Pain physician
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Bleeding risk in interventional pain practice: assessment, management, and review of the literature.
The rarity of published bleeding complications with respect to the practice of interventional pain medicine suggests two possibilities: techniques are being performed in a manner to minimize bleeding or the process of hemostasis is very forgiving. Hence, bleeding complications may increase if techniques are not performed with due skill or if the process of hemostasis is impaired. Interventional pain physicians may be well acquainted with the technical aspects of procedures, but the degree of their expertise in the field of coagulation is unclear. ⋯ This manuscript will present a tool to help stratify the risk of bleeding with specific techniques and specific hemostatic abnormalities. The Overall Risk of Significant Bleeding score may help interventional pain practitioners in their individualized assessment of bleeding risk. If used collectively, this tool may help improve patient safety and data collection, with respect to bleeding complications.
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Knowledge of the relationship of the lumbar sympathetic chain to the vertebral bodies is needed to perform sympathetic block and sympatholysis. This information should be correlated with fluoroscopy to determine the best method to perform this technique clinically. Twenty cadavers were dissected to demonstrate the lumbar sympathetic chain. ⋯ Use of at least two needles is advisable (L2 and L3 vertebral body). Care should be taken to avoid the lumbar vessels. A transdiscal technique recently advocated may also avoid some of the complications with the paramedian technique, but chances of discitis, nerve root injury, accelerated disc degeneration, disc herniation and rupture of the anterior annulus have to be considered when using this technique.
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To evaluate accuracy of needle placement and flow patterns of fluoroscopically guided caudal epidural injections. ⋯ Caudal epidural injections are ideally performed with fluoroscopic guidance as the gold standard for accurate needle placement. However, this does not assure either targeted delivery or accurate placement of the drug.
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This was a pilot study to test the potential effectiveness of intradiscal restorative injection therapy and compare with intradiscal electrothermal therapy (IDET). Thirty-five patients for intradiscal injection and seventy-four for IDET took part in the study. All patients had intractable chronic discogenic low back pain, confirmed by discogram study. ⋯ However, the duration of pain flare-up was notably shorter for restorative injections (8.6 days) than for IDET (33.1 days). Biochemical intradiscal restorative injections may be useful to reduce pain and disability in patients with chronic discogenic low back pain, and have clinically similar efficacy to IDET, but with improved cost-benefit ratio. The results of this study indicate that controlled random prospective comparative studies need to be performed to establish the efficacy of this treatment.
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To demonstrate the effectiveness of Sarapin in prolonging the action of neural blockade with improved pain relief. ⋯ This prospective, double-blind trial of 500 patients undergoing 828 treatments, one time with Sarapin and a subsequent time without, with each patient acting as their own control, showed no significant differences in the pain relief or duration of significant relief with the addition of Sarapin.