Good Pain Relief Research Articles

Current status and future perspectives for endoscopic treatment of local complications in chronic pancreatitis.

Chronic pancreatitis is a progressive disease characterized by irregular fibrosis, cellular infiltration, and parenchymal loss within the pancreas. Chronic pancreatitis treatment includes lifestyle modifications based on disease etiology, dietary adjustments appropriate for each stage and condition, drug therapy, endoscopic treatments, and surgical treatments. Although surgical treatments of symptomatic chronic pancreatitis provide good pain relief, endoscopic therapies are recommended as the first-line treatment because they are minimally invasive. In recent years, endoscopic therapy has emerged as an alternative treatment method to surgery for managing local complications in patients with chronic pancreatitis. For pancreatic stone removal, a combination of extracorporeal shock wave lithotripsy and endoscopic extraction is used. For refractory pancreatic duct stones, intracorporeal fragmentation techniques, such as pancreatoscopy-guided electrohydraulic lithotripsy and laser lithotripsy, offer additional options. Interventional endoscopic ultrasound has become the primary treatment modality for pancreatic pseudocysts, except in the absence of disconnected pancreatic duct syndrome. This review focuses on the current status of endoscopic therapies for common local complications of chronic pancreatitis, including updated information in the past few years.

Standard operating procedure and surgical technique innovation in fully endoscopic microvascular decompression for trigeminal neuralgia: technical note on 189 patients.

Microvascular decompression (MVD) is a well-established and effective treatment for primary trigeminal neuralgia (TN). Endoscopy has been implemented to provide a comprehensive view of neurovascular conflict and minimizes the damages of brain retraction during MVD. To preliminarily evaluate the surgical safety and efficacy of fully endoscopic microvascular decompression (EMVD) for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope. Retrospective clinical analysis of 189 patients with primary TN underwent EMVD between June 2019 and August 2022 was performed. By analyzing the intraoperative situation, the outcomes of postoperative symptoms and the main complications, we evaluated the reliability and effectivity of the operative technique in the treatment of primary TN. We summarized the standard operating procedure of EMVD for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope. In addition, acicular bipolar electrocoagulation technique was developed to handle venous compression. During the follow-up period, good pain relief was achieved in 178 patients (94.2%) and recurrence of pain was observed in 4 patients (2.1%). Postoperative temporary complications included trigeminal dysesthesias (7 patients, 4.8%), cerebrospinal fluid leak (2 patients, 1.1%), hearing difficulty (3 patient, 1.6%), facial paresis (2 patients, 1.1%) and vertigo (5 patients, 2.7%). There were no cases of intracranial hemorrhage, cerebellar swelling and death. This EMVD technique is reliable and effective, and can be used as a routine surgical procedure for primary TN.

Non-invasive Assessment of Microstructural Changes After CyberKnife Radiosurgery for Trigeminal Neuralgia Using Diffusion Tensor Imaging

Background and Aims: Given the absence of a universally accepted non-invasive and objective clinical tool to predict a patient’s response to stereotactic radiosurgery for Trigeminal Neuralgia (TN), this research endeavoured to appraise the potential of Diffusion Tensor Imaging as a predictive tool in managing TN. Objective: This study aimed to assess microstructural changes in the trigeminal nerve following CyberKnife radiosurgery (CKRS) for TN using diffusion tensor imaging (DTI) and to correlate these changes with clinical outcomes. Methods: Twenty-eight TN patients treated with CKRS underwent pre and 4-month post-treatment Three-Tesla magnetic resonance imaging scans with DTI metrics, including fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD), were collected. Clinical outcomes were assessed using the Barrow Neurological Institute Pain Intensity Score (BNI-PIS) at fourth, sixth and ninth months post-CKRS. Results: Twenty-four patients reported good pain relief (responders), while four patients did not experience adequate relief (non-responders). Responders exhibited significantly lower FA (mean drop of 13.8%, P < .001) and lower RA (mean drop of 16.1%, P < .001) compared to non-responders. RD, AD and MD remained constant across the study cohort. Conclusion: DTI metrics, particularly FA and RA, at 4 months post-CKRS, emerged as predictors of long-term treatment effectiveness for TN. These findings suggest the potential utility of DTI in evaluating microstructural changes in the trigeminal nerve post-CKRS and predicting clinical outcomes.

