A systematic review of the use of corticosteroid injections with and without local anaesthetic for trigger finger.

The Efficacy of 95-Hz Topical Vibration in Pain Reduction for Trigger Finger Injection: A Placebo-Controlled, Prospective, Randomized Trial

To compare pain levels of intra-articular hip steroid injections performed with and without prior subcutaneous local anesthesia (LA) injection. Randomized prospective study. University-based musculoskeletal clinic. Forty-one adult patients undergoing a first-time ultrasound-guided unilateral intra-articular hip steroid injection. Subjects were randomized into 1 of 2 groups: intra-articular hip injection with prior subcutaneous LA with 2 mL of lidocaine 1% (With LA) or hip injection without prior subcutaneous LA (Without LA). Visual analog scale (VAS) pain scores (0-100) were collected before and after each injection. Visual analog scale pain score for the intra-articular hip injection. Of the 41 total subjects, 18 were randomized to the Without LA group and 23 to the With LA group. There was no significant difference in baseline (preprocedure) VAS scores between the Without LA (mean ± SD = 39.2 ± 27.2) and With LA (41.2 ± 24.0) groups ( P = 0.864). The mean ± SD VAS score for the subcutaneous LA injection in the With LA group was 20.4 ± 16.1. There was no significant difference in VAS scores for the intra-articular hip injection between the Without LA (48.5 ± 27.7) and With LA (39.5 ± 25.7) groups ( P = 0.232). Subcutaneous injection of lidocaine before an intra-articular hip injection did not significantly decrease pain from the intra-articular hip injection. Providers may perform intra-articular hip injections with a 22-gauge 3.5-inch spinal needle without the need for an extra subcutaneous LA injection.

Background Adhesive capsulitis is a common cause of glenohumeral joint pain and stiffness that significantly interferes with patients' lives and ability to work. Since no specific treatment options have been well established, this research examines arthrographic injection of the glenohumeral joint with steroid and local anesthetic versus local anesthetic alone for the treatment of adhesive capsulitis. Methods A double-blinded randomized controlled trial was conducted with patients diagnosed with idiopathic adhesive capsulitis. They were randomized to one of two groups: (1)local anesthetic plus steroid or (2)local anesthetic. A musculoskeletal radiologist performed all of the image-guided injections using a standardized patient-blinded technique. Outcome measures included shoulder range of motion, grip strength, and scores on the Shoulder Pain and Disability Index (SPADI), Constant Score, and Visual Analog Scale (VAS) for pain. Evaluations occurred at baseline and 3-, 6- and 12-weeks post-injection. Results Thirty-seven patients were enrolled in the study. There was no significant improvement in shoulder range of motion and grip strength with local anesthetic plus corticosteroid injection compared to local anesthetic alone. Shoulder range of motion was better at all time points for the group with local anesthetic alone. Both groups showed significant improvements in their VAS and SPADI pain scores at all post-injection follow-up appointments (p=.011). The SPADI results showed significantly better disability scores for the local anesthetic plus steroid group (p=.012) and improved pain scores from baseline at all follow-up times (p=.011), whereas the local anesthetic group had significant pain relief for only the first 3 weeks (p=.050). Conclusion Intra-articular injection with local anesthetic plus steroid was beneficial in improving pain but not range of motion when compared to injection with local anesthetic alone.

The pain from corticosteroid injections is not an insignificant issue for patients with trigger finger. The aim of this study was to evaluate the efficacy of subcutaneous single-injection digital block (SSIDB) for pain reduction during trigger finger corticosteroid injection. Ninety patients requiring corticosteroid injections for trigger finger were randomized to three groups: SSIDB with 2ml of 1% lidocaine, SSIDB with 1ml of 1% lidocaine and no digital block (control group). In SSIDB groups, the intrasynovial corticosteroid injections were performed after digital nerve block. In control group, ethyl chloride spray was applied prior to intrasynovial injection of the corticosteroid and 1% lidocaine mixture. The pain during lidocaine needle insertion, lidocaine infiltration, corticosteroid needle insertion and corticosteroid infiltration were determined with a visual analog scale (VAS). The VAS pain scores for corticosteroid needle insertion in both SSIDB groups were significantly lower than the VAS pain scores in control group (p < 0.001). The VAS pain score during corticosteroid infiltration in 2ml of 1% lidocaine group was significantly lower than 1ml of 1% lidocaine group (p = 0.008), and in control group (p < 0.001). Pain during nerve block procedure in both SSIDB groups was significantly lower than the pain from corticosteroid injection in the control group (p < 0.05 and p < 0.05). Subcutaneous single-injection digital block with 2ml of 1% lidocaine was highly effective in reducing pain associated with injection of corticosteroid for trigger finger.

