Number Of Repeated Injections Research Articles

Trends Over Time in the Use, Carbon Footprint and Costs of Facet Joint Injections and Medial Branch Blocks to Manage Lumbar Pain in England: Retrospective Analysis of an Administrative Dataset.

Retrospective analysis of an administrative dataset. This study aims to investigate changing practice over a six-year period in the use of repeated lumbar facet joint injections/medial branch blocks in England. Patient data were extracted from the Hospital Episodes Statistics database for the period 1st April 2015 to 31st March 2021 for the index lumbar injection and for repeat lumbar injections performed within oneyear of the first. The exposure of interest was two injections within 180days or three within oneyear. Patients aged <17years and where the body site was listed as cervical, thoracic or sacral were excluded. Data were available for 134,249 patients of which, 8,922 (6.6%) had either two injections within 180days or three injections within oneyear. First injections fell from 42,511 in 2015/16 to 13,368 in 2019/20 as did the number of repeat injections: 4,018 to 424 for the same period. If all years had the same carbon footprint as 2019/20, 2.8 kilotons of CO2e would have been saved over the fiveyears, enough to power 2,575 average UK homes for 1year. The financial cost of injections decreased from £27.6 million in 2015/16 to £7.9 million in 2019/20. The number of patients having repeated lumbar injections has decreased over time but has not been eliminated. More work is needed to educate patients and clinicians regarding alternative and more effective treatments.

To compare the analgesic efficacy of two different doses of epidural ketamine in chronic low back-pain patients: A randomised double-blind study.

Background and Aims:Ketamine, an adjunct to epidural steroid injections (ESI) for chronic back-pain provides better quality and prolonged duration of analgesia. The present study aims to evaluate the analgesic efficacy in terms of pain scores, duration of pain-free period, patient satisfaction score (PSS) and number of repeat injections with 25 mg versus 50 mg ketamine as adjuvants to ESI.Methods:In a prospective, randomised, double-blind trial at a tertiary care hospital, 60 patients of chronic low back-pain of either sex, aged 18–65 years, received preservative free 25 mg ketamine in Group I and 50 mg ketamine in Group II as adjunct to 40 mg triamcinolone in total 6 ml volume given epidurally. Baseline data along with follow-ups at 2, 4, 8 and 12 weeks post-procedure included assessment of pain using Visual Analogue Scale (VAS), duration, number of repeat blocks using PSS, Quality of Life (QoL) and side-effects. Categorical data analysed using the Chi-Square test, and continuous data using paired t-test.Results:Pain evaluation within the groups over time showed significant improvement from baseline (P = 0.000), and between the groups showed comparable VAS scores at 12 weeks (P = 0.392). The PSS, pain-free duration and number of repeat injections were also statistically comparable. However, the QoL improved more in Group II vs Group I (P = 0.024). The short-lasting side effects were more in Group II, but no features of neurotoxicity were observed in any patient.Conclusion:The analgesic efficacy of adjuvant therapy with 50 mg ketamine appeared comparable to 25 mg ketamine. Although, there was a better quality of life and longer pain-free interval with 50 mg ketamine, the side effects were more.

Skuteczność ranibizumabu w idiopatycznej neowaskularyzacji naczyniówkowej – opis serii przypadków

Objective: To evaluate the efficacy of the ranibizumab intravitreal injection in idiopathic choroidal neovascularization. Material and methods: The study included 3 patients (4 eyes), aged 17, 37 and 46, with visual acuity deterioration, warping and distortion of the central image lasting for 2–5 weeks. Inflammatory background of the disease was excluded. The baseline examination and follow-up included the best corrected visual acuity (BCVA), fluorescein angiography and central retinal thickness (CRT) analysis using optical coherence tomography (OCT). When ICNV was diagnosed, intravitreal injections of ranibizumab were administered. Results: During the first follow-up test, 3 eyes showed improvement of BCVA, and in the fourth eye BCVA remained unchanged. In funduscopy, all patients showed reduced haemorrhage and oedema of the central retina. The OCT showed a reduction of the CRT and improvement in the morphology of the macula. The observation period ranged from 4 to 55 months, and the number of repeated injections during the observation ranged from 2 to 5. Conclusions: Injections of ranibizumab into the vitreous brought a significant improvement in the function of the treated eye, and in the morphology of the retina in OCT.

