A randomized, double-blind, prospective study comparing the efficacy of continuous versus pulsed radiofrequency in the treatment of lumbar facet syndrome.

STUDY OBJECTIVES: To compare the efficacy of continuous radiofrequency (CRF) thermocoagulation with pulsed radiofrequency (PRF) in the treatment of lumbar facet syndrome. DESIGN: Prospective, randomized, double-blinded study. SETTING: Ambulatory pain clinic at a level-I trauma center and teaching institution. PATIENTS: 50 ASA physical status I, II, and III patients, at least 18 years of age, scheduled to undergo CRF or PRF for lumbar back pain. INTERVENTIONS: Target facet joints were identified with oblique radiographic views. Continuous radiofrequency thermocoagulation was delivered at 80 degrees C for 75 seconds, while PRF was delivered at 42 degrees C with a pulse duration of 20 ms and pulse rate of two Hz for 120 seconds. MEASUREMENTS: Visual analog scale (VAS) pain assessment and Oswestry Low Back Pain and Disability Questionnaire (OSW) were administered at baseline and then at three months. Comparisons between groups and within groups were made of the relative percentage improvement in VAS and OSW scores. MAIN RESULTS: No significant differences in the relative percentage improvement were noted between groups in either VAS (P = 0.46) or OSW scores (P = 0.35). Within the PRF group, comparisons of the relative change over time for both VAS (P = 0.21) and OSW scores (P = 0.61) were not significant. However, within the CRF group, VAS (P = 0.02) and OSW scores (P = 0.03) showed significant improvement. CONCLUSIONS: Although there was no significant difference between CRF and PRF therapy in long-term outcome in the treatment of lumbar facet syndrome, there was a greater improvement over time noted within the CRF group.

Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases.

Prostate cancer is the second most common cancer in American men and new surgical techniques have led to less invasive options for prostate surgery. Innovations in robotic technology have enabled robotic systems to become a more common sight in operating theatres throughout the United States. Approximately 1,500 consecutive patients scheduled for elective robotic prostatectomy (RP) were reviewed. Patient demographics were recorded and significant intraoperative and postoperative events were reviewed. At our institution the mean age for patients undergoing RP is 60.3 (41-79) years; the mean body mass index is 27.3 kg m(-2). The mean operative time, defined as the time from the start of insufflation to closure is 177.5 (81-365) min and mean blood loss is 109 (50-750) mL. There was a 1.3% incidence of postoperative anemia (hemoglobin <10 g dL) where patients required blood transfusions (15/1,500). Three patients were diagnosed with postoperative pulmonary emboli and were treated with IV heparin with no additional sequelae. The most common anesthesia-related complication was corneal abrasions, which were seen in 3% of cases. One patient required postoperative mechanical ventilation because of laryngeal edema secondary to multiple intubation attempts from an unexpectedly difficult airway. Anesthetic and perioperative complications are rare for patients undergoing robotic-assisted laparoscopic prostatectomy at our institution. Our institution has performed more robotic prostatectomies than any other institution in the world and we review our experience delivering anesthesia for the first 1,500 patients undergoing this operation.

Anesthetic challenges in a patient with lymphangioleiomyomatosis complicated by myasthenia gravis.

Lymphangioleiomyomatosis is a rare restrictive lung disease that is often associated with pneumothorax and prolonged intubation. We report the successful anesthetic management of a patient with lymphangioleiomyomatosis, myasthenia gravis, and idiopathic thrombocytopenic purpura undergoing laparoscopic partial nephrectomy for renal lesions, and discuss anesthetic management strategies for this rare disease process.