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Kim J, Yun M, Han AH, Pauzi MF, Jeong JH, Yoo Y, Moon JY. Thoracic sympathetic ganglion blocks: real-world outcomes in 207 chronic pain patients. Reg Anesth Pain Med 2024; 49:528-535. [PMID: 37726196 DOI: 10.1136/rapm-2023-104624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Thoracic sympathetic ganglion block (TSGB) is a procedure to manage sympathetically maintained upper extremity pain (sympathetically maintained pain). To date, only a few studies have evaluated the clinical effectiveness of TSGB in pain medicine. This study investigated (1) the relationship between technical success of TSGB and pain reduction in patients with chronic upper extremity pain and (2) relevant clinical factors for a positive TSGB outcome. METHODS We retrospectively reviewed medical data in 232 patients who received TSGB from 2004 to 2020. Technical success and a positive outcome of TSGB were defined as a temperature increase of ≥1.5°C at 20 min and a pain reduction with ≥2 points on the 11-point Numerical Rating Scale at 2 weeks post-TSGB, respectively. Correlations were assessed using correlation coefficients (R), and multivariable regression model was used to identify factors relevant to TSGB outcomes. RESULTS 207 patients were ultimately analyzed; among them, 115 (55.5%) patients positively responded to TSGB, and 139 (67.1%) achieved technical success after TSGB. No significant relationship existed between the pain reduction and the temperature increase after TSGB (R=0.013, p=0.855). Comorbid diabetes (OR 4.200) and adjuvant intake (OR 3.451) were positively associated, and psychiatric comorbidity (OR 0.327) and pain duration (OR 0.973) were negatively associated with TSGB outcome. CONCLUSIONS We found no significant association between the temperature increase and pain reduction after TSGB. Further studies are warranted to identify significant factors associated with TSGB outcomes in patients with complex regional pain syndrome and neuropathic pain diseases.
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Affiliation(s)
- Jeongsoo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Minsu Yun
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Andrew Hogyu Han
- Dept of Anesthesiology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Mohd Faeiz Pauzi
- Dept. of Anaesthesiology and Intensive Care, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Jae Hoon Jeong
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Yongjae Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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Ye P, Zheng T, Gong C, Pan X, Huang Z, Lin D, Jin X, Zheng C, Zheng X. A proof-of-concept study of ultrasound-guided continuous parasacral ischial plane block for postoperative pain control in patients undergoing total knee arthroplasty. J Orthop Surg Res 2024; 19:339. [PMID: 38849964 PMCID: PMC11162005 DOI: 10.1186/s13018-024-04822-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Continuous peripheral nerve blocks are widely used for anesthesia and postoperative analgesia in lower limb surgeries. The authors aimed to develop a novel continuous sacral plexus block procedure for analgesia during total knee arthroplasty. METHODS The study comprised two stages. In Stage I, the authors built upon previous theories and technological innovations to develop a novel continuous sacral plexus block method, ultrasound-guided continuous parasacral ischial plane block (UGCPIPB) and subsequently conducted a proof-of-concept study to assess its effectiveness and feasibility. Stage II involved a historical control study to compare clinical outcomes between patients undergoing this new procedure and those receiving the conventional procedure. RESULTS The study observed a 90% success rate in catheter placement. On postoperative day (POD) 1, POD2, and POD3, the median visual analog scale (VAS) scores were 3 (range, 1.5-3.5), 2.5 (1.6-3.2), and 2.7 (1.3-3.4), respectively. Furthermore, 96.3% of the catheters remained in place until POD3, as confirmed by ultrasound. The study revealed a significant increase in skin temperature and peak systolic velocity of the anterior tibial artery on the blocked side compared with those on the non-blocked side. Complications included catheter clogging in one patient and leakage at the insertion site in two patients. In Stage II, the novel technique was found to be more successful than conventional techniques, with a lower catheter displacement rate than the conventional procedure for continuous sciatic nerve block. CONCLUSION UGCPIPB proved to be an effective procedure and safe for analgesia in total knee arthroplasty. CHINESE CLINICAL TRIAL REGISTRY NUMBER ChiCTR2300068902.