Abstract PR305

Background & Objectives: The purpose of this systematic review is to emphasize the efficacy of a parasagittal interlaminar (PIL) approach. Materials & Methods: In this systematic review, we included five studies that compared parasagittal IL with either midline IL (MIL) or TF-LESI. A total of 296 patients who had undergone different types of LESI were observed across the five studies; the average pain and functional improvements were calculated and compared amongst groups. Results: Two comparative studies between PIL and MIL approach followed-up 137 patients between 6 and 12 months after injection. Results showed better pain (54.3% vs. 22.8%) and functional improvement (45.7% vs. 24.8%) using the parasagittal approach at the 6 month period (Figure 1:A,B). A 12 month follow-up for pain and function improvements with the PIL approach is superior to the MIL approach (53.4% vs. 14.7%) and (55% vs. 27.7%), respectively. A comparative analysis of PIL and TF injections in 159 patients showed slightly better pain improvements (45.7% vs 40.09%) in the PIL group (Figure 1:C) at 6-month follow-up period. A 12 months follow-up between PIL and TF showed a near equivalent effectiveness for pain (58.9% vs. 63.2%) and functional improvement (47.3% vs. 48.1%). Third LESI injection were more common in the TF group (30%) than the PIL group (18.8%) and a number of repeated injections were generally lower among PIL than MIL group.Conclusion: Results of this systematic review showed better outcomes with a PIL as compared to a MIL, and near equivalent efficacy as compared to the TF approach. If we consider that TF injections are associated with greater risk, increasing reimbursement costs for TF-LESI, and that the FDA issued a warning based on unfavorable reports of TF injections. The Parasagittal IL approach should be considered as an efficacious and cost-effective alternative for TF injections. Disclosure of Interest: None declared

Pain Reduction and Repeat Injections After Transforaminal Epidural Injection With Particulate Versus Nonparticulate Steroid for the Treatment of Chronic Painful Lumbosacral Radiculopathy

BackgroundThe corticosteroid choice for a lumbar transforaminal epidural steroid injection (TFESI) remains controversial. Whether to utilize particulate or nonparticulate steroid preparations for these injections remains an unanswered question in the literature. ObjectiveTo determine if a particulate or nonparticulate steroid is more effective in the treatment of electromyography (EMG)-confirmed lumbosacral radiculopathy. DesignMulticenter retrospective cohort study. SettingTwo tertiary academic spine centers. PatientsConsecutive patients, aged 18 years or older, with EMG-confirmed lumbosacral radiculopathy. InterventionsTFESI with a particulate or nonparticulate steroid to treat radicular pain within 6 months of EMG. Main Outcome MeasuresThe primary outcome was the proportion of patients with ≥50% pain reduction on the numerical rating scale after TFESI. Secondary outcomes included mean numerical rating scale score reduction and number of repeat TFESIs. Short-term (<30 days) and intermediate (≥30 days) outcomes were compared between patients who received a TFESI with a particulate versus nonparticulate steroid. ResultsSeventy-eight patients, with an age ± standard deviation of 56 ± 16 years and a mean symptom duration of 49 ± 71 months, were included. Forty-one patients (52%) received dexamethasone, 23 (30%) received triamcinolone, and 14 (18%) received betamethasone. There was no statistically significant difference in the proportion of patients who reported ≥50% pain reduction between the particulate and nonparticulate groups at short-term follow-up (35%; 95% confidence interval [CI], 21-51 versus 28%; 95% CI, 13-43) or at intermediate follow-up (40%; 95% CI, 21-59 versus 39%; 95% CI, 19-59). There was no difference in the mean number of injections administered between groups at intermediate follow-up (P = .26). ConclusionsThis study demonstrates no significant differences in pain reduction or the number of repeat injections with particulate compared with nonparticulate transforaminal epidural steroid injection in patients with EMG-confirmed painful lumbosacral radiculopathy. These findings suggest a new population for whom nonparticulate steroid appears to be an appropriate first-line therapy, although confirmation with a randomized study is needed. Level of EvidenceIII

