Nerve Injection Research Articles

Effect of Lingual Nerve Block and Localised Somatosensory Abnormalities in Patients With Burning Mouth Syndrome-A Randomised Crossover Double-Blind Trial.

To investigate the effect of a lingual nerve block on spontaneous pain in patients with burning mouth syndrome (BMS) and to estimate associated somatosensory abnormalities by quantitative sensory testing (QST). A standardised QST battery including cold detection threshold (CDT), warmth detection threshold (WDT), thermal sensory limen (TSL), paradoxical heat sensation (PHS), cold pain threshold (CPT), heat pain threshold (HPT), mechanical pain threshold (MPT), wind-up ratio (WUR) and pressure pain threshold (PPT) was performed at the oral mucosa of the most painful site and intraoral control site in 20 BMS patients, and at the tongue and cheek mucosa in 22 age- and gender-matched healthy controls. The effect of a lingual nerve block on spontaneous burning pain reported by the BMS patients on a 0-10 cm visual analogue scale (VAS) was investigated in a randomised double-blind crossover design using (1 mL) lidocaine (lido) or saline (sal) with an interval of 1 week. The BMS patients were grouped into 'central' and 'peripheral' mechanisms based on the effect of the lingual nerve injections. For each BMS patient, Z-scores and Loss/Gain scores were computed. Differences among groups and sites were analysed using a two-way ANOVA. Differences within group were assessed by paired t-test. The 20 BMS patients were characterised on the basis of VAS changes (ΔLido-ΔSal) as a peripheral BMS subgroup (n = 9) with pain relief more than 1 cm on the VAS and a central BMS subgroup (n = 11) with pain relief less than 1 cm. BMS patients (n = 20) had lower sensitivity to thermal stimuli (i.e., CDT, WDT, TSL, CPT, HPT and PPT) and higher sensitivity to mechanical stimuli (i.e., PPT) compared with controls (p ≤ 0.007). Based on Loss/Gain coding, L1G0 (loss of thermal somatosensory function with no somatosensory gain, 55.0%) was the most frequent coding in the BMS group, which was higher than 11.4% in the control group (p < 0.001). Surprisingly, there was no significant difference between the peripheral and central BMS subgroups with regard to the Z-scores of any of the nine QST parameters (p > 0.097). The results of the lingual nerve blocks demonstrated two distinct phenotypes with either peripheral or central mechanisms but no direct impact on somatosensory function. Overall, somatosensory function in BMS patients seems abnormal in the painful areas compared to matched controls with a conspicuous loss of thermosensory function.

Current and Novel Therapies for Cluster Headache: A Narrative Review.

Cluster headache (CH) is an excruciating and debilitating primary headache disorder. The prevalence is up to 1.3%, and the typical onset is around age 30. Often misdiagnosed as migraine, particularly in children, the diagnosis rate of CH has been increasing among women. CH is characterized by intense unilateral pain and autonomic symptoms, significantly impacting patients' quality of life, mental health, and productivity.Genetic associations suggest a familial risk for developing CH, with lifestyle factors also potentially playing a role. The pathophysiology involves alterations in both central and peripheral nervous system, with the hypothalamus, trigeminocervical complex, and neuropeptides such as calcitonin gene-related peptide (CGRP) being implicated.Nonpharmacological treatments focus on patient education and lifestyle modifications, while pharmacological treatments include acute therapies such as oxygen and subcutaneous or nasal sumatriptan, as well as preventive therapies like verapamil, lithium, and CGRP monoclonal antibodies. Transitional options include oral corticosteroids and greater occipital nerve injections. Emerging interventional procedures offer new avenues for managing refractory cases. Noninvasive vagal nerve stimulation and occipital nerve stimulation show promise for both acute and preventive treatment. Careful consideration of safety profiles is crucial in specific populations such as pregnant patients and children.Current treatments still leave patients highly burdened by limited efficacy and side effects. Future research continues to explore novel pharmacological targets, interventional procedures, and the potential role of psychedelics in CH management. Comprehensive, multifaceted treatment strategies are essential to improve the daily functioning and quality of life for individuals with CH.

Survey of Practice Patterns in the Use of Superior Laryngeal Nerve Blocks.

