Ultrasound-guided genicular nerve radiofrequency treatment: prospective randomized comparative trial of a 3-nerve protocol versus a 5-nerve protocol.

OBJECTIVES: Genicular nerve radiofrequency procedures increasingly are being performed to treat chronic pain due to knee osteoarthritis. Targeting additional sensory nerves and improving target identification by using ultrasound guidance could improve treatment success. The aim of this study was to compare the effectiveness of targeting only the traditional genicular nerves versus targeting the traditional genicular nerves plus 2 additional sensory nerves in ultrasound-guided genicular nerve radiofrequency procedures in patients with chronic knee osteoarthritis. METHODS: A total of 80 patients were randomized into 2 groups. Patients in the 3-nerve-targeted group received a genicular radiofrequency procedure in which the traditional genicular nerves were targeted: the superior lateral, superior medial, and inferior medial nerves. The 5-nerve-targeted group received a genicular radiofrequency procedure in which the recurrent fibular and infrapatellar branches of the saphenous nerve were targeted in addition to the traditional genicular nerves. The numeric rating scale, Short Form-36, Western Ontario and McMaster Universities Arthritis Index, Quantitative Analgesic Questionnaire, and patient satisfaction were evaluated before treatment, at week 1 after treatment, and at months 1, 3, and 6 after treatment. RESULTS: Both techniques provided significant pain reduction and functional improvement up to 6 months after the procedure (P < .05). The 5-nerve-targeted group showed significant improvement with regard to the numeric rating scale, Western Ontario and McMaster Universities Arthritis Index total, and Short Form-36 score compared with the 3-nerve-targeted group at each follow-up point. No differences in the Quantitative Analgesic Questionnaire or patient satisfaction scores were observed between the groups. CONCLUSIONS: The ultrasound-guided 5-nerve-targeted technique is a safe method and a more effective therapeutic procedure than the traditional 3-nerve-targeted technique for chronic knee osteoarthritis. TRIAL REGISTRATION: www.ClinicalTrials.gov ID: NCT05073887.

Fluoroscopy-Guided Versus Fluoroscopy-Confirmed Ultrasound-Guided S1 Transforaminal Epidural Injection with Pulsed Radiofrequency: A Prospective, Randomized Trial.

OBJECTIVE: The aim of this prospective randomized controlled study was to compare the effectiveness and accuracy of the ultrasound- and fluoroscopy-guided S1 transforaminal epidural injection combined with pulsed radiofrequency in patients with lumbosacral radicular pain caused by S1 nerve involvement. MATERIALS AND METHODS: A total of 60 patients were randomized into 2 groups. Patients received S1 transforaminal epidural injection combined with pulsed radiofrequency under either ultrasound or fluoroscopy guidance. Primary outcomes were estimated with Visual Analog Scale scores at 6 months. Secondary outcomes included Oswestry Disability Index, Quantitative Analgesic Questionnaire, and patient satisfaction scores during the 6-month follow-up period and procedure-related variables including procedure time and accuracy of the needle replacement. RESULTS: Both techniques provided significant pain reduction and functional improvement for 6 months compared to baseline (P < .001), without statistical significance between groups at each follow-up point. There was no significant difference in pain medication consumption (P=.441) and patient satisfaction scores (P=.673) between groups. The fluoroscopy guidance for combined transforaminal epidural injection with pulsed radiofrequency at S1 provided a greater accuracy for the cannula replacement (100%) than the ultrasound (93.3%), without significant difference between groups (P=.491). CONCLUSION: The ultrasound-guided combined transforaminal epidural injection with pulsed radiofrequency at S1 level is a feasible alternative to fluoroscopy guidance. In this study, we reported that the ultrasoundguided technique resulted in similar treatment benefits including improvement in pain intensity and functionality and reduction in pain medication consumption as those in the fluoroscopy group, while reducing the risk for radiation exposure.

