Evaluation of the effectiveness of caudal epidural steroid injection as an adjuvant to ganglion impar pulsed radiofrequency therapy in chronic coccygodynia.

Background: This study aimed to evaluate the effectiveness of adding caudal epidural steroid injection (CESI) to ganglion impar pulsed radiofrequency (GI-PRF) therapy in patients with refractory chronic coccygodynia, and to determine the effect of pain duration and trauma on treatment success. Materials and methods: Forty patients who underwent GI-PRF (n = 20) or GI-PRF + CESI (n = 20) were retrospectively assessed for age, gender, pain duration, history of trauma to the coccyx, Numerical Rating Scale (NRS) pain scores pre-procedure and 1, 3, and 6 months post-procedure and satisfaction rates at 6 months post-procedure. Satisfaction was categorized as excellent, high, moderate, and low. Results: In both groups, NRS scores were significantly decreased at 6 months (pre-vs. 6 mo. post-procedure: GI-PRF [8 vs. 5], GI-PRF + CESI [8.5 vs. 3.5]; p < 0.001). The proportion of patients reporting excellent satisfaction was significantly higher in the GI PRF + CESI group (50 % vs. 15 %; p < 0.05). Patients with trauma history in the GI-PRF + CESI group had significantly lower median NRS values at 6 months compared to patients in both groups with negative trauma history (p < 0.02). Within the GI-PRF only group, patients with trauma history had significantly lower NRS scores at 6 months than those without a history of trauma (p = 0.012). Pain duration did not significantly impact satisfaction levels (p = 0.055). Conclusion: GI-PRF therapy was effective in coccygodynia, especially in patients with positive trauma history, and adjuvant CESI increased patient satisfaction by providing better pain control.

The effect of consecutive facet medial branch radiofrequency denervation and dorsal root ganglion pulse radiofrequency therapy on lumbar facet joint pain.

OBJECTIVES: The aim of this study was to evaluate the efficacy of consecutive facet medial branch (FMB) radiofrequency denervation (RFD) and dorsal root ganglion pulse radiofrequency (DRG PRF) therapy in patients with chronic lumbar facet joint pain. METHODS: The study included 27 patients with chronic lumbar pain who had ≥50% pain reduction after FMB block for suspected lumbar facet syndrome and subsequently underwent FMB RFD together with PRF to the adjacent DRG. The patients were retrospectively analyzed in terms of age, gender, pre-procedure symptom duration, history of previous back surgery, FMB RFD and DRG PRF level and side, and numerical rating scale scores immediately before and at 1, 3, and 6 months after the procedure, and subjective pain reduction at 6 months post-treatment. Treatment success was defined as ≥50% subjective pain reduction at 6 months. RESULTS: A total of 19 women and 8 men with a mean age of 57.7±12.4 years were analyzed. Twenty patients (74.1%) had no prior history of low back surgery. The success rate of the procedure in terms of subjective pain reduction at 6 months was 82.5% (n=25). The subjective percentage of pain reduction at post-procedure 6 months was significantly lower in patients with a pre-procedure symptom duration of 12 months or longer compared to those whose pre-procedure symptom duration was <12 months (p=0.04). CONCLUSION: Our study results show that the analgesic efficiency of DRG PRF added to FMD RFD treatment can be increased in patients with short symptom durations.

Multimodal Analgesia in Pediatric Cancer Pain Management: A Retrospective Single-Center Study.

