Single needle versus double needle celiac trunk neurolysis in abdominal malignancy pain management: a randomized controlled trial / Neurólise do tronco celíaco com o uso de agulha única versus agulha dupla no manejo da dor abdominal maligna: estudo randômico controlado

Abstract Background: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach. Methods: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. Results: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0%; 13.8 ± 1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards Visual Analog Scale: double needles celiac neurolysis = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) and single needle celiac neurolysis = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) after 1 day, 1 week, 1 and 3 months respectively. However, Visual Analog Scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). Conclusion: Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.

Resumo Introdução: A neurólise do plexo celíaco guiada por tomografia computadorizada tornou-se uma técnica quase segura para aliviar a dor abdominal maligna. Comparamos a técnica de agulha única mudando o posicionamento do paciente e a técnica de agulha dupla usando a abordagem anterocrural posterior. Métodos: No grupo designado para neurólise celíaca com agulha dupla (n = 17), a técnica de abordagem anterocrural posterior foi utilizada com duas agulhas para injetar 12,5 mL de fenol a 10% de cada lado em decúbito ventral. No grupo designado para neurólise celíaca com agulha única (n = 17), a abordagem anterocrural posterior foi utilizada com uma única agulha para injetar 25 mL de fenol a 10% do lado esquerdo com o paciente em decúbito lateral esquerdo e posteriormente virado para o lado direito. Os parâmetros de monitorização foram a taxa de falha dos bloqueios e a duração do posicionamento dos pacientes, o tempo da técnica, os escores da escala visual analógica, as complicações (hipotensão, diarreia, vômitos, hemorragia, dano neurológico e infecção) e a analgesia de resgate. Resultados: A taxa de falha dos bloqueios e a duração do posicionamento dos pacientes aumentaram significativamente na neurólise celíaca com o uso de agulha dupla vs. agulha única (30,8% vs. 0%,13,8 ± 1,2 vs. 8,9 ± 1; p = 0,046, p ≤ 0,001, respectivamente). Além disso, o tempo da técnica foi significativamente maior na neurólise celíaca com agulha dupla que na neurólise celíaca com agulha única (24,5 ± 5,1 vs. 15,4 ± 1,8; p ≤ 0,001). Não houve diferença significativa em relação aos escores da escala visual analógica: neurólise celíaca com agulha dupla = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) e neurolise celíaca com agulha única = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) após um dia,uma semana, um e três meses, respectivamente. No entanto, os escores da escala visual analógica para cada grupo foram significativamente menores comparados aos valores basais (p ≤ 0,001). Não houve diferença estatisticamente significativa quanto à analgesia de resgate e complicações (p > 0,05). Conclusão: A neurólise celíaca com o uso de agulha única e a alteração do posicionamento do paciente apresenta uma taxa menor de falha do bloqueio, menos tempo de procedimento e menor duração do posicionamento do paciente que o uso de duas agulhas para neurólise celíaca em malignidade abdominal.

Reduction assisted by a double-needle repositor for femoral neck fractures of Garden types Ⅲ-Ⅳ / 中华创伤骨科杂志

Objective@#To compare the efficacy between reduction assisted by a double-needle repositor and manual reduction in the treatment of femoral neck fractures of Garden types Ⅲ-Ⅳ.@*Methods@#From May 2015 to October 2017, 67 patients with femoral neck fracture of Garden type Ⅲ or Ⅳ were treated by hollow screw fixation at Department of Orthopaedics, The Second Affiliated Hospital to Shanxi Medical University. They were divided into 2 groups according to the different reduction methods. The reduction was assisted by a double-needle repositor in 37 cases (group A); they were 21 males and 16 females with an age of 46.2±8.1 years and there were 13 cases of Garden type Ⅲ and 24 cases of Garden type Ⅳ. The reduction was conducted manually in another 30 cases (group B); they were 18 males and 12 females with an age of 48.8±9.1 years and there were 13 cases of Garden type Ⅲ and 17 cases of Garden type Ⅳ. The 2 groups were compared in terms of reduction time, anatomical reduction rate, operation time, intraoperative bleeding volume, fracture healing time, postoperative complications and Harris hip scores at the last follow-up.@*Results@#There were no significant differences between the 2 groups of patients in their preoperative general data, indicating they were compatible(P>0.05). All the 67 patients were followed up for 20 to 30 months (average, 24 months). The anatomic reduction rate in group A [94.6% (35/37)] was significantly higher than that in group B [83.3% (25/30)]; the reduction time, operation time and fracture healing time in group A (33.2±4.6 min, 70.2±5.0 min and 4.6±0.7 months) were significantly shorter than those in group B (45.8±8.6 min, 90.6±9.2 min and 5.6±0.6 months); the Harris hip scores at the last follow-up in group A (84.3±8.6 points) were significantly higher than in group B (81.2±7.8 points) (all P<0.05). There was no significant difference in intraoperative bleeding volume or postoperative complications between the 2 groups (P>0.05).@*Conclusion@#Reduction assisted by a double-needle repositor is fine for femoral neck fractures of Garden types of Ⅲ-Ⅳ, because it has advantages of limited invasion, simplicity, a high rate of anatomical reduction, quick reduction and good functional recovery.

Reduction assisted by a double-needle repositor for femoral neck fractures of Garden types Ⅲ-Ⅳ / 中华创伤骨科杂志

Objective To compare the efficacy between reduction assisted by a double-needle repositor and manual reduction in the treatment of femoral neck fractures of Garden types Ⅲ-Ⅳ.Methods From May 2015 to October 2017,67 patients with femoral neck fracture of Garden type Ⅲ or Ⅳ were treated by hollow screw fixation at Department of Orthopaedics,The Second Affiliated Hospital to Shanxi Medical University.They were divided into 2 groups according to the different reduction methods.The reduction was assisted by a double-needle repositor in 37 cases (group A);they were 21 males and 16 females with an age of 46.2 ± 8.1 years and there were 13 cases of Garden type Ⅲ and 24 cases of Garden type Ⅳ.The reduction was conducted manually in another 30 cases (group B);they were 18 males and 12 females with an age of 48.8 ± 9.1 years and there were 13 cases of Garden type Ⅲ and 17 cases of Garden type Ⅳ.The 2 groups were compared in terms of reduction time,anatomical reduction rate,operation time,intraoperative bleeding volume,fracture healing time,postoperative complications and Harris hip scores at the last follow-up.Results There were no significant differences between the 2 groups of patients in their preoperative general data,indicating they were compatible(P ＞ 0.05).All the 67 patients were followed up for 20 to 30 months (average,24 months).The anatomic reduction rate in group A [94.6％ (35/37)] was significantly higher than that in group B [83.3％ (25/30)];the reduction time,operation time and fracture healing time in group A (33.2 ±4.6 min,70.2 ±5.0 min and 4.6 ±0.7 months) were significantly shorter than those in group B (45.8 ±8.6 min,90.6 ± 9.2 min and 5.6 ± 0.6 months);the Harris hip scores at the last follow-up in group A (84.3 ± 8.6 points) were significantly higher than in group B (81.2 ±7.8 points) (all P ＜0.05).There was no significant difference in intraoperative bleeding volume or postoperative complications between the 2 groups (P ＞ 0.05).Conclusion Reduction assisted by a double-needle repositor is fine for femoral neck fractures of Garden types of Ⅲ-Ⅳ,because it has advantages of limited invasion,simplicity,a high rate of anatomical reduction,quick reduction and good functional recovery.