Clinical Impact of Comprehensive Nursing Intervention Combined with Percutaneous Radiofrequency Thermocoagulation for Treating Primary Trigeminal Neuralgia in the Elderly.

Background: Percutaneous radiofrequency thermocoagulation is the foremost minimally invasive approach for treating primary trigeminal neuralgia. However, postoperative complications may arise, necessitating tailored clinical care to enhance patient compliance and mitigate surgical risks. Objective: This study aimed to explore the impact of comprehensive nursing intervention combined with percutaneous radiofrequency thermocoagulation on the management of primary trigeminal neuralgia in elderly patients. Design: A retrospective analysis was conducted. Setting: The study was conducted at the Department of Pain Management, Xuanwu Hospital of Capital Medical University. Participants: A total of 126 elderly patients diagnosed with primary trigeminal neuralgia underwent percutaneous radiofrequency thermocoagulation at our hospital between June 2019 and August 2022. They were enrolled as an observation cohort and randomly assigned to either the control group or the intervention group, with 63 patients in each. Intervention: The control group received standard nursing care, while the intervention group received comprehensive nursing interventions. Primary Outcome Measures: The study assessed (1) negative emotional changes, (2) postoperative status, (3) complications, and (4) quality of life. Results: After the nursing care, the intervention group exhibited significantly lower anxiety and depression scores compared to the control group (P < .05). Additionally, the intervention group had reduced length of hospital stay and pain scores, along with higher nursing satisfaction scores, relative to the control group (P < .05). There was a significant difference in the total complication rate between the two groups (P < .05), with the intervention group experiencing fewer complications. Moreover, the quality of life scores were significantly higher in the intervention group (P < .05). Conclusions: Comprehensive nursing intervention alongside percutaneous radiofrequency thermocoagulation in elderly patients with primary trigeminal neuralgia can decrease complication rates and enhance treatment confidence. These findings support the clinical adoption and dissemination of such interventions.

A Retrospective Comparison of Low-Temperature Plasma Ablation and Radiofrequency Thermocoagulation of the Thoracic Nerve Root for Refractory Postherpetic Neuralgia.

BACKGROUND: Radiofrequency thermocoagulation (RFT) of the thoracic nerve root is commonly employed in treating medication-refractory thoracic post-herpetic neuralgia (PHN). However, RFT procedures' suboptimal pain relief and high occurrence of postoperative skin numbness present persistent challenges. Previous single-cohort research indicated that the low-temperature plasma coblation technique may potentially improve pain relief and reduce the incidence of skin numbness. Nevertheless, conclusive evidence favoring coblation over RFT is lacking. OBJECTIVES: To compare the clinical outcomes associated with coblation to those associated with RFT in the treatment of refractory PHN. STUDY DESIGN: Retrospective matched-cohort study. SETTING: Affiliated Hospital of Capital Medical University. METHODS: Sixty-eight PHN patients underwent coblation procedures between 2019 and 2020, and 312 patients underwent RFT between 2015 and 2020 in our department. A matched-cohort analysis was conducted based on the criteria of age, gender, weight, pain intensity, pain duration, side of pain, and affected thoracic dermatome. Pain relief was assessed using the numeric rating scale (NRS), the Medication Quantification Scale (MQS) Version III and the Neuropathic Pain Symptom Inventory (NPSI), which were employed to indicate pain intensity, medication burden, and comprehensive pain remission at 6, 12, and 24 months. Numbness degree scale scores and complications were recorded to assess safety. RESULTS: We successfully matched a cohort of 59 patients who underwent coblation and an equivalent number of patients who underwent RFT as a PHN treatment. At the follow-up time points, both groups' NRS, MQS, and NPSI scores exhibited significant decreases from the pre-operation scores (P < 0.05). The coblation group's NRS scores were significantly lower than the RFT group's at the sixth and the twenty-fourth months (P < 0.05). At 24 months, the MQS values in the coblation group were significantly lower than those in the RFT group (P < 0.05). Furthermore, the coblation group's total intensity scores on the NPSI were significantly lower than the RFT group's at the 12- and 24-month follow-ups (P < 0.05). At 6 months, the coblation group's temporary intensity scores on the NPSI were significantly lower than the RFT group's (P < 0.05). Notably, the occurrence of moderate or severe numbness in the coblation group was significantly lower than in the RFT group at 6 and 12 months (P < 0.05). No serious adverse effects were reported during the follow-up. LIMITATIONS: This analysis was a single-center retrospective study with a small sample size. CONCLUSION: In this matched cohort analysis, coblation achieved longer-term pain relief with a more minimal incidence rate of skin numbness than did RFT. Further randomized controlled trials should be conducted to solidify coblation's clinical superiority to RFT as a PHN treatment.