Superior laryngeal nerve (SLN) injection is performed for a variety of upper aerodigestive tract-related indications. Existing literature examines the efficacy of SLN injection for specific indications. However, there is a paucity of insight into overall practice patterns and a lack of standardization, particularly with regards to medication and dosing, treatment time frame, and circumstances. The goal of this study is to elucidate the practice patterns of SLN injection and allow for broader understanding of its utilization. This is a descriptive study of results from an electronic survey disseminated via email to US-based and international otolaryngologists and laryngologists. 80 responses were collected. 53.8% responders endorsed utilizing SLN injection in their practice, including 39/43 laryngologists (90.7%). Responders perform SLN injection for an array of indications, using a variety of anesthetic and steroid combinations and dosages. The most used steroid is triamcinolone (81.4%). The most used anesthetic is lidocaine (53.5%). 43% of respondents endorse willingness to perform bilateral injections simultaneously. Follow-up after initial injection is highly inconsistent, as are time intervals between injections and number of injections performed. With regards to side effects and complications discussed prior to the procedure, 95% counseled patients on pain/discomfort while roughly half of responders discussed bleeding/hematoma, aspiration risk, vasovagal response, and/or globus sensation, respectively. This is the first known study investigating the practice patterns of SLN injection. The substantial variability of responses reflects a lack of standardization of this procedure despite its widespread use. Further study is needed to optimize protocols. Levels 5 and 6 Laryngoscope, 2024.

The Impact of Pudendal Nerve Injection in Vaginal Surgery: A Secondary Analysis

Importance Evidence regarding the effect of pudendal nerve blockade during vaginal surgery is conflicting. Previous studies compared pudendal nerve blockade to either normal saline placebo injection or no injection, demonstrating small or no difference in pain outcomes. Studies investigating nerve blocks at the time of vaginal surgery have not evaluated the effect of infiltration of the space around the pudendal nerve. Objective The aim of the study was to determine whether intraoperative pudendal nerve injection (bupivacaine or normal saline) will result in improved pain scores and satisfaction compared with patients who receive no pudendal injection. Study Design We performed a secondary analysis of 2 randomized controlled trials investigating postoperative pain after vaginal reconstructive surgery, comparing the outcomes of the following 3 groups: control (no pudendal injection), intervention (bilateral pudendal nerve blockade), and placebo (bilateral normal saline pudendal injections). The primary outcome was postoperative pain scores. Secondary outcomes were opioid use, patient satisfaction, and postoperative complications. Linear mixed effects models were applied to outcomes, and treatment effects with 95% confidence intervals were estimated at each time point from the model. Results One hundred four patients who underwent vaginal surgery were included: 36 pudendal nerve block, 35 normal saline pudendal injection, and 33 no injection. The groups were well-matched. Linear mixed effects models demonstrated no significant differences between treatment groups for postoperative pain severity scores, opioid use, and patient-reported satisfaction at each time point. Conclusions Normal saline injection and no injection seem to have no clinically meaningful difference in effect, and either could reasonably serve as control for pudendal blockade during vaginal surgery.

Peripheral Nerve Injury After Deoxycholic Acid (ATX-101) Injection in an Experimental Rat Model.

Deoxycholic acid (ATX-101) is a drug administered by subcutaneous injection for local fat reduction. However, ATX-101 treatment has been reported to cause marginal mandibular nerve injury with noticeable functional deficits when targeting submental fat. As a cytolytic agent with some selectivity for adipocytes, ATX-101 may damage the lipid-rich myelin surrounding peripheral nerves. This study seeks to characterize the nerve injection injury from ATX-101 in an experimental rat model. Using a rat sciatic nerve injection model, intrafascicular and extrafascicular injections of deoxycholic acid (ATX-101) were compared to lidocaine (positive control) and saline (negative control). Nerves were harvested at a 2-week endpoint for histomorphometric analysis. Cross-sectional area of nerve injury was significantly increased by ATX-101 injection at 75±15% with intrafascicular ATX-101 (p<0.001), 41±21% with extrafascicular ATX-101 (p<0.01), and 38±20% with positive control lidocaine (p<0.01) compared to 7±13% with negative control saline. Demyelinating injury was a significant mechanism of injury in the affected nerve fibers compared to uninjured nerve fibers (p<0.04), but there was no difference in axon-to-myelin area ratio between the lidocaine and ATX-101 cohorts. After two weeks, Wallerian degeneration was evident with only small regenerating nerve fibers present in the ATX-101-injured groups compared to saline (2.54±0.26um vs 5.03±0.44um, p<0.001) in average width. Deoxycholic acid (ATX-101) is capable of extensive nerve injury in rats. The mechanism of action for ATX-101 does not preferentially target myelin more than other common neurotoxic agents. Appropriate knowledge of surgical anatomy and injection technique is necessary for any practitioners providing ATX-101 injections.

