Nerve Block Injection Research Articles

Facet joint disorders: from diagnosis to treatment.

One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of chronic spinal pain syndromes, respectively. Common facet joint disorders are degenerative disorders, such as osteoarthritis, hypertrophied superior articular process, and facet joint cysts; septic arthritis; systemic and metabolic disorders, such as ankylosing spondylitis or gout; and traumatic dislocations. The facet pain syndrome from osteoarthritis is suspected from a patient's history (referred pain pattern) and physical examination (tenderness). Other facet joint disorders may cause radicular pain if mass effect from a facet joint cyst, hypertrophied superior articular process, or tumors compress the dorsal root ganglion. However, a high degree of morphological change does not always provoke pain. The superiority of innervating nerve block or direct joint injection for diagnosis and treatment is still a controversy. Treatment includes facet joint injection in facet joint osteoarthritis or whiplash injury provoking referred pain or decompression in mass effect in cases of hypertrophied superior articular process or facet joint cyst eliciting radicular pain. In addition, septic arthritis is treated using a proper antibiotic, based on infected tissue or blood culture. This review describes the diagnosis and treatment of common facet joint disorders.

Comparison of Pain Perception Between Local Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Patients Undergoing Orthodontic Lower Premolar Extractions

Comparison of Pain Perception Between Local Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Patients Undergoing Orthodontic Lower Premolar Extractions

Anatomical proposal of local anesthesia injection for median nerve block in treating hyperhidrosis with botulinum neurotoxin.

Hyperhidrosis, causing excessive sweat, can be treated with Botulinum neurotoxin injection. Botulinum toxin, an effective and safe treatment for hyperhidrosis, unfortunately involves significant pain due to multiple injections. This study aims to propose a more efficient and less painful approach to nerve blocks for relief, by identifying optimal injection points to block the median nerve, thereby enhancing palmar hyperhidrosis treatment. This study, involving 52 Korean cadaver arms (mean age 73.5years), measured the location of the median nerve relative to the transverse line at the pisiform level to establish better nerve block injection sites. In between the extensor carpi radialis and palmaris longus, the median nerve was located at an average distance of 47.39 ± 6.43mm and 29.39 ± 6.43mm from the transverse line at the pisiform level. To minimize discomfort preceding the botulinum neurotoxin injection, we recommend the optimal injection site for local anesthesia to be located 4cm distal to the transverse line of the pisiform, within the tendons of the palmaris longus and flexor carpi radialis muscles.

Greater Occipital Nerve Block or Suboccipital Intramuscular Injections are effective for management of Postdural Puncture Headache: A placebo-controlled study

Greater Occipital Nerve Block or Suboccipital Intramuscular Injections are effective for management of Postdural Puncture Headache: A placebo-controlled study

Evaluating the effect of using anti-stress balls as a distraction technique in reducing pain during inferior alveolar nerve block injection: a randomized clinical trial.

The aim of this study is to evaluate the effect of using anti-stress balls in reducing patients' pain during injection of the inferior alveolar nerve block (IANB). In this randomized clinical trial, 32 individuals were divided into two groups. The conventional method of anesthesia injection was performed using IANB conventional injection technique. During the injection, individuals in the anti-stress ball group were asked to use the anti-stress ball as a distraction technique. For the control group, no supersede methods were used for pain control. Finally, both groups were asked to record their pain utilizing the numerical rating scale (NRS). The participants' vital signs were monitored before and after injection. Kolmogorov-Smirnov test, independent T-test, and Fisher's exact chi-square test were performed for statistical analysis (α = 0.05). Sixteen females and 16 males in the age range of 40 to 20years old participated in this study. The mean pain score in the anti-stress ball group was significantly lower (p < 0.001). In both sexes, the pain score in the anti-stress ball group was significantly lower (males p < 0.001 and females p = 0.001). In addition, in all age ranges, the pain score in the control group was higher except for the above 35years old participants (p = 0.078). Moreover, there were no significant differences in individuals' vital signs (p > 0.05). Utilizing an anti-stress ball reduces patients' pain significantly during IANB in both sexes and individuals who are below 35 yearswithout changing vital signs. IRCT20220815055704N1.

Pain relief after major ankle and hindfoot surgery with repetitive peripheral nerve blocks: A feasibility study.

