Pain physician
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Cervical interlaminar epidural injection (CILEI) is commonly used to treat acute or chronic pain that affects the head, neck, and upper extremities. Thus far, studies on CILEI have focused on determining the optimal volume of contrast medium or analyzing the spread of contrast medium during a CILEI. To our knowledge, few studies have attempted to assess the correlation between epidurogram patterns and clinical outcomes of CILEI. ⋯ If the duration of symptoms is lengthy, central stenosis is severe, or contrast medium spread is limitedly solely within the central canal and does not reach the dorsal root ganglion any further, the outcome after a CILEI is likely to be poor. Therefore, efforts should be made to spread injectate around the dorsal root ganglion at the target level.
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Review Case Reports
Painful Diabetic Neuropathy - Spinal Cord Stimulation, Peripheral Nerve Stimulation, Transcutaneous Electrical Nerve Stimulation, and Scrambler Therapy: A Narrative Review.
First-line medications for the treatment of painful diabetic neuropathy (PDN) are associated with a substantial rate of discontinuation due to adverse effects or insufficient efficacy. Neuromodulation techniques have been used for PDN, but a comprehensive review of the literature that incorporates several distinct device categories has yet to be undertaken. ⋯ The evidence for neuromodulation devices for the treatment of PDN mostly comprises open-label prospective trials or case reports. SCS has the most volume of evidence for efficacy. Studies regarding TENS show mixed results, possibly due to numerous device varieties. PNS and ST may hold promise based on their proposed mechanisms of action, but prospective controlled trials are needed.
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Lumbar disc herniation (LDH) is the main cause of low back pain and/or radiculopathy. Currently, epidural intervention is a widely used and effective conservative treatment method for managing low back and radicular pain caused by LDH. ⋯ In short-term and intermediate-term follow-up, the PIL approach has the highest probability for pain relief and functional improvement.
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Randomized Controlled Trial
Comparison of Erector Spinae Plane Block at the Level of the Second Thoracic Vertebra With Suprascapular Nerve Block for Postoperative Analgesia in Arthroscopic Shoulder Surgery.
Appropriate postoperative pain management in shoulder surgeries is the mainstay of rehabilitation therapy and subsequent improved functional outcomes. However, adequate pain control either with opioids or interscalene brachial plexus block is often challenged by their side effects. In this context, this study compared the suprascapular nerve block (SSNB) to the newly emerging erector spinae plane block at the second thoracic vertebral level (high thoracic-ESPB) as an alternative pain therapy. ⋯ SSNB is not inferior to high thoracic-ESPB in the context of phrenic nerve sparing pain control for arthroscopic surgeries. Moreover, SSNB is a more established technique with more predicted sensory distributions and a lower risk of LA toxicity.
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Randomized Controlled Trial
Transforaminal Versus Interlaminar Approach of Full-Endoscopic Lumbar Discectomy Under Local Anesthesia for L5/S1 Disc Herniation: A Randomized Controlled Trial.
Local anesthesia is feasible for both transforaminal and interlaminar approaches in percutaneous endoscopic lumbar discectomy (PELD). However, the optimal approach for PELD has not yet been established at the L5/S1 segment under local anesthesia with 1% lidocaine. ⋯ Both TELD and IELD can provide good clinical outcomes for L5/S1 DH under local anesthesia with 1% lidocaine. TELD was superior to IELD in terms of surgical-related experience and complications.