Anesthesiology and Pain Medicine最新文献

{"title":"Evaluating the Effect of Pressure-Controlled Versus Volume-Controlled Ventilation Modes on Intraoperative Bleeding in Rhinoplasty: A Randomized Clinical Trial.","authors":"Behrooz Zaman, Masood Mohseni, Samad Noorizad, Soudabeh Jalali Motlagh, Taymaz Amiraslani, Monal Sayyahi","doi":"10.5812/aapm-151582","DOIUrl":"10.5812/aapm-151582","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative bleeding is one of the major challenges in rhinoplasty.</p><p><strong>Objectives: </strong>This study aimed to evaluate the effect of pressure-controlled ventilation (PCV) versus volume-controlled ventilation (VCV) modes on intraoperative bleeding during rhinoplasty.</p><p><strong>Methods: </strong>In a double-blinded randomized clinical trial, 58 candidates for rhinoplasty were randomly assigned to the PCV or VCV groups. Anesthesia was induced and maintained using the same total intravenous anesthesia (TIVA) method in both groups. The amount of bleeding was assessed by counting blood-soaked gauze and measuring the content of the suctioned fluid. Additionally, bleeding in the surgical field was assessed by the surgeon using the Boezaart criterion.</p><p><strong>Results: </strong>The mean intraoperative bleeding volume was 30 ± 45 mL in the PCV group and 100 ± 120 mL in the VCV group (P < 0.001). According to logistic regression analysis, the odds of experiencing moderately severe or severe bleeding in the VCV group were 5.4 times higher than in the PCV group. After adjusting for confounding variables, the odds ratio increased to 26.8 (95% CI = 1.2, 59.3).</p><p><strong>Conclusions: </strong>The results of the study suggest that the pressure-controlled mode may lead to lower intraoperative bleeding compared to the volume-controlled mode. The decrease in peak airway pressure is likely a contributing factor to this observation.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 5","pages":"e151582"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612797","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":"Comparing the Sedative Effect of Dexmedetomidine and Propofol in Mechanically Ventilated Patients Using Salivary Alpha-Amylase as a Stress Marker: A Randomized Open-Label Trial.","authors":"Ahmed Mohamed Ibrahim, Mohammed Said ElSharkawy, Reda Khalil Abdelrahman, Abdallah Elabd Hassan, Mohammed Gaber Ibrahim Saad, Ismail Ahmed Elzoughari, Abdelkarem Hussini Ismail Alsayed, Asmaa Abdelbadie, Rehab Abd El Fattah Helal","doi":"10.5812/aapm-149364","DOIUrl":"10.5812/aapm-149364","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving mechanical ventilation (MV) in the intensive care unit (ICU) experience significant distress, which triggers a stress response.</p><p><strong>Objectives: </strong>This study aimed to assess the effectiveness of dexmedetomidine and propofol in reducing stress levels, using salivary alpha-amylase (SAA) as a specific indicator of stress.</p><p><strong>Methods: </strong>A randomized, open-label trial was conducted involving 40 patients newly placed on MV. In a parallel study design, participants were randomly assigned into two equal groups (n = 20) through the sealed envelope method using computer-generated randomization. Group D received dexmedetomidine at a dosage of 0.2 to 1.4 μg/kg/h, while group P received propofol at a dosage of 0.3 to 4 mg/kg/h for sedation. Salivary alpha-amylase levels were measured according to the kit manufacturer's protocol.</p><p><strong>Results: </strong>Salivary alpha-amylase levels were significantly lower in group D than in group P at 12, 24, 36, and 48 hours after the initiation of MV (P < 0.05). Heart rate and mean arterial pressure were also significantly lower in group D at 12, 18, and 24 hours (P < 0.05). The duration of MV was significantly shorter in group D compared to group P (4.4 ± 1.85 vs 6.1 ± 2.45 days, P = 0.018). There were no significant differences in ICU length of stay, mortality, or adverse events between the groups.</p><p><strong>Conclusions: </strong>Dexmedetomidine demonstrated superior stress-reducing effects compared to propofol in MV patients, as evidenced by lower SAA levels and improved hemodynamic stability. The shorter duration of MV in the dexmedetomidine group further suggests potential clinical benefits of its use in managing stress in MV patients.