Duration Of Pain Relief Research Articles

Comparison of the eficacy of epidural steroid injection applied in cervical and lumbar regions.

Epidural injections have been used for many years in the treatment of chronic pain in patients with chronic backleg pain and chronic neck-arm pain. We aimed to compare the efficacy of lumbar and cervical epidural steroid injections on pain palliation, duration of pain relief and patient satisfaction. This is a Retrospective, observational single-center study. A total of 159 patients (96 females, 63 males) who were performed epidural steroid injections in cervical and lumbar regions were included in the study. The patients were divided into two groups as lumbar epidural steroid injection 'Group 1' and cervical epidural steroid injection 'Group 2'. We retrospectively evaluated the patients for numerical rating scale (NRS) prior and after the injection, the duration of the pain relief, whether any complication occured related to injection and patient satisfaction. 130 patients in Group 1 and 29 patients in Group 2 were evaluated. Median NRS before the procedure: 8 in Group 1, 7 in Group 2 and median NRS after the procedure: 3 in Group 1, 4 in group 2. Patient satisfaction with the procedure 56.15% in Group 1 and 48.62% in Group 2. Mean duration of pain relief 7.23 months in Group 1 and 8.17 months in Group 2. There were no statistically significant difference in the evaluated parameters between the two groups. It was observed that the pain relief, duration of pain relief and patient satisfaction were similar for cervical and lumbar epidural steroid injections.

Клиническая эффективность и безопасность применения препарата Ракстан-сановель у пациентов с острой болью в поясничном отделе позвоночника (результаты многоцентрового постмаркетингового обсервационного исследования)

Aim: to analyze the efficacy (time of onset, severity and duration of pain relief) and safety of a nonsteroidal anti-inflammatory drug (NSAID), Rakstan-sanovel (flurbiprofen; further Rakstan), in the complex treatment of patients with acute LBP. Patients and Methods: the study involved 210 patients with acute LBP, randomly divided into 2 similar groups of 105 subjects. In the control group (CG), a standard treatment regimen was used for two consecutive weeks. Drug therapy included any NSAID (except Rakstan), muscle relaxants, B vitamins in the doses recommended in the patient information leaflet. Non-drug therapy included physical exercise or physiotherapy (patients could receive one of these treatments or a combination of them) as determined by the doctor. In the main group (MG), Rakstan was used to relieve pain in combination with other necessary concomitant therapy (muscle relaxants, B vitamins, physical exercise and physiotherapy). The tendency of clinical condition was analyzed according to the following scales: VAS, Roland-Morris Disability Questionnaire, CGI (to assess the overall clinical impression of the doctor and the patient), EQ-5D-5L. The total duration of drug intake follow- up was 10 days, as well as 2 subsequent weeks. Results: the majority of patients were female (the quantitative proportion of male and female was 1:1,4); the average age was 43.5 [29; 57] years with a disease duration of 14.4±6.3 days. Lumbar spondylosis was the predominant trigger of pain in 105 (50%) patients, sacroiliac joint injury — in 39 (18.6%), degenerative-dystrophic changes of the intervertebral disc — in 66 (31.4%). The majority (68%) of patients in both groups had a moderate pain level with a score of 45–74 points according to the VAS. By the end of the therapy course, the average difference between groups according to VAS was 19 points. By the end of the therapy course, 90% of patients with MG had reached a zero level of pain according to VAS, while in CG — only 50%. Besides, 2 weeks after the end of treatment, no pain recurrence was registered in the MG, and there was an improvement equaled 69% (41.6 points) in the assessment of the functional state according to the Roland-Morris Disability Questionnaire in the MG, while in the CG it reached only 24% (14.3 points). Assessment of the general clinical impression of the doctor according to the CGI questionnaire in the MG showed that 86 out of 105 patients rated their condition as "completely normal", while in the CG only 1 patient gave such an assessment. Adverse events (nausea, stomach pain, dizziness, diarrhea) were noted in 4 patients of the CG. Conclusions: the use of Rakstan allows to accelerate the recovery of patients with acute LBP without the development of additional adverse events, which may have a significant benefit in rational therapy, as well as in the prevention of chronification and relapses in patients of this category. KEYWORDS: acute lower back pain, non-steroidal anti-inflammatory drugs, flurbiprofen, Rakstan, recurrence. FOR CITATION: Danilov A.B., Merkulova D.M., Zhivolupov S.A. et al. Clinical efficacy and safety of the Rakstan-Sanovel in patients with acute low back pain (results of a multicenter postmarketing observational study). Russian Medical Inquiry. 2022;6(10):541–550 (in Russ.). DOI: 10.32364/2587-6821-2022-6-10-541-550.

Does the application of pulse radiofrequency to the suprascapular nerve provide additional benefit in patients who have undergone glenohumeral intra-articular steroid injection and suprascapular nerve block?

