A Comparative Study of Endoscopic versus Percutaneous Epidural Neuroplasty in Lower Back Pain: Outcomes at Six-Month Follow Up.

Background and Objectives: Endoscopic epidural neuroplasty (EEN) facilitates adhesiolysis through direct epiduroscopic visualization, offering more precise neural decompression than that exhibited by percutaneous epidural neuroplasty (PEN). We aimed to compare the effects of EEN and PEN for 6 months after treatment with lower back and radicular pain in patients. Methods: This retrospective study compared the visual analog scale (VAS) and Oswestry disability index (ODI) scores in patients with low back and radicular pain who underwent EEN or PEN with a steering catheter. The medical records of 107 patients were analyzed, with 73 and 34 undergoing EEN and PEN, respectively. Results: The VAS and ODI scores decreased at all time points after EEN and PEN. VAS and ODI scores decreased more in the EEN group than those in the PEN group at 1 day and 1- and 6-months post-procedure, indicating superior pain relief for both lower back and radicular pain through EEN. Conclusions: EEN is a superior treatment of pain control than PEN in lower back and radicular pain patients.

Association of age-related hearing loss, tinnitus, and chronic low back pain in middle-aged and older Korean adults.

This was a cross-sectional study conducted to evaluate the association between hearing impairment and low back pain (LBP) using data from the Korean National Health and Nutrition Examination Survey. A total of 5,504 middle-aged and older Korean adults (aged ≥50 years old) who underwent plain radiography of the lumbar spine and pure tone audiometry were included. The presence of LBP was evaluated using a questionnaire, which included a question on whether the patient had experienced LBP that lasted for more than 30 days during the past three months. Patients with age-related hearing loss (ARHL) were defined as those with bilateral hearing impairment who met the following criteria: 1) normal otologic examination results, 2) average pure-tone hearing thresholds of ≤15 dB in both ears, and 3) no occupational noise exposure. Multivariable logistic regression analysis showed that ARHL was not associated with LBP (odds ratio, 1.33; 95% CI, 0.94-1.89) after adjusting for potential confounders in the final model. However, when participants without both ARHL and tinnitus were defined as the reference group, the results showed that the participants with both ARHL and tinnitus were more likely to have LBP (OR, 1.86; 95% CI, 1.11-3.11). These results indicate that ARHL with tinnitus is significantly associated with LBP. We recommend that elderly patients with ARHL and tinnitus increase their daily physical activities and engage in more muscle-strengthening exercises to prevent LBP.

Comparison of the McGRATHTM Video Laryngoscope and Macintosh Laryngoscope for Orotracheal Intubation in a Simulated Difficult Airway Scenario: An Open-Label, Randomized Clinical Trial.

Background and Objectives: Difficult intubation, which may be encountered unexpectedly during anesthesia, can increase patients' morbidity and mortality. The McGRATH video laryngoscope is known to provide improved laryngeal visibility in patients with difficult or normal airways. The purpose of this study was to evaluate the efficacy of the McGRATH video laryngoscope for orotracheal intubation compared with that of conventional Macintosh laryngoscopes in simulated difficult airway scenarios. Materials and Methods: In this randomized controlled trial, patients who were scheduled for surgery under general anesthesia requiring orotracheal intubation were assigned to the Macintosh laryngoscope (n = 50) or McGRATH video laryngoscope (n = 45) groups. In this study, to create a simulated difficult airway condition, the subjects performed manual in-line stabilization and applied a soft cervical collar. The primary outcome was the rate of successful intubation within 30 s. The time required for an intubation, glottis grade, intubation difficulty scale (IDS score), the subjective ease of intubation, and optimal external laryngeal manipulation (OLEM) were evaluated. In addition, complications caused by each blade were investigated. Results: The intubation success rate within 30 s was not significantly different between the two groups (44 (88.0%) vs. 36 (80.0%), p = 0.286). The glottic grade was better in the McGRATH group than in the Macintosh group (p = 0.029), but neither the intubation time (26.3 ± 8.2 s vs. 24.2 ± 5.0 s, p = 0.134) nor the rates of oral bleeding (2 (4.0%) vs. 0 (0.0%)) and tooth injury (0 (0.0%) vs. 1 (2.2%)) were significantly different between the two groups. Conclusions: The use of the McGRATH video laryngoscope did not improve the intubation success rate or shorten the intubation time. However, the McGRATH video laryngoscope provided a better glottis view than the conventional Macintosh laryngoscope in patients with a simulated difficult airway.

