Pub Date : 2022-03-28DOI: 10.1136/rapm-2021-103307
N. Hussain, Jatinder S. Gill, Jarod Speer, M. Abdel-Rasoul, A. Abd-Elsayed, Safdar N. Khan, A. Nguyen, Thomas T Simopoulos, T. Weaver
Introduction While spinal cord stimulator implant is an increasingly safe procedure, one of the most feared complications is spinal cord injury. Still, literature regarding its incidence remains highly variable. This retrospective analysis aims to evaluate the incidence of spinal cord injury after spinal cord stimulator implant using a large-scale claims database. Methods The PearlDiver-Mariner database of national all payer claims was used to identify patients who underwent spinal cord stimulator implant (percutaneous or paddle) and developed subsequent spinal cord injury within 45 days. The primary outcome was to determine the overall incidence of spinal cord injury after spinal cord stimulator implant. Secondary outcomes included an evaluation of potential factors associated with developing spinal cord injury using univariable and multivariable regression analysis. Results A total of 71,172 patients who underwent a spinal cord stimulator implant were included in the analysis, of which 52,070 underwent percutaneous and 19,102 underwent paddle spinal cord stimulator lead implant. The overall incidence of spinal cord injury after spinal cord stimulator implant (any lead type) was found to be 0.42% (302 patients). The incidence of spinal cord injury after percutaneous and paddle lead implants did not differ at 0.45% (233 patients) and 0.36% (69 patients)(p=0.12), respectively. Overall, variables associated with a significantly increased OR (95% confidence interval) of developing spinal cord injury included male gender by 1.31 times (1.04 to 1.65)(p=0.02); having a claim for low molecular weight heparin within 30 days by 3.99 times (1.47 to 10.82)(p<0.01); a diagnosis for osteoporosis within 1 year by 1.75 times (1.15 to 2.66)(p<0.01); and a diagnosis of cervical or thoracic spinal canal stenosis within 1 year by 1.99 (1.37 to 2.90)(p<0.001) and 4.00 (2.63 to 6.09)(p<0.0001) times, respectively. Conclusions Overall, our results support the notion that spinal cord stimulator implant continues to be a safe procedure for chronic pain patients. However, risk factor mitigation strategies for the prevention of spinal cord injury after spinal cord stimulator implant should be undertaken prior to performing the procedure.
{"title":"Evaluating the incidence of spinal cord injury after spinal cord stimulator implant: an updated retrospective review","authors":"N. Hussain, Jatinder S. Gill, Jarod Speer, M. Abdel-Rasoul, A. Abd-Elsayed, Safdar N. Khan, A. Nguyen, Thomas T Simopoulos, T. Weaver","doi":"10.1136/rapm-2021-103307","DOIUrl":"https://doi.org/10.1136/rapm-2021-103307","url":null,"abstract":"Introduction While spinal cord stimulator implant is an increasingly safe procedure, one of the most feared complications is spinal cord injury. Still, literature regarding its incidence remains highly variable. This retrospective analysis aims to evaluate the incidence of spinal cord injury after spinal cord stimulator implant using a large-scale claims database. Methods The PearlDiver-Mariner database of national all payer claims was used to identify patients who underwent spinal cord stimulator implant (percutaneous or paddle) and developed subsequent spinal cord injury within 45 days. The primary outcome was to determine the overall incidence of spinal cord injury after spinal cord stimulator implant. Secondary outcomes included an evaluation of potential factors associated with developing spinal cord injury using univariable and multivariable regression analysis. Results A total of 71,172 patients who underwent a spinal cord stimulator implant were included in the analysis, of which 52,070 underwent percutaneous and 19,102 underwent paddle spinal cord stimulator lead implant. The overall incidence of spinal cord injury after spinal cord stimulator implant (any lead type) was found to be 0.42% (302 patients). The incidence of spinal cord injury after percutaneous and paddle lead implants did not differ at 0.45% (233 patients) and 0.36% (69 patients)(p=0.12), respectively. Overall, variables associated with a significantly increased OR (95% confidence interval) of developing spinal cord injury included male gender by 1.31 times (1.04 to 1.65)(p=0.02); having a claim for low molecular weight heparin within 30 days by 3.99 times (1.47 to 10.82)(p<0.01); a diagnosis for osteoporosis within 1 year by 1.75 times (1.15 to 2.66)(p<0.01); and a diagnosis of cervical or thoracic spinal canal stenosis within 1 year by 1.99 (1.37 to 2.90)(p<0.001) and 4.00 (2.63 to 6.09)(p<0.0001) times, respectively. Conclusions Overall, our results support the notion that spinal cord stimulator implant continues to be a safe procedure for chronic pain patients. However, risk factor mitigation strategies for the prevention of spinal cord injury after spinal cord stimulator implant should be undertaken prior to performing the procedure.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"20 1","pages":"401 - 407"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84353415","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}