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 5","pages":"e149364"},"PeriodicalIF":0.0,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673759","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":"Deep Neuromuscular Block with Low Pressure Pneumoperitoneum in Laparoscopic Abdominal Surgeries: A Randomized Controlled Trial.","authors":"Ahmed Mohamed Ibrahim, Mohammed Said ElSharkawy, Reda Khalil Abdelrahman, Abdallah Elabd Hassan, Mohammed Gaber Ibrahim Saad, Ismail Ahmed Elzoughari, Abdelkarem Hussini Ismail Alsayed, Asmaa Abdelbadie, Rehab Abd El Fattah Helal","doi":"10.5812/aapm-150995","DOIUrl":"10.5812/aapm-150995","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain management remains a challenge in laparoscopic abdominal surgeries.</p><p><strong>Objectives: </strong>The purpose of this research was to determine the effects of deep neuromuscular blockade (NMB) in conjunction with low-pressure pneumoperitoneum )PP) on postoperative pain, surgical parameters, and recovery outcomes.</p><p><strong>Methods: </strong>This randomized controlled double-blind study included 44 participants undergoing laparoscopic abdominal surgery. Patients were randomized equally into two groups (22 each): Group D received deep NMB, while group M received moderate NMB using cis-atracurium, through the utilization of computer-generated random numbers enclosed within sealed, opaque envelopes, following a parallel approach. Regarding deep NMB, following an initial dose of 0.15 mg/kg, a continuous infusion of 0.06 - 0.12 mg/kg/hr was administered to maintain a post-tetanic count between 1 and 2, with low PP pressure of 10 - 12 mmHg. Conversely, for moderate NMB, after the same initial dose of 0.15 mg/kg, the continuous infusion commenced upon the train-of-four count returning to 2, with the rate adjusted to sustain a count between 1 and 3, and standard PP pressure of 15 mmHg. The primary outcome was postoperative pain intensity as measured by Numerical Rating Scale (NRS) scores in the post-anesthesia care unit (PACU). The secondary outcomes included postoperative pain intensity measured by NRS scores from 2 hours to 48 hours post-surgery, time to first analgesic administration, cumulative opioid consumption within the initial 48-hour postoperative period, and patient-reported satisfaction with postoperative pain management. Statistical analysis using SPSS v26 included tests for normality (Shapiro-Wilks), with parametric data analyzed by <i>t</i>-test, non-parametric data by Mann-Whitney, and qualitative data by chi-square/Fisher's test.</p><p><strong>Results: </strong>Group D experienced a considerably longer time until the first analgesic rescue compared to group M (9.82 ± 1.5 hours vs. 7.23 ± 1.19 hours, P < 0.001). Morphine consumption in the first 24 hours was lower in Group D (10.77 ± 1.51 mg vs. 13.09 ± 1.74 mg, P < 0.001). At 6, 8, and 12 hours postoperatively, group D exhibited significantly lower pain scores (P < 0.05). Surgical duration, surgical field quality, complication rates, and patient satisfaction were comparable between groups.</p><p><strong>Conclusions: </strong>Deep NMB combined with low-pressure PP provided superior postoperative analgesia without compromising surgical field quality or increasing complications in laparoscopic abdominal surgeries.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 5","pages":"e150995"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673760","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 Effectiveness and Safety of Rhomboid Intercostal Block for Postoperative Pain Management in Thoracic and Breast Surgical Procedures: A Meta-analysis.","authors":"Taufik Saputra, Doso Sutiyono, Widya Istanto Nurcahyo","doi":"10.5812/aapm-150753","DOIUrl":"10.5812/aapm-150753","url":null,"abstract":"<p><strong>Background: </strong>The rhomboid intercostal block (RIB) is an emerging regional anesthesia (RA) technique used for pain control following thoracic and breast surgery. However, comprehensive documentation on its effectiveness and safety profile remains limited. This study aims to assess the effectiveness and safety of RIB in thoracic and breast surgical procedures.</p><p><strong>Methods: </strong>A study search was conducted following PRISMA 2020 guidelines in PubMed, Cochrane Library, Embase, Scopus, and ProQuest from 2016 to 2023 to identify randomized controlled trials (RCTs) evaluating the effectiveness and safety of RIB in thoracic and breast surgeries. The primary outcome was patient pain scores at rest, recorded at one, six, 12, and 24 hours post-surgery. Secondary outcomes included 24-hour opioid consumption and rates of postoperative nausea and vomiting (PONV).