Role of Adjuvants in Enhancing the Efficacy and Duration of Anesthesia Blocks: A Comprehensive Review.

Anesthesia blocks are integral to modern pain management, offering targeted and effective relief for various surgical and procedural interventions. These techniques, including regional and peripheral nerve blocks (PNBs), involve the administration of local anesthetics to specific body areas, either through epidural, spinal, or direct nerve injections. While effective, incorporating adjuvants, substances added to local anesthetics, can significantly enhance their efficacy and prolong their duration. Adjuvants such as opioids, corticosteroids, alpha-2 agonists, and nonsteroidal anti-inflammatory drugs (NSAIDs) are used to amplify analgesic effects, reduce the need for general anesthesia, and improve postoperative outcomes. This review explores the role of adjuvants in optimizing anesthesia blocks, examining their mechanisms of action, clinical benefits, and safety considerations. Adding adjuvants can lead to enhanced pain control, reduced dosage of local anesthetics, and fewer systemic side effects. By integrating adjuvants into anesthesia practice, clinicians can achieve more precise and sustained pain management, tailoring approaches to individual patient needs and specific procedural demands. This comprehensive review highlights current evidence on using adjuvants, their impact on anesthesia block effectiveness, and future research directions. Understanding the role of adjuvants is crucial for improving patient outcomes and advancing pain management techniques in various surgical settings.

Effects of meridian sinew tuina after identifying the treatment area under ultrasound localization combined with greater and third occipital nerve injections in cervicogenic headache: a randomized controlled trial protocol.

Cervicogenic headache (CEH) is a secondary headache characterized by chronic, unilateral headache. Ultrasound-guided injections of the greater occipital nerve (GON) and the third occipital nerve (TON) are effective in the treatment of CEH, as is meridian sinew tuina for the treatment of CEH, but the evidence of clinical efficacy of combining these two therapies is valid. Therefore, we have designed a randomized controlled trial with the aim of investigating the efficacy and safety of ultrasound localization meridian sinew tuina combined with GON and TON injections for the treatment of CEH. In this study, we enroll 60 patients experiencing CEH. The control group receives ultrasound-guided injections of GON and TON. The intervention group is treated with ultrasound localization meridian sinew tuina combined with the injection of GON and TON. Meridian sinew tuina is performed once a day for 30 min for 3 days. The primary observational index includes the Short-Form of McGill Pain Questionnaire (SF-MPQ). The Secondary outcomes include Cervical Range of Motion (ROM) and Medical Infrared Thermography (MIT). MIT is used to measure the change in skin temperature in the area of the patient's meridian sinew tuina treatment of GON and TON before and after the intervention. There are 5 time points assessed as baseline, day 3, day 15, day 30, and day 60. This study proposes to combine ultrasound-guided injections of GON and TON for the treatment of CEH after identifying the treatment area of meridian sinew tuina under ultrasound localization. Meanwhile, MIT is utilized to provide objective evidence of the efficacy of CEH. ChiCTR2300076128.