Ultrasound-guided PENG block versus intraarticular corticosteroid injection in hip osteoarthritis: a randomised controlled study.

Background: This study aimed to compare the effectiveness of the pericapsular nerve group (PENG) block and intra-articular injection (IAI) of steroid-bupivacaine in the treatment of hip osteoarthritis (OA). Methods: After randomization, patients received either a PENG block or IAI under ultrasound-guidance. Clinical evaluations were recorded at baseline, day 1, and weeks 1, 4, and 8 post-intervention. The numerical rating scale (NRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris Hip Scale (HHS) scores, pain medication use determined by a quantitative analgesic questionnaire, and patient satisfaction were evaluated. Results: Sixty patients were included in this study. NRS scores improved significantly for both groups during the follow-up compared to pretreatment (P < 0.001), with better pain scores for the PENG group (P < 0.001) at day 1 with larger effect size (Cohen's d = 4.62), and IAI group at 4 (Cohen's d = 5.15) and 8 (Cohen's d = 4.33) weeks (P < 0.001). There was no significant difference in pain medication consumption (P = 0.499) and patient satisfaction (P = 0.138) between groups. Patients in the IAI group experienced significant improvement in HHS (Cohen's d = 2.16, P = 0.007) and WOMAC (Cohen's d = 1.02, P = 0.036) scores at 8 weeks compared to the PENG group. Conclusions: The ultrasound-guided PENG block provides effective pain relief which improves functionality and quality of life in hip OA patients up to 2 months. The PENG block can be considered an easy, safe, and useful alternative treatment modality for hip OA.

Ultrasound-guided rhomboid intercostal block versus erector spinae plane block for unilateral dorsal back myofascial pain syndrome: a prospective, randomized trial.

BACKGROUND: The aim of this study was to investigate the effects of erector spinae plane block (ESPB) and rhomboid intercostal block (RIB) on pain, disability, quality of life and patient satisfaction in patients with myofascial pain syndrome (MPS). METHODS: In this prospective randomized controlled double-blind study, 60 patients with a diagnosis of MPS were randomized into two groups. In group ESPB (N.=30), US-guided ESPB was performed, and in group RIB (N.=30), US-guided RIB was performed. The pain severity of the patients was assessed using the Numerical Rating Scale before treatment, and immediately after the intervention, on the first day, and one, two, four and six weeks after the intervention. The Short Form-36 Health Survey (SF-36) for health-related Quality of Life, the Neck Disability Index (NDI), and patient satisfaction were evaluated before treatment and six weeks after treatment. RESULTS: In both groups, significant improvements were observed in all parameters during the six-week follow-up period compared to pretreatment values (P<0.05). There was no statistically significant difference between groups for any parameters at any time interval. CONCLUSIONS: This study showed that ESPB and RIB blocks are effective techniques for pain, disability, and quality of life in patients with MPS. We suggest that the interfascial space can be useful in the administration of analgesic agents for the treatment of MPS.

Predictive factors associated with successful response to utrasound guided genicular radiofrequency ablation.

Background: Ultrasound-guided genicular nerve radiofrequency (RF) procedures are of interest in the management of chronic knee pain. A wide variety of demographic, clinical, and procedural characteristics can affect treatment success. This study aimed to determine predictive factors to provide superior treatment outcomes. Methods: The demographic, clinical, and technical data of patients who received genicular nerve RF for knee pain between September 2016 and September 2021 were evaluated. A positive outcome was defined as at least 50% pain relief on a pain score for at least 6 months. Logistic regression analysis was performed to determine the factors associated with a successful response to genicular RF. Results: Among 206 patients who underwent genicular RF, 62% of the patients reported successful outcomes at 6 months. In the multivariate model, targeting 5 nerves (odds ratio [OR], 6.184; 95% confidence interval [CI], 2.291-16.690; P < 0.001) was the most significant predictor of successful outcomes. Multivariable logistic regression analysis showed that prognostic genicular nerve block with a 50% cut-off value (OR, 2.109; 95% CI, 1.038-4.287; P = 0.039), no opioid use (OR, 2.753; 95% CI, 1.405-5.393; P = 0.003), and depression (OR, 0.297; 95% CI, 0.124-0.713; P = 0.007) were the predictive factors significantly associated with response to genicular RF. Conclusions: Clinical and technical factors associated with better treatment outcomes were ultimately targeting more nerves, performing prognostic block, no opioid use, and no depression. These results are expected to be considered when selecting patients for genicular RF.

