{"title":"Comparison of Modified Mallampati Classification in Supine and Sitting Positions to Predict Difficult Tracheal Intubation in Diabetic Patients.","authors":"Diya Sarah Jacob, Sonal Bhat, Sunil Vasudev Rao","doi":"10.5812/aapm-145034","DOIUrl":"10.5812/aapm-145034","url":null,"abstract":"<p><strong>Background: </strong>Airway management of patients with long-standing diabetes poses a major challenge for anaesthesiologists due to stiff joint syndrome affecting the atlanto-occipital joint. In certain cases requiring immobilization, the Mallampati test must often be performed in the supine position for obvious reasons.</p><p><strong>Objectives: </strong>Hence, we determined the diagnostic precision (sensitivity and specificity) of the modified Mallampati test in sitting and supine positions among the diabetic population in predicting difficult tracheal intubation.</p><p><strong>Methods: </strong>A single-center prospective observational study on adult diabetic patients undergoing general anesthesia and orotracheal intubation was carried out. An observer recorded the modified Mallampati in the sitting posture during the pre-anesthetic examination. The Mallampati in the supine position was determined while in the operating room, and the difficulty of intubation was noted, and diagnostic precision was calculated. The main objective was to predict a difficult airway by calculating the sensitivity, specificity, positive predictive value, and negative predictive value.</p><p><strong>Results: </strong>Out of the 150 participants, Mallampati grading in a sitting position was correctly able to identify 42.5% of difficult intubation cases, whereas it was 97.5% with Mallampati in the supine position. Mallampati grading in the sitting position was able to correctly identify 89.1% of easy intubation cases, which was 63.6% with Mallampati in the supine position. The correlation of Mallampati in the supine position with CL grading was statistically significant (P < 0.001).</p><p><strong>Conclusions: </strong>Among diabetic patients, the modified Mallampati test in the supine position can be considered a more accurate and sensitive predictor of difficult intubation than the sitting posture.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 2","pages":"e145034"},"PeriodicalIF":0.0,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11088840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140915599","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}
Shahrokh Ebnerasooli, Arash Barghi, Karim Nasseri, N. Moghimi
{"title":"Peri-articular Dextrose Prolotherapy: Investigating the Effect of Injection Site on Knee Osteoarthritis Pain: A Double-Blind, Randomized, Clinical Trial","authors":"Shahrokh Ebnerasooli, Arash Barghi, Karim Nasseri, N. Moghimi","doi":"10.5812/aapm-140966","DOIUrl":"https://doi.org/10.5812/aapm-140966","url":null,"abstract":"Background: Osteoarthritis (OA) is a chronic health condition that affects millions of people worldwide. It not only causes pain and physical limitations but also impacts mental health, sleep, work participation, and even mortality. Peri-articular dextrose prolotherapy has been shown to reduce knee osteoarthritis pain; however, the effect of injection sites on its effectiveness is not clear. Objectives: This study aimed to investigate the effect of injection points on pain intensity, joint stiffness, and physical activity in patients with knee osteoarthritis who underwent peri-articular dextrose prolotherapy. Methods: This double-blind clinical trial involved 26 patients with grade 2 and 3 bilateral knee osteoarthritis. Three times every one week, dextrose and lidocaine were injected as interventions. Injection sites were positioned within acupuncture points on one knee, but were relocated by 1.5 centimeters to the medial side of the same acupuncture points on the other knee. Pain intensity, joint stiffness, and physical activity were evaluated using the Visual Analog Pain Scale (VAS) and the Persian version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before the intervention and at each follow-up visit at 1 and 2 months post-injection. Results: Pain intensity score, joint stiffness, physical performance, and WOMAC were significantly decreased one and two months after the intervention in both groups (P = 0.0001). The improvement in the patients of both groups was similar, and the two study groups did not have a statistically significant difference in terms of study outcomes (P = 0.37). Conclusions: Prolotherapy with dextrose is an effective treatment for knee osteoarthritis.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"57 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140376356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Bedewy, Maged Salah Mohamed, H. M. Sultan, M. S. Khalil
