scholarly journals Laparoscopic approach to refractory extraspinal sciatica and pudendal pain caused by intrapelvic nerve entrapment

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nucelio Lemos ◽  
Corey Sermer ◽  
Gustavo Fernandes ◽  
Augusta Morgado-Ribeiro ◽  
Andrea Rossos ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Rating Scale ◽  
Laparoscopic Approach ◽  
Pain Reduction ◽  
Numeric Rating Scale ◽  
Opioid Therapy ◽  
Invasive Technique ◽  
Opioid Use ◽  
Nerve Entrapments ◽  
Perioperative Complication

AbstractEntrapments of the intrapelvic portions of the lumbosacral plexus are an important extraspinal cause of sciatica and pudendal neuralgia. They can be treated using Laparoscopic Neuronavigation (LANN), a minimally invasive technique that has set the foundations of an emerging field in Medicine—Neuropelveology. This retrospective-prospective study analyzes the outcomes of 63 patients treated with the LANN technique over a 10 year time period. One year after surgery, 78.3% of patients reported clinically relevant pain reduction, defined as ≥ 50% reduction in Numeric Rating Scale (NRS) score; these results were maintained for a mean follow up of 3.2 years. Preoperative chronic opioid use (≥ 4 months of ≥ 10 mg morphine equivalents/day) was a predictor of poor surgical outcome—clinically relevant pain reduction was observed in only 30.8% in this group of patients, compared to 91.5% in patients not regularly taking opioids preoperatively (p < 0.01). Perioperative complication rate was 20%. Our results indicate that the LANN technique is an effective and reproducible approach to relieve pain secondary to intrapelvic nerve entrapments and that preoperative chronic opioid therapy significantly reduces the likelihood of a successful surgical outcome. This study provides detailed information on perioperative complication and postoperative course, which is essential for patient consenting.

scholarly journals Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001474
Author(s):  
Ellaha Kakar ◽  
Ryan J Billar ◽  
Joost van Rosmalen ◽  
Markus Klimek ◽  
Johanna J M Takkenberg ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Rating Scale ◽  
Meta Analysis ◽  
Numeric Rating Scale ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Music Intervention ◽  
Opioid Use ◽  
Beneficial Effects

ObjectivesPrevious studies have reported beneficial effects of perioperative music on patients’ anxiety and pain. We performed a systematic review and meta-analysis of randomised controlled trials investigating music interventions in cardiac surgery.MethodsFive electronic databases were systematically searched. Primary outcomes were patients’ postoperative anxiety and pain. Secondary outcomes were hospital length of stay, opioid use, vital parameters and time on mechanical ventilation. PRISMA guidelines were followed and PROSPERO database registration was completed (CRD42020149733). A meta-analysis was performed using random effects models and pooled standardised mean differences (SMD) with 95% confidence intervals were calculated.ResultsTwenty studies were included for qualitative analysis (1169 patients) and 16 (987 patients) for meta-analysis. The first postoperative music session was associated with significantly reduced postoperative anxiety (SMD = –0.50 (95% CI –0.67 to –0.32), p<0.01) and pain (SMD = –0.51 (95% CI –0.84 to –0.19), p<0.01). This is equal to a reduction of 4.00 points (95% CI 2.56 to 5.36) and 1.05 points (95% CI 0.67 to 1.41) on the State-Trait Anxiety Inventory and Visual Analogue Scale (VAS)/Numeric Rating Scale (NRS), respectively, for anxiety, and 1.26 points (95% CI 0.47 to 2.07) on the VAS/NRS for pain. Multiple days of music intervention reduced anxiety until 8 days postoperatively (SMD = –0.39 (95% CI –0.64 to –0.15), p<0.01).ConclusionsOffering recorded music is associated with a significant reduction in postoperative anxiety and pain in cardiac surgery. Unlike pharmacological interventions, music is without side effects so is promising in this population.

