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Battaglia AG, D’Apolito R, Labionda F, Ramazzotti J, Zagra L. Ultrasound-Guided Hip Injections with High Density Hyaluronic Acid: Outcome at One Year Follow Up. J Clin Med 2024; 13:2515. [PMID: 38731044 PMCID: PMC11084914 DOI: 10.3390/jcm13092515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background: The ultrasound-guided viscosupplementation of the hip joint with hyaluronic acid (HA) is considered a standard procedure among the conservative treatments for hip arthritis. The aim of this study was to evaluate the clinical benefit and the incidence of adverse events of the technique in an observational study at one year follow up. Methods: We evaluated a consecutive series of 85 patients with a diagnosis of symptomatic arthritis who underwent intra-articular ultrasound-guided hyaluronic acid injections. The scales used for evaluation were modified Harris Hip Score (mHHS), WOMAC (Western Ontario and McMaster University), and Hip Outcome Score (HOS) with subscale Sport (HOSs), for pain the Visual Analogic Scale (VAS). The patients were classified according to Tonnis' radiological classification of arthritis (range 0-3): 20 patients (grade 0), 32 (grade 1), 18 (grade 2), 15 (grade 3). Results: At last follow up, all the scales increased: mHHS from 59.35 to 82.1, HOS from 69.45 to 78.53, HOss from 47.4 to 58.11, VAS from 6.09 to 3.97, WOMAC from 33.2 to 31.5 (p < 0.05 for all the parameters); the results were elaborated with GraphPad Prism v5.0 (Prism Software La Jolla, CA, USA) using Wilcoxon's test. A total of 13 patients out of 85 needed arthroplasty, all classified as Tonnis grade 3. No serious adverse events were noted due to the procedure. Conclusions: Based on our findings, indication for the use of hyaluronic acid is limited to patients with mild to moderate arthritis. Patients in advanced arthritis refusing replacement surgery and asking for this treatment should be informed about the poor results of the technique even in the short term.
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Affiliation(s)
- Antonino Giulio Battaglia
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, 20157 Milan, Italy; (R.D.); (F.L.); (J.R.); (L.Z.)
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Yue L, Zheng S, Hua L, Li H, Yang Y, Li J, He L. Ultrasound-guided Versus Computed Tomography Fluoroscopy-assisted Cervical Transforaminal Steroid Injection for the Treatment of Radicular Pain in the Lower Cervical Spine: A Randomized Single-blind Controlled Noninferiority Study. Clin J Pain 2023; 39:68-75. [PMID: 36650602 DOI: 10.1097/ajp.0000000000001091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023]
Abstract
OBJECT To estimate the contrast dispersion short-term clinical efficacy and safety of ultrasound (US)-guided transforaminal steroid injection (TFSI) compared with computed tomography (CT) guidance for the treatment of cervical radicular pain. METHOD A total of 430 patients with cervical radicular pain from cervical herniated disk or cervical spondylosis were recruited in the randomized, single-blind, controlled, noninferiority trial. The patients were randomly assigned to receive either the US-guided or CT-guided TFSI for 1 affected cervical nerve. The dispersion pattern of contrast was monitored at the time of TFSI in both groups, using CT. Patients were assessed for pain intensity by numeric rating scale (NrS) and functional disability by Neck Disability Index (NDI) at baseline, 1 and 3 months after the intervention. Complications were also recorded. RESULTS The satisfactory rate of contrast distribution was respectively 92.1% in US group and 95.8% in CT group. Pain reduction and functional improvement were showed in both groups during follow-up. Statistical difference was not observed in the decrease in NRS pain scores and NDI scores between 2 groups with F =1.050, P =0.306 at 1 month and F =0.103, P =0.749 at 3 months after intervention. No permanent and severe complications were observed. CONCLUSIONS This study demonstrated that US provided a noninferior injectate spread pattern and similar improvement of radicular pain and functional status when compared with CT-guided TFSI. US may be advantageous during this procedure because it allows visualization of critical vessels and avoids radiation exposure.
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Affiliation(s)
- Li Yue
- Department of Pain, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing City, Jiangsu Province
| | - Shuyue Zheng
- Department of Pain, Beijing Shijitan Hospital, Capital Medical University
| | - Lei Hua
- Department of Pain, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing City, Jiangsu Province
| | - Hongfu Li
- Department of Pain, Beijing Shijitan Hospital, Capital Medical University
| | - Yuchen Yang
- Department of Pain, Beijing Shijitan Hospital, Capital Medical University
| | - Juanhong Li
- Department of Pain, Beijing Shijitan Hospital, Capital Medical University
| | - Liangliang He
- Department of Pain, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
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Djaali W, Mihardja H, Viventius Y, Teja Y, Bunawan HL, Setiawan M, Yunita L. The Role of Acupuncture in Interventional Pain Management. Med Acupunct 2021; 33:329-334. [PMID: 35003500 DOI: 10.1089/acu.2021.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Interventional pain management has been recognized over the last couple of decades for treating chronic-pain syndromes. Acupuncture is a nonpharmacologic therapeutic option for pain management and may be an option for different patients with contraindications for interventional pain management. This review explores this options. Method: This limited review examines the role of acupuncture for managing head-and-neck pain and lower-back pain, according to interventional pain management. Conclusions: Acupuncture at various points, corresponding to the stellate ganglion, which is ST 10 Shuitu, and corresponding to the splanchnic nerve and the facet joint of the lumbar vertebra-which are Ex-B2 paravertebra-can be applied for pain management in the head-and-neck area and in the lower-back area. According to various research findings, acupuncture is effective and safe for reducing pain in the head and neck area, as well as in the lower back.
