scholarly journals Intrapelvic Obturator Internus Muscle Injections: A Novel Fluoroscopic Technique

2015 ◽  
Vol 2;18 (2;3) ◽  
pp. E237-E243
Author(s):  
Assia Valovska
Keyword(s):  
Dimensional Space ◽  
Symptomatic Relief ◽  
Case Series ◽  
Pain Reduction ◽  
Pain Scale ◽  
Pelvic Cavity ◽  
Obturator Internus ◽  
Complex Anatomy ◽  
Scale Scores ◽  
Obturator Internus Muscle

The obturator internus (OI) muscle is important in adult chronic noninfectious pelvic, perineal, gluteal, and retrotrochanteric pain syndromes. Evaluation and management of these patients’ pain can be challenging because of the complex anatomy of this region, broad differential diagnosis, and lack of specific physical examination findings. Consequently, several clinicians have advocated the use of image guided injections to assist in the accurate diagnosis of OI-related symptoms and provide symptomatic relief to affected patients. We present 2 case series describing a novel fluoroscopically guided contrast controlled transpectineal approach to intrapelvic OI injections. Unlike prior fluoroscopically guided OI injection techniques, the approach described in the present 2 cases utilized multiple standard pelvic views, thus facilitating optimal needle positioning in three-dimensional space. This technique utilized standard fluoroscopic pelvic views to accurately measure needle depth within the pelvic cavity permitting the bulk of the OI to be injected in a controlled and safe fashion. The first patient underwent a left intrapelvic OI muscle injection with bupivacaine 0.25% and 40 mg methylprednisolone. The average pre- and postprocedural visual analog pain scale scores were 5 out of 10 and 2 out of 10, respectively, with a self-reported 75% pain reduction. The second patient underwent a right intrapelvic OI muscle injection with bupivacaine 0.25% and 40 mg methylprednisolone. The average pre- and postprocedural visual analog scale scores were 8 out of 10 and 1 out of 10, respectively, with a self-reported 90% pain reduction. Larger scale studies should be undertaken to evaluate the therapeutic efficacy and generalized accuracy of this technique. Key words: Obturator internus muscle, pelvic, perineal, gluteal, retrotrochanteric pain, fluoroscopic, transpectineal

scholarly journals Erector spinae plane block and altered hemostasis: is it a safe option? -a case series-

2020 ◽  
Vol 73 (5) ◽  
pp. 445-449 ◽  
Author(s):  
João Galacho ◽  
Mariano Veiga ◽  
Lucindo Ormonde
Keyword(s):  
Anticoagulation Therapy ◽  
Case Series ◽  
Pain Scale ◽  
Ventilator Weaning ◽  
Erector Spinae ◽  
Regional Analgesia ◽  
Erector Spinae Plane Block ◽  
Analgesic Regimen ◽  
Scale Scores ◽  
Effective Analgesia

Background: We described 5 cases of uneventful administration of the erector spinae plane (ESP) block to patients with altered hemostasis.Case: Five patients were admitted to the intensive care unit with altered hemostasis, defined by the activated partial thromboplastin time ratio or internatinal normalized ratio exceeding 1.5 times the normal value; platelet count equal to or below 80000/μl; or use of anticoagulation therapy. A multimodal analgesic regimen was used for all patients, which proved unsatisfactory and limited successful ventilator weaning, until the administration of the ESP block. Effective analgesia was observed in all patients, with at least 70% reduction in numeric pain scale scores and 83% reduction in opioid consumption, which enabled successful ventilator weaning. No neurologic or hemorrhagic complications were recorded during daily surveillance over 5 days.Conclusions: The ESP block may be a suitable regional analgesia technique for patients with altered hemostasis. Further studies are needed to support this finding.