Objectives A multimodal approach to pain management, including potential interventional techniques, is suggested to achieve adequate pain control. This study discusses the techniques and medications employed to manage pain in pediatric oncology patients. Methodology This study included 90 patients under 18 years of age who underwent pain management in the algology clinic between 2002 and 2020. From the algology follow-up records, the following data were recorded: demographic information, follow-up time, cancer diagnosis and stage, cause and location of pain, systems involved, duration and intensity of pain, analgesic and adjuvant drugs prescribed, routes and duration of drug administration, complications, interventional procedures if performed, "pain intensity" scores prior to and following treatment, and daily and total analgesic consumption of the patients. Results The mean age was 11.4±4.1 years (min-max: 2-17). Leukemia and lymphoma were the most frequently diagnosed (30%). Of the 31 features identified in the staging, 27 (87.1%) were stage 4 at admission. The causes of pain in children were neoplasms in 81.2% (n = 73). At admission, 72.3% (n = 65) had severe pain for at least a month. It was determined that 90% (n = 81) of the patients were using opioids and 28.9% (n = 26) were using dual opioids. The mean tramadol dose was 129.0±97.9 mg/day (12-380 mg/day), and the mean morphine dose was 14.8±11.3 mg/day (1-52 mg/day). The mean transdermal fentanyl dose was 33.2±21.6 µgr/h (12-75 µgr/h). Adjuvant therapy was administered in 25.6% (n = 24) of the patients. Epidural catheterization was performed on 6.6% (n = 6) of the patients. The mean initial pain scores were 5.2±1.7, which decreased to 1.5±0.7 with a significant difference (p < 0.001). In the study, 93% (n = 84) of the patients had no pain management complications noted. Conclusions The pain level that pediatric cancer patients endure critically influences their and their family's quality of life. The fact that opioid-related adverse effects associated with pediatric pain management occur far less frequently than previously thought may help prevent opiophobia. Effective and safe analgesia can be provided with multimodal analgesia to manage pediatric cancer pain.

Awareness of Postdural Puncture Headache Among Specialists who Perform Lumbar Punctures and/or Monitor Patients Following the Procedure.

Objective: Lumbar puncture (LP) is performed by specialists in different branches of medicine, complications may be encountered in various settings. In our study, we evaluated the awareness and knowledge of the diagnosis and treatment of post-dural puncture headache (PDPH) among specialists who performed LP and/or encountered complications. Methods: This was a prospective questionnaire/scale study of 253 physicians: LP performers (anaesthesiologists, Group A; others, Group B) and those who worked in departments that did not perform LP but frequently encountered complications following LP (Group C). The questionnaire assessed specialization, frequency of LPs utilization, needle types used, positions employed, awareness of LP complications, diagnosis, management, and risk factors for PDPH. Results: Group A had the highest percentage of physicians who stated they had knowledge about PDPH (Group A: 96.4%, Group B: 77.3%, Group C: 39.4%; P=0.000). Group C was found to be statistically less informed than the other two groups (P=0.000). It was determined that only one (1%) physician from Group C correctly answered the question about the diagnostic criteria for PDPH. Conclusion: To our knowledge this is the first study in which the awareness of PDPH has been compared according to physicians' fields of specialisation. We believe that post-specialty training programs should be organized for physicians who will either perform LP or monitor patients who have undergone LP, and the curriculum content in relevant specialties should be reviewed.

The effect of postdural puncture headache on pre-existing and new-onset headaches after cesarean section: A retrospective study.

Background: Obstetric patients are at higher risk of postdural puncture headache (PDPH) than other age- and sex-matched individuals. The debate over the long-term effects of PDPH continues. In this study, we aimed to assess the development of new-onset headaches or worsening of pre-existing chronic headaches in patients who underwent cesarean section under spinal anesthesia and developed PDPH. Methods: Forty patients who developed PDPH (Group P) after cesarean section surgery (post-cesarean section-PCS), 80 patients who underwent cesarean section under spinal anesthesia (Group S), and 80 patients who underwent cesarean section under general anesthesia (Group G) were evaluated in the study. Chronic headache and other related symptoms that were present before pregnancy (pre-gestational-PG) and within 12 months after cesarean section were assessed. Results: Eight of the 40 patients in Group P had a new-onset chronic headache after cesarean surgery, which was significantly higher than the rates in the other groups (p = 0.001). Of the patients whose pre-existing headache worsened during the PCS period, seven were in Group P, and four were in Group S (p = 0.020), while none was in Group G. According to the multiple logistic regression analysis, the risk of worsening headache increased by 1.51-fold for every 1 unit increase in the PG Numerical Rating Scale (NRS). Conclusion: In conclusion, patients who develop PDPH appear to be at higher risk of developing new-onset headaches or worsening of pre-existing headaches compared with those who do not. We believe that keeping a headache diary for patients who will undergo dural puncture for whatever purpose, and also long-term follow-up of these patients for the risk of chronic headaches may increase awareness of this issue.

