U.S. cereal rye winter cover crop growth database.

Winter cover crop performance metrics (i.e., vegetative biomass quantity and quality) affect ecosystem services provisions, but they vary widely due to differences in agronomic practices, soil properties, and climate. Cereal rye (Secale cereale) is the most common winter cover crop in the United States due to its winter hardiness, low seed cost, and high biomass production. We compiled data on cereal rye winter cover crop performance metrics, agronomic practices, and soil properties across the eastern half of the United States. The dataset includes a total of 5,695 cereal rye biomass observations across 208 site-years between 2001-2022 and encompasses a wide range of agronomic, soils, and climate conditions. Cereal rye biomass values had a mean of 3,428 kg ha-1, a median of 2,458 kg ha-1, and a standard deviation of 3,163 kg ha-1. The data can be used for empirical analyses, to calibrate, validate, and evaluate process-based models, and to develop decision support tools for management and policy decisions.

Examining the care of noncommunicable diseases at the first level of providing services during the COVID-19 pandemic.

Aim: Providing services for patients with noncommunicable diseases is one of the main responsibilities of health systems. During the COVID-19 pandemic, the care of these patients faced problems. This study investigates the ways of providing optimal care to patients during pandemics like COVID-19. Subject and methods: This study was conducted in 2021 in Tehran province using an analytical cross-sectional method. Six hundred participants were selected for the study. In order to examine the challenges and solutions for receiving services, a questionnaire was completed and its reliability and validity were checked; finally, a telephone interview was completed over a period of 3 months. Results: Among study participants, 68.2% were female, and the highest percentage was in the age group of 50-60 years. Fifty-four percent were illiterate or had primary education, 48.8% had diabetes, 42.8% had high blood pressure, and 8.3% had both diseases. Forty-three percent of the interviewees had not used health care services during the COVID-19 pandemic, the main reason for which was the fear of contracting COVID-19. The outbreak of coronavirus disease had affected the care of noncommunicable diseases for 63% of the interviewees. Conclusion: The fundamental need for changes in the health system was revealed by the COVID-19 pandemic. The need for flexibility in the health system will inevitably arise when similar cases occur, and policymakers and managers should consider necessary measures in this regard. The use of new technologies is one of the ways to replace traditional models.

The use of alternative irrigation and cropping systems in forage production may alleviate the water scarcity in semi-arid regions.

BACKGROUND: Strategies to enhance the efficient use of irrigation water require a major shift in irrigation and cropping systems. It was hypothesized that (i) replacing water-demanding crops such as corn silage with more drought-tolerant forages species, (ii) adoption of intercropping instead of monoculture, and (iii) use of alternative irrigation methods, may alleviate the water shortage in semi-arid regions, while producing high-quality forage. RESULTS: Adoption of drip irrigation (DRIP) and alternate furrow irrigation (AFI) reduced water consumption by 43% and 20%, respectively. Additionally, DRIP produced 11% more biomass than the conventional furrow irrigation. The intercropped ratio of 50% sorghum and 50% amaranth under DRIP maximized forage production and improved irrigation water-use efficiency (IWUE). Principal component analysis indicated that the DRIP increased the dry matter yield and IWUE, whereas the AFI improved the forage quality. The intercropped ratio of 75% sorghum and 25% amaranth demonstrated the highest yield stability and was considered superior cropping system regardless of the irrigation strategies. CONCLUSIONS: DRIP and AFI strategies were effective in reducing water consumption, with DRIP being the most water-efficient method. Intercropping sorghum and amaranth at a ratio of 50:50 under DRIP resulted in the highest forage yield and IWUE. While sole amaranth had the highest forage quality, intercropping sorghum and amaranth increased dry matter production with better forage quality than sorghum monoculture. Overall, the combination of DRIP and intercropping sorghum and amaranth at a ratio of 50:50 considered as a suitable strategy for improving forage yield and quality, as well as IWUE. © 2023 Society of Chemical Industry.

Comparative Evaluation of Caudal Epidural Method to Ultrasound-Guided S1 Transforamen Block in Patient's Lumbar Discectomy with Failed Back Syndrome Symptoms: A Double-Blind Clinical Trial.