Comparison of Temperature and Pain Changes between the Drip and Topical Methods of Administering the Transnasal Sphenopalatine Ganglion Block.

The objective of this study was to compare facial temperatures and the visual analogue scale (VAS) between the drip method and the topical method of transnasal sphenopalatine ganglion block (SPGB). The transnasal SPGB is administered to patients with facial or head and neck pain. In the transnasal approach, the drip and topical methods are frequently used. We compared facial temperatures and VAS after transnasal SPGB. Medical records of 74 patients who visited the pain clinic and underwent transnasal SPGB were retrospectively reviewed. A total of 156 transnasal SPGB were performed. The patients were divided into the drip-method and topical-method groups. Facial temperatures were measured in six areas of the right and left forehead, maxilla, and mandible before and 30 min after completion of the transnasal SPGB. Temperatures were compared before and 30 min after SPGB in each group and between the two groups. VAS scores were compared at the same times of SPGB in each group and between the two groups. In the drip-method group, there were significant increases at four areas of the face in temperature changes at 30 min after SPGB. In the topical-method group, there was no significant difference in the temperature changes at 30 min after SPGB. There were statistically significant differences in the facial temperature changes between the two groups in the right forehead (p = 0.001), left forehead (p = 0.015), and right maxillary area (p = 0.046). In herpes zoster, there were statistically significant differences in the VAS scores between before and 30 min after SPGB in both groups (p < 0.001, p = 0.008) and between two groups (p < 0.001). In migraine, there were statistically significant differences in VAS scores between before and 30 min after SPGB in both groups (p < 0.001, p = 0.004) and between two groups (p = 0.014). Transnasal SPGB using two methods showed different temperature changes and VAS scores.

Association between Dietary Protein Intake, Regular Exercise, and Low Back Pain among Middle-Aged and Older Korean Adults without Osteoarthritis of the Lumbar Spine.

This study aimed to evaluate the effect of dietary protein intake and regular exercise on low back pain (LBP) using data from the Korea National Health and Nutrition Examination Survey. A total of 2367 middle-aged and older adults (≥50 years) who underwent dual-energy X-ray absorptiometry and plain radiography of the lumbar spine were included. LBP was defined using a questionnaire to determine the presence of LBP lasting more than 30 days in the preceding three months. Twenty-four-hour dietary recall data were used to estimate protein intake, and regular exercise was assessed using the International Physical Activity Questionnaire. Multivariable logistic regression analysis revealed that men who did not perform regular exercise had a high probability of LBP (odds ratio [OR] 2.34; 95% confidence interval [CI] 1.24−4.44). Low protein intake (<0.8 g/kg/day) was associated with high odds for LBP in women (OR 1.83; 95% CI 1.12−2.99). Low protein intake and lack of regular exercise were also associated with a higher probability of LBP in women (OR 2.91; 95% CI 1.48−5.72). We recommend that women over 50 years of age consume the recommended daily amount of protein to prevent LBP and engage in regular exercise.

Efficacy of the bispectral index and Observer's Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial.

OBJECTIVE: The bispectral index (BIS) has been used to monitor sedation during spinal anesthesia. We evaluated the correlation between BIS and the Observer's Assessment of Alertness/Sedation Scale (OAA/S) in patients sedated with dexmedetomidine, propofol, or midazolam. METHODS: This prospective, randomized study included 46 patients scheduled for knee arthroplasty under spinal anesthesia with sedation. The patients were randomized to receive sedation with dexmedetomidine (n = 15), propofol (n = 15), or midazolam (n = 16). Correlation between BIS and OAA/S was assessed during sedation in the three groups. RESULTS: A linear correlation was observed between BIS and OAA/S, and there was no significant difference in BIS score between the groups during mild to moderate sedation status (OAA/S 3-5). During deep sedation (OAA/S 1-2), the BIS score in the midazolam group was significantly higher than that in the propofol and dexmedetomidine groups (74.4 ± 11.9 vs 67.7 ± 9.5 vs 62.6 ± 12.2). CONCLUSIONS: BIS values differed at the same level of sedation between different sedative agents. Objective sedation scores should therefore be used in combination with BIS values for the assessment of sedation levels during spinal anesthesia.

