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Medial branch block

Zachary L McCormick, Heejung Choi, Rajiv Reddy, Raafay H Syed, Meghan Bhave, Mark C Kendall, Dost Khan, Geeta Nagpal, Masaru Teramoto, David R Walega
BACKGROUND AND OBJECTIVES: No previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain. METHODS: In this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75% relief) were randomized to MBN C-RFA or T-RFA...
March 2019: Regional Anesthesia and Pain Medicine
Allen S Chen, Vincent F Miccio, Clark C Smith, George C Christolias, Adam R Blanchard
Objective: To determine if skin wheals reduce procedural pain associated with lumbar medial branch blocks (MBBs) performed with 25-gauge needles. Design: Prospective comparative observational study. Setting: Outpatient Physical Medicine & Rehabilitation and interventional pain practice within an academic tertiary care center. Subjects: Ninety-nine consecutive patients who underwent lumbar MBBs for facet pain were included...
February 12, 2019: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Eldon Loh, Jennifer N Reid, Fatimah Alibrahim, Blayne Welk
BACKGROUND AND OBJECTIVES: Radiofrequency ablation (RFA) is a common treatment modality for chronic axial spine pain. Controversy exists over its effectiveness, and outcomes in a real-world setting have not been evaluated despite increasing use of RFA. This study examined changes in healthcare utilization and opioid use after RFA in Ontario, Canada. METHODS: This retrospective cohort study was conducted in Ontario using administrative data. Ontario residents receiving their initial RFA between 1 January 2009 and 31 March 2015 were included...
January 23, 2019: Regional Anesthesia and Pain Medicine
Barbara Versyck, Gerbrand Groen, Geert-Jan van Geffen, Patrick Van Houwe, Ronald Law Bleys
INTRODUCTION: The interfascial thoracic wall blockades Pecs I and Pecs II are increasingly applied in breast and axillary surgery. Despite the clear anatomical demarcations depicted at their introduction, the clinical outcome is more variable than would be expected based upon the described anatomy. In order to elucidate factors that explain this variability, we evaluated the spread of each injection - medial Pecs I, lateral Pecs I, the deep injection of the Pecs II - separately. MATERIALS AND METHODS: A correlation of in vivo landmarks and ultrasound images with ex vivo ultrasound, reconstructed anatomical planes, histology and magnetic resonance imaging...
January 21, 2019: Clinical Anatomy
So Young Kwon, Jong-Woan Kim, Min Ji Cho, Abdullah Hussain Al-Sinan, Yun-Joung Han, Young Hoon Kim
BACKGROUND: Few studies have been conducted on the utility of cervical spine phantoms for practicing cervical procedures. Here, we describe a simple method for creating a cervical spine phantom and investigate whether the use of a gelatin-based phantom is associated with improved proficiency in performing ultrasound-guided cervical medial branch block. METHODS: A cervical spine phantom was prepared using a cervical spine model immersed in a mixture of gelatin and psyllium husk...
December 2018: Medicine (Baltimore)
David J Kennedy, Ryan Fraiser, Patricia Zheng, Lisa Huynh, Joshua Levin, Matthew Smuck, Byron J Schneider
Objective: To determine if intra-articular (IA) injection of corticosteroids is effective in reducing the need for radiofrequency ablation (RFA) in those with dual comparative medial branch block (MBB)-confirmed lumbar z-joint pain. Design: This was a randomized, double blind, placebo-controlled study. Setting: Two academic medical centers. Subjects: Fifty-six consecutive subjects who had ≥80% pain relief during an initial screening MBB were recruited...
December 12, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
In-Suk Bae, Hyoung-Joon Chun, Koang-Hum Bak, Hyeong-Joong Yi, Kyu-Sun Choi, Kee D Kim
No abstract text is available yet for this article.
November 24, 2018: World Neurosurgery
Christoph Thalhamer, Julia Hahne, Omer Matthijs, Peter Machacek
BACKGROUND: With a life-time prevalence of 39%, low back pain (LBP) is one of the most common musculoskeletal disorders. Correct diagnosis of underlying causes is commonly seen as a prerequisite for successful therapy of LBP. Currently, there is no useful, non-invasive clinical test to diagnose painful lumbar zygapophyseal joints. Clinical tests with high diagnostic accuracy are therefore desirable. Inter-rater reliability is commonly seen as a prerequisite of test validity. The objective of this pilot study was thus to evaluate inter-rater reliability of new clinical pain provocation tests for diagnosing painful lumbar zygapophyseal joints...
