Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: a randomized controlled study.

OBJECTIVES: The objective of this study was to determine the effects of combining pulsed radiofrequency (PRF) treatment and transforaminal epidural injection (TFEI) to treat patients with chronic refractory lumbar radicular pain caused by lumbar spinal stenosis. STUDY DESIGN: Randomized control trial. SETTINGS: Interventional pain management practice. METHOD: Sixty-two patients were assigned to the study groups (PRF group = 31; control group = 31). Under fluoroscopic guidance, the RF needle was positioned close to the lumbar dorsal root ganglion. The PRF group received 3 cycles of PRF treatment, and sensory stimulation without RF lesioning was applied to the control group. After PRF or sham lesioning, a local anesthetic with steroid was injected. The primary outcome of a successful response was defined as: 1) ≥50% or 4-point pain reduction in the numerical rating scale (NRS) without an increase in the Oswestry disability index (ODI) or medication quantification scale (MQS), or mean score <4 in the global perceived effect (GPE) scale; or 2) ≥30% or 2-point pain reduction in NRS with a simultaneous decrease in ODI, MQS, or ≥6 points in the GPE scale. RESULT: The number of patients with successful treatment results was higher in the PRF group at 2 months (P = 0.032) and 3 months (P = 0.018). No significant differences were observed in terms of the secondary outcome variables between the 2 groups. CONCLUSION: The TFEI provided significant short-term pain relief and PRF can be applied in conjunction with TFEI to achieve higher treatment efficacy compared with TFEI alone.

Clinical experiences of performing transforaminal balloon adhesiolysis in patients with failed back surgery syndrome: two cases report.

Epidural fibrosis is a contributing factor to the persistent pain that is associated with failed back surgery syndrome (FBSS) and other pathophysiologies, particularly as it inhibits the passage of regional medications to areas responsible for pain. Therefore, effective mechanical detachment of epidural fibrosis can contribute to pain reduction and improve function in FBSS patients. In this report, we describe the successful treatment of FBSS patients with epidural adhesiolysis using a Fogarty catheter via the transforaminal approach.

Treatment of digit ulcers in a patient with Buerger's disease by using cervical spinal cord stimulation -a case report-.

Buerger's disease (thromboangiitis obliterans) is known as a segmental inflammatory vasculitis that involves the small-sized and medium-sized arteries, veins, and nerves. Most effective treatment for Buerger's disease is smoking cessation. Except for the cessation of tobacco use, surgical revascularization is available in severe ischemia and a distal target vessel. Amputation has been used as the last treatment option of the disease up to the present. Increasing limb survival and decreasing amputation rate is important. This case describes the use of spinal cord stimulation (SCS) in patient with Buerger's disease and its effect is not only the complete healing of ulcers but also amputation is not performed.

Transforaminal hypertonic saline for the treatment of lumbar lateral canal stenosis: a double-blinded, randomized, active-control trial.