Major ankle and hindfoot surgery (e.g., ankle, triple and subtalar arthrodesis) typically causes severe postoperative pain, especially the first two postoperative days. Current modalities of postoperative analgesic treatment often include continuous peripheral nerve blocks of the saphenous and sciatic nerves via catheters in order to extend the duration of pain- and opioid-free nerve blockade to 48 h. Unfortunately, the 48 h-efficacy of continuous infusion via a catheter is reduced by a high displacement rate. We hypothesised that one-time repetition of the single injection peripheral nerve blocks would provide effective analgesia with a low opioid consumption the first 48 postoperative hours. Eleven subjects preoperatively received a popliteal sciatic and a saphenous single injection nerve block with a protracted local anaesthetic mixture. Surgery was performed under general anaesthesia. The one-time repetition of the single injection nerve block was carried out approximately 24 h after the primary nerve block. The main outcomes were pain and cumulative opioid consumption during the first 48 postoperative hours. Nine of the 11 (82%) patients had effective analgesia without opioids during the first 48 postoperative hours. Two patients each required a single dose of 7.5 mg of oral morphine equivalents after 43 h. One-time repetition of single injection saphenous and sciatic nerve blocks consistently provided effective analgesia practically without opioids for 48 h after major elective ankle and hindfoot surgery.

Epidural Injection Method for Long-Term Pain Management in Rats with Spinal Stenosis.

Epidural injection is one of the most common nonsurgical treatment options for long-term pain relief in lumbar spinal stenosis. Recently, various nerve block injections have been used for pain management. Among them, nerve block through epidural injection is a safe and effective method for the clinical treatment of low back or lower extremity pain. Although the epidural injection method has a long history, the effectiveness of long-term epidural injections in disc diseases has not been scientifically proven. In particular, to verify the safety and efficacy of drugs in preclinical studies, the route and method of drug administration in terms of the clinical application method and duration of use must be established. However, there is no standardized method for long-term epidural injections in a rat model of stenosis to identify the precise efficacy and safety of epidural injections. Therefore, standardizing the epidural injection method is very important for evaluating the efficacy and safety of drugs used for back or lower extremity pain. We describe the first standardized long-term epidural injection method for evaluating the efficacy and safety of drugs according to their route of administration in rats with lumbar spinal stenosis.

Effect of the inferior alveolar nerve block injection versus maxillary infiltration with two local anesthetic agents on cardiovascular parameters: A randomized comparative double-blind clinical trial

Abstract This study aimed to assess the effect of inferior alveolar nerve (IAN) block of the mandible and infiltration anesthesia of the maxilla using lidocaine plus epinephrine or prilocaine with felypressin anesthetic agents on systolic and diastolic blood pressures, heart rate (HR) and peripheral oxygen saturation rate of patients. This randomized double-blind clinical trial evaluated 112 patients in four groups (n=28) based on the jaw (maxilla or mandible) and type of anesthetic agent (lidocaine with epinephrine or prilocaine with felypressin). Groups 1 and 2 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, with 2% lidocaine plus 1:80.000 epinephrine. Groups 3 and 4 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, using prilocaine with felypressin. Systolic and diastolic blood pressures and HR were measured by an automatic upper arm blood pressure monitor and the percentage of peripheral oxygen saturation rate was measured by a finger pulse oximeter 10 minutes before the injection, immediately after injection, 10 minutes after injection and 20 minutes after injection. The mean diastolic blood pressure showed a greater reduction following the administration of lidocaine with epinephrine, as compared with prilocaine with felypressin (p&lt;0.001). The mean HR showed a significantly greater increase following the administration of lidocaine with epinephrine, as compared with prilocaine with felypressin (p&lt;0.001). The effect of type of anesthetic agent on diastolic blood pressure depended on the type of injection (p=0.033). Administration of 2% lidocaine with 1:80.000 epinephrine, in comparison to prilocaine with felypressin, can cause changes in cardiovascular parameters such as heart rate and diastolic blood pressure in patients undergoing restoration of a maxillary or mandibular molar tooth. Type of injection has no significant effect on cardiovascular parameters.

What's New in Sports Medicine.

What's New in Sports Medicine.

