Local Anesthetic Injection Research Articles

How does corticosteroid (CS) and local anesthetic (LA) injection compare with LA injection alone for adults with Morton's neuroma?

How does corticosteroid (CS) and local anesthetic (LA) injection compare with LA injection alone for adults with Morton's neuroma?

A Case Report on an Uncommon Complication Following the Extraction of Maxillary Molars: A Subconjunctival Hemorrhage

Background This case report presents a complication, subconjunctival hemorrhage, after extraction of maxillary first and second molar residual roots. This is a very rare complication, with only four reported cases of sub-conjunctival hemorrhage in the literature. Case Presentation In this case report, a 62-year-old woman who had an extraction of maxillary first and second molar residual roots developed sub-conjunctival hemorrhage the day after the extraction. The condition was asymptomatic, and the hemorrhage dispersed in five days without any medical intervention except regular monitoring. Conclusion Clinicians should keep this rare complication in mind and take necessary precautions during local anesthesia and extraction. Practical Implications Clinicians should consider the possibility of this post-operative complication and perform surgical procedures with the utmost care, starting from aspiration during local anesthetic injection to post-surgical management of the area to prevent hemorrhage.

CT-guided infiltration of the ischiofemoral space in young patients with ischiofemoral impingement is an effective diagnostic tool.

To present our technique of diagnostic CT-guided ischiofemoral space injection and report on pain response, complications, and associated imaging findings in young patients with ischiofemoral impingement (IFI). Retrospective case series of patients with a clinical diagnosis of IFI that underwent CT-guided IFS injection with local anesthetic in a prone position with the feet in maximum internal rotation between 06/2019 and 04/2021. The response was evaluated using maximum subjective pain evaluation on a 0-10 visual analog scale (VAS) during a standardized pre- and postinterventional clinical examination. Patient charts and radiographic imaging data were reviewed to report associated imaging findings and subsequent surgeries. Eleven patients (13 hips, 9 females) with a median age of 31 years (interquartile range; IQR: 25-37 years) were included. Median baseline VAS was 7 points (IQR: 5-8) with a pain reduction of 5 points (IQR: 5-7 points, p = 0.001) after the injection. One patient reported transient ischial nerve paresthesia, otherwise, no complications occurred. Quadratus femoris muscle edema was present in 85% (11 of 13 hips). Excessively high femoral torsion (11/13 hips, 85%) and cam deformities (8/13 hips, 62%) were the most common osseous deformities. Eight of 13 hips (62%) underwent subsequent surgery for IFI. CT-guided diagnostic injection of the ischiofemoral space is safe and feasible. In young IFI patients, diagnostic IFS injections have the potential to improve the differential diagnosis of hip pain and to inform decision-making with regard to a possible benefit of joint-preserving hip surgery. In young patients with hip pain, diagnosis of IFI can be challenging due to concomitant pathologies. Furthermore, surgical treatment in these patients is controversial. In this context, CT-guided diagnostic infiltrations of the ischiofemoral space may facilitate not only the initial diagnosis of IFI, but could also improve surgical decision-making. CT-guided diagnostic injection of local anesthetic in the ischiofemoral space is safe. In young patients with IFI, it leads to subjective pain reduction. In young patients with concomitant osseous deformities, it may improve surgical decision-making.

Pain Scoring in Uterine Evacuation for Incomplete Abortion Using Isolated Paracervical Block vs Combined Paracervical and Intrauterine Lignocaine Instillation: A Randomized Clinical Trial