Objectives:Lateral epicondylitis is the most common condition affecting the elbow however conservative treatment for the condition remains controversial. Various approaches have been described including braces, physical therapy, corticosteroid injections, and platelet-rich-plasma (PRP) injections. PRP is taken from a centrifuged blood sample and consists mainly of platelets and growth factors. Although research surrounding injections in lateral epicondylitis continues to evolve, randomized controlled trials have shown that PRP injections are associated with decreased pain at two-year follow-up. Visual analog scale (VAS) pain scores and other patient reported outcome measures (PROMs) such as Disabilities of the Arm, Shoulder, and Hand (DASH) have been used previously; however, no studies to date have used the Single Assessment Numeric Evaluation (SANE). It was hypothesized that patients would report improvements in pain and function at four weeks and four months after PRP injection. The primary outcomes were SANE and VAS pain scores. The secondary aim was to determine a minimum clinically important difference (MCID) value for SANE for this procedure.Methods:This was a retrospective review of a prospectively collected PROM database from 2021-2023. All patients who received a PRP injection for lateral epicondylitis were included in this study. Patients were excluded if they were missing baseline SANE or VAS pain scores, received an injection anywhere besides the common extensor tendon origin, or had overlapping conditions such as cervical radiculopathy, cubital tunnel or carpal tunnel syndrome. Baseline patient characteristics including sex, age, smoking history, history of depression or anxiety, disease chronicity, and hand dominance were collected. Previous history of physical therapy, corticosteroid injection, PRP injection, and procedure characteristics including milliliters (ml) of PRP injected and number of fenestrations were also collected. All PRP injections were ultrasound guided and conducted using the health-system standardized protocol with leukocyte-rich plasma. Primary outcomes included SANE and VAS pain scores at baseline, four weeks, and four months post-injection. MCID was calculated using the distribution-based method, calculated as half of the standard deviation of the change in SANE score. Additional outcomes included if the patient experienced any adverse events following injection, underwent subsequent injection within the study period.Results:A total of 36 patients met criteria for analysis. More than half the patients were male (n=20, 55.6%), and the average age was 50.15±9.31 years. Only 5.6% of patients were current smokers (n=2). Fifteen patients (41.7%) had histories of depression, and 10 patients (27.8%) had histories of anxiety. Most patients received an injection after experiencing symptoms for 10.62±9.56 months on average. The majority of patients previously tried or were concurrently going to physical therapy (n=28, 77.8%). Fourteen patients (38.9%) had received a previous corticosteroid injection, and five patients (13.9%) had received a previous PRP injection.The injection procedure typically consisted of 2.36±0.66 ml of PRP with 5.74±3.03 fenestrations. Most injections were done in the dominant arm (n=28, 77.8%). A total of six patients went on to have a repeat injection (16.7%). There were five patients who experienced increased post-procedure pain (13.9%) and one who experienced nerve irritation (2.8%). All adverse events eventually resolved.SANE scores at baseline, four-week, and four-month follow-up were 53.06±23.28, 57.22±27.32, 65.19±27.07. The difference between baseline and follow-up at four weeks was not statistically significant (p=0.245), but the follow-up scores at four months were found to be statistically higher than baseline scores (p=0.044). The average changes from baseline to four weeks and baseline to four months were 7.04±30.77 and 15.50±28.13, respectively. VAS pain scores at baseline, four-week, and four-month follow-up were 5.14±2.10, 4.25±2.66, 3.17±2.81. Follow-up scores at four weeks and four months were found to be statistically lower than baseline scores (p=0.006, p=0.003). The average changes from baseline to four weeks and baseline to four months were -1.29±2.29 and -2.44±2.99, respectively. A history of prior corticosteroid injection was not significantly associated with changes in SANE scores at four weeks or four months after PRP injection (p=0.149, p=0.602, respectively). The SANE MCID values at four weeks and four months were 15.39 and 14.07, respectively. Of those patients who reported, 44.4% met the four-week value and 37.5% met the four-month value.Conclusions:Patients after PRP injection for lateral epicondylitis demonstrated increased SANE scores at four months and decreased VAS pain scores at four weeks and four months. The change in SANE scores at four weeks was not statistically significant. These results may indicate that there are greater pain reducing effects as well as milder extremity functionality improvement effects associated with PRP injection. This may be in part due to the inherent nature of the disease with the more prevalent symptom being pain over loss of function. PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis. Physicians should discuss patient expectations for improvement during the early post-injection period.

