1
|
Hussain N, Speer J, Abdallah FW. Analgesic Effectiveness of Liposomal Bupivacaine versus Plain Local Anesthetics for Abdominal Fascial Plane Blocks: A Systematic Review and Meta-analysis of Randomized Trials. Anesthesiology 2024; 140:906-919. [PMID: 38592360 DOI: 10.1097/aln.0000000000004932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Liposomal bupivacaine is reported to prolong the duration of analgesia when used for abdominal fascial plane blocks compared to plain local anesthetics; however, evidence from randomized trials is mixed. This meta-analysis aims to compare the analgesic effectiveness of liposomal bupivacaine to plain local anesthetics in adults receiving abdominal fascial plane blocks. METHODS Randomized trials comparing liposomal bupivacaine and plain (nonliposomal) local anesthetics in abdominal fascial plane blocks were sought. The primary outcome was area under the curve rest pain between 24 to 72 h postoperatively. Secondary outcomes included rest pain at individual timepoints (1, 6, 12, 24, 48, and 72 h); analgesic consumption at 0 to 24, 25 to 48, and 49 to 72 h; time to analgesic request; hospital stay duration; and opioid-related side effects. Data were pooled using the Hartung-Knapp-Sidik-Jonkman random effects method. RESULTS Sixteen trials encompassing 1,287 patients (liposomal bupivacaine, 667; plain local anesthetics, 620) were included. The liposomal bupivacaine group received liposomal bupivacaine mixed with plain bupivacaine in 10 studies, liposomal bupivacaine alone in 5 studies, and both preparations in 1 three-armed study. No difference was observed between the two groups for area under the curve pain scores, with a standardized mean difference (95% CI) of -0.21 cm.h (-0.43 to 0.01; P = 0.058; I2 = 48%). Results were robust to subgroup analysis based on (1) potential conflict of interest and (2) mixing of plain local anesthetics with liposomal bupivacaine. The two groups were not different for any of the day 2 or day 3 secondary outcomes. CONCLUSIONS This systematic review and meta-analysis suggests similar analgesic effectiveness between liposomal bupivacaine and plain local anesthetics when used for fascial plane block of the abdominal wall. The authors' analysis does not support an evidence-based preference for liposomal bupivacaine compared to plain local anesthetics for abdominal fascial plane blocks. EDITOR’S PERSPECTIVE
Collapse
Affiliation(s)
- Nasir Hussain
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Jarod Speer
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Faraj W Abdallah
- Department of Anesthesiology and Pain Management, and the Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| |
Collapse
|
2
|
Greer M, Kamma S, Tran H, Etumuse B, Shah JD, El-Abed Y, Onyemachi JO, Hussain N, Pittelkow TP, D’Souza RS. Misinformation Persists in Complementary Health: Evaluating the Reliability and Quality of YouTube-Based Information on the Use of Acupuncture for Chronic Pain. J Pain Res 2024; 17:1509-1518. [PMID: 38646592 PMCID: PMC11032134 DOI: 10.2147/jpr.s459475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Acupuncture is commonly used to treat chronic pain. Patients often access public social media platforms for healthcare information when querying acupuncture. Our study aims to appraise the utility, accuracy, and quality of information available on YouTube, a popular social media platform, on acupuncture for chronic pain treatment. Methods Using search terms such as "acupuncture for chronic pain" and "acupuncture pain relief", the top 54 videos by view count were selected. Included videos were >1 minute duration, contained audio in English, had >7000 views, and was related to acupuncture. One primary outcome of interest was categorizing each video's usefulness as useful, misleading, or neither. Another primary outcome of interest was the quality and reliability of each video using validated instruments, including the modified DISCERN (mDISCERN) tool and the Global Quality Scale (GQS). The means were calculated for the video production characteristics, production sources, and mDISCERN and GQS scores. Continuous and categorical outcomes were compared using Student's t-test and chi-square test, respectively. Results Of the 54 videos, 57.4% were categorized as useful, 14.8% were misleading, and 27.8% were neither. Useful videos had a mean GQS and mDISCERN score of 3.77±0.67 and 3.48±0.63, respectively, while misleading videos had mean GQS and mDISCERN score of 2.50±0.53 and 2.38±0.52, respectively. 41.8% of the useful videos were produced by a healthcare institution while none of the misleading videos were produced by a healthcare institution. However, 87.5% of the misleading videos were produced by health media compared to only 25.8% of useful videos from health media. Discussion As patients increasingly depend on platforms like YouTube for trustworthy information on complementary health practices such as acupuncture, our study emphasizes the critical need for more higher-quality videos from unbiased healthcare institutions and physicians to ensure patients are receiving reliable information regarding this topic.
Collapse
Affiliation(s)
- Majesty Greer
- Howard University College of Medicine, Washington, DC, USA
| | - Sai Kamma
- University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Henry Tran
- University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Bright Etumuse
- University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Jay D Shah
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - Youshaa El-Abed
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Jane O Onyemachi
- University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas P Pittelkow
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
3
|
Hussain N, Trivedi PJ. Risk Stratification in Primary Sclerosing Cholangitis: Does Size Matter? Dig Dis Sci 2024; 69:1083-1087. [PMID: 38347370 DOI: 10.1007/s10620-023-08262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 04/19/2024]
Affiliation(s)
- Nasir Hussain
- National Institute of Health Research (NIHR) Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Liver Unit, University Hospitals Birmingham National Health Service Foundation Trust Queen Elizabeth, Birmingham, UK
| | - Palak J Trivedi
- National Institute of Health Research (NIHR) Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK.
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
- Liver Unit, University Hospitals Birmingham National Health Service Foundation Trust Queen Elizabeth, Birmingham, UK.
| |
Collapse
|
4
|
Hussain N, D'Souza RS. Finding diamonds in the rough: evaluating the quality of meta-analyses in chronic pain - an infographic. Reg Anesth Pain Med 2024:rapm-2024-105447. [PMID: 38508590 DOI: 10.1136/rapm-2024-105447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Nasir Hussain
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
5
|
Shahzad H, Hussain N, D'Souza RS, Bhatti N, Orhurhu V, Abdel-Rasoul M, Simopoulos T, Essandoh MK, Khan SN, Weaver T. Incidence of subsequent surgical decompression following minimally invasive approaches to treat lumbar spinal stenosis: A retrospective review. Pain Pract 2024; 24:431-439. [PMID: 37955267 DOI: 10.1111/papr.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND CONTEXT Surgical decompression is the definitive treatment for managing symptomatic lumbar spinal stenosis; however, select patients are poor surgical candidates. Consequently, minimally invasive procedures have gained popularity, but there exists the potential for failure of therapy necessitating eventual surgical decompression. PURPOSE To evaluate the incidence and characteristics of patients who require surgical decompression following minimally invasive procedures to treat lumbar spinal stenosis. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE Patients who underwent minimally invasive procedures for lumbar spinal stenosis (Percutaneous Image-guided Lumbar Decompression [PILD] or interspinous spacer device [ISD]) and progressed to subsequent surgical decompression within 5 years. OUTCOME MEASURES The primary outcome was the rate of surgical decompression within 5 years following the minimally invasive approach. Secondary outcomes included demographic and comorbid factors associated with increased odds of requiring subsequent surgery. METHODS Patient data were collected using the PearlDiver-Mariner database. The rate of subsequent decompression was described as a percentage while univariable and multivariable regression analysis was used for the analysis of predictors. RESULTS A total of 5278 patients were included, of which 3222 (61.04%) underwent PILD, 1959 (37.12%) underwent ISD placement, and 97 (1.84%) had claims for both procedures. Overall, the incidence of subsequent surgical decompression within 5 years was 6.56% (346 of 5278 patients). Variables associated with a significantly greater odds ratio (OR) [95% confidence interval (CI)] of requiring subsequent surgical decompression included male gender and a prior history of surgical decompression by 1.42 ([1.14, 1.77], p = 0.002) and 2.10 times ([1.39, 3.17], p < 0.001), respectively. In contrast, age 65 years and above, a diagnosis of obesity, and a Charlson Comorbidity Index score of three or greater were associated with a significantly reduced OR [95% CI] by 0.64 ([0.50, 0.81], p < 0.001), 0.62 ([0.48, 0.81], p < 0.001), and 0.71 times ([0.56, 0.91], p = 0.007), respectively. CONCLUSIONS Minimally invasive procedures may provide an additional option to treat symptomatic lumbar spinal stenosis in patients who are poor surgical candidates or who do not desire open decompression; however, there still exists a subset of patients who will require subsequent surgical decompression. Factors such as gender and prior surgical decompression increase the likelihood of subsequent surgery, while older age, obesity, and a higher Charlson Comorbidity Index score reduce it. These findings aid in selecting suitable surgical candidates for better outcomes in the elderly population with lumbar spinal stenosis.