Abstract Background Nerve block is a technique whereby local anesthetic solutions are infiltrated around a nerve (or perineurally) to provide anesthesia and analgesia. Nerve block for intraoperative and postoperative pain management is associated with improved analgesia, fewer opioid-related adverse events, earlier ambulation and shorter hospital stay when compared to intravenous opioid analgesia alone. Objective To compare efficacy of paracervical block alone versus combined paracervical block and intrauterine lidocaine installation in pain management of first trimesteric incomplete abortion. Patients and Methods A total of 80 women with first trimesteric incomplete miscarriage were admitted to the emergency department for uterine evacuation at Ain Shams University Maternity Hospital, in the period from September 2021 to September 2023 and underwent uterine evacuation using either paracervical block or combined paracervical block and intrauterine lidocaine instillation then pain score was obtained using visual analogue scale. Pain score was done 10 minutes after injection of local anaesthetic, 5 minutes after starting procedure and 1 hour postevacuation. Results It also showed that there was no statistically significant difference between both groups regarding need of opioids and time interval till opioids need. Exploring other factors that might have affected the success or failure of procedure in the study population it was found that age, parity were significant predictors such that the younger the age, the less the parity the more likely failure of procedure. Also being previous section was linked more to success than failure. Conclusion The combination of intrauterine lidocaine and paracervical block has no additive effect on conventional paracervical block in reducing the pain during uterine evacuation for incomplete abortion, but successful evacuation resulted in lower pain score and reduced needs for opioid.

Minimally Invasive Sacroiliac Joint Fusion versus Non Surgical Management in Chronic Sacroiliitis: A Systematic Review and Meta-Analysis

Abstract Background Sacroiliac joint fusion for low back pain attributed to sacroiliac joint is beneficial in a subset of patients. However, varied conservative treatments were measured in previous studies. Moreover, there are lack of well design and long-term follow-up studies. Aim of the Work The primary objective of this study was to determine whether sacroiliac joint fusion was superior to conservative treatment for patients with low back pain in pain and function. Materials and Methods In the current metaanalysis, the 18 studies included 1457 patients with chronic sacroiliitis, from which 841 patients underwent Non-surgical management & 616 patients underwent minimally invasive SI fusion. The mean age of pooled sample is 50 years. The follow up period ranged from 2 weeks to 72 months. Results In our meta-analysis, there was significant decrease in pain scores in patient treated with minimally invasive sacroiliac joint fusion. The decrease reported in the included studies of VAS and ODI after MISJF is clinically relevant statistically significant. In terms of pain reduction: all conservative treatment modalities showed statistically significant reduction of pain at the end of follow up except in local anesthetic injection. In terms of disability score (ODI): all conservative treatment modalities showed statistically significant reduction of ODI score at the end of follow up. There was a dramatic relief of pain in cases treated with joint fusion than those treated with conservative treatment. Using EQ-5D time trade-off scale, there was improvement in patient quality of life on patient treated with joint fusion higher than in cases of conservative management, but was statistically insignificant. We found that proportion of patients who were able to walk for distance more than one kilometer were higher in case treated with joint fusion, but it was statistically insignificant. By month 24, we observed 39 severe adverse events after sacroiliac joint arthrodesis, including sacroiliac joint pain, postoperative gluteal hematoma, and postoperative nerve impingement. With conservative treatment there were no reported complications except in one study. In fusion group few complication reported mostly were : hematoma formation, piriformis syndrome, cellulitis, deep-soft tissue infection, Implant penetration, non-displaced fracture and persistent joint pain. Conclusion In cases of low back pain related to chronic sacroiliitis, improvements in pain, and disability, observed following minimally invasive SIJF surgery was statistically significant compared to non-surgical management.

Comparison between Ultrasound Guided Quadratus Lumborum Block and Caudal Block in Children Undergoing Lower Abdominal Surgeries