Pub Date : 2022-03-16DOI: 10.1136/rapm-2022-103607
R. Greengrass
I read with interest the recent article by Mentsoudis et al regarding the risk/benefits of midazolam preoperatively in a total joint arthroplasty population. They reported no association of midazolam with delirium, a significantly decreased incidence of cardiac and pulmonary complications and an increased incidence of falls. In a previously published review using the same Premier Healthcare Database examining the same total joint population as the current article, the authors determined that patients receiving shortacting benzodiazepines had significantly lower risks of postoperative delirium. The lesser incidences of delirium may have been because of neuroprotection accorded by midazolam during periods of vascular embolization incurred by arthroplasty surgery. Indeed, cerebral protective effects from midazolam have been previously reported by Michenfelder and others. 4 In the current database analysis, the authors confirm that there is no increased risk of delirium from midazolam (and cite collateral investigations thus the long held view that midazolam results in increased incidences of delirium may be unfounded. Of interest in an article cited by some members of the ASA regarding inappropriate medication use in older adults, it is stated “all benzodiazepines increase risk of delirium”; however, midazolam is not mentioned in this article and no citations are listed to substantiate this statement. In the current article, the authors also determined a significantly decreased risk of pulmonary and cardiac complications in patients who received midazolam which leads to speculation of additive cardiac and pulmonary protective effects in this subset of patients. The possible association of increased falls is difficult to understand particularly with the knowledge of decreased delirium associated with midazolam administration and rapid dissolution of midazolam effect if only given preoperatively. The authors also determined that gabapentinoids when combined with midazolam increased sedationrelated complications which would be expected when adding any sedative agent. I concur with the authors that indiscriminate use of any drug, including midazolam, should be discouraged; however, the documented benefits of decreased delirium, and lesser pulmonary and cardiac complications in a total joint population should not preclude its use in this population of patients when indicated.
{"title":"Midazolam and delirium: can you have it both ways?","authors":"R. Greengrass","doi":"10.1136/rapm-2022-103607","DOIUrl":"https://doi.org/10.1136/rapm-2022-103607","url":null,"abstract":"I read with interest the recent article by Mentsoudis et al regarding the risk/benefits of midazolam preoperatively in a total joint arthroplasty population. They reported no association of midazolam with delirium, a significantly decreased incidence of cardiac and pulmonary complications and an increased incidence of falls. In a previously published review using the same Premier Healthcare Database examining the same total joint population as the current article, the authors determined that patients receiving shortacting benzodiazepines had significantly lower risks of postoperative delirium. The lesser incidences of delirium may have been because of neuroprotection accorded by midazolam during periods of vascular embolization incurred by arthroplasty surgery. Indeed, cerebral protective effects from midazolam have been previously reported by Michenfelder and others. 