Near total head resection of pancreas in patients with chronic pancreatitis - Outcome of a novel surgical technique

BackgroundChronic pancreatitis (CP) is characterized by debilitating pain which affects patients' quality of life. Early surgical intervention has been shown to mitigate pain and prevent a decline in quality of life. The present study evaluated the impact of bile duct and duodenum preserving pancreatic head resection (BDPPHR), an innovative technique, on pain relief, functional outcomes, postoperative morbidity, and mortality in patients with CP. MethodsBetween March 2019 and July 2022, a total of 37 patients underwent bile duct and duodenum preserving pancreatic head resection (BDPPHR) for pain relief in patients with CP. Post-operative outcomes were assessed by Izbicki pain score, exocrine insufficiency, endocrine insufficiency, and return to work. The safety of the surgical procedure was determined by evaluation of postoperative morbidity and mortality as per Clavien-Dindo scores. ResultsBDPPHR showed a significant reduction in Izbicki pain scores with 30 (81 %) patients experiencing complete or partial pain relief up to 18 months of follow up. 32(86 %) patients ceased narcotic use by the end of the 18-month follow-up period. 33 (89 %) patients were able to resume regular work at the end of 18 months. There were no significant alterations in both exocrine and endocrine statuses post-surgery. The median duration of hospital stay was 4.5 days (3-11). Major complications occurred in 2 (5 %) patients. There was no post-operative mortality. ConclusionBDPPHR is a novel and safe technique of near total head resection which results in very good pain relief in 81 % of patients.

Anatomic total shoulder arthroplasty using hybrid glenoid fixation with a porous-coated titanium post. Two- to ten-year follow-up of 256 cases with primary glenohumeral osteoarthritis

BackgroundAnatomic total shoulder arthroplasty is one of the recommended surgical treatments for severe glenohumeral osteoarthritis, providing good pain relief and function. Aseptic loosening of the glenoid component, however, is a major cause for revision. Hybrid components have been introduced, combining traditional cemented fixation with porous titanium bone ingrowth to improve fixation. The purpose of this study was to report our midterm to longterm experience using such a component, including clinical outcomes and implant survival. MethodsWe reviewed all patients who were operated for primary osteoarthritis during the period 2011-19, leaving a minimum of 2-year follow-up. The severity of the osteoarthritis was graded using Samilson-Prieto score, while glenoid morphology was graded using the modified Walch classification. Clinical outcomes included Western Ontario Osteoarthritis of the Shoulder (WOOS) index, EQ-5D-5L, and Constant-Murley score. Postoperative radiographs were analyzed for radiolucent lines. Patient records were studied for complications including revisions. Supplementary data for revision and outcome were obtained from the Danish Shoulder Arthroplasty Registry. Kaplan-Meier estimates for implant survival were calculated. ResultsA total of 256 arthroplasties in 224 patients were included (mean age: 69 years ± 9 years, 149 females). 81% of cases were graded radiographically as severe osteoarthritis, according to Samilson-Prieto. Walch type B1 was most commonly followed by B2 (29% and 28% respectively). The mean follow-up time was 49 months (range 24-127). The response rate for patient reported outcomes was 91%. The median WOOS index was 94% (81%-99%), the median EQ-5D-5L was 0.87 (0.69-0.95), and the mean Constant-Murley score was 75 (SD 17.7). 13 cases (6%) had a WOOS index below 50%. 8.2% had complications related to surgery. A radiolucent line had developed around the central post in six cases and at the bone-cement interface in three cases at follow-up. Six cases had been revised (2.3%); three due to aseptic loosening of the glenoid. The 10-year survival estimate was 95.6 % (95% CI: 87.9%-98.5%). ConclusionAnatomic total shoulder arthroplasty with hybrid glenoid fixation provides excellent clinical outcome with a low complication rate in patients, with primary glenohumeral osteoarthritis. The 10-year survival rate is high and comparable to that reported for the best- performing all-polyethylene components. Longer observation is needed to see if hybrid fixation will outperform standard all-cemented components.

