Pain physician
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Randomized Controlled Trial
Effect of thoracic epidural analgesia on pro-inflammatory cytokines in patients subjected to protective lung ventilation during Ivor Lewis esophagectomy.
Thoracic epidural analgesia (TEA) has a well-known effect on neurohormonal response. Attenuation of stress response by post-operative epidural analgesia has shown beneficial effects such as lower pain scores and less immunological alterations. ⋯ Our study concluded that TEA reduced the systemic pro-inflammatory response and provided optimal post-operative pain relief. Although there were no significant differences in adverse events, there was a trend towards improved outcome. Further clinical studies with larger numbers of patients are required.
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In spite of the widespread performance of intra-articular zygapophyseal joint (IAZJ) injections, we know of no systematic analysis to date that examines the risks and types of adverse events when IAZJ injections are performed. ⋯ Fluoroscopically guided IAZJ injections have minimal adverse effects. The most common immediate adverse event was vasovagal reaction and most common delayed adverse event was injection site soreness.
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Despite recent developments in implantable neurostimulation devices, the adjustment of stimulation levels to the patient's postural changes has remained a problem so far. ⋯ The findings of the present work are similar to those described in previous publications that showed the relationship between postural changes and several stimulation thresholds and pulse energy. The posture which requires lower energy - and whose corresponding therapeutic range (TR) is narrower--is supine decubitus.
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Clinical Trial
Fluoroscopically guided infiltration of the cervical nerve root: an indirect approach through the ipsilateral facet joint.
Transforaminal infiltrations in the cervical spine are governed by a higher rate of vascular puncture than in the lumbar spine. The purpose of our study is to assess the safety and efficacy of percutaneous, fluoroscopically guided nerve root infiltrations in cases of cervical radiculopathy. An indirect postero-lateral approach was performed through the ipsilateral facet joint. ⋯ There were no clinically significant complications noted in our study. Fluoroscopically guided transforaminal infiltrations through the ipsilateral facet joint seem to be a feasible, efficacious, and safe approach for the treatment of patients with cervical radiculopathy. This approach facilitates needle placement and minimizes risk of complications.
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Headache following head injuries has been reported for centuries. The majority of post-traumatic headache (PTH) patients will report resolution of their complaints within a few months from the time of the initial injury. PTHs can contribute to disability, lost productivity, and health care costs. ⋯ During 7 days of high cervical dorsal column electrical nerve stimulation trial, he reported almost 90% pain reduction and significant improvement on his quality of life. On 12 months follow-up after he underwent a permanent implant of high cervical dorsal column electrical nerve stimulation, he reported the same level of pain reduction along with 100% satisfaction rate. To the best of our knowledge, there have been no publications to date concerning the application of high cervical nerve stimulation for PTH.