4 In the current database analysis, the authors confirm that there is no increased risk of delirium from midazolam (and cite collateral investigations thus the long held view that midazolam results in increased incidences of delirium may be unfounded. Of interest in an article cited by some members of the ASA regarding inappropriate medication use in older adults, it is stated “all benzodiazepines increase risk of delirium”; however, midazolam is not mentioned in this article and no citations are listed to substantiate this statement. In the current article, the authors also determined a significantly decreased risk of pulmonary and cardiac complications in patients who received midazolam which leads to speculation of additive cardiac and pulmonary protective effects in this subset of patients. The possible association of increased falls is difficult to understand particularly with the knowledge of decreased delirium associated with midazolam administration and rapid dissolution of midazolam effect if only given preoperatively. The authors also determined that gabapentinoids when combined with midazolam increased sedationrelated complications which would be expected when adding any sedative agent. I concur with the authors that indiscriminate use of any drug, including midazolam, should be discouraged; however, the documented benefits of decreased delirium, and lesser pulmonary and cardiac complications in a total joint population should not preclude its use in this population of patients when indicated.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"118 1","pages":"449 - 450"},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77396824","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}
Pub Date : 2022-03-14DOI: 10.1136/rapm-2022-103482
Nitchanant Kitcharanant, P. Leurcharusmee, Pakawat Wangtapun, P. Kantakam, N. Maikong, P. Mahakkanukrauh, D. Tran
Background During total hip arthroplasty (THA) using the direct anterior approach, orthopaedic surgeons can identify all anatomical landmarks required for pericapsular nerve group (PENG) blocks and carry out the latter under direct vision. This cadaveric study investigated the success of surgeon-performed PENG block. Success was defined as dye staining of the articular branches of the femoral and accessory obturator nerves. Methods 11 cadavers (18 hip specimens) were included in the current study. To simulate THA in live patients, an orthopaedic surgeon inserted trial prostheses using the direct anterior approach. Subsequently, a block needle was advanced until contact with the bone (between the anterior inferior iliac spine and iliopubic eminence). 20 mL of 0.1% methylene blue was injected. Cadavers were then dissected to document the presence and dye staining of the femoral, lateral femoral cutaneous, obturator and accessory obturator nerves as well as the articular branches of the femoral, obturator and accessory obturator nerves. Results Methylene blue stained the articular branches of the femoral nerve and the articular branches of the accessory obturator nerve (when present) in all hip specimens. Therefore, surgical PENG block achieved a 100% success rate. Dye stained the femoral and obturator nerve in one (5.6%) and two (11.1%) hip specimens, respectively. No dye staining was observed over the accessory obturator nerve in the pelvis nor the lateral femoral cutaneous nerve. Conclusion Surgeon-performed PENG block during direct anterior THA reliably targets the articular branches of the femoral and accessory obturator nerves. Future trials are required to compare surgeon-performed PENG block with anaesthesiologist-performed, ultrasound-guided PENG block, and surgeon-performed periarticular local anaesthetic infiltration.
{"title":"Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study","authors":"Nitchanant Kitcharanant, P. Leurcharusmee, Pakawat Wangtapun, P. Kantakam, N. Maikong, P. Mahakkanukrauh, D. Tran","doi":"10.1136/rapm-2022-103482","DOIUrl":"https://doi.org/10.1136/rapm-2022-103482","url":null,"abstract":"Background During total hip arthroplasty (THA) using the direct anterior approach, orthopaedic surgeons can identify all anatomical landmarks required for pericapsular nerve group (PENG) blocks and carry out the latter under direct vision. This cadaveric study investigated the success of surgeon-performed PENG block. Success was defined as dye staining of the articular branches of the femoral and accessory obturator nerves. Methods 11 cadavers (18 hip specimens) were included in the current study. To simulate THA in live patients, an orthopaedic surgeon inserted trial prostheses using the direct anterior approach. Subsequently, a block needle was advanced until contact with the bone (between the anterior inferior iliac spine and iliopubic eminence). 