Context: Spinal anesthesia is commonly used for many surgical procedures because of its rapid onset and reliable anesthetic effects. Nevertheless, postoperative lower back pain (LBP) remains a frequent complication, with reported rates varying substantially across the literature. This systematic review and meta-analysis aimed to synthesize the available evidence and estimate the overall incidence of both short-term acute and long-term persistent LBP following spinal anesthesia. Evidence Acquisition: Major databases, including PubMed, Scopus, Embase, and Web of Science, were systematically searched to identify studies of LBP after spinal anesthesia. Following data extraction, relevant outcomes were pooled for analysis. Given the expected methodological heterogeneity across studies, a random-effects model was used for data synthesis. Between-study heterogeneity was quantified using Cochran's Q test and the I2 statistic. Publication bias was assessed using funnel-plot inspection and established statistical methods. Results: The review included 15 studies comprising 4,478 patients, of which 11 provided sufficient data for meta-analysis. The pooled overall rate of postprocedural LBP was 25.65% (95% CI: 19.54% - 32.29%), with substantial between-study heterogeneity (I2 = 96.84%). Subgroup analyses showed an acute LBP prevalence of 21.96% (95% CI: 16.01% - 28.56%) and a chronic LBP prevalence of 44.98% (95% CI: 26.95% - 63.73%). Marked heterogeneity persisted across these subgroups. Most included studies involved orthopedic, urologic, or obstetric/gynecologic surgery. Discussion: Back pain is frequently reported after spinal blocks during both short- and long-term recovery phases. However, substantial methodological heterogeneity among the primary studies precludes the establishment of a definitive causal relationship. Well-designed prospective studies using standardized assessment tools are needed to clarify the clinical implications of these findings.
Background:Chronic spinal pain, led by low back pain (LBP), which affects 619 million people globally and is projected to reach 843 million by 2050, is the main cause of disability. Although epidural steroid injections (ESIs) are recommended at Level I-A, their efficacy is often limited by technical factors, such as scarring, and they provide incomplete diagnostic information. We propose diagnostic targeted epidural injection (dTEI) via a Racz catheter, focused on detailed epidurography and anatomical exploration, as an essential diagnostic-therapeutic triage tool to overcome these drawbacks. Objectives:The objective of this study is to evaluate the efficacy of the procedure in a mixed low back pain population. Methods:A retrospective analysis was conducted on 99 patients with chronic radiculopathy, LBP, Post-Spine Surgery Syndrome type 2 (PSPS-2), or spinal stenosis (VAS > 40, duration > 3 months) treated with dTEI between January and December 2023. Outcomes, including Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Quality of Life (QoL), and opioid use (morphine equivalent dose), were evaluated at one-month follow-up. Success was defined as either a VAS reduction greater than 50% or achievement of the Minimum Clinically Important Difference (MCID). Results:The mean age was 67.57 years. Significant improvements were observed in VAS scores (from 78.18 to 57.88, P < 0.001) and QoL scores (from 45.33 to 51.62, P = 0.001). Minimal therapeutic success according to MCID was achieved by 59.6% of patients. Opioid consumption was significantly reduced by 38%. Subgroup analysis showed that the spinal stenosis group achieved the best outcomes across all metrics. No correlation was found between the surgeon's subjective assessment of technical success (contrast runoff/defect reduction) and superior clinical outcome. Conclusions:Diagnostic targeted epidural injection serves as a valuable diagnostic tool with significant therapeutic potential, optimizing patient selection in a stepwise management pathway. It effectively reduces pain and opioid use and provides detailed anatomical information to selectively guide nonresponders toward more complex and costly therapies, such as spinal cord stimulation or epiduroscopy. The primary value of the technique lies in diagnostic clarification and refinement of the therapeutic trajectory.