Background: Post-lumbar surgery syndrome (PLSS) refers to persistent or recurrent pain following spinal surgery with an unknown cause. It is commonly associated with epidural fibrosis (EF). Some studies suggest that epidural steroid injection (ESI) can effectively alleviate pain in PLSS, particularly when targeting the S1 nerve root using S1 transforaminal epidural steroid injection (S1-TFESI). A key factor in a successful block is accurately visualizing the first dorsal sacral foramen, and the needle's destination is the dorsal S1 foramen. Although S1-TFESI is often performed under fluoroscopy through the transforaminal route, an alternative to reduce radiation exposure is ultrasound guidance. This study aimed to compare the efficacy of ultrasound-guided caudal epidural steroid injection (CESI) and S1-TFESI in PLSS patients. Methods: A randomized double-blinded clinical trial was conducted involving 52 PLSS patients who were randomly assigned to either the CESI group or the S1-TFESI group. The patients were positioned prone. A linear transducer with a curve at a low frequency (2 - 5 MHz) was used to visualize the area. An aseptically prepared puncture site was used to insert a 2- to 5-MHz curved ultrasound probe with an ultrasound gel to identify the articular processes of the lower lumbar vertebrae and the posterior sacral surface. The probe was then positioned longitudinally to the para-sacral area, about 2 cm lateral to the midline. The articular process represented the L5/S1 level at the farthest caudal side, and the S1 posterior sacral foramen was represented by the concavity at the posterior sacral surface that was somewhat caudal. The probe was angled caudally to provide enough room for the needle to enter the S1 foramen. The injection site for the needle tip was the S1 foramen. A combination of triamcinolone (40 mg, 1 mL), normal saline (2 mL), and ropivacaine (0.2%) was administered. For TFS1 ESI, 5 mL of the combination was used. For CESI, the sacral hiatus was palpated in the prone position, and a linear high-frequency transducer was placed transversely to obtain a transverse view of the sacral hiatus. A combination of triamcinolone 40 mg and ropivacaine (0.2%) totaling 10 mL was employed. The Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) were used to assess patients' preoperative and postoperative conditions, and adverse events were recorded. Follow-up was conducted one week and one month after the procedures. Results: In both groups, NRS and ODI scores decreased at different time points after treatment, compared to baseline (P < 0.001). The CESI group had lower median ODI scores after one week and one month, although this difference did not reach statistical significance (P = 0.334). Despite similar baseline NRS ratings, the CESI group had statistically significantly lower mean NRS scores at one week and one month (P < 0.001). Conclusions: The current study demonstrated that both CESI and TFESI treatments for PLSS following lumbar discectomy are effective and safe. These procedures can alleviate pain and reduce disability. Although the success rates of the two procedures are comparable, CESI appears to be more successful in reducing pain at the one-week and one-month follow-up.

Plant Growth Regulators Improve Grain Production and Water Use Efficiency of Foeniculum vulgare Mill. under Water Stress.

The development of methods increasing plant water use efficiency (WUE) would enhance the ability to grow wild aromatic and medicinally important species. The aim of this research was to determine the effect of plant growth regulators (PGRs) applied by spraying on stress resistance and WUE of fennel subjected to water stress. Plants in the generative stage were more drought tolerant than those in the vegetative stage. Water stress at vegetative stage decreased plant biomass and grain yield by 60% and 61%, respectively. Severe water stress in vegetative stage reduced grain production by 56%, and grains had 43% lower mass than those from non-stressed plants. Application of PGRs at both stages of growth increased grain yield and biomass, but the magnitude of increase depended on the type and application time of PGRs. Plants grown in well-watered conditions and sprayed with methyl jasmonate during the vegetative stage had the highest grain production (2.7 g plant-1), whereas under moderate water stress, plants yielded the best (2.1 g plant-1) when sprayed with epibrassinolide. The maximum WUE for grain (0.91 g L-1) and essential oil production (20 mg L-1) was noted in plants exposed to moderate stress and treated with methyl jasmonate during the vegetative stage.

Prone position: A possible method to decrease post dural puncture headache (PDPH) during surgery.