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Affiliation(s)
- Wahyuningsih Djaali
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Universitas Negeri Jakarta, East Jakarta, DKI Jakarta, Indonesia
| | - Hasan Mihardja
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Center for the Development and Application of Traditional Medicine of DKI Jakarta, Jakarta, Indonesia
| | - Yoshua Viventius
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yolanda Teja
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hanggoro Laka Bunawan
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Marshellia Setiawan
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Lisa Yunita
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Abstract
PURPOSE OF REVIEW The introduction of ultrasound guidance in interventional pain management leads to the development of new interventional pain management techniques. Ultrasound-guided (UG) interventional pain management is rapidly developing and increasingly more commonly used, due to its many advantages over traditional radiologic imaging modalities. This review will summarize recent literature around novel interventional pain techniques with ultrasound guidance published over the last 18 months. RECENT FINDINGS Many new interventional pain management methods have been described in the last few years in the literature. The use of ultrasonography in interventional pain management played a crucial role in these developments. This review includes newly described interventional methods in the literature. The review particularly focussed on the methods that are used to treat the pain in the hip, shoulder, knee, and lumbar area. These new techniques hold promise for significant improvements in the efficacy and safety of interventional pain management. SUMMARY There have been many innovations in UG interventional procedures, however, some of them require more rigorous validation before their widespread use.
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Davis J, Ozcan MS, Kamdar JK, Shoaib M. Stellate ganglion block used to treat reversible cerebral vasoconstriction syndrome. Reg Anesth Pain Med 2021; 46:732-734. [PMID: 33875578 DOI: 10.1136/rapm-2021-102675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND We present a case report of a patient who developed severe reversible cerebral vasoconstriction syndrome, which was worsening despite typical interventional and supportive care. We administered a stellate ganglion block (SGB) and monitored the vasospasm with transcranial Doppler measurements. CASE REPORT A 25-year-old woman was admitted with recurrent headaches and neurological symptoms, which angiography showed to be caused by diffuse, multifocal, segmental narrowing of the cerebral arteries leading to severe ischemia in multiple regions. Typical treatment was initiated with arterial verapamil followed by supportive critical care, including nimodipine, intravenous fluids, permissive hypertension, and analgesia. Vasospasm was monitored daily via transcranial Doppler ultrasound (TCD). After symptoms and monitoring suggested worsening vasospasm, an SGB was administered under ultrasound guidance. Block success was confirmed via pupillometry, and repeat TCD showed improved flow through the cerebral vasculature. Improvement in vascular flow was accompanied by a gradual reduction in acute neurological symptoms, with the patient reporting no headaches the following morning. CONCLUSIONS For patients with reversible cerebral vasoconstriction syndrome who develop severe signs or symptoms despite typical treatment, sympathetic blockade may be a possible rescue therapy. This may extend to other causes of severe vasospasm as well, and further study is needed to determine if the SGB should be included in routine or rescue therapy.
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Affiliation(s)
- Jeffrey Davis
- Anesthesiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Mehmet S Ozcan
- Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jay K Kamdar
- Anesthesiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Maria Shoaib
- Neurology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Efficacy and Safety of Ultrasound-Guided Radiofrequency Treatment for Chronic Pain in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Pain Res Manag 2020; 2020:2537075. [PMID: 33014212 PMCID: PMC7520688 DOI: 10.1155/2020/2537075] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/23/2020] [Indexed: 12/18/2022]
Abstract
Background Knee osteoarthritis (KOA) is a common degenerative disease associated with joint dysfunction and pain. Ultrasound-guided radiofrequency (RF) may be a promising therapy in the treatment of chronic pain for KOA patients. Objective To evaluate the efficacy and safety of ultrasound-guided RF treatment for chronic pain in patients with KOA. Design A systematic review was conducted, and a meta-analysis was carried out when possible. Setting. We examined the studies evaluating the clinical efficiency of ultrasound-guided RF on chronic pain in KOA population. Method A systematic review for the efficacy and safety of ultrasound-guided RF treatment for pain management of KOA patients was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) from the date of inception to February 2020, and a meta-analysis was conducted. The primary outcomes of pain intensity (visual analogue scale or numerical rating scale) and knee function [the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)] were evaluated from baseline to various follow-up times by random-effects model. Heterogeneity was assessed by I 2 statistic and the potential sources of heterogeneity by subgroup and metaregression analyses, respectively. Results Eight publications with 256 patients were included in the meta-analysis. RF could relieve pain with -4.196 of pooled mean difference and improve knee function by decreasing 23.155 points in WOMAC. Three patients had ecchymosis, two with hypoesthesia and one with numbness after the procedure, and improved within 6 months. Furthermore, study design and treatment target were the sources of heterogeneity by subgroup and metaregression analyses, accounting for 37% and 74% of variances, respectively. Target of genicular nerve achieved better pain relief than intra-articular or sciatic nerve. Sensitivity analysis showed that removal of any single study was unlikely to overturn the findings. Limitations. There were some limitations in the study. Firstly, the small number of relevant studies limited the confidence level of the meta-analysis. Also, the significant heterogeneity may not be explained due to the limited data. Secondly, the direct comparison of two different guidance methods (ultrasound vs. fluoroscopy) for RF therapy is lacking. In addition, the outcomes were blindly assessed in the meta-analysis from all studies according to evaluation of bias, which could affect the reality of the data. Finally, most of the studies only provided short follow-up times, so we could not analyze the long-term effectiveness of ultrasound-guided RF in the treatment of patients with KOA. Conclusions Ultrasonography is an effective, safe, nonradiative, and easily applicable guidance method for RF in pain relief and functional improvement in KOA patients.