Efficacy of 10% Dextrose versus Expressed Breast Milk in Relieving Procedural Pain in Neonates – A Randomized Controlled Trial

Aim: This study aims to compare the efficacy of 10% dextrose (10%D) and expressed breast milk (EBM) in relieving heel prick pain in neonates assessed by premature infant pain profile-revised (PIPP-R). Settings and Design: This study was done in the neonatal intensive care unit under the department of pediatrics, hospital-based prospective, randomized controlled trial. Subjects and Methods: The study includes neonates born between ≥34 weeks and ≤42 weeks of gestational age. The 72 enrolled neonates were randomized into two intervention groups (EBM and 10%D). One milliliter of test solution was given to the baby 30 s before the heel prick. Pain reactions were scored using the PIPP-R scoring system, and two independent observers were chosen, who were blinded to what intervention was given. Results: For the EBM solution, the mean PIPP-R at 0 s was 7.19 ± 2, 5.5 ± 1.5 at 30 s, and 4.28 ± 1.65 at 60 s. For the 10%D solution, the mean PIPP-R at 0 s was 4.97 ± 1.42, 2.36 ± 1.44 at 30 s, and 1.69 ± 1.53 at 60 s. The difference in the mean PIPP-R between the two groups was statistically significant, and the 10%D group majority had only minimal pain throughout the procedure. Conclusions: Compared to the EBM group, 10%D significantly lowered the mean PIPP-R score, giving good pain relief and less procedural discomfort.

HOW DOES CARTIVA INTERPOSITIONAL ARTHROPLASTY COMPARE TO ARTHRODESIS IN THE TREATMENT OF HALLUX RIGIDUS? A RETROSPECTIVE COMPARATIVE STUDY WITH 12-MONTH FOLLOW-UP

BackgroundHallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief but sacrifices ROM. Recently the Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is largely based on a single cohort with mixed outcomes. We sought to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre.MethodsRetrospective review of patients undergoing Cartiva SCI or arthrodesis for treating hallux rigidus was conducted. Preoperative arthritis was radiographically graded using the Vanore classification. Patient reported outcomes (PROMs) were assessed using EuroQol 5-dimension score (EQ-5D-5L) and Manchester-Oxford Foot Questionnaire (MOXFQ).ResultsBetween 2017 and 2020 there were 33 cases (17 Cartiva, 16 arthrodesis, mean age 59.0±9.9 years) with a mean follow up of 2.3 years. For the first MTPJ arthrodesis cohort, the MOXFQ domain scores were: Index 3.9±5.8, Walking/Standing 5.1±7.6, Pain 3.2±5.0, and Social Interaction 2.6±4.0. EQ-5D-5L Index score was 0.828±0.270 and the EQ-VAS was 72.5±23.3. For the Cartiva cohort, the MOXFQ domain scores were: Index 7.7±6.0, Walking/Standing 8.9±7.9, Pain 7.1±5.0, and Social Interaction 6.4±5.4. EQ-5D-5L Index score was 0.631±0.234 and the EQ-VAS was 74.8±20.8. There was no statistically significant difference between any MOXFQ domain or EQ-5D-5L scores. However, a negative trend in MOXFQ domains was identified for the Cartiva group, as well as a reoperation rate of 23.5%.ConclusionsThe Cartiva SCI demonstrated no advantage over arthrodesis in PROMs, despite the presumed benefit of preserved ROM. A significant reoperation rate was also observed. Surgeons should be cautious in the use of this novel implant.