OBJECTIVES: Postdural puncture headache (PDPH) is a complication associated with spinal and epidural anesthesia, characterized by a very severe dull, non-throbbing positional headache along with nausea, vomiting and other symptoms. The aim of this study was to compare positional character of PDPH, where the effects of prone and supine positions during surgery were compared for the risk of the headache. METHODS: This cohort study, was carried out at (XXX) University of Medical Sciences from June 2019 to June 2020 after the approval from the Ethical Committee. 1416 patients participated in this study among whom either supine or prone positions were used for the surgery, based on the type of surgical requirements. All patients received spinal where, 18-gauge cannula was inserted and lactated ringer 4 mL per Kg per hour was used for the administration. Using an aseptic technique, a 26-gauge Quincke needle was inserted intrathecally via a midline approach into the L3-L4 or L4-L5 interspace with the patient in the sitting position. Patients received 10 mg 0.5% hyperbaric bupivacaine. 444 patients were operated in the prone position during surgery (P group) and the 972 patients were in the supine position (S group). RESULTS: We compared the rate of PDPH between the two groups. 3 (0.68%) patients with pilonidal sinus were operated in prone position experienced headache and 87 of those operated in supine position (8.95%) had headache (P < 0.001); and the odds ratio of developing headache when operated in supine position was 13.16. CONCLUSIONS: Prone position during surgery appears to be a reliable way to reduce PDPH following spinal or epidural anesthesia.

Suitability and benefits from intercropped sorghum-amaranth under partial root-zone irrigation.

BACKGROUND: The production of sufficient animal feed in arid and semi-arid regions plays a significant role in food security in these areas. The present study was conducted based on the hypothesis that intercropping of sorghum and amaranth, comprising relatively drought tolerant forages, will enhance the yield and quality of the feed under limited irrigation water availability. RESULTS: Implementation of fixed alternate furrow irrigation (FFI) and alternate furrow irrigation (AFI) resulted in a saving of 22.5% and 19.7% of irrigation water, respectively. However, the water saving declined both yield and quality of forage. In conventional furrow irrigation (CFI), the highest dry matter (DM) yield was 15.5 Mg ha-1 , obtained from S50 -A50 treatment. In FFI and AFI, sole sorghum produced the highest DM. However, their maximum yields (11.2 and 12.6 Mg ha-1 , respectively) were not significantly different from yields in S75 -A25 intercropping ratios. Irrigation water use efficiency (IWUE) was similar in CFI and AFI and considerably higher than FFI. Sorghum monoculture and the S75 -A25 intercropping had the highest IWUE (3.4 and 3.3 kg m-3 ), whereas IWUE of the sole amaranth was 1.7 kg m-3 . The partial land equivalent ratio and monetary advantage index of amaranth and sorghum indicated that sorghum would benefit from intercropping as long as its ratio in the intercropping is more than 25%. CONCLUSION: When sufficient irrigation is available, intercropping of sorghum and amaranth can considerably improve yield and quality of emergency feed. However, the benefits from intercropping faded under the two partial root-zone irrigation methods used in the present study. © 2021 Society of Chemical Industry.

Physiological traits, yield, and yield components relationship in winter and spring canola.

BACKGROUND: Understanding the relationship between physiological traits with yield and yield components is an essential step towards developing high-yielding and high-quality canola (Brassica napus L.) cultivars. This study aimed to explore further the relationship between some physiological features, including radiation use efficiency (RUE), and seed yield in canola. RESULTS: Significant differences were found among cultivars regarding maximum leaf area index (LAImax ) and required days to achieve maximum LAI (DLAImax ). All cultivars obtained the minimum LAI required to intercept 90% of the incident radiation, but at different times. Some cultivars like SW102 and Shirali had the same fraction of intercepted photosynthetically active radiation (IPAR) when LAI was maximal, but SW102 had higher IPAR. This indicated that SW102 was more efficient in irradiation capacity and may have a higher photosynthesis rate when exposed to the high irradiation conditions. The average canola RUE in the current study was 3.80 and 3.63 g MJ-1 m-2 in 2014 and 2015, respectively. In general, the crop growth rate was higher in the first year than in the second year due to the fewer cloudy days and more incident radiation. CONCLUSION: Results indicated that duration of growth, crop growth rate, and harvest index were crucial for enhancing biomass and seed yield. Also, a relatively high correlation was found between the RUE and DLAImax . The cultivars that reached their maximum LAI later demonstrated higher RUE, and consequently had higher biological and seed yield. The results obtained could be used to develop an improved canola crop growth model and breeding programs. © 2021 Society of Chemical Industry.