Collapse
Affiliation(s)
- Hania Shahzad
- Department of Orthopedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Nasir Hussain
- Department of Anesthesiology and Pain Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - Nazihah Bhatti
- Department of Orthopedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, Pennsylvania, USA
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Thomas Simopoulos
- Department of Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael K Essandoh
- Department of Anesthesiology and Pain Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Safdar N Khan
- Department of Orthopedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Tristan Weaver
- Department of Anesthesiology and Pain Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
6
|
Hussain N, Brull R, Weber L, Garrett A, Werner M, D'Souza RS, Sawyer T, Weaver TE, Iyer M, Essandoh MK, Abdallah FW. The analgesic effectiveness of perioperative lidocaine infusions for acute and chronic persistent postsurgical pain in patients undergoing breast cancer surgery: a systematic review and meta-analysis. Br J Anaesth 2024; 132:575-587. [PMID: 38199928 DOI: 10.1016/j.bja.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/06/2023] [Accepted: 12/02/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Breast cancer is the most common cancer among women and tumour resection carries a high prevalence of chronic persistent postsurgical pain (CPSP). Perioperative i.v. lidocaine infusion has been proposed as protective against CPSP; however, evidence of its benefits is conflicting. This review evaluates the effectiveness of perioperative lidocaine infusions for breast cancer surgery. METHODS Randomised trials comparing perioperative lidocaine infusions with parenteral analgesia in breast cancer surgery patients were sought. The two co-primary outcomes were the odds of CPSP at 3 and 6 months after operation. Secondary outcomes included rest pain at 1, 6, 12, and 24 h; analgesic consumption at 0-24 and 25-48 h; quality of recovery; opioid-related side-effects; and lidocaine infusion side-effects. Hartung-Knapp-Sidik-Jonkman (HKSJ) random effects modelling was used. RESULTS Thirteen trials (1039 patients; lidocaine: 518, control: 521) were included. Compared with control, perioperative lidocaine infusion did not decrease the odds of developing CPSP at 3 and 6 months. Lidocaine infusion improved postoperative pain at 1 h by a mean difference (95% confidence interval) of -0.65 cm (-0.73 to -0.57 cm) (P<0.0001); however, this difference was not clinically important (1.1 cm threshold). Similarly, lidocaine infusion reduced oral morphine consumption by 7.06 mg (-13.19 to -0.93) (P=0.029) over the first 24 h only; however, this difference was not clinically important (30 mg threshold). The groups were not different for any of the remaining outcomes. CONCLUSIONS Our results provide moderate-quality evidence that perioperative lidocaine infusion does not reduce CPSP in patients undergoing breast cancer surgery. Routine use of lidocaine infusions for perioperative analgesia and CPSP prevention is not supported in this population. SYSTEMATIC REVIEW PROTOCOL PROSPERO CRD42023420888.
Collapse
Affiliation(s)
- Nasir Hussain
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Richard Brull
- Department of Anesthesia and Pain Management, Women's College Hospital and Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Lauren Weber
- The Ohio State University, College of Pharmacy, Columbus, OH, USA
| | - Alexandrea Garrett
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Marissa Werner
- The Ohio State University, College of Arts and Science, Columbus, OH, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tamara Sawyer
- College of Medicine, Central Michigan University, Saginaw, MI, USA
| | - Tristan E Weaver
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Manoj Iyer
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Michael K Essandoh
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Faraj W Abdallah
- Department of Anesthesiology and Pain Management, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
| |
Collapse
|
7
|
Hussain N, Ferguson J, Hirschfield GM, Trivedi PJ. Primary sclerosing cholangitis and the risks of posttransplant lymphoproliferative disorder. Liver Transpl 2024:01445473-990000000-00336. [PMID: 38421957 DOI: 10.1097/lvt.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Nasir Hussain
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre (BRC) Centre for Liver and Gastrointestinal Research University of Birmingham Birmingham, UK
- Liver Unit University Hospitals Birmingham Birmingham, UK
- Institute of Immunology and Immunotherapy College of Medical and Dental Sciences University of Birmingham Birmingham, UK
| | - James Ferguson
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre (BRC) Centre for Liver and Gastrointestinal Research University of Birmingham Birmingham, UK
- Liver Unit University Hospitals Birmingham Birmingham, UK
| | - Gideon M Hirschfield
- Toronto Centre for Liver Disease, Division of Gastroenterology and Hepatology University of Toronto, Toronto, Ontario, Canada
| | - Palak J Trivedi
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre (BRC) Centre for Liver and Gastrointestinal Research University of Birmingham Birmingham, UK
- Liver Unit University Hospitals Birmingham Birmingham, UK
- Institute of Immunology and Immunotherapy College of Medical and Dental Sciences University of Birmingham Birmingham, UK
| |
Collapse
|
8
|
Hussain N, Brull R, Gilron I, Weaver TE, Shahzad H, D'Souza RS, Abdel-Rasoul M, Clarke H, McCartney CJL, Abdallah FW. Association of peri-operative prescription of non-steroidal anti-inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims-based cohort study. Anaesthesia 2024. [PMID: 38385772 DOI: 10.1111/anae.16259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/23/2024]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the mainstays of multimodal pain management. While effective for acute pain control, recent pre-clinical evidence has raised concerns regarding an association between NSAIDs and chronic pain and potential opioid use. Our objective was to explore the association between peri-operative use of prescription NSAIDs and the need for continued opioid prescriptions lasting 90-180 days in previously opioid-naïve patients undergoing total knee arthroplasty. A database of health claims in the USA was used to identify all opioid-naïve adult patients who underwent primary knee arthroplasty between January 2010 and October 2021. We evaluated the magnitude of association between peri-operative prescription NSAID claims and claims for opioids at 90 days postoperatively using multivariable logistic regression models. Secondary outcomes included: the magnitude of association between peri-operative NSAID prescription and claims for opioids at 180 days postoperatively; and identifying other potential factors associated with opioid claims at 90 days postoperatively. After risk adjustment using multivariable logistic regression models in the 789,736-patient cohort, the adjusted odds ratio (95%CI) for a continuous claim of opioids at 90 and 180 days postoperatively among patients with a peri-operative NSAID prescription within 30 days was 1.32 (1.30-1.35), p < 0.001; and 1.12 (1.10-1.15), p < 0.001, respectively. This estimate of effect remained robust at 90 days after accounting for known potential confounders, including pre-existing knee pain and acute postoperative pain severity. Similar analysis of other pain medications (e.g. paracetamol) did not detect such an association. This population-based cohort study suggests that peri-operative prescription NSAID use may be associated with continued opioid prescription claims at 90 and 180 days after knee arthroplasty, even after adjusting for other observed covariates for continuous opioid claims. These novel findings can inform clinical decision-making for post-surgical pain management, risk-benefit discussions with patients and future research.
Collapse
Affiliation(s)
- N Hussain
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - R Brull
- Department of Anesthesiology and Pain Management, Women's College Hospital and Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - I Gilron
- Departments of Anesthesia and Perioperative Medicine and Biomedical and Molecular Science, Centre for Neuroscience Studies, School of Policy Studies, Queen's University, Kingston, ON, Canada
| | - T E Weaver
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - H Shahzad
- Department of Orthopedics, UC Davis Health, Sacramento, CA, USA
| | - R S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Abdel-Rasoul
- Department of Biomedical Informatics, College of Medicine, Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - H Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - C J L McCartney
- Department of Anesthesiology and Pain Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - F W Abdallah
- Department of Anesthesiology and Pain Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesia, and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
9
|
Kleppel DJ, Copeland R, Hussain N, Karri J, Wang E, D'Souza RS. Methodological and statistical characteristics of meta-analyses on spinal cord stimulation for chronic pain: a systematic review. Reg Anesth Pain Med 2024:rapm-2023-105249. [PMID: 38388015 DOI: 10.1136/rapm-2023-105249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND A growing number of meta-analyses (MA) have investigated the use of spinal cord stimulation (SCS) as a treatment modality for chronic pain. The quality of these MAs has not been assessed by validated appraisal tools. OBJECTIVE To examine the methodological characteristics and quality of MAs related to the use of SCS for chronic pain syndromes. EVIDENCE REVIEW An online literature search was conducted in Ovid MEDLINE(R), Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, and Scopus databases (January 1, 2000 through June 30, 2023) to identify MAs that investigated changes in pain intensity, opioid consumption, and/or physical function after SCS for the treatment of chronic pain. MA quality was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) critical appraisal tool. FINDINGS Twenty-five MAs were appraised in the final analysis. Three were considered "high" quality, three "low" quality, and 19 "critically low" quality, per the AMSTAR-2 criteria. There was no association between the publication year and AMSTAR-2 overall quality (β 0.043; 95% CI -0.008 to 0.095; p=0.097). There was an association between the impact factor and AMSTAR-2 overall quality (β 0.108; 95% CI 0.044 to 0.172; p=0.002), such that studies published in journals with higher impact factors were associated with higher overall quality. There was no association between the effect size and AMSTAR-2 overall quality (β -0.168; 95% CI -0.518 to 0.183; p=0.320).According to our power analysis, three studies were adequately powered (>80%) to reject the null hypothesis, while the remaining studies were underpowered (<80%). CONCLUSIONS The study demonstrates a critically low AMSTAR-2 quality for most MAs published on the use of SCS for treating chronic pain. Future MAs should improve study quality by implementing the AMSTAR-2 checklist items. PROSPERO REGISTRATION NUMBER CRD42023431155.