Cartiva interpositional arthroplasty versus arthrodesis in the treatment of Hallux rigidus: A retrospective comparative study with mean 2 year follow up

BackgroundHallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief, but sacrifices ROM. The Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is limited. The aim was to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre. MethodsA retrospective cohort study was conducted, enrolling all adult patients who underwent primary first MTPJ SCI arthroplasty or arthrodesis for the treatment hallux rigidus. The primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included EQ-5D, complication rates, VAS Pain and FAAM (ADL). ResultsBetween 2017 and 2020 there were 33 cases divided into two groups (17 Cartiva SCI, 16 arthrodesis, mean age 59.0 ± 9.9 years) with a mean follow up of 2.3 years. There was no statistically significant difference in any of the MOXFQ, EQ-5D, VAS Pain or FAAM (ADL) outcome scores between the Arthrodesis and SCI groups (p > 0.05). The mean MOXFQ Index score was 7.2 ± 6.4 for the SCI group and 3.9 ± 5.8 for the Arthrodesis group at final follow up (p = 0.15). Although complications were high in both groups, the overall hallux reoperation rate was 29.4 % in the SCI cohort and 0.0 % for arthrodesis. ConclusionThis retrospective comparative study found no significant superiority of Cartiva SCI over arthrodesis in terms of PROMs. Due to the higher rate of further surgical intervention in the SCI cohort, we recommend arthrodesis as the preferred surgical option for hallux rigidus. Level of evidenceIII

Pulsed Radiofrequency Neuromodulation of the Sciatic Nerve in the Management of Posttraumatic Sciatic Neuritis

Abstract Accidental intraneural injection causing nerve injury is an iatrogenic catastrophe. Intramuscular injection (IM) is a common injury affecting the sciatic nerve. Sciatic nerve injury manifests as radicular pain with paraesthesia accompanied by an immediate onset of motor and sensory deficits. Treatment options include medical management with corticosteroids, neuropathic medications, and surgical exploration with or without anastomosis. We report a case of a young boy who presented with shooting pain with Numerical Rating Scale of 8/10 from the left buttock up to the left foot following accidental IM injection. The pain was associated with sensory loss over the left foot. Since he was unresponsive to medical management with corticosteroids and neuropathic medications, he was treated with pulsed radiofrequency neuromodulation of the left sciatic nerve. He responded well for the treatment and was discharged with good pain relief.

Radiocarpal Osteochondral Allografts for Wrist Pain Postproximal Row Carpectomy

Abstract Background Surgical options for patients with recurrent wrist pain after salvage procedures, such as proximal row carpectomy (PRC), are limited and primarily result in total wrist arthrodesis (TWA). Osteochondral allografting (OCA) offers an additional option to address refractory wrist pain due to arthritis while preserving some range of motion. Case Description A 65-year-old, right hand dominant male developed chronic wrist pain, secondary to untreated scapholunate and triangular fibrocartilage complex ligament tears. The patient underwent a PRC, radial styloidectomy, and partial wrist denervation with good initial pain relief. Two years later, symptoms returned with radiographs demonstrating capitate sclerosis. A salvage arthroplasty with OCA produced relief of symptoms. Literature Review Refractory wrist pain after salvage procedures have traditionally been managed with TWA or less commonly, wrist arthroplasty. Capitate resurfacing and interposition have expanded indications for PRC. OCA is a chondral replacement procedure that utilizes cadaveric cartilage allograft plugs to replace damaged cartilage in various articular joint surfaces. Although OCA used in the lower extremity and shoulder has demonstrated improved pain relief and return of function, it has not been reported in the wrist. Clinical Relevance There are limited options for refractory wrist pain after salvage procedures. We present an additional alternative to TWA, by resurfacing the radiocarpal joint affected by chondromalacia after a PRC. This option offers another treatment modality for recurrent wrist pain while still preserving some element of range of motion.

Safety and clinical efficacy of microwave ablation combined with percutaneous vertebroplasty in the treatment of multisegmental spinal metastases.