Utility of thermographic evaluation in spinal cord stimulation therapy DTM workflow for thoracolumbar compression fracture and lumbar spinal canal stenosis

Among the orthopedic conditions that cause low back pain, many patients with thoracolumbar compression fractures and lumbar spinal canal stenosis caused by osteoporosis visit orthopedic surgeons. However, many patients do not respond to analgesics or nerve block injections, and many are at risk or unwilling to undergo surgery due to age or underlying disease. We believe that spinal cord stimulation therapy is a new treatment option for orthopedic low back and leg pain. We have performed spinal cord stimulation for chronic intractable pain in patients with thoracolumbar spine compression fractures and lumbar spinal canal stenosis who had lower limb pain and back pain. There are few reports of spinal cord stimulation therapy treatment by orthopedic surgeons. In many cases, medical medications and nerve blocks do not improve the pain, and surgical treatment may be performed. We evaluated whether minimally invasive spinal cord stimulation therapy for orthopedic diseases improves pain by altering blood flow to the lower extremities using thermography. Methods: Thermography and NRS of both lower extremities were measured before and after spinal cord stimulation therapy in 27 patients (15 women and 12 men) with back and leg pain due to thoracolumbar spine compression fracture and lumbar spinal canal stenosis. Results: Thermography showed an increase in body surface temperature of approximately 6°C. NRS showed an average improvement of 6.4. Discussion: Spinal cord stimulation therapy may improve blood flow in both lower limbs and lower back and leg pain, especially for back and leg pain caused by thoracolumbar vertebral compression fracture and lumbar spinal canal stenosis, among other orthopedic diseases. Thermography is likely to be useful as an evaluation tool.

Ultrasound-Guided Combined Greater Occipital Nerve Block at the C2 Level with Trapezius Trigger Point Injection and Supraorbital-Supratrochlear Nerve Block: More Effective on Allodynia and Disability in Chronic Migraine.

Chronic migraine (CM) patients with cutaneous allodynia (CA) show a poor response to treatment. Long-term studies have yet to be conducted to demonstrate the efficacy of blocks on CA. This study evaluated the improvement in allodynia and disability in CM treated with ultrasound (US)-guided blocks. In this prospective, non-randomized comparative study, 60 CM patients with CA were evaluated for the clinical effectiveness of the therapy using the numeric rating scale (NRS), headache impact test-6 (HIT-6), brush allodynia test, and allodynia symptom checklist (ASC-12). At the first visit, tenderness in the nerve or trapezius muscle was confirmed in the intervention group. US-guided greater occipital nerve block (GONB), GONB, and trapezius muscle injection (TPI), or GONB, TPI, and peripheral trigeminal nerve block (PTNB), respectively, were performed four times once a week for a month. Initial and third-month assessments were performed. The ASC-12 scores decreased in the GONB+TPI+PTNB and GONB groups more than the GONB+TPI group (mean rank, respectively, 26.86, 27.40, 38.39; P = 0.018). The decrease in HIT-6 scores was greater in the GONB+TPI+PTNB group than in the GONB group (mean rank, respectively, 21.98, 39.95, P < 0.017) in the first month. In the third month, the GONB+TPI+PTNB group scored HIT-6 significantly lower than GONB and GONB+TPI (mean rank: 18.84, 38.73, 35.61; P < 0.001). GONB+TPI+PTNB was more successful in alleviating allodynia and disability.

A survey to evaluate and compare patients perception to pain, pressure and discomfort induced by types of injection techniques used for mandibular anaesthesia

Local anaesthesia makes the patient and the dentist comfortable to do treatment with least amount of discomfort, but dental patient’s most frequent fear is of receiving local anaesthetic injections. The present study attempted to evaluate and compare patient’s perception to pain, pressure and discomfort induced by three types of injections (Infiltration, mental nerve block and inferior alveolar nerve block injection) for mandibular anaesthesia. Patients were asked to grade pain, pressure and discomfort associated with injection insertion on visual analog scale. Inferior alveolar nerve block was graded the most painful nerve block, while Infiltration was graded as the least painful. Patient’s perception to pressure and discomfort was highest for inferior alveolar nerve block and lowest to mental nerve block.

Assessment of Anatomical Location and Variation of Mandibular Foramen Using Cone-Beam Computed Tomography: A Cross-Sectional Study

Background: Determining the exact location of mandibular foramen is an important factor prior to Inferior Alveolar Nerve (IAN) block injection. The aim of this study is to assess the position of Mandibular Foramen (MF) and its variations using Cone-Beam Computed Tomography (CBCT).&#x0D; Methods: This study was conducted on CBCT images of 80 females and 80 males (18 to 68 years). The distance between the MF and the anterior border of ramus (A), inferior border of mandible (B), superior border of mandible (C), and occlusal plane was measured. Data were analyzed by the student t-test, bivariate correlation analysis, paired sample t-test, and Pearson’s correlation coefficient.&#x0D; Results: The mean amount of A, B and C distances, and the mean distance from the occlusal plane to the center of MF were 13.76, 24.24, 12.32, and 7.59 mm, respectively, with no significant difference between the right and left sides (p&gt;0.05). The mean B and C distances were significantly smaller in females than males (p&lt;0.05). The mean size of the measured angle was 43.2°. Significant correlations were noted between aging and decreased A distance, and reduction in the angle between the contralateral premolars and MF (p&lt;0.05).&#x0D; Conclusion: Knowledge about the position of MF can enhance the surgical procedures in this region. Using a 21-25 mm needle would be associated with lower risk of needle fracture during IAN block injection. Also, needle insertion angle &lt;45-degrees is optimal for the samples assessed in this study.

