Good Pain Control Research Articles

Bupivacaine/Dexmedetomidine versus Bupivacaine Alone in Caudal Block for Toddlers Undergoing Unilateral Open Inguinal Hernia Repair

Abstract Background Unilateral open inguinal hernia repair surgeries are one of the most frequently performed operations in the pediatric population. Regional anesthetic techniques are commonly used for better control of pain in pediatrics. the most widely used technique of regional anaesthesia in pediatrics is the caudal block. Objective To evaluate the analgesic and sedative effect of dexmedetomedine when given caudally as an adjuvant to bupivacaine in caudal block vs bupivacaine alone in toddlers undergoing unilateral Open inguinal hernia repair surgeries. Patients and Methods The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups; each group consisted of 25 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Results The result of the study reveals that the addition of dexmedetomedine at 1μg/kg to bupivacaine 0.25% in caudal blocks can effectively prolong the duration of postoperative analgesia and causes better sedation than using bupivacaine alone in caudal blocks at similar doses in pediatrics. Conclusion From our study we can conclude that the addition of dexmedetomedine at 1μg/kg to bupivacaine 0.25% in caudal blocks can effectively prolong the duration of postoperative analgesia and causes better sedation in the toddlers undergoing unilateral open inguinal hernia repair surgeries. It is better than using bupivacaine alone in caudal blocks at similar doses.

Decoding the Decade: Exploring the Efficacy of Platelet-Rich Plasma (PRP) in Complex Wound Management - A Comprehensive Study.

Autologous platelet-rich plasma (PRP) therapy has emerged as a promising regenerative treatment modality, offering potential improvements in healing outcomes through its rich content of growth factors and cytokines. We evaluated the effectiveness of PRP therapy in the management of complex wounds, using a decade-long retrospective analysis of treatments conducted at a tertiary care center from 2010 to 2020. The study introduces and assesses the efficacy of the Sandeep's Technique for Assisted Regeneration of Skin (STARS) in enhancing wound healing and quality of life for patients with complex wounds. A prospective interventional study was conducted, involving two phases: the development and initial testing of PRP therapy (2010-2015) and the application and evaluation of the STARS protocol (2015-2020). The study included patients with complex wounds, utilizing autologous PRP prepared through a double spin centrifuge technique. Outcome measures included wound-healing rates, infection management, and complication rates, compared to conventional treatment methods. The study treated 500 wounds in 432 patients with autologous PRP, noting significant improvements in wound-healing rates, 97.7% had infection control without antibiotics (even in MRSA cases), and all had a good pain control. Histopathological examinations confirmed collagen-rich healing with minimal scarring. The STARS protocol demonstrated the potential of PRP therapy in accelerating wound healing, reducing the need for additional surgical interventions, and enhancing patient outcomes. PRP therapy, particularly when administered following the STARS protocol, represents a safe, effective, and patient-friendly approach for the management of complex wounds. This study supports the integration of PRP therapy into regenerative care strategies, suggesting a shift toward more innovative and efficacious treatments in wound management.

Long-Term Patient-Reported Outcomes following Proximal Row Carpectomy.

Background Proximal row carpectomy (PRC) is a procedure used for pain relief from arthrosis that preserves some degree of range of motion (ROM). Dorsal capsular interposition (DCI) is an option for cases where some chondral loss of the capitate is present. Purposes The aim of this study is to assess what factors influence long-term patient-reported outcomes following PRC and specifically to evaluate the role of DCI. Additionally, this study aims to report the long-term postoperative ROM in patients with DCI. Methods Patients who underwent PRC in the period between 2002 and 2017 were retrospectively identified, resulting in a cohort of 162 patients. Patient-reported outcomes were obtained using validated questionnaires and were completed by 59 patients at a median follow-up time of 8.5 years (interquartile range [IQR]: 6.0-13). Multivariable linear regression was performed to identify factors independently associated with patient-reported outcomes. Results The median PRWE (Patient-Rated Wrist Evaluation) score was 17 (IQR: 5.5-52), the median QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) score was 16 (IQR: 4.5-39), and the median NRS (Numeric Rating Scale) Pain score was 1 (IQR: 0-3). The mean flexion-extension ROM was 70 ± 24 degrees. After correcting for gender, involvement of the capitate cartilage was independently associated with worse QuickDASH scores. Conclusions PRC is associated with good functional outcomes and pain control at long-term follow-up. This generally also applied to patients who underwent DCI; however, the role of DCI in those with capitate cartilage injury remains unclear. Preexistent damage to the capitate cartilage was associated with worse QuickDASH scores. Level of Evidence II, Prognostic study.