Ultrasound-guided trigeminal nerve approach at the level of the pterygopalatine fossa in cat cadavers

ObjectiveTo describe an ultrasound-guided suprazygomatic approach to the trigeminal nerve block in cat cadavers. Study designProspective descriptive study. AnimalsTen feline cadaver heads. MethodsA 25:75 methylene blue–iopamidol mixture (0.1 mL cm–1 cranium length) was injected into 10 cadaver heads using an ultrasound-guided suprazygomatic approach. A computed tomography (CT) scan was performed to identify contrast presence at the orbital fissure, foramen rotundum and ovale, followed by anatomical dissection to identify staining of the pterygopalatine fossa (PPF), extraconal retrobulbar area, mandibular and maxillary nerves. Descriptive statistics were used to summarize results. ResultsA total of 20 injections were performed. Of these, 1/20 misinjection occurred and excluded from further reporting. The volume of injectate was 0.9 (0.9–1.1) mL [median (range)]. Staining of the PPF, extraconal space, maxillary and mandibular nerves over more than 6 mm was achieved in 19/19 (100%), 18/19 (95%), 17/19 (89%) and 19/19 (100%) of injections, respectively. CT showed presence of contrast within 5 mm of the orbital fissure, foramen rotundum and ovale in 18/19 (95%), 19/19 (100%) and 19/19 (100%) of the injections, respectively. No intracranial migration was observed. Conclusions and clinical relevanceThis cadaver study illustrates that the suprazygomatic ultrasound-guided trigeminal nerve injection technique can successfully stain the PPF, retrobulbar cone extraconally, mandibular and maxillary nerves. Consequently, this technique has the potential to be used in vivo in cats to desensitize areas innervated by the trigeminal nerve.

Mylohyoid Nerve Injection for Unsuccessful Anesthesia of Posterior Teeth with Successful Inferior Alveolar Nerve Block.

Background and objective: variations in mylohyoid could lead to failure of an inferior alveolar nerve blockade. This study aimed to evaluate the impact of mylohyoid nerve variation on the persistence of pain following a successful inferior alveolar nerve block. Method: This clinical study was performed at the oral and maxillofacial department/college of Dentistry, Hawler Medical University. All patients with pain following a successful inferior alveolar nerve block were enrolled in this study. An additional submucosal injection (infiltration technique) as few drops in the lingual mucosa of the offending tooth is given by the same surgeon Results: A total of fifty patients were enrolled in this study,30 males and 20 females. age range was (16-56). Among the total only 20 patients (60%females,40% males) experienced pain on the lingual side during the attempt of dental extraction. Following lingual infiltration, all the cases were treated successfully in a pain free environment. Descriptive statistics was used to analyze the data. Conclusion: Lingual submucosal injection of 1/3 of 1.8 ml of local anesthesia might be an effective way to block all possible nerve variation on the lingual side. Keywords: Inferior alveolar nerve block (IANB), mylohyoid nerve variation, lingual mucosal infiltration, pain.

Upscaling Facial Nerve Injections: Ultrasound Guidance to Avoid "Minimal Complications".

Upscaling Facial Nerve Injections: Ultrasound Guidance to Avoid "Minimal Complications".

Ulnar Nerve Hydrodissection at the Elbow With Ultrasound Guidance

Background: Ulnar neuropathy at the elbow (UNE) is common, and treatment ranges from bracing and nonsteroidal anti-inflammatory drugs (NSAIDs) to surgical decompression. Prior to surgical intervention, some patients may opt to receive perineural injections to the ulnar nerve. The goal of this injection is to reduce pain, improve symptoms, and decrease nerve cross-sectional area through mechanical decompression. While the use of hydrodissection as a treatment for carpal tunnel syndrome has been well studied, there are few studies evaluating its utility in UNE. Indications: Ultrasound-guided perineural injections can be used to alleviate symptoms of UNE caused by compression. The use of a gel stand-off technique is helpful in maintaining adequate visualization of the needle with a steeper needle angle. Technique Description: The procedure was carried out with patient supine, shoulder abducted to 90°, and the forearm supinated. A 15-6 MHz linear array ultrasound transducer was used to localize the right ulnar nerve proximal to the retrocondylar groove at an area of focal hypoechogenicity and increased nerve cross-sectional area. A 3 mL mixture of 2 mL of 1% lidocaine and 1 mL of 10 mg/mL dexamethasone was injected using a sonographically guided in-plane anterior-to-posterior technique. Results: Our patient was seen 3 weeks after her right-sided ulnar nerve hydrodissection and had experienced temporary reduction in symptoms. Discussion/Conclusion: UNE is a common cause of focal neuropathy. Most patients will experience adequate relief of symptoms with conservative treatment modalities. If patients do not experience adequate symptom relief, ultrasound-guided ulnar nerve injection is a minimally invasive option that can provide symptom relief. However, if patients continue to experience significant symptom burden, it is reasonable to discuss surgical options for ulnar nerve decompression. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Ultrasound-guided and ‘blind’ sciatic nerve injection techniques: Comparison in rat cadavers

