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Xu Y, Wu J, Jiang Q, Lv Y, Pu S, Li C, Du D. Prediction of the Efficacy of Lumbar Sympathetic Block in Patients with Lower Extremity Complex Regional Pain Syndrome Type 1 Based on the Sympathetic Skin Response. Pain Ther 2023; 12:785-796. [PMID: 37014620 PMCID: PMC10199976 DOI: 10.1007/s40122-023-00499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION Complex regional pain syndrome type 1 (CRPS-1) is prevalent after trauma, with intractable pain being the most prominent clinical symptom. The impact of sympathetic block on CRPS is unclear. The goal of this study was to explore the characteristics that predict successful symptom relief with lumbar sympathetic block (LSB) in patients with lower extremity CRPS-1. METHODS The study was designed as a prospective cohort study. Ninety-eight patients diagnosed with lower extremity CRPS-1 between March 2021 and March 2022 were enrolled as participants. All of the patients received two LSB treatments within a month. Sympthetic skin response (SSR) and numeric rating scale (NRS) were recorded before and after LSB treatment. The procedure was judged as a clinically positive response if the patients a 50% or greater reduction in NRS scores. Patients were divided into positive response and negative response groups after LSB treatment: LSB (+) and LSB (-), and the different characteristics and examination findings of the two groups of patients were compared. Furthermore, a multivariable logistic regression model was utilized to evaluate the predictors of successful symptom relief following LSB treatment. RESULTS A total of 43.9% (43/98) of patients experienced successful symptom relief, while 56.1% (55/98) had unsuccessful symptom relief. After LSB treatment of all subjects, the overall NRS score decreased, the SSR amplitude increased, and the SSR latency shortened in the affected extremity (P < 0.05). There was a significant difference in the change in SSR amplitude between the LSB (-) and LSB (+) groups (P = 0.000). A 12-month disease duration had an OR (odds ratio) of 4.477 (P = 0.009), and a 510-µV baseline SSR amplitude of the affected extremity had an OR of 7.508 (P = 0.000) in the multivariable analysis that included these explanatory variables. CONCLUSIONS Patients with lower extremity CRPS-1 can experience significant pain relief after LSB treatment. The predictors of successful symptom relief after LSB treatment were a baseline SSR amplitude of the affected extremity < 510 µV and a disease duration < 12 months. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (ID: ChiCTR2000037755, date of registration: September 4, 2020).
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Affiliation(s)
- Yongming Xu
- Department of Pain Management Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Junzhen Wu
- Department of Pain Management Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Qingqing Jiang
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Lv
- Department of Pain Management Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Shaofeng Pu
- Department of Pain Management Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Chen Li
- Department of Pain Management Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Dongping Du
- Department of Pain Management Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, 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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Xu Y, Jiang Q, Xu X, Pu S, Lv Y, Li C, Wu J, Du D. The Tourniquet Ischemia Test Effectively Predicts the Efficacy of Lumbar Sympathetic Block in Patients with Lower Extremity Complex Regional Pain Syndrome Type 1. J Pain Res 2022; 15:1659-1667. [PMID: 35698569 PMCID: PMC9188397 DOI: 10.2147/jpr.s365954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background Neuropathic pain is the most common clinical sign of complex regional pain syndrome (CRPS). Currently, lumbar sympathetic block (LSB) is commonly utilized in lower extremity CRPS that has failed to respond to medication therapy and physical therapy, but its effectiveness is unknown. The tourniquet ischemia test (IT) can distinguish between two types of CRPS: IT-positive CRPS and IT-negative CRPS. Objective The aim of the study was to investigate whether LSB improves pain scores in patients with lower extremity CRPS-1 and to screen factors to predict its efficacy. Study Design Prospective clinical observational study. Setting Pain management center. Subjects Forty-three patients diagnosed with lower extremity CRPS-1 using the Budapest criteria were included as participants. Methods Forty-three CRPS-1 patients were treated with LSB therapy, and all of them underwent a tourniquet ischemia test (IT) before undergoing LSB therapy. LSB therapy was performed using a combination of ultrasonography and fluoroscopy. Then, numeric rating scale (NRS) scores and the symptom relief rates of patients were evaluated at 1, 4, and 12 weeks. Finally, peripheral blood inflammatory cytokine samples were collected before and after the LSB treatment. Results At 4 weeks after the treatment, the total effective symptom relief rate of LSB on CRPS-1 was 25.6% (11/43), with 52.6% (10/19) of IT(+) patients and 4.2% (1/24) of IT(-) patients. There was a significant difference between the IT(-) and IT(+) groups (P = 0.001). The multivariate binary logistic regression analysis revealed that the response to the tourniquet IT was the only significant independent predictor of sympathetic block success (p = 0.007). Conclusion Tourniquet IT is a simple, safe and effective test to distinguish patients with lower extremity CRPS-1. The response to the tourniquet IT is a reliable predictor of LSB effectiveness in lower extremity CRPS-1 patients.