Collapse
Affiliation(s)
- Donald J Kleppel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Royce Copeland
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Jay Karri
- Departments of Orthopedic Surgery and Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Eric Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
10
|
Kumar N, Iyer MH, Hussain N, Essandoh M. Postoperative PAPi: Grading Our Post-LVAD Management. J Cardiothorac Vasc Anesth 2024; 38:588-589. [PMID: 38052690 DOI: 10.1053/j.jvca.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 10/21/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Nicolas Kumar
- Department of Anesthesia, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
11
|
Zhou S, Nerusu LA, Hussain N, Abd-Elsayed A. Sacral neuromodulation. Neuromodulation Techniques for the Spine 2024:137-149. [DOI: 10.1016/b978-0-323-87584-4.00026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
12
|
Abd-Elsayed A, Abdallah RT, Angara P, Bulat E, Caparo MA, Darji J, Dhall R, Engle AM, Fiala KJ, Fishman MA, Grabnar M, Gulati A, Habibi B, Hussain N, Jassal NS, Kalia H, Kim C, Kitei PM, Kodsy M, Lambert J, Larson L, Malik T, Martens JM, Mata N, Mehta N, Mueller MR, Pendem K, Rakesh N, Rausch DK, Rosenblum D, Schwartz GS, Sehmbi H, Shehata P, Silva J, Suric V, Tanios M, Tybout C, Vodapally S, Wahezi SE, Zhou S, Zhu X. Contributors. Radiofrequency Ablation Techniques 2024:vi-ix. [DOI: 10.1016/b978-0-323-87063-4.00004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
13
|
Tybout C, Zhou S, Hussain N, Abd-Elsayed A. Radiofrequency ablation for headache. Radiofrequency Ablation Techniques 2024:169-185. [DOI: 10.1016/b978-0-323-87063-4.00024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
14
|
Busch C, Hussain N, Abd-Elsayed A. Vertebral augmentation with osteotome. Vertebral Augmentation Techniques 2024:53-58. [DOI: 10.1016/b978-0-323-88226-2.00015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
15
|
Abbasi HR, Abd-Elsayed A, Aiyer R, Budwany R, Engle A, Hussain N, Kodsy M, Naji M, Navalgund YA, Patel AM, Robinson C, Schupper AJ, Speer J, Steinberger JM, Storlie NR, Tanios M. Contributors. Decompressive Techniques 2024:vi-vii. [DOI: 10.1016/b978-0-323-87751-0.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
16
|
Robinson C, Hussain N, Abd-Elsayed AA. Methods for percutaneous discectomy. Decompressive Techniques 2024:27-44. [DOI: 10.1016/b978-0-323-87751-0.00013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
17
|
Southerland W, Hussain N, Qing R, Shankar P, Surapaneni S, Burns J, Mahmood S, Yazdi C, Abdel-Rasoul M, Simopoulos TT, Gill JS. Discrepancy Between Reported and Calculated Pain Reduction in Patients With Spinal Cord Stimulation Therapy and Lack of Agreement Between Patient Satisfaction and Degree of Pain Relief. Neuromodulation 2023:S1094-7159(23)00994-7. [PMID: 38159100 DOI: 10.1016/j.neurom.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES This study aimed to determine agreement between reported percentage pain reduction (RPPR) and calculated percentage pain reduction (CPPR) in patients with percutaneous spinal cord stimulation (SCS) implants, and to correlate RPPR and CPPR with patient satisfaction. We also sought to determine which patient-reported outcome measures are most improved in patients with SCS. MATERIALS AND METHODS Fifty patients with percutaneous spinal cord stimulator implants with a mean follow-up of 51.1 months were interviewed and surveyed to assess their pain level, impression of degree of pain relief, satisfaction with the therapy, and desire to have the device again. Baseline pain level was obtained from their preimplant records. RESULTS Overall, RPPR was found to be 53.3%, whereas CPPR was 44.4%. Of all patients, 21 reported <50% pain reduction; however, most of these (12/21, 57%) were satisfied with the outcome of therapy. In terms of individual improvement in outcomes, activities of daily life was the most improved measure at 82%, followed by mood, sleep, medication use, and health care utilization at 74%, 62%, 50%, and 48%, respectively. CONCLUSIONS RPPR appears to be a complex outcome measure that may not agree with CPPR. Overall RPPR is greater than the CPPR. On the basis of our data, these independently valid measures should not be used interchangeably. A 50% pain reduction threshold is not a requisite for patient satisfaction and desire to have the device again. Activities of daily living was the most improved measure in this cohort, followed by mood, sleep, medication usage, and decrease in health care utilization.
Collapse
Affiliation(s)
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Ruan Qing
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, MA, USA
| | - Puja Shankar
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, MA, USA
| | - Sindhuja Surapaneni
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, MA, USA
| | - James Burns
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, MA, USA
| | - Syed Mahmood
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, MA, USA
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Thomas T Simopoulos
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, MA, USA
| | - Jatinder S Gill
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, MA, USA.
| |
Collapse
|
18
|
Johnson JN, Pouraliakbar H, Mahdavi M, Ranjbar A, Pfirman K, Mehra V, Ahmed S, Ba-Atiyah W, Galal MO, Zahr RA, Hussain N, Tadikamalla RR, Farah V, Dzelebdzic S, Muniz JC, Lee M, Williams J, Lee S, Aggarwal SK, Clark DE, Hughes SG, Ganigara M, Nagiub M, Hussain T, Kwok C, Lim HS, Nolan M, Kikuchi DS, Goulbourne CA, Sahu A, Sievers B, Sievers B, Sievers B, Garg R, Armas CR, Paleru V, Agarwal R, Rajagopal R, Bhagirath P, Kozor R, Aneja A, Tunks R, Chen SSM. Society for Cardiovascular Magnetic Resonance 2022 Cases of SCMR case series. J Cardiovasc Magn Reson 2023; 26:100007. [PMID: 38211509 DOI: 10.1016/j.jocmr.2023.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 01/13/2024] Open
Abstract
"Cases of SCMR" is a case series on the SCMR website (https://www.scmr.org) for the purpose of education. The cases reflect the clinical presentation, and the use of cardiovascular magnetic resonance (CMR) in the diagnosis and management of cardiovascular disease. The 2022 digital collection of cases are presented in this manuscript.
Collapse
Affiliation(s)
- Jason N Johnson
- Division of Pediatric Cardiology and Pediatric Radiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdavi
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolmohammad Ranjbar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kristopher Pfirman
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Vishal Mehra
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Shahzad Ahmed
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Wejdan Ba-Atiyah
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed Omar Galal
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Riad Abou Zahr
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Nasir Hussain
- Department of Advanced Cardiac Imaging, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Victor Farah
- Department of Advanced Cardiac Imaging, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | | | - Marc Lee
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jason Williams
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Simon Lee
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Daniel E Clark
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sean G Hughes
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madhusudan Ganigara
- Division of Pediatric Cardiology, The University of Chicago & Biological Sciences, Chicago, IL, USA
| | - Mohamed Nagiub
- Division of Pediatric Cardiology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Cecilia Kwok
- Cardiology Department, Western Health, St Albans, Victoria, Australia
| | - Han S Lim
- Cardiology Department, Austin and Northern Health, University of Melbourne, Victoria, Australia
| | - Mark Nolan
- Cardiology Department, Western Health, St Albans, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Daniel S Kikuchi
- Osler Medical Residency, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Clive A Goulbourne
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Anurag Sahu
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Berge Sievers
- International School Düsseldorf, Düsseldorf, Germany
| | - Berk Sievers
- International School Düsseldorf, Düsseldorf, Germany
| | - Burkhard Sievers
- Department of Internal Medicine, Divisions of Cardiology, Pulmonology, Vascular Medicine, Nephrology and Intensive Care Medicine, Sana Klinikum Remscheid, Germany
| | - Rimmy Garg
- University of Illinois College of Medicine Peoria, OSF St. Francis Medical Center, Peoria, IL, USA
| | - Carlos Requena Armas
- University of Illinois College of Medicine Peoria, OSF St. Francis Medical Center, Peoria, IL, USA
| | - Vijayasree Paleru
- University of Illinois College of Medicine Peoria, OSF St. Francis Medical Center, Peoria, IL, USA
| | - Ritu Agarwal
- Department of Radiology, Eternal Hospital, Jaipur, India
| | - Rengarajan Rajagopal
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pranav Bhagirath
- Department of Cardiology, St. Thomas Hospital, London, England, UK
| | - Rebecca Kozor
- Department of Cardiology, Royal North Shore Hospital, The University of Sydney, St Leonards, Australia
| | - Ashish Aneja
- Department of Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert Tunks
- Division of Pediatric Cardiology, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sylvia S M Chen
- Adult Congenital Heart Disease, The Prince Charles Hospital, Australia.
| |
Collapse
|
19
|
Hussain N, Bhagia G, Doyle M, Rayarao G, Williams RB, Biederman RW. Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining risk. Int J Cardiol Heart Vasc 2023; 49:101298. [PMID: 38035256 PMCID: PMC10682655 DOI: 10.1016/j.ijcha.2023.101298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023]
Abstract
Aims Mitral Annular Disjunction (MAD) refers to embryologic fibrous separation between mitral annular ring and basal left ventricular myocardium. Since its original description, the role of MAD in arrhythmic mitral valve prolapse (MVP) has been the subject of active research. In this study we sought to assess prognostic and imaging characteristics of MVP patients with and without underlying MAD. Methods and results Patients with posterior or bi-leaflet MVP were retrospectively identified via a review of all patients referred to our cardiac magnetic resonance (CMR) imaging laboratory from January 2015 to May 2022. MVP patients were further stratified by underlying MAD status. A total of 100 MVP patients undergoing CMR imaging (52 MVP patients with posterior MAD) were retrospectively identified with female comprising 55 % of the cohort. MVP patients with MAD were more likely to have an abnormal basal inferolateral/ papillary muscles LGE (51 % vs 21 %, p < 0.01). Posterior MAD longitudinal disjunction gap in 'mm' was a predictor of ventricular tachycardia (VT) [1.29, p = 0.01)]. Using ROC curve analysis, a disjunction gap of ≥ 4 mm was predictive of VT (AUC-0.71, p < 0.01), and incorporation of LGE in ROC model further improved AUC to 0.78 confirmed via Akaike information criterion (p < 0.01). Conclusion Abnormal LGE involving basal inferolateral myocardium and papillary muscles may provide etiologic substrate for arrythmia in MVP patients.