Background:Postoperative pain following lumbar spine surgery (LSS) can significantly impact recovery and patient satisfaction. Ultrasound-guided regional techniques such as quadratus lumborum plane block (QLPB) and caudal block (UGCB) have been proposed to enhance postoperative analgesia while reducing opioid consumption and opioid-related adverse effects (AEs). Objectives:To compare the analgesic efficacy and safety of ultrasound-guided QLPB versus ultrasound-guided caudal block in adult lumbar spine stabilization surgery. Methods:This randomized, double-blinded, prospective comparative study included 111 adult patients (18 - 60 years, ASA physical status I - II) scheduled for elective lumbar spine stabilization surgery. Patients were randomly allocated into three equal groups: Control (standard analgesia), ultrasound-guided caudal block (UGCB), or ultrasound-guided QLPB. Blocks were performed under ultrasound guidance after induction of general anesthesia using 0.25% bupivacaine. The primary outcome was the time to first postoperative rescue analgesia. Secondary outcomes included postoperative pain scores using the Numerical Pain Rating Scale (NPRS), total 24-hour postoperative opioid (meperidine) consumption, intraoperative opioid requirements, hemodynamic variables, and block- or opioid-related adverse events over the first 24 postoperative hours. Results:The time until the initial rescue analgesia was significantly delayed with QLPB in comparison to control and Caudal, with medians of 15, 1, and 5 h, respectively (P < 0.001). The total 24-hour (meperidine) intake was significantly diminished with QLPB as opposed to Caudal and control (P < 0.05). Numerical Pain Rating Scale scores were significantly diminished in QLPB and Caudal as opposed to control at 30 min, 1, 2, 4, 8, and 24 h (P < 0.001), with comparability detected at 12 h and 18 h. Intraoperative fentanyl administration was markedly diminished in the QLPB and Caudal groups, in contrast to the control group (P < 0.001). The occurrence of nausea and vomiting exhibited comparability across groups. Conclusions:Both ultrasound-guided caudal block and QLPB significantly improved postoperative analgesia compared with standard analgesic management following lumbar spine stabilization surgery. However, QLPB provided longer-lasting analgesia and was associated with lower postoperative opioid consumption than caudal block, highlighting its advantage for prolonged postoperative pain control.
Background:Trochanteric femur fractures constitute nearly half of all hip fractures and represent the most commonly surgically treated fracture type overall. Postoperative pain is linked to increased morbidity and poorer functional recovery, and its management remains challenging due to the adverse effects associated with commonly prescribed analgesics. Objectives:This study aimed to assess the influence of oral vitamin C supplementation on postoperative pain intensity in patients with trochanteric femur fractures managed with intramedullary nailing. Methods:A prospective, randomized, single-blinded, placebo-controlled clinical trial was performed involving 70 patients allocated to either a vitamin C group or a control group. Participants in the vitamin C group received 1 g of oral vitamin C daily for 40 postoperative days, whereas the control group received a placebo for the same duration. Baseline demographic and clinical characteristics, Visual Analogue Scale (VAS) pain scores, total postoperative metamizole consumption, Harris Hip Score (HHS) values, and complication rates were recorded and compared between groups. Results:No statistically significant differences were observed between groups regarding age, gender distribution, length of hospital stay, fracture side, or fracture classification. The cumulative postoperative VAS scores were significantly lower in the vitamin C group compared with the control group (P = 0.0000). Median postoperative metamizole consumption was lower in the vitamin C group, with a significant difference compared with the control group (P = 0.020). Harris Hip Score values assessed at 6 and 12 weeks postoperatively did not differ significantly between groups (P = 0.760 and P = 0.796, respectively). Conclusions:The findings indicate that vitamin C supplementation significantly reduced subjective postoperative pain and analgesic consumption, suggesting its potential usefulness as an adjunctive measure for pain management following hip fracture surgery.
Background:Lower limb surgeries are typically accompanied by severe postoperative pain, and managing such pain is of great importance. Inadequate pain management can lead to serious complications such as myocardial ischemia and impaired pulmonary function. To manage pain, local anesthetic techniques have been introduced as effective methods. One of these techniques is the high-volume proximal adductor canal block (HI-PAC), in the distal third of the medial thigh, which directly targets the femoral nerve and indirectly the sciatic nerve. Methods:In this double-blind study, patients aged 30 to 70 years with American Society of Anesthesiologists (ASA) physical status I and II who underwent anterior cruciate ligament (ACL) reconstruction were divided into two groups. Both groups received general anaesthesia using the same method. The control group received an ultrasound-guided saphenous nerve block in the proximal third of the anteromedial thigh with 0.2% ropivacaine (15 mL), while the case group received a HI-PAC in the distal third of the thigh with 0.1% ropivacaine (30 mL). Pain intensity and analgesic effectiveness were evaluated at predetermined time points (baseline, 0.5, 2, 4, 6, and 12 hours post-block). Pain severity was assessed using the Numeric Rating Scale (NRS), and agitation was measured with the Ramsay Sedation Score. Data were analyzed using appropriate statistical tests via SPSS version 26. Results:A total of 50 patients participated: 24 in the case group (HI-PAC block) and 26 in the control group (saphenous nerve block). In terms of pain scores (NRS), the initial pain score was 9.20 in group A and 9 in group S. Pain intensity decreased significantly over time in both groups. At 0.5, 2, 4, 6, and 12 hours after the block, the average NRS score was 4.01 in group A and 4.18 in group S. Conclusions:The mean opioid consumption and level of agitation were similar in both groups. Multivariate analysis indicated that both nerve block techniques were equally effective in reducing acute postoperative pain, and the type of block did not have a statistically significant effect on pain severity.
