Objective:- To compare the effectiveness between the radiofrequency ablation of articular branches of obturator and femoral nerves and intraarticular steroid injection for treatment of chronic hip pain secondary to Osteoarthritis(OA)
Methods:- Forty two patients with hip OA were included in a prospective, randomised controlled trial, which were distributed in two group. The
study group (group A) received radiofrequency ablation(RFA) of sensory branches of femoral and obturator nerve, while the control group(group
B) received intra-articular steroid. Outcome measures used were VAS and WOMAC, assessment were done at baseline, 4 weeks, 12 weeks and 24
weeks post procedure. All analyses were based on intention-to-treat using SPSS, version 21. There was signicant improvement of VAS Results:-
score in both groups (p<0.05) in all follow-up period. However at 12 weeks and 24 weeks group A showed more signicant improvement when
compared to Group B. The WOMAC score at 4 weeks follow-up shows no signicant difference in improvement for both pain and function in both
group. However at 12 weeks and 24 weeks, group A showed a signicant improvement (p<0.05) compared to group B.
Conclusions: Both RFA and intra-articular steroid injection reduces pain in hip OA. However, results of radiofrequency ablation in this study
provides longer duration of pain reduction and functional improvement. Hence RFA can be preferred over intra-articular steroid injection for
treatment modality.
Introduction: Treatment for Low Back Pain (LBP) due to Prolapsed Intervertebral Disc (PIVD) includes conservative management, Epidural Steroid Injection (ESI), and surgery. Transforaminal Epidural Steroid Injection (TFESI) is a more recently described approach. All corticosteroid preparations used for TFESI are particulate except dexamethasone and betamethasone sodium phosphate. But while comparing methylprednisolone with dexamethasone, the latter has more potent anti-inflammatory action with least likelihood of causing embolic events and is also less expensive. Aim: To compare the efficacy of transforaminal epidural injection of dexamethasone and methylprednisolone in reducing LBP and disability in prolapsed lumbar intervertebral disc amongst the indigenous population of Manipur, India. Materials and Methods: This was a randomised controlled study on 80 patients with PIVD attending Outpatient Department (OPD) at physical medicine and rehabilitation was conducted from September 2016 to August 2018. A single dose of lumbar TFESI with dexamethasone in the study group and methylprednisolone in the control were given under C-arm guidance. The outcome variables Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) for function were measured at one week, one month and six months. Statistical tests like t-test, Chi-square test were used for intra group and inter group analysis. Results: In the total sample of 80 patients, 40 (15 males and 25 females, mean age: 38.28±8.55 years) were categorised as Dexamethasone patients and 40 (17 males and 23 females; mean age: 39.28±7.80 years) as methylprednisolone patients, there were significant improvement in mean score of VAS and ODI in both the groups (p-value <0.05). At six months, both treatment groups maintained initial observed improvements, with no significant differences between groups on the VAS {95% Confidence Interval (CI), -0.02 to 0.4; p-value=0.07} and ODI (95% CI,-0.21 to 3.43; p-value=0.08). Conclusion: Non-particulate steroid dexamethasone was similar in efficacy to the particulate steroid methylprednisolone in lumbar TFESI. However, in view of the greater safety profile of dexamethasone, it is suggested that dexamethasone may be used as the preferred agent in lumbar TFESI.
Radiofrequency ablation (RFA) of nerves is an upcoming intervention for relieving chronic musculoskeletal pain. However, being relatively new not much publications are available on emergencies during the procedure. 66 years old male, a case of Osteoarthritis knee, underwent RFA genicular nerve of right knee. Conventional RFA of Superolateral, Inferomedial, Superomedial genicular nerves were done under C- arm guidance. Thirty minutes after the procedure, we found a boggy swelling developing over his right knee. It was a hematoma developing on the superomedial aspect of the right kneecap most likely due to injury to Superomedial genicular vessels accompanying the nerve. 67 years old female planned for RFA genicular nerves of both knees under C arm guidance. During the intervention, she complained of numbness around face, and suddenly went into disoriented state with muscle twitching and bluish discoloration of lips. Medicine consultation diagnosed the incident as LA associated systemic toxicity. 57 years old female with chief complaints of pain in left hemiplegic shoulder pain for 6 months duration admitted for suprascapular nerve block. During the procedure patient goes into hypotensive bradycardic episode. 65 years old female admitted for Medial calcaneal block for right heel pain. 24 hours after the procedure she has aggravated pain of foot. RFA is considered as a non-invasive, OPD based procedure for effective pain relief but it is also important to understand such unprecedented emergencies that can happen.
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