Abstract Background Caudal epidural anesthesia is a widely used popular technique for postoperative analgesia. The caudal approach of the epidural space is done through the sacral hiatus. A success rate of 96% was reported, however it can cause complications such as needle trauma, infection, hematoma, inadvertent subarachnoid or intravascular injection of local anesthetic. Quadratus lumborum block (QLB) was found to be an effective method for postoperative analgesia in lower abdominal surgeries. The quadratus lumborum block is also known as the abdominal truncal block. Ultrasound-guided quadratus lumborum block is a technique that was developed to provide visceral and somatic analgesia during abdominal procedures, and it can provide perioperative analgesia for all age groups, including pediatric patients undergoing abdominal surgery. Aim of the Work The aim of this study was to compare the postoperative analgesic efficacies of QLB and the caudal block in pediatric patients undergoing lower abdominal surgeries under general anesthesia. Patients and Methods This prospective randomized controlled double-blind study was carried out on eighty patients between 6-12 years old and undergoing lower abdominal surgeries. Patients were equally categorized into two groups which are quadratus lumborum block group (40 patients) received general anesthesia followed by ultrasound- guided Quadratus Lumborum block (0.3 ml/Kg of 0.25% Bupivacaine) and caudal block group (40 patients) received general anesthesia followed by caudal block (0.5 ml/Kg of 0.25% Bupivacaine). Results VAS score measurements showed no statistically significant difference at baseline, after 1 hr, 18h and 24h postoperative, while VAS score measurements were significantly lower in QLB group than Caudal block group after 2h, 4h, 6h and 12h postoperative. Intraoperative HR and MAP measurements were insignificantly different between both groups. Postoperative HR and MAP measurements were insignificantly different at baseline, after 18h and 24h. Postoperative HR2 measurements were significantly lower in QLB group than Caudal block group after 1h, 2h, 4h, 6h, 12h, 18h and 24h. Time to first analgesic request was significantly higher in QLB group than caudal block group. Total paracetamol consumption was significantly lower in QLB group than caudal block group. Hospital stay was insignificantly different between both groups, also hypotension was reported to be significantly lower in QLB group than caudal block group. There were few cases that experienced postoperative nausea and vomiting in both groups but there was no statistically significant difference in PONV between the two groups. Conclusion Performing QLB (anterior approach) is recommended for pediatric analgesia in lower abdominal surgeries as it is more effective in decreasing total paracetamol consumption, pain scores, and prolonging postoperative analgesia time more than caudal block.

LOCAL ANESTHETIC-INDUCED ALLERGIC REACTIONS IN DENTISTRY: CURRENT PERSPECTIVES AND KEY CONSIDERATIONS

Background: Local anesthetics (LAs) are frequently utilized in dentistry. Despite their generally well-tolerated nature, they can occasionally induce adverse reactions of varying types and severity. The actual prevalence of allergic reactions to these agents remains unknown. The review objectives were to evaluate the occurrence of immediate adverse events in individuals undergoing local anaesthetic injections for dental procedures, observe the frequency of anaphylactic allergic reactions among documented adverse events, and scrutinize the relationship between the atopic history of these patients and documented allergic reactions

Efficacy of a single central injection of lignocaine at the scrotal neck on the behavioural response of lambs to castration

ObjectiveTo compare the behavioural responses of lambs to ring castration with or without local anaesthetic administration by single midline injection at the scrotal neck. Study designBlinded, randomized block design pen study. AnimalsA group of 60 male Merino lambs; 6–8 weeks of age; average body weight of 18.5 ± 0.33 (mean ± standard error of the mean) kg at the time of castration. MethodsLambs were randomly assigned to three groups of 20: 1) NUMNUTS – lamb placed in a marking cradle and ring castrated with 1.5 mL lignocaine 2%; 2) SHAM – lamb placed in marking cradle and the scrotum manipulated as though an elastrator castration ring were applied; and 3) RING – lamb placed in the marking cradle, ring castration performed using an elastrator. Pain-related behaviours annotated for 1 full minute every 5 minutes post-procedure, from video footage collected for 2 hours post-procedure, according to a defined ethogram. ResultsLignocaine administration led to significant (p < 0.05) reductions in restless behaviour at 5 and 10 minutes in NUMNUTS lambs compared with RING (mean = 0.2 ± 0.4 versus 1.0 ± 0.4, respectively) post castration. A significant (p = 0.01) reduction in foot stamping and kicking behaviour at 5 minutes post castration (mean = 1.5 ± 0.4, for RING versus 0.4 ± 0.4 for NUMNUTS) and significant (p = 0.001) reduction in the sum of all acute pain-related behaviours at 5 minutes post castration. Conclusion and clinical relevanceA single midline injection of local anaesthetic at the scrotal neck can alleviate the behavioural responses to ring castration in the immediate post-procedure period. However, the duration of effect was limited, which may be a result of the drug we used. Development of a longer-lasting local anaesthetic formulation is imperative to optimize pain mitigation for ring castration.

