Department Of Pain Management Research Articles

A Comparative Study between the Efficacy of Ultrasound Guided Erector Spinae versus Quadratus Lumborum Plane Blocks in Laparoscopic Appendectomy

Abstract Background Laparoscopic appendectomy is more superior to open appendectomy in terms of wound site infections and pain intensity. Although the laparoscopic technique is minimally invasive, postoperative pain is inevitable, and it may affect the patients’ mobility and cause them to stay in the hospital for a more extended period. Aim of the Work to compare the effectiveness of erector spinae plane block and quadratus lumborum plane block as part of multimodal analgesia for reducing postoperative pain in patients undergoing laparoscopic appendectomy. Patients and Methods This prospective randomized controlled clinical trial was conducted at operative theatres, Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University Hospitals from April until September 2023. Results During this study, 54 patients undergoing laparoscopic appendectomy were enrolled and divided into two equal groups; group A subjected to erector spinae block and group B subjected to quadratus lumborum block. Intraoperative, Post Anaesthesia Care Unit and postoperative haemodynamic, postoperative NRS score, first time of postoperative analgesic request, total amount of postoperative analgesia and serum cortisol levels were measured. In this study there was a significant difference between the two groups regarding NRS scores and total amount of analgesia needed post operatively. In this study, no statistically significant difference was observed between the two groups in terms of serum cortisol levels. In this study, no significant difference was found between the two groups regarding heart rate and mean arterial pressure. Conclusion Both QLB and ESPB are effective as post-operative analgesia techniques for laparoscopic appendectomy. However, our study showed that US-guided ESPB may provide better pain control than QLB. These results allows healthcare providers and patients to choose the most suitable technique based on individual preferences and clinical considerations. However, further research with larger sample sizes and multicentric studies would be valuable to confirm these findings and explore potential variations in different patient populations or surgical settings.

Effectiveness of Ultrasound Guided Quadratus Lumborum Block versus Intravenous Analgesia for Postoperative Pain Management in Patients Undergoing Hip Surgeries

Abstract Background Orthopedic operations such as hip and femur fractures can lead to significant postoperative pain. In these patients, nonopioid analgesia techniques are especially important in aging populations when comorbidities are considered. Aim of the Work to compare the analgesic efficacy of ultrasound guided Quadratus Lumborum (QL) block versus intravenous analgesia for postoperative pain management in patients undergoing hip surgeries under spinal anesthesia. Patients and Methods This prospective interventional study was conducted at Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from January until August 2023. During this study, 40 patients scheduled for hip surgery under spinal anaesthesia were enrolled and divided into two equal groups; quadratus lumborum and control groups, with the same inclusion and exclusion criteria. Total amount of opioid analgesics needed by patients in both groups, pain scores according to the Visual Analog Scale (VAS), first time the patient needed postoperative rescue analgesia, vital data, postoperative length of hospital stay and side effects of drugs were recorded and compared between both groups. Results In our study, no differences were noted between groups regarding demographic data “age, sex, ASA and type of operation”. Regarding hemodynamics, our study revealed that at 10, 20, 40 min, PACU at 30 and 1hr, mean arterial pressures and heart rate were statistically significant higher among control cases compared with quadratus lumborum group. Regarding analgesic efficacy, our study revealed that VAS score was statistically significant higher after 4, 6 and 12hrs, need of 1st rescue analgesic was statistically significant faster 3.60 ± 1.06 vs. 18.00 ± 8.49 hours and total narcotics “mg” was statistically significant higher 60.00 ± 16.16 vs. 40.00 ± 13.69 among control cases compared with quadratus lumborum group. Also, our study revealed that hospital stay “days” was statistically significant longer 2.75 ± 0.44 vs. 1.75 ± 0.64 and side effect respiratory depression and vomiting were statistically significant higher among control cases compared with quadratus lumborum group. Conclusion QL block is effective for analgesia in patients after hip surgery compared with placebo or no block. QLB as a part of multimodal analgesia protocol reduces opioid consumption and pain scores in patients undergoing hip surgeries. The certainty of evidence based on GRADE was moderate.