The Superficial Cervical Plexus Block with the Auriculotemporal Nerve Block for Breaking the Refractory Pain Cycle of Malignant Otitis Externa and Skull Base Meningitis

Abstract Pain can be a severe and distressing symptom in conditions such as malignant otitis externa (MOE) with the associated skull base meningitis and even more following the debridement surgeries done for the same. It can be refractory to conventional therapies, including weak opioids, nonsteroidal anti-inflammatory drugs, and antineuropathic medications. Breaking this cycle of pain is very important in such cases to achieve good pain control and treat the psychological distress of the patient. Since there is a lack of literature for achieving satisfactory pain control in such cases, we successfully adopted a novel approach to break the pain cycle by employing the superficial cervical plexus block and auriculotemporal nerve (ATN) nerve block as the area of pain was in the distribution of these two nerves.

Phantom Limb Pain Improvement Post Right Lower Extremity Amputation With a Liner-type Prosthesis and Pharmacotherapy Combination: A Case Report

BACKGROUND: Phantom limb pain is pain in a missing limb postamputation. There is no sufficient evidence for an effective drug therapy, even though various treatment methods have been tried. Apart from drug therapy, mirror therapy, proprioceptive training, and virtual reality, as well as rehabilitation with appropriate orthotics have been tried. Liner-type prostheses use a silicone liner to reduce shear forces between the skin and the orthosis and to maintain suspension function, thereby relieving pain and improving comfort and functionality for the user. CASE REPORT: A 65-year-old man underwent amputation of his right thigh. On the 10th postoperative day, he complained of phantom limb pain centered on the amputation site. Pregabalin was started but did not alleviate his symptoms. After consultation with a physical therapist, the patient began using a liner prosthesis on the 33rd postoperative day. Symptoms gradually lessened, and positive comments were heard from the patient. Pregabalin and duloxetine were administered for a time but were soon reduced. Due to good pain control, the patient was discharged on the 46th postoperative day. After discharge from the hospital, the patient was able to continue treatment as an outpatient without his symptoms worsening, using a liner prosthesis as needed. CONCLUSION: Right thigh amputation is a very physically and emotionally taxing operation for the patient. Phantom limb pain is a difficult symptom to manage, but it must be adequately controlled for the patient. We have achieved phantom limb pain improvement with a combination of pharmacotherapy and a liner prosthesis. We feel a great need for close collaboration with other professions and for a nonpharmacologic approach in addition to pharmacotherapy. KEY WORDS: Phantom limb pain, amputation, pregabalin, duloxetine, liner type prosthesis

Fluoroscopic Guided Lumbar Erector Spinae (ESP) Field Blocks: A New Technique and Radiographic Analysis

IntroductionLumbar Erector Spinae (ESP) field blocks have become a common postoperative treatment for surgical pain. The use of long-acting medications like liposomal bupivacaine (Exparel) has become a major component of multi-modal postsurgical pain control. Traditionally ESP injections have been performed using ultrasound (U/S) guidance by an anesthesiologist. Spine surgeons have begun to utilize these liposomal injections in their procedures for post-operative pain management. Our study describes a fluoroscopic guided ESP field block technique which provides reproducible muscular coverage and pain control for spine surgery. Material and MethodsSixty patients undergoing single level lumbar fusion were treated preoperatively with bilateral fluoroscopically guided lumbar erector spinae ESP field blocks with liposomal bupivacaine. We looked at two different injection locations involving the ESP or multifidus muscle fascial planes. The injections contained Iohexal, which was used to evaluate the coverage area of the injection. The levels of coverage were recorded, and post-operative pain control was measured immediately, postoperatively, and at 24 hours. ResultsFluoroscopic field blocks at the L3-4 level were found to provide at least four levels of vertebral coverage rostral-caudally in both ESP and MF fascial planes. Pain was well controlled in both injection sites. ConclusionSurgeon-administered fluoroscopic guided ESP field blocks provided a reliable and consistent pattern of coverage with good postoperative pain control. This technique can be easily adopted by spine surgeons.