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Hussain N, Costache I, Kumar N, Essandoh M, Weaver T, Wong P, Tierney S, Rose P, McCartney CJL, Abdallah FW. Is Supraclavicular Block as Good as Interscalene Block for Acute Pain Control Following Shoulder Surgery? A Systematic Review and Meta-analysis. Anesth Analg 2020; 130:1304-1319. [PMID: 32102013 DOI: 10.1213/ane.0000000000004692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Interscalene block (ISB) is the acute pain management technique of choice for shoulder surgery, but its undesirable respiratory side effects have prompted seeking alternatives. Supraclavicular block (SCB) is proposed as an ISB alternative, but evidence of comparative analgesic and respiratory-sparing effects is inconsistent. We compared the analgesic and respiratory effects of SCB and ISB for shoulder surgery. METHODS Trials comparing ISB to SCB for shoulder surgery were sought. We decided a priori that SCB would be an acceptable alternative if it were noninferior for (1) postoperative 24-hour cumulative oral morphine equivalent consumption (primary outcome, noninferiority margin Δ = -25 mg) and (2) postoperative pain (secondary outcome, noninferiority margin Δ = 4.0 cm·hour); and superior for (3) postblock respiratory dysfunction (primary outcome). Opioid-related side effects and block-related complications were also evaluated. RESULTS Fifteen studies (1065 patients) were analyzed. In single-injection blocks, SCB was noninferior to ISB for 24-hour morphine consumption (mean difference for SCB-ISB, MD [95% confidence interval {CI}] = -3.11 mg [-9.42 to 3.19], Δ = -25 mg); it was also noninferior for 24-hour pain scores (MD = 0.78 cm·hour [0.07-1.49], Δ = 4.0 cm·hour); and decreased the odds of respiratory dysfunction (odds ratio [OR] [95% CI] = 0.08 [0.01-0.68]). Similarly, in continuous blocks, SCB was noninferior to ISB for 24-hour morphine consumption (MD = 0.46 mg [-6.08 to 5.15], Δ = -25 mg), and decreased the odds of respiratory dysfunction (OR = 0.22 [0.08-0.57]). SCB also decreased odds of minor block-related complications (OR = 0.36 [0.20-0.68] and OR = 0.25 [0.15-0.41] for single-injection and continuous blocks, respectively). Consequently, the null joint-hypothesis was rejected, and SCB can be considered an acceptable alternative to ISB. CONCLUSIONS For acute pain control following shoulder surgery, high-quality evidence indicates that SCB can be used as an effective ISB alternative. SCB is noninferior for postoperative opioid consumption and acute pain, and it reduces the odds of postblock respiratory dysfunction.
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Affiliation(s)
- Nasir Hussain
- From the Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Ioana Costache
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicolas Kumar
- From the Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio.,Faculty of Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Michael Essandoh
- From the Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Tristan Weaver
- From the Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Patrick Wong
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Tierney
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Rose
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Colin J L McCartney
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Faraj W Abdallah
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.,Department of Anesthesia, and the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Won HS, Yang M, Kim YD. Facet joint injections for management of low back pain: a clinically focused review. Anesth Pain Med (Seoul) 2020; 15:8-18. [PMID: 33329784 PMCID: PMC7713865 DOI: 10.17085/apm.2020.15.1.8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 11/17/2022] Open
Abstract
Lumbar facet joints have been implicated in chronic low back pain in up to 45% of patients with low back pain (LBP). Facet joint pain diagnosis and management are always challenging for pain physicians. Facet joint pain is not diagnosed by specific demographic features, pain characteristics, or physical findings, even though electrodiagnostic studies and imaging modalities are available. Although comparative local anesthetics or placebo saline injections can be used, diagnostic blocks are the only reliable diagnostic measures according to the current literature. Treatment of chronic LBP arising due to facet joint includes intraarticular injections, medial branch blocks, and radiofrequency neurotomy. However, the evidence of their clinical efficacy is continuously under scrutiny. Pain physicians must have a detailed understanding of the spinal anatomy in order to perform safe and effective interventional procedures. This review outlines the important aspects of spinal anatomy as they relate to interventional pain management related to facet joint injections. Additionally, we provide a comprehensive review of the procedure and clinical evidence.
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Affiliation(s)
- Hyung-Sun Won
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea.,Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Miyoung Yang
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea.,Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Yeon-Dong Kim
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea.,Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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Wang H, Liu S, Wang T, Zhang C, Feng T, Tian C. Three-dimensional interventional photoacoustic imaging for biopsy needle guidance with a linear array transducer. JOURNAL OF BIOPHOTONICS 2019; 12:e201900212. [PMID: 31407486 DOI: 10.1002/jbio.201900212] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/24/2019] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
Needle placement is important for many clinical interventions, such as tissue biopsy, regional anesthesia and drug delivery. It is essential to visualize the spatial position of the needle and the target tissue during the interventions using appropriate imaging techniques. Based on the contrast of optical absorption, photoacoustic imaging is well suited for the guidance of interventional procedures. However, conventional photoacoustic imaging typically provides two-dimensional (2D) slices of the region of interest and could only visualize the needle and the target when they are within the imaging plane of the probe at the same time. This requires great alignment skill and effort. To ease this problem, we developed a 3D interventional photoacoustic imaging technique by fast scanning a linear array ultrasound probe and stitching acquired image slices. in vivo sentinel lymph node biopsy experiment shows that the technique could precisely locate a needle and a sentinel lymph node in a tissue volume while a perfusion experiment demonstrates that the technique could visualize the 3D distribution of injected methylene blue dye underneath the skin at high temporal and spatial resolution. The proposed technique provides a practical way for photoacoustic image-guided interventions.