20 mL of 0.1% methylene blue was injected. Cadavers were then dissected to document the presence and dye staining of the femoral, lateral femoral cutaneous, obturator and accessory obturator nerves as well as the articular branches of the femoral, obturator and accessory obturator nerves. Results Methylene blue stained the articular branches of the femoral nerve and the articular branches of the accessory obturator nerve (when present) in all hip specimens. Therefore, surgical PENG block achieved a 100% success rate. Dye stained the femoral and obturator nerve in one (5.6%) and two (11.1%) hip specimens, respectively. No dye staining was observed over the accessory obturator nerve in the pelvis nor the lateral femoral cutaneous nerve. Conclusion Surgeon-performed PENG block during direct anterior THA reliably targets the articular branches of the femoral and accessory obturator nerves. Future trials are required to compare surgeon-performed PENG block with anaesthesiologist-performed, ultrasound-guided PENG block, and surgeon-performed periarticular local anaesthetic infiltration.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"26 1","pages":"359 - 363"},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87091217","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}
Pub Date : 2022-03-10DOI: 10.1136/rapm-2022-103545
Craig Morrison, D-Yin Lin, R. Jaarsma, H. Kroon, Brigid Brown
{"title":"Letter to the Editor in response to Dr Eochangain","authors":"Craig Morrison, D-Yin Lin, R. Jaarsma, H. Kroon, Brigid Brown","doi":"10.1136/rapm-2022-103545","DOIUrl":"https://doi.org/10.1136/rapm-2022-103545","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"368 1","pages":"387 - 387"},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77203542","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}
Pub Date : 2022-03-10DOI: 10.1136/rapm-2022-103503
A. Ni Eochagain
{"title":"Letter to the editor: response to Morrison et al","authors":"A. Ni Eochagain","doi":"10.1136/rapm-2022-103503","DOIUrl":"https://doi.org/10.1136/rapm-2022-103503","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"17 1","pages":"386 - 387"},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85452880","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}
Pub Date : 2022-03-09DOI: 10.1136/rapm-2021-103256
K. El-Boghdadly, J. M. Jack, A. Heaney, N. Black, Marina F Englesakis, H. Kehlet, Vincent W. S. Chan
Background Effective analgesia is an important element of enhanced recovery after surgery (ERAS), but the clinical impact of regional anesthesia and analgesia for colorectal surgery remains unclear. Objective We aimed to determine the impact of regional anesthesia following colorectal surgery in the setting of ERAS. Evidence review We performed a systematic review of nine databases up to June 2020, seeking randomized controlled trials comparing regional anesthesia versus control in an ERAS pathway for colorectal surgery. We analyzed the studies with successful ERAS implementation, defined as ERAS protocols with a hospital length of stay of ≤5 days. Data were qualitatively synthesized. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Findings Of the 29 studies reporting ERAS pathways, only 13 comprising 1170 patients were included, with modest methodological quality and poor reporting of adherence to ERAS pathways. Epidural analgesia had limited evidence of outcome benefits in open surgery, while spinal analgesia with intrathecal opioids may potentially be associated with improved outcomes with no impact on length of stay in laparoscopic surgery, though dosing must be further investigated. There was limited evidence for fascial plane blocks or other regional anesthetic techniques. Conclusions Although there was variable methodological quality and reporting of ERAS, we found little evidence demonstrating the clinical benefits of regional anesthetic techniques in the setting of successful ERAS implementation, and future studies must report adherence to ERAS in order for their interventions to be generalizable to modern clinical practice. PROSPERO registration number CRD42020161200.
背景有效的镇痛是提高术后恢复(ERAS)的重要因素，但区域麻醉和镇痛在结直肠手术中的临床影响尚不清楚。目的探讨区域麻醉对结直肠手术后ERAS的影响。我们对截至2020年6月的9个数据库进行了系统综述，寻求比较区域麻醉与对照组在结直肠手术ERAS途径中的随机对照试验。我们分析了ERAS成功实施的研究，定义为住院时间≤5天的ERAS方案。对数据进行定性合成。使用Cochrane Risk of bias 2工具评估偏倚风险。在29项报告ERAS通路的研究中，只有13项包括1170例患者，方法质量一般，ERAS通路依从性报告较差。硬膜外镇痛在开放手术中的疗效证据有限，而鞘内阿片类药物的脊髓镇痛可能与改善结果有关，但对腹腔镜手术的住院时间没有影响，但剂量必须进一步研究。筋膜平面阻滞或其他区域麻醉技术的证据有限。结论:尽管ERAS的方法质量和报告存在差异，但我们发现很少有证据表明区域麻醉技术在成功实施ERAS的情况下的临床益处，未来的研究必须报告ERAS的依从性，以便其干预措施推广到现代临床实践。普洛斯彼罗注册号CRD42020161200。
