Nicholas A Calotta, Akash Chandawarkar, Shaun C Desai, A Lee Dellon
BACKGROUND:  The radial forearm free flap (RFFF) is a staple of microsurgical reconstruction. Significant attention has been paid to donor-site morbidity, particularly vascular and aesthetic consequences. Relatively few authors have discussed peripheral nerve morbidity such as persistent hypoesthesia, hyperesthesia, or allodynia in the hand and wrist or neuroma formation in the wrist and forearm. Here, we present a diagnostic and therapeutic algorithm for painful neurologic complications of the RFFF donor site...
July 29, 2020: Journal of Reconstructive Microsurgery
Hal Robinson, Shailendra Mishra, Lauren Davies, Fiona Craigen, Vija Vilcina, Simon Parson, Shahida Shahana
BACKGROUND: Pectoralis I and II (Pecs I/Pecs II) blocks are modern regional anesthetic techniques performed in combination to anesthetize the nerves involved in breast surgery and axillary node dissection. Pecs II spread and clinical efficacy is thought to be independent of whether injection occurs between pectoralis minor and serratus anterior or deep to serratus anterior. Injecting deep to serratus anterior onto the rib may be technically easier; however, our clinical experience suggests that this approach may be less effective for axillary dissection...
July 16, 2020: Anesthesia and Analgesia
Renato Filogonio, Marina R Sartori, Susie Morgensen, Driele Tavares, Rafael Campos, Augusto S Abe, Edwin W Taylor, Gerson J Rodrigues, Gilberto De Nucci, Ulf Simonsen, Cléo A C Leite, Tobias Wang
Vascular tone in the reptilian pulmonary vasculature is primarily under cholinergic, muscarinic control exerted via the vagus nerve. This control has been ascribed to a sphincter located at the arterial outflow, but we speculated whether the vascular control in the pulmonary artery is more widespread, such that responses to acetylcholine and electrical stimulation, as well as the expression of muscarinic receptors, are prevalent along its length. Working on the South American rattlesnake ( Crotalus durissus ), we studied four different portions of the pulmonary artery (truncus, proximal, distal, and branches)...
August 1, 2020: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Aditya Mazmudar, Rusheel Nayak, Alpesh A Patel
OBJECTIVE: In this narrative review, the current literature on therapeutic interventions for low back pain of facet joint etiology is assessed from an economic value perspective. SUMMARY OF BACKGROUND DATA: The efficacy and economics of facet joint interventions in the treatment of lumbar back pain is a controversial topic. Trends show that facet joint interventions are becoming increasingly used, perhaps as physicians become more averse to treating chronic low back pain with opioids...
July 10, 2020: Clinical Spine Surgery
Javier De Andrés Ares, Fernando Gilsanz
OBJECTIVES: Although there are different ways of performing medial branch neurotomy on facetogenic low back pain, few studies have compared clinical outcomes of a parallel technique over the medial branch versus a perpendicular technique. We investigated differences in pain outcome with both techniques. DESIGN: This was a prospective, pilot, randomized, pragmatic trial (double-blinded in diagnostic phase). SETTING: A comparative pilot trial was conducted at an academic pain centre...
June 22, 2020: Pain Practice: the Official Journal of World Institute of Pain
Bilal Aleem, Muhammad Muslim Mubashir, Daniel Vardeh
OBJECTIVE: To compare periprocedural pain from mechanodesensitization (MD) with local anesthetic (LA) during medial branch blocks (MBBs), with a secondary outcome to compare diagnostic responses during the five hours postprocedure. METHODS: Forty-four patients with low back pain underwent three level bilateral MMBs. For the LA technique, 0.5 mL of 1% lidocaine was injected subcutaneously on one side, and for MD the skin was stretched using the index finger and thumb on the other...
May 29, 2020: Pain Medicine
Majid Khan, Sherif Meleka
The purpose of this report is to describe the procedure for CT fluoroscopy- guided Cervical medial branch block and facet radiofrequency ablation. CT fluoroscopic guidance allows more-precise needle tip positioning with visualization of bony landmarks and at the same time be aware of the adjoining soft tissue anatomy with good localization of adjacent critical non-targeted areas such as the neural foramina and the dorsal root ganglia. This serves as an alternative method for performing medial branch blocks and facet radiofrequency ablation...