Intra-articular Corticosteroid Injection for Adhesive Capsulitis: A Randomized Controlled Trial

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

Comparison of Trigger Point Lidocaine Injection and Stabilization Splint Use in Myofascial Orofacial Pain Treatment

Objective: This study aims to compare the short-, medium-, and long-term efficacy of trigger point local anesthetic injection and stabilization splint use for myofascial orofacial pain. Materials and methods: Group 1 comprised 15 patients who received trigger point local anesthetic injections (LAI), while Group 2 comprised 15 patients who were treated with a stabilization splint (SS). Analysis of pain-free maximum mouth opening (MMO) measurements, jaw disability checklists (JDC), short-form McGill pain questionnaires (SF-MPQ), and Visual analog scales (VAS) were used for comparison between the groups. Results: The LAI group showed a significantly greater increase in pain-free MMO in all terms (p &lt; 0.001) and had significantly lower values on the JDC in both the medium (p = 0.026) and the long term (p = 0.006). The SF-MPQ was significantly lower in the medium term (p = 0.001) in the LAI group; the VAS showed a significantly greater decrease in the short (p = 0.016) and medium terms (p &lt; 0.001) in the LAI group. Conclusion: The results indicate that a treatment choice can be made between TN lidocaine injection and occlusal splint based on patient tolerance.

PSLBI-14 Assessment of the effective tissue concentrations of injectable lidocaine and a lidocaine-impregnated latex band for castration in calves and lambs

Abstract Tail docking in lambs and castration in lambs and calves are common husbandry practices, both of which cause pain and discomfort, for which many industries recommend or require pain management. The purpose of this study was to assess the effective tissue concentrations of the current standard of care for pain mitigation in calves and lambs during castration or tail docking (injectable lidocaine) and to assess the ability of a lidocaine-loaded elastration band (LLB) to deliver effective concentrations into the scrotal or tail tissues over time. This work comprised four different field trials (n = 50/trial): 1) effective concentrations of injectable lidocaine in the scrotal tissue of dairy calves; 2) the in vivo delivery of effective concentrations of lidocaine from LLBs placed on the calf scrotums; 3) effective concentrations of injectable lidocaine in the scrotal and tail tissue of lambs; and 4) the in vivo delivery of effective concentrations of lidocaine from LLBs placed on the lamb scrotums and tails. Sensation in the tissue of interest was assessed by electrocutaneous stimulation. Sensation was correlated to tissue concentrations of lidocaine by analyzing sampled tissue for lidocaine content by High-Performance Liquid Chromatography (HPLC). Injectable lidocaine allowed for short-term anesthesia for up to 60 min calves, highlighting the importance of finding additional strategies to mitigate long-term pain. An effective concentration (EC) yielding 50% reduction in tissue sensation (EC50) of 0.635 (95% CI 0.462 to 0.829) mg/g was calculated for calf scrotal tissue. Based on HPLC data of processed biopsy samples taken over time, the LLBs yielded tissue concentartions of lidocaine that approached EC50 and exceeded EC95 at 2 and 72 h following application, respectively, and remained above those concentartions for at least 28 d after application. In lambs, injectable lidocaine allowed for short-term anesthesia for up to 180 min following injection. An EC50 of 0.174 (95% CI 0.125 to 0.248) mg/g was calculated for lamb scrotal tissue and an EC50 of 0.0765 (95% CI 0.0533 to 0.113) mg/g was calculated for lamb tail tissue. The use of the LLB provided tissue lidocaine concentrations that met or exceeded the EC50 for at least 21 to 28 d and, based on electrostimulation data, provided local anesthesia for at least 3 d when compared with a control band. The use of an LLB could provide a practical, long-duration alternative to injectable lidocaine for pain mitigation during castration and tail docking. Further studies are warranted to compare the use of LLBs to injectable local anesthetics.

