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Ziaian B, Khezri S, Amirian A, Ranjbar K, Shahriarirad R, Eskandari Kohnaki M. Hypertonic saline solution 5% as an effective cost-beneficial alternative to normal saline for wound healing in patients with diabetic lower-extremity ulcers: a randomized controlled trial. J Diabetes Metab Disord 2023; 22:479-485. [PMID: 37255840 PMCID: PMC10225384 DOI: 10.1007/s40200-022-01167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/27/2022] [Accepted: 11/30/2022] [Indexed: 06/01/2023]
Abstract
Background Diabetic foot ulcer is among the most common complications and causes of mortality and morbidity in patients with diabetes. Herein, we propose using 5% Hypertonic Solution as an alternative to Normal Saline in treating patients with diabetic foot ulcers as an effective cost-benefit therapeutic approach. Methods In this clinical trial, 100 patients with diabetic foot ulcers were divided into two groups. Foot ulcer was washed and treated three times a day with the 5% hypertonic saline solution in the first group, while the second group was treated with normal saline 0.9% and normal washing. Patients were examined for the size and depth of the wound weekly, and the results were recorded after six weeks. Results The mean length and width of the wound in the experimental group significantly decreased six weeks after the start of treatment with hypertonic saline (p < 0.05). The wound healing rate was lower after treatment in both groups of patients who had a longer disease duration and higher HbA1c. Conclusion Treating diabetic foot ulcers with hypertonic saline solution may help improve wound healing. Therefore, rinsing with hypertonic saline is a cheap, safe, simple, and non-invasive treatment protocol for these patients.
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Affiliation(s)
- Bizhan Ziaian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samad Khezri
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Armin Amirian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keivan Ranjbar
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mariye Eskandari Kohnaki
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
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Lo Bianco G, Tinnirello A, Papa A, Marchesini M, Day M, Palumbo GJ, Terranova G, Di Dato MT, Thomson SJ, Schatman ME. Interventional Pain Procedures: A Narrative Review Focusing On Safety and Complications. PART 2 Interventional Procedures For Back Pain. J Pain Res 2023; 16:761-772. [PMID: 36925622 PMCID: PMC10010974 DOI: 10.2147/jpr.s396215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
In patients where conservative approaches have failed to relieve from chronic pain, interventional procedures may be an option in well selected patients. In recent years there has been an increase in the use and development of invasive procedures. Concomitantly, there has also been an increase in the complications associated with these procedures. Taken this into consideration, it is important for healthcare providers to take a cautious and vigilant approach, with a focus on patient safety, in order to minimize the risk of adverse events and ensure the best possible outcome for the patient. This may include careful selection of patients for procedures, use of proper techniques and equipment, and close monitoring and follow-up after the procedure. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopy or ultrasound-guided) interventional procedures and provide strategies to reduce the risk of these complications. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.
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Affiliation(s)
- Giuliano Lo Bianco
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Andrea Tinnirello
- Anesthesiology and Pain Medicine Department, ASST Franciacorta, Ospedale di Iseo, Iseo, 25049, Italy
| | - Alfonso Papa
- Pain Department, AO “Ospedali dei Colli”, Monaldi Hospital, Naples, Italy
| | - Maurizio Marchesini
- Mininvasive Surgery Department, Unit of Pain Medicine IRCCS Maugeri Pavia, Pavia, 27100, Italy
| | - Miles Day
- Pain Research, The Pain Center at Grace Clinic, Texas Tech University HSC, Lubbock, TX, USA
| | - Gaetano Joseph Palumbo
- Azienda Ospedale - Università Padova, Department of Anesthesia and Intensive Care, Padova, Italy
| | - Gaetano Terranova
- Anaesthesia and Intensive Care Department, Asst Gaetano Pini, Milano, Italy
| | | | - Simon J Thomson
- Pain Management, Mid and South Essex University Hospitals NHSFT, Basildon, SS16 5NL, UK
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU School of Medicine, New York, NY, USA
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Lee HJ, Lee J, Park YW, Gil HY, Choi E, Nahm FS, Lee PB. Effectiveness of continuous hypertonic saline infusion with an automated infusion pump for decompressive neuroplasty: a randomized clinical trial. Korean J Pain 2019; 32:196-205. [PMID: 31257828 PMCID: PMC6615446 DOI: 10.3344/kjp.2019.32.3.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/12/2019] [Accepted: 03/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background Hypertonic saline (HS) injections for decompressive neuroplasty (DN) can cause pain. We assessed whether a continuous infusion of HS through an infusion pump would reduce injection-related pain compared with repeated bolus administrations. Methods Fifty patients scheduled for DN were randomized to either the bolus injection or the continuous infusion group. After appropriately placing the epidural catheter, 4 mL of 5% NaCl was injected as four boluses of 1 mL each at 15-minute intervals or infused over 1 hour using an infusion pump. The severity of pain induced by HS injection, as measured by the 11-point numerical rating scale (NRS), was the primary outcome. The severity of low back or lower extremity pain, as measured by the 11-point NRS and Oswestry Disability Index (ODI), 3 months following the procedure, was the secondary outcome. Results Data from 21 patients in the bolus group and 23 in the continuous infusion group were analyzed. No statistically significant difference in injection-related pain was identified between the two groups during the initial HS administration (P = 0.846). However, there was a statistically significant reduction in injection-related pain in the continuous infusion group compared to the bolus injection group from the second assessment onwards (P = 0.001, < 0.001, and < 0.001, respectively). No significant between-group differences in the NRS and ODI scores 3 months post-procedure were noted (P = 0.614 and 0.949, respectively). Conclusions Our study suggests that administering HS through a continuous infusion is a useful modality for reducing HS injection-related pain during DN.