Intra-articular Injections in the Treatment of Symptoms from Ankle Arthritis: A Systematic Review

2018 ◽  
Vol 39 (10) ◽  
pp. 1141-1150 ◽  
Author(s):  
Christopher Vannabouathong ◽  
Gina Del Fabbro ◽  
Brendan Sales ◽  
Christopher Smith ◽  
Chuan Silvia Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Platelet Rich Plasma ◽  
Symptomatic Relief ◽  
Case Series ◽  
P Value ◽  
Ankle Arthritis ◽  
Ankle Osteoarthritis ◽  
Level Of Evidence ◽  
Patient Demographics ◽  
Scale Scores

Background: Intra-articular (IA) injections are commonly used to treat knee arthritis pain; however, whether their efficacy generalizes to ankle arthritis remains debatable. We aimed to evaluate the evidence for IA therapies in the management of this patient population. Methods: We performed a literature search for observational and randomized controlled trials (RCTs). Treatments included corticosteroids (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), and mesenchymal stem cells (MSC). We extracted study details, patient demographics, treatment characteristics, efficacy outcomes, and safety. When feasible, data from RCTs were meta-analyzed using a random-effects model and 95% confidence intervals (CIs) were calculated. A P value <.05 was considered statistically significant. Results: We identified 27 studies (1085 patients). Ankle OA, rheumatoid arthritis (RA), and hemophilic arthropathy populations were examined. The majority of studies were observational (20 studies); the only RCTs were those evaluating HA. Case series demonstrated favorable results in terms of symptomatic relief with CS, HA, PRP, and MSC injections; however, the effects of CS may only be short term and the evidence on MSCs was limited to 1 study with 6 ankle OA patients. Pooled results (3 RCTs, 109 patients) suggested significantly improved Ankle Osteoarthritis Scale scores with HA over saline at 6 months, with a mean difference of 12.47 points (95% CI 1.18-23.77, P = .03). Conclusion: Evidence from small trials favors HA and PRP injections for the treatment of pain associated with ankle osteoarthritis. However, the relative efficacy of all injectable therapies is far from definitive and warrants further high-quality comparative trials. Level of Evidence: Level III, systematic review.

scholarly journals Sternal Reconstruction Using Locked Compression Plates (LCP): Our Experience in Egypt, A Case Series

2020 ◽  
Author(s):  
Kareem Hosny ◽  
Nady MA ◽  
Mohammed A.K Salama Ayyad
Keyword(s):  
Surgical Techniques ◽  
Case Series ◽  
Pain Scale ◽  
Wound Complications ◽  
Time Range ◽  
Primary Tumors ◽  
Post Operative Pain ◽  
Scale Scores ◽  
Sternal Reconstruction ◽  
Sternal Fractures

Abstract Background: Sternal fractures are rare accounting for about 3-8% of traumatic chest. There are many lines of treatments for sternal fractures which can be classified as conservative or surgical. Surgical techniques include wire fixation and sternal plating. There are no standardization of indications for each line of management.We explore if sternal reconstruction using locking titanium plates and self-tapping screws provide the patient with the best chance of proper sternal healing avoiding chronic pain and its complications and allow the patient early mobilization and rapid restoring of his normal life at its maximumMethods: Our inclusion criteria are patients of both gender from 20-60 years of age presented with traumatic sternal fracture at any site or pathological fracture due to metastatic or primary tumors infiltrating the sternum. High Associated Injury Scale scores were excluded. Exclusion criteria also included patients younger than 20 years or older than 60 years. Primary outcome is post-operative pain score and is measured using numerical pain scale ranging from zero to 10 where zero means there is no pain at all and ten is the worst imaginable pain ever. Results: Sternal reconstruction using titanium plates has proven to be an efficient method of stabilization with tremendous immediate relief of pain showed by the differences between pre-operative and post-operative pain scale scores in our patients (n=5) with Median scores being 7 and 1.5 with range being from 7 to 9 and 1 to 3 respectively (p-value= .039). Operative time range between 150 minutes and 90 minutes with median of 120 minutes. Extubation of patients was smooth with no events with median time of extubation being 120 minutes. From our experience, there were no observed wound complications except at the third patient who suffered a small wound hematoma that was resolved by gentle compressing only and needed no further intervention. Conclusion: We recommend adopting sternal reconstruction using titanium plating systems more readily encouraging even larger clinical trials on the way to a clear guidelines. Plating systems show promising results with least pain, better stability, less complications and rapid, smooth recoveryTrial Registration: NCT04092374