Shoulder pain is one of the most common musculoskeletal pain syndromes. Interventional treatments can be applied to patients who do not respond to conservative therapies. Intra-articular steroid injection and suprascapular nerve block are both short-acting and may sometimes be clinically inadequate. In this study, the answer to the question of whether pulse radiofrequency application to the suprascapular nerve provides additional benefit was investigated. Patients who had shoulder pain and were injected between October 2016 and April 2018 were evaluated retrospectively. Totally 160 patients who underwent shoulder injections were included in the study. Patients were divided into two groups: 114 patients who underwent shoulder intra-articular steroid injection and suprascapular nerve block, as Group 1 and 46 patients who underwent pulse radiofrequency to the suprascapular nerve, in addition to shoulder intra-articular steroid injection and suprascapular nerve block, as Group 2. There was no statistical difference between the groups in pre-intervention numerical rating scale (NRS) scores. One month after the intervention, NRS scores of Group 2 were significantly lower than Group 1. In both groups, 1 month after the intervention NRS scores were significantly lower than pre-intervention. The duration of pain relief for Group 2 was longer than Group 1. The satisfaction percentages of patients for Group 2 were higher than Group 1. In addition to glenohumeral intra-articular steroid injection and suprascapular nerve block, pulse radiofrequency application to the suprascapular nerve provides additional benefits in terms of NRS scores, duration of pain relief, and patient satisfaction.

A comparative study of ultrasound-guided serratus anterior plane block with pectoral nerve block type II in breast surgeries

Background: The use of ultrasonography (USG) to identify fascial layers has led to the development of several newer interfascial techniques for analgesia of the chest and abdominal wall. Two such modalities are the Pectoral nerve block (PEC) and Serratus Anterior Plane (SAP) block. Objective: To compare the duration and quality of analgesia provided by ultrasound-guided SAP block with PEC block II in patients undergoing breast surgeries after induction of general anesthesia. Design: Randomized, double-blinded, prospective study. Methods: Sixty female patients were divided into two groups of 30 each. Patients in Group P received USG guided PEC II block, whereas patients in Group S received USG-guided SAP block after induction. Outcome Measure: The primary objective was to compare the duration of pain relief, whereas the secondary objectives were to compare the degree of pain relief, postoperative analgesic requirement within 24 h after the completion of the surgery, patient satisfaction score and complications if any. Results: The mean time of the first dose of analgesic given was 826 ± 405.24 min. in Group P and 1280 ± 264.29 min. in Group S (P < 0.001). The mean numeric rating scale score at rest at 6 h, on movement at 2 h and 6 h and satisfaction scores in Group P were significantly more than Group S. Conclusion: Ultrasound-guided SAP block provides better postoperative analgesia both in quality and duration over PEC II block.

Cooled-radiofrequency neurotomy for the treatment of chronic lumbar facet (zygapophyseal) joint pain: A retrospective study.

Cooled-radiofrequency (CRFA) is a newer technique and may have some theoretical advantages over traditional radiofrequency ablation (TRFA). In this study, we aimed to investigate the efficacy and safety of CRFA for the treatment of lumbar facet joint-mediated pain. In this retrospective study, we evaluated 185 CRFA performed on 105 patients. All patients with axial lower back who received the preliminary diagnosis of lumbar facet joint-mediated pain and refractory to conservative therapy underwent diagnostic medial branch blocks. CRFA was recommended to those patients who responded favorably to two sets of diagnostic medial branch blocks. Pain scores in numeric rating scale (NRS) were recorded pre-treatment and post-treatment at different time-points. The primary outcome measure was to report descriptive NRS score and average % improvement from baseline at each time point. A significant pain relief was determined by a decrease of ≥50% of mean NRS. Secondary outcome measure was the time to repeat treatment with subsequent CRFA. Adverse events were also recorded.Primary outcome measure determined as the improvement in NRS, for at least 50% or more, was achieved in both 1st (4–8 weeks) and 2nd (>2–6 months) follow-up (FU) with 60.5% and 53.6% reduction in NRS respectively. Our subgroup analysis comparing the younger (<50) and older (≥50) age groups showed superior pain relief with CRFA in the older (≥50) age group, both in the 1st (4–8 weeks) and 2nd (>2–6 months) FU time points (63.4% and 58.4% reduction in NRS, respectively). Cooled-radiofrequency ablation is an effective and safe procedure for the treatment of chronic lumbar facet joint related pain. The duration of pain relief was comparable to traditional radiofrequency ablation as reported in the literature.