Background:Midazolam is widely used for its anxiolytic and amnestic effects, while dexmedetomidine provides sedation and analgesia, and ketamine induces sedation, analgesia, and amnesia. Oral administration is commonly accepted in children undergoing inguinal hernia surgeries. Objectives:This study aimed to examine oral dexmedetomidine, ketamine, and midazolam as premedication in children having inguinal hernia operations. Methods:This randomized, double-blind study included 60 children (ages 3 - 7, ASA I-II) who underwent inguinal hernia operations. Subjects were randomly assigned to 3 groups: Group K received oral ketamine at 6 mg/kg, group D received oral dexmedetomidine at 4 µg/kg, and group M received oral midazolam at 0.5 mg/kg. Results:No substantial differences were seen in the five-point sedation score (P = 0.2811) or the Parental Separation Anxiety Scale (PSAS; P = 0.1122). Group D had a markedly reduced recovery time in comparison to groups M and K (P < 0.001). Furthermore, group D exhibited markedly reduced face, legs, activity, cry, and consolability (FLACC) scores at 15 and 20 minutes compared with groups M and K (P = 0.001, 0.016, respectively). Conclusions:Oral dexmedetomidine, ketamine, and midazolam provided comparable sedation quality and parental separation ease in children undergoing inguinal hernia surgeries. However, dexmedetomidine showed significant advantages by reducing recovery time and improving postoperative pain scores, despite a higher incidence of bradycardia in some patients. Thus, oral dexmedetomidine appears to be an efficient and safe alternative for pediatric premedication, provided careful heart rate monitoring.
Context: Nicotine has been investigated in prior studies for its analgesic effects and its impact on postoperative nausea and vomiting (PONV), yet results have been inconsistent. Objectives: This systematic review and narrative synthesis evaluates the effects of perioperative nicotine administration on postoperative pain control and PONV in patients undergoing general anesthesia. Methods: A systematic literature review was conducted, and findings were summarized narratively. Comprehensive searches were performed in PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar for studies published between 2004 and 2023, using a PICO-based approach. The PICO criteria included: Patients undergoing general anesthesia, perioperative nicotine as the intervention, placebo or no nicotine as the comparator, and pain scores as the primary outcome. The Mendeley application was utilized to eliminate duplicate data. Title, abstract, and full-text screenings were independently conducted by all authors using the online review platform Rayyan. Final data were individually extracted into Excel spreadsheets. The risk of bias in the included studies was assessed with the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Eleven studies encompassing 753 participants (384 receiving nicotine, 369 controls) were included. Of these, 514 were female and 239 were male, all having undergone different surgical procedures and receiving nicotine via various methods and dosage forms. The majority of participants were nonsmokers. Primary outcomes across the studies predominantly involved postoperative pain scores, while secondary outcomes included the incidence of PONV, antiemetic requirements, and opioid consumption. No additional analyses were performed due to heterogeneity among the included studies. Conclusions: Although perioperative nicotine administration demonstrated reductions in postoperative pain, nausea, vomiting, and opioid consumption in some studies, the effect of nicotine on PONV was inconsistent. Variability in patient populations, dosage forms, and dosages complicates the formulation of definitive clinical recommendations. Overall, perioperative nicotine shows promise for improving postoperative pain management, but its impact on PONV requires careful consideration. Nicotine administration has been investigated as an analgesic adjunct and as a strategy for preventing PONV. This systematic review aimed to determine the effect of perioperative nicotine administration on postoperative pain and PONV.