A Novel Application of Buprenorphine Transdermal Patch to Relieve Pain in the Knee Joint of Knee Osteoarthritis Patients: A Retrospective Case-Control Study.

Osteoarthritis (OA) is considered to be one of the most disabling diseases. The intra-articular opioid injection has been widely studied for its simplicity, safety, and efficacy in OA. In this study, however, we suggest a novel method of buprenorphine transdermal patch (BTDP) to painful knee joints of OA patients, instead of intra-articular opioid injection, and subsequently compared the knee application with conventional chest application. We retrospectively enrolled 213 patients with knee OA who did not respond to conventional therapy. The Numeric Rating Scale (NRS), adverse effects, and compliance were recorded before and after the application of the BTDP. All parameters were compared between the knee applied group and the chest applied group. After the BTDP application, the NRS score in the knee applied group was lower than that of the chest applied group (p = 0.007). NRS scores after buprenorphine patch decreased to 2.21 ± 0.77, and 2.55 ± 0.71 in the chest applied group and the knee applied group, respectively. The adverse effects were 19.32% in the knee applied group, and 64.00% in the chest applied group. The compliances were 82.95% and 37.60% in the knee applied group and chest applied group, respectively. This novel application of BTDP directly to the painful knee joint of knee OA patients led to a decrease in the NRS score, adverse effects, and an increase in compliance compared with the chest application method.

Early postoperative delirium after hemiarthroplasty in elderly patients aged over 70 years with displaced femoral neck fracture.

PURPOSE: Postoperative delirium is a risk factor for worse outcome after hip fracture surgery in elderly patients. Postoperative delirium is associated with anesthesia, postoperative pain, and patient factors. We investigated the incidence, predictors, and prognostic implications of post-operative delirium after hemiarthroplasty (HA) in elderly patients with femoral neck fracture. PATIENTS AND METHODS: A total of 356 consecutive patients aged >70 years who underwent HA for femoral neck fracture were enrolled. Diagnosis of delirium was made by a psychiatrist based on patient status and an objective scoring system. The patients were divided into 2 categories according to the HA onset time (immediate [≤24 h after surgery] vs delayed delirium [>24 h after surgery]) and its incidence, predictors and mortality were evaluated. RESULTS: Postoperative delirium was diagnosed in 110 patients (30.9%) during hospitalization. Immediate and delayed delirium occurred in 59 (53.6%), and 51 (46.4%) patients, respectively. The independent predictors of immediate delirium included age (odds ratio [OR] 1.47, 95% CI 0.98-2.23, p=0.066), and general anesthesia (OR 2.25, 95% CI 1.17-4.43, p=0.015). The independent predictors of delayed delirium were parkinsonism (OR 5.75, 95% CI 1.66-19.96, p=0.006), intensive care unit stay (OR 1.85, 95% CI 0.97-3.56, p=0.064), and higher American Society of Anesthesiologists grade (OR 2.33, 95% CI 0.90-6.07, p=0.083). On Kaplan-Meier survival analysis, the 2-year survival rate was significantly lower in the immediate delirium group than those in the delayed and control groups (71.0% vs 83.6% vs 87.8%, respectively; p=0.031). CONCLUSION: Immediate and delayed delirium after HA for femoral neck fracture had different predictors and immediate delirium was associated with worse prognosis.

Ultrasonography-guided pulsed radiofrequency of sciatic nerve for the treatment of complex regional pain syndrome Type II.

Although the major mechanism of complex regional pain syndrome (CRPS) involves dysfunctional central or sympathetic nervous system activation, the peripheral nervous system also contributes significantly to its clinical manifestations. Pulsed radiofrequency (PRF) is a recently developed treatment option for neuropathic pain syndromes. Here, we report a case of CRPS Type II after a femur fracture and sciatic nerve injury, in which the pain was treated successfully with ultrasonography-guided selective sciatic nerve PRF application.

Effects of remifentanil and remifentanil-alfentanil administration on emergence agitation after brief ophthalmic surgery in children.