A Comparative Perspective Study between Intrathecal Midazolam &amp; Nalbuphine as an adjuvant with Hyperbaric Bupivacaine for Post-Operative Analgesia in Total Abdominal Hysterectomy

Background: Subarachnoid block is the preferred form of regional anesthesia for obstetric surgeries. Local anesthetic agents alone are insufficient in providing adequate postoperative analgesia, which is an essential factor for the patients &amp; is the sole essence of anesthesia. Adding adjuvant will result in better quality, the efficacy of SAB &amp; will prolong analgesia postoperatively. Due to minimal hemodynamic &amp; respiratory complications, Nalbuphine, an opioid, can be favored as an adjuvant to subarachnoid block. The addition of Nalbuphine in limiting doses to Hyperbaric Bupivacaine offers improved block quality &amp; adequate pre &amp; post-operative analgesia. Midazolam, an imidazobenzodiazepine given intrathecally, raises the threshold of pain; it also has hypnotic, anticonvulsant, muscle relaxant &amp; amnesic effects of other benzodiazepines.&#x0D; Objectives: Primarily to compare the duration of pain relief in the postoperative period between administration of Intrathecal Nalbuphine (1mg) &amp; Midazolam(2.5mg) ( Timing of 1st rescue analgesia). Secondarily to compare the onset of action &amp; duration of motor &amp; sensory block (Modified Bromage Scale), Effect on Hemodynamic Parameters, 24 hours requirement of analgesic (No. of Injection Paracetamol 15-20mg/kg ), Degree of sedation(Modified Ramsay Sedation Scale) &amp; After-effects(PONV, Pruritis, Shivering &amp; Retention of urine).&#x0D; Methodology: The study type will be a Comparative Prospective Study on 60 ASA 1 &amp; 2 females in the age group 35-75 years, planned for total abdominal hysterectomy will be separated in two equivalent Group M (n=30) &amp; Group N (n=30). Group M will receive combination Midazolam preservative-free 0.5 ml (2.5 mg) with 0.5% Hyperbaric Bupivacaine 2.5 ml(12.5 mg), &amp; Group N will receive combination Nalbuphine 1 ml (1 mg) with Hyperbaric Bupivacaine (0.5%) 2.5 ml (12.5mg) by Intrathecal Route. Analgesia duration in the postoperative period, the onset of action &amp; duration of motor &amp; sensory block, effect on hemodynamic parameters, 24 hours analgesics requirement, degree of sedation, after-effects, if any, will be studied &amp; compared.&#x0D; Conclusion: Expected to prove the hypothesis that adding which of the following adjuvant 1mg Nalbuphine or 2.5mg Midazolam with 0.5% Hyperbaric Bupivacaine intrathecally given in SAB prolongs the postoperative analgesia duration more as compared to other.

Comparative Randomised Study between Bupivacaine with Clonidine and Ropivacaine with Clonidine Used Caudally for Postopertaive Analgesia in Paediatric Hypospadias Surgery

Background: This study was conducted to compare and evaluate the caudal epidural clonidine when mixed with ropivacaine and bupivacaine in prolonging postoperative analgesia in children of Indian genotype undergoing hypospadias surgery, as well as compare the intraoperative haemodynamics using caudal bupivacaine with clonidine vs ropivacaine with clonidine. The study was also aimed at studying the side effects and the duration of post-operative pain relief of bupivacaine with clonidine v/s ropivacaine with clonidine.&#x0D; Methods: This is a prospective randomised comparative study that was carried out in the Department of Anaesthesiology, KEM Hospital, Pune, over 12 months (from October 2016 to September 2017), among 56 children having an ASA Grade of II, aged between 1 to 8 years admitted for hypospadias surgery. The data gathered was cleaned using Microsoft Excel, before statistical analysis was done.&#x0D; Results: It was observed that caudal epidural analgesic duration was more in the bupivacaine clonidine group than in the ropivacaine clonidine group. The sedation score was higher at the second hour in the bupivacaine clonidine group. The HR and mean arterial pressure values were found to be notably higher in the ropivacaine clonidine group than those in the bupivacaine clonidine group. Intraoperatively and postoperatively, there was a decrease in pulse rate and MAP but at no time did the value reach the criteria for intervention. Other side effects like postoperative vomiting, nausea, motor blockade, respiratory distress not observed in any group.&#x0D; Conclusion: Bupivacaine 0.25 % 0.5 ml per kg with clonidine 1 microgram / kg via caudal route increased the duration of postoperative analgesia with no adverse effects as compared to ropivacaine 0.25 % with clonidine 1 microgram/ kg. Hence clonidine is more efficient in increasing postoperative analgesia when added with Bupivacaine as compared to ropivacaine in Indian genotype in hypospadias surgery.

The impact of adherence to a guideline for minimizing opioid use for treatment of pain in an urban emergency department.