{"title":"Role of regional anesthesia and analgesia in enhanced recovery after colorectal surgery: a systematic review of randomized controlled trials","authors":"K. El-Boghdadly, J. M. Jack, A. Heaney, N. Black, Marina F Englesakis, H. Kehlet, Vincent W. S. Chan","doi":"10.1136/rapm-2021-103256","DOIUrl":"https://doi.org/10.1136/rapm-2021-103256","url":null,"abstract":"Background Effective analgesia is an important element of enhanced recovery after surgery (ERAS), but the clinical impact of regional anesthesia and analgesia for colorectal surgery remains unclear. Objective We aimed to determine the impact of regional anesthesia following colorectal surgery in the setting of ERAS. Evidence review We performed a systematic review of nine databases up to June 2020, seeking randomized controlled trials comparing regional anesthesia versus control in an ERAS pathway for colorectal surgery. We analyzed the studies with successful ERAS implementation, defined as ERAS protocols with a hospital length of stay of ≤5 days. Data were qualitatively synthesized. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Findings Of the 29 studies reporting ERAS pathways, only 13 comprising 1170 patients were included, with modest methodological quality and poor reporting of adherence to ERAS pathways. Epidural analgesia had limited evidence of outcome benefits in open surgery, while spinal analgesia with intrathecal opioids may potentially be associated with improved outcomes with no impact on length of stay in laparoscopic surgery, though dosing must be further investigated. There was limited evidence for fascial plane blocks or other regional anesthetic techniques. Conclusions Although there was variable methodological quality and reporting of ERAS, we found little evidence demonstrating the clinical benefits of regional anesthetic techniques in the setting of successful ERAS implementation, and future studies must report adherence to ERAS in order for their interventions to be generalizable to modern clinical practice. PROSPERO registration number CRD42020161200.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"28 1","pages":"282 - 292"},"PeriodicalIF":0.0,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73469156","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}
Pub Date : 2021-10-19DOI: 10.1136/rapm-2021-ASRAspringmtg2021
Dan Varonin, N. Schott, E. Soffin, Lauren A. Wilson, M. Fiasconaro, Beena Green, B. Heidotten, E. Buckley, Theresa Brands, Jessica Talbert, L. Wase, Joy Chen, K. Nouri, Cathy Michalsky, Catherine McCarthy, G. Answini, W. Hurford
{"title":"Scientific Abstracts from the 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, March 13–15, 2021, Lake Buena Vista, Florida","authors":"Dan Varonin, N. Schott, E. Soffin, Lauren A. Wilson, M. Fiasconaro, Beena Green, B. Heidotten, E. Buckley, Theresa Brands, Jessica Talbert, L. Wase, Joy Chen, K. Nouri, Cathy Michalsky, Catherine McCarthy, G. Answini, W. Hurford","doi":"10.1136/rapm-2021-ASRAspringmtg2021","DOIUrl":"https://doi.org/10.1136/rapm-2021-ASRAspringmtg2021","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"76 1","pages":"1018 - 1028"},"PeriodicalIF":0.0,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80624392","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}
Pub Date : 2020-03-30DOI: 10.1101/2020.03.27.20045674
Y. Eshraghi, R. Khan, O. Said, C. Velasco, M. Guirguis
Background: Chronic knee pain from conditions such as osteoarthritis (OA) is a significant problem in a growing and aging population. Cooled radiofrequency ablation (CRFA) is an emerging technique to treat chronic knee pain. There is significant literature noting the clinical outcomes of CRFA in anatomic locations including the peripheral joints and the lumbar spine. This retrospective study found significant improvements in Pain Disability Index (PDI) scores and Numerical Pain Rating Scale (NPRS) scores for patients with chronic knee pain who underwent cooled radiofrequency ablation (CRFA) therapy of the genicular nerves. Objectives: This retrospective study evaluated the effectiveness of CRFA in the general chronic knee pain population. Study Design: Retrospective electronic chart review. Setting: Outpatient non-profit practice. Methods: After institutional review board approval, we reviewed the data of 205 patients who had undergone cooled radiofrequency ablation therapy of the genicular nerves at a multiple-site pain practice between December 5, 2017 and September 4, 2019. The primary outcome was improvement in Pain Disability Index (PDI) scores. The secondary outcomes were pain scores, assessed by the Numerical Pain Rating Scale (NPRS), and opioid consumption, assessed by daily Morphine Equivalent Dose (MED). From the 205 patients who met inclusion criteria, there were 104 patients who had PDI scores both before and after the CRFA procedure that were collected in the appropriate time frame. For these 104 patients, the pain scores and opioid consumption before and after the CRFA procedure were also collected. The age of the 104 patients ranged from 21 to 89 years. There were 38 males and 66 females. Results: The mean PDI score before genicular nerve block and CRFA was 38.7, and the mean PDI score after CRFA was 26.5. After CRFA treatment, 