Collapse
Affiliation(s)
- Nasir Hussain
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
- Wilson Medical Center, United Health Service, Johnson City, NY 13790, USA
| | - Geeta Bhagia
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
- Benefis Health System, Great Falls, MT 59404, USA
| | - Mark Doyle
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
| | - Geetha Rayarao
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
| | - Ronald B. Williams
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
| | - Robert W.W. Biederman
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
- West Virginia University, Morgantown, WV 26506, USA
- Medical University of South Carolina, Charleston, SC 29425, USA
| |
Collapse
|
20
|
Todd I, Faust R, Herrero-Martinez E, Hussain N, Kawinski A, Lennard A, Roux NL, Macdonald J, Mayer M, Palacios R, Dangy-Caye A. Dynamic Regulatory Assessment: Unpacking the Process Reveals Readiness to Pilot for Europe-An EFPIA View. Clin Ther 2023; 45:1142-1147. [PMID: 37704457 DOI: 10.1016/j.clinthera.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/21/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023]
Abstract
The medicines regulatory network of the European Economic Area comprises 30 countries, their National Competent Authorities (NCA), and the European Medicines Agency (EMA). The NCAs and EMA are involved at different stages of the medicine life cycle; not all are engaged in a particular medicine's development discussions. As a result, knowledge management (ie, acquisition and transfer between medicine developer and the NCAs) is fragmented and inefficient. Dynamic regulatory assessment (DRA), a regulatory science concept developed by the European Federation of Pharmaceutical Industries and Associations (EFPIA), could drive increased connectedness supporting more continuous knowledge building. DRA works via iterative release and assessment of discrete data packets (DDPs) at mutually agreed milestones during development, culminating in more efficient development and faster authorization. This commentary seeks to build on an earlier article by unpacking the DRA concept, with a particular focus on DDPs. Its aim is to show how DDPs can support efficient and predictable release of data to encourage development and assessment of promising medicines, and it makes the case for piloting the DRA concept with European regulators now.
Collapse
Affiliation(s)
| | | | | | | | - Adam Kawinski
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | | | - Nadege Le Roux
- Celgene, a Bristol Myers Squibb company, Boudry, Switzerland
| | | | - Mark Mayer
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | |
Collapse
|
21
|
Madan E, Hussain N, Gill JS, Simopoulos TT. The contralateral oblique fluoroscopic view is associated with a lower incidence of postdural puncture headache in patients undergoing percutaneous spinal cord stimulation. Pain Pract 2023; 23:886-891. [PMID: 37381678 DOI: 10.1111/papr.13265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Spinal cord stimulation (SCS) is a minimally invasive therapy that is increasingly used to treat refractory neuropathic pain. Although this technique has a low incidence of serious long-term adverse sequelae, the risk of complications such as inadvertent dural puncture remains. OBJECTIVES The goal of this article was to determine the impact of the contralateral oblique (CLO) fluoroscopic view incidence of postdural puncture headache (PDPH) during spinal cord stimulator implantation as compared to lateral fluoroscopic view. METHODS This was a single academic institution retrospective analysis of electronic medical records spanning an approximate 20-year time period. Operative and postoperative notes were reviewed for details on dural puncture, including technique and spinal level of access, the development of a PDPH, and subsequent management. RESULTS Over nearly two decades, a total of 1637 leads inserted resulted in 5 PDPH that were refractory to conservative measures but responded to epidural blood patch without long-term complications. The incidence of PDPH per lead insertion utilizing loss of resistance and lateral fluoroscopic guidance was 0.8% (4/489). However, adoption of CLO guidance was associated with a lower rate of PDPH at 0.08% (1/1148), p < 0.02. CONCLUSIONS The incorporation of the CLO view to guide epidural needle placement can decrease the odds of a PDPH during percutaneous SCS procedures. This study further provides real-world data supporting the potential enhanced accuracy of epidural needle placement in order to avoid unintentional puncture or trauma to deeper spinal anatomic structures.
Collapse
Affiliation(s)
- Elena Madan
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Jatinder S Gill
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas T Simopoulos
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
22
|
Mageswaran P, Dufour J, Aurand A, Knapik G, Hani H, Blakaj DM, Khan S, Hussain N, Tiwari M, Vallabh J, Weaver T, Marras WS. Wearable motion-based platform for functional spine health assessment. Reg Anesth Pain Med 2023:rapm-2023-104840. [PMID: 37813527 DOI: 10.1136/rapm-2023-104840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Low back pain is a significant burden to society and the lack of reliable outcome measures, combined with a prevailing inability to quantify the biopsychosocial elements implicated in the disease, impedes clinical decision-making and distorts treatment efficacy. This paper aims to validate the utility of a biopsychosocial spine platform to provide standardized wearable sensor-derived functional motion assessments to assess spine function and differentiate between healthy controls and patients. Secondarily, we explored the correlation between these motion features and subjective biopsychosocial measures. METHODS An observational study was conducted on healthy controls (n=50) and patients with low back pain (n=50) to validate platform utility. The platform was used to conduct functional assessments along with patient-reported outcome assessments to holistically document cohort differences. Our primary outcomes were motion features; and our secondary outcomes were biopsychosocial measures (pain, function, etc). RESULTS Our results demonstrated statistically significant differences in motion features between healthy and patient cohorts across anatomical planes. Importantly, we found velocity and acceleration in the axial plane showed the largest difference, with healthy controls having 49.7% and 55.7% higher values, respectively, than patients. In addition, we found significant correlations between motion features and biopsychosocial measures for pain, physical function and social role only. CONCLUSIONS Our study validated the use of wearable sensor-derived functional motion metrics in differentiating healthy controls and patients. Collectively, this technology has the potential to facilitate holistic biopsychosocial evaluations to enhance spine care and improve patient outcomes. TRIAL REGISTRATION NUMBER NCT05776771.
Collapse
Affiliation(s)
- Prasath Mageswaran
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan Dufour
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Alexander Aurand
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Gregory Knapik
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Hamed Hani
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Dukagjin M Blakaj
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
- Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Safdar Khan
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
- Orthopedics, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nasir Hussain
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Maneesh Tiwari
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jayesh Vallabh
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
- Physical Medicine & Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tristan Weaver
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
23
|
Hussain N, Brull R, Vannabouathong C, Robinson C, Zhou S, D'Souza RS, Sawyer T, Terkawi AS, Abdallah FW. Analgesic Effectiveness of Motor-sparing Nerve Blocks for Total Knee Arthroplasty: A Network Meta-analysis. Anesthesiology 2023; 139:444-461. [PMID: 37364292 DOI: 10.1097/aln.0000000000004667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND The analgesic effectiveness of contemporary motor-sparing nerve blocks used in combination for analgesia in total knee arthroplasty is unclear. This network meta-analysis was conducted to evaluate the analgesic effectiveness of adding single-injection or continuous adductor canal block (ACB) with or without infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (iPACK) to intraoperative local infiltration analgesia (LIA), compared to LIA alone, after total knee arthroplasty. METHODS Randomized trials examining the addition of single-injection or continuous ACB with or without single-injection block at the iPACK to LIA for total knee arthroplasty were considered. The two primary outcomes were area-under-the-curve pain scores over 24 to 48 h and postoperative function at greater than 24 h. Secondary outcomes included rest pain scores at 0, 6, 12, and 24 h; opioid consumption (from 0 to 24 h and from 25 to 48 h); and incidence of nausea/vomiting. Network meta-analysis was conducted using a frequentist approach. RESULTS A total of 27 studies (2,317 patients) investigating the addition of (1) single-injection ACB, (2) continuous ACB, (3) single-injection ACB and single-injection block at the iPACK, and (4) continuous ACB and single-injection block at the iPACK to LIA, as compared to LIA alone, were included. For area-under-the-curve 24- to 48-h pain, the addition of continuous ACB with single-injection block at the iPACK displayed the highest P-score probability (89%) of being most effective for pain control. The addition of continuous ACB without single-injection block at the iPACK displayed the highest P-score probability (87%) of being most effective for postoperative function. CONCLUSIONS The results suggest that continuous ACB, but not single-injection ACB and/or single-injection block at the iPACK, provides statistically superior analgesia when added to LIA for total knee arthroplasty compared to LIA alone. However, the magnitude of these additional analgesic benefits is clinically questionable. EDITOR’S PERSPECTIVE
Collapse
Affiliation(s)
- Nasir Hussain
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Richard Brull
- Department of Anesthesiology and Pain Management, Women's College Hospital and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Chris Vannabouathong
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Christopher Robinson
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, Massachusetts
| | - Steven Zhou
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tamara Sawyer
- College of Medicine, Central Michigan University, Saginaw, Michigan
| | - Abdullah Sulieman Terkawi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California
| | - Faraj W Abdallah
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
24
|
Kumar N, Mitchell J, Siemens A, Deiparine S, Saddawi-Konefka D, Hussain N, Iyer MH, Essandoh M, Sawyer TR, Hao D. Left-Sided Double-Lumen Tube vs EZ-Blocker for One-Lung Ventilation in Thoracic Surgery: A Systematic Review and Meta-Analysis. Semin Cardiothorac Vasc Anesth 2023; 27:171-180. [PMID: 37347963 DOI: 10.1177/10892532231184781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background. The EZ-Blocker is the newest generation of bronchial blocker and offers a potential alternative to left-sided double lumen tubes for lung isolation and one-lung ventilation during thoracic surgery. Methods. Databases were searched for randomized controlled trials comparing left-sided double lumen tube to the EZ-Blocker for one-lung ventilation during thoracic surgery. The time for placement, incidence of intraoperative displacement, and surgeons' rating of lung collapse quality were designated as coprimary outcomes. The safety profiles of the two devices, including the incidence of airway trauma and post-extubation discomfort were also examined. Results. Six randomized controlled trials (495 patients) were analyzed. Compared to the EZ-Blocker, the left-sided double lumen tube was faster to place by a weighted mean difference of [95% CI] of -61.24 seconds [-102.48, -20.00] (P = .004) and was much less likely to become displaced during lung isolation with an odds ratio [95% CI] of .56 [.34, .91] (P = .02). The left-sided double lumen tube and the EZ-Blocker provided similar surgeon-rated quality of lung isolation. Although the left-sided double lumen tube caused a greater degree of post-extubation sore throat, there was a similar incidence of carinal trauma and post-extubation hoarseness compared to the EZ-Blocker. Conclusion. Our analysis suggests that the left-sided double lumen tube can be placed more quickly and is less prone to intraoperative displacement compared to the EZ-Blocker; the quality of lung collapse is similar. Thus, evidence appears to support the continued utilization of the left-sided double lumen tube for routine thoracic surgery requiring one-lung ventilation.
