Indications and Future Perspectives of a Minimally Invasive Ultrasound-guided Double-needle Joint Lavage.

Arthroscopic joint lavage was proposed as a treatment option for different joint conditions such as septic or inflammatory arthritis. Ultrasound (US) is today considered a fundamental tool in musculoskeletal diseases as for diagnostic and guide for interventional procedures such as synovial fluid sampling and drug injections. To enable faster recovery and to have an alternative to surgery, to reduce risks and costs, we performed an US-guided double-needle lavage of the shoulder joint. Here, we present two different clinical cases, the first with septic arthritis and the second with recalcitrant gouty arthritis, successfully treated with this technique.

Superficial peroneal nerve entrapment neuropathy and role of pulsed radiofrequency neuromodulation.

Peripheral neuropathy secondary to entrapment of the nerves is not an uncommon etiology. Nerve entrapment is a common occurrence following trauma or surgery and poses significant diagnostic challenge. Entrapment neuropathy (EN) may not respond to standard neuropathic medication and may need invasive treatment. Pulsed radiofrequency (PRF) application is a recent modality and is gaining popularity for many EN as it does not cause neural ablation unlike conventional radiofrequency ablation. In this report, we present a case of young patient who presented with severe lower lateral leg pain in whom superficial peroneal nerve (SPN) EN was suspected and diagnostic SPN injection under ultrasound guidance confirmed the diagnosis. He subsequently underwent PRF neuromodulation and experienced long-lasting pain relief.

Beyond the Pericapsular Nerve Group (PENG) Block: A Narrative Review.

The pericapsular nerve group block shows promising results in providing pain relief with a potential motor-sparing effect in hip fracture patients. In this narrative review, we analyze the published articles, and we describe the structures achieved when performing the block. We conducted a literature search to identify the articles performing the pericapsular nerve group block, in the adult or paediatric population, from November 1, 2018, to May 15, 2021. Of the 68 selected articles, 38 were considered eligible, including 1 double-blinded randomized comparative trial, 4 observational studies, and 33 case series and case reports. The technique was described in both acute and chronic pain settings, mainly performed as single shot. All studies described effective analgesia. Quadriceps weakness was experienced in some patients. It has been described as easy to perform and has a low rate of complications. It lacks, however, adequately powered randomized controlled trials to assess its clinical value and efficacy.

Cryoneurolysis of Innervation to Sacroiliac Joints: Technical Description and Initial Results-A Case Series.

The sacroiliac joint (SIJ) is a common source of pain in patients with low back pain. Untreated pain from the SIJ can lead to prolonged discomfort and financial burden. Interventional treatments for SIJ-related pain include intraarticular steroid injection and radiofrequency ablation but both procedures provide pain relief for a limited duration. Cryoneurolysis is another neuroablative technique that is effective in various chronic pain conditions. However, there is no clear description of SIJ cryoneurolysis in the published literature. In this report, we present 5 patients with SIJ-related pain and we describe the ultrasound-guided SIJ cryoneurolysis technique and its analgesic efficacy.

Ultrasound-Guided Hydrodissection for Baxter's Neuropathy Secondary to Plantar Fasciitis: A Case Report.

Plantar heel pain is a common pain condition encountered in clinical practice. The common etiologies include plantar fasciitis, calcaneal spur, calcaneus stress fracture, systemic causes, and trauma. Neurogenic causes, including entrapment at the tarsal tunnel or Baxter's nerve entrapment, can contribute to the heel pain and should not be overlooked. In this case report, we describe a patient with severe heel pain, presenting with overlapping features of plantar fasciitis and neuropathic pain. Magnetic resonance imaging suggested Baxter's nerve entrapment, and a subsequent ultrasound-guided hydrodissection of Baxter's nerve provided long-lasting pain relief.

Genicular nerve block for postoperative pain relief after total knee replacement.

There are several modalities described to manage postoperative pain after a total knee replacement (TKR). Presently the regional anaesthesia techniques used after TKR focus on more peripheral, motor sparing blocks so as to facilitate early ambulation along with good quality pain relief. We describe use of ultrasound guided 3 point genicular nerve block (GNB) for managing postoperative pain successfully after a TKR.

Ultrasound Guided Transversus Abdominis Plane Block for Anterior Cutaneous Nerve Entrapment Syndrome.

Anterior cutaneous nerve entrapment syndrome (ACNES) is one the most common cause of chronic abdominal wall pain. The syndrome is mostly misdiagnosed, treated wrongly and inadequately. If diagnosed correctly by history, examination and a positive carnett test, the suffering of the patient can be relieved by addressing the cause i.e. local anaesthetic with steroid injection at the entrapment site. Conventionally, the injection is done by landmark technique. In this report, we have described 2 patients who were diagnosed with ACNES who were offered ultrasound guided transverses abdominis plane (TAP) injection who got significant pain relief for a long duration of time.

Electrocardiographic changes after lung resection: Case report and brief review.

The incidence of acute coronary syndrome after a lung resection is less, especially in an asymptomatic patient. However, arrhythmias are very commonly encountered which can be benign or may require anti-arrhythmic agents thereby increasing stay postoperatively in the Intensive Care Unit. We encountered unexpected ST-T changes after a left upper lobectomy under general anesthesia in a 60-year-old lady in the immediate postoperative period that made us to review the literature for electrocardiographic abnormalities after lung resection surgeries.

Anaesthetic consideration in patients with Gorham's syndrome: A case report and review of the literature.

Gorham's syndrome (GS) is a rare disorder characterized by proliferation of vascular channels resulting in destruction and resorption of osseous matrix leading to bone loss. Bone loss leads to joint instability and problems during airway management and positioning for surgery. Respiratory involvement further complicates anaesthesia management. We report the anaesthetic care of a 21-year-old male patient of known GS for spine decompression and fusion in prone position. Airway management, induction technique, pathophysiology of the disease, drug selection and other concerns of anaesthesia for major spine surgery has been discussed reviewing the sparse literature available.