Attitude changes toward chronic pain management of pain physicians in Turkey during the COVID-19 pandemic.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has led to a decrease or interruption of outpatient and elective interventional procedures of patients with chronic pain worldwide. This study aims to investigate the attitude changes of pain physicians in Turkey in the treatment of chronic pain patients and the compliance of these changes with the published guidelines. METHODS: A total of 113 pain physicians were sent an online questionnaire forms to be completed voluntarily. RESULTS: The questionnaire was completed by 61% (n=69) of the total physicians to whom it was sent to. The rate of physicians who did not request the COVID-19 polymerase chain reaction test from their patients before any interventional procedure was 48% (n=33). The rate of physicians who ignored the immunosuppressive effect and while prescribing opioids and did not reduce the opioid dose was 42% (n=29). The rate of physicians who did not reduce the corticosteroid dose they used in their interventional procedures was 61% (n=42). It was determined that 49.1% (n=28) of physicians who applied facet joint medial branch radiofrequency denervation (RFD) during the pandemic period decreased the number of diagnostic blocks they ap-plied compared to the pre-pandemic period. It was found that 51% (n=24) of the physicians who applied genicular nerve RFD during this period did not perform any diagnostic blocks. CONCLUSION: It was found that the majority of physicians did not change their preferences in the dose and/or type of opioid and corticosteroid drugs, but they tended to reduce the number of diagnostic blocks they applied before facet joint medial branch/genicular RFD procedures.

Intraoperative pectoral block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: A randomized controlled trial.

BACKGROUND AND METHODS: With the increasing rate of breast cancer surgery, the pain management of these patients gains importance. The aim of this study is to compare the ultrasound (US) guided thoracic paravertebral block (TPV) versus intraoperative pectoral nerve block (PECS) with a low volume local anaesthetic for postoperative analgesia after breast cancer surgery. A total of 41 patients underwent mastectomy and sentinel lymph node biopsy or modified radical mastectomy were included in this randomized controlled, single-blinded trial. The patients were divided into two groups as PECS and TPV blocks. In the PECS group, 10 ml of 0.5% bupivacaine was administered to the fascial plane by the surgeon. In the TPV group, 25 ml of 0.25% bupivacaine at T3 level was administered by the anaesthetist under US-guidance. Visual analogue scale (VAS) scores and additional analgesic requirements were recorded at postoperative 0, 6, 12, 24 and 48 h. RESULTS: In the TPV group, mean VAS score (VAS0) was significantly lower (p ˂ 0.001). In other time periods, there was no significant difference between the groups. CONCLUSIONS: It was observed that intraoperative PECS block was as effective as TPV in providing postoperative analgesia and additional analgesic requirements were similar. This result suggests PECS block may be a good alternative to TPV.

Comparison of the suprainguinal fascia iliaca compartment block with continuous epidural analgesia in patients undergoing hip surgeries: a retrospective study.

BACKGROUND AND OBJECTIVE: Pain control is one of the major concerns after major hip surgeries. Suprainguinal fascia iliaca compartment block (S-FICB) is an alternative analgesic technique that can be considered as an effective and less invasive method than epidural analgesia (EA). In this retrospective study, we compared postoperative analgesic efficacy of single shot ultrasound guided S-FICB and EA after major hip surgery. METHODS: We retrospectively examined 150 patients who underwent major hip surgeries and who received S-FICB or EA. Seventy-two patients submitted to EA and 78 patients who received S-FICB were included and their medical records retrospectively reviewed. Morphine consumptions, VAS scores, and side effects were recorded. Patients under antiplatelet or anticoagulant theraphy were also registered. Morphine consumption and VAS scores were the primary endpoints, succes rate and complications were the secondary endpoints of our study. P-values less than 0.05 were considered statistically significant. RESULTS: Morphine consumption was lower at the emergence in the EA group but there was no statistically significant difference between the two groups according to total opioid consumption (0 [0-0] vs 0 [0-0]; p = 0.52). There was no difference between VAS scores in the first 18 hours. Hypotension was significantly higher in the EA group (9 vs 21; p = 0.04). CONCLUSION: In conclusion, S-FICB can provide comparable analgesia with EA in the early postoperative period after hip surgery but VAS scores were found lower in the EA group than S-FICB group after 18th hour. Hypotension has occured more frequently in patients receiving EA.