The influence of chief complaint on opioid use in the emergency department

2006 ◽  
Vol 2 (4) ◽  
pp. 228 ◽  
Author(s):  
Kathleen Puntillo, RN, DNSc, FAAN ◽  
Martha Neighbor, MD ◽  
Garrett K. Chan, APRN, BC, PhD ◽  
Roxanne Garbez, RN, MS, ACNP
Keyword(s):  
Emergency Department ◽  
Rating Scale ◽  
Patient Discharge ◽  
Numeric Rating Scale ◽  
Opioid Use ◽  
Pain Scores ◽  
Patient Pain ◽  
Nurses And Physicians ◽  
Time Of Admission ◽  
Numeric Rating

The aim of this study was to explore factors influencing emergency department (ED) clinicians’ use of opioids in treating selected patients. Patients who either received or did not receive opioids in the ED, as well as their nurses and physicians, were interviewed before patient discharge. We found that the decrease in patients’ mean (SD) pain intensity from the time of admission to the ED (7.3 ± 2.4 on a 0 to 10 numeric rating scale) to discharge (5.0 ± 2.9) was statistically significant (t93 = 8.4, p < 0.001, 95 percent CI = 1.7, 2.8) for all groups except those with trauma-related pain. The factor that most frequently led physicians of patients with abdominal pain and nurses in general to administer no opioids was that the patient was “not in that much pain.” However, the patients in question had self-reported pain scores that indicated moderate pain. Our findings lead us to conclude that clinicians inaccurately infer severity of patient pain. This in turn can influence the prescription of opioids and the patient’s decrease in pain.

scholarly journals Efficacy and Safety of Transdermal Buprenorphine versus Oral Tramadol/Acetaminophen in Patients with Persistent Postoperative Pain after Spinal Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Jae Hyup Lee ◽  
Jin-Hyok Kim ◽  
Jin-Hwan Kim ◽  
Hak-Sun Kim ◽  
Woo-Kie Min ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spinal Surgery ◽  
Rating Scale ◽  
Medication Compliance ◽  
Pain Reduction ◽  
Numeric Rating Scale ◽  
Persistent Pain ◽  
Efficacy And Safety ◽  
Open Label ◽  
Persistent Postoperative Pain

Purpose. Control of persistent pain following spinal surgery is an unmet clinical need. This study compared the efficacy and safety of buprenorphine transdermal system (BTDS) to oral tramadol/acetaminophen (TA) in Korean patients with persistent, moderate pain following spinal surgery.Methods. Open-label, interventional, randomized multicenter study. Adults with persistent postoperative pain (Numeric Rating Scale [NRS] ≥ 4 at 14–90 days postsurgery) were enrolled. Patients received once-weekly BTDS (n=47; 5 μg/h titrated to 20 μg/h) or twice-daily TA (n=40; tramadol 37.5 mg/acetaminophen 325 mg, one tablet titrated to 4 tablets) for 6 weeks. The study compared pain reduction with BTDS versus TA at week 6. Quality of life (QoL), treatment satisfaction, medication compliance, and adverse events (AEs) were assessed.Findings. At week 6, both groups reported significant pain reduction (mean NRS change: BTDS −2.02; TA −2.76, bothP<0.0001) and improved QoL (mean EQ-5D index change: BTDS 0.10; TA 0.19, bothP<0.05). The BTDS group achieved better medication compliance (97.8% versus 91.0%). Incidence of AEs (26.1% versus 20.0%) and adverse drug reactions (20.3% versus 16.9%) were comparable between groups.Implications. For patients with persistent pain following spinal surgery, BTDS is an alternative to TA for reducing pain and supports medication compliance. This trial is registered with Clinicaltrials.gov:NCT01983111.

scholarly journals Intrapelvic entrapment of sacral nerve roots by abnormal bundles of the piriformis muscle: description of an extra-spinal cause of sciatica and pudendal neuralgia