Comparison of two techniques of airway anaesthesia for awake fibreoptic nasotracheal intubation in patients with anticipated difficult airway

Introduction: The success of awake fibreoptic assisted intubation often depends on the adequacy of anaesthesia of the airway and patient comfort for the procedure. Aim: To compare the standard technique (nerve block) of airway anaesthesia with simple aspiration of lignocaine. Methods: Thirty patients in whom difficult airway was anticipated were randomly allocated into either Group A (Aspiration) and Group B (Nerve block). In Group A, 0.2 mL/kg of 1.5% lignocaine was trickled on to the dorsum of the tongue while the patient was encouraged to breathe through the mouth. In Group B, superior laryngeal nerve block and intratracheal injection of lignocaine was used. Fibreoptic bronchoscopy was then carried out by a consultant anaesthesiologist, who was blinded to the local anaesthetic technique used. The patient responses to instrumentation of pharynx, glottis and trachea, and tolerance of the endotracheal tube were noted. Results: Two cases were excluded from the study because of bleeding resulting in subsequent loss of visualisation of glottis through bronchoscope. There was no statistical or clinical difference in the patient responses between the two groups (P &gt; 0.05) due to fibreoptic bronchoscope in the pharynx, larynx and endotracheal tube in the trachea or with regard to the use of rescue medications. Conclusions: Aspiration of 1.5% lignocaine (0.2 mL/kg) provides clinically comparable conditions for intubation as the nerve block technique for awake fibreoptic nasotracheal intubation in patients with anticipated difficult airway.

ERECTOR SPINAE PLANE BLOCK CATHETER: A GOAL STANDARD FOR THORACIC ANAESTHESIA?

<h3>Background</h3> Recent advances in Enhanced Recovery post Thoracic surgery has introduced various fascial plane blocking techniques that block dorsal, lateral, and anterior cutaneous nerves of the thorax and abdomen. Erector spinae plane (ESP) block is a relatively novel truncal nerve plane block increasing used in thoracic analgesia. Blockage of dorsal and ventral rami of the thoracic nerves allows for effective pain management post open thoracotomies and video assisted thoracic surgery. Due to limitation by duration of action of single shot nerve blocks,(paravertebral and ESP block), continuous pain relief using catheters have been widely used with good patient outcome. <h3>Method</h3> Patients undergoing elective and urgent thoracic surgeries under general anaesthesia in a single thoracic and trauma unit in the United Kingdom were appropriately selected based on comorbidities, performance status, and indication plus duration of thoracic surgery. Retrospective data on single shot nerve block injections and patient-controlled analgesia (PCA) use was collected for fifty patients. Prospectively, ESP catheter was inserted in fifty patients by consultant anaesthetist or thoracic surgeon pre procedure and post routine intraoperative anaesthesia care and multimodal analgesia. We compared total opioid consumption, postoperative pain scores (visual analog scale), mobility with physiotherapy, complications, and length of stay. <h3>Results</h3> Forty patients were included in both groups. Five cases were removed due to incomplete data. Total opioid consumption over 24 hours and 48 hours was measured. Total opiod consumption was significantly low in patients receiving continuous ESP catheters. Pain score was lower in the recovery and post operative ward in patients with ESP catheters. Pain nurse review in ESP catheter group day 1 postoperatively allowed for better optimisation of analgesia, improved adherence to documentation of acute pain observation chart. ESP catheter did not affect physiotherapy care and patients completed 100m in less than 48 hours. There was no statistically significant difference in adverse effects between single shot vs catheter patients, however, increased PCA use in single shot blocks contributed to post operative drowsiness and nausea in five patients. <h3>Conclusion</h3> ESP catheter has shown to provide safe and effective analgesia post thoracic surgery while decreasing opioid consumption. We could demonstrate a significant improvement in patient outcome, with the ESP catheters when compared to single shot blocks. Early physiotherapy and good analgesics provided early mobilization and less days in hospital stay and reduced complications. On account of technical ease and low procedural risk of ESP block under ultrasound guidance, it is favorable for use in thoracic surgery compared to more invasive nerve blocks. More education, compliance and multimodal care is required to utilize ESP catheter for successful postoperative pain management.