Pericapsular nerve group block and lateral femoral cutaneous nerve block versus fascia iliaca block for multimodal analgesia after total hip replacement surgery: A retrospective analysis.

Optimal pain control with limited muscle weakness is paramount for a swift initiation of physical therapy and early discharge. Fascia iliaca compartment block (FICB) has been recommended since it offers good pain control with a low risk of motor block. Pericapsular nerve group (PENG) block with lateral femoral cutaneous block (LFCN) has been proposed as an effective alternative to FICB that offers better pain control with a considerably lower risk of motor block. We aimed to compare the aforementioned blocks and determine which one yielded the lowest numeric rating scale (NRS) score. We designed a retrospective analysis of patients undergoing elective total hip arthroplasty. The primary outcome was the NRS score at 6, 12, and 24 hours. The secondary outcomes were total opioid consumption, time to first PRN opioid, and time to first postoperative ambulation. 52 patients were recruited, (13 PENG plus LFCN, 39 FICB). PENG plus LCFN resulted in a lower NRS at all three-time points (mean difference and 95%CI at 6 h 0.378 [-0.483; 1.240], at 12 h 0.336 [-0.378; 1.050], and at 24 h 0.464 [0.013; 0.914] P = 0.02). Moreover, less PRN opioids were requested in the PENG plus LCFN vs. FICB group (0 [0;7.5] vs 60 [15;80] milligrams of morphine equivalents, P = 0.001). No delay in the first ambulation or initiation of physical rehabilitation was reported in either group. PENG plus LCFN seems to offer better pain control and lead to less PRN opioids. Neither block hindered physical therapy nor ambulation. These results need to be confirmed with a larger prospective and randomized study.

Radiosurgical Decompression of Trigeminal Nerve and Its Correlation with Functional Outcome in Tumor-Related Trigeminal Neuralgia

BackgroundThe target selection during gammaknife radiosurgery(GKRS) in cases of tumor related trigeminal neuralgia(TRTGN) is always debatable. Here we discuss the correlation of regression of tumor size, degree of release of the nerve with long term pain control. MethodsTotal 50 cases of TRTGN were treated with GKRS (tumor was targeted) during the period March 2012 and March 2023. Post GKRS radiology was categorised in to three types(Type 1 – tumor volume remained same/reduced, additional segment of nerve not seen, Type 2 – tumor volume reduced, additional segment of trigeminal nerve seen but tumor still adherent to the nerve, Type 3 – tumor volume reduced, adjacent nerve seen completely separated from tumor). Pre and post GKRS pain score(BNI I to III –good, BNI IV&V – poor) was correlated with the above subgroups. ResultAt a median follow up of 46.5 months 18 cases have type 1, 23 showed type 2 and 9 showed type 3 radiological response. Ten(55.5%) patients with type 1, 15(65.21%) with type 2 and 7(77.8%) with type 3 responses had good pain control. The outcome among these three was not statistically significant(p=0.519).Five patients with type 3 radiological response were off medication which was statistically better than type 1 radiological response with three patients(p = 0.012) and type2 radiological response with two patients(p = 0.002). ConclusionPost GKRS tumor volume reduction may show good pain control in TRTGN. This further allows visualization of additional segment of nerve that can be targeted in the second session for treating recurrent or failed cases.

