Anesthesiology and Pain Medicine最新文献

{"title":"Expression of Concern for Magnesium and Ketamine Gargle and Postoperative Sore Throat [Anesth Pain Med. 2015; 5 (3): e22367].","authors":"Mahmood Reza Alebouyeh","doi":"10.5812/aapm-175518","DOIUrl":"10.5812/aapm-175518","url":null,"abstract":"","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 2","pages":"e175518"},"PeriodicalIF":0.0,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computational Anesthesiology: A New Frontier at the Intersection of Data Science and Perioperative Medicine.","authors":"Firoozeh Madadi","doi":"10.5812/aapm-175132","DOIUrl":"10.5812/aapm-175132","url":null,"abstract":"","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 2","pages":"e175132"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facial Expression-based Pain Detection: Development and Validation in the Post-anesthesia Care Unit.","authors":"Fazel Tarkhan, Ali Bijani, Shayan Alijanpour, Seyed Hossein Hamidi","doi":"10.5812/aapm-171818","DOIUrl":"10.5812/aapm-171818","url":null,"abstract":"<p><strong>Background: </strong>Objective pain assessment in non-communicative patients remains challenging. Facial expressions are valid indicators of pain; however, manual coding is not practical.</p><p><strong>Objectives: </strong>This study aimed to develop and validate a real-time facial pain assessment system (FPAS) for detecting pain using deep learning-based facial expression analysis.</p><p><strong>Methods: </strong>This cross-sectional study enrolled 50 postoperative patients in the post-anesthesia care unit (PACU) of a teaching hospital. The system performed parallel processing of facial action units using FaceMesh and emotion recognition using DeepFace, with individual baseline calibration and temporal stabilization. At 1, 5, 10, 15, and 30 minutes after PACU admission, the system generated a 0 - 10 Visual Analog Scale (VAS) pain score and a four-level categorical classification, which were simultaneously compared with patients' self-reported VAS ratings. Pearson correlation, the intraclass correlation coefficient (ICC), linear mixed-effects models, and classification metrics were used.</p><p><strong>Results: </strong>Fifty patients (60% female; mean age, 44.6 years) were enrolled. The Pearson correlation between the FPAS and patient self-reported VAS scores was 0.74 (P < 0.001). The ICC was 0.71 (95% CI: 0.64 - 0.77). Pain scores decreased significantly over time with both methods (P < 0.001), and the time × method interaction was not significant (P = 0.11). Categorical emotion classification showed 56% overall accuracy (Cohen's kappa = 0.43, P < 0.001), with the greatest agreement for the neutral class (sensitivity 72%, specificity 85%). For the four-level pain intensity classification, overall accuracy was 78.5%, with sensitivity ranging from 44% (severe pain) to 85% (no pain).</p><p><strong>Conclusions: </strong>The automated FPAS demonstrated a strong correlation and acceptable agreement with patient self-reported VAS scores for postoperative pain monitoring in the PACU, supporting its potential as an adjunctive assessment tool. However, broader validation in larger, more diverse cohorts is needed before its clinical implementation.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 2","pages":"e171818"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexmedetomidine as an Adjuvant in Femoral Nerve Block for Ease of Preoperative Positioning and Postoperative Analgesia in Hip and Proximal Femur Surgery.","authors":"Anushka Choudhary, Shaila Surendra Kamath, Priyanka Mahanta","doi":"10.5812/aapm-170873","DOIUrl":"10.5812/aapm-170873","url":null,"abstract":"<p><strong>Background: </strong>Perineural dexmedetomidine has been shown to improve block quality, accelerate onset, and prolong block duration when used as an adjuvant to local anaesthetics.</p><p><strong>Objectives: </strong>This study assessed the effects of adding dexmedetomidine to bupivacaine in an ultrasound-guided femoral nerve block (USG-FNB) on positioning for spinal anaesthesia and postoperative analgesia in patients undergoing surgery for hip and proximal femur fractures.</p><p><strong>Methods: </strong>This hospital-based observational study included 100 adults undergoing surgery for hip or proximal femur fractures. Using convenience sampling, participants were classified into two groups of 50 according to the femoral nerve block received: Group C received bupivacaine alone, and Group D received bupivacaine with dexmedetomidine at 1 µg/kg as an adjuvant. Once the visual analogue scale (VAS) score was < 3, patients were placed in the sitting position, and spinal anaesthesia was administered.