Pain physician
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Randomized Controlled Trial Comparative Study
Sonographic Guidance for Supraclavicular Brachial Plexus Blocks: Single vs. Double Injection Cluster Approach.
The cluster approach for supraclavicular brachial plexus block (SC-BPB) can be easily performed but may result in asymmetric local anesthetic (LA) spread. The authors hypothesized that the use of a cluster approach in each of the 2 planes would achieve better 3-dimensional LA distribution than the traditional single cluster approach. ⋯ The DI approach can be performed easily as single cluster approach and increases the consistency of ultrasound-guided SC-BPB over the SI approach in terms of the rate of blocking of all 4 nerves. Key words: Brachial plexus block, corner pocket approach, cluster approach, multiple injection, supraclavicular block, ultrasound.
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Failed back surgery syndrome (FBSS) is a cause of significant morbidity for up to 40% of patients following spine surgery, and is estimated to cost almost $20 billion. Treatment options for these patients currently include conventional medical management (CMM), repeat operation, or spinal cord stimulation (SCS). Much of the published data regarding cost effectiveness of SCS comprise smaller scale randomized controlled trials (RCTs) rather than large databases capturing practices throughout the US. SCS has been shown to have superior outcomes to CMM or repeat spinal operation in several landmark studies, yet there are few large studies examining its long-term economic impact. ⋯ We found that from 2000 to 2012, only 4.3% of patients across the United States with FBSS were treated with SCS. Long-term total annual costs for these patients were significantly reduced compared to patients with conventional management. Although implantation of an SCS system results in a short-term increase in costs at one year, the subsequent annual cumulative costs were significantly decreased long-term in the following 9 years after implantation. This study combines the largest group of FBSS patients studied to date along with the longest follow-up interval ever analyzed. Since SCS has repeatedly been shown to have superior efficacy to CMM in randomized clinical trials, the current study demonstrating improved long-term health economics at 1, 3, 6, and 9 years supports the long-term cost utility of SCS in the treatment of FBSS patients. Key words: Failed back surgery syndrome, spinal cord stimulation, back pain, leg pain, neuromodulation, FBSS, SCS.
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Meralgia paraesthetica (MP) is a condition originally described by Bernhardt in 1878 and was eventually named by Roth in 1895. It is caused by compression of the lateral femoral cutaneous nerve (LFCN) resulting in varying types of discomfort. Severity of the symptoms can range from mildly uncomfortable to painfully disabling. ⋯ In our patients, the MP syndrome was clearly related to the operation because symptoms appeared in the immediate post-operative period and were not present beforehand. LVR is a relatively new and evolving procedure with few reports of associated peri-operative complications. Key words: Meralgia paraesthetica, laparoscopy, rectopexy, lateral femoral cutaneous nerve.
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Previous studies have reported a high incidence of re-collapse of the augmented vertebrae after percutaneous vertebral augmentation (PVA) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral vacuum cleft (IVC) during long-term follow-up. Previous IVC might be considered an important predisposing factor for re-collapse, but the prior studies could not find a significant correlation. ⋯ PVA treatment was initially effective in all patients with OVCFs. However, significant re-collapse of the augmented vertebrae with IVCs, especially those with inferior endplate IVCs, was found with long-term follow-up. Key words: Intravertebral vacuum cleft, percutaneous vertebral augmentation, osteoporotic vertebral compression fractures, affected vertebrae, augmented vertebrae.
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Review Meta Analysis
Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
The management of chronic pain is a complex challenge worldwide. Cannabis-based medicines (CBMs) have proven to be efficient in reducing chronic pain, although the topic remains highly controversial in this field. ⋯ The current systematic review suggests that CBMs might be effective for chronic pain treatment, based on limited evidence, primarily for neuropathic pain (NP) patients. Additionally, GI AEs occurred more frequently when CBMs were administered via oral/oromucosal routes than by inhalation.Key words: Cannabis, CBMs, chronic pain, postoperative pain, review, meta-analysis.