Pain physician
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Randomized Controlled Trial
The Effect of Ultrasound-guided Bilateral Erector Spinae Plane Block With and Without Dexmedetomidine on Intraoperative and Postoperative Pain in Laparoscopic Cholecystectomies: A Randomized, Controlled, Double-blind, Prospective Trial.
Laparoscopic cholecystectomy is the most common surgical procedure performed in the Western world. While it is performed with minimally invasive procedures, patients often complain of moderate to severe postoperative pain, and the role of the anesthesiologist for its effective management remains crucial. Modern anesthesiology practices have embraced trunk blocks which can contribute to perioperative, multimodal analgesia. There is emerging literature about the favorable effect of erector spinae plane block in the reduction of pain after laparoscopic cholecystectomy. ⋯ Erector spinae plane block performed either with ropivacaine or with a combination of ropivacaine and dexmedetomidine is a novel and safe method, which was found to be more effective compared to standard analgesia protocols in patients undergoing laparoscopic cholecystectomy and thus, it can improve the quality of perioperative analgesia.
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Multicenter Study
Long-term Outcomes of Pulsed Radiofrequency for Supraorbital Neuralgia: A Retrospective Multicentric Study.
Pulsed radiofrequency (PRF) is a percutaneous, micro-invasive, and micro-destructive neuromodulation technology. It has been reported to be useful in the treatment of supraorbital neuralgia (SN). However, the long-term effectiveness and safety of this technique in SN has not been reported yet. ⋯ The performance of PRF for the treatment of SN was confirmed to be favorable in a multicentric, relatively large scale, and long-term perspective.
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Observational Study
Effects of Hypovitaminosis D on Preoperative Pain Threshold and Perioperative Opioid Use in Colorectal Cancer Surgery: A Cohort Study.
Postoperative pain after colorectal cancer surgery has a significant impact on postoperative physical and mental health. Vitamin D deficiency has been correlated with both acute pain states, including postoperative and post-traumatic pain, and several chronic pain diseases. The effects of hypovitaminosis D on preoperative pain threshold and perioperative opioid use in colorectal cancer surgery still need to be studied. ⋯ On the basis of the study results, hypovitaminosis D is associated with increased perioperative opioid consumption in colorectal cancer surgery. Sensory perception and pain threshold of patients with insufficient 25 (OH) D3 concentration were more sensitive, and PET was lower. History of DM, vitamin D, and vitamin C may be factors related with SSI. Future studies are needed to investigate their relationship further and discover if postoperative pain and pain threshold can benefit from vitamin D supplementation in these patients.
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Various minimally invasive procedures for treating discogenic pain have been reported in recent years. A Disc-FX® system can be used to perform nucleus pulposus (NP) removal, radiofrequency ablation, and annuloplasty under the guidance of x-ray fluoroscopy. However, when a probe tip with focused heat is placed on the intradiscal/subannular area to perform nucleo-annuloplasty using radiofrequency lesioning, thermal injury to the spinal cord or spinal nerves is a concern. ⋯ The results of this study are limited due to the use of a cadaveric spine, which could not reflect the effect of soft tissue such as muscles and connective tissue around the disc. The position of the temperature measuring probe was relatively fixed. This cadaver demonstration was conducted at the L4-L5 level, which is mostly not restricted by the height of the iliac crest. CONCLUSIONS: When performing NP ablation and annular modification, the epidural peripheral temperature should always be kept below 37°C. This preliminary in vitro research using human cadaveric discs showed that radiofrequency maintained the epidural space at a safe temperature during nucleo-annuloplasty.
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Randomized Controlled Trial
Exercise Facilitates the M1-to-M2 Polarization of Microglia by Enhancing Autophagy via the BDNF/AKT/mTOR Pathway in Neuropathic Pain.
In neuropathic pain following peripheral nerve injury, microglia are rapidly activated and accumulated in the spinal cord. Physical exercise can alleviate neuropathic pain. However, the exact mechanism underlying this analgesic effect is not fully understood. ⋯ Exercise training promoted the recovery of sciatic nerve injury in mice, possibly by regulating microglial polarization through BDNF/AKT/mTOR signaling-mediated autophagy flux. We confirmed the efficacy of exercise training in alleviating neuropathic pain and suggest a new therapeutic target for neuropathic pain.