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Affiliation(s)
- Peng Ye
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-Constructed Laboratory of "Belt and Road,", Fujian Emergency Medical Centre, Fuzhou, China
| | - Ting Zheng
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Cansheng Gong
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xuan Pan
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Zhibin Huang
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Daoyi Lin
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiangyan Jin
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Chunying Zheng
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
| | - Xiaochun Zheng
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
- Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-Constructed Laboratory of "Belt and Road,", Fujian Emergency Medical Centre, Fuzhou, China.
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Choi EJ, Kim S, Lim D, Jin HS, Hong SM, Lee PB, Nahm FS. Effect duration of lumbar sympathetic ganglion neurolysis in patients with complex regional pain syndrome: a prospective observational study. Sci Rep 2024; 14:12693. [PMID: 38830944 PMCID: PMC11148052 DOI: 10.1038/s41598-024-63732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/31/2024] [Indexed: 06/05/2024] Open
Abstract
Lumbar sympathetic ganglion neurolysis (LSGN) has been used for long-term pain relief in patients with complex regional pain syndrome (CRPS). However, the actual effect duration of LSGN has not been accurately measured. This prospective observational study measured the effect duration of LSGN in CRPS patients and investigated the relationship between temperature change and pain relief. After performing LSGN, the skin temperatures of both the maximum pain site and the plantar area in the affected and unaffected limbs were measured by infrared thermography, and pain intensity was assessed before and at 2 weeks, 1 month, and 3 months. The median time to return to baseline temperature was calculated using survival analysis. The skin temperature increased significantly at all-time points relative to baseline in both regions (maximum pain site: 1.4 °C ± 1.0 °C, plantar region: 1.28 °C ± 0.8 °C, all P < 0.001). The median time to return to baseline temperature was 12 weeks (95% confidence interval [CI] 7.7-16.3) at the maximum pain site and 12 weeks (95% CI 9.4-14.6) at the plantar area. Pain intensity decreased significantly relative to baseline, at all-time points after LSGN. In conclusion, the median duration of the LSGN is estimated to be 12 weeks.
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Affiliation(s)
- Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sunmin Kim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Dongsik Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - Sung Man Hong
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, South Korea
| | - Pyung Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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Huang T, Yao H, Huang J, Wang N, Zhou C, Huang X, Tan X, Li Y, Jie Y, Wang X, Yang Y, Liang Y, Yue S, Mao Y, Lai S, Zheng J, He Y. Effectiveness of acupuncture for pain relief in shoulder-hand syndrome after stroke: a systematic evaluation and Bayesian network meta-analysis. Front Neurol 2023; 14:1268626. [PMID: 38046583 PMCID: PMC10693460 DOI: 10.3389/fneur.2023.1268626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background Shoulder-hand syndrome (SHS) is a common complication after stroke, and SHS-induced pain significantly hampers patients' overall recovery. As an alternative therapy for pain relief, acupuncture has certain advantages in alleviating pain caused by SHS after stroke. However, choosing the best treatment plan from a variety of acupuncture options is still a serious challenge in clinical practice. Therefore, we conducted this Bayesian network meta-analysis to comprehensively compare the effectiveness of various acupuncture treatment methods. Methods We systematically searched for randomized controlled trials (RCTs) of acupuncture treatment in patients with post-stroke SHS published in PubMed, Embase, Cochrane, and Web of Science until 9 March 2023. We used the Cochrane bias risk assessment tool to assess the bias risk in the included original studies. Results A total of 50 RCTs involving 3,999 subjects were included, comprising 19 types of effective acupuncture interventions. Compared to single rehabilitation training, the top three interventions for VAS improvement were floating needle [VAS = -2.54 (95% CI: -4.37 to -0.69)], rehabilitation + catgut embedding [VAS = -2.51 (95% CI: -4.33 to -0.68)], and other multi-needle acupuncture combinations [VAS = -2.32 (95% CI: -3.68 to -0.94)]. The top three interventions for improving the Fugl-Meyer score were eye acupuncture [Meyer = 15.73 (95% CI: 3.4627.95)], other multi-needle acupuncture combinations [Meyer = 12.22 (95% CI: 5.1919.34)], and traditional western medicine + acupuncture + traditional Chinese medicine [Meyer = 11.96 (95% CI: -0.59 to 24.63)]. Conclusion Multiple acupuncture methods are significantly effective in improving pain and upper limb motor function in post-stroke SHS, with relatively few adverse events; thus, acupuncture can be promoted. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, CRD42023410957.