Chronic Pain: An Update of Clinical Practices and Advances in Chronic Pain Management.

Chronic pain affects a significant amount of the population and represents a heavy personal and socioeconomic burden. Chronic pain mechanisms can be categorized as nociceptive, neuropathic, or nociplastic. Although mechanism-based pain treatment is optimal, different types of pain mechanisms may overlap in patients. Recently, the biopsychosocial model with the multidisciplinary pain management program is widely accepted as one of the most effective methods to assess and manage chronic pain. The treatment of chronic pain consists of a personalized, stepwise, and multimodal approach that includes pharmacotherapy, psychotherapy, integrative treatments, and interventional procedures. Somatic and peripheral nerve blocks for the treatment of chronic pain are often deferred. With the increasing use of ultrasound in pain medicine, newly defined interfascial plane blocks, which may be performed alone or as an adjuvant to multimodal management, have gained popularity. Adequate pain management can improve physical functioning, mental health and quality of life indicators, and reduce pain chronification. The aim of this current article is to perform a comprehensive and updated review of existing treatment options, particularly interfascial plane blocks in chronic pain syndromes.

Peroneal nerve palsy due to synovial cyst: An unusual cause of foot drop in a nine-year-old child.

Foot drop is the inability to dorsiflex the foot, and peroneal nerve palsy, a common cause of foot drop, is a rare condition in pediatric patients. Herein, we present a nine-year-old patient with foot drop due to peroneal nerve palsy verified by electrophysiologic examination. A cystic mass was observed in ultrasonography and magnetic resonance imaging, and hyaluronic acid was detected in the cystic material by histopathological examination. The patient was referred to surgery, and one month after surgery, an increase in muscle strength was observed. It should be kept in mind that peroneal nerve palsy due to synovial cysts may cause foot drop in pediatric patients.

Swallowing in Parkinson's disease: How is it affected?

OBJECTIVES: The aim of this study was to evaluate the swallowing in patients with Parkinson's disease (PD) using comprehensive and multimodal methods. PATIENTS AND METHODS: The present study was conducted on 120 patients and 60 controls between January 2017 and January 2018. All participants' demographic data were recorded, and the swallowing of the subjects was evaluated by using several methods, including clinic, electrophysiologic, endoscopic and ultrasonographic procedure. First, the swallowing functions of the patient and control groups were compared. Subsequently, the patients were divided into two groups as patients with (n = 63) or without (n = 57) dysphagia symptoms according to their clinical evaluation. Finally, the data of these three groups were compared. RESULTS: In comparison with healthy subjects, the swallowing evaluated by all diagnostic methods were affected in patients with PD. This effect was greater in patients with clinically symptomatic dysphagia. No difference was found between patients without dysphagia symptoms and healthy controls based on clinic, endoscopic and some electrophysiologic methods. Interestingly, thickness of all oral phase muscles in healthy controls were significantly higher than both dysphagic and non-dysphagic PD patients according to ultrasonography. CONCLUSION: Although it is widely known that dysphagia symptoms in patients with PD usually occur in advanced stages and cause serious problems for patients, the present study establishes that swallowing functions may have been affected in early stage patients without dysphagia symptoms. Assessment of swallowing functions is important and should be also assessed in patients without dysphagia symptoms. Moreover, ultrasonographic method may be used in the diagnosis and follow-up of patients with PD.