To evaluate the analgesic effectiveness of bilateral erector spinae plane block versus thoracic epidural analgesia in open cardiac surgeries approached through midline sternotomy

BackgroundThe efficacy of the erector spinae plane (ESP) block in mitigating postoperative pain has been shown for a range of thoracic and abdominal procedures. However, there is a paucity of literature investigating its impact on postoperative analgesia as well as its influence on weaning and subsequent recovery in comparison to thoracic epidural analgesia (TEA) in median sternotomy-based approach for open-cardiac surgeries and hence the study.MethodsIrrespective of gender or age, 74 adult patients scheduled to undergo open cardiac surgery were enrolled and randomly allocated into two groups: the Group TEA (thoracic epidural block) and the Group ESP (bilateral Erector Spinae Plane block). The following variables were analysed prospectively and compared among the groups with regard to pain control, as determined by the VAS Scale both at rest (VASR) and during spirometry (VASS), time to extubation, quantity and frequency of rescue analgesia delivered, day of first ambulation, length of stay in the intensive care unit (ICU), and any adverse cardiac events (ACE), respiratory events (ARE), or other events, if pertinent.ResultsClinical and demographic variables were similar in both groups. Both groups had overall good pain control, as determined by the VAS scale both at rest (VASR) and with spirometry (VASS) with Group ESP demonstrating superior pain regulation compared to Group TEA during the post-extubation period at 6, 9, and 12 h, respectively (P > 0.05). Although statistically insignificant, the postoperative mean rescue analgesic doses utilised in both groups were comparable, but there was a higher frequency requirement in Group TEA. The hemodynamic and respiratory profiles were comparable, except for a few arrhythmias in Group TEA. With comparable results, early recovery, fast-track extubation, and intensive care unit (ICU) stay were achieved.ConclusionsThe ESP block has been found to have optimal analgesic effects during open cardiac surgery, resulting in a decreased need for additional analgesic doses and eliminating the possibility of a coagulation emergency. Consequently, it presents itself as a safer alternative to the potentially invasive thoracic epidural analgesia (TEA).

Erector spinae plane blocks for opioid-sparing multimodal pain management after pediatric cardiac surgery

ObjectivePeripheral regional anesthesia is proposed to enhance recovery. We sought to evaluate the efficacy of bilateral continuous erector spinae plane blocks (B-ESpB) for postoperative analgesia and the impact on recovery in children undergoing cardiac surgery. MethodsPatients aged 2 through 17 years undergoing cardiac surgery in the enhanced recovery after cardiac surgery program were prospectively enrolled to receive B-ESpB at the end of the procedure, with continuous infusions via catheters postoperatively. Participants wore an activity monitor until discharge. B-ESpB patients were retrospectively matched with control patients in the enhanced recovery after cardiac surgery program. Outcomes of the matched clusters were compared using exact conditional logistic regression and generalized linear modeling. ResultsForty patients receiving B-ESpB were matched to 78 controls. There were no major complications from the B-ESpB or infusions, and operating room time was longer by a median of 31 minutes. While blocks were infusing, patients with B-ESpB received fewer opioids in oral morphine equivalents than controls at 24 hours (0.60 ± 0.06 vs 0.78 ± 0.04 mg/kg; P = .02) and 48 hours (1.13 ± 0.08 vs 1.35 ± 0.06 mg/kg; P = .04), respectively. Both groups had low median pain scores per 12-hour period. There was no difference in early mobilization, length of stay, or complications. ConclusionsB-ESpBs are safe in children undergoing cardiac surgery. When performed as part of a multimodal pain strategy in an enhanced recovery after cardiac surgery program, pediatric patients with B-ESpB experience good pain control and require fewer opioids in the first 48 hours.

[Translated article] Closing wedge high tibial osteotomy: An old-fashioned technique? Survival, clinical and radiological outcomes of a case series analysis