To evaluate the safety and efficacy of microwave ablation (MWA) combined with percutaneous vertebroplasty (PVP) in the treatment of multisegmental (2-3 segments) osteolytic spinal metastases. This study comprised a retrospective analysis of data from 20 patients with multisegmental (2-3 segments) osteolytic spinal metastases who received MWA combined with PVP. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, Quality of Life Questionnaire-Bone Metastases 22 (QLQ-BM22), and local recurrence before and after the operation were measured. The occurrence of complications was observed to evaluate safety. All operations were completed successfully with no serious complications. Transient nerve injury occurred in two cases, but recovered after symptomatic treatment. The bone cement leakage rate was 13.9% (6/43). The mean baseline VAS scores were 7.25 ± 0.91 before treatment and 7.25 ± 0.91, 3.70 ± 1.12, 2.70 ± 0.73, 2.40 ± 0.68, 2.25 ± 0.71, and 2.70 ± 0.92 at 1 day, 1 week, 1, 3, and 6 months after treatment; all values were significantly lower (P < 0.001). The mean baseline ODI score decreased from 56.90 ± 9.74 before treatment to 41.90 ± 7.09, 38.10 ± 7.93, and 38.80 ± 10.59 at 1, 3, and 6 months after treatment, respectively; all values were significantly lower (P < 0.001). The average QLQ-BM22 baseline score decreased from 54.10 ± 5.36 before treatment to 44.65 ± 5.22, 43.05 ± 4.78, 42.30 ± 4.06, and 42.15 ± 5.47 at 1 week, 1, 3, and 6 months after treatment; all values were significantly lower (all P < 0.001). The postoperative survival time of all patients was >6 months. In three patients, four vertebral segments recurred 6 months after operation. MWA combined with PVP is a safe and effective treatment for multisegmental osteolytic vertebral metastases that can effectively relieve pain, improve spinal function, improve quality of life, and delay tumor progression. However, it is a long operation, necessitating good preoperative preparation and effective intraoperative pain relief measures.

The BioPro Thumb Carpometacarpal Hemiarthroplasty: Case Series and Surgical Technique.

Thumb carpometacarpal (CMC) osteoarthritis is painful and debilitating. Here, we explore outcomes of a modular, press-fit thumb CMC hemiarthroplasty prosthesis (BioPro). This surgical option permits minimal bone resection, sparing the trapezium, hence allowing revision options if necessary. A retrospective review of all cases of the modular thumb CMC implants performed at one community US center between 2018 and 2021 were included and invited for email or telephone review. Electronic records were examined for demographics, patient outcomes, and morbidity. Eleven patients underwent 11 thumb CMC joint hemiarthroplasties, mean age was 64.8 years (SD: 7.68y), with 6 females. Six received surgery on their dominant extremity. Two were manual workers (both in the medical field), 6 office-based, 2 retired, and 1 homemaker. The preoperative median pain score (Visual Analog Score) was 8/10 (range: 5 to 10), reducing to 1/10 (range: 1 to 10) ( P =0.000033) with a median follow-up of 23 months (range: 13 to 39mo). In all, 8/11 patients reported they would recommend this surgery to friends and family and opt for the same surgery on their contralateral hand if necessary. One patient reported persistent pain a year postoperatively. On review, the head of the implant was placed too deep into the trapezium. Another center found that this patient had a postoperative trapezium fracture and underwent revision with implant removal and conversion to a suspension arthroplasty. At 12 months, 10/11 thumb CMC hemiarthroplasty showed good pain relief, function, and patient satisfaction. The BioPro has a low risk of subluxation and allows salvage options to remain available should failure occur.

Angioleiomyoma of the Foot: Clinical and Functional Outcomes of Surgical Treatment in a Case Series.