Analyzing the Effect of Intraoperative Stimulation Voltage on Facial Numbness Following Radiofrequency Thermocoagulation in the Treatment of Idiopathic Trigeminal Neuralgia.

INTRODUCTION: Radiofrequency thermocoagulation (RFT) effectively alleviates idiopathic trigeminal neuralgia (ITN); however, postoperative facial numbness poses a significant challenge. This issue arises due to the close proximity of high-temperature thermocoagulation, which not only ablates pain-related nociceptive fibers but also affects tactile fibers. Intraoperative sensory stimulation voltage (SV), which reflects the distance between the RFT cannula and the target nerve, potentially possesses the ability to prevent tactile fiber injury. This study aimed to investigate the influence of SV on postoperative facial numbness and provide valuable insights to mitigate its occurrence. METHODS: A retrospective analysis was performed on 72 ITN patients with maxillary division (V2) pain who underwent RFT between 2020 and 2022. Among them, 13 patients with SV ≤ 0.2 V constituted the low SV group. Subsequently, a matched-cohort analysis was conducted on the remaining 59 patients. The patients paired with the low SV patients were subsequently enrolled in the high SV group, adhering to a 1:1 match ratio. The primary outcome was the facial numbness scale assessment at 3 days, 3 months and 6 months post-surgery. The pain intensity and medication burden served as the secondary outcomes. RESULTS: We successfully matched a cohort consisting of 12 patients in the low SV group and 12 patients in the high SV group. Each patient experienced various degrees of facial numbness at 3 days post-RFT. Notably, the low SV group exhibited a higher incidence of moderate numbness (66.7% vs. 16.67%, P = 0.036), whereas the high SV group had more cases of mild numbness at the 6-month follow-up (25% vs. 83.3%, P = 0.012). Both groups demonstrated significant decreases in pain intensity and medication burden compared to before the operation. CONCLUSIONS: SV proved to be a reliable parameter for mitigating the degree of postoperative facial numbness in RFT treatment for ITN. A relatively high sensory SV ranging from 0.3 to 0.6 V during the RFT procedure results in less facial numbness in the treatment of ITN.

Long non-coding RNA Snhg16 Lessens Ozone Curative Effect on Chronic Constriction Injury mice via microRNA-719/SCN1A axis.

We investigated the function and molecular mechanism of long non-coding RNA (lncRNA) small nucleolar RNA host gene 16 (Snhg16) in modifying ozone treatment for neuropathic pain (NP) in a mouse model of chronic constriction injury (CCI). Pain-related behavioral responses were evaluated using paw withdrawal threshold (PWT), paw lifting number (PLN), and paw withdrawal latency (PWL) tests. Interleukin (IL)-1ß, IL-10, IL-6, and tumor necrosis factor-alpha (TNF-α) were measured by ELISA and qRT-PCR to evaluate neuroinflammation. qRT-PCR was performed to detect expressions of Snhg16, microRNA (miR)-719, sodium voltage-gated channel alpha subunit 1 (SCN1A), and inflammatory factors. Bioinformatics, dual-luciferase reporter assay, and RNA pull-down verified the underlying molecular mechanisms. Snhg16 expression increased in CCI mice. Snhg16 overexpression retarded the curative effect of ozone and induced NP. miR-719 was sponged by Snhg16. SCN1A was a target of miR-719. Inhibition of miR-719 markedly reversed the effects of Snhg16 on pain-related behavioral responses and neuroinflammation. Upregulation of SCN1A partly abrogated the effects of elevated miR-719 levels on the occurrence of NP. The findings demonstrate that lncRNA Snhg16 promotes NP progression in CCI mice by binding to miR-719 to increase SCN1A expression. The Snhg16/miR-719/SCN1A axis may influence the curative effects of ozone therapy in treating NP.

Ultrasound Guidance Combined with C-Arm Fluoroscopy in Selective Semilunar Ganglion Radiofrequency Thermocoagulation Through the Foramen Ovale for Trigeminal Neuralgia: A Randomized Controlled Trial.