</p><p><strong>Results: </strong>Median heart rate was significantly higher in Group D than in Group C at all assessed time points, except at 3 hours, when the groups were comparable. Participants in Group D achieved a VAS score < 3 significantly sooner after the block and had a significantly longer time to first rescue analgesia postoperatively than those in Group C (P = 0.001). Time to recovery from spinal anaesthesia was similar between groups. The mean number of rescue analgesic doses was significantly higher in Group C than in Group D.</p><p><strong>Conclusions: </strong>Dexmedetomidine demonstrated a superior analgesic profile as an adjuvant to a femoral nerve block, facilitating patient positioning for spinal anaesthesia and reducing postoperative rescue analgesic requirements.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 2","pages":"e170873"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Delivery of Transforaminal Epidural Steroid Injection (TFESI) for Radiculopathy Associated with Acute Lumbar Disc Prolapse Through Physiotherapist-led Assessment, Consent, and Direct Listing.","authors":"Greta Mattocks, Layla Meshykhi, Benjamin Thornton, Andreas Goebel, Martin Wilby, Canisius Dzapasi, David Woodward, Maneesh Bhojak, Manish Gupta","doi":"10.5812/aapm-171054","DOIUrl":"10.5812/aapm-171054","url":null,"abstract":"<p><strong>Context: </strong>Invasive treatments for lumbar radiculopathy with persistent symptoms and concordant disc prolapse include a transforaminal epidural steroid injection (TFESI) and microdiscectomy. Evidence supports TFESI as a potential first-line alternative to surgery. Our expedited nerve root block service (ERBS) reduced progression to surgery; however, waiting times remained suboptimal.</p><p><strong>Objectives: </strong>We evaluated a streamlined pathway incorporating physiotherapy-led consent and direct TFESI listing.</p><p><strong>Methods: </strong>This retrospective observational study evaluated a pathway modification in which the pre-procedure specialist consultation was removed. Two Musculoskeletal Clinical Assessment Service (MCAS) physiotherapists were trained to assess suitability, obtain consent, and list patients directly for TFESI, with consultant validation conducted virtually. The primary outcomes were the median waiting time from MCAS consent to TFESI and the change in waiting time compared with the previous pathway. Secondary outcomes were the proportion of listings validated, patient-reported response to TFESI, progression to surgery, and the association between TFESI response and disc pathology.</p><p><strong>Results: </strong>A total of 129 patients provided consent (mean age, 47.3 ± 12.7 years; 95% confidence interval (CI), 45.1 - 49.5; 63.6% female), with 100% validation. The median waiting time from MCAS consent to TFESI was 50 days (range, 2 - 262 days), representing a 37-day reduction (43%) compared with the previous pathway. A positive TFESI response occurred in 83% of patients, and 14% required microdiscectomy. Response rates were similar for disc protrusion (84%) and extrusion (81%).</p><p><strong>Conclusions: </strong>A physiotherapy-led ERBS pathway was associated with reduced waiting times and no identified safety concerns, while maintaining a low conversion rate to surgery.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 2","pages":"e171054"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency Ablation for Refractory Palmar and Plantar Hyperhidrosis: A Case Report.","authors":"Karim Hemati, Shima Movassaghi, Parnian Hemati","doi":"10.5812/aapm-172975","DOIUrl":"10.5812/aapm-172975","url":null,"abstract":"<p><strong>Introduction: </strong>Palmar and plantar hyperhidrosis (PH) is characterized by sweat production that far exceeds thermoregulatory needs and often has substantial effects on daily functioning, social interaction, and mental health. The condition results from sympathetically mediated overstimulation of the eccrine glands, which are innervated by unmyelinated cholinergic C-type fibers. Radiofrequency ablation (RFA) offers a minimally invasive approach to symptom control in refractory PH through heat-mediated disruption of these sympathetic fibers. Reports describing staged upper- and lower-limb RFA for combined palmar and plantar disease in a single patient remain uncommon; this is the primary reason for presenting this case.