{"title":"Comparison Between Erector Spinae Plane Block versus Serratus Anterior Plane Block Regarding Analgesia and Stress Response After Modified Radical Mastectomy: Randomized Controlled Trial","authors":"A. Bedewy, Maged Salah Mohamed, H. M. Sultan, M. S. Khalil","doi":"10.5812/aapm-142189","DOIUrl":"https://doi.org/10.5812/aapm-142189","url":null,"abstract":"Background: Modified radical mastectomy (MRM) is the primary surgical treatment for breast cancer, yet it leads to significant postoperative pain. Objectives: This randomized controlled trial evaluates the effects of an erector spinae plane block (ESPB) versus a serratus anterior plane block (SAPB) on post-MRM pain management and stress response reduction. Methods: Sixty individuals scheduled for unilateral MRM under general anesthesia from October 2021 to October 2022 were divided into three groups. Group A comprised 20 patients who received ultrasound-guided ESPB (20 mL of 0.25% bupivacaine). Group B included 20 patients who received ultrasound-guided SAPB (20 mL of 0.25% bupivacaine). Group C was treated with intravenous morphine based on pain scores. Anesthesia was induced using 2 μg/kg of fentanyl and 2 - 3 mg/kg of propofol. The study compared the three groups regarding pain scores using a numerical rating scale, serum cortisol levels, total fentanyl, and morphine consumption, changes in mean arterial blood pressure (MAP) and heart rate (HR) during surgery, and the occurrence of postoperative complications. Results: Statistically significant reductions in pain scores were observed in group A compared to groups B and C. Moreover, group A exhibited a significant decrease in postoperative morphine consumption, serum cortisol levels 1 hour post-surgery (P = 0.021), MAP, and postoperative vomiting and nausea compared to group B. Furthermore, groups A and B showed statistically significant improvements in all parameters compared to group C. Conclusions: The study demonstrates that ESPB provides superior analgesic effects compared to SAPB in patients undergoing MRM, with reduced morphine use and lower postoperative cortisol levels. Both blocks offer more effective pain control than intravenous morphine alone.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"121 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140381050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed El-Tawansy, Ahmed Mohamed Elnajar, Hossam Abdel Baky Mahmoud, Mohamed Ibrahim Amin, A. Bedewy
{"title":"Validity of Ultrasound in Correlation with Cormack-Lehane Grading in Obese Patients: A Cross-Sectional Study","authors":"Ahmed El-Tawansy, Ahmed Mohamed Elnajar, Hossam Abdel Baky Mahmoud, Mohamed Ibrahim Amin, A. Bedewy","doi":"10.5812/aapm-142701","DOIUrl":"https://doi.org/10.5812/aapm-142701","url":null,"abstract":"Background: Ultrasound (US) of the upper airway has the potential to be a valuable addition to traditional clinical evaluation methods. Objectives: This work aimed to assess the validity of US in correlation with Cormack-Lehane grading (CLG) in obese patients. Methods: This cross-sectional work was performed on 78 patients ranging in age between 21 and 60 years, both genders with the American Society of Anesthesiologists (ASA) II-III individuals and body mass index (BMI) 30 kg/m² or more, under general anesthesia with endotracheal tube placement. Each separate finding by the US and conventional clinical airway assessment methods before anesthesia induction correlated to the CLG of the same patient after the induction of anesthesia. Grades III and IV are categorized as difficult laryngoscopy. Results: A significant positive association existed among CLG and duration of US measures, pre-epiglottis spaces (Pre-E) ratios, to the distance between a point mid away vocal cords and epiglottis, Pre-E, ratio of hyomental distance extension/hyomental distance neutral and Mallampati; however, there was a significant negative correlation with skin to anterior commissure, hyomental distance extension, hyomental distance neutral, sternomental distance, and thyromental distance (P < 0.05). The ratio between Pre-E over the distance between the epiglottis and a point midway through the vocal cords at cut-off > 2.23 can discriminate difficult laryngoscopy with sensitivity 100% and specificity 100% and area under the curve of 1. Conclusions: The sonographic assessment of the upper airway aids in predicting individuals who might have challenges with airway management. A reliable indicator of a challenging laryngoscopy was the sonographic parameter ratio of Pre-E to the distance between the vocal cords' midway point and the epiglottis.