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Affiliation(s)
- Hang Wang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, University of Science and Technology of China, Hefei, Anhui, China
| | - Songde Liu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, University of Science and Technology of China, Hefei, Anhui, China
| | - Tong Wang
- Department of Optics and Optical Engineering, University of Science and Technology of China, Hefei, Anhui, China
| | - Chenxi Zhang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, University of Science and Technology of China, Hefei, Anhui, China
| | - Ting Feng
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu, China
| | - Chao Tian
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui, China
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, University of Science and Technology of China, Hefei, Anhui, China
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Qiu Z, Jia Y, Shen Y, Zhou Q, Sun X, Zhu X, Li S. Acupotomy by an ultrasound-guided technique: A protocol for a systematic review. Medicine (Baltimore) 2019; 98:e17398. [PMID: 31626093 PMCID: PMC6824636 DOI: 10.1097/md.0000000000017398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acupotomy is a miniature surgery instrument. It can cut and detach the abnormal, cicatricial, and contractured tissues by causing only microtrauma. Acupotomy has been widely used clinically with a satisfactory efficacy. With the development of ultrasound technology, ultrasound-guided acupotomy has shown great value in clinical practice. But it is not yet clear that ultrasound-guided acupotomy is very effective and safe. Therefore, it is important to re-evaluate the available evidence to reach a relatively convincing conclusion that acupotomy by ultrasound-guided technique is a better choice than traditional acupotomy. The purpose of this systematic review is to provide a method for evaluating the effectiveness and safety of acupotomy by ultrasound-guided technique. METHODS This systematic review will be performed by searching relevant randomized controlled trials (RCTs) without any language or publication status restriction from inception to December 2019 by 2 researchers in nine databases (PubMed, Medline, Embase, Cochrane Library, Chinese literature databases, Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI], China Science and Journal Database [CSJD], and Wanfang Database). All RCTs evaluating acupotomy by the ultrasound-guided technique will be included in this study. Visual analog scale (VAS) and change of symptom will be assessed as the primary outcomes. The change in the ultrasound image, safety and adverse events, and acceptability will be assessed as secondary outcomes. The selection of study, data collection and analysis, and assessment of the study quality will be completed independently by 2 researchers. RevMan v.5.3 will be used for meta-analysis if no significant heterogeneity is detected. Continuous outcomes will be presented as the mean difference (MD) or standardized MD, while dichotomous data will be expressed as the relative risk. RESULTS This study will provide a high-quality synthesis of QL and AR to assess the effectiveness and safety of acupotomy by ultrasound-guided technique. CONCLUSION This systematic review will provide evidence to judge whether acupotomy by ultrasound-guided technique is an effective the efficacy and safety intervention. PROSPERO REGISTRATION NUMBER CRD42018109070.
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Affiliation(s)
- Zuyun Qiu
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital, Beijing
| | - Yan Jia
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital, Beijing
| | - Yifeng Shen
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Qiaoyin Zhou
- Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Xiaojie Sun
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital, Beijing
| | - Xinyue Zhu
- Beijing First Hospital of Integrated Chinese and Western Medicine, Department of Rehabilitation Medicine, Beijing, China
| | - Shiliang Li
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital, Beijing
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Park KD, Lee WY, Nam SH, Kim M, Park Y. Ultrasound-guided selective nerve root block versus fluoroscopy-guided interlaminar epidural block for the treatment of radicular pain in the lower cervical spine: a retrospective comparative study. J Ultrasound 2018; 22:167-177. [PMID: 30519991 DOI: 10.1007/s40477-018-0344-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/30/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Recent studies have compared the therapeutic efficacy and safety of the procedure using ultrasound and fluoroscopy. However, there are no published studies comparing the therapeutic efficacy and safety of fluoroscopy (FL)-guided cervical interlaminar epidural steroid injection (CIESI) with that of ultrasound (US)-guided selective nerve root block (SNRB). This study aimed to compare the mid-term effects and advantages of US-guided SNRB with FL-guided CIESI for radicular pain in the lower cervical spine through assessment of pain relief and functional improvement. METHODS Patients with radicular pain in the lower cervical spine who received US-guided SNRB (n = 51) or FL-guided CIESI (n = 61) were included in this retrospective study. All procedures were performed using FL or US. The complication frequencies during the procedures, adverse events, treatment effects, and functional improvement were compared at intervals of 1, 3, and 6 months after the last injection. RESULTS Both the neck disability index and verbal numeric scale showed improvements at 1, 3, and 6 months after the last injection in both groups, with no significant differences between groups (p < 0.05). Furthermore, the treatment success rate at all time points was not significantly different between groups. Logistic regression analysis revealed that the injection method (US- or FL-guided), sex, analgesic use, pain duration, number of injections, and age were not independent predictors of treatment success. Blood was aspirated before injection in 8% (n = 5) and 0% of patients in the FL-guided and US-guided groups, respectively. In seven patients of the FL-guided group, intravascular contrast spread was noted during injection. CONCLUSIONS Our results suggest that, compared with FL-guided CIESI, US-guided SNRB requires a shorter administration duration while providing similar pain relief and functional improvements.