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Affiliation(s)
- Ting Huang
- The First School of Clinical Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Hongfang Yao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junneng Huang
- The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Ning Wang
- The First School of Clinical Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Chunjun Zhou
- The First School of Clinical Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Xuyang Huang
- The First School of Clinical Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Xiangyuan Tan
- The First School of Clinical Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Yanyan Li
- Department of Traditional Chinese Medicine, Nanning Maternal and Child Health Hospital, Nanning, China
| | - Yuyu Jie
- The First School of Clinical Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Xiang Wang
- Sainz College of New Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Yu Yang
- The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Yingye Liang
- The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Siqian Yue
- The First School of Clinical Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Yawen Mao
- The First School of Clinical Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Songxian Lai
- The First School of Clinical Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Jingyiqi Zheng
- The First School of Clinical Medicine, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Yufeng He
- The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, China
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Bovaira M, García-Vitoria C, Carrera A, Reina MA, Boezaart AP, Tubbs RS, Millán MS, Reina F. Human lumbar sympathetic blockade: An anatomical study to address potential block failure. Clin Anat 2023; 36:360-371. [PMID: 35869857 DOI: 10.1002/ca.23938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/06/2022]
Abstract
The lumbar sympathetic block is often used to treat complex regional pain syndrome, but it seems to have a high failure rate. This study seeks anatomical explanations for this apparent failure in order to refine our block procedure. Two simulated sympathetic trunk blocks were carried out on four fresh, cryopreserved unembalmed human cadavers under fluoroscopic control at the L2 vertebral body level, followed by two further simulated blocks at the L4 vertebral body level on the other side. Dye was injected, and the areas were dissected following a specific protocol. We then describe the anatomy and the spread of the dye compared to the spread of the contrast medium on fluoroscopy. The ganglia were differently located at different vertebral levels, and differed among the cadavers. Following this anatomical clarification, we now prefer to perform lumbar sympathetic blocks at the fourth lumbar vertebra level, using an extraforaminal approach at the caudal end of the vertebra, avoiding the anterolateral margin of the vertebral body at the midpoint.
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Affiliation(s)
- Maite Bovaira
- Anesthesia Department, Hospital Intermutual de Levante, Sant Antoni de Benaixeve, Valencia, Spain
| | - Carles García-Vitoria
- Anesthesia Department, Hospital Intermutual de Levante, Sant Antoni de Benaixeve, Valencia, Spain
| | - Ana Carrera
- The Clinical Anatomy, Embryology, and Neuroscience Research Group (NEOMA), Unit of Human Anatomy, School of Medicine, University of Girona, Girona, Spain
| | - Miguel A Reina
- CEU-San-Pablo University School of Medicine, Madrid and the Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - André P Boezaart
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.,Group Chief Medical Officer at Lumina Ltd, Lumina Health, Surrey, UK
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, St. George's, West Indies.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Marta San Millán
- The Clinical Anatomy, Embryology, and Neuroscience Research Group (NEOMA), Unit of Human Anatomy, School of Medicine, University of Girona, Girona, Spain.,University School of Health and Sport (EUSES), University of Girona, Girona, Spain
| | - Francisco Reina
- The Clinical Anatomy, Embryology, and Neuroscience Research Group (NEOMA), Unit of Human Anatomy, School of Medicine, University of Girona, Girona, Spain
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