Efficacy of Intra-articular Platelet-rich Plasma versus Hydrocortisone with Local Anaesthetic Injection in Temporomandibular Joint Disorders - A Prospective Study

Abstract Introduction: Temporomandibular joint (TMJ) is subjected to many disorders commonly termed temporomandibular disorders (TMDs) which include TMJ hypermobility, ankylosis and internal derangement. In the past, many non-invasive conservative treatment modalities were tried out for their treatment which include joint unloading, the use of anti-inflammatory agents and physiotherapy. In recent times, injections of corticosteroids and platelet-rich plasma (PRP) into the TMJ have been proposed as alternative therapeutic methods. The main objective of the prospective study was to compare the efficacy of intra-articular injection of PRP and hydrocortisone with local anaesthetic agents in reducing the symptoms in patients with TMDs. Materials and Methods: This prospective study included 30 patients with TMDs, out of which 15 patients (Group I) received PRP injections and 15 patients (Group II) received hydrocortisone with local anaesthetics for arthrocentesis in their affected joints. The patients were assessed for pain, maximum interincisal mouth opening, TMJ sound and disc displacement. Results: The pain was markedly reduced in patients who received PRP injections (Group I) as compared to those who received hydrocortisone injection (Group II). An increase in mouth opening was similar in both the groups, and TMJ sounds were reduced in patients who received PRP. Magnetic resonance imaging also showed that PRP-treated patients showed better articular disc repair than patients treated with hydrocortisone. Discussion: PRP increases chondrocyte proliferation and production of matrix molecules and helps maintain the integrity of the chondral surface, thereby facilitating joint movement, whereas corticosteroids are more potent anti-inflammatory agents and they act by inhibiting prostaglandin synthesis which is the mediator of inflammation. Thus, the use of PRP has been proven to show better results in reducing the symptoms of TMDs and also helped in articular disc repair.

Cutaneous sensory block area of the laparoscopic-assisted transversus abdominis plane block.

Different approaches and techniques are used to apply a transversus abdominis plane block (TAP), but their characteristics are poorly described. Precise injection of local anaesthetic is considered crucial to achieving the desired block effect. Laparoscopic-assisted TAP (L-TAP) is a blind technique and potentially less reliable than ultrasound (US)-guided techniques. This study assessed the cutaneous sensory block area (CSBA) after an L-TAP adopting a subcostal dual block approach. Thirty elective laparoscopic cholecystectomy patients received bilateral L-TAPs. The CSBA was mapped 150 min. after block application using cold sensation and a sterile marker, photo-documented and transferred to a transparency sheet from which the area was calculated. The median CSBA of the subcostal bilateral dual L-TAP was 161 cm2 (interquartile range: 131-217 cm2; range: 67-408 cm2). In all patients, the CSBA mainly covered the skin over the epigastrium, whereas 23% also had an infraumbilical component. In none of the patients did the CSBA cover the abdominal wall laterally to a vertical line through the anterior superior iliac spine. The subcostal bilateral dual L-TAP produces a heterogeneous non-dermatomal CSBA of varying size and distribution across the medial epigastric abdominal wall, similar to the CSBA described in the existing literature on US-guided subcostal TAP. The authors have no sources of funding to declare for this manuscript. Not relevant.

Comparison of Analgesic Effect of Local Anesthetic Injection for Pain Relief During Peripheral Venous Insertion in Adult Surgical Patients: A Prospective Observational Study