BACKGROUND: Sevoflurane is commonly usedin pediatric anesthesia due to its non-irritating airway properties, and rapid induction and emergence. However, it is associated with emergence agitation (EA) in children. EA may cause injury to the child or damage to the surgical site and is a cause of stress to both caregivers and families. The efficacy of remifentanil and additional alfentanil on EA in the pediatric patients underwent ophthalmic surgery with sevofluraneanesthesiawas not well evaluated to date. This study was designed to compare the effects of remifentanil and remifentanil plus alfentanil on EA in children undergoing ophthalmic surgery with sevofluraneanesthesia. METHODS: Children (aged 3-9 years) undergoing ophthalmic surgery undersevoflurane anesthesia were randomly assigned to group S (sevoflurane alone), group R (sevofluraneandremifentanil infusion, 0.1 µg/kg/min), or group RA (sevoflurane withremifentanil infusion and intravenous injection of alfentanil 5 µg/kg 10 min before the end of surgery). Mean arterial pressure (MAP), heart rate (HR), and sevoflurane concentration were checked every 15 min after induction of anesthesia. The incidence of EA, time to extubation from discontinuation of sevoflurane inhalation, and time to discharge from the postanesthesia care unit was assessed. RESULTS: The incidence of EA was significantly lower in groups R (32 %, 11/34; P = 0.01) and RA (31 %, 11/35; P = 0.008) than group S (64 %, 21/33). The time to extubation was prolonged in group RA (11.2 ± 2.3 min; P = 0.004 and P = 0.016) compared with groups S (9.2 ± 2.3 min) andR (9.5 ± 2.4 min). MAP and HR were similar in all three groups, apart from a reduction in HR at 45 min in groups R and RA. However, the sevoflurane concentration was lower in groups R and RA than group S (P < 0.001). CONCLUSIONS: The administration of remifentanil to children undergoing ophthalmic surgery undersevoflurane anesthesia reduced the incidence of EA without clinically significant hemodynamic changes. However, the addition of alfentanil(5 µg/kg)10 min before the end of surgery provided no additional benefit compared withremifentanil alone. CLINICAL TRIAL NUMBER: NCT02486926 , June.29.2015.

Distribution range of cervical interlaminar epidural injections: a comparative study with 2.5 mL, 5 mL, and 10 mL of contrast.

BACKGROUND: Cervical interlaminar epidural injection (CIEI) is widely used in the management of acute or chronic neck and upper extremity pain. There is no consensus regarding the optimal volume of solution to be used for CIEI. STUDY DESIGN: Randomized, double blind controlled trial. OBJECTIVE: The purpose of this study was to evaluate how many spinal segments would be covered with different volumes of contrast medium, given by fluoroscopically guided CIEI, in efforts to establish the optimal volume of medication with consideration of clinical pathologic lesions. METHODS: One hundred and twenty-six CIEI were performed at C7-T1 in 133 patients. All patients were divided into 3 groups (A, B, and C) according to the amount of contrast medium used: 2.5 mL for group A, 5 mL for group B, and 10 mL for group C. The extent of contrast medium spread was determined by anteroposterior and lateral view under fluoroscopy. LIMITATION: We did not evaluate the clinical outcomes with pain measurements during the study period. RESULTS: The total number of vertebral segments of contrast media spread and spreading range of caudad or cephalad were significantly different among the 3 groups (P < 0.001). However, groups B and C in cephalad spreading and groups A and B in caudad spreading did not show any significant difference. A proportion of the patients with a cephalad spread of up to C4 and C2 in group A (59.5% and 31%) was significantly different from that in the other 2 groups (92.9% and 69.1% in group B and 97.6% and 73.8% in group C) (P < 0.001). CONCLUSION: Five mL for CIEI at C7-T1 could be an optimal volume for distribution to the lower cervical spine for degenerative cervical spinal diseases, as well as to the upper cervical spine for head and facial pain.

Tongue bite in a patient with tracheostomy after prone position -A case report-.

A 22-year-old man underwent an operation for posterolateral fusion of the lumbar spine at L3-5. He was ventilated via a tracheostomy site in a prone position for 210 minutes. Ventilator function and eyeballs were checked periodically. After changing his position to supine for the wake-up test, it was noticed that his tongue was self-inflicted and looked to be cut unless immediate decompression was applied. After several manual attempts to open the mouth failed, anesthesia depth was deepened with thiopental sodium and neuromuscular blocker to decompress and reposition the tongue into the intraoral cavity. Minimal teeth marks and scarring remained after seven months without any complications.