IntroductionClosing wedge high tibial osteotomy (CW-HTO) is a surgical option for active patients with medial knee pain and mild–moderate osteoarthritis with varus limb deformity. Despite its good reported results, this technique has been losing popularity. The aim of this study was to analyse the survival rate, clinical functional outcomes and radiological results of CW-HTO. MethodsIt is a retrospective case series study. Seventy patients with primary knee osteoarthritis, operated on between 2010 and 2020 in a single Spanish tertiary hospital using the CW-HTO technique and with a minimum follow-up of 2 years were analysed. ResultsSurvival rate was 87.6% and 75.5% after a follow-up of 5 and 10 years respectively. Functional outcomes were good-to-excellent (KSS 77.7/100 and OKS 35.6/48) and good pain control (VAS 3.9/10) and high satisfaction (7.2/10) were achieved. Limb varus malalignment was significantly corrected (mean postoperative HKA angle 177.6° and MPTA 90.7°). However, 30% of patients presented hypocorrection, which was associated with inferior survival, functionality and satisfaction. ConclusionCW-HTO technique can be useful for patients with knee osteoarthritis and varus limb. It allows to correct varus malalignment while achieving good-to-excellent functional outcomes, good pain control, high patient satisfaction and acceptable medium-long term survival rate. However, it is associated with a non-negligible risk of hypocorrection or medial hinge disruption.

Dexamethasone versus Dexmedetomidine as Adjuvants in Ultrasound Popliteal Sciatic Nerve Block for Hallux Valgus Surgery: A Mono-Centric Retrospective Comparative Study.

Ultrasound popliteal sciatic nerve block (UPSNB) is commonly performed in foot and ankle surgery. This study aims to assess the use of dexmedetomidine and dexamethasone as adjuvants in UPSNB for hallux valgus (HV) surgery, comparing their efficacy in producing motor and sensory block and controlling postoperative pain. The adverse event rate was also evaluated. This mono-centric retrospective study included 62 adult patients undergoing HV surgery: 30 patients received lidocaine 2% 200 mg, ropivacaine 0.5% 50 mg and dexamethasone 4 mg (Group 1), whereas 32 patients received lidocaine 2% 200 mg, ropivacaine 0.5% 50 mg, and dexmedetomidine 1 mcg/Kg (Group 2). At first, the visual analogue scale (VAS) was evaluated after 48 hours. The other outcomes were time to motor block regression, evaluation of the first analgesic drug intake, analgesic effect, adverse effects (hemodynamic disorders, postoperative nausea and vomiting (PONV)) and patient satisfaction. The continuous data were analyzed with student's t-test and the continuous one with χ2. Statistical significance was set at a p-value lower than 0.05. No significant difference was found in VAS after 48 hours (4.5 ± 1.6 vs 4.7 ± 1.7, p = 0.621) to motor block regression (18.9 ± 6.0 vs 18.7 ± 6, p = 0.922). The number of patients that took their first analgesic drug in the first 48 h (p = 0.947 at 6 hours; p = 0.421 at 12 hours; p = 0.122 at 24 hours and p = 0.333 at 48 hours) were not significant. A low and similar incidence of intraoperative hemodynamic disorders was recorded in both groups (hypotension p = 0.593; bradycardia p = 0.881). Neither PONV nor other complication was found. Patients in Group 1 reported a lower degree of interference with sleep (p = 0.001), less interference with daily activities (P = 0.002) and with the affective sphere (P = 0.015) along with a more satisfactory postoperative pain management (p < 0.001) as compared to Group 2. No significant differences were observed in the duration of motor and sensory blockade between patients in both groups. Additionally, both groups showed good pain control with a low rate of adverse effects, even if there was no clinical difference between the groups. However, patients who received dexamethasone reported experiencing less interference with their sleep, daily activities and overall emotional well-being, and overall pain control.

Safety and Efficacy of Radiofrequency Ablation of Gasserian Ganglion in Trigeminal Neuralgia