Open Treatment of Osteochondral Lesions of the Talus With Bone Grafting and Particulated Juvenile Cartilage Allografting

2021 ◽  
pp. 193864002110097
Author(s):  
Suhas P. Dasari ◽  
Thomas M. Langer ◽  
Derek Parshall ◽  
Brian Law
Keyword(s):  
Therapeutic Option ◽  
Symptomatic Improvement ◽  
Pain Scale ◽  
Osteochondral Lesions ◽  
Outcome Scores ◽  
Scale Scores ◽  
Open Treatment ◽  
Bone Autograft

Background: Large cystic osteochondral lesions of the talus (OLT) are challenging pathological conditions to treat, but particulated juvenile cartilage allografts (PJCAs) supplemented with bone grafts are a promising therapeutic option. The purpose of this project was to further elucidate the role of PJCA with concomitant bone autografts for treating large cystic OLTs with extensive subchondral bone involvement (greater than 150 mm2 in area and/or deeper than 5 mm). Methods: We identified 6 patients with a mean OLT area of 307.2 ± 252.4 mm2 and a mean lesion depth of 10.85 ± 6.10 mm who underwent DeNovo PJCA with bone autografting between 2013 and 2017. Postoperative outcomes were assessed with radiographs, Foot and Ankle Outcome Scores (FAOS), and visual pain scale scores. Results: At final follow-up (27.0 ± 12.59 weeks), all patients had symptomatic improvement and incorporation of the graft on radiographs. At an average of 62 ± 20.88 months postoperatively, no patients required a revision surgery. All patients contacted by phone in 2018 and 2020 reported they would do the procedure again in retrospect and reported an improvement in their symptoms relative to their preoperative state, especially with pain and in the FAOS activities of daily living subsection (91.93 ± 9.04 in 2018, 74.63 ± 26.86 in 2020). Conclusion: PJCA with concomitant bone autograft is a viable treatment option for patients with large cystic OLTs. Levels of Evidence: Level IV

scholarly journals Feasibility of motor-assisted elliptical to improve walking, fitness and balance following pediatric acquired brain injury: A case series

2021 ◽  
pp. 1-13
Author(s):  
Judith M. Burnfield ◽  
Guilherme M. Cesar ◽  
Thad W. Buster
Keyword(s):  
Brain Injury ◽  
Cardiovascular Response ◽  
Case Series ◽  
Acquired Brain Injury ◽  
Future Research ◽  
Arm Support ◽  
Scale Scores ◽  
Balance Deficits ◽  
Walking Velocity ◽  
Vas Scores

PURPOSE: Walking, fitness, and balance deficits are common following acquired brain injury (ABI). This study assessed feasibility, acceptability, and usefulness of a modified motor-assisted elliptical (ICARE) in addressing walking, fitness, and balance deficits in children with chronic ABIs. METHODS: Three children (>  5 years post-ABI) completed 24 ICARE exercise sessions (exercise time, speed, and time overriding motor-assistance gradually increased) to promote mass repetition of gait-like movements and challenge cardiorespiratory fitness. Parents’ and children’s perceptions of ICARE’s safety, comfort, workout, and usability were assessed. Cardiovascular response, gait and balance outcomes were assessed. RESULTS: No adverse events occurred. Parent’s Visual Analogue Scale (VAS) scores of perceived device safety (range 80–99), workout (range 99–100), and usability (range 75–100) were high, while comfort were 76–80 given commercial harness fit and arm support. Children’s VAS scores all exceeded 89. Comfortable walking velocity, 2-Minute Walk Test, fitness, and Pediatric Balance Scale scores improved post-training, with many outcomes surpassing established minimal clinically important differences. CONCLUSION: Following engagement in moderate- to vigorous-intensity exercise promoting repetitive step-like movements on a specially adapted motor-assisted elliptical, three children with chronic ABI demonstrated improvements in walking, fitness and balance. Future research in community-based environments with a larger cohort of children with ABI is needed.