August 2020: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Reza Ehsanian, Renee M Rosati, David J Kennedy, Byron J Schneider
OBJECTIVES: To identify significant bleeding complications following spinal interventions in patients taking medications with antiplatelet or anticoagulation effect. DESIGN: Retrospective chart review of a 12-month period. SETTING: Outpatient academic medical practice. INTERVENTIONS: Injections during outpatient interventional spine clinical encounters, including 14 cervical transforaminal epidural steroid injections, 26 cervical medial branch blocks, seven cervical radiofrequency neurotomies, three cervical facet joint injections, 88 lumbar transforaminal epidural steroid injections, 66 lumbosacral medial branch blocks, 18 lumbosacral radiofrequency neurotomies, 13 lumbar facet joint injections, one caudal epidural steroid injection, 11 sacral transforaminal epidural steroid injections, and 32 sacroiliac joint injections...
May 1, 2020: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Steven P Cohen, Arun Bhaskar, Anuj Bhatia, Asokumar Buvanendran, Tim Deer, Shuchita Garg, W Michael Hooten, Robert W Hurley, David J Kennedy, Brian C McLean, Jee Youn Moon, Samer Narouze, Sanjog Pangarkar, David Anthony Provenzano, Richard Rauck, B Todd Sitzman, Matthew Smuck, Jan van Zundert, Kevin Vorenkamp, Mark S Wallace, Zirong Zhao
BACKGROUND: The past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial. METHODS: After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee...
June 2020: Regional Anesthesia and Pain Medicine
Debbie Lee, David R Walega
Quebec platelet disorder (QPD) is a condition that causes delayed-onset bleeding after hemostatic challenges. While there are interventional spine procedure (ISP) guidelines for managing patients on blood thinners or with common bleeding disorders, there are none for approaching patients with unique coagulopathies. We report a patient with QPD and extensive history of postprocedural bleeding complications (PPBCs) who presented with chronic cervical facet pain. After consulting a hematologist and administering antifibrinolytic agent with platelet transfusions, the patient underwent medial branch nerve blocks (MBNBs) followed by radiofrequency ablation (RFA) without experiencing PPBCs...
April 2020: A&A Practice
Sanjeeva Gupta, Manohar Sharma
BACKGROUND: Pain medicine practices vary across different regions within a country and between countries. OBJECTIVES: The objective of the survey was to study the variation in interventional pain medicine practices in the United Kingdom (UK) and the United States (US). METHODS: A survey was designed in 2019 on Survey Monkey®. Pain physicians from the UK and the US were invited to respond. RESULTS: A total of 120 responses were received from pain physicians in the UK and 122 from the US...
March 2020: Pain Physician
Xiaoxiao Zhou, Houlin Ji, Jinhua Guo, Yang Yang, Pan Cai, Xianlong Zhang
BACKGROUD: The osteotomy of the posterolateral overhanging part (PLOP) of the greater trochanter via posterior approach has been used for the hip arthroplasty for decades with good results. However, the osteotomy method remains undefined and the precise adjacent structures around PLOP have not been reported. The purpose of this study was to present a modified PLOP osteotomy approach and perform a detailed study of the topographic and surgical anatomy of the PLOP. METHODS: The peri-PLOP soft tissue and the bony parameters were measured using 10 cadavers with 20 hips and 20 skeletal hip specimens, respectively...
February 24, 2020: BMC Musculoskeletal Disorders
Georg Riegler, Christopher Pivec, Suren Jengojan, Johannes A Mayer, Christoph Schellen, Siegfried Trattnig, Gerd Bodner
BACKGROUND: This study aimed to determine the peripheral cutaneous nerve fields (CNF), their variability, and potential overlap by selectively blocking the intermediate (IFCN) and medial (MFCN) femoral cutaneous nerves and the infrapatellar branch of the saphenous nerve (IPBSN) in healthy volunteers. METHODS: In this prospective study, ultrasound-guided nerve blockades of the IFCN, MFCN, and IPBSN in 14 healthy volunteers were administered. High-frequency probes (15-22MhZ) and 1 mL of 1% lidocaine per nerve were used...
February 17, 2020: Clinical Anatomy
Byron J Schneider, Lisa Doan, Marc K Maes, Kevin R Martinez, Alan Gonzalez Cota, Nikolai Bogduk
OBJECTIVE: To determine the effectiveness of lumbar medial branch thermal radiofrequency neurotomy based on different selection criteria and procedural techniques. DESIGN: Comprehensive systematic review. METHODS: A comprehensive literature search was conducted, and all authors screened and evaluated the studies. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess all eligible studies. OUTCOME MEASURES: The primary outcome measure assessed was the success rate of the procedure, defined by varying degrees of pain relief following neurotomy...