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Affiliation(s)
- Yongming Xu
- Department of Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Qingqing Jiang
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Xiaoliang Xu
- Department of Anesthesiology, Cixi People’s Hospital, Cixi, Zhejiang, People’s Republic of China
| | - Shaofeng Pu
- Department of Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Yingying Lv
- Department of Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Chen Li
- Department of Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Junzhen Wu
- Department of Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Dongping Du
- Department of Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
- Correspondence: Dongping Du; Junzhen Wu, Department of Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, People’s Republic of China, Tel +86-21-24058896, Fax +86-21-240598896, Email ;
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Jain D, Mohan VK, Shams A, Bhoi D. Beyond Quadratus Lumborum block: A technique for ultrasound guided Lumbar Sympathetic block. PAIN MEDICINE 2022; 23:2095-2097. [PMID: 35639964 DOI: 10.1093/pm/pnac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Dhruv Jain
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Virender Kumar Mohan
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Abini Shams
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Debesh Bhoi
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Marada S, Punj J, Dhar A, Bhoi D, Mohan V, Trikha A, Pandey RK, Darlong V. To Assess Technical Feasibility of Ultrasound Lumbar Sympathetic Block with Electrical Stimulation Needle in Out of Plane Needle Orientation: A Prospective Interventional Study. PAIN MEDICINE 2021; 23:873-877. [PMID: 34402914 DOI: 10.1093/pm/pnab258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We describe technical feasibility of a new technique of ultrasound lumbar sympathectomy (ULS) validated by fluoroscopy. DESIGN Prospective interventional study. SETTING Pain block area. SUBJECTS Thirty patients of peripheral arterial disease (PAD) with rest pain numerical rating score (NRS) ≥ 3 were recruited. METHODS In lateral position, curved probe (FUJIFILM SonoSite Edge, 2-5 MHz) was placed transversely at iliac crest. An electrical stimulation needle was inserted out-plane, below lower pole of kidneys directed anterior to the vertebral body below. When needle tip was not visualized, current of 2.0 A was applied. Patients quadriceps contractions, ultrasound psoas contractions and bone contact guided needle placement and confirmed on fluoroscopy. Other parameters noted were: number of needle insertions, vertebral level, Pain NRS at baseline and at 4 hrs, 24 hrs, one week and two weeks post block, temperature rise and any other complications. RESULTS In all patients, needle tip was correctly placed in one to three attempts. In 73% patients, needle tip was at L3. Baseline Pain NRS was 8 (IQR 7-8) which decreased to 2 (IQR 2-3) at one week post-procedure and maintained at this range till 2 weeks later. Temperature rise of > 20C was noted in all patients. CONCLUSION ULS can safely be performed in patients of PAD by out-plane approach in lateral patient position with electrical stimulation needle. Before injection of drug, aspiration of blood should be ruled out in view of possibility of aortocaval injection.