OBJECTIVE: To explore the clinical value of ultrasound guidance combined with C-arm guidance during selective semilunar ganglion radiofrequency thermocoagulation via the foramen ovale for trigeminal neuralgia. METHODS: This study enrolled 48 patients diagnosed with trigeminal neuralgia between January 2021 and December 2021 in the Department of Pain Management at Xuanwu Hospital. Patients were randomly and equally divided into a C-arm-only group and an ultrasound-combined-with-C-arm (ultrasound+C-arm) group, according to a random number table. After exclusions, 42 patients were analyzed. Of these, 21 patients underwent selective semilunar ganglion radiofrequency thermocoagulation via the foramen ovale guided by the C-arm alone, whereas 21 patients underwent the same procedure guided by ultrasound combined with C-arm. The number of punctures, the amount of time elapsed until the target area of the semilunar ganglion was punctured, the cumulative dose of radiation exposure, and puncture-related complications were recorded during the operation. Numerical rating scale scores and radiofrequency thermocoagulation-related complications were evaluated preoperatively and at 1 day, 3 days, 7 days, 1 month, and 3 months after surgery. RESULTS: The number of punctures, the amount of time elapsed until the target area of the semilunar ganglion was punctured, and the cumulative dose of radiation exposure were all lower in the ultrasound+C-arm group than in the C-arm-only group (all P < 0.05). No significant differences were found in numerical rating scale scores and radiofrequency thermocoagulation-related complications between the two groups (P > 0.05). No puncture-related complications occurred in either of the groups. CONCLUSION: Ultrasound guidance combined with C-arm guidance could be safely used for puncturing the semilunar ganglion via the foramen ovale, with more efficiency and less radiation exposure than C-arm guidance alone.

Long-term recurrence-free survival and complications of percutaneous balloon compression and radiofrequency thermocoagulation of Gasserian ganglion for trigeminal neuralgia: A retrospective study of 1313 cases.

OBJECTIVE: To estimate long-term recurrence, complications after percutaneous balloon compression (PBC) and radiofrequency thermocoagulation (RFT) of gasserian ganglion among a large sample of patients with trigeminal neuralgia (TN) during a long-term follow-up. METHODS: A retrospective analysis of 1313 patients undergoing PBC or RFT for the treatment of TN was conducted from 2006 to 2020. Recurrence-free survival (RFS) was assessed by the Kaplan-Meier method. Complications including facial numbness, corneal reflex decrease and masseter weakness were also estimated. RESULTS: For patients who received first initial PBC and RFT, the median RFS was 130.1 months (95% CI: 124.4, 135.9) and 123.3 months (95% CI: 117.6, 128.9) in PBC and RFT group with log-rank p = 0.108. The RFS rate was, respectively, 90.6% (95% CI: 88.1%-93.3%) and 91.4% (95% CI: 89.1%-93.7%) at 1 year, 84.6% (95% CI: 81.4%-87.8%) and 83.3% (95% CI: 80.3%-86.3%) at 3 years, 81.5% (95% CI: 78.1%-85.0%), and 78.6% (95% CI: 75.2%-81.9%) at 5 years, 71.5% (95% CI: 67.5%-75.5%), and 64.8% (95% CI: 61.0%-68.7%) at 10 years in two groups. No significant difference was observed in facial numbness degree between two groups after procedure. Compared with PBC group, ophthalmic complication prevalence was higher in RFT group (9.6%) (p = 0.001). However, masseter weakness incidence was lower (10.7%) than that in PBC group (24.0%) with p < 0.001. CONCLUSIONS: Patients with TN seemed to attain similar long-term benefit from PBC and RFT, especially in elderly. However, in order to reduce postoperative complications, PBC provided a safer and alternative for treating TN involving ophthalmic division, whereas RFT could be employed as a preferred regimen for maxillary and mandibular TN.

Identification of Foramen Ovale With H-Figure Fluoroscopic Landmark Improves Treatment Outcomes in Idiopathic Trigeminal Neuralgia.

BACKGROUND: Because it is traditionally difficult and time-consuming to identify the foramen ovale (FO) with fluoroscopy, we recently developed the H-figure method to acquire fluoroscopic view of FO with shorter procedure time and less radiation. However, the impact of such an H-figure approach on the clinical outcomes of trigeminal ganglion radiofrequency thermocoagulation (RFT) in treating idiopathic trigeminal neuralgia (ITN) remains unclear. METHODS: In a 12-month follow-up retrospective cohort study, patients with ITN had fluoroscopy-guided RFT of trigeminal ganglion via either classic approach (n = 100) or H-figure approach (n = 136) to identify FO. Data of continuous variables were analyzed with a Shapiro-Wilk test for normality and subsequently with a Mann-Whitney test, and the binary data were analyzed with a χ 2 test. The primary outcome was the facial pain measured by a Visual Analog Scale (VAS) 1 year after the treatment. The secondary outcomes included the quality of the fluoroscopic FO views, the threshold voltage to provoke paresthesia, the procedure time, the number of fluoroscopic images, and the facial numbness VAS. RESULTS: Compared with the classic approach group, the H-figure approach group was associated with better long-term pain relief after the procedure, with significantly fewer patients had pain 3 months (6.6% vs 17.0%, P = .012) and 12 months (21.3% vs 38.0%, P = .005) after the procedure, and among patients who had pain after the procedure, patients in the H-figure group had significantly less pain 6 months after the procedure (VAS median [interquartile range (IQR)]: 3 [2-6] vs 6 [4-7], P < .001). Moreover, compared to the classic approach, the H-figure approach provided better fluoroscopic view of FO, lower threshold voltage to elicit paresthesia (median [IQR]: 0.2 [0.2-0.3] vs 0.4 [0.4-0.5] V, P < .0001), with shorter procedure time (median [IQR]: 7.5 [6.0-9.0] vs 14.0 [10.0-18.0] min, P < .0001), and required fewer fluoroscopic images (median [IQR]: 4.0 [3.0-5.0] vs 8.0 [6.0-10.0], P < .0001). CONCLUSIONS: RFT of the trigeminal ganglion using the H-figure approach is associated with superior longer term clinical pain relief than the classic approach in treating ITN.