BACKGROUND: Degenerative lumbar spinal stenosis is one of the most common causes of chronic lower back pain and radiculopathy. Spinal stenosis is anatomically classified as central and lateral spinal canal stenosis. Many treatment modalities and techniques, including surgery and epidural injection, have been used to manage the pain. However, the effect of hypertonic saline injection via the transforaminal approach has not yet been studied. OBJECTIVES: The aim of this study is to determine the effect of adding hypertonic saline to conventional transforaminal epidural steroid injections (TFEI) to provide pain relief for chronic radiculopathy patients secondary to lateral canal spinal stenosis. STUDY DESIGN: A double-blind, randomized, active-control trial. SETTING: An interventional pain management practice in a hospital, Republic of Korea. METHODS: Two groups: the hypertonic group received hypertonic saline combined with triamcinolone and the control group received normal saline combined with triamcinolone. A total of 68 patients were randomly allocated into either 2 groups by a computer-generated randomization program. Twenty-seven patients in the hypertonic group and 26 patients in the control group were assessed. A total of 53 patients were included in this analysis. Outcome measures were taken at baseline, one, 2, 3, 4, and 6 months post-procedure. The primary outcome measures included the numerical rating scale (NRS) and the proportion of substantial responders. The secondary outcome measures included the Oswestry disability index (ODI), the proportion of substantial and moderate responders, and patient satisfaction. RESULTS: Transforaminal epidural injection of steroids, with or without the addition of 10% hypertonic saline, was effective and provided significant pain relief with the improvement of functional outcome within 4 months. The addition of hypertonic saline was superior in efficacy compared with conventional TFEI at 3 months follow-up. The differences in the absolute pain scores did not demonstrate statistical significance between the 2 groups. The reduction in pain intensity from the baseline was greater in the hypertonic group and demonstrated higher rates of satisfaction. The use of hypertonic saline also extended the duration of significant pain relief to 6 months compared with baseline. LIMITATIONS: The lack of placebo group and small sample size. CONCLUSION: Superior short-term pain relieving efficacy, but limited long-term effects of hypertonic saline, when added to TFEIs.

Effect of pretreatment with gabapentin on withdrawal movement associated with intravenous rocuronium injection.

BACKGROUND: The major disadvantage of rocuronium is the withdrawal movement associated with its injection. The analgesic effect of perioperative gabapentin has been evaluated. We investigated the effects of gabapentin on the withdrawal movement induced by rocuronium injection. METHODS: 86 ASA physical status I or II patients, aged 18-69 years who were scheduled to undergo elective surgery with general anesthesia were enrolled. Patients were randomly allocated into two groups to receive either gabapentin 600 mg or placebo 2 hours prior to surgery. The patient's response to rocuronium injection was graded using a 4-point scale. RESULTS: The incidence of withdrawal movement after rocuronium administration was significantly lower in the gabapentin group (55.0% in the control group vs 28.6% in the gabapentin group). The number of patients with generalized response indicating severe pain, was 9 (22.5%) in the control group and 3 (7.1%) in the gabapentin group. CONCLUSIONS: Pretreatment with a single oral dose of gabapentin 600 mg reduced the incidence and severity of withdrawal movement after rocuronium administration.

Ultrasound-guided evaluation of the bifurcation of the femoral artery and vein in pediatric patients.

BACKGROUND: The femoral arteries (FA) and femoral veins (FV) are useful access sites for diagnostic and interventional procedures. In adults, the usual puncture sites are 1-3 cm distal from the inguinal crease. In children, however, the optimal puncture site vessels are not known. The aim of our study was to assess the number of branches and bifurcation sites of the femoral vessels in children by using ultrasonography. METHODS: Color Doppler ultrasonography was used to determine bifurcation sites of the FA and FV, relative to the inguinal crease, in 48 children (median age, 4 yr; median weight, 18.7 kg) with American Society of Anesthesiologists (ASA) Physical Status (PS) score 1-2 and who were scheduled for general anesthesia. RESULTS: The numbers of FAs and FVs at the inguinal crease were 1.83 +/- 0.39 and 1.08 +/- 0.29, respectively, in infants, and 1.83 +/- 0.58 and 1.0 +/- 0.0, respectively, in 10-year-old children. The bifurcation site of the FA in infants and those aged 10 years was 0.78 +/- 0.30 cm and 1.47 +/- 0.27 cm proximal to the inguinal crease, respectively (P < 0.05), whereas the bifurcation site of the FV in these two age groups was -0.96 +/- 0.27 cm and -2.29 +/- 1.09 cm distal to the inguinal crease, respectively (P < 0.05). CONCLUSIONS: In children, the FA frequently bifurcates proximal to the inguinal crease, whereas the FV bifurcates distal to the inguinal crease. However, there are anatomical differences among age groups, so care should be taken to avoid complications during femoral vessel cannulation.