February 10, 2020: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Taylor Burnham, Aaron Conger, Fabio Salazar, Russell Petersen, Richard Kendall, Shellie Cunningham, Masaru Teramoto, Zachary L McCormick
BACKGROUND: Cervical medial branch radiofrequency ablation (CMBRFA) is an effective treatment for facetogenic pain in patients selected by Spine Intervention Society (SIS) guidelines of 100% symptom improvement with dual medial branch blocks (MBBs) ± placebo block. Patient selection for CMBRFA using ≥80% symptom improvement after dual concordant MBBs is common; however, this has not been studied. OBJECTIVE: To evaluate the effectiveness of CMBRFA and compare outcomes in individuals selected by 80-99% vs 100% symptom improvement with dual concordant MBBs...
February 5, 2020: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Diego A Portela, Douglas Castro, Marta Romano, Aitor Gallastegui, Fernando Garcia-Pereira, Pablo E Otero
OBJECTIVE: To investigate the distribution and nerve staining of two volumes of lidocaine-dye solution after ultrasound-guided erector spinae plane (ESP) injections in canine cadavers. STUDY DESIGN: Experimental cadaveric study. ANIMALS: A total of nine canine cadavers. METHODS: ESP injections were performed between the longissimus thoracis muscle and the dorsolateral edge of the ninth thoracic transverse process. Two cadavers were transversally cryosectioned after unilateral ESP injections [0...
October 30, 2019: Veterinary Anaesthesia and Analgesia
Georg C Feigl, Mathias Schmid, Peter K Zahn, Carla A Avila González, Rainer J Litz
BACKGROUND: Incomplete peripheral nerve blocks distal to the popliteal region are commonly considered a sciatic and femoral/saphenous nerve block failure. The existence of a much more distal innervation area of the posterior femoral cutaneous nerve (PFCN) as described has not been assumed yet. We therefore investigated the distal termination of the PFCN in the lower leg. METHODS: In 83 human lower extremities embalmed with Theil's method, the course of the PFCN was investigated from the sub-gluteal fold to the most distal macroscopically dissectible branch...
March 2020: British Journal of Anaesthesia
Philip Kaller, Gloria Hohenberger, Patrick Holweg, Franz Josef Seibert, Martin Ornig
OBJECTIVE: The so-called ankle block represents a local anesthesia form which enables easy performance of all surgical procedures of the foot and ankle. INDICATIONS: Interventions distal to the medial and lateral malleoli. CONTRAINDICATIONS: Acute and chronic infections in the area of injection; allergy to the local anesthesia. SURGICAL TECHNIQUE: All five sensory foot nerves are blocked. The two deep lying nerves, the tibial nerve and the deep fibular nerve, can be directly anesthetized perineurally using anatomical landmarks...
February 2020: Operative Orthopädie und Traumatologie
Christian Woiciechowsky, Leonie Mercedes Richter
BACKGROUND AND STUDY AIMS:  Low back pain is well documented as an extremely common health problem. The most frequently used treatment is radiofrequency denervation for chronic low back pain. However, different clinical studies could only show a limited to no improvement regarding the decrease of pain intensity and duration of the effect. The main reasons for these limited effects seem to be due to the size of the lesion and difficulties in locating the exact placement of the cannula near the medial branch as well as or additional pathologies...
May 2020: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Pablo E Otero, Santiago E Fuensalida, Pedro C Russo, Natali Verdier, Carlos Blanco, Diego A Portela
This study aimed to describe the anatomical distribution of dye injected in the erector spinae plane (ESP) in a porcine living model, which could aid to reveal factors potentially relevant to the unexplained clinical effects of the ESP block. Six pigs received 0.6 mL/kg of 0.25% new methylene blue at the level of the sixth thoracic vertebra through either a cranial-to-caudal or a caudal-to-cranial in-plane ultrasound-guided bilateral ESP injection 20 min before euthanasia.Spread of dye evaluated through transverse cryosections (four injections) extended from T5 to T10 and from T5 to T8 when a cranial-to-caudal direction of injection was used, and from T5 to T9 and from T5 to T8 when the opposite direction of injection was used...
March 2020: Regional Anesthesia and Pain Medicine
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