ObjectiveTo compare the success rate and extent of sciatic nerve staining with a bupivacaine–dye solution using two injection techniques: ‘blind’ or ultrasound-guided approach. Study designProspective, experimental, randomized, cadaveric study. AnimalsAdult female Wistar rat cadavers [n = 24, mass 352 g (323–374)]. MethodsEach sciatic nerve was randomly allocated to one of two groups: ‘blind’ (group B) or ultrasound-guided approach (group US) to injection. Following injection of bupivacaine–dye solution (0.1 mL), gross anatomical dissection was performed to visualize nerve staining, categorizing it as either positive or negative. The length of nerve staining was then measured and visual inspection conducted to identify potential nerve damage. Fisher's exact test was used to compare positive or negative nerve staining, and the Wilcoxon signed rank test used to compare the length of nerve staining between groups. ResultsIn group B, the bupivacaine–dye solution stained 16/24 sciatic nerves (67% success). In group US, staining was successfully observed in all 24 nerves (100% success, p < 0.004). The length of nerve staining [median (interquartile range)] was 2 (2–3) mm in group B and 5 (4–6) mm in group US (p < 0.001). One sciatic nerve in group B had injectate distributed over 16 mm, suggestive of an intraneural injection. No signs of laceration or nerve damage were visible under 6× magnification in either group. Conclusions and clinical relevanceThe ultrasound-guided approach for sciatic nerve injection demonstrated a higher success rate with superior injectate distribution when compared with the ‘blind’ approach. Ultrasound guidance is recommended over a ‘blind’ approach for sciatic nerve block in rats when possible.

The effect of aromatherapy with Lavender-Neroli oil and music in management of pediatric dental anxiety: a randomized control trial

AimThis study aimed to evaluate the efficacy of aromatherapy with Lavender-Neroli essential oil combined with background music in reducing dental anxiety and pain during anesthesia in children.Materials and methodsA total of 56 children aged 6–10 years old who needed dental treatment with inferior alveolar nerve injection (IANB) were randomly divided into two groups: Group 1 (Experimental, n = 28) aromatherapy with music group, and Group 2 (Control, n = 28) the placebo group. Children in the group 1 were asked to inhale the aromatic blend of Lavender-Neroli essential oil using a nasal mask similar to one that is used for nitrous oxide after modifying it by adding a 3D printed box on its circle hole and listening to their favorite music as a background before 5 min and during anesthesia, meanwhile in the placebo group children were asked to wear an empty nasal mask. Anxiety and pain were been assessed before and after anesthesia using the self-report anxiety scale Facial image scale (FIS), Observational pain assessment scale Face-Legs-Activity-Cry-Consolability (FLACC), heart rate, SPO2 saturation, diastolic and systolic blood pressure.ResultsDental anxiety and vital signs except SPO2 saturation were significantly lower in the aromatherapy with music group when compared to the control group (p < 0.05), with no differences in pain perception between groups (p = 0.176).ConclusionsAromatherapy with Lavender-Neroli oil combined with music seems to be a useful and safe non-pharmacologic technique for managing dental anxiety in children.

A Comparison of Precision and Safety using Three Recognized Ultrasound-Guided Approaches to Cervical Medial Branch Blocks: A Cadaver Study