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Affiliation(s)
- Ki Deok Park
- Department of Rehabilitation Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Woo Yong Lee
- Department of Anesthesiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Sang Hyun Nam
- Department of Plastic and Reconstructive Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Myounghwan Kim
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Yongbum Park
- Department of Physical Medicine and Rehabilitation, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye 7 dong 761-7, Nowon-gu, 139-707, Seoul, South Korea.
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Shaaban MH, Reyad RM, Ghobrial HZ, Hashem RH. Ultrasound guided versus fluroscopic guided pulsed radiofrequency therapy of the stellate ganglion in neuropathic pain: A prospective controlled comparative study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kim HT, Kim SY, Byun GJ, Shin BC, Lee JY, Choi EJ, Choi JB, Hong JH, Choi SW, Kim YD. State of education regarding ultrasound-guided interventions during pain fellowships in Korea: a survey of recent fellows. Korean J Pain 2017; 30:287-295. [PMID: 29123624 PMCID: PMC5665741 DOI: 10.3344/kjp.2017.30.4.287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/17/2017] [Accepted: 09/19/2017] [Indexed: 12/03/2022] Open
Abstract
Background Recently, the use of ultrasound (US) techniques in regional anesthesia and pain medicine has increased significantly. However, the current extent of training in the use of US-guided pain management procedures in Korea remains unknown. The purpose of the present study was to assess the current state of US training provided during Korean Pain Society (KPS) pain fellowship programs through the comparative analysis between training hospitals. Methods We conducted an anonymous survey of 51 pain physicians who had completed KPS fellowships in 2017. Items pertained to current US practices and education, as well as the types of techniques and amount of experience with US-guided pain management procedures. Responses were compared based on the tier of the training hospital. Results Among the 51 respondents, 14 received training at first- and second-tier hospitals (Group A), while 37 received training at third-tier hospitals (Group B). The mean total duration of pain training during the 1-year fellowship was 7.4 months in Group A and 8.4 months in Group B. Our analysis revealed that 36% and 40% of respondents in Groups A and B received dedicated US training, respectively. Most respondents underwent US training in patient-care settings under the supervision of attending physicians. Cervical root, stellate ganglion, piriformis, and lumbar plexus blocks were more commonly performed by Group B than by Group A (P < 0.05). Conclusions Instruction regarding US-guided pain management interventions varied among fellowship training hospitals, highlighting the need for the development of educational standards that mandate a minimum number of US-guided nerve blocks or injections during fellowships in interventional pain management.
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Affiliation(s)
- Hyung Tae Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Hospital, Jeonju, Korea
- Committee on Ultrasound in Pain Medicine, Korean Pain Society, Seoul, Korea
| | - Sae Young Kim
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
- Committee on Ultrasound in Pain Medicine, Korean Pain Society, Seoul, Korea
| | - Gyung Jo Byun
- Department of Anesthesiology and Pain Medicine, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Korea
- Committee on Ultrasound in Pain Medicine, Korean Pain Society, Seoul, Korea
| | - Byung Chul Shin
- Mac Pain Clinic, Seoul, Korea
- Committee on Ultrasound in Pain Medicine, Korean Pain Society, Seoul, Korea
| | - Jin Young Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
- Committee on Ultrasound in Pain Medicine, Korean Pain Society, Seoul, Korea
| | - Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Committee on Ultrasound in Pain Medicine, Korean Pain Society, Seoul, Korea
| | - Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Suwon, Korea
- Committee on Ultrasound in Pain Medicine, Korean Pain Society, Seoul, Korea
| | - Ji Hee Hong
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Korea
- Committee on Ultrasound in Pain Medicine, Korean Pain Society, Seoul, Korea
| | - Seung Won Choi
- Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, School of Medicine, Wonkwang University, Wonkwang Institute of Scinece, Iksan, Korea
| | - Yeon Dong Kim
- Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, School of Medicine, Wonkwang University, Wonkwang Institute of Scinece, Iksan, Korea
- Committee on Ultrasound in Pain Medicine, Korean Pain Society, Seoul, Korea
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Park KD, Lim DJ, Lee WY, Ahn J, Park Y. Ultrasound versus fluoroscopy-guided cervical medial branch block for the treatment of chronic cervical facet joint pain: a retrospective comparative study. Skeletal Radiol 2017; 46:81-91. [PMID: 27815597 DOI: 10.1007/s00256-016-2516-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/11/2016] [Accepted: 10/17/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the mid-term effects and advantages of the ultrasound (US)-guided with fluoroscopy(FL)-guided cervical medial branch blocks (CMBBs) for chronic cervical facet joint pain through assessment of pain relief, functional improvement, and injection efficiency. METHODS Patients with chronic cervical facet joint pain who received US- (n = 68) or FL-guided CMBBs (n = 58) were included in this retrospective study. All procedures were performed using a FL or US. The complication frequencies, treatment effects, functional improvement, and injection efficiency of CMBBs were compared at 1, 3, and 6 months after the last injection. RESULTS Both the NDI and VNS scores showed improvements at 1, 3, and 6 months after the last injection in both groups, with no significant differences between groups (p < 0.05). Furthermore, the treatment success rate at all time points was not significantly different between groups. Logistic regression analysis revealed that the injection method (US- or FL-guided), the number of injections, sex, analgesic use, and age were not independent predictors of treatment success. Compared with FL-guided CMBB, US-guided CMBB was associated with a shorter administration duration and fewer needle passes. CONCLUSIONS Our results suggest that, compared with FL-guided CMBBs, US-guided CMBBs require a shorter administration duration and fewer needle passes, while providing similar pain relief and functional improvements. Therefore, US-guided CMBBs can be considered as an effective alternative for the conservative management of chronic cervical facet joint pain.