Efficacy, safety, and tolerability of sublingual fentanyl orally disintegrating tablet in the treatment of breakthrough cancer pain: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Breakthrough pain (BTP) is an important challenge in treatment and requires a rapid onset of action for pain control. BTP should be adequately controlled with a stable dose of a short-acting oral opioid. So far, no drug is available for the treatment of BTP in cancer patients in Iran, so we designed the first study in Iran to investigate the effect of sublingual fentanyl in relief of pain episodes in these patients. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of sublingual fentanyl in the treatment of breakthrough pain in cancer patients. METHOD: This study was a randomized double-blind placebo-controlled clinical trial in cancer patients with breakthrough pain (at least 1-4 episodes of acute pain with moderate to severe pain daily) referred to the pain clinic of Akhtar and Masih Daneshvari hospitals in 2019. The study consisted of two stages: 100 patients were selected by simple, non-random sampling and entered the open-label titration phase. The primary efficacy endpoint was the sum of pain intensity difference over 30 min post-administration. Secondary efficacy endpoints included pain intensity difference (PID) and pain relief (PR) throughout the 60-min post-dose assessment period. In the double-blind study, patients were randomly divided into two groups of placebo (n=50) and intervention (sublingual fentanyl tablet) (n=50). For evaluation of efficacy, 10 episodes were treated in each group and the results were recorded by the patient. (Clinical trial registration: IRCT20131124015515N8). RESULTS: A total of 100 patients entered the titration phase, primary efficacy of sublingual fentanyl was 3.5±0.6 and secondary efficacy of sublingual fentanyl (60 min, after treatment) was 0.3±0.6 which was statistically significant. In the titration phase, the treatment success rate was 100%. In the double-blind phase of the study, the pain intensity in multiple episodes showed a significant improvement at 15, 30, 45, and 60 min after drug administration (P=0.0001). The intensity of pain in each episode was significantly decreased compared to the next episode (P=0.0001). The mean frequency of pain episodes in the sublingual fentanyl group showed a significant decrease (P=0.0001). The most common adverse drug events in the titration phase were drowsiness (20%), dizziness (7%), and nausea 4%, and in the double-blind phase only drowsiness (12%). (Cancer Research Center, Shahid Beheshti University of Medical Sciences, Survey). CONCLUSION: Sublingual fentanyl appears to be effective for patients with rapid-onset analgesia, has short-acting duration, is effective medication, safe, and well tolerated. It is a suitable choice in Iranian patients with chronic cancer-related pain controlled suffering from acute pain episodes related to cancer.

New Model for Couple Therapy for Patients with Chronic Pain and their Caregivers: An Attempt to Improve Quality of Life and Reduce Pain.

BACKGROUND: Several psychological interventions have been implemented to manage chronic pain. In this study, in addition to the patients, his/her spouses have participated in the program. Besides, this innovative therapy integrates several practical approaches into one comprehensive protocol. OBJECTIVE: This study aimed to analyze the effectiveness of couple therapy (patient/caregiver-oriented) on improving the quality of life and reducing pain among patients with chronic pain. METHODS: The present study is a quasi-experimental and clinical trial with a control group with pretest and posttest. The authors conducted this study at LABAFINEJAD Hospital in Tehran on 30 patients with chronic pain and their spouses by having a short form of a questionnaire for quality of life and chronic pain score questionnaire to measure the effectiveness of the treatment. RESULTS: The results indicated that this treatment increased two aspects of quality of life remarkably, social function and strength for continuing the performance; that help boosts interpersonal relationships as well. Regarding the results, although the couple-based treatment could improve all aspects of pain, the two primary subscales, physical health and mental health, both enhanced. Besides, the treatment reduced the intensity of pain. CONCLUSION: Couple-based intervention through increasing social support, improving the quality of sex, decentralizing of pain, and paying attention to the neglected needs of caregivers and patients with chronic pain can improve quality of life and reduce pain in patients.

Technical Principles of Dual-Energy Cone Beam Computed Tomography and Clinical Applications for Radiation Therapy.