Preprocedure ultrasound imaging combined with palpation technique in epidural labor analgesia.

BACKGROUND: For parturients with paroxysmal uterine contraction pain, rapid analgesia is needed. We used preprocedure ultrasound imaging combined with the palpation technique in epidural analgesia for labor, and evaluated the usefulness of this technique in epidural labor analgesia. AIM: To evaluate the usefulness of preprocedure ultrasound imaging in epidural analgesia for labor. METHODS: In this prospective randomized observational study, 72 parturients were assigned to two groups (combined or palpation group). The target interspace of all parturients was first identified by the palpation technique. Then in the combined group, preprocedure ultrasound imaging was used before epidural puncture. In the palpation group, only the traditional anatomical landmarks technique (palpation technique) was performed. The primary outcome was total duration of the epidural procedure (for the ultrasound group, the duration of the preprocedure ultrasound imaging was included). The secondary outcomes were the number of skin punctures, the success rate at first needle pass, the number of needle passes, the depth from the skin to epidural space, and the complications of the procedure. RESULTS: Total duration of the epidural procedure was similar between the two groups (406.5 ± 92.15 s in the combined group and 380.03 ± 128.2 s in the palpation group; P = 0.318). A significant improvement was demonstrated for epidural puncture and catheterization in the combined group. The number of needle passes was 1.14 in the combined group and 1.72 in the palpation group (P = 0.001). The number of skin puncture sites was 1.20 in the combined group and 1.25 in the palpation group (P = 0.398). The success rate at first needle pass was 88.89% in the combined group and 66.67% in the palpation group (P = 0.045). CONCLUSION: This study demonstrated that the total duration of epidural procedures with preprocedure ultrasound imaging combined with the palpation technique was not longer than the traditional anatomical landmarks technique, which were performed by six experienced anesthesiologists in parturients with normal weights undergoing labor analgesia.

Low-temperature plasma radiofrequency ablation for the management of refractory cluster headache.

INTRODUCTION: Although the sphenopalatine ganglion (SPG) has been considered a site of therapeutic potential for cluster headache (CH), the optimal technique of SPG is still to be determined. Low-temperature plasma radiofrequency ablation (LTPRA) has been proposed as an alternative treatment for several neuropathic pain diseases. AIM: To evaluate the effect of LTPRA of SPG in treating chronic and episodic CH. MATERIAL AND METHODS: The patients with CH, who achieved temporary pain relief following SPG block, treated using LTPRA between January 2015 and October 2017 were reviewed. Seventy-six patients were included: 50 patients suffered from episodic CH and the remaining 26 patients from chronic CH. The primary outcomes were clinical improvement rate, defined as the percentage of partial and complete pain relief results at 1 day, 12 months, and 24 months of follow-up after the operation. RESULTS: Clinical improvement rates were 92.3%, 92.3% and 73.1% in chronic CH and 73.1%, 84% and 68% in episodic CH at each follow-up time point, respectively. 3 chronic CH patients and 7 episodic CH patients showed no pain relief after the operation. Drooping eyelids were found in 2 cases, one recovered at the 3-month follow-up but another one did not in the 24-month follow-up. No serious complications occurred intraoperatively or postoperatively. CONCLUSIONS: LTPRA can be considered an effective and alternative surgical modality in treating patients with chronic and episodic CH, based on SPG block.

Coblation Discoplasty Alleviates Cervical Chest Pain After Positive Ultrasound-Guided Nerve Root Block: A Retrospective Study.