The Effect of Quadratus Lumborum Block vs Erector Spinae Block in Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy

Abstract Background However, the postoperative pain following laparoscopic cholecystectomy consists of both somatic and visceral components with pain originating from port entry wounds, gallbladder resection and abdominal insufflation that leads to peritoneal distention and peritoneal damage. Aim of the Work to compare analgesic efficacy of Quadratus lumborum block versus erector spinae block in postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Study Design prospective randomized controlled clinical trial Methods This prospective randomized controlled clinical trial was conducted at operative theatres, Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University Hospitals from March until August 2023. During this study, 80 patients electively scheduled for laparoscopic cholecystectomy were enrolled and divided into two equal groups; group A subjected to quadratus lumborum block and group B subjected to erector spinae block. Intraoperative, Post Anaesthesia Care Unit and postoperative haemodynamic, postoperative VAS score, first time of postoperative analgesic request, total amount of postoperative analgesia, time needed for postoperative mobilization and side effects of study procedures were evaluated. Results In this study there was no significant difference between the two groups as regards VAS score. In this study there was no significant difference between the two groups according to total amount of analgesia needed post operatively. In this study there was no significant difference between the two groups according to total amount of analgesia needed post operatively. In this study time needed for mobilization was insignificant different between two groups. In this study, no statistically significant disparity was observed between the two groups in terms of side effects. In this study, no significant difference was found between the two groups according to the first time postoperative analgesia. Conclusion This study showed comparable effect of both QLB and ESPB in patients undergoing laparoscopic cholecystectomy.

The Effect of Erector Spinae Plane Block on Postoperative Quality of Recovery after Laparoscopic Cholecystectomy

Abstract Background The postoperative pain following laparoscopic cholecystectomy consists of both somatic and visceral components with pain originating from port entry wounds, gallbladder resection and abdominal insufflation that leads to peritoneal distention and peritoneal damage. Objective To determine whether erector spinae plane block improves post operative pain, opioid consumption, nausea, vomiting and early mobilization in patients undergoing (LC). Patients and Methods This prospective randomized controlled interventional study was conducted at operative theatres, Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University Hospitals for 6 months. Results These results suggest that ESPB can be effective option for postoperative pain management in laparoscopic cholecystectomy, allowing healthcare providers and patients to choose the most suitable technique based on individual preferences and clinical considerations. However, further research with larger sample sizes and multicentric studies would be valuable to confirm these findings and explore potential variations in different patient populations or surgical settings. Conclusion The incorporation of specific numerical findings from multiple studies accentuates the robust evidence suggesting that erector spinae plane block is associated with superior pain control, faster recovery, and reduced reliance on rescue analgesia in laparoscopic cholecystectomy. These quantitative outcomes underscore the potential of ESP block as a transformative analgesic technique in the realm of perioperative care.

Comparison between Anterior Approach and Posterior Approach of Suprascapular Nerve Block for Postoperative Analgesia in Shoulder Arthroscopy

Abstract Background Severe intraoperative and postoperative pain associated with arthroscopic shoulder surgery has high incidence reaching up to 45%, it is often significant enough to interfere with initial recovery and rehabilitation. This pain is difficult to manage without large-dose opioids. Aim of the Work compare between anterior approach and posterior approach of suprascapular nerve block for postoperative analgesia in shoulder arthroscopy. Patients and Methods The study was conducted in Ain Shams University Eldemerdash Hospitals after approval from the ethics committee of anesthesia, intensive care and pain management department and written patients‟ consent. It included a total of 72 adult patients aged 18-60 years, Scheduled for shoulder arthroscopic surgeries. Patients were randomly divided into two equal groups, 36 each, according to the inclusion and exclusion criteria. Results no statistically significant differences in pain scores at 6, 12, and 24 hours postoperatively between the anterior SSNB and posterior SSNB groups. Postoperative First analgesia request time/hour early in posterior approach comparing to anterior approach (6.03±0.74, 5.64±0.68).opioid requirements were statistically different between the two groups, with a benefit in favour of the anterior route in the recovery area and during the first 24 postoperative hours. Conclusion the main finding is the anterior approach of SSNB provided superior analgesia compared with posterior approach of SSNB in postoperative opioid consumption.

Outcomes of Twice Repeated High-Voltage Long-Duration Pulsed Radiofrequency Treatment in Subacute Postherpetic Neuralgia: a Retrospective Single-Center Analysis.