2021 ◽  
Author(s):  
Corey Sermer ◽  
Adrienne L K Li ◽  
Gustavo L Fernandes ◽  
Augusta M Ribeiro ◽  
Giancarlo Polesello ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Rating Scale ◽  
Clinical Success ◽  
Case Series ◽  
Laparoscopic Approach ◽  
Numeric Rating Scale ◽  
Piriformis Muscle ◽  
Nerve Roots ◽  
Sacral Nerve ◽  
Sacral Foramina

Abstract Piriformis syndrome is a well-known extra-spinal cause of sciatica characterized by the entrapment of the sciatic nerve by variant bundles of the piriformis muscles in the deep gluteal space. In this case series, we describe the entrapment of intrapelvic portions of the sacral nerve roots by a variant bundle of the piriformis muscle originating medially to the sacral foramina, the surgical technique for the laparoscopic treatment of this condition, and the outcomes of the first eight cases treated with this technique. Five female and three male patients presenting with sciatica, pudendal pain and lower urinary tract symptoms underwent a laparoscopic exploration of the intrapelvic portion of the sacral nerve roots and transection of the abnormal piriformis bundle. Surgical technique is demonstrated in the Supplementary Video. Clinical success was achieved in seven of the eight patients, with a reduction of pain numeric rating scale from 8.5 (±1.2; 7–10) pre-operatively to 2.1 (±2.6; 0–7), 1-year following surgery. In conclusion, entrapment of intrapelvic portions of the sacral nerve roots by variant bundles of the piriformis originating medially to the sacral foramina are an extraspinal cause of sciatica, which can be treated though a laparoscopic approach.

Local Anesthetics delivered through Pleural Drainages improve Pain and Lung Function after Cardiac Surgery

2015 ◽  
Vol 66 (02) ◽  
pp. 198-202 ◽  
Author(s):  
Issam Ismail ◽  
Thierry Siemeni ◽  
Stefan Ruemke ◽  
Felix Fleissner ◽  
Ruoyu Zhang ◽  
...  
Keyword(s):  
Lung Function ◽  
Rating Scale ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Pain Reduction ◽  
Numeric Rating Scale ◽  
Forced Expiratory Volume ◽  
Lidocaine Group ◽  
Comparison Results ◽  
Numeric Rating

Objective Pleural tubes after coronary artery bypass graft (CABG) surgery usually cause pain resulting interalia in an impact of postoperative breathing. Therefore, the influence of intrapleural lidocaine application through special double-lumen chest tubes with respect to pain relief and lung function was investigated and compared with placebo. Methods In this study, 40 patients who underwent CABG got intrapleural injection either with 2% lidocaine (n = 20) or placebo (0.9% saline solution) (n = 20) on the first 2 days after surgery. Pain was measured by pain intensity numeric rating scale (NRS) (0 = no pain; 10 = the most intense pain) and lung function by portable spirometer. Results On the first postoperative day (POD1), mean pain reduction was NRS 1.9 for the lidocaine group with an improvement of the forced expiratory volume in 1 second (FEV1) of 0.51 L. Similar results were shown on the second postoperative day (POD2) with a decreased pain level of mean NRS 1.65 and an FEV1 improvement of 0.26 L. In comparison, results of the placebo group showed no significant pain reduction, neither on the POD1 (NRS 0.35; p = 0.429) nor on the POD2 (NRS 0.55; p = 0.159). Also, there was no significant influence of FEV1 after placebo on the POD1 (FEV1 = 0.048 L; p = 0.70) or on the POD2 (FEV1 = 0.0135 L; p = 0.925). Conclusion Intrapleural application of lidocaine is a safe and feasible method to reduce drainage-related pain and improving lung function after CABG.

scholarly journals PREST: Pain REduction with bone metastases STereotactic radiotherapy: A phase III randomized multicentric trial

2019 ◽  
Author(s):  
Francesco Cellini ◽  
Stefania Manfrida ◽  
Francesco Deodato ◽  
Savino Cilla ◽  
Ernesto Maranzano ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Rating Scale ◽  
Prognostic Score ◽  
Progression Free Survival ◽  
Pain Reduction ◽  
Numeric Rating Scale ◽  
Phase Iii ◽  
Open Label ◽  
Free Survival ◽  
Numeric Rating

