Anesthesiology and Pain Medicine最新文献

Introduction: Failed neck surgery syndrome (FNSS) following posterior cervical spine fusion (PSF) presents a considerable challenge in pain management.

Objective: This study aims to report the potential utility of the cervical erector spinae plane block (ESPB) as an influential adjunctive therapy in a patient with FNSS who was refractory to medical therapy and unable to undergo spinal cord stimulation (SCS) due to financial constraints.

Methods: This case report details a 74-year-old male with persistent, debilitating axial neck pain lasting one year following PSF, without neural or motor deficits, and with device failure ruled out. Given the risks of cervical epidural steroid injection in this patient, a fluoroscopically guided bilateral cervical ESPB at the C7 level was administered for temporary pain relief.

Result: This technique was associated with substantial pain relief and improved functional outcomes, as demonstrated by reductions in the Numerical Rating Scale (NRS) and Neck Disability Index (NDI) scores.

Conclusion: This case underscores the potential utility of the cervical ESPB as an effective adjunctive therapy for managing pain in FNSS, providing a minimally invasive alternative to conventional treatment approaches.

Introduction: Morton's neuroma is a painful, degenerative neuropathy that is initially managed with conservative treatments. In refractory cases, surgical excision is typically indicated. Minimally invasive percutaneous procedures provide a viable alternative to surgery.

Objective: While both pulsed radiofrequency (PRF) and conventional radiofrequency (CRF) have been individually reported as effective treatments for Morton's neuroma, we aim to utilize a combination of PRF and CRF for pain management.

Case presentation: We report the case of a 61-year-old male with a five-year history of right foot Morton's neuroma, presenting with severe pain that was refractory to conservative management, including multiple corticosteroid injections. Radiofrequency was performed as follows: 5 minutes at 42°C, 1 minute at 60°C, and 1 minute at 70°C.

Result: The patient experienced significant pain relief, with follow-up Numerical Rating Scale (NRS) of 1 at two weeks, 1 at one month, and 2 at seven months post-treatment.

Conclusions: This case suggests that the combined application of PRF and CRF may serve as a promising alternative for managing refractory Morton's neuroma.

Background: Postoperative shivering is an involuntary, spontaneous, and repetitive contraction of skeletal muscles that causes patient restlessness, increased oxygen consumption, wound infection, surgical bleeding, and cardiac events. Patients undergoing spine surgery in the prone position are particularly susceptible to hypothermia.

Objectives: Given the importance of controlling postoperative shivering in these patients, the present study aimed to investigate the effect of intraoperative dexmedetomidine (Dex) infusion in preventing shivering after general anesthesia in patients undergoing spine surgery in the prone position.

Methods: In this double-blind randomized clinical trial, 60 American Society of Anesthesiologists (ASA) class I or II patients undergoing vertebral surgery in the prone position were enrolled. Patients in the study group (n = 30) received Dex infusion during surgery, while those in the placebo group (n = 30) received an equivalent volume of 0.9% normal saline. Hemodynamic variables, frequency and severity of shivering, and drug side effects were recorded.

Results: The mean arterial pressure (MAP) at 90 minutes (P = 0.022), immediately before extubation (P = 0.001), and after extubation (P = 0.001), as well as HR values at 60 minutes (P = 0.020), 90 minutes (P = 0.001), immediately before extubation (P = 0.001), and after extubation (P = 0.001), were significantly lower in the study group compared to the placebo group. The frequency of bradycardia (26.7% vs. 0%, P = 0.002) and hypotension (20% vs. 0%, P = 0.012) was significantly higher in the study group. At all evaluated times, the mean body temperature in the study group was significantly higher than in the placebo group (P < 0.05). The frequency (10% vs. 30%, P = 0.003) and intensity (P = 0.001) of shivering in the study group were significantly lower than in the placebo group.

Conclusions: This study demonstrated that the preventive use of Dex infusion during surgery reduces the frequency and severity of postoperative shivering in patients undergoing spinal surgery in the prone position. However, this method was associated with hypotension and bradycardia in some patients.

Background: Millions of computer users experience chronic neck and shoulder pain (CNSP) and reduced health-related quality of life (HRQoL) due to upper cross syndrome (UCS). While strengthening exercises for the posterior trunk alleviate symptoms, it remains unclear whether isometric or isotonic exercises are more effective.

Objectives: This study aimed to compare the effects of isometric and isotonic exercises on CNSP and HRQoL in individuals with UCS, and to evaluate these outcomes against a non-intervention group.

Methods: In this randomized clinical trial (RCT), 43 UCS patients with CNSP were divided into three groups: Isometric exercises (n = 15), isotonic exercises (n = 14), and a control group (n = 14). Over 8 weeks, exercise groups completed 3 sessions per week (40 - 60 minutes each). Pain was assessed using the Visual Analog Scale (VAS) and HRQoL was assessed using the 36-item short form health survey (SF-36) questionnaire, both pre- and post-intervention.

Results: Both isometric and isotonic exercises significantly reduced CNSP and improved HRQoL compared to the control group. Isometric exercises yielded a 70.4% pain reduction (P < 0.001) and a 14.9% HRQoL improvement (P = 0.002), while isotonic training showed a 47.6% pain reduction (P = 0.001) and a 17.7% HRQoL improvement (P < 0.001). Between-group differences were not statistically significant (pain: P = 0.853; HRQoL: P = 0.999). Although isometric exercises slightly favored pain reduction and isotonic exercises showed marginal HRQoL gains, these differences should not be overstated.