</p><p><strong>Results: </strong>This meta-analysis included five RCTs with a total of 368 patients. Rhomboid intercostal block led to a significant reduction in NRS scores one hour post-surgery (SMD = -1.33; 95% CI = -1.74 to -0.91; P < 0.00001, I² = 18%, P = 0.27), 12 hours post-surgery (SMD = -0.74; 95% CI = -0.99 to -0.48; P < 0.00001, I² = 36%, P = 0.21), and 24 hours post-surgery (SMD = -1.62; 95% CI = -2.56 to -0.69; P = 0.0006, I² = 91%, P < 0.00001). Regarding secondary outcomes, the RIB group showed a significant reduction in 24-hour opioid consumption (SMD = -4.49; 95% CI = -6.09 to -2.90; P < 0.00001, I² = 95%, P < 0.00001) and PONV rates (RR = 0.29; 95% CI = 0.18 to 0.47; P < 0.00001, I² = 0%, P = 0.88).</p><p><strong>Conclusions: </strong>Rhomboid intercostal block provides effective pain reduction and lowers opioid consumption within 24 hours post-surgery, while also minimizing PONV rates.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 5","pages":"e150753"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673761","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":"An Investigation of the Pediatric Rigid Bronchoscopy Complication with Three Different Anesthesia Regimes.","authors":"Tahereh Chavoshi, Faranak Rokhtabnak, Nasrin Nouri, Seyedbabak Mojaveraghili, Alireza Eshghi, Reza Salehi","doi":"10.5812/aapm-150953","DOIUrl":"10.5812/aapm-150953","url":null,"abstract":"<p><strong>Background: </strong>Foreign body aspiration is common in children and poses a significant risk of morbidity and mortality. Rigid bronchoscopy is the most common method for removing aspirated foreign bodies.</p><p><strong>Objectives: </strong>Anesthesiologists play a critical role in managing these procedures, aiming to find the best strategies with the fewest complications. This study aims to compare anesthesia-related complications during rigid bronchoscopy in children using muscle relaxants versus no muscle relaxants.</p><p><strong>Methods: </strong>In this clinical trial, 60 eligible children were randomly divided into three equal groups: SP: Spontaneous ventilation with sevoflurane and propofol; VA: Controlled ventilation with sevoflurane and atracurium; VR: Controlled ventilation with sevoflurane and rocuronium. At the end of anesthesia, complications such as cough, bucking, hypoxemia, laryngospasm, and bronchospasm were compared, along with the pulmonologist's level of satisfaction, surgery duration, and total anesthesia time in the three groups.</p><p><strong>Results: </strong>The comparison between the SP, VR, and VA groups revealed the following: No significant difference was found in the incidence of cough and respiratory distress following foreign body aspiration among the three groups (P = 0.262 and P = 0.762, respectively); minimum oxygen saturation during rigid bronchoscopy differed significantly between the groups (P = 0.013); bucking during bronchoscopy was significantly more frequent in the SP group (P = 0.017); laryngospasm was significantly more common in the SP group compared to the other two groups (P = 0.004); agitation during recovery was significantly lower in the propofol (SP) group; pulmonologist satisfaction was highest in the VR group, followed by the VA group, with a significant difference compared to the SP group (P = 0.021); although the SP group experienced more frequent hypoxemia, the difference was not statistically significant; there was no significant difference in anesthesia or bronchoscopy duration across the three groups.</p><p><strong>Conclusions: </strong>The study results suggest that using muscle relaxants in rigid bronchoscopy offers several advantages, including fewer intraoperative complications such as bucking and laryngospasm. Additionally, controlled ventilation reduced the need for intravenous anesthetics and opioids, minimizing adverse effects and shortening recovery times.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 4","pages":"e150953"},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612760","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":"Comparison of Three Tracheal Intubation Procedures Using Personal Protective Equipment, Direct and Video Laryngoscopes: An Open, Randomized, Parallel Clinical Trial.","authors":"Dita Aditianingsih, Pryambodho Pryambodho, Jonathan Antonius Wibowo, El Nissi Leonard, Chrisella Annabelle","doi":"10.5812/aapm-148208","DOIUrl":"10.5812/aapm-148208","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, severe respiratory failure is a life-threatening condition, and life-saving tracheal intubation is a high-risk aerosol- and droplet-generating procedure. It is crucial to protect healthcare workers without compromising patient safety during intubation. The use of personal protective equipment (PPE) and different types of laryngoscopes are measures to reduce the risk of infectious transmission that might impact the intubation process.