scholarly journals Intravenous lidocaine in cancer-related neuropathic pain: case series

2021 ◽  
Author(s):  
Danny Steven Castiblanco-Delgado ◽  
Daniela Seija-Butnaru ◽  
Bilena Margarita Molina-Arteta
Keyword(s):  
Neuropathic Pain ◽  
Care Service ◽  
Case Series ◽  
Palliative Care Service ◽  
Pain Scale ◽  
Bolus Administration ◽  
Series Type ◽  
Effective Analgesia ◽  
Initial Bolus ◽  
Reduce Pain Intensity

Introduction: Administering systemic lidocaine has been shown to deliver effective analgesia for both cancer-related and non-cancer pain. Adverse effects and toxicity are rare with controlled administration. Objective: To report the results obtained after the indication to manage with IV lidocaine infusion to control neuropathic pain flares in 9 cancer patients. Methodology: Observational, descriptive, case series-type study. A search was conducted in the files of the Pain and Palliative Care Service of the National Cancer Institute - Instituto Nacional de Cancerología - in Bogotá. Patients over 18 years old diagnosed with cancer, who experienced high intensity neuropathic pain and with the cognitive ability to rate their pain in a numerical analogue scale (NAS), without any absolute contraindications for the use of IV lidocaine were included; patients were assessed between September 27 and November 21, 2019. Results: 9 patients experiencing a pain flare-up which was characterized as neuropathic were registered, of which 89 % had some improvement following the administration of an initial lidocaine bolus. After one hour, 60 % reported over 40% improvement in the initial NAS. After 24 hours all patients had experienced some improvement, with a reduction of 46% in the pain scale as compared to the baseline. Conclusions: In this series of cases, the intravenous infusion of lidocaine as an option for the management of neuropathic pain flares seems to reduce pain intensity following the initial bolus administration.

Surgical excision of extensive sacrococcygeal chordomas assisted by occlusion of the abdominal aorta

2010 ◽  
Vol 12 (5) ◽  
pp. 490-496 ◽  
Author(s):  
Liu Xue-Song ◽  
You Chao ◽  
Yang Kai-Yong ◽  
Huang Si-Qing ◽  
Zhang Heng
Keyword(s):  
Abdominal Aorta ◽  
Postoperative Radiotherapy ◽  
Balloon Dilation ◽  
Surgical Excision ◽  
Neurological Dysfunction ◽  
Pelvic Cavity ◽  
Large Tumor ◽  
Electrophysiological Monitoring ◽  
Complex Anatomy

Object An extensive sacrococcygeal chordoma is considered a challenge for neurosurgeons. Because of the complex anatomy of the sacral region, the risk of uncontrollable intraoperative hemorrhage, and the typically large tumor size at presentation, complete resections are technically difficult and the tumor recurrence rate is high. The aim of this study was to assess the value of using occlusion of the abdominal aorta by means of a balloon dilation catheter and electrophysiological monitoring when an extensive sacrococcygeal chordoma is removed. Methods Between 2004 and 2008, 9 patients underwent resection of extensive sacrococcygeal chordomas in the authors' department with the aid of occlusion of the abdominal aorta and electrophysiological monitoring. All of these operations were performed via the posterior approach. The records of the 9 patients were reviewed retrospectively. Results Wide resections were performed in 6 cases and marginal excisions in the other 3. Five patients underwent postoperative radiotherapy. Intraoperative hemorrhage was controlled at 100–400 ml. Postoperatively, none of the patients had any new neurological dysfunction, and 2 patients regained normal urinary and bowel function. The mean follow-up period was 31.4 months (range 10–57 months). No patient developed local recurrence or had metastatic spread of tumor during follow-up. Conclusions Occlusion of the abdominal aorta and electrophysiological monitoring are useful methods for assisting in resection of sacrococcygeal chordoma. They can reduce intraoperative hemorrhage and entail little chance of tumor cell contamination. They can also help surgeons to protect the organs in the pelvic cavity and neurological function. Use of these methods could give patients better quality of life.