Collapse
Affiliation(s)
- Nicolas Kumar
- Harvard Medical School, Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Justin Mitchell
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Andrew Siemens
- Harvard Medical School, Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Selina Deiparine
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Daniel Saddawi-Konefka
- Harvard Medical School, Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tamara R Sawyer
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - David Hao
- Harvard Medical School, Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
25
|
Hussain N, Aneela S, Aqsa N, Saeed A, Aziz T, Majid A, Abdulhakeem SA, Al-Abbas NS, Shaer NA, Barqawi AA, Alghamdi S, Shakoori A, Alshareef SA. Screening of IL-22 first and second introns and FOXP3 second exon for SNPs and mutations with potential role in the susceptibility of SLE in selected population. Eur Rev Med Pharmacol Sci 2023; 27:8628-8638. [PMID: 37782178 DOI: 10.26355/eurrev_202309_33787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The main objective of performing this study was the mutational analysis of Forkhead box family member (FoxP3) and Interleukin-22 (IL-22) genes and their associations with systemic lupus erythematosus (SLE). MATERIALS AND METHODS A total of sixty blood samples were collected from SLE patients from different hospitals in Lahore. Proforma was based on American College of Rheumatology (ACR) criteria. The total time for this research was one year (2018-2019). DNA was extracted, and FoxP3 and IL-22 genes were polymerized through PCR and further sequenced through the Sanger Sequencing method. Chromas version 2.6.6 was used for the similarity index of sequences. NG_060763 and NG_007392.1 were used as Reference Sequences of IL-22 and FoxP3 genes, respectively. RESULTS Three already identified Single Nucleotide Polymorphisms (SNPs) in the IL-22 gene i.e., rs2227491, rs2227485, and rs2227513, were confirmed in the sequencing results of SLE patients. Results showed that there were nine novel mutations (27.27%) in the case of the IL-22 gene in the studied genotyped samples. These SNPs had remarkably increased allele T frequency in rs2227485 and allele C frequency in rs2227491 and rs2227513. On the other hand, in the case of FoxP3 gene exon 2, there was an addition of T at position 10 in the intronic portion, thus not involved in the progression of the disease. CONCLUSIONS The importance of cytokine-mediated signaling pathways, such as the IL-22 gene, is thus established. Novel variants in the IL-22 gene likely contributed significantly to the development of this autoimmune disorder. The current study found that the dysregulation of the inflammatory markers in SLE is not related to the FoxP3 gene, even though FoxP3 is implicated in the tolerance process.
Collapse
Affiliation(s)
- N Hussain
- Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Sydó N, Iftikhar U, Csulak E, Meza A, Merkely B, Bonikowske AR, Carta KAG, Hussain N, Assaf Y, Murphy JG, Lopez-Jimenez F, Squires RW, Bailey KR, Allison TG. Exercise Test Predicts Both Noncardiovascular and Cardiovascular Death in a Primary Prevention Population. Mayo Clin Proc 2023; 98:1297-1309. [PMID: 37661140 DOI: 10.1016/j.mayocp.2023.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/30/2023] [Accepted: 05/30/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To identify specific causes of death and determine the prevalence of noncardiovascular (non-CV) deaths in an exercise test referral population while testing whether exercise test parameters predict non-CV as well as CV deaths. PATIENTS AND METHODS Non-imaging exercise tests on patients 30 to 79 years of age from September 1993 to December 2010 were reviewed. Patients with baseline CV diseases and non-Minnesota residents were excluded. Mortality through January 2016 was obtained through Mayo Clinic Records and the Minnesota Death Index. Exercise test abnormalities included low functional aerobic capacity (ie, less than 80%), heart rate recovery (ie, less than 13 beats/min), low chronotropic index (ie, less than 0.8), and abnormal exercise electrocardiogram (ECG) of greater than or equal to 1.0 mm ST depression or elevation. We also combined these four abnormalities into a composite exercise test score (EX_SCORE). Statistical analyses consisted of Cox regression adjusted for age, sex, diabetes, hypertension, obesity, current and past smoking, and heart rate-lowering drug. RESULTS The study identified 13,382 patients (females: n=4736, 35.4%, 50.5±10.5 years of age). During 12.7±5.0 years of follow-up, there were 849 deaths (6.3%); of these 162 (19.1%) were from CV; 687 (80.9%) were non-CV. Hazard ratios for non-CV death were significant for low functional aerobic capacity (HR, 1.42; 95% CI, 1.19 to 1.69; P<.0001), abnormal heart rate recovery (HR, 1.36; 95% CI, 1.15 to 1.61; P<.0033), and low chronotropic index (HR, 1.49; 95% CI, 1.26 to 1.77; P<.0001), whereas abnormal exercise ECG was not significant. All exercise test abnormalities including EX_SCORE were more strongly associated with CV death versus non-CV death except abnormal exercise ECG. CONCLUSION Non-CV deaths predominated in this primary prevention cohort. Exercise test abnormalities not only predicted CV death but also non-CV death.
Collapse
Affiliation(s)
- Nóra Sydó
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
| | - Umair Iftikhar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alejandra Meza
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | | | - Nasir Hussain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yazan Assaf
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Ray W Squires
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kent R Bailey
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Thomas G Allison
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Department of Pediatric and Adolescent Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
27
|
Hussain N, Alkhateeb MA, Bashir A, Iqbal R, Hussain T, Aziz T, Al-Abbas NS, Shaer NA, Alamri AS, Alhomrani M, Shakoori A, Labban S. Deletions of SMNI gene exon 7 and NAIP gene exon 5 in spinal muscular atrophy patients in selected population. Eur Rev Med Pharmacol Sci 2023; 27:7935-7945. [PMID: 37750622 DOI: 10.26355/eurrev_202309_33552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Spinal muscular atrophy (SMA) is common among various populations because the genetic makeup is monogamous due to consanguineous marriages. Two genes, i.e., survival motor neuron (SMN1) and neuronal apoptosis inhibitory protein (NAIP) are mapped to the SMA vicinity of chromosome 5q13. The main objective of the study was to develop a solitary advanced genetic tool for the diagnosis of SMA by using SMN1 gene exon 7 and NAIP gene exon 5. PATIENTS AND METHODS This study involved SMA patients (n=84) belonging to different clinical features and socio-economic status. The identity of the intact NAIP gene is primarily based on the amplification of exon 5 only in those SMA patients that have a deletion of SMN1 gene exon 7. Healthy controls (n=84) were also included in this study. The mutational analysis was observed through the Sanger sequencing method, where chromatograms were observed by using Chromas version 2.6.0. RESULTS This study showed a higher prevalence of SMA in females than in males. NAIP gene is considered a phenotype modifier as most SMA patients (94.90%) have SMN1 exon 7 deletion along with a deletion in exon 5 of the NAIP gene. Single nucleotide conversion C-T in exon 7 of SMN1 gene leads to its complete deletion. Mutated proteins encoded by SMN1 and NAIP genes also result in degeneration and muscle weakness in SMA patients. CONCLUSIONS These SMA-associated gene deletions can be used as a molecular evaluation tool for pre- and postnatal diagnosis of SMA. This will be valuable when there is a need for precise and consistent results with a strong focus on quantification.
Collapse
Affiliation(s)
- N Hussain
- Institute of Microbiology and Molecular Genetics, New Campus, University of the Punjab, Lahore, Pakistan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Kumar N, Flores AS, Mitchell J, Hussain N, Kumar JE, Wang J, Fitzsimons M, Dalia AA, Essandoh M, Black SM, Schenk AD, Stein E, Turner K, Sawyer TR, Iyer MH. Intracardiac thrombosis and pulmonary thromboembolism during liver transplantation: A systematic review and meta-analysis. Am J Transplant 2023; 23:1227-1240. [PMID: 37156300 DOI: 10.1016/j.ajt.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
Intracardiac thrombosis and/or pulmonary thromboembolism (ICT/PE) is a rare but devastating complication during liver transplantation. Its pathophysiology remains poorly understood, and successful treatment remains a challenge. This systematic review summarizes the available published clinical data regarding ICT/PE during liver transplantation. Databases were searched for all publications reporting on ICT/PE during liver transplantation. Data collected included its incidence, patient characteristics, the timing of diagnosis, treatment strategies, and patient outcomes. This review included 59 full-text citations. The point prevalence of ICT/PE was 1.42%. Thrombi were most often diagnosed during the neohepatic phase, particularly at allograft reperfusion. Intravenous heparin was effective in preventing early-stage thrombus from progressing further and restoring hemodynamics in 76.32% of patients it was utilized for; however, the addition of tissue plasminogen activator or sole use of tissue plasminogen activator offered diminishing returns. Despite all resuscitation efforts, the in-hospital mortality rate of an intraoperative ICT/PE was 40.42%, with nearly half of these patients dying intraoperatively. The results of our systematic review are an initial step for providing clinicians with data that can help identify higher-risk patients. The clinical implications of our results warrant the development of identification and management strategies for the timely and effective treatment of these tragic occurrences during liver transplantation.