The treatment of herpes zoster-related pain is challenging, and requires a variety of methods including pulse radio frequency modulation. Among them, single-time high-voltage long-term pulsed radiofrequency (HL-PRF) has been proved to be an effective treatment for subacute postherpetic neuralgia. However, it has the possibility of poor long-term curative effect and recurrence of neuralgia. In this study, we aim to identify the clinical efficacy and safety of twice repeated HL-PRF treatment in patients with subacute postherpetic neuralgia. We conducted a retrospective analysis of subacute postherpetic neuralgia patients who underwent HL-PRF treatment. Pain Management Department of First Affiliated Hospital of Wannan Medical College. We enrolled all patients with subacute postherpetic neuralgia, who underwent HL-PRF treatment from January 2023 to October 2023. The primary outcome variable was the visual Analog Scale (VAS) scores at 1, 4, 8, and 12 weeks after treatment. Secondary outcomes included Pittsburgh sleep quality index (PSQI), 36-item short-form health survey (SF-36) score, and total effective rate after treatment. A total of 63 patients were included in the analysis. Among them, 33 patients received single-time HL-PRF treatment (Group S) and 30 patients received twice repeated HL-PRF treatment (Group T). Pain scores, PSQI scores, and SF-36 score were reduced in both groups after treatment (P < 0.001). Compared to group S, the VAS scores, PSQI scores, anxiety scores, and depression scores were significantly lower at 1, 4, 8, and 12 weeks in group T. (P < 0.001). The total efficiency rate at 12 weeks after treatment of group T was statistically higher than that of group S (60.6% vs 86.7%, P < 0.05). Twice repeated high-voltage long-duration PRF therapy demonstrates satisfactory efficacy in patients with subacute postherpetic neuralgia and is associated with no significant adverse reactions.

Evaluation of preoperative melatonin on emergence agitation after herniorrhaphy surgeries in pediatrics

Background and objective Emergence agitation is a common phenomenon in children recovering from general anesthesia. An emergence agitation reaction increases the risk of injuring the surgical repair, the patient, and the caregivers. Thus, we aim to explore the efficacy of melatonin premedication on emergence agitation in children undergoing herniorrhaphy surgeries. Patients and methods A randomized prospective triple-blinded trial was conducted on 117 children with herniorrhaphy surgeries conducted at the Anesthesia, ICU, and Pain Management Department, Menoufia University hospitals from April 2022 to July 2023. Results Yale preoperative scale at the start did not significantly differ among the studied groups (P&gt;0.05). However, the Yale preoperative scale at 1 was significantly higher in group 1 with a mean of 10.2±1.9 than in group 2 (9.5±1.4) and group 3 (5.9±1.4) (P&lt;0.001). The agitation score at 5 h was significantly higher among group 1 with a mean of 2.77±0.67 than group 2 (2.56±0.64) and group 3 (2.03±0.96) (P&lt;0.001). Also, agitation scores at 10 and 15 h were significantly higher in group 1 (3.36±0.63, 4.2±0.66) than in group 2 (3.2±0.66, 3.79±0.73) and group 3 (1.74±0.88, 2.03±1.04), respectively (P&lt;0.001). Conclusion Melatonin premedication decreased the agitation scale postoperatively. The decrease was significantly higher in high doses in preventing emergence agitation in children. High-dose melatonin compared with low dose might have a significant effect in preventing emergence agitation.

Development and evaluation of the effectiveness of the educational and methodological complex of the module «Features of dental care for patients with concomitant diseases» of the Federal State Educational Standard of Higher Education in the specialty 31.05.03

Order No. 984 of August 20, 2020 of the Ministry of Science and Higher Education of the Russian Federation approved the Federal State Educational Standard of Higher Education – a specialty in the specialty 31.05.03 «Dentistry», programs are developed and approved by the organization independently with the formation of requirements for the results of its development in the form of universal, general professional and professional competencies of graduates. At the Department of Pain Management in Dentistry of Moscow State Medical University named after. A. I. Evdokimov developed the program «Features of providing dental care to patients with concomitant diseases» and an educational and methodological complex consisting of a textbook (monograph), a course of video lectures, an educational and methodological manual (workbook) for self-preparation of students for classes. In order to control the acquired knowledge, a bank of test tasks and situational tasks was created. An analysis of the performance of 1,306 students of the Faculty of Dentistry, who studied in the 9th semester, demonstrated the high efficiency of the developed program and educational and methodological complex.