The opioid epidemic has significantly evolved over the last three decades. The initiation and continuation of prescription opioids for pain control were one of the primary contributors, across different medical settings. The emergency department (ED) is typically the first place patients go to for management of acute pain, and often where opioid naïve patients first become exposed to opioids. In 2018, the ED of University Hospital located in Newark, NJ implemented a pain guideline to ensure that patients are not unnecessarily exposed to opioids. The goal of our study was to determine whether provider adherence was successful in reducing opioid administration. We conducted a retrospective review of pharmacy records of patients treated for pain in the ED within the time frame January 1, 2017 and December 31, 2019. We analyzed the change in our practice by comparing the amount of opioid and non-opioid medications administered and the number of patients administered each type, as well as the change in our utilization of specific medications. The t-test or the χ2 test were used as applicable. There were decreases in the mean number of opioid doses administered in 2017 (1273) compared to 2019 (498; p = 0.027). There was an increase in non-opioid analgesics administered, (mean 2017: 1817, mean 2019: 2432.5, p = 0.018). There was also an increase in the proportion of patients given non-opioid analgesics (mean 2017: 22%, mean 2019: 28%, p < 0.0001). There were increases in administrations of acetaminophen (40% to 52%) and ibuprofen (30% to 35.1%), and decreases in administrations of hydromorphone (2.5% to 0.03%), morphine (11.5% to 5.6%), oxycodone (10.6% to 5.3%), and tramadol (5.7% to 1.9%) (all p < 0.0001). A guideline that emphasizes the use of non-opioid analgesics first line treatment for acute pain can be effective for reducing opioid administration in the ED. Through the use of our guideline, we reduced the number of patients who have received opioid analgesics and, at the same time, increased non-opioid analgesic administration. Future studies should explore readmission rates, duration of pain relief in patients managed with non-opioid versus opioid analgesics, and perception of relief through the use of satisfaction scores.

Phase II Multi-Institutional Study of Low-Dose (2 Gy x 2) Palliative Radiotherapy for Symptomatic Bone Metastases From Multiple Myeloma

<h3>Purpose/Objective(s)</h3> Painful osteolytic bone lesions are common in patients with multiple myeloma (MM). Radiotherapy (RT) is effective in providing pain relief from MM bone lesions in over 80% of patients. There is no consensus as to the most effective dose or fractionation for palliation. Shorter courses of RT are not only more convenient for patients and their families, but they also have less impact on timing of systemic therapies. There is precedent for using 2 Gy x 2 for palliation of lymphomas, which have similar radiosensitivity to myeloma. The primary objective is to determine whether treatment with 2 Gy x 2 to painful myeloma bone lesions achieves patient-reported pain reduction comparable to historical controls at 4 weeks. Secondary objectives will assess QOL endpoints, use of analgesia and time to pain relief, and duration of pain relief. <h3>Materials/Methods</h3> Patients who consent to participation will complete quality of life and pain questionnaires (Brief Pain Index, EORTC QLQ-BM22, and EORTC QLQ-C30) prior to treatment and at 2,4,8 weeks and 6 months following treatment. Pain response, as defined by the international consensus on palliative RT for bone metastases, will be measured based on BPI and daily oral morphine equivalent. Reirradiation at standard dose can be considered at ≥4 weeks following initial treatment for indeterminate pain response or pain progression. Cytogenetics and International Myeloma Working Group risk stratification and response criteria are recorded, when available, but are not required for patient participation. <h3>Results</h3> This trial, supported by ILROG, has opened at 7 institutions with one more in process of opening. Prior to COVID, accrual was 1.5 patients per month. Since COVID, enrollment has been at 0.7 patients per month. A total of 18 patients have been accrued. The median age of patients accrued is 65.5 years with 7/18 female patients. Fourteen patients are Caucasian. Twelve patients have an ECOG performance score of 1-2. Thirteen patients had pain response captured at 4 weeks following RT. Of the 5 patients that did not complete questionnaires at 4 weeks post-RT, 2 expired, 1 was lost to follow-up, 1 had a missed evaluation and 1 had pain progression). The most common site of treatment was the shoulder (4/18). <h3>Conclusion</h3> This ongoing prospective trial in palliation of multiple myeloma bone lesions is feasible and able to accrue at multiple institutions and will provide valuable information as to the role of low-dose RT in this population.

Endoscopic ultrasonography-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer: An update.