PO148 / #309 EVALUATION OF SPINAL CORD STIMULATION THORACOLUMBAR COMPRESSION FRACTURE AND SPINAL CANAL STENOSIS: E-POSTER VIEWING

According to the 2019 National Survey on Basic Living Conditions by the Ministry of Health, Labor and Welfare, low back pain is a common disease with the complaint rate ranking the first for men and the second for women. Relating the orthopedic diseases of low back pain, many patients visit medical institutions, with thoracolumbar compression fracture and lumbar spinal canal stenosis caused by osteoporosis. However, many patients do not respond to analgesics and nerve block injections, and hesitate to undergo surgery with consideration of the risks associated with age and underlying diseases.

A Prospective Clinical Study Evaluating the Efficacy of Intra-Ligamentary Anesthetic Solutions in Mandibular Molars Diagnosed as Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis.

Accomplishing painless endodontic treatment, especially in the mandibular molar region, is challenging. Hence, the aim of the study was to compare the efficacy of 2% lidocaine and 4% articaine when used as supplemental intra-ligamentary (IL) anesthesia in mandibular molars having symptomatic irreversible pulpitis with symptomatic apical periodontitis after failed Inferior Alveolar Nerve Block (IANB) injection. In this prospective study, one-hundred and forty-seven adult patients diagnosed with irreversible pulpitis in a mandibular tooth were included who received IANB with 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Patients who experienced pain were recorded using the Heft–Parker visual analog scale (HP-VAS score ≥ 55 mm) and received supplement intra-ligament injection with either4% articaine or 2% lidocaine with 1:100,000 epinephrine. Supplementary intra-ligament injections resulted in 82.6% and 91.3% of profound anesthesia in the first molar region for 2% lidocaine and 4% articaine, respectively. Similarly, an additional IL injection of articaine success percent (78.9%) in the second molar region was higher than lidocaine (63.1%). The overall success ratio revealed no significant difference in achieving profound anesthesia of either solution. In this study population, there was no difference in the success ratio of anesthesia between 2% lidocaine and 4% articaine when used as supplemental IL injection.

Onset of action and duration of efficacy of inferior alveolar nerve block versus single lingual subperi-osteal injection of 4% articaine in mandibular second molars: A randomized clinical trial

Onset of action and duration of efficacy of inferior alveolar nerve block versus single lingual subperi-osteal injection of 4% articaine in mandibular second molars: A randomized clinical trial

A case report of native vertebral osteomyelitis caused by Cutibacterium modestum

BackgroundCutibacterium modestum was named in 2020. C. modestum was previously called Propionibacterium humerusii. Several implant-associated infections caused by Cutibacterium species have been previously reported, but native vertebral osteomyelitis due to these bacteria has rarely been reported.Case presentationA 72-year-old man, who had previously received several nerve block injections for low back pain, was referred to our hospital for deterioration in back pain in the last 1 month. MRI findings were suggestive of L5-S1 vertebral osteomyelitis. Blood cultures and bone biopsy culture revealed the presence of Gram-positive bacilli. The isolate was identified as C. modestum by 16SrRNA gene sequencing. A diagnosis of vertebral osteomyelitis caused by C. modestum was made. Minocycline followed by oral amoxicillin was administered for 3 months. His symptom improved and did not recur after treatment completion.ConclusionA case of vertebral osteomyelitis caused by C. modestum was encountered. Although C. modestum is very similar to C. acnes, it could be accurately identified by 16SrRNA gene sequencing. This case represents the first documented C. modestum infection in humans.

A Systematic Review on Nerve-Related Adverse Effects following Mandibular Nerve Block Anesthesia.

Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. The aim of the present systematic review is to assess the nerve-related adverse effects of IAN block anesthesia. A structured and systematic search was performed on the major electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and CINAHL) for studies published in English until 30 September 2021. A total of 131 articles were identified through database searching using combinations of keywords. Fifteen papers were included and assessed for eligibility. Overall, nerve damage following an IAN block anesthesia injection is a rare occurrence, probably due to the direct nerve trauma of the needle, a neurotoxic effect of the used anesthetic solution and/or a combination of them. From a medico-legal point of view, a balanced discussion prior to nerve block anesthesia should be pursued in order to avoid patients’ reluctance to undergo necessary dental treatment due to the remote eventuality of nerve injury.