Conclusions: Both isometric and isotonic exercises improved CNSP and HRQoL in UCS patients, with no significant difference between them. Slight trends favoring each should be interpreted cautiously. Longer-term studies are warranted.

Background: The erector spinae plane block (ESPB) has traditionally been performed under ultrasound guidance, while fluoroscopic guidance has emerged as an alternative approach.

Objectives: This study aims to compare the efficacy of ESPB using ultrasound and fluoroscopic guidance in patients with cervical pain.

Methods: This case series study includes fourteen patients with axial neck pain scheduled for cervical ESPB. According to the approach of ESPB (ultrasound or fluoroscopic guidance), patients were divided into two groups: Eight underwent ultrasound-guided ESPB, and six received fluoroscopy-guided ESPB. Pain and disability were assessed using the Numerical Rating Scale (NRS) and the Neck Disability Index (NDI) at baseline (pre-procedure), two weeks post-procedure, and three months post-procedure.

Results: Both groups demonstrated significant improvements in NRS and NDI scores over time (P = 0.005). However, no statistically significant differences were observed in pain scores or disability indices at any of the evaluation points.

Conclusions: This study suggests that fluoroscopy-guided ESPB is as effective as ultrasound-guided ESPB for managing cervical radicular pain, providing a viable alternative for clinicians.

Background: This is a prospective observational study. Dexamethasone is commonly associated with postoperative hyperglycemia. There is limited data on the glycemic effect of dexamethasone among the diabetic population.

Objectives: In the current investigation, postoperative glucose levels were measured in both diabetic and non-diabetic individuals, and then a single dose of intraoperative dexamethasone was administered.

Methods: A total of 86 participants, with ASA I/II, were categorized into two groups: Diabetic and non-diabetic. Each group consisted of 43 individuals. The participants' ages ranged from 18 to 70 years. During the operation, a single dosage of dexamethasone, with a maximum of 8 milligrams, was provided intraoperatively. "Postoperative nausea and vomiting" (PONV), random blood glucose (RBG), and pain ratings were recorded before surgery, immediately after surgery, after 12 hours, and 24 hours following surgery. Preoperative blood glucose levels were also recorded. The "Chi-square test and the unpaired t-test" were used for comparison and to analyze the data. A significance level of P < 0.05 was deemed significant.

Results: There was a statistically significant variance in RBG levels between diabetics and non-diabetics (P = 0.001). At various time periods, there was no correlation between the severity of PONV and diabetes among the participants. At various time intervals, the length of the procedure and the pain levels were equivalent to one another. In each group, there was a significant rise in RBG up to 12 hours, followed by a decline after 24 hours to a level similar to preoperative values.

Conclusions: A single dose of intraoperative "dexamethasone" was associated with transient hyperglycemia postoperatively up to 12 hours, which was more pronounced among the diabetic population and without major adverse effects like PONV in either group.

Introduction: We presented a 39-year-old man with polyarteritis nodosa (PAN) experienced significant leg pain unresponsive to oral medications.

Case presentation: Two sequential lumbar sympathetic blocks with ropivacaine and triamcinolone resulted in over 70% pain reduction (NRS 9-10 to NRS 3) over a three-month follow-up period.

Conclusions: To our knowledge, this is the first report showing the efficacy of lumbar sympathetic block in controlling PAN-associated pain.

Introduction: The erector spinae plane block (ESPB) is a novel regional anesthesia technique that is increasingly incorporated into multimodal analgesia as part of enhanced recovery after surgery (ERAS) pathways in various surgical procedures, including spine surgery.

Case presentation: We report the successful use of spinal anesthesia (SA), ESPB, and magnesium sulfate in a high-risk patient with systemic sclerosis and pulmonary fibrosis undergoing laminectomy. A multimodal approach was selected due to the patient's underlying condition. This strategy minimized respiratory complications associated with general anesthesia while providing effective surgical anesthesia and postoperative pain control without opioid-related complications.

Conclusions: Our case highlights the utility of ESPB, not only for postoperative pain management but also as a valuable adjunct to primary anesthesia, especially in high-risk patients.

Background: Inadequately managed acute pain following abdominal surgery can lead to patient discomfort, anxiety, respiratory issues, delirium, myocardial ischemia, prolonged hospital stays, and persistent pain.

Objectives: This research compares the quadratus lumborum (QL) block to intraperitoneal and periportal bupivacaine infiltration for postoperative analgesia after laparoscopic cholecystectomy.

Methods: This randomized double-blind study included seventy patients aged 21 to 60 years, randomly selected from Ain Shams University Hospital between March 2022 and March 2023, scheduled for elective laparoscopic cholecystectomy. The patients were divided into two groups of 35 based on postoperative pain management: Group A received intraperitoneal and periportal infiltration, while group B underwent the QL block, with details on placement and duration.

Results: The results indicated a substantial decrease in Visual Analogue Scale (VAS) scores at 6 hours postoperatively, with group B exhibiting a median pain level of 3 [IQR 3 - 5] compared to group A's median of 5 [IQR 5 - 6], yielding a P-value of less than 0.001. The data indicate that group B had significantly enhanced postoperative analgesia within the initial 6 hours, both in a static condition and during movement. Moreover, patients in group B required fewer postoperative analgesics during the first 24 hours following surgery compared to group A.

Conclusions: Following laparoscopic cholecystectomy, the QL block proved more effective than intraperitoneal and periportal bupivacaine infiltration in reducing postoperative pain scores for 6 hours and in reducing total opioid and analgesic use for 24 hours postoperatively.