Pancreatic cancer produces disabling abdominal pain, and the pain medical management for pancreatic cancer is often challenging because it mainly relies on the use of narcotics (major opioids). However, opioids often provide suboptimal pain relief, and the use of opioids can lead to patient tolerance and several side effects that considerably reduce the quality of life of pancreatic cancer patients. Endosonography-guided celiac plexus neurolysis (EUS-CPN) is an alternative for pain control in patients with nonsurgical pancreatic cancer; EUS-CPN consists of the injection of alcohol and a local anesthetic into the area of the celiac plexus to achieve chemical ablation of the nerve tissue. EUS-CPN via the transgastric approach is a safer and more accessible technique than the percutaneous approach. We have reviewed most of the studies that evaluate the efficacy of EUS-CPN and that have compared the different approaches that have been performed by endosonographers. The efficacy of EUS-CPN varies from 50% to 94% in the different studies, and EUS-CPN has a pain relief duration of 4–8 wk. Several factors are involved in its efficacy, such as the onset of pain, previous use of chemotherapy, presence of metastatic disease, EUS-CPN technique, type of needle or neurolytic agent used, etc. According to this review, injection into the ganglia may be the best technique, and a good visualization of the ganglia is the best predictor for a good EUS-CPN response, although more studies are needed. However, any of the 4 different techniques could be used to perform EUS-CPN effectively with no differences in terms of complications between the techniques, but more studies are needed. The effect of EUS-CPN on pain improvement, patient survival and patient quality of life should be evaluated in well-designed randomized clinical trials. Further research also needs to be performed to clarify the best time frame in performing a EUS-CPN.

Dexmedetomidine Added to Ropivacaine for Ultrasound-guided Erector Spinae Plane Block Prolongs Analgesia Duration and Reduces Perioperative Opioid Consumption After Thoracotomy: A Randomized, Controlled Clinical Study.

Objectives:Single-injection erector spinae plane block (ESPB) provides good control of pain relief after open thoracotomy surgeries. However, the duration of pain relief does not last long. For this purpose, we hypothesized that adding α2-adrenoceptor agonist, dexmedetomidine, for interfascial nerve blockade may increase the duration of analgesia. There are only few studies using dexmedetomidine for interfasical nerve blocks in humans. In this study, our aim is to investigate whether addition of dexmedetomidine to ropivacaine for ESPB could effectively prolong the duration of postoperative analgesia and reduce opioid consumption after open thoracotomy.Materials and Methods:Sixty patients with esophageal cancer were randomized to receive ESPB using 28 mL of 0.5% ropivacaine, with 2 mL of normal saline (group R) or 0.5 µg/kg dexmedetomidine in 2 mL (group RD) administered interfascially. ESPB was performed at the fifth thoracic level under ultrasound guidance. The primary outcome was the duration of analgesia. The secondary outcomes were total postoperative sufentanil consumption, Numeric Rating Scale pain scores, Ramsay Sedation Scale scores and adverse effects.Results:The duration of analgesia in group RD (505.1±113.9) was longer than that in group R (323.2±75.4) (P<0.001). The total postoperative sufentanil consumption was lower in group RD (23.3±10.0) than in group R (33.8±13.8) (P=0.001). There was no significant difference in the incidence of adverse effects between the 2 groups.Conclusion:After open thoracotomy, addition of dexmedetomidine to ropivacaine for ESPB effectively prolonged the duration of postoperative analgesia and reduced opioid consumption without increasing additional incidence of adverse effects.

Оцінка ефективності лікування кишкової форми аскаридозу в дітей

Актуальність. Паразитарні захворювання і в XXI столітті залишаються одним із найбільш частих видів патології і є медико­соціальною проблемою. З числа виявлених гельмінтозів 90 % випадків реєструються в дитячого населення. Найбільш часто зустрічається аскаридоз та ентеробіоз. Важливим є комплексний підхід до корекції порушень, викликаних як прийомом антигельмінтних препаратів, так і присутністю гельмінтів в організмі. Мета: оцінити ефективність комплексного лікування кишкового аскаридозу в дітей. Матеріали та методи. В основу роботи покладено результати обстеження 178 дітей віком від 3 до 18 років із кишковою формою аскаридозу. Діагностика аскаридозу здійснювалася за допомогою копрологічного дослідження та методу концентрування Parasep. Із обстежених дітей було сформовано дві групи: I група (n = 99) отримувала альбендазол (200–400 мг на добу) в комплексній терапії аскаридозу (антигістамінний препарат, сорбент, пробіотик), II група (n = 80), окрім стандартної схеми, отримувала додатково препарат Ворміл Фіто. Результати. Середня тривалість купірування больового синдрому в дітей групи порівняння становила 3,6 ± 0,2 дня, основної групи — 2,6 ± 0,9 дня, p &lt; 0,001. Прояви диспептичного синдрому нівелювались упродовж 5,3 ± 0,3 дня у дітей групи порівняння та 4,3 ± 0,2 дня — у дітей основної групи, p &lt; 0,01. Ознаки астеновегетативного синдрому в дітей групи порівняння зникали на 8­му — 10­ту добу, у той час як у дітей основної групи — на 6­ту — 7­му добу. Застосування комплексного лікування дітей дозволило скоротити на 27,8 % термін купірування больового, на 14,0 % — диспептичного та на 25,0 % — астеновегетативного синдромів. Клінічне одужання у дітей, пролікованих запропонованим методом, відбувалося швидше, у середньому в 1,8 раза, порівняно з методом лікування з використанням тільки альбендазолу (Вормілу). Паразитологічна ефективність запропонованого методу становить 95 %, тоді як застосування тільки альбендазолу (Вормілу) — 89,8 %. Висновки. Додавання фітокомплексу Ворміл Фіто до схеми лікування хворих із аскаридозом прискорює одужання, швидко покращує їх самопочуття, забезпечує високий показник клінічної та паразитарної ефективності.