Partial meniscectomy using needle arthroscopy associated with significantly less pain and improved patient reported outcomes at two weeks after surgery: A comparison to standard knee arthroscopy

Higher patient resilience has been shown to be associated with improved patient-reported outcome measures (PROMs) at 6 months after hip arthroscopy. To examine the relationship between patient resilience and PROMs at minimum 2 years after hip arthroscopy. Cross-sectional study; Level of evidence, 3. Included were 89 patients (mean age, 36.9 years; mean follow-up, 4.6 years). Patient demographics, surgical details, and preoperative International Hip Outcome Tool-12 (iHOT-12) and visual analog scale (VAS) pain scores were collected retrospectively. Postoperative variables were collected via a survey and included the Brief Resilience Scale (BRS), Patient Activation Measure-13 (PAM-13), Pain Self-efficacy Questionnaire-2 (PSEQ-2), VAS satisfaction, and postoperative iHOT-12, and VAS pain scores. Based on the number of standard deviations from the mean BRS score, patients were stratified as having low resilience (LR; n = 18), normal resilience (NR; n = 48), and high resilience (HR; n = 23). Differences in PROMs were compared between the groups, and a multivariate regression analysis was performed to assess the relationship between pre- to postoperative change (Δ) in PROMs and patient resilience. There were significantly more smokers in the LR group compared with the NR and HR groups (P = .033). Compared with the NR and HR groups, patients in the LR group had significantly more labral repairs (P = .006), significantly worse postoperative iHOT-12, VAS pain, VAS satisfaction, PAM-13, and PSEQ-2 scores (P < .001 for all), and significantly lower ΔVAS pain and ΔiHOT-12 scores (P = .01 and .032, respectively). Regression analysis showed significant associations between ΔVAS pain and NR (β = -22.50 [95% CI, -38.81 to -6.19]; P = .008) as well as HR (β = -28.31 [95% CI, -46.96 to -9.67; P = .004) and between ΔiHOT-12 and NR (β = 18.94 [95% CI, 6.33 to 31.55]; P = .004) as well as HR (β = 20.63 [95% CI, 6.21 to 35.05]; P = .006). Male sex was a significant predictor of ΔiHOT-12 (β = -15.05 [95% CI, -25.42 to -4.69]; P = .006). The study results indicate that lower postoperative resilience scores were associated with significantly worse PROM scores, including pain and satisfaction, at 2 years after hip arthroscopy.

Comparison of warm and cold contrast media for hysterosalpingography: a prospective, randomized study

