Pain physician
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Cervical epidural steroid injection (ESI) has been used to alleviate axial or radicular pain incurred from various cervical pathologies, including herniated intervertebral disc (HIVD) and spinal stenosis (SS). However, the superiority of the transforaminal ESI (TFESI) method over the interlaminar ESI (ILESI) in terms of clinical effectiveness for the radicular pain is still controversial. ⋯ Comprehensive reviews of selected articles revealed TFESI could not be recommended over ILESI for the sake of a preferential cervical radiculopathy control due to the weak evidential strength.
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Meta Analysis
Efficacy of Nalbuphine as a Local Anesthetic Adjuvant for Brachial Plexus Block: A Systematic Review and Meta-analysis.
Nalbuphine has been increasingly used as a local anesthetic adjuvant to extend the duration of analgesia in brachial plexus block (BPB). ⋯ Perineural use of nalbuphine in BPB is an effective strategy for analgesia in adult patients undergoing upper extremity surgery.
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Complex Regional Pain Syndrome (CRPS) is a chronic debilitating neuropathic pain condition characterized by autonomic and inflammatory features that typically occurs after a traumatic event. Spinal cord stimulation (SCS) has been shown to be effective in the treatment of chronic CRPS refractory to conventional treatment modalities. The collective evidence of novel parameters of SCS for treating CRPS has not been characterized extensively. ⋯ LF-SCS is superior to conventional therapy/placebo SCS stimulation. However, more evidence is required to demonstrate that novel SCS parameters are superior to LF-SCS in improving pain scores and functional outcomes.
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Single-injection regional analgesia techniques can provide effective analgesia for abdominal hysterectomy. However, few randomized controlled trials (RCTs) have directly compared these techniques for total abdominal hysterectomy (TAH), and the best strategy remains unknown. ⋯ Single-injection blocks are effective analgesic techniques for TAH. Among them, the erector spinae plane block and quadratus lumborum block seem to have superior effects. Further studies should evaluate techniques other than TAPB and wound infiltration to draw definitive conclusions.
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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.