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Affiliation(s)
- Snehitha Marada
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Punj
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Dhar
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Debesh Bhoi
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Virender Mohan
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Kumar Pandey
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanlal Darlong
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
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Joo Y, Kim EK, Song HG, Jung H, Park H, Moon JY. Effectiveness of virtual reality immersion on procedure-related pain and anxiety in outpatient pain clinic: an exploratory randomized controlled trial. Korean J Pain 2021; 34:304-314. [PMID: 34193636 PMCID: PMC8255151 DOI: 10.3344/kjp.2021.34.3.304] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background The study investigated virtual reality (VR) immersion in alleviating procedure-related pain in patients with chronic pain undergoing fluoroscopy-guided minimally-invasive intervention in a prone position at an outpatient clinic. Methods In this prospective randomized controlled study, 38 patients undergoing lumbar sympathetic ganglion block were randomized into either the VR or the control group. In the VR group, procedure-related pain was controlled via infiltration of local anesthetics while watching a 30-minute VR hypnotic program. In the control group, the skin infiltration alone was used, with the VR device switched off. The primary endpoint was an 11-point score on the numerical rating scale, indicating procedure-related pain. Patients’ satisfaction with pain control, anxiety levels, the need for additional local anesthetics during the procedure, hemodynamic stability, and any adverse events were assessed. Results Procedure-related pain was significantly lower in the VR group (3.7 ± 1.4) than in the control group (5.5 ± 1.7; P = 0.002). Post-procedural anxiety was lower in the VR group than in the control group (P = 0.025), with a significant reduction from pre-procedural anxiety (P < 0.001). Although patients’ satisfaction did not differ significantly (P = 0.158) between the groups, a higher number of patients required additional local anesthetics in the control group (n = 13) than in the VR group (n = 4; P = 0.001). No severe adverse events occurred in either group during the study. Conclusions VR immersion can be safely used as a novel adjunct to reduce procedural pain and anxiety during fluoroscopic pain intervention.
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Affiliation(s)
- Young Joo
- Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea
| | - Eun-Kyung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Gul Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Haesun Jung
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Hanssl Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Cañada-Soriano M, Priego-Quesada JI, Bovaira M, García-Vitoria C, Salvador Palmer R, Cibrián Ortiz de Anda R, Moratal D. Quantitative Analysis of Real-Time Infrared Thermography for the Assessment of Lumbar Sympathetic Blocks: A Preliminary Study. SENSORS 2021; 21:s21113573. [PMID: 34063768 PMCID: PMC8196638 DOI: 10.3390/s21113573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/09/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022]
Abstract
Lumbar sympathetic blocks (LSBs) are commonly performed to treat pain ailments in the lower limbs. LSBs involve injecting local anesthetic around the nerves. The injection is guided by fluoroscopy which is sometimes considered to be insufficiently accurate. The main aim was to analyze the plantar foot skin temperature data acquired while performing LSBs in patients with complex regional pain syndrome (CRPS) affecting the lower limbs. Forty-four LSBs for treating lower limb CRPS in 13 patients were assessed. Pain medicine physicians visualized the infrared thermography (IRT) video in real time and classified the performance depending on the observed thermal changes within the first 4 min. Thirty-two percent of the cases did not register temperature variations after lidocaine was injected, requiring the needle to be relocated. Differences between moments are indicated using the 95% confidence intervals of the differences (CI 95%), the Cohen effect size (ES) and the significance (p value). In successful cases, after injecting lidocaine, increases at minute 7 for the mean (CI 95% (1.4, 2.1 °C), p < 0.001 and ES = 0.5), at minute 5 for maximum temperature (CI 95% (2.3, 3.3 °C), p < 0.001 and ES = 0.6) and at minute 6 for SD (CI 95% (0.2, 0.3 °C), p < 0.001 and ES = 0.5) were observed. The results of our preliminary study showed that the measurement of skin temperature in real time by infrared thermography is valuable for assessing the success of lumbar sympathetic blocks.
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Affiliation(s)
- Mar Cañada-Soriano
- Applied Thermodynamics Department (DTRA), Universitat Politècnica de València, 46022 Valencia, Spain;
| | - José Ignacio Priego-Quesada
- Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain
- Research Group in Medical Physics (GIFIME), Department of Physiology, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; (R.S.P.); (R.C.O.d.A.)
- Correspondence: (J.I.P.-Q.); (D.M.)
| | - Maite Bovaira
- Anaesthesia Department, Hospital Intermutual de Levante, Sant Antoni de Benaixeve, 46184 Valencia, Spain; (M.B.); (C.G.-V.)
| | - Carles García-Vitoria
- Anaesthesia Department, Hospital Intermutual de Levante, Sant Antoni de Benaixeve, 46184 Valencia, Spain; (M.B.); (C.G.-V.)
| | - Rosario Salvador Palmer
- Research Group in Medical Physics (GIFIME), Department of Physiology, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; (R.S.P.); (R.C.O.d.A.)
| | - Rosa Cibrián Ortiz de Anda
- Research Group in Medical Physics (GIFIME), Department of Physiology, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; (R.S.P.); (R.C.O.d.A.)
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain
- Correspondence: (J.I.P.-Q.); (D.M.)