Is regression of catheter-related epidural granuloma possible? A case report.

Epidural granuloma may develop as a complication during long-term use of intrathecal analgesics. To the best of our knowledge, it is not mentioned in the current literature that discontinuation of therapy may cause a regression of epidural granulation and clinical symptoms. In this case, we aimed to present spontaneous regression of epidural granuloma within 2 months after removal of epidural port.

Effects of Major Ozone Autohemotherapy on Physical Functionality and Quality of Life in Fibromyalgia Syndrome: A Prospective Cross-sectional Study.

CONTEXT: No specific treatment exists for fibromyalgia syndrome (FMS), and usually patients continue to experience pain indefinitely and their quality of life decreases. Major ozone autohemotherapy (MAH) is a complementary treatment for FMS that stimulates the body's antioxidant system. OBJECTIVE: This study aims to prospectively evaluate the effects of MAH on pain, quality of life, and general health status in FMS. DESIGN: The research team designed a prospective cross-sectional study. SETTING: The study took place at the algology clinic at Mersin University in Yenisehir, Mersin, Turkey. PARTICIPANTS: Participants were 40 patients with FMS, aged 18 to 65, who were admitted to the clinic between February 15 and August 15, 2019. INTERVENTION: Participants completed 13 sessions of major ozone autohemotherapy (MAH), two sessions per week in the first five weeks and one session per month for the remaining three months. In the following three months, the last administered dose was repeated. OUTCOME MEASURES: Patients completed the Fibromyalgia Impact Questionnaire (FIQ) and the Quality of Life-short form (SF-36), at baseline (PRE), at five weeks after 10 sessions of MAH (PT), at 9 weeks after 11 sessions (PT1), and postintervention at 17 weeks after 13 sessions (PT3). RESULTS: Significant improvement in FIQ and SF-36 scores was observed in all periods compared to the previous period (P < .05). Between two consecutive measurements the most prominent improvements in both FIQ scores (P < .001) and SF-36 scores was observed between baseline and the PT period (P < .001). Significant improvement also occurred in all SF36 subscale scores between PT and PT3 (P ≤ .02). CONCLUSIONS: The study was the first to demonstrate the efficacy of MAH for fibromyalgia patients as found using FIQ and SF-36 questionnaires repeated at certain intervals. The study found that MAH provided improvements in quality of life and general health status for FMS patients.

The effect of ultrasound-guided serratus anterior plane block in addition to intrathecal morphine on early postoperative period after video-assisted thoracoscopic surgery.

BACKGROUND: The aim of this study was to evaluate the effect of serratus anterior plane block in addition to intrathecal morphine for early postoperative period after video-assisted thoracoscopic surgery on the amount of morphine consumption and the Visual Analog Scale scores. METHODS: This single-blind, randomized-controlled study included a total of 64 patients (39 males, 25 females; mean age: 53.6±17.0 years; range, 20 to 89 years) who were scheduled for video-assisted thoracoscopic surgery in a tertiary hospital between September 2019 and March 2020. Postoperative pain control was achieved with intrathecal morphine 0.6 mg addition to serratus anterior plane block (Group ITM+SAPB) or with only intrathecal morphine (Group ITM) after an induction of anesthesia. The serratus anterior plane block was performed with a single injection of 0.4 mL/kg of 0.25% bupivacaine at the level of fifth rib with ultrasound guidance. Morphine consumption, pain scores, and side effects were recorded in the postoperative period. RESULTS: The mean morphine consumption was significantly lower in the ITM+SAPB group at all time points. Compared to the control group, the Visual Analog Scale-resting and coughing scores were significantly lower in the first 12 h after surgery. Pain scores were significantly higher in the ITM+SAPB group in patients where the trocar was inserted at upper level of the fifth rib than the lower level (3-5 vs. 5-8) during the first 6 h after surgery. CONCLUSION: The use of serratus anterior plane block in addition to intrathecal morphine is a safe and effective way to improve pain control for early postoperative period after video-assisted thoracoscopic surgery. The serratus anterior plane block ensures better analgesia until the peak effect of spinal morphine occurs.