EVALUATION OF EMOTIONAL DISTRESS IN A COHORT OF NEWLY DIAGNOSED CANCER PATIENTS: A STUDY OF 67 INDIVIDUAS

Purpose: To evaluate distress in newly diagnosed cancer patients. Subjects and Methods: Cross-sectional prospective study of 67 newly diagnosed patients at the Department of Pain management and Palliative Care, 108 Military Central Hospital, from August to October 2023. The patient's level of distress was assessed by the Distress Thermometer - DT and the Problem List (PL) of NCCN February 2022, Vietnamese version. Results: The average distress score among newly diagnosed cancer patients was 4.42 ± 2.237, with 3% reporting no distress, 44.8% experiencing mild distress, and 52.2% reporting moderate to severe distress (≥ 4 points). Common sources of distress among the participants included physical discomfort (94.0%), with 73.1% reporting sleep problems and 71.6% experiencing fatigue. Emotional challenges were prevalent as well (91.0%), with 49.3% reporting feelings of sadness and 47.8% experiencing anxiety. Additionally, concerns regarding self-care (53.7%) and financial worries (43.3%) were notable contributors to distress, accounting for 76.1% of the participants' concerns overall. The rate of moderate and severe distress in newly diagnosed cancer patients were statistically significantly related to age (more prevalent in patients under 60), gender (higher in females) education level (more in those with secondary school education or less), income (higher in those with below-average incomes), health insurance benefits (higher in patients with less comprehensive coverage).

Comparison of initial percutaneous balloon compression versus radiofrequency thermocoagulation followed by percutaneous balloon compression in the treatment of trigeminal neuralgia.

There are a variety of minimally invasive interventional treatments for trigeminal neuralgia, and the efficacy evaluation is different. The preferred treatment scheme is still controversial. This study aims to investigate the differences in treatment effects between patients with primary trigeminal neuralgia (PTN) treated with percutaneous balloon compression (PBC) for the first intervention and patients with pain recurrence after radiofrequency thermocoagulation (RT) who then received PBC for PTN, and to offer clinicians and patients more scientifically grounded and precise treatment alternatives. We retrospectively analyzed 103 patients with PTN admitted to the Department of Pain Management of the Second Affiliated Hospital of Guangxi Medical University from January 2020 to December 2021, including 49 patients who received PBC for the first time (PBC group) and 54 patients who received PBC for pain recurrence after RT (RT+PBC group). General information, preoperative pain score, intraoperative oval foramen morphology, oval foramen area, balloon volume, duration of compression, and postoperative pain scores and pain recurrence at each time point on day 1 (T1), day 7 (T2), day 14 (T3), 1 month (T4), 3 months (T5), and 1 year (T6) were collected and recorded for both groups. The differences in treatment effect, complications and recurrence between the 2 groups were compared, and the related influencing factors were analyzed. The differences of general information, preoperative pain scores, foramen ovale morphology, foramen ovale area, T1 to T3 pain scores between the 2 groups were not statistically different (all P>0.05). The balloon filling volume in the PBC group was smaller than that in the RT+PBC group, the pain scores at T4 to T6 and pain recurrence were better than those in the RT+PBC group (all P<0.05). Pain recurrence was positively correlated with pain scores of T2 to T6 (r=0.306, 0.482, 0.831, 0.876, 0.887, respectively; all P<0.01). The choice of PBC for the first intervention in PTN patients is superior to the choice of PBC after pain recurrence after RT treatment in terms of treatment outcome and pain recurrence.

Efficacy and safety of different nerve block methods for the treatment of pudendal neuralgia

Objective: To identify efficacy and safety of pudendal nerve block in tubing through the third posterior sacral foramen for the treatment of pudendal neuralgia (PN). Methods: A retrospective study with 222 PN patients was conducted in the Department of Pain Management of Beijing Tsinghua Changgung Hospital from January 2020 to April 2023. These patients were divided into two groups based on their treatment methods: pudendal nerve block in tubing through the third posterior sacral foramen (observation group, n=101) and ultrasound-guided pudendal nerve block (control group, n=121). Primary outcome measure was the 90-day postoperative pain relief rate. Secondary outcome measures included visual analog scale (VAS) at 1, 7, 14, 30 and 90 d after surgery, the incidence of tramadol uses after surgery, postoperative self-rating anxiety scale (SAS) scores and the incidence of adverse events. Factors that influenced pain relief within 90 days after surgery were analyzed by using binary logistic regression analysis. Results: Observation group included 34 males and 67 females, aged (49.8±16.0) years old. Control group included 38 males and 83 females, aged (43.7±14.0) years old. The 90-day postoperative pain relief rate of the observation group patients was 38.6% (39/101), which was higher than the 24.0% (29/121) of the control group patients (P=0.018). Both the observation group and the control group showed an interaction effect of time and group after treatment for VAS scores (both P<0.05). In intra-group comparison, the VAS scores at 1, 7, 14, 30 and 90 d after treatment in both groups were lower than those before treatment (all P<0.05). In inter-group comparison, the differences of the VAS scores were not statistically significant in the observation group compared with those in the control group at 1, 7, 14, 30 and 90 d after surgery (all P>0.05). The SAS score of the observation group at 90 d after surgery was 51.5±6.2, which was lower than the 53.4±5.8 of the control group (P=0.022). There was no statistically significant difference in the incidence of postoperative tramadol uses and adverse events between the two groups (both P>0.05). Pudendal nerve block in tubing through the third posterior sacral foramen was a protective factor for pain postoperative relief in PN patients at 90 d after surgery (OR=1.92, 95%CI: 1.05-3.48, P=0.033). Conclusion: Pudendal nerve block in tubing through the third posterior sacral foramen is a safe and effective minimally invasive treatment. It has a higher postoperative pain relief rate within 90 d after surgery, without increasing the uses of postoperative rescue analgesics and the incidence of adverse events.

