Pain physician
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Randomized Controlled Trial Comparative Study
Comparison of Pain Reduction and Changes in Serum Cortisol and Glucose Levels to Different Doses of Lumbar Epidural Dexamethasone: A Prospective Study.
Lumbar epidural steroid injection (LESI) is an effective treatment for low back pain. However, it may result in increased blood glucose levels, decreased plasma cortisol concentrations, and suppression of the adrenocorticotropic hormone axis. ⋯ After the first lumbar epidural injection of either 4 mg or 8 mg of dexamethasone, there was a reduction in pain in both groups. There was no significant difference in serum cortisol and glucose levels before treatment and during follow-up. Therefore, 4 mg or 8 mg of dexamethasone can be considered a treatment for patients who have low back pain.
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Randomized Controlled Trial
Comparison of Intravascular Uptake and Technical Ease Between Anteroposterior and Oblique Views During Lumbar Medial Branch Block.
Inadvertent intravascular injection of local anesthetics can lead to false-negative results following lumbar medial branch block (MBB) performed to diagnose facet joint origin pain. A previous study demonstrated that the type of approach method could affect the incidence of intravascular injections and technical ease of the procedure. ⋯ The overall incidence rate of intravascular injection during lumbar MBB showed nearly 20% in both approach methods groups. The OB approach and left side MBBs were associated with a longer total procedure time and a higher radiation dose.
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Randomized Controlled Trial
Pediatric Postoperative Pain Control With Quadratus Lumborum Block and Dexamethasone in Two Routes With Bupivacaine: A Prospective Randomized Controlled Clinical Trial.
Ultrasound-guided Quadratus Lumborum block (QLB) is a regional analgesia approach that has been reported to provide effective post-operative pain relief for both abdominal and retroperitoneal surgery. Bupivacaine is the most often used and well documented local anesthetic medication in children. Dexamethasone is a systemic glucocorticoid that is often used to minimize postoperative nausea, vomiting, and pain to improve recovery quality after surgery. ⋯ Dexamethasone may be more effective when added to bupivacaine than when given systemically in analgesic effects without any impact on the other secondary pain-related outcomes. Dexamethasone as an adjuvant to bupivacaine has a marked hand on prolongation of the postoperative duration of analgesia, less request for rescue analgesia, and fewer side effects as compared to bupivacaine if used as a sole agent in QLB.
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Approximately 70% of Americans use social media platforms, and use of specific platforms, such as Instagram, Twitter, Snapchat, and TikTok, is especially common among adults under 30. The presence of social media accounts among residency and fellowship programs in academic medicine has been used to connect with other specialties, highlight achievements and research, disseminate information to the general public, and as a recruiting tool for applicants. ⋯ Less than 20% of the pain fellowship programs are currently utilizing Twitter and/or Instagram. When compared to primary anesthesiology residencies, social media presence among pain fellowships is much lower. By utilizing basic social media strategies, including image-based content posting, hashtags, and videos, programs can increase their engagement with the social media community, and increase their overall number of followers, thus expanding their potential reach to prospective applicants. Although social media can be an effective tool for branding purposes, it is vital to address the safe use of social media among all trainees.
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Observational Study
Radiofrequency Treatment of Iliac and Paravertebral Cluneal Nerves for Low Back Pain.
Paravertebral cluneal nerves are constrained within a tunnel consisting of the thoracolumbar fascia and the iliac crest's superior rim as they pass over the iliac crest. Their involvement in low back pain has not been presented previously. ⋯ Cluneal trigger points should be considered in the differential diagnosis of pain in the lower back, flank, lower abdominal, buttock, trochanteric, groin, and thigh area. It is one form of so-called "pseudo-sciatica." The authors' diagnostic injection protocol suggests that most patients with cluneal trigger points may successfully be treated with percutaneous radiofrequency ablation.