Background: Trigeminal neuralgia (TN) is characterized by intractable pain in one or more division of trigeminal nerve. Pharmacologic management is first line treatment for TN, when it fails interventional treatment options are considered like percutaneous procedures or micro vascular decompression. Radio frequency thermoscoagulation is an effective option for medically refractory cases to control pain.Objective: To evaluate the safety and efficacy of Radiofrequency thermocoagulation of the gasserian ganglion for the treatment of trigeminal neuralgia.Methods: Total 44 patients were included in this prospective obsarvational study who were already diagnosed with trigeminal neuralgia and refractory to medical management. All patients were treated by radiofrequency thermocoagulation after confirming the position of needle tip by sensory and motor stimuli. Three lesions were created at 60-70oC for 90 second each. Patients were assessed for pain relief, corneal reflex, numbness and masticatory muscle weakness at immediate post procedural stage, 1 week, 1 month and at 6 months.Results: Twenty eight patients had pain over both mandibular (V3) and maxillary (V2) division, 12 patients had mandibular (V3) and 4 patients had only maxillary (V2) division involvement. Excellent pain relief was archived in 38 (86.36%) patients, 4 patients (9.09%) have good pain control and 2 (4.54%) patient developed poor pain control with development of Anesthesia dolorosa in 1 patient. None of them develop complete facial numbness, 41 patients developed tolerable numbness and 2 patients develop somewhat bothersome, Facial numbness. Three patients developed unilateral masseter muscle weakness however no patients developed corneal ulcers, blindness or other complications.Conclusion: Temperature controlled thermocoagulation is a safe and effective treatment options for trigeminal neuralgia.

Novel Techniques of Radiotherapy in the Management of Oncologic Pain

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Oncologic pain (OP), in general, increases with disease progression. Moderate or severe intensity OP occurs in around 30% of cancer patients receiving treatment and in 60% to 90% of patients with advanced cancer. Radiotherapy (RT) is an effective non-pharmacological method of treatment of OP. Two new techniques of RT are available for pain control: ablative RT for oligometastatic disease and lattice RT, for voluminous tumors. We will review their efficacy and results, concluding that OP is a complex biologic phenomenon and its successful treatment requires careful assessment of its nature, understanding the different types and patterns. Specific pain management with new radiation techniques can be effective and provide good pain control, allowing the reduction of analgesics use, improving the quality of life.

Current pediatric pain practice in Nigeria, South Africa, Uganda, and Zambia: A prospective survey of anesthetists.

Children in hospital experience significant pain, either inherent with their pathology, or caused by diagnostic/therapeutic procedures. Little is known about pediatric pain practices in sub-Saharan Africa. This survey aimed to gain insight into current pain management practices among specialist physician anesthetists in four sub-Saharan African countries. A survey was sent to 365 specialist physician anesthetists in Nigeria, South Africa, Uganda and Zambia. Content analysis included descriptive information about the respondents and their work environment. Thematic analysis considered resources available for pediatric pain management, personal and institutional pain practices. One hundred and sixty-six responses were received (response rate 45.5%), with data from 141 analyzed; Nigeria (27), South Africa (52), Uganda (41) and Zambia (21). Most respondents (71.83%) worked at tertiary/national referral hospitals. The majority of respondents (130/141, 91.55%) had received teaching in pediatric pain management. Good availability was reported for simple analgesia, opioids, ketamine, and local anesthetics. Just over half always/often had access to nurses trained in pediatric care, and infusion pumps for continuous drug delivery. Catheters for regional anesthesia techniques and for patient-controlled analgesia were largely unavailable. Two thirds (94/141, 66.67%) did not have an institutional pediatric pain management guideline, but good pharmacological pain management practices were reported, in line with World Health Organization recommendations. Eighty-eight respondents (62.41%) indicated that they felt appropriate pain control in children was always/often achieved in their setting. This survey provides insight into pediatric pain practices in these four countries. Good availability of a variety of analgesics, positive pain prescription practices, and utilization of some non-pharmacological pain management strategies are encouraging, and suggest that achieving good pain control despite limited resources is attainable. Areas for improvement include the development of institutional guidelines, routine utilization of pain assessment tools, and access to regional anesthesia and other advanced pain management techniques.