Background:Interscalene brachial plexus block (ISB) remains the gold standard for analgesia in arthroscopic shoulder surgery (ASS). However, ISB is associated with a higher incidence of hemidiaphragmatic paralysis (DP). Objectives:This study compares ultrasound-guided interscalene brachial plexus block (USG-ISB) with a combination of ultrasound-guided pericapsular nerve block (USG-PENB) and superficial cervical plexus block (SCPB) to evaluate analgesic efficacy and the incidence of DP. Methods:In this prospective, triple-blinded randomized trial, 42 American Society of Anesthesiologists (ASA) I - II patients undergoing elective ASS were randomized into two groups after induction of general anesthesia (GA): Group A (ISB, 10 mL 0.25% bupivacaine) or group B [pericapsular nerve block (PENB) 10 mL + SCPB 5 mL 0.25% bupivacaine]. Blocks were performed under ultrasound guidance. The primary outcome was the incidence of DP; secondary outcomes included pain scores, opioid consumption, pulmonary function, and patient satisfaction. Results:Compared with group A, group B demonstrated a delayed time to first request for rescue analgesia (13.24 vs. 8.38 hours; P < 0.001) and reduced 24-hour fentanyl consumption (135.71 vs. 192.86 mcg; P = 0.012). Pulmonary function was significantly better preserved in group B (P < 0.05). The incidence of DP was lower in group B (4.76% vs. 38.1%; P = 0.02). Pain scores at 6, 12, and 18 hours were also lower in group B (P < 0.05). Both groups showed no differences in hypotension, bradycardia, or patient satisfaction. Conclusions:The combination of PENB and SCPB provides analgesia non-inferior to ISB, while significantly reducing the incidence of DP and opioid requirements. For individuals at risk of respiratory impairment, this approach presents a lower-risk alternative without compromising pain control efficacy.
Background:Shoulder pain is widely recognized as one of the most prevalent complications following cholecystectomy procedures. The management of postoperative shoulder discomfort primarily relies on pharmacological interventions. Pregabalin, a commonly prescribed medication, is valued for its efficacy in modulating neuropathic pain. Objectives:This study aimed to evaluate the impact of preoperative pregabalin, in combination with paracetamol, on the control of shoulder pain after cholecystectomy. Methods:This randomized, double-blind clinical trial enrolled 90 patients aged 20 - 60 years, scheduled for cholecystectomy at Imam Ali Hospital in Bojnourd in 2023. Patients were selected by convenience sampling and randomly assigned to one of three groups. The first group received 300 mg of oral pregabalin one hour before surgery, as well as 1 g of intravenous paracetamol 30 minutes before the end of the operation, followed by dosing every 6 hours for 24 hours. The second group received only oral pregabalin as premedication one hour prior to surgery. The third group received standard care (standard multimodal analgesia with diclofenac as needed), without pregabalin or paracetamol. The primary outcome was the severity of shoulder pain during recovery and at 6, 12, 18, and 24 hours postoperatively, measured using the Visual Analog Scale (VAS). Results:Significant differences were observed in the severity of postoperative shoulder pain among the three groups at all-time intervals (P < 0.05). Inter-group comparisons revealed that the severity of shoulder pain in the first group was significantly lower than in the third group at all-time points (P < 0.05). Additionally, the second group exhibited significantly lower shoulder pain severity compared to the third group at all-time points except at 18 and 24 hours postoperatively (P < 0.05). There was a notable reduction in pain severity over time in the first and second groups (P < 0.001). Conclusions:According to the study findings, premedication with oral pregabalin and intravenous paracetamol effectively alleviated postoperative shoulder pain across all time intervals without adverse effects. Pregabalin premedication alone also demonstrated analgesic effects, though with a shorter duration compared to the combination regimen.
Background:Numerous medical interventions have been utilized to prevent postoperative shivering. Due to the potential complications associated with the use of pethidine, such as respiratory failure, the exploration of alternative drugs for the prevention and treatment of postoperative shivering has been a key consideration. Objectives:The aim of this study was to assess the preventive effects of ketamine and dexmedetomidine on shivering in patients undergoing inguinal herniorrhaphy under spinal anesthesia. Methods:This triple-blind randomized clinical trial involved patients who were candidates for inguinal herniorrhaphy with spinal anesthesia. Patient, investigator/administering, and outcome assessor were blinded. The necessary sample size was 150, estimated based on statistical formula at a 95% confidence interval and 80% power. Patients were randomly assigned using a computer-generated random sequence allocation and a randomized block sampling design with block sizes of six to ensure balanced allocation across the three groups: Ketamine, dexmedetomidine, and control. Randomization was performed using random sequence allocation software and randomized block sampling with 6 blocks for all 3 treatment groups. The severity of shivering was assessed using the Bedside Shivering Assessment Scale (BSAS) at multiple time points: Immediately, 5, 15, and 30 minutes after spinal anesthesia, and upon entering the recovery room, 15 minutes later, and at discharge from recovery. Data were analyzed using IBM SPSS Statistics version 21 software. Quantitative data were expressed as mean ± standard deviation, while qualitative data were presented as percentages. The mean of the variables was compared using Student's t-test, and the chi-square test was employed to compare qualitative data. Results:The severity of shivering was notably lower in the dexmedetomidine group at 5, 15, and 30 minutes after spinal anesthesia induction, during recovery, and 15 minutes after recovery. The intensity of shivering upon exiting recovery was similar in the ketamine and dexmedetomidine groups and significantly lower than in the control group. Systolic blood pressure was significantly lower in the dexmedetomidine group upon entry into recovery and 15 minutes after recovery. Throughout all time periods, patients in the dexmedetomidine group exhibited significantly lower heart rates. Conclusions:Both ketamine and dexmedetomidine proved effective in reducing post-herniorrhaphy shivering compared to the control group, with the effect being notably greater in the dexmedetomidine group.