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Interventional Therapies for Pain in Cancer Patients: a Narrative Review. Curr Pain Headache Rep 2021; 25:44. [PMID: 33961156 DOI: 10.1007/s11916-021-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Pain is a prevalent symptom in the lives of patients with cancer. In light of the ongoing opioid epidemic and increasing awareness of the potential for opioid abuse and addiction, clinicians are progressively turning to interventional therapies. This article reviews the interventional techniques available to mitigate the debilitating effects that untreated or poorly treated pain have in this population. RECENT FINDINGS A range of interventional therapies and technical approaches are available for the treatment of cancer-related pain. Many of the techniques described may offer effective analgesia with less systemic toxicity and dependency than first- and second-line oral and parenteral agents. Neuromodulatory techniques including dorsal root ganglion stimulation and peripheral nerve stimulation are increasingly finding roles in the management of oncologic pain. The goal of this pragmatic narrative review is to discuss interventional approaches to cancer-related pain and the potential of such therapies to improve the quality of life of cancer patients.
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Wang Y, Wang AZ, Wu BS, Zheng YJ, Zhao DQ, Liu H, Xu H, Fang HW, Zhang JY, Cheng ZX, Wang XR. Chinese Association for the Study of Pain: Experts consensus on ultrasound-guided injections for the treatment of spinal pain in China (2020 edition). World J Clin Cases 2021; 9:2047-2057. [PMID: 33850924 PMCID: PMC8017500 DOI: 10.12998/wjcc.v9.i9.2047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/31/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Spinal pain (SP) is a common condition that has a major negative impact on a patient’s quality of life. Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice. This clinical expert consensus describes the purpose, significance, implementation methods, indications, contraindications, and techniques of ultrasound-guided injections. This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.
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Affiliation(s)
- Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Ai-Zhong Wang
- Department of Anesthesiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Bai-Shan Wu
- Department of Algology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yong-Jun Zheng
- Department of Algology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Da-Qiang Zhao
- Department of Anesthesiology, Jiahui International Hospital, Shanghai 200233, China
| | - Hui Liu
- Department of Algology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hua Xu
- Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Hong-Wei Fang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
| | - Jin-Yuan Zhang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
| | - Zhi-Xiang Cheng
- Department of Algology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Xiang-Rui Wang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
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Correlation between paravertebral spread of injectate and clinical efficacy in lumbar transforaminal block. Sci Rep 2020; 10:11508. [PMID: 32661332 PMCID: PMC7359339 DOI: 10.1038/s41598-020-68474-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/24/2020] [Indexed: 11/24/2022] Open
Abstract
The potential paravertebral space includes spinal nerves, dorsal rami, rami communicants, and sympathetic chains. This study evaluated correlations between paravertebral spread of injectate and clinical efficacy in lumbar transforaminal block. We retrospectively analysed the data of 88 patients who received transforaminal blocks for lumbar radicular pain. We categorized patients into two groups: patients with ≥ 50% pain reduction on a numeric rating scale at 30 min following a block (responder group), and patients with < 50% pain reduction (non-responder group). Paravertebral spread of injectate was graded as limited to the anterior, middle, and posterior 1/3 of the anterolateral aspect of vertebral bodies; spread between the posterolateral margins of bodies and the posterior epidural space was considered no spread. Clinical and fluoroscopic data, perfusion index, temperature, and cold sensation were compared between the groups. Among 54 patients analysed, 26 (48.1%) experienced ≥ 50% and 28 (51.9%) < 50% pain reduction. Paravertebral spread occurred in 33 (61.1%) patients; 19 (57.6%) responders and 14 (42.4%) non-responders. On analysis, paravertebral spread, epidural spread patterns, perfusion index change ratios, temperature changes, and cold sensation changes showed no differences between responder and non-responder groups. Paravertebral spread occurred in 61.1%, with no correlation with the clinical efficacy of lumbar transforaminal block.
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Punj J, Marada S. Ultrasound lumbar sympathetic block: Out of plane approach with insulated stimulation needle - Case series of three patients. Indian J Anaesth 2020; 64:148-150. [PMID: 32139935 PMCID: PMC7017674 DOI: 10.4103/ija.ija_686_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/14/2019] [Accepted: 01/06/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jyotsna Punj
- Department of Anesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Snehitha Marada
- Department of Anesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
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