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Affiliation(s)
- Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jaewoo Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeon wook Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Young Gil
- Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Suwon, Korea
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyung Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Degeneration, whether from age or postsurgical, in the ventral and lateral epidural space can lead to irritation of both the nerve roots and of the nerves present in the epidural space, the peridural membrane and the posterior longitudinal ligament. This irritation is often accompanied by mild scarring. Neuroplasty is a specific procedure designed to relieve this irritation. The effectiveness of neuroplasty is not affected by the extent of spinal stenosis. Neuroplasty can be performed in the lumbar, thoracic and cervical spine, and using caudal, transforaminal and interlaminar approaches. Postprocedural home exercises are an integral part of the procedure. There are multiple high-grade studies positive for the effectiveness and safety of neuroplasty. Neuroplasty should be offered prior to surgery in patients with persistent back and/or extremity pain.
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Affiliation(s)
- Standiford Helm
- The Helm Center for Pain Management, Laguna Woods, CA 92637, USA
| | - Nebojsa Nick Knezevic
- Vice Chair for Research & Education, Department of Anesthesiology & Pain Management, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.,Clinical Associate Professor, Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
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Bhatia A, Nelson A, Cohen SP. Breaking Bad (Tissue): Epidural Adhesiolysis and Its Outcomes. Anesth Analg 2018; 124:1755-1757. [PMID: 28525502 DOI: 10.1213/ane.0000000000001931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anuj Bhatia
- From the *Department of Anesthesia and Pain Management and †Institute of Health Policy Management and Evaluation, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; ‡Department of Anesthesiology and Perioperative Care, University of California Irvine School of Medicine, Irvine, California; Departments of §Anesthesiology and Critical Care Medicine, ‖Neurology, and ¶Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland; and Departments of #Anesthesiology and **Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
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Choi EJ, Yoo YJ, Lee PB, Kim YC, Lee SC, Moon JY. A Retrospective Study to Evaluate the Effect of Concentration of Hypertonic Saline on Efficacy and Safety of Epidural Adhesiolysis. Anesth Analg 2017; 124:2021-2029. [DOI: 10.1213/ane.0000000000001925] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ferreira LEN, Muniz BV, dos Santos CP, Volpato MC, de Paula E, Groppo FC. Comparison of liposomal and 2-hydroxypropyl-β-cyclodextrin–lidocaine on cell viability and inflammatory response in human keratinocytes and gingival fibroblasts. J Pharm Pharmacol 2016; 68:791-802. [DOI: 10.1111/jphp.12552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/29/2016] [Indexed: 01/27/2023]
Abstract
Abstract
Objectives
The aim of this study was to observe the effect multilamellar liposomes (MLV) and 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) in the in-vitro effects of lidocaine in cell viability, pro-inflammatory cytokines and prostaglandin E2 release of both human keratinocytes (HaCaT) and gingival fibroblasts (HGF) cells.
Methods
HaCaT and HGF cells were exposed to lidocaine 100–1 μm in plain, MLV and HP-β-CD formulations for 6 h or 24 h. The formulation effects in cell viability were measured by XTT assay and by fluorescent labelling. Cytokines (IL-8, IL-6 and TNF-α) and PGE2 release were quantified by ELISA.
Key findings
MLV and HP-β-CD formulations did not affect the HaCaT viability, which was significantly decreased by plain lidocaine after 24 h of exposure. Both drug carriers increased all cytokines released by HGF after 24-h exposure, and none of the carriers was able to reduce the PGE2 release induced by lidocaine.
Conclusion
The effect of drug carrier in the lidocaine effects was dependent on the cell type, concentration and time of exposure. MLV and HP-β-CD showed benefits in improving cell viability; however, both of them showed a tendency to increase cytokine release when compared to the plain solution.
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Affiliation(s)
- Luiz Eduardo Nunes Ferreira
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas – UNICAMP, Piracicaba, São Paulo, Brazil
| | - Bruno Vilela Muniz
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas – UNICAMP, Piracicaba, São Paulo, Brazil
| | - Cleiton Pita dos Santos
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas – UNICAMP, Piracicaba, São Paulo, Brazil
| | - Maria Cristina Volpato
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas – UNICAMP, Piracicaba, São Paulo, Brazil
| | - Eneida de Paula
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas – UNICAMP, Piracicaba, São Paulo, Brazil
| | - Francisco Carlos Groppo
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas – UNICAMP, Piracicaba, São Paulo, Brazil
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Lee F, Jamison DE, Hurley RW, Cohen SP. Epidural lysis of adhesions. Korean J Pain 2014; 27:3-15. [PMID: 24478895 PMCID: PMC3903797 DOI: 10.3344/kjp.2014.27.1.3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 11/05/2022] Open
Abstract
As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.
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Affiliation(s)
- Frank Lee
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - David E. Jamison
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Robert W. Hurley
- Department of Anesthesiology, Neurology, Psychiatry & Orthopaedics and Rehabilitation, University of Florida, Gainesville, USA
| | - Steven P. Cohen
- Department of Anesthesiology and Critical Care Medicine and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, and Walter Reed National Military Medical Center, Baltimore, USA
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Cavallini M, Antonioli B, Gazzola R, Tosca M, Galuzzi M, Rapisarda V, Ciancio F, Marazzi M. Hyaluronidases for treating complications by hyaluronic acid dermal fillers: evaluation of the effects on cell cultures and human skin. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-013-0855-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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