Introduction:Postoperative cerebrospinal fluid (CSF) leak is an uncommon but clinically important complication of lumbar spine surgery, typically presenting with orthostatic headache. When conservative management and dural repair are unsuccessful, image-guided interventions may be required. Case Presentation:We report a 48-year-old woman who developed a refractory CSF leak with disabling orthostatic headache following multilevel lumbar decompression. Despite initial conservative management and revision dural repair, symptoms persisted. Heavily T2-weighted magnetic resonance myelography (HT2W-MRM) localized the leak to the L4-L5 level. Conventional approaches such as re-exploration, lumbar drainage, or standard lumbar epidural blood patch (EBP) were relatively contraindicated because extensive postoperative fibrosis, adhesions, and altered epidural anatomy rendered direct lumbar access unsafe and technically impractical. The main intra-procedural challenges included navigating through scarred epidural planes and ensuring precise blood delivery to the leak site without risking additional dural trauma. Given the presence of postoperative fibrosis and technical inaccessibility via standard lumbar approaches, a fluoroscopy-guided caudal epidural blood patch (CEBP) was performed. A flexible epidural catheter was inserted through the sacral hiatus and advanced under real-time fluoroscopy to the identified leak site. Twenty milliliters of autologous blood were injected incrementally into the posterior epidural space. The patient experienced complete resolution of orthostatic headache and cessation of CSF leakage within 24 hours. At both two-week and two-month follow-up visits, she remained symptom-free, with no neurological deficits or recurrence. No procedural complications were observed. Conclusions:This case highlights the feasibility, safety, and clinical efficacy of catheter-guided CEBP performed under fluoroscopic guidance for treating complex, refractory CSF leaks in the early postoperative period. Importantly, it is one of the first reports to demonstrate this approach immediately following failed surgical dural repair, a scenario rarely documented in the literature. By integrating high-resolution MR myelography with precise catheter navigation, targeted therapy can be delivered effectively in anatomically altered spines where conventional techniques are contraindicated. Thus, this case uniquely illustrates how catheter-guided caudal access can serve as a novel, minimally invasive option in the early postoperative setting when direct lumbar access is no longer feasible.
Background:Failed back surgery syndrome (FBSS) is a challenging chronic pain condition following spinal surgery, often resistant to conventional therapies. Caudal epidural injection is a mainstay for managing FBSS, yet its effects on intracranial pressure (ICP), particularly in adults with post-surgical anatomical changes, remain poorly understood. Optic nerve sheath diameter (ONSD) measured by ultrasound offers a non-invasive surrogate marker for detecting alterations in ICP. Methods:This prospective single-center clinical trial enrolled 46 adult FBSS patients scheduled for therapeutic caudal epidural injection at Imam Hussein Hospital, Tehran, Iran. Each participant received a standardized two-stage, 30 mL caudal epidural injection. The ONSD and hemodynamic parameters [systolic, diastolic and mean arterial blood pressure (SBP), (DBP), (MAP), heart rate (HR)] were assessed at baseline, immediately, and then at 10, 20, and 40 minutes post-injection. All measurements were performed by blinded, trained personnel using validated protocols. Results:Caudal epidural injection produced a significant, transient increase in mean ONSD (baseline: 4.8 ± 0.49 mm; immediate post-injection: 5.1 ± 0.50 mm; P < 0.001), which normalized within the observation period. No patient exhibited symptoms or clinical signs of raised ICP. While serial monitoring indicated statistically significant reductions in SBP, DBP, MAP, and HR at 40 minutes, all values remained within physiologically acceptable ranges. No major procedural complications or adverse neurological outcomes occurred. Conclusions:Standard-volume caudal epidural injection in adults with FBSS causes a temporary, asymptomatic elevation in ONSD, reflecting a reversible change in ICP. The procedure was well tolerated, with minimal and clinically insignificant hemodynamic effects, supporting its safety and utility in this patient population.
