 minutes, followed by a peribulbar block using a 10 mL mixture of 4 mL lidocaine 2%, 4 mL bupivacaine 0.5%, and 2 mL normal saline containing 150 international units (IU) hyaluronidase. The peribulbar dexmedetomidine group (n = 31) received 50 mL normal saline intravenously over 10 minutes, followed by a peribulbar block using a 10 mL mixture of 4 mL lidocaine 2%, 4 mL bupivacaine 0.5%, 1 mL normal saline with 150 IU hyaluronidase, and 1 mL normal saline containing 50 µg dexmedetomidine. Sensory and motor block onset and duration, analgesia duration, and patient and surgeon satisfaction were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Peribulbar dexmedetomidine prolonged the median duration of postoperative analgesia by 3.2 hours. Patients who received peribulbar dexmedetomidine benefitted from a longer time to request postoperative analgesia than those who got intravenous dexmedetomidine (7.17 ± 2.0 hours vs 5.79 ± 2.1 hours; P = 0.048). Motor block duration was longer in the peribulbar group compared to the intravenous group (198.34 ± 17.3 minutes vs 148.93 ± 13.7 minutes; P = 0.001). Patient and surgeon satisfaction was higher in the peribulbar dexmedetomidine group compared to the intravenous dexmedetomidine group (P = 0.048, P = 0.016, respectively). Strabismus surgery duration was shorter in the intravenous dexmedetomidine group than in the peribulbar group (38.01 ± 8.3 minutes vs 55.01 ± 11.9 minutes; P &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Our study took place at a single-center with a small sample size limited to adult patients undergoing strabismus surgery. The study was not powered to identify differences in speed of sensory block onset and duration, or speed of motor block onset. However, peribulbar dexmedetomidine prolonged the motor block's duration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Peribulbar dexmedetomidine outperforms intravenous dexmedetomidine in terms of postoperative analgesia and motor block duration when used as an adjunct to peri","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E819-E827"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771227","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":"Comment on \"Comparing the Effectiveness and Safety of Dexamethasone, Methylprednisolone and Betamethasone in Lumbar Transforaminal Epidural Steroid Injections\".","authors":"Gozde Dagistan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E965"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771007","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}