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Kilgore Guy posted an update a month ago
gesic, patient-controlled analgesia, inflammatory response, immune function.BACKGROUND Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, which results from median nerve compression. A lot of nonsurgical modalities are available for the management of mild to moderate situations. Local Hyalase hydrodissection (HD) of the entrapped median nerve could offer a desirable sustained symptom alleviation. OBJECTIVES To evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain, functional status, and nerve conduction in patients with CTS. STUDY DESIGN A randomized, double-blinded trial. SETTING Anesthesia, pain, and rheumatology clinics in a university hospital. METHODS Patients 60 patients with CTS (> 6 months’ duration). INTERVENTION patients were allocated equally into either group 1 (HD with Hyalase + 10 mL saline solution injection), or group 2 (HD with 10 mL saline solution only). MEASUREMENTS assessment of pain using Visual Analog Scale (VAS), functional disability (FD) score, and nerve conduction studies before injection, and over 6 months a CTS over 6 months follow-up duration. KEY WORDS Carpal tunnel syndrome, Hyalase, median nerve hydrodissection.BACKGROUND Chronic degeneration of the zygapophyseal joints in the cervical or lumbar spine are common causes of axial back pain. Radiofrequency (RF) ablation is a treatment modality in the denervation of facet joint-related pain. Although multiple factors have been theorized to contribute to the size of the optimal RF lesion, the addition of hypertonic saline solution has been posited to create larger RF lesion sizes. OBJECTIVES This study compares lesion of 20-gauge RF monopolar probe using 2% lidocaine, 0.9% normal saline solution, and 3% saline solution administered through the RF needle prior to ablation, with subsequent lesion sizes recorded. STUDY DESIGN Randomized, double-blinded, ex vivo study using clinically relevant conditions. SETTING Procedural laboratory in an academic institution. METHODS RF ablation lesions were reproduced in room temperature (21°C ± 2°C) chicken breast specimens with 20-gauge monopolar RF probes inserted. RF was applied for 90 seconds at 80°C after injection of 1 mL of eithethe null, and TOST accepted as equivalent all 3 comparisons. LIMITATIONS In vivo anatomy and physiology of a human organism was not used for this study. Samples were not warmed to physiologic temperature. Randomization resulted in slightly unequal sample sizes, although all groups were of sufficient size that the central limit theorem should apply. CONCLUSIONS Three commonly used solutions were found to have equivalent lesion sizes from monopolar probe RF ablation. KEY WORDS Radiofrequency, ablation, lesion shape, lesion size, monopolar RF, hypertonic saline solution.BACKGROUND Superior hypogastric plexus neurolytic (SHP-N) block is the mainstay management for pelvic cancer pain of visceral origin when oral opioids fail due to inefficacy or intolerance to side effects. Unfortunately, SHP-N has the potential to control pelvic pain in 62%-72% of patients at best, because chronic pelvic pain may assume additional characteristics other than visceral. OBJECTIVE Combining SHP-N with pulsed radiofrequency (PRF) of the sacral roots might block most of the pain characteristics emanating from the pelvic structures and improve the success rate of SHP-N in controlling pelvic and perineal cancer pain. STUDY DESIGN This study was a prospective randomized controlled clinical trial. SETTINGS The research took place in the interventional pain unit of a tertiary center in the university hospital. Smad3 signaling METHODS Fifty-eight patients complaining of cancer-related chronic pelvic and perineal pain were randomized to either the PRF + SHP group (n = 29), which received SHP-N combined with PRF of the saTRY ClinicalTrials.gov. NCT03228316. KEY WORDS Pelvic pain, pulsed radiofrequency, sacral roots, superior hypogastric plexus.BACKGROUND Acute pain management in patients on buprenorphine opioid agonist therapy (BOAT) can be challenging. It is unclear whether BOAT should be continued or interrupted for optimization of postoperative pain control. OBJECTIVES To determine an evidence-based approach for pain management in patients on BOAT in the perioperative setting, particularly whether BOAT should be continued or interrupted with or without bridging to another mu opioid agonist and to identify benefits and harms of either perioperative strategy. STUDY DESIGN Systematic literature review with qualitative data synthesis. SETTING Hospital, perioperative. METHODS The study protocol was registered on PROSPERO (Registration number 9030276355). Medline via OVID, EMBASE, CINAHL, and the Cochrane CENTRAL register of trials were searched for prospective or retrospective observational or controlled studies, case series, and case reports that described perioperative or acute pain care for patients on BOAT. References of narrative and systematic e that one particular strategy provides superior postoperative pain control, but interruption of BOAT may result in harm, including failure to return to baseline BOAT doses, continuing non-BOAT opioid use, or relapse of opioid use disorder. LIMITATIONS There were a limited number of articles relevant to the study question consisting of case reports and retrospective observational studies. Some omitted relevant details. No prospective studies were found. CONCLUSIONS There is no clear benefit to bridging or stopping BOAT but failure to restart it may pose concerns for relapse. We recommend continuing BOAT in the perioperative period when possible and incorporating an interdisciplinary approach with multimodal analgesia. KEY WORDS Opioid use disorder, opiate substitution treatment, buprenorphine, buprenorphine-naloxone, buprenorphine opioid agonist therapy, postoperative pain, acute pain, multimodal analgesia.BACKGROUND Ginger has been proposed as a complementary treatment for musculoskeletal pain. However, efficacy, type, and safety remains unclear. OBJECTIVES To determine the effectiveness of consumption or topical application of ginger for pain relief and knee function improvement in patients with knee osteoarthritis. STUDY DESIGN Systematic review with meta-analysis of randomized clinical trials. METHODS An electronic search was performed on Medline, Central, CINAHL, PEDro, SPORTDiscus, and LILACS databases. The eligibility criteria for selecting studies included clinical trials that compared consumption and/or topical ginger with placebo or other interventions for the pain relief and knee function in patients with medical diagnosis of knee osteoarthritis. RESULTS Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 4 studies were included. For the comparison capsules versus placebo, mean difference for pain was -7.88 mm; 95% confidence interval (CI), 11.92 to 3.85 (P = 0.00), and standard mean difference for knee function was -1.