Background:Chronic pain is a complex condition affecting a significant portion of the population, and various approaches are being explored for its management. Objectives:This study aims to design and evaluate a telemedicine system for chronic pain management. Methods:A developmental cross-sectional study was conducted in three phases: Identifying a minimum dataset through literature review and expert opinion, developing and testing a prototype using Nielsen's Ten Heuristics, and finalizing and evaluating the system with the Questionnaire for User Interface Satisfaction (QUIS). Results:The minimum dataset included 56 elements across eight categories. The system was developed as a web-based platform. Usability evaluation based on Nielsen's ten principles showed that the highest number of issues (n = 9) and the greatest severity (mean score 2.37) were related to the system-real world consistency. User satisfaction with the interface was favorable, with mean scores of 8.07 ± 0.41 for specialists and 7.73 ± 0.55 for patients. Conclusions:The designed telemedicine system for chronic pain management, considering its features, provides specialized services to patients with chronic pain who are unable to visit a pain specialist in person. Additionally, by eliminating unnecessary visits to medical centers, this system can be beneficial in reducing related costs.
Background:Patient-controlled analgesia (PCA) is a widely used method for managing postoperative pain. However, its impact on hospital length of stay (LOS) is unclear due to patient population variation. Currently, there is limited data directly comparing LOS in limb fracture patients receiving PCA versus those exclusively receiving nurse-administered analgesia (NAA). Objectives:To assess the impact of PCA in combination with NAA on hospital LOS and postoperative pain scores in limb fracture surgery patients compared to NAA alone. Methods:A retrospective chart review was conducted to examine the LOS between all postoperative Northeast Georgia Health System (NGHS) patients between 18 and 75 years of age who underwent surgical limb fracture repairs between 2019 and 2024, specifically evaluating those who exclusively received NAA versus those who received a combination of PCA and NAA. The PCA and NAA groups each consisted of 49 patients. The PCA group self-administered intravenous (IV), epidural, or peripheral nerve analgesics via PCA pumps in addition to receiving nurse-administered transdermal or intramuscular analgesics. The NAA group received transdermal, intramuscular, or IV analgesics exclusively via manual administration by nursing staff. Medications included in this study were morphine, oxycodone, hydromorphone, fentanyl, and acetaminophen. Measured outcome variables include hospital LOS and pre- and postoperative pain scores, which were directly taken from NGHS's electronic medical record. Results:The two groups studied included patients who received IV PCA in addition to NAA (termed as PCA) and patients who exclusively received transdermal, intramuscular, and/or IV NAA (termed as non-PCA). A total of n = 49 patients underwent limb fracture repair and received PCA, and 49 patients from the non-PCA group were matched accordingly. After propensity matching, average preoperative pain scores between the non-PCA and PCA groups were similar at 5.64 and 5.60, respectively. Patients in the PCA group had higher mean postoperative pain scores (μ = 4.92) compared to the NAA group (μ = 4.41), with a mean difference of 0.51 points (P = 0.046). Conclusions:This retrospective analysis suggests that the use of PCA in conjunction with NAA is associated with increased LOS and higher postoperative pain scores when compared to NAA alone in patients undergoing surgical repair of limb fractures.
Background:Propofol is one of the most commonly used drugs in anesthesia, but administering it to patients often causes significant pain and discomfort. Numerous studies have been conducted on various methods to mitigate this adverse effect due to its prevalence. Methods:This study was conducted in 2025 at Kashani Hospital in Isfahan, Iran, involving 150 patients undergoing elective surgery who received propofol for anesthesia induction. They were randomly assigned to five groups: Normal saline (control), transcutaneous electrical nerve stimulation (TENS), acetaminophen, intravenous lidocaine, or intravenous fentanyl. Additionally, this randomized, double-blind, controlled clinical trial (allocation ratio 1:1) employed block randomization. Patients, along with the assessor and the data analyst, were blinded. Statistical analyses were performed using ANOVA, chi-square, and repeated-measures ANOVA. Pain during injection was rated using a 0 - 10 numerical scale. Results:There was no statistically significant difference in pain intensity between the intervention groups when comparing their mean pain scores (P > 0.05). However, in most comparisons, the normal saline group had the highest average pain scores. Conclusions:All interventions except saline reduced propofol injection pain. Secondary outcomes, including patient satisfaction, recovery time, and hemodynamic stability, were also evaluated, and no significant adverse effects were observed among the interventions. These findings support the use of multiple safe strategies to minimize discomfort during anesthesia induction.