Abstract Background Palliative antalgic treatments represent an issue for clinical management and a challenge for scientific research. Radiotherapy (RT) plays a central role. Techniques such as stereotactic body radiotherapy (SBRT) were largely investigated in several phase 2 studies with good symptom response, becoming widely adopted. Still is lacking evidence from randomized, direct comparison of RT and SBRT. Methods/Design The PREST trial was designed as an interventional study without medicinal, randomized 1:1, open-label, multicentric, phase 3. Inclusion criteria: painful spinal bone metastases presenting pain level >4 (or >1 if assuming analgesic) at numeric rating scale (NRS); expected intermediate/high prognosis (superior to 6 months) according to the Mizumoto prognostic score; low spine instability neoplastic score (SINS) sores (<7); magnetic resonance imaging (MRI) assessment of the bulky lesion. Patients will be assigned to either standard conventional radiotherapy administering 4 Gy x5 fractions (fx) to whole involved vertebra or SBRT by intensity modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) administering 7 Gy x3 fx (to the whole involved vertebra) + 10 Gy x3 fx on the macroscopic disease (Gross Tumor Volume -GTV). In the experimental arm, the GTV will be contoured by registration with baseline MRI. Discussion Primary endpoint is overall pain reduction, defined in term of variation between baseline and 1-month evaluation; pain will be measured by Numeric Rating Scale (NRS) score. Secondary endpoints include: pain control duration; retreatment rates (after a minimum interval of 1 month); local control assessed with RECIST Criteria; symptom progression free survival; progression free survival; overall survival and quality of life (at 0, 30 and 90 days). Accrual of 330 lesions is planned. Experimental arm is expected to improve overall pain response rates of 15% respect to standard arm (60% according to Chow et al 2012).

scholarly journals PREST: Pain REduction with bone metastases STereotactic radiotherapy: A phase III randomized multicentric trial

2019 ◽  
Author(s):  
Francesco Cellini ◽  
Stefania Manfrida ◽  
Francesco Deodato ◽  
Savino Cilla ◽  
Ernesto Maranzano ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Rating Scale ◽  
Prognostic Score ◽  
Progression Free Survival ◽  
Pain Reduction ◽  
Numeric Rating Scale ◽  
Phase Iii ◽  
Open Label ◽  
Free Survival ◽  
Numeric Rating

Abstract Background Palliative antalgic treatments represent an issue for clinical management and a challenge for scientific research. Radiotherapy (RT) plays a central role. Techniques such as stereotactic body radiotherapy (SBRT) were largely investigated in several phase 2 studies with good symptom response, becoming widely adopted. Still is lacking evidence from randomized, direct comparison of RT and SBRT. Methods/Design The PREST trial was designed as an interventional study without medicinal, randomized 1:1, open-label, multicentric, phase 3. Inclusion criteria: painful spinal bone metastases presenting pain level >4 (or >1 if assuming analgesic) at numeric rating scale (NRS); expected intermediate/high prognosis (superior to 6 months) according to the Mizumoto prognostic score; low spine instability neoplastic score (SINS) sores (<7); magnetic resonance imaging (MRI) assessment of the bulky lesion. Patients will be assigned to either standard conventional radiotherapy administering 4 Gy x5 fractions (fx) to whole involved vertebra or SBRT by intensity modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) administering 7 Gy x3 fx (to the whole involved vertebra) + 10 Gy x3 fx on the macroscopic disease (Gross Tumor Volume -GTV). In the experimental arm, the GTV will be contoured by registration with baseline MRI. Discussion Primary endpoint is overall pain reduction, defined in term of variation between baseline and 3-month evaluation; pain will be measured by Numeric Rating Scale (NRS) score. Secondary endpoints include: pain control duration; retreatment rates (after a minimum interval of 1 month); local control assessed with RECIST Criteria; symptom progression free survival; progression free survival; overall survival and quality of life (at 0, 30 and 90 days). Accrual of 330 lesions is planned. Experimental arm is expected to improve overall pain response rates of 15% respect to standard arm (60% according to Chow et al 2012).