Angioleiomyoma is a benign soft-tissue tumor that arises from the smooth muscle cells in the tunica media of the blood vessels. Although the most common location for these neoplasms is the uterine wall, they can also originate from lower limbs. Altogether, these neoplasms account for 0.2% of all those located in the foot and ankle region. Signs and symptoms of foot angioleiomyoma can be a localized pain, swelling, and functional impairment. To date, only case reports and case series with small populations have been reported in the literature to describe the clinical picture of these neoplasms and the effectiveness of surgical treatment. In this study, we report our results of surgical treatment for angioleiomyomas of the foot. Thirteen cases suffering from angioleiomyoma of the foot underwent surgical resection in our institution between January of 2017 and January of 2022. For each case, we recorded preoperative and postoperative symptoms, and their preoperative and postoperative functional status according to both Musculoskeletal Tumor Society Score (MSTS) and American Orthopedic Foot and Ankle Society Score (AOFAS). Eventual complications and local recurrence were reported. Each patient had at least mild pain before surgical treatment. The mean preoperative MSTS and AOFAS were 22.1 and 76.8, respectively. The mean tumor size was 17.7mm. Preoperatively, each patient underwent resection with wide margins. None had local recurrences or major complications at their latest follow-up. After surgery, the mean postoperative MSTS and AOFAS increased to 29.5 and 98.8, respectively. Each case had a marked increment of their functionality and a reduction of their pain after surgery. Our results suggest that surgical approach with tumor resection should be considered a safe and reliable treatment for foot angioleiomyomas in light of the extremely low risk of local recurrence and because of the good postoperative pain relief and functional restoration that can be obtained after the treatment.

The value of TECAR in acute painful osteoporotic vertebral fractures: a pilot study.

Low-back pain is frequent, especially in the active adult population after an osteoporotic vertebral fracture. Several orthopaedic conditions can cause low back pain, significantly worsening the quality of life. The treatments vary from drugs, physical therapy, kinesiology, and local infiltration. TECARs have a crucial role in treating the inflammatory causes of pain, with several studies demonstrating the efficacy of 0.5 Mh radio frequency longwave therapy in treating low-back pain. We treat twenty consecutive patients with low back pain after a vertebral amielic spinal fracture with or without leg pain, using a combination of painkillers, orthosis, and half of them tecar therapy. The patients were treated three times a week, every other day, for 20 sessions. We evaluated clinical outcomes using the visual analogic scale for indi-vidual pain. Tests started before the beginning of therapies and eight weeks after the end of the treatment. Visual analogic scale (VAS) score significantly improved from an average value pretreatment to a 50% reduction average value eight weeks posttreatment. Patients denoted a more significant improvement in VAS and empiric patient satisfaction in the group with low back pain also treated with TECAR. Acute back pain is a relatively common clinical situation. The treatments for this condition are different, and they can give 2 a crucial role in diathermia, shortwave, microwave, and tecar therapy. This study concludes that the association between painkillers, orthosis, exercises, and tecar therapy in treating low-back Pain after an amyelic vertebral spine fracture type genant, with or without leg pain, can significantly reduce pain and improve the quality of life. ''Highlights'' Diathermy Tecar is an almost new and updated physical therapy that uses electromagnetic waves to treat muscle and joint pain through capacitive and resistive pads. It provides good pain relief for several sharp pains. The physiotherapist should be trained to use them appropriately in acute settings.

A Randomized Controlled Trial Comparing the Effect of Two-Time Durations of Balloon Compression During Percutaneous Balloon Compression in Resistant Trigeminal Neuralgia

BACKGROUND: Percutaneous balloon compression of the trigeminal nerve’s gasserian ganglion for the treatment of trigeminal neuralgia is an interventional pain procedure with results comparable to microvascular decompression surgery. The procedure is safe in experienced hands and has less morbidity associated with it. However, there is a lack of clear-cut guidelines about the details of the technique like balloon shape, inflation pressure, and duration of inflation. So, keeping the inflation pressure and shape of the balloon constant, we studied the effect of the duration of inflation of the balloon and its effect on pain relief in refractory trigeminal neuralgia cases. OBJECTIVES: To study the outcome with 2 different durations of balloon inflation times in terms of pain relief and complications after percutaneous balloon compression. STUDY DESIGN: Prospective parallel design randomized, controlled trial. SETTING: The study was conducted in a tertiary care hospital in North Eastern India after obtaining approval from the Institutes’ ethics committee (Dean/2018/EC/449). The study was also registered with the Clinical Trials Registry of India (CTRI no. CTRI/2019/03/018166). All patients referred to a pain clinic for unilateral facial pain were screened for the study over 2 years from April 2019 to March 2021. METHODS: Forty patients who met the diagnosis of trigeminal neuralgia and who did not respond satisfactorily to medications were included in the study. They underwent routine blood investigations and a magnetic resonance image of the brain to rule out any medical or surgical conditions. Percutaneous balloon compression was conducted under C-arm guidance using a 12 gauge cannula and a 4 Fr Fogarty balloon was used for compressing the gasserian rootlets. RESULTS: Patients who underwent 90 seconds as well as 120 seconds showed good pain relief. The 2 groups did not show any significant difference in pain relief based on the duration of compression. Visual analog scale scores were reduced from 7-8 to 0-3. Masseter muscle weakness was present in 47.5% of patients post-procedure and recovered in all except one patient. LIMITATIONS: We have followed up with our patients for a short period of 6 months only. We could not measure the intra-luminal compression pressure of the balloon. CONCLUSION: There is no difference in the pain relief obtained by the 2 different durations of compressions. A longer duration of compression, however, has more incidence of side effects. KEY WORDS: Idiopathic trigeminal neuralgia, percutaneous balloon compression, time duration, shape of balloon, masseter muscle weakness, facial numbness, corneal dysesthesia