Interlaminar versus Transforaminal Epidural Steroid Injections for the Treatment of Symptomatic Lumbar Spinal Stenosis

Lumbar spinal stenosis is a common condition that causes axial low back pain, radicular pain, and neurogenic claudication. Epidural steroid injections are commonly used for the treatment of radicular symptoms and neurogenic claudication associated with symptomatic lumbar spinal stenosis. No prior study has evaluated whether transforaminal or interlaminar epidural steroid injections produce better clinical outcomes. Retrospective case control study. For each technique, 19 patients were retrospectively identified who received their first fluoroscopically guided epidural steroid injection for radicular and neurogenic claudication symptoms caused by lumbar spinal stenosis over a 12-month interval. All patients had corresponding MRI findings and had failed previous non-invasive therapies. Outcomes included the visual analog scale (VAS, 0-10 scale) immediately before the injection, immediately after the injection, and upon follow up at 4-6 weeks. Surgery rates and number of repeat injections over a 3 year period were also analyzed. The patient groups were matched for age and level of stenosis on MRI. There was no statistically significant difference between the two groups in pre injection to follow up VAS scores (P=0.919). The difference between number of repeat injections between the interlaminar and transforaminal groups was not statistically significant (0.91-mean 2.47 and 2.58, respectively). Both the interlaminar and transforaminal groups experienced statistically significant improvement in VAS scores from before the injection to after the injection, and on follow up. Low numbers underwent surgery (11% in the interlaminar group vs 15% in the transforaminal group, not significant, P=0.63). In the current study, neither transforaminal nor interlaminar steroid injections resulted in superior short term pain improvement or fewer long term surgical interventions or repeat injections when compared with each other.

Transcutaneous cymetra injection for glottal incompetence: Follow-up

Problem: Transcutaneous injection of alloderm (cymetra) for glottal incompetence demonstrates comparable results to traditional thyroplasty type I. However, cymetra is noted to have a 20% re-absorption rate and thus re-injection may be needed. The purpose of this investigation was to longitudinally evaluate individuals treated with cymetra and determine any patterns with regard to the need for re-injection. Methods: Retrospective chart review was conducted of individuals undergoing cymetra injection from August 2001 through October 2003. The number of repeat injections was assessed across medical (side of paralysis, etiology, duration) and demographic (age, gender) variables at initial visit and compared with physiologic (gap size) and perceptual (Voice Handicap Index) variables at subsequent visits. Results: Fifty-four individuals (mean age, 64.4 years; 31 males [57%] and 23 females [43%]) underwent cymetra injection during the study period. Fifty-three had unilateral vocal fold paralysis, 40 (74%) left-sided and 13 (24%) right-sided, and one had bilateral bowing. Seventeen (31.5%) underwent repeat cymetra injection, 6 underwent 2 re-injections, and 2 underwent 3 re-injections. Characteristics of the re-injection group included significantly higher age (71.5), higher proportion of males (12), and left-sided paralysis (14). Initial gap size was not correlated with the need for re-injection. Conclusion: Approximately one third (31.5%) of individuals undergoing transcutaneous cymetra injection for glottal incompetence required a repeat injection owing to re-absorption. The re-injection group was older, more likely to be male, and have a left-sided paralysis. Full details of correlations between the study variables will be reported. Significance: Re-absorption of cymetra following injection for glottal incompetence is more common in older males with left-sided paralysis. Support: None reported.