BackgroundThe hyaluronic acid (HA) injections are widely used in knee osteoarthritis (OA) patients. We conducted the study comparing the efficacy and safety of single injection of Crosslinked Hyaluronic Acid Platform Hyaluronan (CHAP-HA) with 3-injection of linear hyaluronan in knee OA patients.MethodsThis was a randomized two-arms, evaluator-blinded, controlled, single-center study. Participants with knee OA received single CHAP-HA or three-injection of linear-HA. The 140 patients aged 35–85 years with radiographically confirmed knee OA were enrolled. At week 4, 12, 26, 39, and 52, visual analog scale (VAS) pain score, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, timed up and go (TUG) and subject’s adverse events (AE) of these 2 groups were recorded. Primary outcome of the differences of VAS pain score at week 26 between groups was analyzed with analysis of covariance (ANCOVA). At week 52, those who met the inclusion criteria could receive a CHAP-HA injection and being followed-up for the adverse events for 4 weeks.ResultsThe trial was conducted from September 2015 to April 2017. A total 140 subjects were available for analysis (71 in the CHAP-HA group and 69 in the linear-HA group). At 26th week, there were significant more improvements in VAS pain scores in CHAP-HA compared with linear-HA. Both CHAP-HA and linear-HA showed significant improvements in the VAS pain score at week 26 compared with the baseline, and the occurrence of adverse events during the study period showed no between-group difference. In subjects with KL = 2, both groups showed significant improvements in VAS pain scores within 26 weeks. In patients with KL = 3, only CHAP-HA group showed significant improvement in VAS pain from 4 to 39 weeks. No unexpected or severe AEs were reported.ConclusionsA single injection of CHAP-HA may be safe and more effective for 26 weeks in patients with knee OA by comparing to linear-HA; moreover, the pain relief effect of CHAP-HA may remain until 52 weeks. For patients with more severe OA, CHAP-HA was demonstrated to be more preferable to relieve OA pain. Furthermore, repeat treatment of CHAP-HA or using CHAP-HA after a three-injection HA was proved to be safe.Trial registrationClinicalTrials.gov: NCT03643588. Date: August 23, 2018 (retrospectively registered).Level of Evidence: Therapeutic Level I.

Purpose of this study is to examine the relationship between the magnetic resonance imaging (MRI) findings, pain scores, and opiates use in patients with lumbar spinal stenosis (LSS) undergoing lumbar epidural steroid (LES) injections by retrospective review of 719 patients' electronic medical records. Reviewed were Visual Analog Scale (VAS) pain scores and opioid use before and 8 to 12 weeks after series of LES injections. The stenosis pain index (SPI) was produced by adding an assigned numerical value of severity (1=mild, 2=moderate, 3=severe) to the number of lumbar vertebral levels affected by LSS on MRI (lateral or central). The average age of patients was 68.4 years. There was no relationship between the pretreatment age, sex, or number of vertebral levels affected on MRI with pretreatment VAS pain scores or opioid use. The degree of LSS present on MRI, categorized as a mild, moderate, or severe, correlated clearly with initial VAS pain scores (P=0.017). The improvement in VAS pain scores after LES injections correlated well with number of levels affected (P=0.003) and the severity of stenosis (P=0.12). Positive correlation was observed between change in VAS pain score 8 to 12 weeks after the series of LES injections and the SPI (P=0.001). There were no differences found in opioid use. The improvement in VAS pain scores after LES injections correlated well with the changes in the SPI except in those patients classified on MRI as severe LSS and more than 3 lumbar levels affected. That patient group is unlikely to benefit from LES injections.

Preoperative multimodal analgesia decreases 24-hour postoperative narcotic consumption in elective spinal fusion patients