Percutaneous Tenotomy for Chronic Tennis Elbow: A Minimally Invasive Technique with Better Outcomes - A Case Series.

Tennis elbow (lateral epicondylitis elbow) is a self-limiting disease of indeterminate pathogenesis. Conservative therapy is the treatment of choice. In chronic tennis elbow with failure of conservative therapy; surgical treatment is a method of choice. Percutaneous tenotomy of extensor origin for patients with chronic tennis elbow is a minimally invasive technique with better long-term outcomes. Ten patients (six males, four females) presented with chronic tennis elbow, who did not respond to conservative treatment/non-surgical intervention for more than 6 months underwent percutaneous tenotomy in an outpatient setting. Two patients were lost to follow-up at 2 months' post-operative. The remaining eight patients were evaluated at a mean follow-up of 3 years and assessed using the numerical rating scale, disabilities of the arm, shoulder and hand questionnaire ,and Oxford elbow score. These scores had a statistically significant difference in baseline to 3-year follow-up values (P < 0.05). No adverse outcomes, recurrence of symptoms, and signs of lateral epicondylitis elbow were noted and none required open surgical release. Percutaneous tenotomy, a minimally invasive technique is an effective and well-tolerated treatment for chronic tennis elbow and gives good pain relief and functional recovery.

Microvascular decompression using autologous muscle graft for trigeminal neuralgia: a case series and meta-analysis.

We aimed to describe a case series of patients diagnosed with trigeminal neuralgia (TN) who were submitted to microvascular decompression (MVD) using autologous muscle graft (AMG) and perform a systematic review and meta-analysis. Forty-four adult patients who underwent MVD using AMG between 2012 and 2022 were studied retrospectively. Demographic, clinical, and surgical factors were assessed. We systematically reviewed PubMed, Embase, and Cochrane Library from inception to May 2023. We used random-effects model for all outcomes. Heterogeneity was assessed with I2. We used R software 4.3.1 for all statistical analyses. Among patients in the case series, the mean age was 52 ± 12.9 years, and the proportion of females was 65.9%. Forty-one patients (93.2%) presented complete pain relief after a mean follow-up of 7.7 years. The pooled analysis of immediate pain relief was 91.3% (95% CI 82-96%; I2=78%). The good pain relief during follow-up was 88.2% (95% CI 78-94%; I2=80%) at follow-up. The recurrence rates at 6, 12, 36 months, and during follow-up were 6.2%, 10.5%, 10.3%, and 11%, respectively. In this case series and meta-analysis of over 440 patients, our findings suggest that the practice of MVD using AMG may be an efficient option in the short term as surgical treatment for TN. Further trials should compare AMG with other materials and its effectiveness in a long-term follow-up.