Background:Effective postoperative pain management is necessary to enhance patient recovery and satisfaction following the creation of an arteriovenous fistula (AVF). Objectives:This work compares the role of Ultrasound (US) guided and landmark-guided Intercostobrachial nerve (ICBN) block and serratus plane block (SPB) after supraclavicular plexus block (SCPB) for anesthesia in the creation of AVF in the medial side of the arm. Methods:This randomized, double-blind trial was carried out on 75 patients, 18 - 65 years old, both sexes undergoing creation AVF in the medial side of the arm. Participants were randomized equally into three groups receiving SCPB, followed by traditional landmark ICBN (TICBN) in group T, US-guided ICBN in group U, or US-guided SPB in group S. Results:Groups U and S needed less local anesthesia supplementation than group T (8%, 12%, 44%, P < 0.05). Time for first rescue analgesia was delayed in U and S as opposed to T, and in U as opposed to S (P < 0.001). Fentanyl consumption was diminished in U and S than T, and in U than S (P < 0.001). Visual Analogue Scale scores were diminished in U and S as opposed to T at 2 and 4 hours, with no difference between U and S; at 8 hours, T and U had diminished VAS than S (P < 0.05). Patient satisfaction was better in the U than in the T and S (P = 0.002). Conclusions:US guided ICBN and SPB provide superior anesthesia and postoperative analgesia as opposed to TICBN following the creation of AVF in the arm medial side.
Background:Epidural steroid injections (ESIs) are widely employed for managing low back pain (LBP), particularly when conservative treatment fails. The Racz catheter technique offers targeted drug delivery and mechanical adhesiolysis, potentially enhancing outcomes in chronic LBP. Objectives:The present study aimed to compare the Racz catheter technique and the conventional technique in lumbar epidural steroid injection for the management of LBP. Methods:This randomized, controlled, double-blind study was conducted on a sample of 60 patients, aged 18 - 65, comprising both sexes, who had persistent lumbar pain, grade 1 spondylolisthesis, and facet osteoarthropathy with small disc findings on radiological examination. Participants were randomized equally into two groups. The Racz catheter group received lumbar epidural steroids using a Racz catheter, while the conventional lumbar group received conventional lumbar steroid injections. Results:The Visual Analog Scale (VAS) and Oswestry Low Back Disability Questionnaire (OSW) scores were insignificantly different at baseline, immediately post-procedure, and at 1 month between both groups. However, they were significantly lower at 2 months, 4 months, and 6 months in the Racz catheter group compared to the conventional lumbar group (P < 0.05). Incidences of hypotension, paraesthesia, bleeding, and headache were insignificantly different between both groups. Patient satisfaction levels were significantly higher in the Racz catheter group than in the conventional lumbar group (P < 0.05). Conclusions:The Racz catheter technique is a superior interventional option for lumbar epidural steroid delivery in patients with persistent LBP, providing enhanced pain relief, improved functional outcomes, greater patient satisfaction, and equivalent procedural safety compared to the conventional technique.
Background:Intravenous regional anesthesia (IVRA) is a widely used technique for hand and wrist surgeries. However, conventional upper arm IVRA requires higher anesthetic doses, which increases the risk of systemic toxicity. Forearm IVRA offers potential advantages, including lower anesthetic requirements and improved tourniquet tolerance. Objectives:The study aims to compare the efficacy, analgesic effectiveness, and safety of forearm versus upper arm IVRA in elective hand and wrist surgeries. Methods:In this prospective, randomized, open-label clinical trial, 140 adult patients, classified as American Society of Anesthesiologists (ASA) physical status I - II and aged 21 - 65 years, scheduled for elective hand or wrist surgery at Ain Shams University Hospitals, were randomized into two equal groups: Upper arm IVRA and forearm IVRA. The outcomes measured included block success, onset of analgesia, tourniquet pain-free duration, pain scores, rescue analgesia requirements, and patient and surgeon satisfaction. Results:Block success rates were similar between the forearm and upper arm IVRA groups (94.3% vs. 91.4%, P = 0.512). Forearm IVRA demonstrated a significantly longer tourniquet pain-free duration (45.7 ± 4.6 vs. 43.2 ± 4.7 minutes, P = 0.002) and a longer time to the first postoperative analgesic request (8.9 ± 0.9 vs. 5.8 ± 1.0 hours, P < 0.001), with lower 24-hour nalbuphine consumption (11.4 ± 4.2 vs. 28.7 ± 3.4 mg, P < 0.001). Patient satisfaction was higher in the forearm group (P < 0.001), while surgeon satisfaction did not differ significantly (P = 0.145). Conclusions:Forearm IVRA is an effective and safe alternative to upper arm IVRA for hand and wrist surgeries, offering superior tourniquet tolerance, prolonged analgesia, reduced opioid requirements, and higher patient satisfaction.