Fluoroscopically guided low-volume peritendinous corticosteroid injection for Achilles tendinopathy. A safety study.

The safety and efficacy of corticosteroid injection for the treatment of Achilles tendinopathy is not known, with some reports indicating the hazard of tendon rupture and others extolling the efficacy of such injections. This study was undertaken to assess the safety of fluoroscopically guided corticosteroid injections into the peritendinous space for the treatment of Achilles tendinopathy. A series of patients was treated with fluoroscopically guided corticosteroid injections into the space surrounding the Achilles tendon. Major and minor complications were recorded, as were the number of repeat injections, the duration of symptomatic relief attained with the injection, and a subjective rating of symptoms related to the Achilles tendon. Of eighty-three patients who had been treated, seventy-eight were available for follow-up and forty-three met our requirement for a minimum two-year follow-up (average duration of follow-up, 37.4 months). No major complications and one minor complication occurred in the forty-three patients. Seventeen (40%) of the patients reported improvement after the procedure, twenty-three (53%) thought that their condition was unchanged, and three (7%) felt that their condition was worse than it had been prior to the injection. This retrospective cohort study establishes the safety of low-volume injections of corticosteroids for the treatment of Achilles tendinopathy when the needle is carefully inserted into the peritendinous space under direct fluoroscopic visualization.

Product Yield and Gaping in Cold‐smoked Atlantic Salmon (Salmo salar) Fillets as Influenced by Different Injection‐salting Techniques

ABSTRACTProduct yield and fillet gaping severity were determined in cold‐smoked Atlantic salmon fillets subjected to injection‐salting. Effects of process parameter settings (brine injection pressure, number of repeated injections, needle speed, injection of brine in 1 or 2 directions, and chilled fillet resting before smoking) were tested. Repeated injections increased the yield up to 5.3% (wt/wt). Increasing injection pressure significantly increased the severity of fillet gaping in smoked fillets by 18%. Brine injection directions or needle speed did not affect smoking yield. The stability of the injection system was high. The results show that choice of process parameter settings during injection‐salting affects product yield after smoking.

Endocrine manipulations and ontogenesis of male sexual behaviour in Locusta: studies on precocene‐induced early adultiforms

ABSTRACT. Fourth‐ and third‐instar permanent adultiforms of Locusta migratoria migratorioides (R.&amp;F.) were produced by applying 7‐ethoxy‐precocene II (precocene III) to hoppers in earlier stages. The mating behaviour of male adultiforms and the effects of injected exogenous juvenile hormone III (JH) on this behaviour were investigated quantitatively and the results were compared to those obtained for normal adult males and for adult males chemically allatectomized by precocene III. Fourth‐ and third‐instar adultiform males exhibited sexual behaviour and injections of JH intensified this behaviour in a dose‐dependent manner, though the number of repeated injections in which a cumulative dose is administered was found to be not less important than the amount of the cumulative dose itself. Huge repeated doses (6×144=864 μg) of JH temporarily induced normal intensity of mating behaviour in fourth‐instar male adultiforms. The same doses of JH intensified mating behaviour also in third‐instar adultiform males, but less markedly so than in fourth‐instar ones. For restoring temporarily normal intensity of mating behaviour in chemically allatectomized but morphogenetically normal adult males, much smaller doses (2×36=72, or 2×72=144μg) of JH were sufficient. In contrast, even huge doses of JH were unable to induce mating behaviour in normal (no precocene‐treated) male hoppers. Thus, the ethological ontogenesis (=‘ethogenesis’) of the male's mating behaviour, including the response of the system to JH, is clearly accelerated by precocious metamorphosis. However, this is not a simple ‘all or none’ effect, because adultiforms in earlier stadia exhibit less intense male mating behaviour and more limited response to JH than adultiforms in later stadia or adults.