BACKGROUND: Ultrasound (US) guidance is widely used for needle positioning for cervical medial branch blocks (CMBB) and radiofrequency ablation, however, limited research is available comparing different approaches. OBJECTIVE: We aimed to assess the accuracy and safety of 3 different US-guided approaches for CMBB. STUDY DESIGN: A cadaveric study divided into ultrasound-guided needle placement and fluoroscopy evaluation stages. SETTING: Department of Pathology, Forensic, and Insurance Medicine, Semmelweis University. METHODS: Sonographically guided third occipital nerve (TON), C3, C4, C5 and C6 medial branch injections and radiology evaluations were performed. The 3 approaches compared were: 1. ES (published by Eichenberger-Siegenthaler): US probe in the coronal plane to visualize the cervical articular pillars, needle approach out of the plane, from anterior to posterior. 2. Fi (published by Finlayson): US probe in the transverse plane to visualize a cervical articular pillar and its lamina, needle approach in the plane, from posterior to anterior. 3. FiM (Modified Finlayson approach): Needles are placed as in Fi, but then adjusted with a coronal view of the cervical articular pillars. Fluoroscopy images were taken and later evaluated, for “crude”, “high precision” and “dangerous” placement. RESULTS: One hundred and fifty-five needle placements were assessed (10 were excluded, as no anterior-posterior fluoroscopy images were saved). Interobserver agreement on position of needle placement between the 5 observers was very high; the Fleiss’ Kappa was 0.921. For crude placement, no significant differences were identified between various approaches; (77.6%, 79.5%, and 75.6% for the ES, Fi, and FiM respectively). However, for placement in predefined high-precision zones, ES resulted in significantly more success (ES: 42.9%, Fi: 22.7%, and FiM: 24.4%, P = 0.032). Fi and FiM resulted in no dangerous placements, while ES led to the potential compromise of the exiting nerve root and vertebral artery on three occasions. In 10% of the placements, the levels were identified wrongly, with no difference between the various approaches. LIMITATIONS: Feedback from a live patient, may prevent some existing nerve root injections, unlike in a cadaver. Though a higher number of needles were placed in this study than in most available publications, the number is still low at each individual medial branch level. CONCLUSION: Fi proved safer than ES. Fi was equally successful in targeting the articular pillar, however, ES proved the most successful in placing the needle in the center of the articular pillar. Adding another, (coronal) US view to check needle position in FiM did not improve safety or precision. Identifying CMB levels with the US is challenging with all approaches, therefore we still recommend using fluoroscopy for level identification. While there were pros and cons with either procedure, the efficacy findings of previous papers were not replicated on elderly cadavers with arthritic necks. KEY WORDS: Cervical facet, medial branch block, safety, accuracy, ultrasound, fluoroscopy

Assessment of Two Distinct Anatomical Landmarks for Suprascapular Nerve Injection: A Cadaveric Study.

The suprascapular nerve block (SSNB) is a commonly used procedure for the management of pain in various shoulder pathologies. Both image-guided and landmark-based techniques have been utilized successfully for SSNB, though more consensus is needed regarding the optimal method of administration. This study aims to evaluate the theoretical effectiveness of a SSNB at two distinct anatomic landmarks and propose a simple, reliable way of administration for future clinical use. 14 upper extremity cadaveric specimens were randomly assigned to either receive an injection 1cm medial to the posterior acromioclavicular (AC) joint vertex or 3cm medial to the posterior AC joint vertex. Each shoulder was injected with a 10ml Methylene Blue solution at the assigned location, and gross dissection was performed to evaluate the anatomic diffusion of the dye. The presence of dye was specifically assessed at the suprascapular notch, supraspinatus fossa, and spinoglenoid notch to determine the theoretic analgesic effectiveness of a SSNB at these two injection sites. Methylene Blue diffused to the suprascapular notch in 57.1% of the 1 cm group and 100% of the 3 cm group, the supraspinatus fossa in 71.4% of the 1 cm group and 100% of the 3 cm group, and the spinoglenoid notch in 100% of the 1 cm group and 42.9% of the 3 cm group. Given its superior coverage at the more proximal sensory branches of the suprascapular nerve, a SSNB injection performed 3 cm medial to the posterior AC joint vertex provides more clinically adequate analgesia than an injection site 1cm medial to the AC junction. Performing a SSNB injection at this location allows for an effective method of anesthetizing the suprascapular nerve.