Patient and physician radiation exposure during minimally invasive lumbar decompression: A prospective assessment of X-ray exposure risks.

Minimally invasive lumbar decompression (mild®) is becoming a popular procedure for treating lumbar spinal stenosis (LSS) secondary to hypertrophic ligamentum flavum (LF). The mild® procedure is commonly performed under live fluoroscopic guidance and carries a risk of radiation exposure to the patient and healthcare. One physician performed mild® on 41 patients at the Cleveland Clinic Department of Pain Management from October 2019 to December 2021, while wearing a radiation exposure monitor (Mirion Technologies). Mean fluoroscopy time, mean exposure per case, and mean exposure per unilateral level decompressed were the primary outcomes measured. The secondary outcome was to provide a comparison of radiation exposure during similar fluoroscopically guided procedures. Mean patient fluoroscopy exposure time was 2.1 min ±0.9 (range: 1.1-5.6) fluoroscopy time per unilateral level decompressed. The mean patient radiation skin exposure from mild® was 1.1 ± 0.9 mGym2, and the mean total dose was 142.3 ± 108.6 mGy per procedure. On average, the physician was exposed to an average deep tissue exposure of 4.1 ± 3.2 mRem, 2.9 ± 2.2 mRem estimated eye exposure, and 14.7 ± 11.0 mRem shallow tissue exposure per unilateral level decompressed. An individual physician would exceed the annual exposure limit of 5 Rem after approximately 610 mild® procedures per year. This study is an attempt to quantify the radiation exposure to the physician and patient during the mild® procedure. Compared with other fluoroscopically guided pain management procedures, patient and physician radiation exposure during mild® was low.

Trigeminal Ganglion Electrical Stimulation for Trigeminal Nerve Postherpetic Neuralgia: A Retrospective Study.

To investigate the clinical outcome of trigeminal ganglion electrical stimulation for the treatment of trigeminal postherpetic neuralgia (TPHN). A retrospective analysis of clinical data was performed on six patients who suffered from severe postherpetic neuralgia involving the trigeminal nerve maxillary and mandibular branch. They were admitted under the Pain Management Department of the First Hospital of Shanxi Medical University from July 2022 to February 2023 and underwent trigeminal ganglion electrical stimulation therapy. Visual analogue scale (VAS) scores, pregabalin dosage, pittsburgh sleep quality index (PSQI), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) were recorded before treatment, as well as after treatment at 1, 4, 8, 12, and 24-week. Adverse reactions related to the treatment were also documented. After trigeminal ganglion electrical stimulation therapy, the VAS scores, PSQI scores, anxiety scores, depression scores, and pregabalin dosage of six patients showed significant reductions at 1, 4, 8, 12, and 24 weeks. (P < 0.05). No serious adverse reactions occurred in any of the patients. Trigeminal ganglion electrical stimulation effectively relieved postherpetic neuralgia in the distribution areas of the trigeminal nerve 2 and 3 branches, reduced the dosage of analgesics, improved the quality of sleep, and alleviated anxiety and depression symptoms in patients. Our data suggested that It was a safe and effective clinical.

Short- and long-term test-retest reliability of the English version of the 7-item DN4 questionnaire- a screening tool for neuropathic pain.