November 6, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Sayed E Wahezi, Jocelin Jones Molina, Edward Alexeev, John S Georgy, Nogah Haramati, Stephen A Erosa, Jay M Shah, Sherry Downie
BACKGROUND: Neck pain is one of the most common causes of chronic pain and the fourth leading cause of disability worldwide; it is estimated that between 36% to 67% of this pain is due to facet arthropathy. For patients who have pain refractory to conservative treatments literature supports management with diagnostic cervical medial branch blocks (cMBBs) to identify the associated facet innervation as the source of pain followed by therapeutic radiofrequency ablation (RFA) of the identified nerves...
October 24, 2018: PM & R: the Journal of Injury, Function, and Rehabilitation
Shin Who Park, Ja Young Choi, Kang Jae Jung
The great auricular nerve (GAN) is a sensory branch of the cervical plexus originating from the C2 and C3 nerve roots that innervates the external ear, mandibular angle, and parotid gland. Since idiopathic GAN neuralgia is a rare condition and branches of the GAN overlap with other cervical and cranial nerves, its diagnosis is challenging and can be confused with other facial neuralgias. This article describes the case of a 55-year-old woman with intractable unilateral periauricular and lateral head pain. No significant findings were found on cervical and brain imaging...
October 2018: Journal of Oral & Facial Pain and Headache
Kaustuv Dutta, Samarjit Dey, Prithwis Bhattacharyya, Sharat Agarwal, Priyanka Dev
BACKGROUND: Sacroiliac joint dysfunctional pain has always been an enigma to the pain physician, whether it be the diagnosis or the treatment. Diagnostic blocks are the gold standard way to diagnose this condition. Radiofrequency neurotomy of the nerves supplying the sacroiliac joint has shown equivocal results due to anatomical variation. Intraarticular depo-steroid injection is a traditional approach to treating sacroiliac joint pain. For long-term pain relief, however, lesioning the sacral lateral branches may be a better approach...
September 2018: Pain Physician
R Seidel, K Zukowski, A Wree, M Schulze
BACKGROUND AND OBJECTIVES: Ultrasound-guided intermediate cervical plexus block with perivascular local anesthetic infiltration is an established anesthetic procedure for carotid endarterectomy. In this prospective pilot study an additional subplatysmal block of the superficial ansa cervicalis is presented for the first time. The target structures are the anastomoses between the facial nerve (cervical and marginal mandibular branches) and cervical plexus. METHODS: An ultrasound-guided intermediate cervical plexus block (20 ml of ropivacaine 0...
October 1, 2018: Der Anaesthesist
A Nair, J Dolan, K E Tanner, C M Kerr, B Jones, P J Pollock, C F Kellett
BACKGROUND: Placement of local anaesthetic within the adductor canal using ultrasonography is an alternative to femoral nerve blocks for postoperative pain relief after knee joint replacement surgery. However, the effect of an inflated thigh tourniquet on the distribution of local anaesthetic within the adductor canal is unknown. The aim of this cadaveric study was to compare the distribution of radio-opaque dye within the adductor canal in the presence or absence of an inflated thigh tourniquet...
October 2018: British Journal of Anaesthesia
Hesham Elsharkawy, Robert Maniker, Robert Bolash, Prathima Kalasbail, Richard L Drake, Nabil Elkassabany
BACKGROUND AND OBJECTIVES: Fascial plane blocks are rapidly emerging to provide safe, feasible alternatives to epidural analgesia for thoracic and abdominal pain. We define a new option for chest wall and upper abdominal analgesia, termed the rhomboid intercostal and subserratus plane (RISS) block. The RISS tissue plane extends deep to the erector spinae muscle medially and deep to the serratus anterior muscle laterally. We describe a 2-part proof-of-concept study to validate the RISS block, including a cadaveric study to evaluate injectate spread and a retrospective case series to assess dermatomal coverage and analgesic efficacy...