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Affiliation(s)
- Ki Deok Park
- Department of Rehabilitation Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Dong-Ju Lim
- Seoul Spine Institute, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Woo Yong Lee
- Department of Anesthesiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - JaeKi Ahn
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Yongbum Park
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea.
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Ultrasound indications for chronic pain management: an update on the most recent evidence. Curr Opin Anaesthesiol 2016; 29:600-5. [PMID: 27388794 DOI: 10.1097/aco.0000000000000369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The ability of ultrasound to provide detailed anatomic visualization while avoiding radiation exposure continues to make it an appealing tool for many practitioners of chronic pain management. This review will present the most recent evidence regarding the use of ultrasound-guidance for the performance of interventional procedures in the treatment of chronic pain. RECENT FINDINGS For a variety of different procedures, studies continue to compare ultrasound-guided techniques to commonly used fluoroscopic or landmark-based techniques. Small, randomized controlled trials are beginning to demonstrate that ultrasound-guided approaches to interventional pain procedures can be as well tolerated and effective as the traditionally used techniques, while providing some potential advantages in terms of decreased radiation exposure, avoidance of vascular structures, and in some cases, improved efficiency and decreased rates of adverse effects. SUMMARY Despite continued interest in ultrasound-guided techniques for chronic pain management procedures, the evidence is still limited mainly to small, randomized trials and case series. For some procedures, such as stellate ganglion block and peripheral joint injections, recent evidence appears to be tilting in favor of ultrasound-guidance as the preferred technique, though fluoroscopy continues to be a much more reliable method for detection of intravascular uptake of injectate.
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Abstract
OBJECTIVES To evaluate the feasibility of ultrasound (US) detection of the middle cervical sympathetic ganglion (CSG). MATERIALS AND METHODS We examined 52 consecutive patients with 104 bilateral middle CSGs. We identified middle CSG according to our sonographic assessment criteria. After finding oval-shaped hypoechoic structure on transverse scan, we verified a continuous, hypoechoic line connecting the bulbous structure at both sides. The basic US characteristics were evaluated using the size, location, relationship to the common carotid artery, and relationship to the inferior thyroidal artery. RESULTS The middle CSG was identified in 41% (43/104). The mean size of the middle CSG was 3.8±1.5 mm in width, 1.9±0.7 mm in height, and 8.7±3.2 mm in length. They were primarily located at the C6 level (41/43, 95%). Regarding the relationship with common carotid artery, 88% (38/43) were lateral type and 12% (5/43) were medial type. Regarding the relationship with the inferior thyroid artery, 34% (15/43) were anterior type, 26% (11/43) were posterior type, and 40% (17/43) were unable to access the relationship. DISCUSSION Direct visualization of middle CSG based on the understanding of both its location and US features may reduce complications and improve the accuracy of US-guided neck procedures.
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Sarı S, Aydın ON, Turan Y, Şen S, Özlülerden P, Ömürlü İK, Gulastı F. Which imaging method should be used for genicular nerve radio frequency thermocoagulation in chronic knee osteoarthritis? J Clin Monit Comput 2016; 31:797-803. [DOI: 10.1007/s10877-016-9886-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
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Korbe S, Udoji EN, Ness TJ, Udoji MA. Ultrasound-guided interventional procedures for chronic pain management. Pain Manag 2015; 5:465-82. [PMID: 26402316 PMCID: PMC4976830 DOI: 10.2217/pmt.15.46] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities.
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Affiliation(s)
- Samuel Korbe
- Department of Anesthesiology & Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Esther N Udoji
- Department of Radiology, University of Chicago, Chicago, IL 60637, USA
| | - Timothy J Ness
- Department of Anesthesiology & Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Mercy A Udoji
- Department of Anesthesiology & Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
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Mariano ER, Marshall ZJ, Urman RD, Kaye AD. Ultrasound and its evolution in perioperative regional anesthesia and analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:29-39. [DOI: 10.1016/j.bpa.2013.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/22/2013] [Indexed: 11/30/2022]
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Deimel GW, Hurdle MFB, Murthy N, Cartwright JA, Smith J, Pingree MJ. Sonographically guided costotransverse joint injections: a computed tomographically controlled cadaveric feasibility study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2083-2089. [PMID: 24277889 DOI: 10.7863/ultra.32.12.2083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The primary purpose of this study was to describe and validate a novel sonographically guided costotransverse (CTRV) joint injection technique. METHODS The bilateral T3-T10 CTRV joints of an unembalmed cadaveric specimen were localized using a 12-3-MHz linear array transducer. A 22-gauge, 2.5-in spinal needle was directed into the CTRV joint using an in-plane, lateral-to-medial approach under direct sonographic guidance. After needle placement, 3-dimensional computed tomographic (CT) images were obtained to assess the locations of the needle tips. This step was followed by injection of an iodinated contrast agent and repeated CT to assess the contrast flow pattern. An experienced musculoskeletal radiologist reviewed the CT images and assessed the accuracy of the injections (intra- or extra-articular). For intra-articular injections, a quantitative assessment of the percentage of injectate within the joint was performed. RESULTS A total of 16 sonographically guided CTRV joint injections were completed on a single torso-pelvis specimen. Using our technique, 11 of 16 sonographically guided CTRV joint injections (68.8%) placed the contrast agent into the target joint. Quantitative analysis of the arthrograms showed 6 of 11 intra-articular injections (54.5%) with greater than 50% injectate within the joint capsule. CONCLUSIONS To our knowledge, this study is the first to determine the feasibility of sonographically guided CTRV joint injections. Overall, 68.8% of injection attempts produced acceptable CTRV joint arthrograms, which compares favorably to a previously reported 76% accuracy rate for fluoroscopically guided CTRV joint injections. Although these injections are technically challenging, the use of sonographic guidance to perform CTRV joint injections is feasible and warrants further investigation to establish its role in the management of patients presenting with thoracic pain syndromes.