Comparison between transcutaneous electrical nerve stimulation and metoclopramide in preventing postoperative nausea and vomiting after gastrointestinal laparoscopic surgery-A prospective and randomized study

Background: Postoperative nausea and vomiting is a common complication after laparoscopic surgery and general anesthesia. It increases the patient’s discomfort and compromises the surgical outcome. Aims and Objectives: The study aimed to compare the effectiveness of Transcutaneous Electrical Nerve Stimulator (TENS) and Injection of Metoclopramide for the prevention of post-operative nausea and vomiting in patients undergoing gastrointestinal laparoscopic surgery. The secondary objective of the study was to find out the percentage of cases needed rescue antiemetic drug (Inj. Ondansetron) when prophylaxis failed. Materials and Methods: The study was a prospective, double-blind, randomized trial conducted at M.G.M. Medical College and M.Y. Hospital, Indore. 90 patients of 18–60 years of age, ASA physical status I-II, undergoing elective laparoscopic gastrointestinal surgery were included. Patients were allocated randomly into two equal groups. Group T received TENS (the stimulation group) at P6 acupressure point, whereas group M received an injection of Metoclopramide before induction of anesthesia. Patients in both groups were observed for 24 h postoperatively for the incidence of nausea and vomiting and the requirement for rescue antiemetic. Results: The percentage of Postoperative Nausea Vomiting (PONV) and requirement of rescue antiemetics in both the groups were comparable in the first 6 h following laparoscopic gastrointestinal surgeries (P=1.000). There was no significant difference in PONV and rescue antiemetic requirement at 24 h in both the groups. Conclusion: TENS stimulation at P6 acupressure point is comparable to injection of Metoclopramide in preventing postoperative nausea and vomiting after laparoscopic gastrointestinal surgeries.

Transient side shift of cluster headache attacks after unilateral greater occipital nerve injection.

Attacks of cluster headache (CH) are usually side-locked in most, but not all, patients. In a few patients, the side may alternate between or, rarely, within cluster episodes. We observed seven cases in whom the side of CH attacks temporarily shifted immediately or shortly after unilateral injection of the greater occipital nerve (GON) with corticosteroids. In five patients with previously side-locked CH attacks and in two patients with previously side-alternating CH attacks, a side shift for several weeks occurred immediately (N = 6) or shortly (N = 1) after GON injection. We concluded that unilateral GON injections might cause a transient side shift of CH attacks through inhibition of the ipsilateral hypothalamic attack generator causing relative overactivity of the contralateral side. The potential benefit of bilateral GON injection in patients who experienced a side shift after unilateral injection should be formally investigated.

Characterization of a chronic cough in cerebellar ataxia, neuropathy, vestibular areflexia syndrome.

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a common cause of late-onset ataxia that often presents with chronic cough. This study is the first to characterize the CANVAS cough both objectively and subjectively. A cross-sectional study of 13 patients was conducted. Medical records and available esophagram, modified barium swallow study, esophageal manometry, and video laryngostroboscopy data were reviewed. Leicester cough questionnaire (LCQ) and Eating Assessment Tool-10 were administered to evaluate quality of life (QoL) impairments and dysphagia symptoms, respectively. CANVAS history questionnaire was developed to characterize the clinical course. 92% of patients endorsed chronic cough that preceded gait instability by a median of 16 years. Cough was dry (67%), disturbed sleep (75%), triggered by various factors, including talking, eating, and dry/spicy foods, did not respond to standard reflux therapy, and inconsistently responded to neuromodulators and superior laryngeal nerve injections. Despite perceived cough severity worsening or remaining constant in most patients, no correlation was found between cough duration and total LCQ scores. Patients reported significantly more negative social QoL impacts compared to physical QoL impacts. Ataxia duration and years of cough before ataxia symptoms were directly and inversely correlated with total LCQ scores, respectively. Imaging data revealed esophageal dysmotility (71%), vestibular penetration (57%), vestibular aspiration (14%), supraglottic compression (63%), vocal fold lesions/atrophy (50%), and arytenoid erythema (38%). Chronic cough is a hallmark presenting symptom in CANVAS with predominantly psychosocial QoL effects and unrecognized laryngeal alterations. In cases of idiopathic, refractory chronic cough, genetic testing for CANVAS should be considered, especially in association with sensory, cerebellar, and/or vestibular involvement. VI.