Landmark-guided Injections for Treatment of Sacroiliac Joint Pain

<h3>Research Objectives</h3> To investigate patients' degree and duration of pain relief from landmark-guided injections without fluoroscopy or image-guidance for the treatment of sacroiliac joint (SIJ) pain. <h3>Design</h3> A retrospective cohort study was conducted to examine patients' degree and duration of SIJ pain relief from landmark-guided injections. Patients' self-reported measures to the provider's common follow-up questions were assessed in the electronic medical record from their follow-up visits. <h3>Setting</h3> An out-patient orthopedic spine surgery clinic. <h3>Participants</h3> 311 patients identified as having SIJ pain that received at least one landmark-guided injection were reviewed. Four patients with a history of image-guided or fluoroscopy-guided SIJ injections were excluded. <h3>Interventions</h3> The SIJ was palpated and a landmark-guided, periarticular injection consisting of an anesthetic agent and corticosteroid was administered with a 22-gauge needle without image or fluoroscopy guidance. The patient was prepped using an aseptic technique and ethyl chloride. <h3>Main Outcome Measures</h3> The primary outcomes included the duration of relief recorded in weeks and the degree of relief recorded as a percentage. Secondary outcomes included reported adverse side effects. Covariates of interest including age, smoking status, BMI, reason for pain onset, and sex were collected for further comparative analysis. <h3>Results</h3> Of these 311 patients included in this review, 191 patients returned for follow-ups with reports of duration and degree of pain relief. The average length of relief reported was 8.88 weeks. The average percent relief reported was 53.55%. Reported adverse side effects included: increased low back pain, an irregular menstrual cycle, and vaginal bleeding unrelated to menstruation. No other adverse side effects were reported. No comparisons between outcomes and covariates were statistically significant. <h3>Conclusions</h3> Landmark-guided SIJ injections are a reasonable and safe treatment option for SIJ pain, as our patient population had on average greater than 50% sustained relief for over 2 months. This treatment option is a more affordable and accessible option that can be done quickly in the clinic as compared to the gold-standard approach of fluoroscopically-guided SIJ Injections. A prospective, controlled study of the efficacy of these injections is underway at our institution. Other future research should investigate patients' degree and length of relief from subsequent landmark-guided injections. <h3>Author(s) Disclosures</h3> No conflicts to report.

Postoperative Pain Management: Efficacy of Caudal Tramadol in Pediatric Lower Abdominal Surgery: A Randomized Clinical Study.

BackgroundOne of the methods of pain control after pediatric surgical procedures is regional techniques, including caudal block, despite their limitations.ObjectivesIn this study, the pain score and complications of caudal tramadol were evaluated in pediatrics following lower abdominal surgery.MethodsIn this study, 46 children aged 3 to 10 years were allocated into two equal groups (R and TR) for performing caudal analgesia after lower abdominal surgery. The injectate contained 0.2% ropivacaine 1 mL/kg in the R group (control group) and tramadol (2 mg/kg) and ropivacaine in the TR group. The pain score, duration of pain relief, amount of paracetamol consumption, hemodynamic alterations, and possible complications at specific times (1, 2, and 6 hours) were evaluated in both groups.ResultsNo considerable difference was observed in the pain score between the groups in the first and second hours (P > 0.05). However, in the sixth hour, the TR group had a significantly lower pain score than the R group (P < 0.05). Compared to the R group, the TR group had a longer period of analgesia and lower consumption of analgesic drugs (P < 0.05). Heart rate and blood pressure differences were not significant between the two groups (P > 0.05). Similarly, the duration of operation and recovery time were not remarkably different between the two groups (P > 0.05). Complications had no apparent differences between these two groups, as well (P > 0.05).ConclusionsIn this study, the addition of tramadol to caudal ropivacaine in pediatric lower abdominal surgery promoted pain relief without complications.