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Affiliation(s)
- George W Deimel
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA.
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Narouze SN, Provenzano DA. Sonographically guided cervical facet nerve and joint injections: why sonography? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1885-1896. [PMID: 24154892 DOI: 10.7863/ultra.32.11.1885] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Samer N Narouze
- Center for Pain Medicine, Summa Western Reserve Hospital, 1900 23rd St, Cuyahoga Falls, OH 44223 USA.
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Utility of stellate ganglion block in atypical facial pain: a case report and consideration of its possible mechanisms. Case Rep Med 2013; 2013:293826. [PMID: 24065993 PMCID: PMC3770018 DOI: 10.1155/2013/293826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/27/2013] [Indexed: 11/25/2022] Open
Abstract
We present this report of a young patient with chronic severe atypical facial pain who was successfully controlled with stellate ganglion block under ultrasound guidance. The patient had a history of severe disabling, unilateral, facial neuropathic pain with minimal response to analgesic medications. Upon assessment the patient had features suggestive of trigeminal neuralgia, although postherpetic neuralgia could not be ruled out. As a diagnostic test intervention, stellate ganglion block was tried under ultrasound guidance. The patient showed significant improvement in pain control and functional disability lasting beyond 10 weeks. Subsequent blocks reinforced the analgesia. Atypical facial pain has several differential diagnoses. The involvement of sympathetic system in its causation or sustenance is uncertain. Stellate ganglion block achieves sympathetic block of cervicofacial structures, and its blockade has been shown to affect chronic pain conditions. Although its mechanism is not clear, one has to consider its possible role in conditions of stress apart from directly controlling the sympathetic activity. There is certainly a role in exploring the potential benefits of stellate ganglion block in such clinical conditions. The technique of stellate block under ultrasound is also described, as it influences the safety and precision of the block.
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Morillas-Sendin P, Ortega-Romero A, del-Olmo C. Basic considerations before injections and scanning techniques. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.trap.2014.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cervical epidural steroid injections for the treatment of cervical spinal (neck) pain. Curr Pain Headache Rep 2013; 17:314. [PMID: 23315021 DOI: 10.1007/s11916-012-0314-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cervical epidural steroid injections (CESI) are an accepted treatment for neck pain with a radicular component, and may be accomplished by using either transforaminal (CTFESI) or interlaminar (CILESI) approaches. CESIs are routinely performed using real-time fluoroscopic-guidance in conjunction with the injection of water soluble, iodine-based contrast media to enhance visualization of intravascular injections. Digital subtraction angiography (DSA) imaging is an adjuvant to fluoroscopic methods for visualizing blood vessels while performing spinal injections. However, as with any neuraxial procedure, various complications associated with CESIs have been reported. Complications are directly associated with the technical procedures of CESIs. Particulate steroids may have a prolonged duration of action but non-particulate steroids are safer for CESIs. Blunt-beveled needles are less likely than sharp-beveled needles to penetrate blood vessels to cause bleeding complications during CTFESI procedures. Small doses of local anesthetics appear to be safe and assist in identifying intravascular injections previously overlooked by conventional techniques.
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Ultrasound Guided Spine Injections: Advancement Over Fluoroscopic Guidance? CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0016-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee recommendations for education and training in ultrasound-guided interventional pain procedures. Reg Anesth Pain Med 2013; 37:657-64. [PMID: 23080347 DOI: 10.1097/aap.0b013e318269c189] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The use of ultrasound in pain medicine for interventional axial, nonaxial, and musculoskeletal pain procedures is rapidly evolving and growing. Because of the lack of specialty-specific guidelines for ultrasonography in pain medicine, an international collaborative effort consisting of members of the Special Interest Group on Ultrasonography in Pain Medicine from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies developed the following recommendations for education and training in ultrasound-guided interventional pain procedures. The purpose of these recommendations is to define the required skills for performing ultrasound-guided pain procedures, the processes for appropriate education, and training and quality improvement. Training algorithms are outlined for practice- and fellowship-based pathways. The previously published American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anaesthesia and Pain Therapy education and teaching recommendations for ultrasound-guided regional anesthesia served as a foundation for the pain medicine recommendations. Although the decision to grant ultrasound privileges occurs at the institutional level, the committee recommends that the training guidelines outlined in this document serve as the foundation for educational training and the advancement of the practice of ultrasonography in pain medicine.