PURPOSE: Medical imaging is an indispensable tool in radiotherapy for dose planning, image guidance and treatment monitoring. Cone beam CT (CBCT) is a low dose imaging technique with high spatial resolution capability as a direct by-product of using flat-panel detectors. However, certain issues such as x-ray scatter, beam hardening and other artifacts limit its utility to the verification of patient positioning using image-guided radiotherapy. METHODS AND MATERIALS: Dual-energy (DE)-CBCT has recently demonstrated promise as an improved tool for tumor visualization in benchtop applications. It has the potential to improve soft-tissue contrast and reduce artifacts caused by beam hardening and metal. In this review, the practical aspects of developing a DE-CBCT based clinical and technical workflow are presented based on existing DE-CBCT literature and concepts adapted from the well-established library of work in DE-CT. Furthermore, the potential applications of DE-CBCT on its future role in radiotherapy are discussed. RESULTS AND CONCLUSIONS: Based on current literature and an investigation of future applications, there is a clear potential for DE-CBCT technologies to be incorporated into radiotherapy. The applications of DE-CBCT include (but are not limited to): adaptive radiotherapy, brachytherapy, proton therapy, radiomics and theranostics.

Effectiveness of intradiscal injection of radiopaque gelified ethanol (DiscoGel®) versus percutaneous laser disc decompression in patients with chronic radicular low back pain.

BACKGROUND: Low back pain secondary to discopathy is a common pain disorder. Multiple minimally invasive therapeutic modalities have been proposed; however, to date no study has compared percutaneous laser disc decompression (PLDD) with intradiscal injection of radiopaque gelified ethanol (DiscoGel®). We are introducing the first study on patient-reported outcomes of DiscoGel® vs. PLDD for radiculopathy. METHODS: Seventy-two patients were randomly selected from either a previous strategy of PLDD or DiscoGel®, which had been performed in our center during 2016-2017. Participants were asked about their numeric rating scale (NRS) scores, Oswestry disability index (ODI) scores, and progression to secondary treatment. RESULTS: The mean NRS scores in the total cohort before intervention was 8.0, and was reduced to 4.3 in the DiscoGel® group and 4.2 in the PLDD group after 12 months, which was statistically significant. The mean ODI score before intervention was 81.25% which was reduced to 41.14% in the DiscoGel® group and 52.86% in the PLDD group after 12 months, which was statistically significant. Between-group comparison of NRS scores after two follow-ups were not statistically different (P = 0.62) but the ODI score in DiscoGel® was statistically lower (P = 0.001). Six cases (16.67%) from each group reported undergoing surgery after the follow-up period which was not statistically different. CONCLUSIONS: Both techniques were equivalent in pain reduction but DiscoGel® had a greater effect on decreasing disability after 12 months, although the rate of progression to secondary treatments and/or surgery was almost equal in the two groups.

The Long-term Effects of Percutaneous Laser Disc Decompression (PLDD) Treatment on Lumbar Disc Protrusion: A 2-Year Follow-up.

Introduction: Nowadays many physicians have focused their attention on using low invasive methods for the treatment of disc protrusion. Thus, the current study was carried out to evaluate the effect and therapeutic outcomes of clinical percutaneous laser disc decompression (PLDD) in the treatment of chronic low back pain caused by disc protrusion during a two-year follow-up. Methods: This historical cohort study was conducted on 40 patients, who were suffering from chronic low back pain caused by disc protrusion diagnosed, and referred to the pain clinic of Akhtar Hospital from March to August 2016 were treated with PLDD and were followed up for at least two years after performing PLDD (from 2018 to 2019). All the information has been extracted using medical records and patient interview. The severity of pain was measured by the Numeric Rating Scale (NRS), and the Oswestry disability index (ODI) was measured before and two years after the treatment. Results: The most common sites for two-level PLDD were L4-S1 and L3-L5, and the most common sites for one-level PLDD were L5-S1 and L4-L5. Overall, the levels of pain and functional disability two years after PLDD showed significant improvements (P =0.0001). The results revealed no statistically significant differences in NRS and ODI scores between the two groups of men and women two years after PLDD (P >0.05). Furthermore, they indicated no statistically significant differences in NRS and ODI scores between the different disc protrusion levels two years after PLDD (P >0.05). Conclusion: It seems that the PLDD is a low-invasive, safe, and effective method that can be used in patients with chronic low back pain caused by a disc protrusion. Therefore, it can be considered as a suitable choice in treating patients with chronic low back pain caused by a disc protrusion.

Outcomes of Ultrasound-Guided Gastrocnemius Injection With Botulinum Toxin for Chronic Plantar Fasciitis.