OBJECTIVE: Cervical chest pain (CCP), as 1 atypical symptom associated with cervical spondylosis, often overlaps with other chest-related diseases. CCP obviously relieved after ultrasound-guided cervical nerve root block near a herniated disc should be considered as a potential pathologic source. The purpose of this study is to investigate whether coblation discoplasty can alleviate CCP after positive ultrasound-guided nerve root block. METHODS: From August 2016 to September 2019, 21 patients with high suspicion of CCP experienced over 50% pain relieve after ultrasound-guided diagnostic nerve root block. Through 12 months of follow-up, the primary efficacy was assessed with visual analogue scale (VAS) of CCP, and secondary outcomes included: neck pain VAS, neck disability index (NDI), the proportion of significant CCP relief, the rating of CCP alleviation, the patient satisfaction index (PSI), and analgesic consumption. Adverse events were recorded to evaluate safety. RESULTS: Following postoperative 12 months, a time-course analysis confirmed a robust decline in VAS of CCP (P < 0.0001), and a similar recovery trend was shown in VAS of neck pain and NDI (P < 0.0001). After treatment, the number of patients taking analgesics decreased (P < 0.0001), and around 60% of patients reported notable relief and satisfaction with treatment. No serious complications were observed. CONCLUSIONS: After positive ultrasound-guided nerve root block, coblation discoplasty can provide up to 12 months of relief for intractable CCP.

Blockade of Erythropoietin-Producing Human Hepatocellular Carcinoma Receptor B1 in Spinal Dorsal Horn Alleviates Visceral Pain in Rats.

Objective: This experiment was designed to determine whether erythropoietin-producing human hepatocellular carcinoma (Eph) receptors were involved in the development of visceral pain. Methods: Adult male Sprague-Dawley rats were randomly divided into three groups receiving different treatments (n = 16 per group): intracolonic vehicle (control group), intracolonic 2, 4, 6-trinitrobenzene sulfonic acid (TNBS) (TNBS group), and intracolonic TNBS and intrathecal EphB1 receptor blocking reagent (TNBS + EphB2-Fc group). Visceral hyperalgesia was evaluated with quantification of visceral pain threshold induced by colorectal distention. The spinal expressions of EphB1 and ephrinB2 and levels of their phosphorylated forms (p-EphB1 and p-ephrinB2) were assessed by Western blotting and immunohistochemistry. Results: The TNBS-treated rats developed significant visceral hyperalgesia. The spinal expressions of EphB1, p-EphB1, ephrinB2, and p-ephrinB2 were significantly increased in the TNBS group compared with the control group, but visceral hyperalgesia and elevation of spinal EphB1 and p-EphB1 expressions were evidently alleviated by intrathecal administration of EphB2-Fc in the TNBS + EphB2-Fc group. The number of EphB1- and p-EphB1-immunopositive cells, the average optical (AO) value of EphB1, and its phosphorylated form in the spinal dorsal horn were significantly increased in the TNBS group than in the control group, but they were obviously reduced by intrathecal administration of EphB2-Fc. There were no significant differences in the number of ephrinB2- and p-ephrinB2-immunopositive cells and the AO value of ephrinB2 and its phosphorylated form between the TNBS and TNBS + EphB2-Fc groups. Conclusion: EphB1 receptors in the spinal dorsal horn play a pivotal role in the development of visceral pain and may be considered as a potential target for the treatment of visceral pain.

Cervicogenic dizziness alleviation after coblation discoplasty: a retrospective study.

OBJECTIVE: Little is known about the therapeutic relationship between coblation discoplasty and cervicogenic dizziness (CGD). CGD can be caused by abnormal proprioceptive inputs from compressed nerve roots, intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc. The aim was to analyze the efficacy of coblation discoplasty in CGD through intradiscal nerve ablation and disc decompression in a 12-month follow-up retrospective study. METHODS: From 2015 to 2019, 42 CGD patients who received coblation discolplasty were recruited as the surgery group, and 22 CGD patients who rejected surgery were recruited as the conservative group. Using intent-to-treat (ITT) analysis, we retrospectively analyzed the CGD visual analogue scale (VAS), neck pain VAS, CGD frequency score, and the CGD alleviation rating throughout a 12-month follow-up period. RESULTS: Compared with conservative intervention, coblation discoplasty revealed a better recovery trend with effect sizes of 1.76, 2.15, 0.92, 0.78 and 0.81 in CGD VAS, and effect sizes of 1.32, 1.54, 0.93, 0.86 and 0.76in neck pain VAS at post-operative 1 week, and 1, 3, 6, 12 months, respectively. The lower CGD frequency score indicated fewer attacks of dizziness until postoperative 3 months (p < 0.01). At post-operative 12 months, the coblation procedure showed increased satisfactory outcomes of CGD alleviation rating (p < .001, -1.00 of effect size). CONCLUSIONS: Coblation discoplasty significantly improves the severity and frequency of CGD, which is important inbridging unresponsive conservative intervention and open surgery.Key messagesThere is a correlation between the degenerative cervical disc and cervicogenic dizziness (CGD).CGD can be caused by abnormal proprioceptive inputs from a compressed nerve root and intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc.Cervical coblation discoplasty can alleviate CGD through ablating intradiscal nerve endings and decompressing the nerve root.