Personalized multitarget biologic injection in the spine: prospective case series of multitarget platelet-rich plasma for low back pain

2021 ◽  
Author(s):  
Edilson S Machado ◽  
Mary A Ambach ◽  
José MP Caldas ◽  
Jason J Wei ◽  
Markus Bredemeier
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Platelet Rich Plasma ◽  
Case Series ◽  
Pain Scale ◽  
Roland Morris Disability Questionnaire ◽  
Low Back ◽  
Visual Analog Pain Scale ◽  
Paravertebral Muscles ◽  
Disability Questionnaire

Aim: To evaluate the use of a multitarget platelet-rich plasma (PRP) injection approach for the treatment of chronic low back pain (LBP). Materials & Methods: Forty-six patients with more than 12 weeks of LBP who failed conservative treatments were injected with PRP into the facet joints, intervertebral discs, epidural space and/or paravertebral muscles. Visual analog pain scale and Roland-Morris Disability Questionnaire scores were measured at baseline and predefined intervals. Results: Mean visual analog pain scale was reduced from 8.48 to 5.17 and mean Roland-Morris Disability Questionnaire from 18.0 to 10.98 at 12 weeks (p < 0.001). These statistically significant improvements were sustained over 52 weeks. No adverse effects were observed. Conclusion: Our PRP approach demonstrated clinically favorable results and may be a promising treatment for chronic LBP.

scholarly journals Buccal Mucosal Grafts for Urethroplasty: Comparison of Postoperative Oral and Perineal Morbidity

2009 ◽  
Vol 91 (2) ◽  
pp. 116-117 ◽  
Author(s):  
Khalid Abdel-Galil ◽  
Ian Eardley ◽  
Richard Loukota
Keyword(s):  
Donor Site ◽  
Pain Scale ◽  
Perineal Pain ◽  
Visual Analogue Pain Scale ◽  
Urethral Reconstruction ◽  
Visual Analogue Pain ◽  
Buccal Mucosa Graft ◽  
Buccal Mucosal Graft ◽  
Graft Harvest ◽  
Scale Scores

INTRODUCTION A prospective study of postoperative oral and perineal pain experienced by a group of patients undergoing buccal mucosal graft harvest for urethral reconstruction. PATIENTS AND METHODS A consecutive group of 24 male patients undergoing buccal mucosa graft harvest for urethral recon8truction of stricture disease was prospectively studied between June 2006 and December 2008. All patients were examined pre-operatively and entered into the study prospectively. After surgery, all patients were reviewed at 24 h and 48 h. On both occasions, they were asked to complete a proforma containing visual analogue pain scales for both the oral donor site as well as the perineum. RESULTS A statistically significant higher level of pain was experienced from the perineum than the oral donor site on both the first and second postoperative days. CONCLUSIONS Comparative analysis of visual analogue pain scale scores between oral donor site and perineum showed that patients experience significantly more pain from the latter postoperatively.

Pain reduction by dehydrated human amnion/chorion membrane allograft in nondiabetic leg ulcers might be an early indicator of good response: A case series

2020 ◽  
Vol 33 (4) ◽  
Author(s):  
Simon M. Mueller ◽  
Alexander A. Navarini ◽  
Peter Itin ◽  
Simon Schwegler ◽  
Severin Laeuchli ◽  
...  
Keyword(s):  
Case Series ◽  
Pain Reduction ◽  
Leg Ulcers ◽  
Human Amnion ◽  
Early Indicator
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