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Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-012-0003-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Jee H, Lee JH, Kim J, Park KD, Lee WY, Park Y. Ultrasound-guided selective nerve root block versus fluoroscopy-guided transforaminal block for the treatment of radicular pain in the lower cervical spine: a randomized, blinded, controlled study. Skeletal Radiol 2013; 42:69-78. [PMID: 22609989 DOI: 10.1007/s00256-012-1434-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the short-term effects and advantages of ultrasound-guided selective nerve root block with fluoroscopy-guided transforaminal epidural block for radicular pain in the lower cervical spine through assessment of pain relief, functional improvement, and safety. METHODS A total of 120 patients with radicular pain from cervical spinal stenosis or cervical herniated disc were enrolled. All procedures were performed using a fluoroscopy or ultrasound apparatus. The subjects were randomly assigned to either the fluoroscopy (FL) or ultrasound (US) group. The complication frequencies during the procedures, treatment effects, and functional improvement of the nerve root block were compared at 2 and 12 weeks after the procedures. RESULTS Verbal Numeric Pain Scale (VNS) improved 2 weeks and 12 weeks after the injections in both groups. Statistical differences were not observed in VNS, Neck Disability Index (NDI), and effectiveness between the groups. In 21 patients at US, vessels were identified at the anterior aspect of the foramen. Eleven patients had a critical vessel at the posterior aspect of the foramen and five patients had on artery continue medially into the foramen, forming, or joining a segmental feeder artery. In both cases, the vessels might well have been in the pathway of the needle correctly positioned under fluoroscopic guidance. Five cases of intravascular injections were observed only in FL without significant difference between the groups. CONCLUSIONS The US-guided method may facilitate identifying critical vessels at unexpected locations relative to the intervertebral foramen and avoiding injury to such vessels, which is the leading cause of the reported complications from cervical transforaminal injections. On treatment effect, using either method of epidural injections to deliver steroids for cervical radicular pain, secondary to herniated intervertebral disc or foraminal stenosis, significant improvements in function and pain relief were observed in both groups after the intervention. However, significant difference was not observed between the groups. Therefore, the ultrasound-guided method was shown to be as effective as the fluoroscopy-guided method in pain relief and functional improvement, in addition to the absence of radiation and avoiding vessel injury at real-time imaging.
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Affiliation(s)
- Haemi Jee
- Department of Medical Science, University of Ulsan College of Medicine, Seoul, Korea
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Zhang L, Yao J, Zhang T, Jin J, Zeng X, Yue Z. Stellate ganglion block may prevent the development of neurogenic pulmonary edema and improve the outcome. Med Hypotheses 2012. [PMID: 23207183 DOI: 10.1016/j.mehy.2012.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neurogenic pulmonary edema (NPE) is an acute and serious complication after a central nervous system insult with high mortality. The pronounced activation of sympathetic nervous system and the release of vasoactive substances are necessary prerequisites for the development of NPE. We introduce a hypothesis that stellate ganglion block (SGB) may prevent NPE development on the basis of the inhibition of sympathetic overactivation, reduction of the concentration of norepinephrine and attenuation of baroreflex sensitivity, and improve the outcome by improving cerebral blood flow and pulmonary circulation and maintaining cardiovascular stability. In clinical practice, the guidance technique and close monitoring might guarantee the safety of SGB. If our hypothesis is supported by further experiments, this may open a new doorway for the treatment of NPE.
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Affiliation(s)
- Lili Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
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Boe BA, Webster G, Asher Y, Tsao S, Suresh S, Steinhorn DM. Percutaneous, Ultrasound-Guided Stellate Ganglion Nerve Block Suppresses Recurrent Ventricular Fibrillation in an Infant Awaiting Heart Transplant. Circ Arrhythm Electrophysiol 2012; 5:e93-4. [DOI: 10.1161/circep.112.974329] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian A. Boe
- From the Department of Pediatrics (B.A.B.), Division of Cardiology (G.W., S.T.), Department of Anesthesiology (Y.A., S.S.), and Section of Critical Care Medicine (D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gregory Webster
- From the Department of Pediatrics (B.A.B.), Division of Cardiology (G.W., S.T.), Department of Anesthesiology (Y.A., S.S.), and Section of Critical Care Medicine (D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yogen Asher
- From the Department of Pediatrics (B.A.B.), Division of Cardiology (G.W., S.T.), Department of Anesthesiology (Y.A., S.S.), and Section of Critical Care Medicine (D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sabrina Tsao
- From the Department of Pediatrics (B.A.B.), Division of Cardiology (G.W., S.T.), Department of Anesthesiology (Y.A., S.S.), and Section of Critical Care Medicine (D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Santhanam Suresh
- From the Department of Pediatrics (B.A.B.), Division of Cardiology (G.W., S.T.), Department of Anesthesiology (Y.A., S.S.), and Section of Critical Care Medicine (D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David M. Steinhorn
- From the Department of Pediatrics (B.A.B.), Division of Cardiology (G.W., S.T.), Department of Anesthesiology (Y.A., S.S.), and Section of Critical Care Medicine (D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
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Ultrasound-guided cervical spine injections: ultrasound "prevents" whereas contrast fluoroscopy "detects" intravascular injections. Reg Anesth Pain Med 2012; 37:127-30. [PMID: 22354064 DOI: 10.1097/aap.0b013e31823f3c80] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The ASRA Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med 2010; 35:S1-9. [PMID: 20216019 DOI: 10.1097/aap.0b013e3181d22fe0] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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