67.38% of patients had a decrease in their PDI scores, 27.9% had no change, and 4.81% had an increase in their PDI scores. P-value <0.001 with 95% CI Median (-11, -7). The mean NPRS score before genicular nerve block and CRFA was 6.98, and the mean NPRS score after CRFA was 4.18. P-value <0.001 with 95% CI Median (-3, -2). The largest group of patients, 49% of patients, had a pain score reduction of 2.25 points, while the next largest group, 17.3% of patients, had a reduction of 0.75 points, followed by 12.5% of patients with a reduction of 3.75 points. When comparing Morphine Equivalent Dose (MED) before and after the CRFA procedure, 37.5% of patients were not on opioid medication at any time during the study; additionally, the MED did not change for the majority of patients (80.77%), while the MED decreased for 13.46% of patients and increased for 5.77% of patients. Mean MED before GNB and CRFA was 17.13 and 15.91 after CRFA. P=0.025 with 95% CI Median (0,0). No serious adverse events were reported. Limitations: Retrospective nature of the study. Conclusions: This study demonstrates the clinical effectiven
{"title":"Cooled radiofrequency ablation of the genicular nerves for treatment of chronic knee pain","authors":"Y. Eshraghi, R. Khan, O. Said, C. Velasco, M. Guirguis","doi":"10.1101/2020.03.27.20045674","DOIUrl":"https://doi.org/10.1101/2020.03.27.20045674","url":null,"abstract":"Background: Chronic knee pain from conditions such as osteoarthritis (OA) is a significant problem in a growing and aging population. Cooled radiofrequency ablation (CRFA) is an emerging technique to treat chronic knee pain. There is significant literature noting the clinical outcomes of CRFA in anatomic locations including the peripheral joints and the lumbar spine. This retrospective study found significant improvements in Pain Disability Index (PDI) scores and Numerical Pain Rating Scale (NPRS) scores for patients with chronic knee pain who underwent cooled radiofrequency ablation (CRFA) therapy of the genicular nerves. Objectives: This retrospective study evaluated the effectiveness of CRFA in the general chronic knee pain population. Study Design: Retrospective electronic chart review. Setting: Outpatient non-profit practice. Methods: After institutional review board approval, we reviewed the data of 205 patients who had undergone cooled radiofrequency ablation therapy of the genicular nerves at a multiple-site pain practice between December 5, 2017 and September 4, 2019. The primary outcome was improvement in Pain Disability Index (PDI) scores. The secondary outcomes were pain scores, assessed by the Numerical Pain Rating Scale (NPRS), and opioid consumption, assessed by daily Morphine Equivalent Dose (MED). From the 205 patients who met inclusion criteria, there were 104 patients who had PDI scores both before and after the CRFA procedure that were collected in the appropriate time frame. For these 104 patients, the pain scores and opioid consumption before and after the CRFA procedure were also collected. The age of the 104 patients ranged from 21 to 89 years. There were 38 males and 66 females. Results: The mean PDI score before genicular nerve block and CRFA was 38.7, and the mean PDI score after CRFA was 26.5. After CRFA treatment, 67.38% of patients had a decrease in their PDI scores, 27.9% had no change, and 4.81% had an increase in their PDI scores. P-value <0.001 with 95% CI Median (-11, -7). The mean NPRS score before genicular nerve block and CRFA was 6.98, and the mean NPRS score after CRFA was 4.18. P-value <0.001 with 95% CI Median (-3, -2). The largest group of patients, 49% of patients, had a pain score reduction of 2.25 points, while the next largest group, 17.3% of patients, had a reduction of 0.75 points, followed by 12.5% of patients with a reduction of 3.75 points. When comparing Morphine Equivalent Dose (MED) before and after the CRFA procedure, 37.5% of patients were not on opioid medication at any time during the study; additionally, the MED did not change for the majority of patients (80.77%), while the MED decreased for 13.46% of patients and increased for 5.77% of patients. Mean MED before GNB and CRFA was 17.13 and 15.91 after CRFA. P=0.025 with 95% CI Median (0,0). No serious adverse events were reported. Limitations: Retrospective nature of the study. Conclusions: This study demonstrates the clinical effectiven","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"9 1","pages":"735 - 736"},"PeriodicalIF":0.0,"publicationDate":"2020-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76895319","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}
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