</p><p><strong>Case presentation: </strong>A 21-year-old man (American Society of Anesthesiologists physical status I) presented with a 10-year history of progressive palmar and plantar hyperhidrosis that had not shown durable responses to conservative or prior interventional treatment. He used topical aluminum chloride for 2 months without meaningful benefit and subsequently underwent 2 sessions of palmar botulinum toxin injections 5 months apart, which reduced palmar sweating by an estimated 50 - 60% for approximately 2 months per session; the lower limbs were not treated. Eighteen months before the current admission, he underwent RFA of the right thoracic sympathetic chain at another center. This produced approximately 80% improvement in palmar sweating, although sweating persisted along the ulnar nerve distribution; the benefit lasted only approximately 4 months, after which symptoms recurred to baseline. During the present admission, staged RFA was performed bilaterally at L3, with different lower-limb protocols selected in advance based on the prior treatment response and the greater severity of plantar sweating on the left. Seven days later, bilateral RFA was performed at T3. At the 2-week, 1-month, and 7-month follow-up visits, the patient reported no compensatory sweating or change in cutaneous sensation. By his own assessment, overall sweating of the palms and soles was reduced by approximately 90% from baseline, with a satisfaction score of 9/10 and subjectively improved quality of life.</p><p><strong>Conclusions: </strong>Staged RFA targeting both the thoracic and lumbar sympathetic chains appears to be a reasonably safe palliative option for patients with refractory combined palmar and plantar hyperhidrosis, with a more favorable complication profile than surgical sympathectomy. This case is considered reportable because it involves combined, staged treatment of both the upper and lower limbs in a single patient.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 1","pages":"e172975"},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Vitamin C on Postoperative Pain in Patients with Trochanteric Femur Fracture.","authors":"Mirza Sivro, Faruk Hodžić, Tarik Branković","doi":"10.5812/aapm-169833","DOIUrl":"10.5812/aapm-169833","url":null,"abstract":"<p><strong>Background: </strong>Trochanteric femur fractures constitute nearly half of all hip fractures and represent the most commonly surgically treated fracture type overall. Postoperative pain is linked to increased morbidity and poorer functional recovery, and its management remains challenging due to the adverse effects associated with commonly prescribed analgesics.</p><p><strong>Objectives: </strong>This study aimed to assess the influence of oral vitamin C supplementation on postoperative pain intensity in patients with trochanteric femur fractures managed with intramedullary nailing.</p><p><strong>Methods: </strong>A prospective, randomized, single-blinded, placebo-controlled clinical trial was performed involving 70 patients allocated to either a vitamin C group or a control group. Participants in the vitamin C group received 1 g of oral vitamin C daily for 40 postoperative days, whereas the control group received a placebo for the same duration. Baseline demographic and clinical characteristics, Visual Analogue Scale (VAS) pain scores, total postoperative metamizole consumption, Harris Hip Score (HHS) values, and complication rates were recorded and compared between groups.</p><p><strong>Results: </strong>No statistically significant differences were observed between groups regarding age, gender distribution, length of hospital stay, fracture side, or fracture classification. The cumulative postoperative VAS scores were significantly lower in the vitamin C group compared with the control group (P = 0.0000). Median postoperative metamizole consumption was lower in the vitamin C group, with a significant difference compared with the control group (P = 0.020). Harris Hip Score values assessed at 6 and 12 weeks postoperatively did not differ significantly between groups (P = 0.760 and P = 0.796, respectively).</p><p><strong>Conclusions: </strong>The findings indicate that vitamin C supplementation significantly reduced subjective postoperative pain and analgesic consumption, suggesting its potential usefulness as an adjunctive measure for pain management following hip fracture surgery.