Dual-neuromodulation strategy in pain management of herpes zoster ophthalmicus: retrospective cohort study and literature review

Background Effective pain control of herpes zoster ophthalmicus (HZO) is not only essential to attenuate the clinical symptoms but to reduce the risk of postherpetic neuralgia development. Recently, neuromodulation therapy has been one promising option for neuropathic pain and increasingly applied in management of zoster-related pain. One key factor of neuromodulation treatment is the therapeutic site for the impaired nerves. In this study we aim to investigate one novel dual-neuromodulation strategy, targeting the level of the peripheral branch and trigeminal ganglion, in the pain management of HZO. Methods Dual neuromodulation strategy combining short-term peripheral nerve stimulation (PNS) with pulsed radiofrequency (PRF) of trigeminal ganglion was compared with single PNS treatment for HZO-related pain. Clinical recordings of patients were retrospectively reviewed. The primary outcome was the pain severity, assessed by the visual analogue scale (VAS) before and after neuromodulation therapy. Results PNS achieved significant relief of pain with or without PRF treatment before discharge, which provided enduring therapeutic effect up to 12-month follow-up. The mean reduction of VAS was 6.7 ± 1.4 in dual modulation therapy (n = 13) at last follow-up and 5.4 ± 1.5 in PNS subgroup (n = 20), respectively. Moreover, dual modulation strategy provided better control of pain compared with PNS therapy alone at each time point. Conclusion It is feasible and effective to combine the PNS and PRF in pain management of HZO. This novel dual modulation strategy of trigeminal pathway may provide additional therapeutic effects of pain symptoms in HZO population.

Use of indocyanine green angiography during endoscopic microvascular decompression for trigeminal neuralgia

BackgroundThe aim of this study was to assess the efficacy of indocyanine green (ICG) angiography during full endoscopic microvascular decompression for trigeminal neuralgia. MethodsWe extracted retrospective data of patients who received ICG videoangiography during full endoscopic microvascular decompression for trigeminal neuralgia. Preoperative neurovascular contact was evaluated by three-dimensional (3D) fusion images using image analysis software Ziostation2 (ZIOSOFT, Tokyo, Japan) and Intraoperative ICG angiography was used in pre and post ICG injection to identify and assess blood flow in the offending vessel for adequate transposition planification and assess for immediate post transposition blood flow or vasospasm respectively. Patients were assessed the next morning for early signs of brainstem infarction and at one month follow up. ResultsThere were 44 patients. All patients had ICG videoangiography done during the procedure. The mean age was 65.5 and male female ratio 3.4:1. Some anatomical variants were identified during this procedure. Five patients (11.3%) had a trigeminocerebellar artery, three patients (6.8%) had a developed superior petrosal vein and one patient (2.2%) had dural adhesions with encasement of anterior inferior cerebellar artery. Among the 44 patients enrolled, 34 had transposition done and 10 had combined transposition either with neurolysis or Teflon interposition. The main offending vessel was Superior cerebellar artery (SCA) in 23 patients (67.6%). In 5 (14.7%) of 34 patients who underwent Transposition, vasospasm was seen and no complications were observed in all patients but 93.1% had good pain control in postoperative. ConclusionICG angiography in endoscopic microvascular decompression is safe and effective in depicting the offending vessel, its branches and some perforators and contributes significantly to the determination of treatment strategy.

RADT-34. CLINICAL OUTCOMES OF LOCALISED AND METASTATIC CENTRAL NERVOUS SYSTEM HAEMANGIOPERICYTOMAS/SOLITARY FIBROUS TUMOURS – A SINGLE INSTITUTION EXPERIENCE

Abstract BACKGROUND/OBJECTIVE Central nervous system (CNS) haemangiopericytomas (HPC) or solitary fibrous tumours (SFT) are rare aggressive tumours. Surgery is the primary modality of treatment, however, often followed by postoperative radiotherapy due to high tendency for local recurrence. Although rare, extracranial metastases to several sites have been described. We aim to report our institutional experience in managing these rare tumours. METHODS Patients with central nervous system HPC/SFT who underwent surgical resection from 2012 to 2022 were included in the study. Data collected included patient demographics, tumour characteristics, treatment details (including primary surgery, radiotherapy and treatment for relapse) and clinical outcomes. RESULTS Five patients were included in this study. All were women and their mean age at diagnosis was 43 years. Four patients presented with intracranial disease and one with cervico-thoracic spine disease. All patients had undergone primary surgery and gross total resection was achieved in two patients. Two patients had grade 1, one with grade 2 and two with grade 3 HPC. Four patients received radiotherapy (median dose 60Gy) and one was on imaging surveillance after surgery. Three patients had relapsed – one with locoregional relapse only, one with distant (liver and bone) relapse and other with locoregional and distant (lung and bone). Time to relapse were 192, 39 and 120 months respectively. Stereotactic radiotherapy was used to treat local relapse in posterior fossa and dura of cervical spine, and metastatic relapse in lung with a stable radiological response. One patient with a painful destructive bone metastases was treated with palliative radiotherapy with good pain control. Four patients were alive at the time of the study, and one was lost to follow up. CONCLUSION We present our institutional experience in management of localised and metastatic HPC/SFT. Stereotactic radiotherapy could be considered an effective treatment modality for small volume relapse of HPC.