The comparison of efficacy and complications of coblation and radiofrequency thermocoagulation for V2/V3 idiopathic trigeminal neuralgia: a retrospective cohort study of 292 cases.

BACKGROUND: Coblation is a novel technique in respect of treating idiopathic trigeminal neuralgia. We aimed to identify the efficacy and complications between radiofrequency thermocoagulation (RFT) and coblation for V2/V3 idiopathic trigeminal neuralgia (ITN) and investigate the risk factors associated with postoperative facial numbness. METHODS: We retrospectively reviewed our cohort of 292 patients who had undergone RFT or coblation for V2/V3 ITN. The characteristics of the baseline were collected before surgery. Pain scores, the degree of facial numbness and other complications were evaluated at discharge and 1 month, 3 months, 6 months and 12 months after surgery. RESULTS: Postoperative pain intensity was apparently alleviated in both groups. The initial and 12-months remission rates were 94.0 and 75.3% in coblation group compared with 96.9 and 78.4% in RFT group (P = 0.462, P = 0.585). The degree of postoperative facial numbness tended to be more severe in RFT group at discharge, 1 month, 6 months and 12 months (P = 0.006, P = 0.026, P = 0.004, P = 0.003). Factors significantly associated with more severe facial numbness were procedure of RFT (OR = 0.46, 95%CI: 0.28-0.76, P = 0.002), history of previous RFT at the affected side (OR = 2.33, 95%CI: 1.21-4.48, P = 0.011), and ITN with concomitant continuous pain (OR = 0.36, 95%CI: 0.18-0.71, P = 0.004). CONCLUSION: Coblation could reduce the degree of postoperative facial numbness for ITN, and the efficacy was no less effective than RFT. History of previous RFT at the affected side, procedure of RFT, ITN with concomitant continuous pain was identified as significant factors of the development of postoperative facial numbness.

Oxycodone versus other opioid analgesics after laparoscopic surgery: a meta-analysis.

BACKGROUND: Intravenous opioids are administered for the management of visceral pain after laparoscopic surgery. Whether oxycodone has advantages over other opioids in the treatment of visceral pain is not yet clear. METHODS: In this study, the analgesic efficiency and adverse events of oxycodone and other opioids, including alfentanil, sufentanil, fentanyl, and morphine, in treating post-laparoscopic surgery visceral pain were evaluated. This review was conducted according to the methodological standards described in the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The PubMed, Embase, and Cochrane databases were searched in December 2019. RESULTS: Ten studies were included in this review. The sample size was 695 participants. The results showed that compared with morphine and fentanyl, oxycodone had a more potent analgesic efficacy on the first day after laparoscopic surgery, especially during the first 0.5 h. There was no significant difference in sedation between the two groups. Compared to morphine and fentanyl, oxycodone was more likely to lead to dizziness and drowsiness. Overall, patient satisfaction did not differ significantly between oxycodone and other opioids. CONCLUSIONS: Oxycodone is superior to other analgesics within 24 h after laparoscopic surgery, but its adverse effects should be carefully considered.

Novel fluoroscopic landmark to significantly facilitate the visualization of foramen ovale in treating idiopathic trigeminal neuralgia.

BACKGROUND AND OBJECTIVES: Access through the foramen ovale (FO) is essential in performing trigeminal ganglion injection, glycerol rhizolysis, balloon compression, and radiofrequency thermocoagulation (RFT) to treat idiopathic trigeminal neuralgia (ITN). However, identification of the FO under fluoroscopy can be difficult and time-consuming, and thus exposes patients to increased radiation and procedure risks. Here we present the 'H-figure' as a novel fluoroscopic landmark to quickly visualize the FO. METHODS: The H-figure landmark can be recognized as the medial border of the mandible and the lateral edge of the maxilla as the two vertical lines, and the superior line of petrous ridge of temporal bone (S-P-T line) as the horizontal line, and the FO fluoroscopic view is then optimized at the center of the H-figure immediately above the S-P-T line. We applied this landmark in a clinical cohort of 136 patients with ITN who underwent fluoroscopy-guided RFT of the trigeminal ganglion. We also compared the H-figure method with the traditional method. The primary outcome was the total number of fluoroscopic images required to visualize the FO (as a proxy of radiation exposure). Secondary measures included the procedure time required to finalize the FO view and the sensory testing voltage for paresthesia. RESULTS: With the H-figure approach we were able to view the FO with an average of 4.2 fluoroscopic shots at an average time of 6.8 min. When compared with the non-H-figure traditional technique, the H-figure method required almost half the fluoroscopic shots in nearly half the procedure duration time, and paresthesia was evoked with half of the voltage. CONCLUSION: The H-figure is an easy fluoroscopic landmark that can help to view the FO with less radiation and procedure time, and the needles placed with this approach can be closer to the target for the RFT treatment of patients with ITN.