scholarly journals Prevention of Acute Postoperative Pain in Breast Cancer: A Comparison between Opioids versus Ketamine in the Intraoperatory Analgesia

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Mirian López ◽  
María Luz Padilla ◽  
Blas García ◽  
Javier Orozco ◽  
Ana María Rodilla
Keyword(s):  
Breast Cancer ◽  
Postoperative Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Systemic Side Effects ◽  
Waking Up

Background. Acute postoperative pain (APP) has a high incidence in breast surgery, and opioids are the most commonly used drugs for its management; however, they are not free from systemic side effects, which may increase comorbidity. In the past few years, opioid-free anaesthesia has been favoured with promising results. Methods. We conducted a descriptive study including 71 patients who underwent breast cancer surgery. The opioid group (n = 41) received fentanyl for induction, remifentanil for maintenance, and rescue morphine before waking up, whereas the ketamine group (n = 30) received a ketamine bolus for induction followed by continuous ketamine infusion during surgery. Later, the presence and intensity of pain were registered, using the Numeric Rating Scale (NRS 1–10) for pain, at different times in the recovery room, at 24 hours and at 3 months. Results. Administration of ketamine is more effective than opioid use for APP prevention in breast cancer surgery because the ketamine group presented with less pain than the opioid group ( p  < 0.05) at all measured times. When there was pain, patients in the ketamine group gave a lower score to its intensity ( p  < 0.05). Conclusions. Ketamine could reduce the incidence of APP in breast cancer surgery, compared to opioids.

Contrast Dispersion on Epidurography May Be Associated with Clinical Outcomes After Percutaneous Epidural Neuroplasty Using an Inflatable Balloon Catheter

Pain Medicine ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 677-685
Author(s):  
Doo-Hwan Kim ◽  
Gyu Yeul Ji ◽  
Hyun-Jung Kwon ◽  
Taejun Na ◽  
Jin-Woo Shin ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Rating Scale ◽  
Balloon Catheter ◽  
Pain Reduction ◽  
Numeric Rating Scale ◽  
Functional Improvement ◽  
Dispersion Pattern ◽  
Lumbar Spinal

Abstract Background Contrast dispersion pattern on epidurography may be associated with clinical improvement after epidural neuroplasty. However, insufficient evidence supports this theory. The current study aims to evaluate the relevance of contrast dispersion and clinical improvement after percutaneous epidural neuroplasty using an inflatable balloon catheter. Methods One hundred patients with lumbar spinal stenosis who underwent combined balloon decompression and epidural adhesiolysis between March 2015 to December 2015 participated in the present study. Participants were divided into two groups by contrast dispersion pattern on postprocedural epidurography: the complete contrast dispersion (CCD) and incomplete contrast dispersion (ICCD) groups. The numeric rating scale (NRS), Oswestry Disability Index (ODI), and global perceived effects (GPE) were each assessed before and one, three, six, nine, and 12 months after the intervention. Results After combined balloon decompression and adhesiolysis, significant pain reduction and functional improvement were maintained up to 12 months in patients with lumbar spinal stenosis. NRS and GPE in the CCD group were significantly lower than in the ICCD group from six to 12 months after the intervention. The ODI in the CCD group was also significantly lower compared with that in the ICCD group from one to 12 months after the intervention. Conclusions Combined balloon decompression and adhesiolysis with the inflatable balloon catheter can provide noteworthy pain reduction and improvement of physical function for a long-term period in patients with lumbar spinal stenosis. Because CCD showed better clinical improvement compared with ICCD, a contrast dispersion pattern may be associated with an improved clinical outcome.

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