Women’s Length of Stay in a Danish Specialized Unit for Perinatally Bereaved Parents

ObjectiveTo describe the clinical characteristics of women admitted to a specialized unit for bereaved parents and to identify the characteristics of women who stayed more than 2 days. DesignA population-based descriptive study. SettingA midwifery-led specialized unit for bereaved parents at Aarhus University Hospital, Denmark. ParticipantsWomen with miscarriage (>14 weeks), missed abortion (>14 weeks), termination of pregnancy (>14 weeks), stillbirth, or death of their neonate during the first 48 hours after birth. MethodsWe collected information from the electronic health care records for women admitted to the unit from January 2012 through December 2018, including parity, type of loss, gestational age, mode and duration of birth, pain relief, and duration of stay. ResultsFrom January 1, 2012. to December 31, 2018, 579 women were admitted to the unit. Hospitalization varied from 1 day to 1 week. More women with a loss after 22 gestational weeks stayed for more than 2 days. In multivariate analyses, the hazard ratio (HR) of staying longer than 2 days was 1.3 times greater for primiparous women than for multiparous women (HR = 1.3, 95% confidence interval [1.0, 1.7]) and 2.4 times greater for women with near-term loss compared to women with perinatal loss before gestational week 22 (HR = 2.4, 95% confidence interval [1.7, 3.6]). ConclusionProviding unlimited stay at a specialized unit for perinatal loss resulted in variation in length of stay. Primiparous women and women who lost neonates or fetuses closer to term gestation were more likely to stay in the unit for up to 8 days. This may indicate a need for individual support not available in standard care.

Sensory Stimulation Threshold: A Viable Tool to Improve the Outcome of Lumbar Facet Radiofrequency Denervation?

BackgroundSensory stimulation threshold (SST) has been used as a surrogate marker to target a nerve branch for radiofrequency (RF) denervation; however, the validity of SST as a prognostic marker is still under debate.ObjectiveTo assess whether lower SST values correlate with better outcomes of radiofrequency denervation for facetogenic low back pain.DesignProspective cohort study.PatientsSixty-seven patients who underwent radiofrequency denervation for low back pain.MethodsCorrelations, between the average percentage of pain relief from diagnostic medial branch block (MBB) and RF denervation procedure outcome, and between SST and RF denervation procedure outcome, were analyzed using Spearman correlation coefficient (rs). Wilcoxon rank sum test was performed to assess whether magnitude and duration of pain relief following RF denervation differed by the levels of SST (<0.5 and ≥0.5) or pain relief (<80% and ≥80%) from diagnostic MBB.ResultsThere was a positive correlation between pain relief after diagnostic MBB and pain relief 2 weeks after denervation (rs 0.31, 95% CI 0.08 to 0.51, p < 0.01), but not between pain relief after MBB and pain relief 6 months after denervation, nor pain relief duration after denervation. There was a negative correlation between SST and pain relief 6 months after denervation (rs −0.41, 95% CI −0.59 to −0.18, p < 0.001). There was also a negative correlation between SST and pain relief duration after denervation (rs −0.33, 95% CI −0.53 to −0.09, p < 0.01).ConclusionSST is a viable measurement with which to guide needle placement during RF denervation for lumbar facet pain, and enhances pain relief outcomes.

Retrospective Study of the Analgesic Effect of Sacroiliac Joint Radiofrequency Denervation

Interventional radiofrequency (RF) ablation techniques are indicated when an adequate effect is not obtained with conservative measures. The primary objective of this study was to evaluate pain relief after RF denervation of the sacroiliac joint. The secondary objective was to evaluate pain intensity and relief duration. The study was retrospective. The study was conducted at Vera Cruz Hospital, Campinas, Brazil. Data were collected from the medical records of patients undergoing RF denervation for low back pain originating in the sacroiliac joint, from January 2015 to December 2017. There were 78 patients studied, between 18 and 65 years old, of both genders, ASA I or II, who underwent knee arthroscopic meniscectomy. The patients were submitted to denervation of sacroiliac joint by 3 types of RF (conventional, pulsed, and cooled). The following parameters were evaluated, number of patients who obtained ? 50% pain relief; pain intensity, measured using the visual analog scale (before the procedure and 15, 30, 90 and 180 days after, performed by the same evaluator); and the use of complementary analgesic for 2 weeks. Of the 78 included patients, 56 (71.8%) underwent conventional RF, 9 (11.5%) underwent pulsed RF, and 13 (16.7%) underwent cooled RF. There were losses to follow-up including 40 patients who underwent conventional RF, 5 who underwent pulsed RF, and 12 who underwent cooled RF, who were retained for 6 months. There was significant pain relief with the three types of RF for up to 6 months of follow-up, with no difference among the types. After 6 months, 90.2% of patients who underwent conventional RF, 100% who underwent pulsed RF, and 91.7% who underwent cooled RF maintained ≥ 50% pain relief. Complementary analgesics were used by 95% of the patients who underwent conventional RF, 80% who underwent pulsed RF, and 91% who underwent cooled RF 2 weeks after the procedure. There were mild adverse effects, such as edema, hematoma, and local pain, without complications. As for limitations, the number of pulsed and cooled RF is low and in a retrospective study some data may be missing, especially from follow-up. RF denervation of the sacroiliac joint is effective and promotes a long-lasting analgesic effect.