In vitro evaluation of genipin-crosslinked gelatin hydrogels for vocal fold injection

Glottic insufficiency is one of the voice disorders affecting all demographics. Due to the incomplete closure of the vocal fold, there is a risk of aspiration and ineffective phonation. Current treatments for glottic insufficiency include nerve repair, reinnervation, implantation and injection laryngoplasty. Injection laryngoplasty is favored among these techniques due to its cost-effectiveness and efficiency. However, research into developing an effective injectable for the treatment of glottic insufficiency is currently lacking. Therefore, this study aims to develop an injectable gelatin (G) hydrogel crosslinked with either 1-ethyl-3-(3-dimethylaminpropyl)carbodiimide hydrochloride) (EDC) or genipin (gn). The gelation time, biodegradability and swelling ratio of hydrogels with varying concentrations of gelatin (6–10% G) and genipin (0.1–0.5% gn) were investigated. Some selected formulations were proceeded with rheology, pore size, chemical analysis and in vitro cellular activity of Wharton's Jelly Mesenchymal Stem Cells (WJMSCs), to determine the safety application of the selected hydrogels, for future cell delivery prospect. 6G 0.4gn and 8G 0.4gn were the only hydrogel groups capable of achieving complete gelation within 20 min, exhibiting an elastic modulus between 2 and 10 kPa and a pore size between 100 and 400 μm. Moreover, these hydrogels were biodegradable and biocompatible with WJMSCs, as > 70% viability were observed after 7 days of in vitro culture. Our results suggested 6G 0.4gn and 8G 0.4gn hydrogels as potential cell encapsulation injectates. In light of these findings, future research should focus on characterizing their encapsulation efficiency and exploring the possibility of using these hydrogels as a drug delivery system for vocal fold treatment.

Paper 03: Suprascapular Neuropathy: Two Distinct Presentations and Outcomes of Decompression

Objectives: Suprascapular neuropathy due to nerve compression or tension at the suprascapular notch is an uncommon source of shoulder pain and rotator cuff weakness with recent increased recognition and treatment. Long considered an elusive diagnosis, work-up can be lengthy and patients may experience treatment delay. We aimed to review presentation patterns and outcomes of arthroscopic suprascapular nerve decompression in a predominantly young and active military population. Methods: The surgical databases of two surgeons were queried for patients treated with arthroscopic suprascapular nerve decompression at the suprascapular notch from 2013 to 2021. Patient data, presentation and workup findings, and outcome measures were collected through review of the electronic medical record. Primary outcome measures were rate of return to active-duty military service, shoulder abduction and external rotation strength, and VAS pain scores. Secondary outcome measures were American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Visual Analogue Scale (VAS), and Single Assessment Numerical Evaluation (SANE) score. Results: Twenty-five patients were identified. Average age was 26.6 years and follow-up 17.9 months (4-62 months). There were two distinct primary presentation types in this cohort: the chief complaint was pain in 13 patients (52%) and weakness in 12 (48%). Supraspinatus and/or infraspinatus atrophy was present on MRI in 10/12 patients with weakness and 0/13 with pain. Electromyography was positive in 9/12 with weakness and negative when obtained in 5 patients with pain. Ultrasound-guided suprascapular nerve injection was performed in 10/13 with pain and provided mean 91% symptom relief. Patients with pain had longer duration of pre-operative symptoms (22.2 [±13.1] vs. 10.3 [±13.6] weeks). Postoperatively, the pain group had significant improvement in VAS scores (6.2 [±1.6] to 1.0 [±0.9]), while the weakness group had significant improvement in abduction and external rotation motor grading (3.7 [±0.7] to 4.7 [±0.4] and 3.3 [±0.8] to 4.4 [±0.6] respectively). Return to duty or sport was 92% at a mean of 14.6 (±9.3) weeks. Conclusions: In this young, active cohort, suprascapular neuropathy presented with one of two distinct primary presenting complaints: pain or weakness. Given different expected work-up findings, categorizing patients into one of these two groups may be beneficial in effectively diagnosing and treating suprascapular neuropathy. Outcomes after arthroscopic suprascapular nerve release at the suprascapular notch predictably led to successful pain relief and strength improvement in patients presenting with pain and weakness respectively. [Table: see text][Table: see text]