BackgroundCorticosteroid injections are used in the treatment of hand and wrist conditions. The co-administration of a local anaesthetic and corticosteroid aims to reduce pain after the injection, although no studies have directly compared this with using corticosteroid alone. The aim is to determine whether pain experienced during the 24 h after a corticosteroid injection to the hand and wrist is no worse than (not inferior to) the pain experienced after a corticosteroid and local anaesthetic injection.MethodsA single-site, patient- and assessor-blinded, non-inferiority randomised control trial recording pain visual analogue scale (VAS) scores in patients with a clinical diagnosis of trigger finger, de Quervains tenosynovitis or carpal tunnel syndrome, treated with a 1-ml triamcinolone (40 mg/1 ml) injection co-administered with or without 1 ml of 1% lidocaine. The primary aim is to investigate a difference in pain VAS scores at 1 h after the injection using a mean change score.A 95% power calculation was made using a minimally clinical important difference of 20 mm as the clinically admissible margin of non-inferiority and an assumed standard deviation of 25 mm, from previous studies. Including a 20% fall out rate, 100 patients are required.DiscussionPatients with a clinical diagnosis of trigger finger, de Quervains and carpal tunnel syndrome, are over the age 18 years old and who are able to give written informed consent will be included. Patients will be excluded if they have had previous surgery or corticosteroid injection for the condition being treated at the site considered for injection.Patients will be electronically randomised and injections delivered during their clinic appointment. Pain is assessed using a 100-mm VAS score taken, before and at the time of injection and at 5 min, 1 h, 2 h, 3 h and 24 h after the injection. The secondary outcomes are to determine a difference in pain VAS score at the time of injection and during the 24 h after.Trial registrationThis study is registered on the IRAS (259336) on November 11, 2019, and EudraCT database on October 31, 2019 (2019-003742-32). REC/HRA approval was given in January 2020, and Clinical Trial Authorisation from the MHRA was given in December 2019. The study is registered on ClinicalTrials.gov (NCT04253457) on February 5, 2020.

Study background: An analysis of the relationship between visual analog scale (VAS) pain scores and Likert pain scores over a period of up to a year in patients who sustained a distal radius fracture (DRF) in order to assess the reliability of using a VAS pain score as a long-term outcome instrument. Methods: Retrospective review was performed of prospectively collected data on all DRF's treated at our institution from 2010-2012 with consented patients. At the initial and each follow-up visit, patients indicated their level of injured extremity pain at rest by using a VAS (VAS-Rest) and when actively using the extremity (VAS-Active). At followup visits, patients completed a question asking what their perceived change in injured wrist pain was since their last orthopedic visit. This Change in Pain (CP) question consisted of a five-level Likert item. Patients' clinic visits were grouped into independent data sets consisting of 3 data points (VAS-Rest, VAS-Active, and CP score). Incomplete data sets were excluded. The difference in VAS pain scores between consecutive visits and the CP score were compared using Spearman's correlation coefficient and linear regression analysis. Results: A total of 74 DRF patients and 119 complete two-visit data sets were included in the study. CP scores and VAS-pain scores were collected at periods of two weeks, four weeks, six weeks, eight weeks, three months, six months, and one year post treatment. Spearman's correlation coefficients between VAS pain scores and patients' CP score were minimal (r<0.3). Linear regression analysis showed a weak relationship between VAS pain scores and CP scores. Conclusion: Although VAS pain scores play a vital role in assessing pain in the short-term setting, the VAS seems to be a poor instrument for comparing treatment outcomes of long-term orthopedic interventions. Multi-dimensional pain questionnaires may be preferable for assessing long-term orthopedic outcomes.

We enrolled 60 patients with American Association of Anesthesiologists grade Ⅰ - Ⅱ undergoing unilateral total knee arthroplasty. All patients received combined epidural and spinal anesthesia,and a nerve stimulator was used to guide placement of a femoral nerve catheter. Patients were divided into three groups according to the catheter location on X-ray : psoas muscle group ( n = 18 ), iliacus muscle group (n = 19) and local group (n =23). Visual analog scale (VAS) pain scores were recorded at rest and with movement at 4, 24 and 48 h postoperatively and sensory blockade of the femoral, obturator and lateral femoral cutaneous nerves was recorded at 24 h. There were no significant differences in femoral nerve blockade among the three groups. Obturator nerve blockade was significantly better in the psoas muscle group than in the iliacus muscle and local groups, and was also better in the local group than in the iliacus muscle group. There was no significant difference in lateral femoral cutaneous nerve blockade between the psoas muscle and iliacus muscle groups, but there was better blockade in both these groups than in the local group. At 4 h postoperatively, VAS pain scores at rest were significantly lower in the psoas muscle group than in the iliacus muscle and local groups, but there were no significant differences in VAS pain scores with movement among the three groups. At 24 and 48 h postoperatively, VAS scores at rest and with movement were significantly lower in the psoas muscle group than in the iliacus muscle and local groups. Key words: Anesthesia and analgesia; Arthroplasty, replacement, knee

Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy