Pain physician
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Randomized Controlled Trial
A Placebo-Controlled Randomized Trial Comparing Oral Midazolam, Dexmedetomidine, and Gabapentin on Prophylaxis of Emergence Agitation After Sevoflurane Anesthesia in Adenotonsillectomy.
Sevoflurane causes emergence agitation (EA) in up to 80% of pediatric patients. ⋯ Premedication using oral midazolam, DEX, or gabapentin reduced the incidence of EA, and DEX provided the best sedation and hemodynamics of all.
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Randomized Controlled Trial
Rhomboid Intercostal versus Serratus Anterior Plane Block for Analgesia After Thoracodorsal Artery Perforator Flap Following Partial Mastectomy: A Randomized Controlled Trial.
The thoracodorsal artery perforator (TDAP) flap has been developed to improve the postoperative aesthetic and psychological states of patients who receive breast-conserving surgery (BCS); nonetheless, the TDAP flap exacerbates the pain that occurs at 2 surgical sites. ⋯ Because of its ability to block both the anterior and posterior hemithorax, the RIB, is more efficient than the SAB at controlling acute pain and reducing opioid consumption in patients undergoing BCS followed by TDAP flaps; thus, the RIB can be employed as a potential alternative in these surgeries.
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Paresthesia-based spinal cord stimulation (SCS) depends upon dorsal column (DC) fiber activation to engage pain-relieving neural mechanisms. However, the mechanisms for 10-kHz paresthesia-free SCS have not been fully elucidated. Preclinical work has shown selective drive of inhibitory dorsal horn neurons, while other hypotheses suggest that DC fibers may be activated. To provide clinical data for guiding mechanism work, we analyzed paresthesia perception thresholds (PPT) over a range of low to high kHz frequency and compared those values to the stimulation parameters from the therapeutic 10-kHz SCS programs used by patients. ⋯ Therapeutic 10-kHz SCS uses stimulation amplitudes far lower than the PPT, providing evidence that therapeutic 10-kHz SCS does not activate dorsal column axons. Additionally, the PPT decreases with increasing kHz frequency, suggesting that a presumed asynchronous pattern of activation from kHz stimulation does not raise the threshold at which sensation occurs.
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Serum 25-hydroxyvitamin D (25[OH]D) deficiency causes osteoporosis and increases muscle weakness, which worsens the risk of falls and osteoporotic vertebral fractures. However, the effect of a lower serum 25(OH)D level on new vertebral fractures, including osteoporotic vertebral refractures and cascade vertebral fractures post percutaneous vertebral augmentation in patients during postmenopause has not been reported. ⋯ A low serum 25(OH)D level is an independent risk factor for new vertebral fractures after percutaneous vertebral augmentation in patients during postmenopause. Appropriate active vitamin D supplementation following percutaneous vertebral augmentation surgery can effectively mitigate the risk of subsequent osteoporotic vertebral fractures.
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Neuropathic pain occurs for various reasons involving adenosine receptors. One of several drugs used to control neuropathic pain is amitriptyline, a tricyclic antidepressant. Amitriptyline has an antinociceptive effect on the A3 adenosine receptor (A3AR). However, the exact mechanisms underlying A3AR activation remain unclear. ⋯ The release of proinflammatory cytokines via NF-kB expression and subsequent inflammatory responses is significantly associated with the development of neuropathic pain. Our study reveals that AMI effectively suppresses NF-kB-related proinflammatory cytokines, offering a promising avenue for treating pain related to peripheral nerve injuries. These findings provide valuable insights into neuropathic pain management.