Background Superior hypogastric neurolytic block is performed to block visceral pelvic pain. This could be performed through the anterior approach guided by CT or ultrasound and through a posterior approach, guided by fluoroscopy or CT. Methods Sixty adult patients with severe visceral pelvic pain (VAS>70 mm) were randomly divided into two groups. Group S: SHP block was done ultrasound guided using the anterior approach and confirmed by fluoroscopy. Group F: SHP block was done fluoroscopic guided using the posterior oblique approach. The VAS (visual analog scale), duration of the technique, time of X-ray exposure, patient satisfaction score, patient global impression of change (PGIC), quality of life score, and daily morphine consumption (mg/day) were measured pre-procedure and at the 1st, 4th, 8th, and 12th week after the procedure. In addition, any side effects of the procedure were recorded. Results There was a significant difference in VAS between the two groups ( P <0.01) (better in group S). The quality of life score was improved from the pre-procedure in both groups ( P <0.05), and morphine consumption was significantly lower in group S than in group F ( P <0.05) at the 1st, 4th, and 8th week and not significant at the 12th week. The two groups show a statistically significant difference as regards the duration of the procedure and X-ray exposure ( P <0.01). There was a statistically significant difference in the satisfactory score between the two groups at the 1st, 4th, 8th, and 12th week ( P <0.01). As regards the PGIC score, there was no statistically significant difference between the two groups ( P >0.05). In group S, no back pain was reported, while 11 patients of group F complained from post-procedure back pain ( P <0.001). Conclusion The anterior ultrasound guided SHPB aided by fluoroscopy is suggested to be more superior to the standard fluoroscopic guided technique in relieving pelvic cancer pain and decreasing morphine consumption.
Objective: Evaluation of the analgesic efficacy and safety of ultrasound-guided pterygopalatine fossa (PPF) block in patients undergoing maxillofacial cancer surgeries under general anesthesia. Methods: Forty-eight patients scheduled for maxillofacial cancer surgeries enrolled in the study were randomly allocated into group (A): ultrasound-guided bilateral PPF block using local anesthetic; and group (B): ultrasound-guided bilateral PPF injection with saline. Our primary outcome was assessing postoperative analgesia using visual analog scale and the amount of nalbuphine used for rescue analgesia.We recorded the operative field's quality, end-tidal sevoflurane concentration, the total amount of nitroglycerin used to achieve the target mean arterial pressure (MAP) of 60-65 mmHg, the frequency of propranolol usage, emergence time and Aldrete score. Results: The VAS score was significantly lower in group A than group B until the 18th postoperative hour (P < 0.0001). The number of patients required nalbuphine (12 versus 24 patients) and total nalbuphine doses were significantly less in group A (10 ± 2 mg) versus group B (20 ± 5 mg) (P < 0.01). Sevoflurane mean end-tidal concentration was significantly less in group A (2.2 ± 0.53%) than in Group B (2.7 ± 0.48%), P-value = 0.019. Total nitroglycerine dose was significantly lower (2.45 ± 0.63 µg/kg/min) in group A than (3.58 ± 0.77 µg/kg/min) in group B (P value<0.05). Conclusions: ultrasound-guided PPF block combined with general anesthesia is a safe technique and helps in providing better operative field by adequate control over the blood pressure. It is effective for decreasing the postoperative pain and analgesic requirements in patients undergoing maxillofacial cancer surgery.