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140385488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparing Apotel and Remifentanil for Multimodal Patient-Controlled Analgesia in Postoperative Pain Management Following Total Knee Arthroplasty Surgery: A Randomized Controlled Trial","authors":"Seyed Ali Golrokh Moghadam, Amin Tajerian, Behnam Mahmoudieh, Mohsen Parsi Khamene, Alireza Kamali","doi":"10.5812/aapm-141975","DOIUrl":"https://doi.org/10.5812/aapm-141975","url":null,"abstract":"Background: Total knee arthroplasty (TKA) is a standard surgical procedure for individuals with debilitating knee arthritis. Effective postoperative pain management is essential for successful recovery, although traditional opioid-based methods have limitations. Objectives: This study aimed to compare the efficacy of Apotel and Remifentanil patient-controlled analgesia in managing postoperative pain after TKA. Methods: This double-blind, randomized, controlled clinical trial took place at Amir-al-Momenin and Qods Hospitals in Arak, Iran, spanning from June 2022 to September 2023. Sixty-two eligible patients scheduled for knee joint replacement were randomly assigned to receive either Apotel (Group A) or Remifentanil (Group R) as part of multimodal analgesia administered via a pain pump for postoperative pain relief in TKA. The study assessed hemodynamic parameters, pain levels (measured using the Visual Analog Scale), analgesic duration, and narcotic consumption. Statistical analyses were performed using SPSS v.27 and Plotly. Results: Subjects exhibited no statistically significant differences in age, gender distribution, duration of surgery, or anesthesia. The hemodynamic status assessment in the recovery room showed no significant differences in SPO2, PR, or MAP between the groups. However, Remifentanil demonstrated superior effectiveness in reducing pain over 24 hours post TKA surgery compared to Apotel, as evidenced by lower average Visual Analog Scale (VAS) scores (P < 0.001), longer duration without the need for narcotic painkillers (P < 0.001), and lower cumulative opioid analgesic consumption in Group R (P < 0.001). Conclusions: Remifentanil demonstrates superior pain control in a multimodal pain management approach compared to Apotel, providing sustained pain reduction over 24 hours post-surgery. Moreover, Remifentanil offers longer-lasting pain relief and results in lower cumulative narcotic painkiller consumption compared to Apotel.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"10 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140232134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Professional Attitudes and Practice of Pediatric Dentists About the Use of Local Anesthesia for the Treatment of Children Under General Anesthesia","authors":"Reyhaneh Faghihian, Aryana Golabbakhsh, Elahe Asnaashari","doi":"10.5812/aapm-143076","DOIUrl":"https://doi.org/10.5812/aapm-143076","url":null,"abstract":"Background: The application of local anesthesia in dental surgeries conducted under general anesthesia poses a challenge in pediatric dentistry. There is a lack of consensus regarding the benefits and drawbacks of using general anesthesia in this field. Objectives: The purpose of this study was to assess the attitudes and practices of pediatric dentists regarding the use of local anesthesia for dental treatments in children under general anesthesia in Iran. Methods: This cross-sectional study involved 110 pediatric dentists from across Iran. The dentists' professional attitudes and practices were assessed using a specially designed questionnaire for this study. The questionnaire was distributed through the Line press system, and the data were analyzed following collection. Results: Regarding professional practices, 34.5% of specialists refrained from using local anesthesia. The most frequent application of local anesthesia was observed in tooth extractions. The preferred local anesthetic agent was 2% lidocaine with 1:100 000 epinephrine. A lower dose than that used in outpatient settings was administered, and most specialists allowed sufficient time for the anesthesia to take effect. Conclusions: This study revealed that opinions and attitudes towards the use of local anesthesia in the dental treatment of children under general anesthesia vary across different specialties and are significantly influenced by the patient's condition, type of treatment, and practice techniques.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"3 9‐10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Shetabi, Darioush Moradi Farsani, Zahra Allafchian