October 2018: Regional Anesthesia and Pain Medicine
S Kendir, Bilge İpek Torun, T Akkaya, A Comert, E Tuccar, I Tekdemir
PURPOSE: The aim of this study is to re-define the anatomical structures which are important for blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site. We also aimed to investigate the spread of the anesthetic toward the areas in which the mentioned nerves lie on cadavers. METHODS: This study was performed on 16 lower extremities of formaldehyde-embalmed eight adult cadavers. The anatomy of adductor canal, courses of the nerves within the canal and the relationships of the saphenous, medial femoral cutaneous, medial retinacular, posterior branch of the obturator and sciatic nerves with each other and with the fascial compartments were investigated...
November 2018: Surgical and Radiologic Anatomy: SRA
Lena F Carstensen, Morten Jenstrup, Jørgen Lund, Jørgen Tranum-Jensen
BACKGROUND AND OBJECTIVES: The popularization of ultrasound-guided nerve blocks in cosmetic and reconstructive breast surgery calls for better anatomical understanding of chest wall innervation. When inserting subpectoral implants, pain from pocket dissection, stretching of muscle, and release of costal attachments may be relieved by blocking the pectoral nerves in the interpectoral (IP) space.We describe the variable anatomy of the pectoral nerves in the IP space in order to define the area to be covered for sufficient blockade, based on cadaver dissections...
November 2018: Regional Anesthesia and Pain Medicine
Olav Rohof, Chee Kean Chen
Background and aims The evidence for interventional treatment of thoracic facet joint pain remains limited. This is partly due to inconsistency of the path of thoracic medial branches and a lower incidence of thoracic facet pain among spine pain patients. The purpose of this study is to evaluate the efficacy of bipolar radiofrequency (RF) neurotomy of medial branches for treating chronic thoracic facet joint pain. Methods This is a retrospective record review of all patients diagnosed to have thoracic facet pain with diagnostic block and subsequently treated with bipolar RF neurotomy of medial branch between January 2012 and December 2015...
October 25, 2018: Scandinavian Journal of Pain
Johan Hambræus, Hans Westergren
Introduction Patients exposed to whiplash trauma are at risk of developing pain and dysfunction of the neck and shoulder. Although rarely discussed in the literature, some patients also develop autonomic dysfunction. Case presentation A previously healthy 41-year-old woman was involved in a "head-on" car crash. During the following 3 years she developed severe and complex post-traumatic pain syndrome, which consisted of neck pain, lumbar pain, sensory-motor dysfunction, and myoclonic muscular contractions...
October 1, 2012: Scandinavian Journal of Pain
O Varela, A Melone, R López-Menchaca, R Sevilla, D Callejo, S López-Álvarez, A Román Fernández, S García, I Mantilla, M Zaballos
OBJECTIVE: Interfascial blocks of the thoracic wall are being developed as an alternative to central blocks in breast surgery. However, there are few studies that have evaluated the anatomical extension of the local anaesthetic. The objective of this study was to analyse, using fluoroscopy, the spreading of two volumes (10 vs. 20ml) of radiological contrast in the serratus-intercostal plane block in an experimental pig model. MATERIAL AND METHODS: Ten Large-White breed pigs were selected to have a bilateral ultrasound serratus-intercostal plane block performed, with the administering of 10ml and 20ml of iopamidol in the right and left hemithorax, respectively...
October 2018: Revista Española de Anestesiología y Reanimación
David S Stolzenberg, Ryan Pheifer, Joshua Armstrong, George Young, Jeffrey Gehret, Jeremy Simon, George C Chang-Chien
BACKGROUND: Neural blockade of the cervical medial branches is a validated procedure in the diagnosis and treatment of cervical zygapophyseal joint pain. Fluoroscopic visualization of the lower cervical medial branch target zones (CMBTZs) in lateral view is sometimes challenging or not possible due to the patient's shoulders obscuring the target. Large shoulders and short necks often exacerbate the problem. Clear visualization is critical to accuracy and safety. OBJECTIVE: We aim to describe a method for optimal fluoroscopic visualization of the lower CMBTZs using a modified swimmer's view...
May 2018: Pain Physician
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