Factors Associated With Long-Term Risk of Recurrence After Percutaneous Radiofrequency Thermocoagulation of the Gasserian Ganglion for Patients With Trigeminal Neuralgia Involving the Ophthalmic Division: A Retrospective Study.

OBJECTIVE: To evaluate risk factors associated with recurrence after radiofrequency thermocoagulation (RFT) of the gasserian ganglion among patients with ophthalmic trigeminal neuralgia (TN) and prognostic factors in terms of recurrence-free survival (RFS) during a long-term follow-up. METHODS: From January 2005 to December 2017, 300 patients with ophthalmic TN underwent RFT. A retrospective analysis of 14-year outcomes was performed. Kaplan-Meier analysis was used for RFS after the procedure. Univariate and multivariate Cox regression analyses were performed to identify risk factors for pain recurrence. RESULTS: The initial effective rate of RFT for ophthalmic TN was 92%. The mean follow-up time was 77.38 ± 43.24 months. The cumulative probability of RFS was 86.94% at 1 year, 80.03% at 2 years, 77.27% at 3 years, 74.01% at 5 years, and 59.92% at 10 years after RFT. The mean duration of RFS was 114.67 months (95% confidence interval [CI] 106.27 to 123.06 months). In multivariate analysis, atypical pain (hazard ratio [HR] = 2.831, 95% CI 1.759 to 4.554, P < 0.001) and mild facial hypesthesia (HR = 2.540, 95% CI 1.309 to 4.931, P = 0.006) before RFT were independently associated with pain recurrence. Patients with a prognostic index (PI) > 1.27 were at high risk for pain recurrence. Major complications included troublesome dysesthesia (0.7%), keratitis (10.9%), diplopia (0.4%), facial paresthesia (6.2%), and masseter weakness (12.7%). Masseter weakness was more common in patients with V3 branch involvement. Three patients lost their sight due to keratitis. CONCLUSION: Our study investigated long-term outcomes and complications of RFT for ophthalmic TN. Patients at high risk for pain recurrence were identified, which might provide a basis for clinical decision making before RFT.

Masticatory Dysfunction After Computed Tomography-Guided Plasma Ablation vs. Radiofrequency Ablation on Gasserian Ganglion for Idiopathic Trigeminal Neuralgia: A Randomized Controlled Trial.

OBJECTIVE: We aimed to evaluate masticatory dysfunction after two different types of ablation on the Gasserian ganglion for the treatment of idiopathic trigeminal neuralgia. We hypothesized that low-temperature plasma radiofrequency ablation (LTP-RFA) was noninferior to radiofrequency thermocoagulation (RFT) with respect to initial efficacy. METHODS: In the randomized, single-blind, parallel-group, noninferiority trial, 204 participants with idiopathic trigeminal neuralgia were randomly allocated to receive plasma ablation in the LTP-RFA group and radiofrequency ablation in the RFT group in a 1:1 ratio, with random block sizes of four or six. Participants were examined at baseline (T0), on the day of discharge (T1), and at the 6-month follow-up (T2). The primary end point was the clinincal effective rate in the LTP-RFA group compared with that in the RFT group after intervention on the day of discharge. Noninferiority was prespecified at -10%. RESULTS: The intention-to-treat analysis revealed that the initial efficacy rates were 91.2% in LTP-RFA group and 93.1% in RFT group (rate ratio [RR] = 0.979, 95% confidence interval [CI]: 0.904-1.061, P = 0.795). The difference between the two groups was 1.9% (95% CI: -5.6% to 9.4%), which showed that LTP-RFA demonstrated noninferiority compared with RFT in initial efficacy. Compared with the RFT group, the LTP-RFA group exhibited a significantly greater improvement in the maximum voltage of the masseter muscles with mean differences of 11.40 (95% CI: 10.52 to 12.27, P < 0.001) at T1 and 17.41 (95% CI: 14.68 to 20.13, P < 0.001) at T2, respectively. Similar results were observed for the asymmetry index of occlusion, the maximum voltage of the anterior temporalis, and the activity index of anterior temporalis / masseter muscles. No serious adverse events were observed in either group. CONCLUSIONS: Compared with the RFT group, noninferior efficacy for pain relief and improvement of masticatory function was revealed in the LTP-RFA group.