{"title":"Effect of Etomidate Versus Midazolam-Sodium Thiopental on Attenuating the Cardiovascular Response to Laryngoscopy and Tracheal Intubation","authors":"H. Shetabi, Darioush Moradi Farsani, Zahra Allafchian","doi":"10.5812/aapm-143382","DOIUrl":"https://doi.org/10.5812/aapm-143382","url":null,"abstract":"Background: Laryngoscopy and tracheal intubation lead to an increased sympathetic reflex response, which is associated with increased heart rate and blood pressure. This response can be detrimental in patients with myocardial ischemia. This study aimed to investigate the effects of etomidate in comparison to a combination of midazolam and sodium thiopental in reducing the sympathetic response to laryngoscopy and tracheal intubation. Methods: This double-blind, randomized clinical trial study was conducted on two groups of 39 candidates for elective surgery under general anesthesia. Anesthesia was induced by etomidate (E) 0.3 mg/kg in the first group and sodium thiopental 2.5 mg/kg and midazolam 0.075 mg/kg in the second group (TM); then, the patients were intubated. Laryngoscopy findings and cardiovascular response were evaluated during the study. Finally, the data were analyzed using SPSS version 23 (IBM SPSS, Armonk, NY, USA). Results: There was no significant difference between the two groups in terms of age (P = 0.82), weight (P = 0.42), height (P = 0.201), body mass index (P = 0.78), gender (P = 0.65), American Society of Anesthesiologists (ASA) physical status (P = 0.36), and laryngoscopy view grading (P = 0.83). The average laryngoscopy time in the E group was less than the TM group (P = 0.019). In the TM group, at 10 minutes after intubation, mean diastolic blood pressure (P = 0.029) and mean arterial blood pressure (P = 0.023) were significantly lower; however, at other times, there was no significant difference between the two groups (P > 0.05). There was no significant difference between the two groups in terms of adverse responses to laryngoscopy and intubation (P = 0.19). Conclusions: The results of the present study showed that etomidate (E) and a combination of midazolam-sodium thiopental (TM) acted similarly in attenuating the cardiovascular response to laryngoscopy and tracheal intubation, and it seems that TM can be used instead of E if needed.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"19 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140243162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shervin Shahinpour, Fatemeh Refahi, Nader Ali Nazemian
{"title":"Effect of Vibration on Acute and Chronic Back Pain After Spinal Anesthesia: A Randomized Clinical Trial","authors":"Shervin Shahinpour, Fatemeh Refahi, Nader Ali Nazemian","doi":"10.5812/aapm-143528","DOIUrl":"https://doi.org/10.5812/aapm-143528","url":null,"abstract":"Background: Post-spinal anesthesia back pain often initiates with needle insertion and may persist for months, particularly among young women following cesarean section. Mechanical vibration has been proposed as an effective method to alleviate this pain. Objectives: The study aimed to evaluate the impact of vibration on reducing pain experienced during needle insertion, as well as its effects one week and one-month post-puncture. Methods: This randomized clinical trial enrolled patients undergoing spinal anesthesia for various surgical procedures. Patients were randomly assigned to either receive routine spinal anesthesia or spinal anesthesia combined with vibration. Demographic data were collected, and pain levels during needle insertion and back pain were assessed using a visual analog scale (VAS). Results: A total of 64 patients were included in the study. There were no significant differences between the two groups in terms of the number of attempts required for needle insertion (P = 0.341), the predominant anatomical level, or the needle approach (midline or paramedian). Ultimately, pain experienced during needle insertion, back pain after one week, and back pain after one month did not differ significantly between the two groups (P = 0.562, P = 0.14, and P = 0.267, respectively) Conclusions: The results of the present study showed that vibration at the site of needle insertion during spinal anesthesia had no effect on acute and chronic back pain on subsequent follow-up due to spinal anesthesia.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"19 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140254440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karim Hemati, Parniyan Hematy, Saeid Rahimi Ghasabeh, Ali Shokooh