Background & objective: The serratus anterior plane block (SAPB) is a recent technique providing effective perioperative analgesia in thoracic surgeries. This study compared the intra–operative hemodynamics and the perioperative analgesic efficacy of superficial SAPB, to deep SAPB, and to thoracic epidural analgesia in thoracotomies. Methodology: one hundred and eighty lung cancer patients scheduled for thoracotomy were randomly allocated to three groups; TEA group, which received thoracic epidural analgesia, SSPB group receiving ultrasound–guided superficial serratus plane block and DSPB group which received US–guided deep serratus plane block. Baseline and intra–operative hemodynamics and total consumption of intraoperative fentanyl and postoperative morphine was noted. Results: Intra–operative mean arterial pressure (MAP) significantly decreased in the TEA group compared to baseline values, whereas no significant changes were found in either SSPB or DSPB groups. Heart rate (HR) did not show significant changes in any group. The time to postoperative analgesic demand was significantly longer in the SSPB and DSPB groups than in the TEA group (p < 0.001). In the first postoperative hour, TEA group had significantly higher visual analogue scale (VAS) scores than SSPB or DSPB groups at rest and with cough. The total consumption of intraoperative fentanyl and postoperative morphine was comparable among all groups. Conclusion: Pre–operative SSPB and DSPB can provide adequate perioperative analgesia without hemodynamic instability when compared to TEA in thoracotomies. Key words: Deep serratus plane block; Superficial serratus plane block; Thoracic epidural analgesia; Analgesia; Thoracotomy Trial registration: The trial was registered at ClinicalTrials.gov with registration number (NCT 04189120). https://clinicaltrials.gov/ct2/show/NCT04189120 Citation: Abdelrahman AS, Al Wasseef MM, Hassan ME, Abdelghafar EM. Evaluating the effect of ultrasound–guided superficial serratus plane block, deep serratus plane block and thoracic epidural analgesia in cancer patients undergoing thoracotomy: A randomized controlled trial. Anaesth. pain intensive care 2021;25(6):713–721; DOI: 10.35975/apic.v25i6.1690
Objectives: This study aims to investigate the efficacy of transforaminal epidural steroid injection (TFESI) versus radiofrequency application on drug consumption for lumbosacral radicular pain relief. Patients and methods: The study, which was conducted between September 2012 and September 2014, included 40 patients with lumbosacral radicular pain. All injections were applied under C-arm fluoroscopy guidance, using a mix of bucaine and lidocaine. patient's intake of analgesic medication was measured at the baseline before the intervention, and again after the intervention by one week ,after 1 month and after three months , to determine the effect of intervention on analgesic drug consumption , amount of drug consumption measured in mgs per day. Results: There was statistically significant difference in the NSAIDs consumption post procedure between the two groups, steroid group had a decrease in NSAIDs (Ibuprofen) consumption more then the PRF group (P-value<0.05), There was statistically significant difference in the tramadol consumption post procedure between the two groups specially after one week and one month, steroid group had a decrease in tramadol consumption more then the PRF group (P-value<0.05) , There was no statistically significant difference in the pregabaline consumption post procedure between the two groups, but steroid group had a decrease in pregabaline consumption more then the PRF group (P-value < 0.05). Conclusion: In this follow-up study, transforaminal epidural steroid injection was found to be effective in both the early period and in the mid-term, And improve the drug consumption more than the radiofrequency application .
Objectives: This study aims to Compare the Effectivenesses of transforaminal epidural steroid injection (TFESI) for the Nerve Roots Steroid Injections Versus Pulsed Radiofrequency Application For Treatment of Chronic Low Back Pain Patients and methods: The study, which was conducted between September 2013 and September 2016, included 40 patients with low back pain (13 males, 27 females; median age 45 years; [min. 22-max. 88 years]). All injections were applied under Carm fluoroscopy guidance, using a mix of methyprdnisone and macain. The valuation parameters are pain evaluation pre and post the procedure (2hrs after the procedure , 1st week ,after one month and after 3 months from the procedure) .the pain evaluation by visual analoge scale (0-10) and low back pain questionare also consumption of analgesic drugs is compared pre and post procedure. Reporting of possible complications Results: As regard pain scores for both groups group there was significant decrease in VAS score in both groups from the preprocedure score (P-value<0.001). Patients in group 1 had less VAS scores in comparison for group 2 (P-value=0.005). also There was significant decrease in LBP score in both groups from the preprocedure score (P-value<0.001). Patients in group 1 had less LBP score in comparison for group 2 (P-value<0.001). Conclusion: In this study, we aimed to present the effectiveness 0f Transforaminal Nerve Roots Steroid Injections Versus Pulsed Radiofrequency Application For Treatment of Chronic Low Back Pain. We found that there was significant decrease in VAS score in both groups from the pre procedure score. Patients in TFESI group had less VAS and low back pain scores in comparison for PRF group , and application of PRF is more safe than steroid injection
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