Background:Chronic shoulder pain frequently affects individuals in contemporary societies. However, the benefits of conventional therapies are limited and do not result in sustained clinical improvement. Objectives:The purpose of this study is to evaluate the potential benefits of integrating pulsed radiofrequency (PRF) neuromodulation into current approaches for managing long-term shoulder pain. Methods:In this prospective, randomized, clinical interventional study, 60 patients suffering from chronic shoulder pain were randomly assigned to two groups. Group A consisted of 30 patients and received a glenohumeral steroid injection of Diprofos® (betamethasone dipropionate 14 mg/2 mL) along with an ultrasound-guided suprascapular nerve (US SSN) block using 10 mL of 0.25% preservative-free bupivacaine. Group B, also comprising 30 patients, underwent the same protocol as group A, with the additional administration of PRF treatment targeting the suprascapular nerve (SSN). Pain and function were assessed using the Shoulder Pain and Disability Index (SPADI), Numerical Rating Scale (NRS), and shoulder active range of motion (AROM) at baseline, 15 days, 1 month, 3 months, and 6 months post-procedure. Results:Both groups showed significant pain and functional improvement throughout the study course. However, group B exhibited superior outcomes at all follow-up points. The SPADI score decreased from 69.71 ± 16.54 at baseline to 48.16 ± 15.77 at six months in group B, compared to 72.02 ± 14.51 to 64.91 ± 14.34 in group A (P < 0.001). Median NRS scores at six months were also significantly lower (P < 0.0001) in group B [2.00 (IQR: 1.00 - 4.00)] compared to group A [5.00 (IQR: 4.00 - 6.00)]. The AROM measurements at six months favored group B for internal rotation (74.77 ± 6.84 vs. 67.10 ± 9.26, P = 0.001), external rotation (74.40 ± 9.90 vs. 67.23 ± 9.32, P = 0.006), and abduction (163.23 ± 9.96 vs. 155.30 ± 10.13, P = 0.003). Flexion improvement at six months was greater in group B (162.80 ± 21.14) than in group A (154.93 ± 12.76), though not statistically significant (P = 0.086). Conclusions:This study showed that the addition of PRF therapy to the SSN significantly improved clinical outcomes compared to the suprascapular nerve block (SSNB) combined with intra-articular corticosteroid injection in patients with chronic shoulder impingement syndrome. The combined modality led to significantly better outcomes in terms of pain alleviation, range of motion, and functional capacity.
Background:Regarding post-adenotonsillectomy pain management, pediatric patients with severe obstructive sleep apnea (OSA) are often treated with lower total opioid doses, and with more short-acting opioid types, relative to their non-severe OSA counterparts. It is unclear whether this practice undermines these patients' pain management and exposes them to a traumatic experience due to under-managed surgical pain. Pain sensitivity differs between adult males and females. Whether the difference exists in the pediatric population, especially related to surgical pain sensitivity, is unclear. Objectives:We explored the differences in pain sensitivity between sexes using a pediatric adenotonsillectomy population and studied the effects of sleep apnea on acute pain responses. Methods:We retrospectively analyzed perioperative pain management approaches in a pediatric adenotonsillectomy surgical population at our medical center. Patients aged 3 to 12 years were grouped into those with less severe OSA or severe OSA. Perioperative pain medications and post-anesthesia care unit (PACU) pain assessments were compared between two groups. Results:Of a total 3,586 patients we analyzed, a higher percentage of severe OSA patients received non-opioid type analgesic medications, as well as fewer and shorter-acting opioids. The use of rescue opioids in the post-operative period did not significantly increase in patients with severe OSA. Post-operative pain scores did not differ between patients with and without severe OSA status. Female patients had significantly higher post-operative pain scores than males in the less severe OSA group, but sex differences in the severe OSA group were not significant. Conclusions:Despite receiving less perioperative opioid, pediatric patients with severe OSA did not demonstrate worse pain scores in post-surgical recovery. Overall, we did not under-manage their post-operative pain with reduced dosages of opioids. We did find that a sex difference in acute pain perception exists even in pre-puberty pediatric population. However, severe OSA reduces pain sensitivity in both sexes, and blunts sex differences in acute pain perception.