{"title":"A Case Report on Pneumocephalus That Occurred Following an Epidural Ozone Injection During Percutaneous Lumbar Disc Decompression Surgery","authors":"Karim Hemati, Parniyan Hematy, Saeid Rahimi Ghasabeh, Ali Shokooh","doi":"10.5812/aapm-142519","DOIUrl":"https://doi.org/10.5812/aapm-142519","url":null,"abstract":": Spinal decompression is a common procedure in spinal, neurosurgery, and orthopedic surgery. While there are a number of known complications associated with it, pneumocephalus (air in the brain) is generally not a recognized complication postoperatively. However, in rare cases, it can occur as a result of spinal decompression surgery. We describe a case of a 54-year-old female patient who developed pneumocephalus following percutaneous lumbar disc decompression surgery of the lumbar spine. The patient presented to the emergency department 3 hours after discharge with severe restlessness, cognitive impairment, nausea, vomiting, and lack of balance. During symptomatic treatment in the emergency department and 1 hour after taking oxygen, the patient’s vital signs improved. Before discharge, a computed tomography (CT) scan was taken again, which showed the disappearance of radiological symptoms. The patient was discharged 12 hours after hospitalization with suitable clinical conditions. Obtaining urgent imaging tests (magnetic resonance imaging [MRI] or CT) at the cranial and spinal levels, along with an electroencephalogram, allows us to diagnose the problem and determine the appropriate course of treatment, whether pharmacological or surgical.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"6 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140260258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aliakbar Nasiri, Farzad Farajzadeh Vajari, Shahryar Sane, R. Afsargharehbagh
{"title":"Assessment of Ganglion Impar Block Effect on Treatment Results of Coccydynia: A Cross-sectional Study","authors":"Aliakbar Nasiri, Farzad Farajzadeh Vajari, Shahryar Sane, R. Afsargharehbagh","doi":"10.5812/aapm-142137","DOIUrl":"https://doi.org/10.5812/aapm-142137","url":null,"abstract":"Background: The ganglion impar block is a minimally invasive technique used for alleviating pain associated with coccydynia. Objectives: This research evaluates the effectiveness of the ganglion impar block in treating patients with coccydynia who have not benefited from conservative treatments. Methods: This cross-sectional analysis reviewed the clinical records of coccydynia patients who received ganglion impar block injections at Urmia Imam Khomeini Hospital, Urmia, Iran, between 2020 and 2022. Data regarding age, gender, body mass index (BMI), onset of pain, and levels of patient satisfaction post-treatment were gathered from the medical records. Results: The study comprised 26 patients, with 4 (15.4%) being male and 22 (84.6%) female. The average age and BMI were 39.15 ± 14.24 years and 28.91 ± 2.14 kg/m2, respectively, which did not show significant variation (P = 0.19). The average Visual Analogue Scale (VAS) score before the ganglion impar block was 6.23 ± 2.35, which reduced to 4.47 ± 2.41 immediately after the procedure. At the 1-month follow-up, the average VAS score had further decreased to 3.47 ± 0.79. The decrease in VAS scores, both immediately after the procedure and at the 1-month follow-up, was statistically significant. The success rate of the block (defined as a reduction in pain of at least 20% from the baseline) was significantly high immediately and one-month post-procedure (P < 0.001). Out of the 26 patients treated with the impar block, satisfaction rates were 42.3% excellent, 27% good, 19.2% fair, and 11.5% poor. Conclusions: The study endorses the trans-sacro-coccygeal “needle inside needle” method for providing relief to patients suffering from coccydynia. The findings revealed significant patient satisfaction, with the majority describing their experience as excellent.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"78 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140077591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}