Collapse
Affiliation(s)
- Nicolas Kumar
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antolin S Flores
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Justin Mitchell
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julia E Kumar
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jack Wang
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Michael Fitzsimons
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam A Dalia
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sylvester M Black
- Division of Transplantation Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Austin D Schenk
- Division of Transplantation Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Erica Stein
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Katja Turner
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tamara R Sawyer
- Central Michigan University College of Medicine, Mt. Pleasant, Michigan, USA
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| |
Collapse
|
29
|
Kuntz G, Kumar N, Gray L, Whitson, Vijayakumar A, Boudoulas KD, Iyer M, Gorelik L, Graul T, Hussain N, Awad H, Essandoh M. Concomitant Percutaneous Atrial Septal Defect Closure With an Amplatzer Septal Occluder and HeartMate 3 Implantation for High-Risk Heart Failure Patients: A Novel Hybrid Strategy. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00464-0. [PMID: 37507307 DOI: 10.1053/j.jvca.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Affiliation(s)
- George Kuntz
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nicolas Kumar
- Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Logan Gray
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Whitson
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ammu Vijayakumar
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Manoj Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Leonid Gorelik
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Thomas Graul
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Hamdy Awad
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| |
Collapse
|
30
|
Abd-Elsayed A, Rupp A, D 'Souza RS, Hussain N, Milam AJ, Strand N, Viswanath O, Falowski S, Sayed D, Deer T. Interventional Pain Physician Burnout During the COVID-19 Pandemic: A Survey from the American Society of Pain and Neuroscience. Curr Pain Headache Rep 2023:10.1007/s11916-023-01121-6. [PMID: 37395899 DOI: 10.1007/s11916-023-01121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE OF REVIEW The study sought to assess the prevalence of physician burnout among interventional pain physicians in 2022. RECENT FINDINGS Physician burnout is major psychosocial and occupational health issue. Prior to the coronavirus disease of 2019 (COVID-19) pandemic, over 60% of physicians reported emotional exhaustion and burnout. Physician burnout was reported to become more prevalent in multiple medical specialties during the COVID-19 pandemic. An 18-question survey was distributed electronically to all ASPN members (n = 7809) in the summer of 2022 to assess demographics, burnout characteristics (e.g., Have you felt burned out due to COVID?), and strategies to cope with burnout and stress (e.g., reached out for mental health assistance). Members were able to complete the survey once and were unable to make changes to their responses once submitted. Descriptive statistics were used to assess the prevalence and severity of physician burnout within the ASPN community. Chi-square tests were used to examine differences in burnout by provider characteristics (age, gender, years practicing, and practice type) with p-values less than 0.05 indicating statistical significance. There were 7809 ASPN members that received the survey email, 164 of those members completed the survey, a response rate of 2.1%. The majority of respondents were male (74.1%, n = 120), 94% were attending physicians (n = 152), and 26% (n = 43) have been in practice for twenty years or longer. Most respondents expressed having experienced burnout during the COVID pandemic (73.5%, n = 119), 21.6% of the sample reported reduced hours and responsibilities during the pandemic, and 6.2% of surveyed physicians quit or retired due to burnout. Nearly half of responders reported negative impacts to their family and social lives as well as personal physical and mental health. A variety of negative (e.g., changes in diet, smoking/vaping) and positive coping strategies (e.g., exercise and training, spiritual enrichment) were employed in response to stress and burnout; 33.5% felt they should or had reached out for mental health assistance and suicidal ideations were expressed in 6.2% due to burnout. A high percentage of interventional pain physicians continue to experience mental symptoms that may lead to risk for significant issues going forward. Our findings should be interpreted with caution based on the low response rate. Evaluation of burnout should be incorporated into annual assessments given issues of survey fatigue and low survey response rates. Interventions and strategies to address burnout are warranted.
Collapse
Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, School of Medicine & Public Health, University of Wisconsin, Madison, WI, USA.
| | - Adam Rupp
- Department of Rehabilitation Medicine, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Ryan S D 'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Colombus, OH, USA
| | - Adam J Milam
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Omar Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Phoenix, AZ, USA
| | - Steven Falowski
- Neurosurgical Associates of Lancaster, Lancaster, PA, 17601, USA
| | - Dawood Sayed
- Department of Anesthesiology, Division of Pain Medicine, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Timothy Deer
- The Spine & Nerve Centers of the Virginias, Charleston, WV, USA
| |
Collapse
|
31
|
ElSaban M, Kleppel DJ, Kubrova E, Martinez Alvarez GA, Hussain N, D'Souza RS. Physical functioning following spinal cord stimulation: a systematic review and meta-analysis. Reg Anesth Pain Med 2023; 48:302-311. [PMID: 37080578 DOI: 10.1136/rapm-2022-104295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Spinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS therapy, efforts to synthesize the evidence on physical functioning are lacking. OBJECTIVE The primary objective of this meta-analysis was to assess long-term physical function following 12 months of SCS for chronic back pain. EVIDENCE REVIEW PubMed, EMBASE, Scopus, and CENTRAL databases were searched for original peer-reviewed publications investigating physical function following SCS. The primary outcome was physical function at 12 months following SCS therapy for chronic back pain compared with baseline. A random effects model with an inverse variable method was used. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to determine the certainty of evidence. FINDINGS A total of 518 studies were screened, of which 36 were included. Twenty-two studies were pooled in the meta-analysis. There was a significant reduction in Oswestry Disability Index (ODI) scores at all time frames up to 24 months following implantation. Pooled results revealed significant improvement in ODI scores at 12 months with a mean difference of -17.00% (95% CI -23.07 to -10.94, p<0.001). There was a very low certainty of evidence in this finding as per the GRADE framework. There was no significant difference in subgroup analyses based on study design (randomised controlled trials (RCTs) vs non-RCTs), study funding, or stimulation type. CONCLUSION This meta-analysis highlights significant improvements in physical function after SCS therapy. However, this finding was limited by a very low GRADE certainty of evidence and high heterogeneity.
Collapse
Affiliation(s)
- Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Donald J Kleppel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| |
Collapse
|
32
|
Orhurhu V, Hussain N, Karri J, Mariano ER, Abd-Elsayed A. Perioperative and anesthetic considerations for the management of neuromodulation systems. Reg Anesth Pain Med 2023; 48:327-336. [PMID: 37080581 DOI: 10.1136/rapm-2022-103660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/04/2022] [Indexed: 04/22/2023]
Abstract
The use of neuromodulation systems is increasing for the treatment of various pathologies ranging from movement disorders to urinary incontinence to chronic pain syndromes. While the type of neuromodulation devices varies, they are largely categorized as intracranial (eg, deep brain stimulation), neuraxial (eg, spinal cord stimulation, dorsal root ganglion stimulation, and intrathecal drug delivery systems), or peripheral (eg, sacral nerve stimulation and peripheral nerve stimulation) systems. Given the increasing prevalence of these systems in the overall population, it is important for anesthesiologists, surgeons, and the perioperative healthcare team to familiarize themselves with these systems and their unique perioperative considerations. In this review, we explore and highlight the various neuromodulation systems, their general perioperative considerations, and notable special circumstances for perioperative management.
Collapse
Affiliation(s)
- Vwaire Orhurhu
- Anesthesiology, University of Pittsburgh Medical Center, Williamsport, Pennsylvania, USA
- Pain Medicine, MVM Health, East Stroudsburg, Pennsylvania, USA
| | - Nasir Hussain
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jay Karri
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Divsion of Pain Medicine, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
33
|
West T, ElSaban M, Hussain N, Schappell J, Rogers K, Orhurhu V, Prokop LJ, D'Souza RS. Incidence of Lead Migration With Loss of Efficacy or Paresthesia Coverage After Spinal Cord Stimulator Implantation: Systematic Review and Proportional Meta-Analysis of Prospective Studies and Randomized Clinical Trials. Neuromodulation 2023:S1094-7159(23)00150-2. [PMID: 37204361 DOI: 10.1016/j.neurom.2023.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/15/2023] [Accepted: 03/24/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE The objective of this meta-analysis was to approximate the incidence of overall lead migration, clinically significant lead migration, and asymptomatic lead migration in patients who have undergone spinal cord stimulator implantation. MATERIALS AND METHODS A comprehensive literature search was performed for studies published before May 31, 2022. Only randomized controlled trials and prospective observational studies with more than ten patients were included. Two reviewers analyzed the articles from the literature search for final inclusion, after which, study characteristics and outcome data were extracted. The primary dichotomous categorical outcome variables were the incidence of overall lead migration, clinically significant lead migration (defined as lead migration resulting in loss of efficacy), and asymptomatic lead migration (defined as lead migration discovered incidentally on follow-up imaging) in patients with spinal cord stimulator implant. Freeman-Tukey arcsine square root transformation for meta-analysis of proportions using random effects (DerSimonian and Laird method) was used to calculate incidence rates for the outcome variables. Pooled incidence rates and 95% CIs were calculated for the outcome variables. RESULTS Fifty-three studies met the inclusion criteria, with a total of 2932 patients having received spinal cord stimulator implants. The pooled incidence of overall lead migration was 9.97% (95% CI of 7.62%-12.59%). Only 24 of the included studies commented on the clinical significance of reported lead migrations, of which every lead migration was clinically significant. In these 24 studies, 96% of the reported lead migrations required a revision procedure or explant. Unfortunately, no studies that reported lead migration commented on asymptomatic lead migrations; therefore, the incidence of asymptomatic lead migrations could not be defined. CONCLUSIONS This meta-analysis found that the rate of lead migration in patients who have received spinal cord stimulator implants is approximately one in ten patients. This likely closely approximates the incidence of clinically significant lead migration owing to the included studies not routinely performing follow-up imaging. Therefore, lead migrations were primarily discovered owing to loss of efficacy, and no included studies clearly reported asymptomatic lead migration. The results of this meta-analysis can be used to inform patients more accurately on the risks and benefits of spinal cord stimulator implantation.