</p><p><strong>Objectives: </strong>This study aimed to evaluate the effects of different levels of PPE and types of laryngoscopes on the duration of the intubation process and its success rate.</p><p><strong>Methods: </strong>We conducted an open, randomized, parallel clinical trial on non-COVID-19 adult patients scheduled for elective and emergency surgeries under general anesthesia from November 2021 to May 2022. Patients were divided into three groups: Group 1 was intubated using a video-guided laryngoscope with operators wearing level three PPE; group 2 was intubated using a direct laryngoscope with operators wearing level three PPE; and group 3 was intubated using a direct laryngoscope with operators wearing level two PPE. Intubation was performed by 2nd- and 3rd-year anesthesia residents.</p><p><strong>Results: </strong>The duration of intubation varied significantly among the groups, with Group 1 taking the longest time (P = 0.046). Group 3 had a higher success rate for first-attempt intubation (P = 0.056).</p><p><strong>Conclusions: </strong>The use of PPE and video-guided laryngoscopy had varying effects on the intubation procedure, with the most notable impact being on the overall length of intubation. Further research with a larger sample size is needed to validate these findings.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 4","pages":"e148208"},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612779","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":"Anesthesia and Airway Management in a Child with Frank Ter Haar Syndrome Suspected Difficult Airway Undergoing Cardiac Surgery: A Case Report.","authors":"Maryam Ghadimi, Yasmin Chaibakhsh, Mohsen Ziyaeifard","doi":"10.5812/aapm-144682","DOIUrl":"10.5812/aapm-144682","url":null,"abstract":"<p><strong>Introduction: </strong>Frank ter Haar syndrome (FTHS) is a rare and complex multisystem congenital genetic disorder that leads to craniofacial, cardiac, and skeletal abnormalities. We report the anesthesia and airway management of a child with FTHS who was referred for repair of atrial septal defect (ASD) and ventricular septal defect (VSD).</p><p><strong>Case presentation: </strong>The patient exhibited craniofacial and skeletal abnormalities, including craniosynostosis, micrognathia, a prominent forehead, hypertelorism, and anteverted nostrils. These features raised the possibility of a difficult airway.</p><p><strong>Conclusions: </strong>For patients with potential difficult airways undergoing elective surgery, the procedure should be postponed until all necessary equipment for managing a difficult airway is available.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 4","pages":"e144682"},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612762","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":"Propofol versus Dexmedetomidine for Sedation of Cancer Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: Randomized Single-Blinded Controlled Study.","authors":"Ahmed Mohamed Soliman, Yehya Mohamed Hamad, Abeer AbdElmonem Almaghraby, Ahmed Abdalla Mohamed, Shady Rady Abdallah","doi":"10.5812/aapm-148512","DOIUrl":"10.5812/aapm-148512","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is a primary diagnostic and therapeutic option for pancreaticobiliary pathologies.</p><p><strong>Objectives: </strong>This study aimed to investigate the efficacy and safety of dexmedetomidine versus propofol during ERCP in cancer patients.</p><p><strong>Methods: </strong>This randomized controlled single-blinded trial was conducted with 202 cancer patients aged 21 to 60 years, of both sexes, with a body mass index of 18.5 to 30 kg/m², and classified as American Society of Anesthesiologists (ASA) class II - III, who were undergoing ERCP. The patients were randomly assigned to two equal groups. The Propofol Group (n = 101) received a loading dose of propofol (1 - 2 mg/kg over 30 seconds) followed by an infusion (0.05 - 0.1 mg/kg/hour). The Dexmedetomidine Group (n = 101) received a loading dose of dexmedetomidine (1 μg/kg over 10 minutes) followed by an infusion (0.2 - 0.7 μg/kg/hour). The maintenance dose was adjusted during the procedure based on vital signs, Bispectral Index (BIS), and oxygen saturation.