The original French version of the "Douleur Neuropathique en 4 Questions (DN4) questionnaire" is a valid screening tool for the identification of neuropathic pain (NeP). The DN4 has been translated into English, but the reliability of the English version has not yet been investigated. The aim of this study was to investigate the 7-item DN4 questionnaire in regards to short-term reliability before (T0) and immediately after (T1) the clinical examination and long-term reliability one week later (T2). A total of 222 participants (age 56.33±16 years, 56 % female) were recruited from a Pain Management Department and Neurosurgery Spinal Clinic. For T2 measurements, the 7-item DN4 was sent by post with the "Patient Global Impression of Change Scale". The scale detects possible changes of symptoms, scoring from "very much improved" (1) to "very much worse" (7). Only participants whose symptoms had not changed much (scores 3-5) were included in the T0-T2 analysis. Weighted Kappa was used to analyse the reliability of the DN4 total scores and unweighted Kappa for the DN4 classifications. Considering missing data and exclusions, data of 215 participants could be used for the T0-T1 and data of 103 participants for T0-T2 analysis. There was almost perfect agreement for the 7-item DN4 total score between T0-T1 (weighted k: 0.891, CI: 0.758-1.024) and T0-T2 (weighted k: 0.850, CI: 0.657-1.043). Classifications between neuropathic pain and no neuropathic pain showed almost perfect agreement (k: 0.835, CI: 0.755-0.915) for T0-T1 and substantial agreement (k: 0.733, CI: 0.598-0.868) for T0-T2. The English 7-item DN4 is a reliable screening tool for neuropathic pain. #RGS0000001759.

Ultrasound- Versus Computed Tomography-Guided Cervical Dorsal Root Ganglia Pulsed Radiofrequencies via Intervertebral Foramen for the Treatment of Postherpetic Neuralgia: A Retrospective Cohort Study

BACKGROUND: Pulsed radiofrequency (PRF) treatment of the dorsal root ganglia (DRG) has recently been used as an important option for postherpetic neuralgia (PHN) patients who do not respond well to drugs. This procedure is commonly guided by computed tomography (CT) or fluoroscopy, but they cannot be performed in real time and are associated with radiation exposure. Ultrasound (US) is a potential alternative option, but no reliable method of US-guided DRG PRF treatment has been reported. OBJECTIVES: The goal of this study was to propose a method for performing US-guided transforaminal PRF on cervical DRG. By comparing the results with those of CT guidance, we also sought to assess the accuracy, safety, and efficacy of this new approach in the treatment of PHN. STUDY DESIGN: A retrospective cohort study. SETTING: The study took place at the department of pain management of a single academic medical center. METHODS: The data of 73 PHN patients receiving 2 sessions of US-guided (US group, n = 26) or CT-guided (CT group, n = 47) cervical DRG PRF were reviewed. US-guided DRG PRF was performed using our proposed protocol. The one-time success rate was used to assess accuracy. The average radiation dose, the number of scans per operation, and the rate of complications were recorded for safety assessment. For the evaluation of pain amelioration, a Numeric Rating Scale (NRS-11), the daily sleep interference score (SIS), and oral medication (i.e., anticonvulsants and analgesics) usage 2 weeks, 4 weeks, 12 weeks, and 24 weeks after treatment were compared to the baseline values and between groups. RESULTS: The one-time success rate in the US group was significantly higher than that in the CT group (P &lt; 0.05). Compared those of the CT group, the mean radiation dose and number of scans per operation were both obviously lower in the US group (P &lt; 0.05). The average operation time was also shorter in the US group (P &lt; 0.05). No obvious serious complications occurred in either group. No obvious between-group difference was found in the NRS-11 score, daily SIS, or rate of oral medications at any of the time points (P &gt; 0.05). The NRS-11 score and SIS significantly decreased after treatment at each follow-up time point (P &lt; 0.05) in both groups. Compared with those at baseline, the use rate of anticonvulsants and analgesics obviously decreased 4 weeks, 12 weeks, and 24 weeks after treatment (P &lt; 0.05). LIMITATIONS: This study was limited by its nonrandomized and retrospective design. CONCLUSIONS: US-guided transforaminal DRG PRF is a safe and effective method for the treatment of cervical PHN. It is a reliable alternative option to the CT-guided procedure, demonstrating great advantages in reducing radiation exposure and the operation time. KEY WORDS: Ultrasound, pulsed radiofrequency, dorsal root ganglion, postherpetic neuralgia, transforaminal

(348) Implementation of Opioid- Free and Opioid-Reduced Protocols for Postoperative Pain Management After Penile Prosthesis Surgery