Efficacy of coblation versus radiofrequency thermocoagulation for the clinical treatment of trigeminal neuralgia.

INTRODUCTION: Postoperative facial numbness is the main complication of radiofrequency thermocoagulation in treating trigeminal neuralgia, which could seriously affect the surgical efficacy. This problem is expected to be resolved by coblation technique. AIM: To compare the long-term efficacy and safety of coblation and percutaneous trigeminal radiofrequency thermocoagulation (PT-RFT) under fluoroscopic guidance in the treatment of trigeminal neuralgia (TN). MATERIAL AND METHODS: A case-control prospective study was carried out. Patients with TN were randomly scheduled to receive coblation or PT-RFT. Both surgical procedures were performed under fluoroscopic guidance. The data, including the degree of pain, pain relief and complications, were recorded during follow-up evaluation, which was performed on the first day and at the end of the first month, third month, sixth month and first year after surgery. RESULTS: A total of 50 patients were enrolled in this study, with 25 patients in each group. The visual analog scale (VAS) scores in both groups at each time point after surgery were significantly lower compared with before surgery (p < 0.05). There were no significant differences in VAS scores or pain relief between the two groups at any time point after surgery (p > 0.05). However, patients in the PT-RFT group exhibited greater facial numbness after surgery (p < 0.05). For other complications, there were no significant differences between the two groups (p > 0.05). CONCLUSIONS: Coblation and PT-RFT showed similar effectiveness in reducing pain; however, coblation was associated with a lower rate of postoperative facial numbness. Therefore, coblation may be a better treatment option for TN.

Computed Tomography-Guided Percutaneous Coblation of the Thoracic Nerve Root for Treatment of Postherpetic Neuralgia.

BACKGROUND: Postherpetic neuralgia (PHN) is one of the most intractable pain disorders and often does not respond to medication, physical, and interventional procedures. Coblation technology has been demonstrated to have potential for neuralgia, but there are rare reports of the efficacy and security of coblation for PHN. The thoracic segment is the most common predilection part of PHN, so we conducted this long-term study to investigate the results of coblation for the treatment of thoracic PHN. OBJECTIVES: The aim of this study was to determine the efficacy and security of computed tomography (CT)-guided coblation of the thoracic nerve root for treatment of PHN. STUDY DESIGN: Self before-after controlled clinical assessment. SETTING: Department of Pain Management, Xuanwu Hospital, Capital Medical University. METHODS: Seventy-seven patients with thoracic PHN sustained for at least 6 months and refractory to conservative therapy were identified. Patients underwent CT-guided percutaneous coblation to ablate the thoracic nerve root for thoracic PHN. The therapeutic effects were evaluated using a Visual Analog Scale (VAS), medication doses, and pain-related quality of life (QoL) scale before coblation, and at 1 week, and at 1, 3, and 6 months after the procedure. Patients who achieved more than 50% pain relief were defined as responders. In addition, adverse effects were also recorded to investigate the security of this procedure. RESULTS: The VAS score significantly decreased from 7.22 ± 1.15 before the coblation to 3.51 ± 1.12 (P = 0.01), 3.02 ± 1.21 (P = 0.006), 3.11 ± 2.15 (P = 0.014), and 2.98 ± 2.35 (P = 0.008) at 1 week, and at 1, 3, and 6 months after the procedure, respectively. The number of responders were 56 (77.78%), 54 (75%), 55 (76.39%), and 54 (75%) at 1 week, and at 1, 3, and 6 months after the procedure, respectively. The doses of anticonvulsants and analgesics were decreased significantly at all time points after the procedure compared with before treatment (P < 0.05). Patient responses on the Brief Pain Inventory Short Form indicated mean scores that were significantly lower than baseline across all domains of pain interference with QoL at all evaluations (P = 0.001). Most of the patients had mild numbness and it did not affect the daily activities after the procedure. No other severe adverse events occurred during or after the procedure. LIMITATIONS: A single-center study, relatively small number of patients, short duration of review of medical record, and the retrospective study. CONCLUSIONS: CT-guided percutaneous thoracic nerve root coblation is an effective and safe method for the treatment of thoracic PHN, and the procedure can also significantly improve the QoL in patients with PHN.