PurposeIntradermal injection of local anesthetic has been reported to have greater analgesic effect for peripheral venous catheter (PVC) insertion than topical application in adult surgical patients. However, the injection of local anesthetic itself is a painful procedure compared to topical application. We compared the analgesic effect of a lidocaine-prilocaine patch with intradermal injection of 2 % lidocaine on pain intensity at the time of analgesia and PVC insertion as assessed by a visual analog scale (VAS) in adult patients. DesignA prospective observational study. MethodsAfter institutional review board (IRB) approval, we studied 70 patients scheduled for surgery and expected to have peripheral venous cannulation in the operating room. Patients who presented in the operating room with a topical anesthetic patch were assigned to the patch group, and patients who presented without a topical anesthetic patch were assigned to the injection group. The injection group received a 2 % lidocaine injection with a 26-gauge (G) needle just before PVC insertion by anesthetists. The patch group received a lidocaine-prilocaine patch on the dorsal hand 1 to 2 hours before the scheduled surgery time by ward nurses. The primary endpoints were pain using the VAS score at the time of PVC insertion and pain associated with the local anesthetic procedure. FindingsThe patch group included 34 patients (21 male, 13 female, age 61 [median], interquartile range [IQR] 45 to 69), and the intradermal injection group included 31 patients (22 male, 9 female, age 60 [median], IQR 52 to 73). All patients analyzed had a 20-G catheter in the dorsal hand. The median VAS score for PVC insertion was 4 in the intradermal injection group (IQR 0 to 14) and 2 in the patch group (IQR 0 to 16) (P = .707). Median VAS scores for the local anesthetic procedure were 16 in the intradermal injection group (IQR 10 to 32) and 0 in the patch group (IQR 0 to 0) (P < .001). ConclusionsWe found no difference in the pain intensity for PVC insertion between topical application of local anesthetic by lidocaine-prilocaine patch and intradermal injection of 2 % lidocaine. VAS scores for anesthetic application were significantly lower in the patch group. The lidocaine-prilocaine patch provided analgesia equivalent to intradermal injection with 2 % lidocaine for PVC but without the pain associated with injection of local anesthetic.

Factors associated with pseudoparalysis in patients with extensive chronic and atraumatic rotator cuff injury

BackgroundPatients with massive chronic atraumatic rotator cuff injuries can be asymptomatic or present severe shoulder dysfunction, a condition known as pseudoparalysis. Our hypothesis is that integrity of the subscapularis, hypertrophy of the Teres minor, and a complete tear of the long head of the biceps tendon are associated with improved active forward flexion range in such patients. Therefore, the objective of this study was to evaluate factors associated with pseudoparalysis. MethodsThis was a single-center cross-sectional study that included patients with massive chronic atraumatic rotator cuff injuries. Range of motion of the affected shoulder, demographic data, specific tests for rotator cuff assessment, and imaging studies were collected. ResultsA total of 68 patients (71 shoulders) were included in the study. At initial evaluation, 41 patients exhibited active forward flexion of the shoulder greater than 90º (No Pseudoparalysis group). Patients with active forward flexion less than 90º (n = 29) underwent subacromial injection of local anesthetic and were then reevaluated. In 15 patients the pseudoparalysis was resolved (False Pseudoparalysis group) and 14 maintained active forward flexion of less than 90° (True Pseudoparalysis group). ConclusionWe concluded that the presence of shoulder shrug sign, Goutallier grade III and IV fatty infiltration and a full-thickness tear of the subscapularis were risk factors for the occurrence of pseudoparalysis. Tear extension, as described by Wieser et al, also demonstrated statistical difference between groups, with greater anterior tear extension (involvement of subscapularis tendon) and greater global tear extension observed in True Pseudoparalysis group. Level of evidenceLevel III; Cross Sectional Design; Epidemiology Study

Ultrasound-Guided Blockade of the Lateral Cutaneous Branch of the Iliohypogastric Nerve to Differentiate Neuropathy From Greater Trochanteric Pain Syndrome: Cadaver Study and Initial Case Series