Abstract Introduction Postoperative pain management after (PP) penile prosthesis is challenging and it has traditionally required opioid medication. In light of the ongoing nationwide opiate epidemic and in an effort to reduce the risk of postoperative opioid dependence, urologic prosthetic surgeons have sought to establish opioid-free and/or opioid-reduced protocols (OFP, ORP respectively) for PP postoperative pain management. Objective This study seeks to investigate the patterns of adoption of OFP or ORP among surgeons who perform PP surgery and potential barriers to their implementation. Methods A 13-question confidential survey was sent to members of the Sexual Medicine Society of North America (SMSNA) via email. The survey was administered via Qualtrics. T-test was used to analyze survey responses. Results 43 urologists responded to the survey, with representation from every American Urologic Association geographic section. Most respondents (73.18%) performed penoscrotal PP and 43% of respondents performed more than 30 PP per year. OFP was used most of the time by 24.39% of respondents and ORP was used most of the time by 73.18%. No significant relationship was found between the use of an OFP/ORP and geographical region, number of implants performed per year, surgical approach, or location of reservoir placement. Of the respondents using an ORP, 100% prescribed 10 doses of opioid medication or less upon discharge. 41.51% of respondents used an OFP/ORP from published literature and 9.43% consulted their local anesthesia or pain management department. The most commonly used modalities of non-opioid analgesia were: non-steroidal anti-inflammatories (95.1%), acetaminophen (87.8%), dorsal penile block (80.4%), gabapentin (46.3%), and pudendal block (43.9%). Following initiation of an ORP/OFP, 9.3% reported an increase in phone calls and 11.6% reported an increase in refill requests. There were no reports of increased patient dissatisfaction. Most respondents (65.8%) were extremely satisfied with their protocols. Conclusions OFP/ORP after PP surgery appear to be widely adopted by the urologic prosthetic community without a significant increase in patient or surgeon dissatisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast (ASB).

Analysis of the efficacy and safety of coblation and pulsed radiofrequency in the treatment of cervicogenic headache

Objective: To explore the efficacy and safety of coblation and pulsed radiofrequency on cervicogenic headache (CEH). Methods: A total of 118 patients with CEH who underwent coblation or pulsed radiofrequency in the Department of Pain Management at Xuanwu Hospital, Capital Medical University from August 2018 to June 2020 was retrospectively collected. Patients were divided into the coblation group (n=64) and the pulsed radiofrequency group (n=54) according to different surgical methods. In the coblation group, there were 14 males and 50 females, aged 29-65 (49.8±10.2) years, while in the pulse radiofrequency group, there were 24 males and 30 females, aged 18-65 (41.7±14.8) years. Visual analogue scale (VAS) score, postoperative numbness in the affected areas and other complications were recorded and compared between the two groups at preoperative 3 d, and 1 month, 3 months and 6 months postoperatively. Results: The VAS score of the coblation group was (7.16±0.91), (3.67±1.13), (1.59±0.91), (1.66±0.84) and (1.56±0.90) before operation, and 3 days, 1 month, 3 months and 6 months after surgery. Likewise, the VAS score of the pulsed radiofrequency group was (7.01±0.78), (1.58±0.88), (1.57±0.94), (3.71±1.08) and (6.92±0.83) at the aforementioned time points. There were statistically significant differences of VAS scores between the coblation group and the pulsed radiofrequency group at 3 days, 3 months and 6 months postoperatively (all P<0.001). Intra-group comparison revealed that VAS scores in the coblation group were significantly lower than those before surgery at all time points after surgery (all P<0.001), while VAS scores in the pulsed radiofrequency group were significantly decreased at 3 days, 1 month and 3 months after surgery (P<0.001). The incidence of numbness was 72% (46/64), 61% (39/64), 6% (4/64) and 3% (2/62) in the coblation group and 7% (4/54), 7% (4/54), 2% (1/54) and 0 (0/54) in the pulsed radiofrequency group, respectively. At 3 days and 1 month after surgery, the incidence of numbness in the coblation group was higher than those in the pulsed radiofrequency group (both P<0.001). In the coblation group, one patient developed pharyngeal discomfort 3 days after surgery, which disappeared spontaneously 1 week after surgery without special treatment. One patient developed vertigo after getting up in the morning at 3 days postoperatively, and the possibility of transient cerebral ischemia was considered. In the pulsed radiofrequency group, one patient developed nausea and vomiting after operation, but spontaneous remission was observed after one hour without special treatment. Conclusions: Both coblation and pulsed radiofrequency are effective and safe in the treatment of CEH. But the VAS scores at 3 and 6 months after coblation is significantly lower than those of pulsed radiofrequency ablation group, and the efficacy is better in those undergoing coblation.