Collapse
Affiliation(s)
- Tyler West
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Justin Schappell
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Kristopher Rogers
- Department of Anesthesiology, University of Illinois Chicago, Chicago, IL, USA
| | - Vwaire Orhurhu
- Department of Anesthesiology, University of Pittsburgh Medical Center, Williamsport, PA, USA
| | | | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
34
|
Hussain N, Weaver T. Response to the Letter to the Editor Regarding: "Identifying Predictors for Early Percutaneous Spinal Cord Stimulator Explant at One and Two Years: A Retrospective Database Analysis". Neuromodulation 2023; 26:710. [PMID: 37028892 DOI: 10.1016/j.neurom.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tristan Weaver
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
35
|
Ang SP, Sidharthan S, Lai W, Hussain N, Patel KV, Gulati A, Henry O, Kaye AD, Orhurhu V. Cannabinoids as a Potential Alternative to Opioids in the Management of Various Pain Subtypes: Benefits, Limitations, and Risks. Pain Ther 2023; 12:355-375. [PMID: 36639601 PMCID: PMC10036719 DOI: 10.1007/s40122-022-00465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/22/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Pain is a global phenomenon encompassing many subtypes that include neuropathic, musculoskeletal, acute postoperative, cancer, and geriatric pain. Traditionally, opioids have been a mainstay pharmacological agent for managing many types of pain. However, opioids have been a subject of controversy with increased addiction, fatality rates, and cost burden on the US healthcare system. Cannabinoids have emerged as a potentially favorable alternative or adjunctive treatment for various types of acute and chronic pain. This narrative review seeks to describe the efficacy, risks, and benefits of cannabinoids as an adjunct or even potential replacement for opioids in the treatment of various subtypes of pain. METHODS In June of 2022, we performed a comprehensive search across multiple databases for English-language studies related to the use of cannabinoids in the treatment of various types pain: neuropathic pain, musculoskeletal pain, acute postoperative pain, cancer pain, and geriatric pain. Data from meta-analyses, systematic reviews, and randomized control trials (RCTs) were prioritized for reporting. We sought to focus our reported analysis on more recent literature as well as include older relevant studies with particularly notable findings. RESULTS There is conflicting evidence for the use of cannabinoids in the management of pain. While cannabinoids have shown efficacy in treating specific chronic pain subtypes such as neuropathic pain, fibromyalgia pain, and geriatric pain, they do not show as clear benefit in acute postoperative and the majority of musculoskeletal pain syndromes. Data trends towards cannabinoids having a positive effect in treating cancer pain, but results are not as conclusive. To date, there is a paucity of data comparing cannabinoids directly to opioids for pain relief. Overall, the side effects of cannabinoids appear to be relatively mild. However, there is still potential for addiction, altered brain development, psychiatric comorbidities, and drug-drug interactions. CONCLUSION Cannabinoids may be effective in specific subtypes of pain, but current evidence and guidelines do not yet support its use as the first-line treatment for any type of acute or chronic pain. Rather, it may be considered a good adjunct or alternative for patients who have failed more typical or conservative measures. Additional studies are needed with standardized forms of cannabinoids, route of delivery, and dosing for greater-powered analysis. Providers must weigh the individualized patient risks, benefits, and concurrent medication list in order to determine whether cannabinoids are appropriate for a patient's pain treatment plan.
Collapse
Affiliation(s)
- Samuel P Ang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Shawn Sidharthan
- Department of Neurology, Northwell Health-Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA
| | - Wilson Lai
- Department of Anesthesiology and Pain Medicine, Northwell Health-Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA
| | - Nasir Hussain
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kiran V Patel
- Department of Anesthesiology, New York University Langone Medical Center, New York, NY, USA
- Department of Anesthesiology and Pain Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Onyeaka Henry
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan D Kaye
- Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU School of Medicine, Shreveport, LA, USA
- Anesthesiology and Pharmacology, LSU School of Medicine, New Orleans, LA, USA
- Anesthesiology and Pharmacology, Tulane School of Medicine, New Orleans, LA, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA.
- MVM Health, East Stroudsburg, PA, USA.
| |
Collapse
|
36
|
Hussain N, Abdallah FW. Reply to authors: effectiveness of continuous adductor canal block. Reg Anesth Pain Med 2023; 48:191-192. [PMID: 36635045 DOI: 10.1136/rapm-2022-104323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Affiliation(s)
- Nasir Hussain
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Faraj W Abdallah
- Anesthesia, University of Ottawa, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| |
Collapse
|
37
|
Hussain N, Orhurhu V, D'Souza R. Spinal Cord Burst Stimulation vs Placebo Stimulation for Patients With Chronic Radicular Pain After Lumbar Spine Surgery. JAMA 2023; 329:845-846. [PMID: 36917058 DOI: 10.1001/jama.2022.24739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Nasir Hussain
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus
| | - Vwaire Orhurhu
- Department of Anesthesia, University of Pittsburgh Medical Center, Susquehanna, Pennsylvania
| | - Ryan D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, Minnesota
| |
Collapse
|
38
|
Kumar N, Iyer MH, Kumar J, Hussain N, Essandoh M. Prognosticating With Left Ventricular Global Longitudinal Strain: A New Opportunity for Cardiac Anesthesiologists. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00172-6. [PMID: 36990806 DOI: 10.1053/j.jvca.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Nicolas Kumar
- Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Julia Kumar
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
39
|
Hussain N, Abdallah FW. Reply to authors: catheter dislodgement after continuous adductor canal block. Reg Anesth Pain Med 2023; 48:385-386. [PMID: 36882269 DOI: 10.1136/rapm-2023-104448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Nasir Hussain
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Faraj W Abdallah
- Anesthesia, University of Ottawa, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| |
Collapse
|
40
|
Al-Jindi P, Hussain N. Trial of Labor After Cesarean Delivery. Advanced Anesthesia Review 2023:809-C322.S10. [DOI: 10.1093/med/9780197584521.003.0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Trial of labor after a previous cesarean (TOLAC) delivery is proposed to meet patients’ needs and decrease maternal mortality compared with repeated cesarean section. TOLAC provides an option for the delivering mother to experience a vaginal delivery. However, this risk is higher if the TOLAC fails, and cesarean section is required after the TOLAC. TOLAC carries around a 1% risk of uterine rupture. The most sensitive sign of uterine rupture is fetal bradycardia, detected by fetal heart tone monitoring. Epidural analgesia does not delay the diagnosis of uterine rupture. Uterine rupture is an obstetric emergency, and efforts should concentrate on resuscitation while the patient is prepared for emergency laparotomy.
Collapse
|
41
|
Haynes E, Hussain N. Hemoglobinopathies and Porphyrias. Advanced Anesthesia Review 2023:465-C178.S16. [DOI: 10.1093/med/9780197584521.003.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Hemoglobinopathies are genetic blood disorders that include α- and β-thalassemia as well as diseases that cause abnormal hemoglobin structure. Porphyrias also encompass a group of metabolic disorders that interfere with the body’s normal hemoglobin production by altering heme synthesis. A series of blood tests is used to confirm the diagnosis of a hemoglobinopathy. Porphyrias are often difficult to diagnose because of their varied presentations and nonspecific symptoms. The medical therapies for both focus less on curative treatments and aim to provide symptomatic management and prevention of crises. In both disease states, acute attacks can be triggered by many factors during the perioperative period. A thorough preoperative evaluation should be performed to evaluate disease severity and the need for additional testing. Possible triggers for acute attacks should be identified and avoided. Postoperative monitoring is needed as these patients are at an increased risk of having an acute crisis as well as postsurgical complications.
Collapse
|
42
|
Zhou S, Hussain N. Maternal Cardiopulmonary Resuscitation. Advanced Anesthesia Review 2023:803-C319.S11. [DOI: 10.1093/med/9780197584521.003.0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Cardiac arrest during pregnancy is a relatively rare phenomenon, as the majority of parturients tend to be younger with fewer comorbidities. While rare, cardiac arrest in pregnancy must be promptly recognized to avoid harm or even death of the mother or fetus. Etiologies are broad, ranging from pathologies related to heart disease or pulmonary embolism and to pregnancy specific-diseases such as preeclampsia or amniotic fluid embolism. While basic life support/advanced cardiac life support protocols should always be followed, the gravid patient always poses challenges. Thus, cardiopulmonary resuscitation must be initiated by an interdisciplinary team familiar with the physiologic changes of pregnancy and the specialized interventions necessary to mitigate harm.
Collapse
|
43
|
Hussain N, Weaver TE. Postoperative Pain. Advanced Anesthesia Review 2023:263-C103.S7. [DOI: 10.1093/med/9780197584521.003.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Postoperative pain, if not treated sufficiently, may progress to a pathological chronic pain syndrome, leading to significant disability and suffering. Preemptive and early treatment has been shown to decrease the incidence of chronic pain down the road. Various medication classes, including opioids, serotonin norepinephrine reuptake inhibitor (SNRIs), tricyclic antidepressant, local anesthetics, α2-agonists, nonsteroidal anti-inflammatory drugs, N-methyl-d-aspartate receptor antagonists, and agonists-antagonists, are at the perioperative consultant’s disposal when treating pain. While most medications in the immediate postoperative period will be given intravenously, other routes of administration, such as oral, epidural, intrathecal, subcutaneous, transcutaneous, transmucosal, intramuscular, and interpleural, may be appropriate under certain circumstances. Adjunctive techniques and therapies, including transcutaneous electrical nerve stimulation (TENS), cryotherapy, acupuncture, and hypnosis, may also be used in order to relieve pain and minimize opioid dosing and side effects.
Collapse
|
44
|
Hussain N, Ahmad M, Sipra H, Ali S, Syed JH, Hussain K, Hassan SW. First insight into seasonal variability of urban air quality of northern Pakistan: An emerging issue associated with health risks in Karakoram-Hindukush-Himalaya region. Chemosphere 2023; 316:137878. [PMID: 36646179 DOI: 10.1016/j.chemosphere.2023.137878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
There is a dire need of air quality monitoring in the high-mountain areas of Karakoram-Hindu Kush-Himalaya (HKH) region, particularly related to the recent activities undergoing the China-Pakistan Economic Corridor (CPEC). This study presents the first baseline monitoring and evaluation findings from Gilgit city, Gilgit-Baltistan. Hourly data collection for air quality parameters (PM2.5, NO, NO2, SO2, O3 and CO) were measured using air-pointer (recordum, Austria) from 1 Jan 2018 to 31 Mar 2018 (winter) and 1 Jun 2018 to 31 Aug 2018 (summer). Our findings depict PM2.5 health limits were crossed in the winter season, while NO, NO2 and SO2 remained below their health limits. O3 and CO showed a rising trend in summer months, crossing the 8-h health limits during the season. Seasonal correlation in meteorology found an inverse relationship between most parameters and temperatures; reverse was true for O3 and CO. In parallel, thermal optical carbon analysis filter-based sampling characterized air quality into mass concentrations of PM2.5, organic carbon (OC), elemental carbon (EC) and various heavy metals. Filter-based PM2.5 correlated well with analyzer-based PM2.5 for all months that were studied, except February and March 2018. PM2.5, OC and EC were higher in summer as compared to winter, whereas higher heavy metal contributions were measured predominantly during summer. Health impacts were found to be above health limits for Ni in children only. Furthermore, principal component analysis-multiple linear regression (PCA-MLR) technique was applied to determine source apportionment, confirming the role of biomass burning in winters, and vehicular emissions in summers, highlighting the need for flexible monitoring of technologies/approaches, and communications among the various public, private agencies, and all relevant stakeholders.