Osteotomía de sustracción lateral tibial: ¿una técnica pasada de moda? Análisis de supervivencia, resultados clínicos y radiológicos de una serie de casos

IntroductionClosing wedge high tibial osteotomy (CW-HTO) is a surgical option for active patients with medial knee pain and mild-moderate osteoarthritis with varus limb deformity. Despite its good reported results, this technique has been losing popularity. The aim of this study was to analyse the survival rate, clinical functional outcomes and radiological results of CW-HTO. MethodsIt is a retrospective case series study. Seventy patients with primary knee osteoarthritis, operated on between 2010 and 2020 in a single Spanish tertiary hospital using the CW-HTO technique and with a minimum follow-up of 2 years were analysed. ResultsSurvival rate was 87,6% and 75,5% after a follow-up of 5 and 10 years respectively. Functional outcomes were good-to-excellent (KSS 77.7/100 and OKS 35.6/48) and good pain control (VAS 3.9/10) and high satisfaction (7.2/10) were achieved. Limb varus malalignment was significantly corrected (mean postoperative HKA angle 177,6° and MPTA 90,7°). However, 30% of patients presented hypocorrection, which was associated with inferior survival, functionality and satisfaction. ConclusionCW-HTO technique can be useful for patients with knee osteoarthritis and varus limb. It allows to correct varus malalignment while achieving good-to-excellent functional outcomes, good pain control, high patient satisfaction and acceptable medium-long term survival rate. However, it is associated with a non-negligible risk of hypocorrection or medial hinge disruption.

Observational study of ropivacaine and compound betamethasone mixture for analgesia after triangular fibrocartilage complex repair under wrist arthroscopy: A single-center randomized double-blind controlled trial

BackgroundThe purpose of this study was to investigate the clinical effect of an intra-articular and local infiltration injection of a compound analgesic mixture of ropivacaine and compound betamethasone on the repair of the triangular fibrocartilage complex under wrist arthroscopy. MethodsThis prospective, double-blind, randomized study involved 20 patients with Atzei type 2 or 3 injuries of the triangular fibrocartilage complex who underwent repair under wrist arthroscopy. Patients were divided into two groups (n = 10) according to the systematic random sampling method. The test group was injected with a “cocktail” mixture for pain relief. The control group was injected with normal saline. The visual analog scale (VAS) pain score, pinch force, wrist joint mobility, wrist joint function score (PRWE score), occurrence of adverse reactions and dosage of analgesic drugs were evaluated before and after the operation in the two groups. ResultsThe resting pain of the patients in the test group was less severe than that of the control group at 12 h, 24 h and 48 h after the operation (P < 0.05), and the pinch force of the patients in the test group was significantly greater than that of the control group at 1 d, 2 d and 3 d after the operation (P < 0.01). The amount of postoperative analgesics used in the test group was significantly lower than that in the control group (P < 0.01), and the patient satisfaction rate in the test group was higher than that in the control group (P < 0.05). There were no postoperative adverse effects in either group. ConclusionAn intra-articular and local infiltration injection of a “cocktail” analgesic mixture in the repair of triangular fibrocartilage complex under wrist arthroscopy can provide good pain control in the early postoperative period and reduce the amount of postoperative analgesic drugs administered, thus improving clinical safety. Level of evidenceLevel II; Randomized Controlled Trial; Treatment Study.