Pain physician
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Randomized Controlled Trial
Effect of Epidural Volume Extension Using Low-Dose Sufentanil Combined with Low-Concentration Ropivacaine on Visceral Pain During Cesarean Sections: A Randomized Trial.
Visceral pain is common in cesarean sections conducted under combined spinal-epidural anesthesia (CSE). Epidural volume extension (EVE) is a technique for enhancing the effect of intrathecal blocks by inducing epidural fluid boluses in the CSE. Whether EVE that uses different drugs can reduce visceral pain during cesarean sections is rarely studied. ⋯ EVE at 15 minutes after spinal anesthesia with a 10 mL combination of low-dose sufentanil (10 mu-g) and low-concentration (0.15%) ropivacaine can effectively reduce the incidence and severity of visceral pain in cesarean sections under CSE. At the same time, using EVE in this way can reduce postoperative opioid consumption and improve intraoperative satisfaction.
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The analysis of epidural procedure utilization has revealed several notable trends over recent years. Utilization increased significantly until 2004, then rose minimally until 2011, followed by gradual declines up to 2019 in the Medicare population. The COVID-19 pandemic led to a marked 19% decline in usage from 2019 to 2020. Additionally, recent studies of interventional pain management techniques showed a 28.9% reduction in use from 2019 to 2022, leading to an average annual decline of 10.9%. ⋯ This two-decade analysis indicates significant shifts in epidural procedure utilization, with steady increases until 2010, followed by a general decline affected by COVID-19 and other contributing factors. An approximate 24% decline in epidural procedure visits for chronic spinal pain management was noted from 2019 to 2022.
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Randomized Controlled Trial
Efficacy of Higher-Voltage Long-Duration Pulsed Radiofrequency for Spinal Zoster-Associated Pain: A Randomized Controlled Trial.
High-voltage (65 V) long-duration pulsed radiofrequency (HL-PRF) is an effective method for managing zoster-associated pain (ZAP), though the limited efficacy of and high recurrence rates associated with the procedure present concerns. ⋯ Using higher voltage in original HL-PRF treatments enhances pain relief, quality of life, and emotional well-being, in addition to reducing medication dependence. Multiple sessions might be preferable to a single treatment, with no additional cost or safety risks. Larger scale, long-term studies are needed to confirm these findings and guide clinical practice.
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Observational Study
Association Between Chronotype and Chronic Neuropathic Pain Sensitivity: A Pilot Prospective, Observational, Single-Center, Cross-Sectional Study.
Chronotype defines an organism's biological preference for timing of activity and sleep. Being a morning chronotype (i.e., tending to wake up early and go to bed earlier at night) is associated with protection against chronic musculoskeletal pain and headaches, but the relationship between chronotype and neuropathic pain sensitivity remains unclear. ⋯ Morning chronotypes are more sensitive to chronic neuropathic pain, reporting higher pain scores than do intermediate chronotypes. However, in this study, morning chronotypes were more resistant to neuropathic pain interference, suggesting that they may experience less disturbance of their physical, mental, and social activities than intermediate chronotypes. Further, larger studies are needed.
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Poorly controlled acute breast surgery postoperative pain is associated with delayed recovery, increased morbidity, impaired quality of life, and prolonged opioid use during and after hospitalization. Recently, ultrasound-guided pectoralis nerve (PECS) I block and serratus anterior plane (SAP) block, together or individually, have emerged as a potential method to relieve pain, decrease opioid requirements, and improve patient outcomes. ⋯ The PECS I/SAP block may potentially reduce pain in patients having breast surgery for cancer by providing analgesia to the lateral and anterior chest wall. While this analysis showed a reduction in intraoperative opioid consumption, no significant postoperative benefit in either pain scores, opioid consumption, or length of stay was observed. This may be in part due to the PECS I/SAP block not providing adequate analgesia to the medial portion of the breast.