ObjectiveNeuropathy of the lateral cutaneous branch of the iliohypogastric nerve (LCBIN) may represent a differential diagnosis for greater trochanteric pain syndrome (GTPS). Ultrasound-guided neural blockade of the LCBIN may lead to diagnosis of this neuropathy. The aim of this study was to evaluate the accuracy of ultrasound-guided nerve block in cadavers and to present a first clinical case series of patients with neuropathy of the LCBIN where the workup for GTPS remained unremarkable. Ultrasound-guided nerve block led to pain relief in these patients, indicating LCBIN neuropathy. MethodsFirst, ultrasound-guided injections at the LCBIN were performed bilaterally in 24 fresh, non-frozen, non-embalmed body donors. Accuracy and nerve localization were validated by anatomic dissection. Second, a clinical case series of nine patients with suspected GTPS who underwent ultrasound-guided diagnostic LCBIN blockade was retrospectively analyzed. ResultsUltrasound-guided injections at the LCBIN yielded 91.7% accuracy (95% confidence interval: 0.80–0.98). On the right side the nerve was found within a range of 3–14 cm from the anterior superior iliac spine, and within a range of 7–15 cm on the left side. This clinical case series indicates that ultrasound-guided blockade at the LCBIN provides temporary pain relief and indicates the presence of LCBIN neuropathy. ConclusionUltrasound has demonstrated high accuracy for localization and injection guidance in the examination of LCBIN. Ultrasound-guided injection of local anesthetics may help to identify LCBIN neuropathy as a differential diagnosis in patients with suspected GTPS.

Assessment of Three Distinct Approaches to Postoperative Pain in Laparoscopic Inguinal Hernia Repair, a Randomized Prospective Study.

Background: Contemporarily, transabdominal preperitoneal repair (TAPP) procedure in inguinal hernia treatment is counted among the routine minimal invasive general surgery practices. Increased patient's comfort, namely less postoperative pain, is considered to be its greatest advantage. However, pain following surgery can still be an important problem. Port site local anesthetic injection (PSLAI), iliohypogastric-/ilioinguinal nerve block (IINB), and preperitoneal local anesthetic spraying (PLAS) are relatively new techniques with sparse data to address this issue. Therefore, we conducted this prospective study to evaluate these three methods in patients who underwent TAPP for inguinal hernia repair. Methods: A total of 99 patients were enrolled and randomized equally into three groups. Every patient received a patient-controlled analgesia (PCA) device. PCA usage, total analgesic demands, and numerical rating scale values were recorded at 2, 6, 12, and 24 hours postoperatively (p.o). Results: Patients' demographic data (age, gender, BMI) did not reveal any significant difference between groups (P > .05). Procedure duration was found to be significantly longer in IINB group compared with others (p < .05). Number of PCA usages, total analgesic demand, additional analgesic requirement did not differ significantly between groups at 24-hour p.o (P > .05). PLAS group was found to have less average NSR score compared with other groups at 24 hours p.o (p < .05). Conclusions: All three procedures show promising outcomes with PLAS technique appearing to be slightly superior in terms of pain management in the immediate postoperative period. However, to reach a conclusion more randomized controlled trials covering various aspects and techniques of minimal invasive approach to inguinal hernia repair should be published.

Efficacy of adductor canal and popliteal plexus block combined with local anesthetic injection in the interspace between the popliteal artery and posterior capsule of the knee and local infiltrative analgesia for postoperative pain and functional outcome after total knee arthroplasty: A randomized controlled study

BackgroundAdductor canal block and periarticular infiltration analgesia (PIA) have been shown to relieve pain in total knee arthroplasty (TKA) effectively. However, their analgesic effectiveness has some limitations. Thus, we considered a novel blocking site that could achieve analgesia without affecting the muscle strength of the lower limbs. MethodsSeventy-two patients undergoing primary unilateral total knee arthroplasty were randomized into two groups. One group was treated with adductor canal and popliteal plexus (APB) combined with interspace between the popliteal artery and posterior capsule of the knee (iPACK) and local infiltration anesthesia (LIA) and the other was treated with PIA. The primary outcomes included postoperative pain, as assessed by the visual analog scale (VAS), and the consumption of oral tramadol. Secondary outcomes included functional recovery and daily ambulation distance. Tertiary outcomes included postoperative adverse effects. ResultsThe APB group had lower VAS scores after surgery at rest and during motion. Compared with the PIA group, the walking distance of the APB group on the second day was greater. The muscle strength of the APB group was lower than that of the PIA group at the early stage. Patients in the APB group also consumed less tramadol than those in the PIA group. There was no difference in the incidence of adverse events between the two groups. ConclusionsAPB combined with iPACK and LIA is a novel block for TKA, and it can reduce postoperative pain sooner after TKA without affecting postoperative functional recovery or increasing complications.