</p><p><strong>Results: </strong>The Dexmedetomidine group showed a significantly lower incidence of intra-procedural hypoxemic events (14.9% vs. 26.7%, P = 0.037) and a comparable incidence of hypotension (17.8% vs. 13.9%, P = 0.441). Dexmedetomidine also demonstrated significantly lower intraoperative pain scores according to the Facial Pain Score (P < 0.05), significantly lower postoperative Visual Analog Scale (VAS) scores (P < 0.05), and a lower frequency of postoperative nausea and vomiting (PONV) compared to the Propofol group. Additionally, there was a significantly higher frequency of endoscopist satisfaction in the Dexmedetomidine group compared to the Propofol group (P < 0.05).</p><p><strong>Conclusions: </strong>Dexmedetomidine can be used as a safe and effective alternative to propofol for deep sedation of cancer patients undergoing ERCP. It is associated with a lower incidence of hypoxemic events, effective intraoperative sedation, quicker recovery, and superior analgesic effects both intraoperatively and postoperatively compared to propofol.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 4","pages":"e148512"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612792","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":"Avoiding Invasive Measures: Sphenopalatine Ganglion Block as a Substitute for Epidural Blood Patch in Post-dural Puncture Headache: A Case Report.","authors":"Saeede Babaiyan, Fatemeh Shakhs Emampour","doi":"10.5812/aapm-148291","DOIUrl":"10.5812/aapm-148291","url":null,"abstract":"<p><strong>Introduction: </strong>Post-dural puncture headache (PDPH) is a well-known consequence of neuraxial anesthesia that can impede patient recovery and delay early discharge. Traditional remedies include hydration and the administration of simple analgesics for symptom relief. When symptoms persist despite conservative interventions, an epidural blood patch (EBP) is typically recommended. However, this invasive procedure carries risks and complications. Our case report aims to explore a potential alternative treatment for PDPH.</p><p><strong>Case presentation: </strong>We present the case of a 22-year-old female who experienced PDPH following spinal anesthesia. Despite initial attempts at conservative management, her symptoms persisted. She then opted for a trans-nasal sphenopalatine ganglion (SPG) block, which resulted in remarkable pain relief and eliminated the need for an EBP.</p><p><strong>Conclusions: </strong>The SPG block emerges as a minimally invasive option for treating PDPH. Multiple studies have demonstrated that patients undergoing SPG block therapy did not require EBP.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 4","pages":"e148291"},"PeriodicalIF":0.0,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612764","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":"Comparison of Transforaminal Magnesium Sulfate with Steroid Injection in the Management of ‎Radicular Back Pain: A Randomized Double-Blinded Clinical Trial Study.","authors":"Farnad Imani, Kambiz Sadegi, Poupak Rahimzadeh, Mania Kaveh, Mahnaz Narimani, Seyed-Hossein Khademi","doi":"10.5812/aapm-148739","DOIUrl":"10.5812/aapm-148739","url":null,"abstract":"<p><strong>Background: </strong>This study compares the effects of transforaminal magnesium sulfate injection versus other methods for managing radicular back pain, highlighting its potential for improved pain relief and functional outcomes.</p><p><strong>Methods: </strong>This randomized, double-blind clinical trial involved 30 patients with radicular back pain who were randomly assigned to receive either transforaminal magnesium sulfate or triamcinolone injection. Primary outcomes were pain intensity and functional disability, assessed using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), respectively. These were evaluated at five time points: Before the injection, 2 weeks, 1 month, 3 months, and 6 months after the injection. Secondary outcomes included drug-related adverse events within the six-month follow-up period.</p><p><strong>Results: </strong>Baseline characteristics were not significantly different between the two study groups. Compared to pre-injection measures, post-injection pain intensity and functional disability were significantly reduced in both groups at all time points (P < 0.001). At all postoperative evaluations, pain intensity and functional disability were lower in the magnesium sulfate group compared to the steroid group (P < 0.001). No drug-related side effects were recorded in either group.</p><p><strong>Conclusions: </strong>For patients with radicular back pain, transforaminal magnesium sulfate injection appears to be an effective and safe alternative to transforaminal steroid injection.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 4","pages":"e148739"},"PeriodicalIF":0.0,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612782","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}