Collapse
Affiliation(s)
- Nasir Hussain
- Department of Environmental Sciences, Karakorum International University, Gilgit, Pakistan; Gilgit-Baltistan Environmental Protection Agency (GB-EPA), Gilgit, Pakistan
| | - Masroor Ahmad
- Department of Environmental Sciences, Karakorum International University, Gilgit, Pakistan
| | - Hassaan Sipra
- Centre for Climate Research and Development, COMSATS University Islamabad, Park Road Tarlai Kalan, 45550, Islamabad, Pakistan
| | - Shuakat Ali
- Department of Environmental Sciences, Karakorum International University, Gilgit, Pakistan
| | - Jabir Hussain Syed
- Department of Meteorology, COMSATS University Islamabad, Park Road Tarlai Kalan, 45550, Islamabad, Pakistan; Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong.
| | - Khadim Hussain
- Gilgit-Baltistan Environmental Protection Agency (GB-EPA), Gilgit, Pakistan
| | - Syed Waqar Hassan
- Gilgit-Baltistan Environmental Protection Agency (GB-EPA), Gilgit, Pakistan
| |
Collapse
|
45
|
Tadros R, Hussain N. Peripheral Arteriosclerotic Disease. Advanced Anesthesia Review 2023:379-C147.S5. [DOI: 10.1093/med/9780197584521.003.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Peripheral arteriosclerotic disease (PAD) commonly affects the lower extremities. Signs and symptoms of PAD are variable and can present classically with claudication or in an advanced state through chronic limb ischemia. To evaluate a patient with risk factors for PAD, a thorough history, review of systems, and physical examination should be obtained. An ankle-brachial index (ABI) less than 0.9 is sensitive and specific for arterial stenosis and diagnostic for PAD. Management typically involves goal-directed medical therapy (GDMT), such as antiplatelet therapy, statins, exercise rehabilitation, and lifestyle modifications (e.g. smoking cessation). Vascular interventions are typically reserved for patients with severe claudication impairing quality of life.
Collapse
|
46
|
Hussain N, Abd-Elsayed A. Nebulizers, Humidifiers, Drug Delivery Systems. Advanced Anesthesia Review 2023:27-C10.S10. [DOI: 10.1093/med/9780197584521.003.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Understanding the basic anesthetic drug delivery devices is paramount for the safe delivery of anesthetics to patients. There are several different methods used to deliver anesthetics and medications to patients, which include the variable bypass vaporizer, measured flow vaporizer, nebulizers, and humidifiers. Each of these devices has nuances and specifics that the anesthesiologist should be aware of.
Collapse
|
47
|
Kumar N, Reeves J, Hussain N, Essandoh M. Dispelling Dogma: Milrinone Therapy Is Safe and Effective in Renally-Impaired Patients, and We Knew This! J Cardiothorac Vasc Anesth 2023; 37:839-840. [PMID: 36805377 DOI: 10.1053/j.jvca.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Nicolas Kumar
- Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeremy Reeves
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| |
Collapse
|
48
|
Hussain N, Brull R, Zhou S, Schroell R, McCartney C, Sawyer T, Abdallah FW. Analgesic benefits of single-shot versus continuous adductor canal block for total knee arthroplasty: a systemic review and meta-analysis of randomized trials. Reg Anesth Pain Med 2023; 48:49-60. [PMID: 36351742 DOI: 10.1136/rapm-2022-103756] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adductor canal block (ACB) can provide important analgesic benefits following total knee arthroplasty (TKA), however, the extent to which these benefits can be enhanced or prolonged by a continuous catheter-based infusion compared with a single-shot injection of local anesthetic is unclear. OBJECTIVES This systematic review and meta-analysis (PROSPERO: CRD42021292738) review sought to compare the analgesic effectiveness of single shot to continuous ACB following TKA. EVIDENCE REVIEW We sought randomized trials from the US National Library of Medicine database (MEDLINE), Excerpta Medica database (EMBASE), and Cochrane Database of Systematic Reviews from inception to November 1, 2021, that compared single-shot to continuous ACB in adult patients undergoing TKA. The primary outcomes were (1) area under the curve (AUC) pain severity at rest and (2) cumulative opioid (oral morphine equivalent) consumption during the first 48 hours postoperatively. Secondary outcomes included postoperative pain severity scores up to 48 hours, cumulative opioid consumption at 24 hours, functional recovery, opioid-related side effects, and block-related complications. Risk of bias of included studies was assessed using the Cochrane risk of bias tool. Statistical pooling was conducted using the Hartung-Knapp-Sidik-Jonkman method for random effects. No funding was obtained for this review. FINDINGS Eleven trials (1185 patients) were included. No differences were observed in rest pain severity (AUC) or cumulative opioid consumption up to 48 hours postoperatively. In addition, no differences were observed in individual postoperative rest pain scores in the recovery room and at 12 and 24 hours, or in cumulative opioid consumption at 24 hours, functional recovery, and opioid-related side effects. Finally, fewer block-related complications were observed with single-shot ACB, with an OR (95% CI) of 0.24 (0.14 to 0.41) (p=0.002). CONCLUSIONS Our results suggest that continuous catheter-based ACB does not enhance or prolong the analgesic benefits when compared with single-shot ACB for TKA over the first 48 hours postoperatively. Overall, the results of our meta-analysis do not support the routine use of continuous ACB for postoperative analgesia after TKA.
Collapse
Affiliation(s)
- Nasir Hussain
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard Brull
- Department of Anesthesiology and Pain Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Steven Zhou
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert Schroell
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Colin McCartney
- Department of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tamara Sawyer
- Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
| | - Faraj W Abdallah
- Department of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
49
|
Hussain N, Brull R, Vannabouathong C, Speer J, Lagnese C, McCartney CJL, Abdallah FW. Network meta-analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction. Anaesthesia 2023; 78:207-224. [PMID: 36326047 DOI: 10.1111/anae.15873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
Anterior cruciate ligament reconstruction can cause moderate to severe acute postoperative pain. Despite advances in our understanding of knee innervation, consensus regarding the most effective regional anaesthesia techniques for this surgical population is lacking. This network meta-analysis compared effectiveness of regional anaesthesia techniques used to provide analgesia for anterior cruciate ligament reconstruction. Randomised trials examining regional anaesthesia techniques for analgesia following anterior cruciate ligament reconstruction were sought. The primary outcome was opioid consumption during the first 24 h postoperatively. Secondary outcomes were: rest pain at 0, 6, 12 and 24 h; area under the curve of pain over 24 h; and opioid-related adverse effects and functional recovery. Network meta-analysis was conducted using a frequentist approach. A total of 57 trials (4069 patients) investigating femoral nerve block, sciatic nerve block, adductor canal block, local anaesthetic infiltration, graft-donor site infiltration and systemic analgesia alone (control) were included. For opioid consumption, all regional anaesthesia techniques were superior to systemic analgesia alone, but differences between regional techniques were not significant. Single-injection femoral nerve block combined with sciatic nerve block had the highest p value probability for reducing postoperative opioid consumption and area under the curve for pain severity over 24 h (78% and 90%, respectively). Continuous femoral nerve block had the highest probability (87%) of reducing opioid-related adverse effects, while local infiltration analgesia had the highest probability (88%) of optimising functional recovery. In contrast, systemic analgesia, local infiltration analgesia and adductor canal block were each poor performers across all analgesic outcomes. Regional anaesthesia techniques that target both the femoral and sciatic nerve distributions, namely a combination of single-injection nerve blocks, provide the most consistent analgesic benefits for anterior cruciate ligament reconstruction compared with all other techniques but will most likely impair postoperative function. Importantly, adductor canal block, local infiltration analgesia and systemic analgesia alone each perform poorly for acute pain management following anterior cruciate ligament reconstruction.
Collapse
Affiliation(s)
- N Hussain
- Department of Anesthesiology, Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - R Brull
- Department of Anesthesiology and Pain Medicine, Women's College Hospital, University of Toronto, ON, Canada
| | - C Vannabouathong
- Department of Anesthesiology, Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - J Speer
- Department of Anesthesiology, Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - C Lagnese
- Department of Anesthesiology, Cleveland Clinic Akron General, Akron, OH, USA
| | - C J L McCartney
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - F W Abdallah
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, ON, Canada.,Department of Anesthesia, and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, ON, Canada
| |
Collapse
|
50
|
Banik RK, Peng S, Hussain N, Goel V, Hagedorn JM, Chai T, Anitescu M, Fillingim RB. The Relationship Between Chronic Pain and Cognitive Decline in Older Population: A Cautionary Tale from Current Literature. Pain Med 2023; 24:110-112. [PMID: 36165693 DOI: 10.1093/pm/pnac144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Ratan K Banik
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sydney Peng
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nasir Hussain
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA
| | - Vasudha Goel
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Thomas Chai
- Department of Anesthesiology, Division of Pain Management, MD Anderson Cancer Center, Houston, Texas, USA
| | - Magdalina Anitescu
- Department of Anesthesiology, University of Chicago, Chicago, Illinois, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| |
Collapse
|