Unilateral Horner syndrome and trigeminal palsy after lumbar epidural analgesia during labor

Case report: The present case report explains a rare and unusual complication of self-limiting unilateral Horner syndrome and trigeminal palsy after Lumbar Epidural analgesia for Normal delivery. A 22-year-old healthy primigravida at 38 weeks gestation, with an unremarkable medical history and prenatal course, was admitted to the hospital in active labor. Epidural anesthesia was administered during the first stage of labor under oxytocin infusion. The procedure was uneventful, with the patient experiencing good pain relief and no motor block. However, approximately 25 minutes after epidural placement, the patient reported left eyelid heaviness, decreased sensation on the left cheek, miosis, ptosis, and redness in the left eye. Neurologic symptoms were limited to this presentation, and the patient's blood pressure dropped briefly but returned to normal with ephedrine. The patient's symptoms resolved after about 3 hours. Later, the epidural catheter was repositioned, and the patient experienced pain relief for a limited time before again developing eye symptoms. Despite stable hemodynamics, the infusion was stopped, and the patient received Entonox for pain relief. Due to a failure to progress, a cesarean delivery was performed, and the patient fully recovered from the epidural block. No further signs or symptoms of Horner's syndrome or trigeminal nerve palsy were observed postoperatively. Conclusion: This case underscores the importance of recognizing and managing rare neurological complications, such as Horner's syndrome and trigeminal nerve palsy, in the context of epidural anesthesia during labor. While the symptoms observed were transient and resolved postpartum, healthcare providers should remain vigilant and ready to respond to such adverse events, ensuring the safety and well-being of both the mother and the newborn.

Microvascular decompression for trigeminal neuralgia: an experience of 84 operated cases

AimWe retrospectively analyse and review the results of microvascular decompression performed for trigeminal neuralgia. We also discuss the surgical nuances, complication avoidance and compare our results with other reported studies.Materials and methodsThis is a retrospective study in which the data of eighty-four patients who underwent microvascular decompression for trigeminal neuralgia in the last ten years from 2013 till May 2023 at our institute (Neuron hospital and SSG Hospital, Vadodara, India) was reviewed. The preoperative pain characteristics, radiology reports and the degree and duration of post-operative pain relief and neurologic outcome was assessed. MRI was done preoperatively in all the cases to rule out a secondary cause for trigeminal neuralgia. All the cases of secondary trigeminal neuralgia were excluded from the study. A favourable outcome was defined as a post-operative Barrow Neurological Institute pain intensity score of 1.ResultsEighty patients had excellent immediate postoperative pain relief without any need for medications. None of these patients have developed any recurrence of pain till date. Four operated patients did not experience any pain relief after surgery.ConclusionMicrovascular decompression for trigeminal neuralgia is a safe and effective procedure which treats the root cause of the disease and hence provides good long term pain relief.

Electroacupuncture at Trigger point gains better pain relief effectiveness than Electroacupuncture at Meridian point: A non-blind randomized trial of chronic neck pain treatment among patients at Traditional Medicine Hospital

Neck pain is one of the leading causes of disabilities and increasing economic and social burden. Methods affecting the trigger point (TrP) have initially shown good pain relief effectiveness and decreased degree of invasion in patients. The research is conducted to evaluate the effectiveness of Electroacupuncture (EA) at TrP in chronic neck pain (CNP) treatment. A non-blind randomized study on 125 patients with CNP at Traditional Medicine Hospital in Ho Chi Minh City from September 2020 to June 2021. Patients will be randomly classified into EA at the TrP group or EA at the meridian points group. There were 62 patients in the TrP group and 63 patients in the other group. After 4 weeks, in the TrP group, the Questionnaire Douleur Saint-Antoine (QDSA) score of 38.2 ± 2.6 decreased to 9.3 ± 5.7, compared with the meridian points group’s QDSA score of 37.8 ± 2.3 decreased to 12.3 ± 7.1. The percentage of patients to reach good pain relief effectiveness of EA at TrP measured by QDSA is 71.0%, statistically significantly higher than 47.6% of the other group. The decrease in the number of TrPs of EA at TrP is higher and has statistical value compared with EA at meridian points. EA at TrP showed better pain relief effectiveness, has a higher percentage of patients reaching good pain relief effectiveness measured by QDSA, and decreases the number of TrPs more than EA at meridian points does on patients with CNP.