Clinical efficacy of transforaminal endoscopic discectomy in the treatment of recurrent lumbar disc herniation: a single-center retrospective analysis

PurposeTo investigate the clinical efficacy of transforaminal endoscopic discectomy (TED) in treating recurrent lumbar disc herniation.MethodsClinical datal of 31 patients who were hospitalized in the Department of Pain Management, First Affiliated Hospital of Nanchang University, between 2015 and 2018 due to recurrent lumbar disc herniation were collected and analyzed retrospectively. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were used to assess alterations of patients’ leg pain intensity and nerve function, respectively. The Modified MacNab criteria were used to evaluate patients’ excellent and good rates.ResultsCompared to clinical data before surgery, there was a significant reduction in VAS scores (P < 0.01) along with a significant improvement in JOA scores (P < 0.01) at 2 years after revision surgery. The patients’ excellent and good rates were 83.9% at the 2 years after surgery.ConclusionThe TED is safe and effective in the long term and is applicable to the treatment of recurrent lumbar disc herniation.

Predictors of response for percutaneous balloon compression for the treatment of recurrent trigeminal neuralgia following surgical procedures: a retrospective study.

Recurrent trigeminal neuralgia (TN) after surgical procedures can be rather difficult to treat, and standardized treatment measures are not available yet. It is unclear whether percutaneous balloon compression (PBC) can be used as the preferred surgical treatment for postoperative recurrent TN. To determine the efficacy of PBC and identify the predictors of response of PBC for the treatment of recurrent TN following TN-related surgeries, we retrospectively collected and analyzed the data of patients with recurrent TN following surgical treatments who underwent PBC under three-dimensional computed tomography (3D-CT) guidance at the Department of Pain Management of Beijing Tiantan Hospital, Capital Medical University from January 2018 to January 2022. We found, within 1month after PBC, that the total efficacy of PBC on recurrent TN following TN-related surgeries was 86.7%. Based on the effectiveness of PBC 1month postoperatively, patients were divided into the effective group (130, 86.7%) and the ineffective group (20, 13.3%). Fourteen (10.8%) patients in the effective group had undergone RFT before, which was significantly lower than that in the ineffective group (6, 30%, p = 0.02). Multivariate logistic regression analysis showed that previous RFT alone (OR = 0.20, 95%CI 0.06-0.66, P = 0.01) was an independent predictor of the negative response of PBC. Thus, PBC was found to be a moderately effective and safe treatment for recurrent TN after TN-related surgery. However, previous RFT procedures may predict a slightly worse outcome after PBC.

Pulsed Radiofrequency Combined With Methylene Blue Paravertebral Nerve Block Effectively Treats Thoracic Postherpetic Neuralgia.

ObjectiveTo compare the effect, safety, and patient satisfaction of pulsed radiofrequency combined with methylene blue paravertebral nerve block and pulsed radiofrequency alone in the treatment of thoracic postherpetic neuralgia (PHN).MethodsA total of seventy-two patients with PHN diagnosed in the Department of Pain Management of Shengjing Hospital at China Medical University, from September 2019 to April 2021, were enrolled in the study. Patients were randomly divided into two groups. Group A (n = 36) received pulsed radiofrequency treatment. Group B (n = 36) received pulsed radiofrequency + methylene blue paravertebral nerve block. Patients were followed-up at 1 day, 1 week, 1 month, 3 months, and 6 months after treatment. Observation at each follow-up included basic patient characteristics, Visual Analog Scale (VAS), Hospital Anxiety and Depression Scale (HAD), the Insomnia Severity Index (ISI), patient satisfaction, complications, and side effects.ResultsCompared with preoperative values, the VAS scores significantly decreased in both groups at each postoperative time point (1 day, 1 week, and 1, 3, and 6 months; all p < 0.05). Compared with group A, VAS scores in group B were significantly lower 1 week and 1 month after surgery (p < 0.05). Patients in group B had lower HAD scores than those in group A 1 week after surgery (p < 0.05). Patients in group B had lower ISI scores than those in group A 1 day, 1 week, and 1, 3, and 6 months after surgery (p < 0.05). The pregabalin dosage in group B was lower than that in group A at 1 and 6 months after surgery (p < 0.05). Patient satisfaction was higher in group B than in group A at 1 week and 6 months after surgery (p < 0.05). There were no serious complications or side effects in either group.ConclusionPulsed radiofrequency combined with methylene blue paravertebral nerve block is superior to pulsed radiofrequency alone in the treatment of thoracic PHN, which can significantly relieve PHN and improve the condition of sleep and emotional disorders. Therefore, it is a safe and effective treatment method.