Fundaments of Thermal Analgesia in Humans: Exploring New Methods of Pain Relief

Heat is often used for pain relief but basic information related to the potential mechanisms are not well understood in humans. This manuscripts reviews clinical studies of heat induced pain relief in humans, analyses basic laboratory studies, and offers possible mechanisms of action based on these animal findings particularly as related to TRPV1 channels. Many of the laboratory studies done on TRPV1 channels likely have strong correlations in humans. Recent human studies are discussed that provide insights on onset of action, duration of pain relief, and relationship of thermal energy delivered to analgesic effect with correlation to these laboratory findings. The term analgesic nociceptive boundary is offered to describe the amount of thermal energy needed to cause maximal pain relief while not causing nociception or tissue damage. This boundary provides a framework for future clinical development.

Vertebral Augmentation of Cancer-Related Spinal Compression Fractures: A Systematic Review and Meta-Analysis.

Systematic review and meta-analysis. To compare the magnitude and duration of pain relief with vertebral augmentation to any other therapy for the treatment of cancer-related vertebral compression fractures through meta-analysis of randomized controlled trials. Derived from search on PubMed, EMBASE, CINAHL, Scopus, Central, Scopus, and Web of Science databases in May 2020. Studies selected were limited to randomized controlled trials comparing vertebral augmentation, either Balloon Kyphoplasty or Percutaneous Vertebroplasty (PVP) with or without additional therapy to any other intervention or placebo/sham. The methodological quality of each included study was assessed according to the Cochrane Collaboration's domain-based framework. Random effects model, Q test, and I2 statistics were implemented. Of 180 records identified, 7 were considered relevant, and included 476 participants. The risk of bias was considered "Low" in all studies. In five of the studies, vertebral augmentation alone (either PVP or Balloon Kyphoplasty) comprised one group, while comparative treatments included nonsurgical management, Kiva implantation, PVP and radiofrequency therapy, PVP and chemotherapy, PVP and intrasomatic injection of steroid, and PVP with 125I seeds. Two studies compared PVP with an additional therapy against the standard of care. With regard to changes in pain severity, the effect sizes varied from 0.0 (95% -1.7 to 1.7) to -5.1 (95% -5.3 to -4.9). Most studies demonstrated a positive and statistically significant effect associated with PVP. Four of the seven studies demonstrated a clinically significant effect as well. Other than cement leakage, with an event rate of 0.24 (95% CI 0.11-0.44) or 24% (95% CI 11%-44%), there were no major adverse events consistently observed across multiple studies. The included randomized controlled trials demonstrated an overall positive and statistically significant effect of vertebral augmentation surgeries, such as vertebroplasty and kyphoplasty, for the treatment of cancer-related vertebral compression fractures, especially when compared with nonsurgical management, radiofrequency ablation, or chemotherapy alone.Level of Evidence: 1.

Traditional Korean Medicine as Collaborating Treatments with Conventional Treatments for Knee Osteoarthritis: A Protocol for a Systematic Review and Meta-Analysis.

BackgroundKnee osteoarthritis (OA) is a degenerative disease of the joint cartilage with no definite treatment in the early stage. Several previous review studies have shown that alternative medical treatments, including acupuncture, moxibustion, and herbal medicines, are effective in improving the symptoms of the disease and the patient’s quality of life. However, no systematic review study has shown the effectiveness of the combination of conventional and alternative therapies. Therefore, the aim of our study is to determine the most effective combination therapies and to provide evidence for the effectiveness and safety of integrated therapies. This article describes the protocol for the methods that will be applied in our systematic review.MethodsWe will conduct an electronic search of nine databases: PubMed, Embase, Cochrane, Google Scholar (first 100 articles), four Korean databases (KoreaMed, Korean Studies Information Service System, Research Information Service System, and Oriental Medicine Advanced Searching Integrated System), and one Chinese database (China National Knowledge Infrastructure). Only randomized controlled studies that reported on both conventional treatment (drugs and hyaluronic acid) and traditional Korean medicine (acupuncture, moxibustion, and herbal medicines) will be selected. The primary outcomes will be pain and function of the joint. The secondary outcomes will include pain relief duration, total effective rate, incidence of adverse events, and quality of life. We will assess the methodological quality of the included studies using the Cochrane risk of bias tool. For the meta-analysis, standardized mean differences and risk ratios with 95% confidence intervals will be applied for continuous and dichotomous data, respectively.ResultsThis review will evaluate the effectiveness and safety of several Korean medicine treatments combined with conventional treatments for knee OA.ConclusionOur review will provide a good foundation for the integrative treatment of knee OA.