Preoperative Hip Injection Response Does Not Reliably Predict 2-Year Postoperative Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

PurposeTo determine whether response to preoperative local anesthetic or corticosteroid intra-articular injections can predict 2-year postoperative outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). MethodsThis was a retrospective analysis of patients undergoing hip arthroscopy for FAIS at a single institution from 2014-2020. Patients who underwent preoperative intra-articular hip injection were classified based on injection type (local anesthetic, corticosteroid) and whether they experienced pain relief following injection (responders, non-responders). Responders were matched 2:1 by age, BMI, and sex with non-responders. Patient reported outcomes (PROs) including Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form Survey mental (SF-12-MCS) and physical component summary (SF-12-PCS) and visual analogue scale (VAS) pain were collected preoperatively and 2-years postoperatively. Mean score change and Minimal Clinically Important Difference (MCID) achievement were calculated and compared between groups. ResultsThe matched cohort included 126 total patients (42 non-responders, 84 responders; 74.6% female; mean ± SD age: 30.9 ± 9.9 years; BMI: 24.7 ± 3.7 kg/m2) with no differences in demographic or radiographic hip variables. Both groups demonstrated significant 2-year postoperative score improvements across all PROs, except SF-12-MCS, which remained unchanged. There was no difference in mean score change or MCID achievement across all PROs between corticosteroid injection responder and non-responder groups. In the local anesthetic group, MCID achievement was similar across all PROs, except VAS pain which showed greater percentage of MCID achievement among local anesthetic non-responders relative responders (Responders: 55.0%, Non-responders: 89.5%; p = 0.03). Significant ceiling effects were most readily apparent among the injection responders group with greater percentages of patients achieving maximal 2-year postoperative survey scores (36.9% HOOS-ADL, 19.0% HOOS-Pain, 15.5% HOOS-QoL, 32.1% HOOS-Sport). ConclusionsResponse to preoperative injection with either corticosteroid or local anesthetic did not predict 2-year outcomes after hip arthroscopy in patients with FAIS. Level of EvidenceLevel III, retrospective matched cohort study.

CT-guided steroid injections for the diagnosis and management of piriformis syndrome

Objectives: Piriformis syndrome (PS) is an extra-spinal tunnel neuropathy affecting the sciatic nerve. While typically diagnosed clinically, with confirmation through exclusion of other conditions, accurate diagnosis remains challenging. This study assesses the clinical outcomes of computed tomography (CT)-guided corticosteroid injection for suspected PS, considering its potential role as both a diagnostic and a therapeutic intervention. Materials and Methods: We conducted a retrospective review of 32 patients suspected to have PS, based on clinical presentation and examination findings, who underwent CT-guided steroid injections between July 2013 and February 2020. Effectiveness was evaluated qualitatively through clinic letters from patient reviews with a mean follow-up of 5 months (range 3–7) Results: Thirty-two patients received 44 injections. The cohort had an average age of 45 years, with many being physically active. Initial follow-up showed that 56% experienced pain relief, though 16% of these cases were short-lived. About 19% reported partial benefit, while 31% reported no improvement. Repeat injections were performed on nine patients, with some undergoing up to two repeat procedures. About 47% of patients were discharged following injections, repeats, or surgery, while 53% required further specialist input. Conclusion: CT-guided corticosteroid injections appear to be a valuable management tool for diagnosis and treatment of PS, particularly when conservative management fails. However, the long-term benefits are inconsistent, highlighting the need for a more standardized treatment pathway. Given the high degree of diagnostic uncertainty and lack of accurate diagnostic tools for PS, we propose the use of local anesthetic and steroid injections as a diagnostic approach, as well as a management option.