BACKGROUND:Despite multiple studies suggesting the significant benefits of epidural lysis for failed back surgery syndrome (FBSS), comparative evaluations with different approaches of epidural lysis remain limited. The present study aims to investigate the efficacy of caudal catheter-based epidural lysis of adhesions techniques versus transforaminal epidural lysis in treating pain and disability after L5-S1 lumbar surgery. METHODS:This study was a double-blinded randomized clinical trial conducted on patients diagnosed with FBSS after lumbar spine surgery at the level of L5-S1 and complained of pain for more than 3 months. These patients who were referred to the Imam Reza Hospital pain clinic in Mashhad, Iran, in 2023, were randomly assigned to one of two groups: one undergoing caudal epidural lysis of adhesions with a catheter, and the other received L5-S1 transforaminal epidural lysis. The intensity of patients' pain and their motor and sensory function were evaluated before intervention and 4 weeks, and 12 weeks post-intervention. Outcomes were compared within and between the two groups using the Numerical Rating Scale (NRS) and the Oswestry Disability Index (ODI) questionnaire to assess their functional status. RESULTS:During follow-up, the ODI, back NRS, and leg NRS scores were significantly lower in patients who underwent epidural lysis with catheter compared to the transforaminal group ( P < 0.05). The caudal catheter group showed success rates of ODI, back NRS, and leg NRS factors among 73.5%, 79.4%, and 70.6% of patients, respectively. The transforaminal lysis group was successful in 54.5%, 48.5%, and 48.5% of patients in terms of ODI, back NRS, and leg NRS factors, respectively. Additionally, at the 12-week follow-up, the rate of treatment success in terms of ODI (χ 2 = 4.53, P = 0.02) and back NRS (χ 2 = 5.78, P = 0.01) was significantly higher in the caudal lysis group compared to the transforaminal lysis group. However, no significant difference was observed in leg NRS outcomes at 12 weeks after treatment (χ 2 = 0.25, P = 0.109). CONCLUSION:In conclusion, this study indicates that caudal epidural lysis with a catheter is more effective than transforaminal lysis in terms of pain reduction and functional improvement for patients with L5-S1 level FBSS.
Patients with nasopharyngeal cancer and following head/neck radiotherapy often experience a difficult airway during subsequent surgical treatment. Pre-operative airway examination usually reveals certain degrees of radiation-induced fibrosis over the neck, trismus, a higher Mallampati class, and an upper lip bite test grade. Available pre-operative transnasal videoendoscopic and radiological imaging findings might show vulnerable mucous membrane irregularities and anatomical abnormalities over the nasopharynx and larynx, and edematous or distorted epiglottis and vocal cords. Along with aforementioned adverse impacts, the need for mounting devices, such as halo-vest stabilization, would further restrict patients' cervical spines mobility and lead to more difficult endotracheal intubation. Both non-technical and technical skills, and various intubating tools/devices have been discussed in an evidence-based approach. Among them, videolaryngoscopy with/without flexible video-endoscopy is advocated for such difficult airway scenarios. In this short communication, we present our successful experience in applying StyleTubation (video intubating stylet technique) in such a difficult airway scenario (nasopharyngeal carcinoma patient, severe post-radiation fibrosis over the neck, mounted a halo-vest stabilization device, undergoing cervical spine surgery).
The number and complexity of office-based aesthetic procedures in Taiwan have increased, and many now involve intravenous sedation or general anesthesia. In response, the Taiwan Society of Anesthesiologists (TSA) developed this consensus statement to provide a national safety framework for anesthesia and sedation in aesthetic medicine clinics. The recommendations were formulated by reviewing prior TSA guidance, including the Society's 2020 consensus on mild-to-moderate sedation and the 2021 recommendation on safe total intravenous anesthesia and target-controlled infusion, together with relevant international guidance and best practices. The final recommendations were refined through structured expert review and committee consensus. The document addresses nine domains: scope and indications, definitions of sedation depth, personnel qualifications, patient evaluation including fasting and informed consent, monitoring standards, principles of drug administration, emergency preparedness, post-sedation recovery and discharge, and quality assurance based on the Tracking and Reporting Outcomes Of Procedural Sedation system. These recommendations aim to help aesthetic medicine clinics in Taiwan deliver safer, high-quality, patient-centered anesthesia and sedation services.
BACKGROUND:Opioid-free anesthesia (OFA) is an emerging practice in cancer care, providing adequate analgesia with reduced side effects. The objective of the study is to evaluate whether ketamine can replace morphine for performing OFA by assessing the acute pain relief achieved and to evaluate its effect on chronic pain. METHODS:A total of 182 women undergoing modified radical mastectomy were recruited and randomized into the morphine group and the ketamine group. Participants in the morphine group received 0.05 mg/kg morphine 20 minutes before induction, and those in the ketamine group received 0.40 mg/kg bolus and 1.00 mg/kg/hour ketamine infusion until axillary dissection. The numerical rating pain scale (NRS) at 0, 2, 6, 12, and 24 hours postsurgery was recorded, and the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) was filled out the next day. The chronic pain score at 3 and 6 months after surgery was noted. RESULTS:The mean NRS at 24 hours was 2.385 ± 0.965 in the ketamine group and 2.240 ± 0.996 in the morphine group (P = 0.336). The APS-POQ-R showed that, on average, patients in the ketamine group and the morphine group experienced moderate to severe pain for and 28.00% and 27.72% of the time in a day, respectively, and rescue analgesia usage was also comparable. The incidence of chronic pain was 28.9% and 21.2% (P = 0.31) at 3 months and 32.1% and 21.2 % (P = 0.19) at 6 months in the ketamine group and the morphine group, respectively, and not statistically significant. CONCLUSION:The results demonstrated that both ketamine and morphine provided similar levels of acute pain relief during the procedure, with no significant difference in pain outcomes between the two groups. These findings suggest that ketamine may be a viable alternative to morphine in the management of pain during OFA, with similar efficacy in both acute and chronic pain relief.