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 1","pages":"e169833"},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13181815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Protrusion to Extrusion: Reassessing the Selective Role of Intradiscal Interventions.","authors":"Babak Eslami, Reza Atef Yekta, Hossein Majedi, Alireza Khajehnasiri, Ebrahim Espahbodi, Alireza Montaseri, Maziar Maghsoudloo, Noushin Rezaalizade, Alireza Rezaee","doi":"10.5812/aapm-168119","DOIUrl":"10.5812/aapm-168119","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Extruded lumbar disc herniations are traditionally managed surgically, whereas contained protrusions are more commonly considered suitable for percutaneous intradiscal procedures. However, extrusion itself may not be a universal contraindication to all needle-based intradiscal interventions, particularly when the fragment is non-sequestered and remains continuous with the parent disc. This narrative review evaluates the evidence, safety considerations, and clinical positioning of intradiscal procedures in extruded, non-sequestered lumbar disc herniations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Evidence acquisition: &lt;/strong&gt;A structured narrative review was conducted using PubMed/MEDLINE, Embase, Scopus, the Cochrane Library, Google Scholar, reference-list screening, and selected technical or manufacturer documents. The review focused on intradiscal interventions used or debated for lumbar disc herniation with radicular symptoms, including percutaneous laser disc decompression and targeted PLDD (T-PLDD), radiofrequency nucleoplasty, oxygen-ozone (O&lt;sub&gt;2&lt;/sub&gt;-O&lt;sub&gt;3&lt;/sub&gt;) discolysis, gelified ethanol, and mechanical decompression devices. Epidural injections, endoscopic or open discectomy, and procedures primarily investigated for discogenic axial low back pain or the regenerative treatment of degenerative disc disease were excluded from the main synthesis. Evidence was interpreted according to study design, disc morphology, direct applicability to extruded non-sequestered herniation, clinical outcomes, and safety reporting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The evidence base is limited and heterogeneous. T-PLDD and radiofrequency nucleoplasty provide the most direct, although still low-certainty, clinical evidence for extruded or uncontained herniations. Oxygen-ozone discolysis has biological plausibility, particularly through modulation of inflammation and potential facilitation of fragment resorption; however, most clinical data are derived from mixed-morphology cohorts. Gelified ethanol has encouraging observational data, including studies that permitted non-contained lesions, but extrusion-specific outcomes remain insufficient. Mechanical decompression devices differ from the other modalities because the reviewed evidence and device technical guidance primarily relate to contained herniations, free fragments are excluded in the manufacturer's technical guide, and extrapolation to extruded or sequestered lesions is not supported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Extrusion alone should not be considered a universal contraindication to all intradiscal interventions. Nevertheless, current evidence remains insufficient to support these procedures as alternatives to guideline-supported conservative care or surgical discectomy. Intradiscal interventions may be considered only as selective, non-first-line, intermediate options in carefully selected patients with extruded but non-sequestered lumbar disc herniations, preserved continuity with ","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 1","pages":"e168119"},"PeriodicalIF":0.0,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Apneic Oxygenation During Induction of General Anesthesia in Children Undergoing Adenotonsillectomy: A Prospective Randomized Controlled Study.","authors":"Safaa Gaber Ragab, Ahmed Ali Lotfy, Joseph Makram Botros, Hasnaa Mohsen Hashem, Rana Ahmed Abdelghaffar, Doaa Lotfy Abdel Baky","doi":"10.5812/aapm-169980","DOIUrl":"10.5812/aapm-169980","url":null,"abstract":"<p><strong>Background: </strong>Children undergoing adenotonsillectomy often have partial airway obstruction due to hypertrophic tonsils and adenoids, increasing their risk of oxygen desaturation during anesthesia induction.