BACKGROUND: The objective of this study was to determine whether the injection of botulinum toxin A (BTA) in the medial head of the gastrocnemius muscle could yield improvements in function and disability in patients with chronic plantar fasciitis with follow-up 12 months after treatment. METHODS: Thirty-two patients with chronic plantar fasciitis were included in the study and randomly allocated to the BTA and placebo groups. The visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate pain levels pre- and postinjection as well as function of the foot, respectively. Patients were also asked to rate their treatment satisfaction 1 year after injection. The range of dorsiflexion was measured before and 12 months after the injection. RESULTS: At the 12-month follow-up, the mean VAS decreased from 7.8 to 4 in the placebo group and from 8 to 0.33 in the BTA group. Furthermore, the mean AOFAS scores increased from 48.4 to 65.3 in the placebo group and from 45.5 to 90.6 in the BTA group. The postinjection scores in the BTA group were significantly higher than those in the placebo group (P < .001). Patient satisfaction in the BTA group was higher than that in the placebo group at the 12-month follow-up. CONCLUSION: In patients with chronic plantar fasciitis, the use of BTA had a positive effect on improvement in pain and foot function 1 year after treatment. LEVEL OF EVIDENCE: Level I, prospective randomized controlled trial.

Restricting motion effects in CT coronary angiography.

OBJECTIVE: Evaluation of coronary CT image blur using multi segment reconstruction algorithm. METHODS: Cardiac motion was simulated in a Catphan. CT coronary angiography was performed using 320 × 0.5 mm detector array and 275 ms gantry rotation. 1, 2 and 3 segment reconstruction algorithm, three heart rates (60, 80 and 100bpm), two peak displacements (4, 8 mm) and three cardiac phases (55, 35, 75%) were used. Wilcoxon test compared image blur from the different reconstruction algorithms. RESULTS: Image blur for 1, 2 and 3 segments in: 60 bpm, 75% R-R interval and 8 mm peak displacement: 0.714, 0.588, 0.571 mm (1.18, 0.6, 0.4 mm displacement) 80 bpm, 35% R-R interval and 8 mm peak displacement: 0.869, 0.606, 0.606 mm (1.57, 0.79,0.52 mm displacement) 100 bpm, 35% R-R interval and 4 mm peak displacement: 0.645, 0.588, 0.571 mm (0.98, 0.49, 0.33 mm displacement). The median image blur overall for 1 and 2 segments was 0.714 mm and 0.588 mm respectively (p < 0.0001). CONCLUSION: Two-segment reconstruction significantly reduces image blur. ADVANCES IN KNOWLEDGE: Multisegment reconstruction algorithms during CT coronary angiography are a useful method to reduce image blur, improve visualization of the coronary artery wall and help the early detection of the plaque.

Effects of Caudal Epidural Dexmedetomidine on Pain, Erythrocyte Sedimentation Rate and Quality of Life in Patients with Failed Back Surgery Syndrome; A Randomized Clinical Trial.

OBJECTIVE: To evaluate the effects of dexmedetomidine in caudal epidural on controlling pain, erythrocyte sedimentation rate (ESR) and quality of life in patients with failed back surgery syndrome (FBSS). METHODS: The study was a single-blind clinical trial. From the total of 70 patients suffering from low back pain caused by a failed back surgery syndrome were referred to Akhtar and Imam Hossein Hospitals between the ages of 25 to 75 years with a history of back pain more than 12 weeks and a visual analogue scale (VAS) score of higher than 3, and 50 people were randomly selected and divided into two groups of dexmedetomidine and control. The control group received an epidural dose of 10 cc containing triamcinolone and bupivacaine, and the dexmedetomidine group received an epidural dose of 10 cc, containing dexmedetomidine, triamcinolones and bupivacaine with diluted normal saline. Epidural caudal injections were performed in the abdomen in a laid down position. Before starting the study and at the end of the fourth week, the two test groups were measured for visual analogue scale (VAS) and ESR and were asked to complete the quality of life questionnaire. RESULTS: Overall, 50 patients with FBSS were enrolled. The mean age was 53.88 ± 8.9 years (range 25-75); 54% (27/50) were men. The results showed that the injection of dexmedetomidine in epidural caudal was associated with decreased pain (p=0.001) and improved quality of life (p=0.022), while showed no significant effect on ESR (p=0.110). CONCLUSION: Administration of dexmedetomidine in the epidural caudal is effective in controlling pain and quality of life in patients with failed back surgery syndrome.