</p><p><strong>Objectives: </strong>This study aimed to evaluate whether apneic oxygenation via nasal cannula prevents oxygen desaturation during tracheal intubation in children aged 3 - 10 years undergoing adenotonsillectomy while assessing its effects on intubation conditions and hemodynamic stability.</p><p><strong>Methods: </strong>In this prospective, single-blinded, randomized controlled trial, 140 children scheduled for adenotonsillectomy were allocated to either standard intubation (group A, n = 70) or apneic oxygenation (group B, n = 70; 0.2 L/kg/min via nasal cannula). The primary outcome was the lowest peripheral oxygen saturation (SpO₂) during intubation.</p><p><strong>Results: </strong>Peripheral SpO₂ was significantly lower during intubation in group A (97.40 ± 2.96) than in group B (99.91 ± 0.28) (P < 0.001). Group B also maintained significantly higher SpO₂ immediately after intubation (99.91 ± 0.28%) than group A (97.77 ± 2.24%; P < 0.001). No episodes of desaturation occurred in group B during the procedure (P < 0.001). In group A, 21.43% of patients desaturated to ≤ 95% (P < 0.001). Severe desaturation (SpO₂ < 92%) occurred in 7.14% of controls but was absent in group B (P = 0.023). Intubation time, intubation attempts, and bradycardia rates were comparable between groups (P > 0.05).</p><p><strong>Conclusions: </strong>Apneic oxygenation during intubation in children undergoing adenotonsillectomy effectively prevented desaturation without compromising safety or procedural efficiency.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 2","pages":"e169980"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Diagnostic Targeted Epidural Injection in the Diagnosis and Management of Chronic Spinal Pain: A Retrospective Analysis on 99 Patients.","authors":"Alvise Martini, Vittorio Schweiger, Loris Anastasio, Luca Polati, Enrico Polati","doi":"10.5812/aapm-168719","DOIUrl":"10.5812/aapm-168719","url":null,"abstract":"<p><strong>Background: </strong>Chronic spinal pain, led by low back pain (LBP), which affects 619 million people globally and is projected to reach 843 million by 2050, is the main cause of disability. Although epidural steroid injections (ESIs) are recommended at Level I-A, their efficacy is often limited by technical factors, such as scarring, and they provide incomplete diagnostic information. We propose diagnostic targeted epidural injection (dTEI) via a Racz catheter, focused on detailed epidurography and anatomical exploration, as an essential diagnostic-therapeutic triage tool to overcome these drawbacks.</p><p><strong>Objectives: </strong>The objective of this study is to evaluate the efficacy of the procedure in a mixed low back pain population.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 99 patients with chronic radiculopathy, LBP, Post-Spine Surgery Syndrome type 2 (PSPS-2), or spinal stenosis (VAS > 40, duration > 3 months) treated with dTEI between January and December 2023. Outcomes, including Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Quality of Life (QoL), and opioid use (morphine equivalent dose), were evaluated at one-month follow-up. Success was defined as either a VAS reduction greater than 50% or achievement of the Minimum Clinically Important Difference (MCID).</p><p><strong>Results: </strong>The mean age was 67.57 years. Significant improvements were observed in VAS scores (from 78.18 to 57.88, P < 0.001) and QoL scores (from 45.33 to 51.62, P = 0.001). Minimal therapeutic success according to MCID was achieved by 59.6% of patients. Opioid consumption was significantly reduced by 38%. Subgroup analysis showed that the spinal stenosis group achieved the best outcomes across all metrics. No correlation was found between the surgeon's subjective assessment of technical success (contrast runoff/defect reduction) and superior clinical outcome.</p><p><strong>Conclusions: </strong>Diagnostic targeted epidural injection serves as a valuable diagnostic tool with significant therapeutic potential, optimizing patient selection in a stepwise management pathway. It effectively reduces pain and opioid use and provides detailed anatomical information to selectively guide nonresponders toward more complex and costly therapies, such as spinal cord stimulation or epiduroscopy. The primary value of the technique lies in diagnostic clarification and refinement of the therapeutic trajectory.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 1","pages":"e168719"},"PeriodicalIF":0.0,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13181816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}