Dry Needling and Antithrombotic Drugs

Many clinicians increasingly use dry needling in clinical practice. However, whether patients’ intake of antithrombotic drugs should be considered as a contraindication for dry needling has not been investigated to date. As far as we know, there are no publications in analyzing the intake of antiplatelet or anticoagulant agents in the context of dry needling techniques. A thorough analysis of existing medications and how they may impact various needling approaches may contribute to improved evidence-informed clinical practice. The primary purpose of this paper is to review the current knowledge of antithrombotic therapy in the context of dry needling. In addition, reviewing guidelines of other needling approaches, such as electromyography, acupuncture, botulinum toxin infiltration, and neck ultrasound-guided fine-needle aspiration biopsy, may provide specific insights relevant for dry needling. Based on published data, taking antithrombotic medication should not be considered an absolute contraindication for dry needling techniques. As long as specific dry needling and individual risks are properly considered, it does not change the risk and safety profile of dry needling. Under specific circumstances, the use of ultrasound guidance is recommended when available.

Quantitative coronary angiography versus intravascular ultrasound guidance for drug-eluting stent implantation (GUIDE-DES): study protocol for a randomised controlled non-inferiority trial

IntroductionAngiography remains the gold standard for guiding percutaneous coronary intervention (PCI). However, it is prone to suboptimal stent results due to the visual estimation of coronary measurements. Although the benefit of intravascular ultrasound (IVUS)-guided PCI is becoming increasingly recognised, IVUS is not affordable for many catheterisation laboratories. Thus, a more practical and standardised angiography-based approach is necessary to support stent implantation.Methods and analysisThe Quantitative Coronary Angiography versus Intravascular Ultrasound Guidance for Drug-Eluting Stent Implantation trial is a randomised, investigator-initiated, multicentre, open-label, non-inferiority trial comparing the quantitative coronary angiography (QCA)-guided PCI strategy with IVUS-guided PCI in all-comer patients with significant coronary artery disease. A novel, standardised, QCA-based PCI protocol for the QCA-guided group will be provided to all participating operators, while the PCI optimisation criteria will be predefined for both strategies. A total of 1528 patients will be randomised to either group at a 1:1 ratio. The primary endpoint is the 12-month cumulative incidence of target-lesion failure defined as a composite of cardiac death, target-vessel myocardial infarction or ischaemia-driven target-lesion revascularisation. Clinical follow-up assessments are scheduled at 1, 6 and 12 months for all patients enrolled in the study.Ethics and disseminationEthics approval for this study was granted by the Institutional Review Board of Asan Medical Center (no. 2017-0060). Informed consent will be obtained from every participant. The study findings will be published in peer-reviewed journal articles and disseminated through public forums and academic conference presentations. Cost-effectiveness and secondary imaging analyses will be shared in secondary papers.Trial registration numberNCT02978456.

Greater occipital nerve blockade using ultrasound guidance for the headache of spontaneous intracranial hypotension - A case report -

BackgroundSpontaneous intracranial hypotension occurs due to cerebrospinal fluid leakage from the spinal column, and orthostatic headache is the most common clinical presentation. Recent studies showed that bilateral greater occipital nerve blockade demonstrated clinical efficacy in relieving post-dural puncture headache after caesarean section. CaseA 40-year-old male who presented severe orthostatic headache was consulted to our pain clinic from neurology department. He initially felt a dull nature pain over the whole occipital area which then spread over the frontal and parietal areas. His headache was combined with nausea and vomiting. An epidural blood patch was delayed until final cisternography, and bilateral greater occipital nerve blockade using ultrasound guidance was performed instead. After the blockade, the previously existing headache around the occipital and parietal areas disappeared completely, but mild headache persisted around the frontal area.ConclusionsGreater occipital nerve blockade could be a good therapeutic alternative to improve headache resulting from spontaneous intracranial hypotension.

Ultrasound navigation during retrobulbar blockade in children with retinoblastoma and enucleation of the eyeball

BACKGROUND: The retrobulbar block in children is used to enucleate analgesia in the intra- and postoperative period and prevent oculocardiac reflex (OCD), postoperative nausea, and vomiting. However, when the block is performed blindly, it results in serious complications. AIM: This study aimed to evaluate the efficacy and safety of a retrobulbar block performed under ultrasound guidance compared with a retrobulbar block performed blindly during enucleation of the eyeball in children with retinoblastoma. MATERIALS AND METHODS: A prospective randomized controlled trial was performed. The study included 40 patients who met the inclusion criteria. The patients were divided into two groups: 20 patients who underwent ultrasound-guided retrobulbar blockade (RBВ + ultrasound) and 20 patients who underwent blindly retrobulbar blockade (RBВ). RESULTS: There was an insignificant decrease in intraoperative opioid requirements in the RBB + ultrasound group, where the average dose of fentanyl was 41.4 g/kg, and in the RBB group, 4.70.8 g/kg (p 0.05). The time before the administration of the first dose of analgesic in the postoperative period was 4.70.8 h in the RBB group and 11.73.3 h in the RBB + ultrasound group (p 0.05). VAS and CHIPPS scores obtained 6 h after the end of surgery in the RBB + ultrasound and RBB groups were 1.8 (1.2; 2) and 2.5 (3.8; 4.5) points (p 0.05), respectively. CONCLUSION: There was no statistically significant difference between the time of the retrobulbar blockade under ultrasound guidance and the retrobulbar regional block performed blindly. Retrobulbar blockade performed under ultrasound guidance provides a decrease in intraoperative opioid requirements, stable intraoperative hemodynamics, and longer postoperative analgesia.

Cryoneurolysis for Digital Neuralgia in Professional Baseball Players: A Case Series

ObjectiveWe describe a non-surgical approach to refractory digital neuralgia using cryoneurolysis in a series of 3 professional baseball players.BackgroundThumb injuries are common in baseball players and can sometimes be challenging to effectively manage. Depending on the injury, current treatments include anti-inflammatories, immobilization, physical therapy, corticosteroid injections, and/or surgery. A subset of patients, however, fail nonoperative management yet do not have a clear indication for surgery. Cryoneurolysis or cyroanalgesia is an FDA-approved form of neuromodulation, which has been used safely and effectively on a variety of peripheral nerves. The mechanism of action involves percutaneous introduction of a small probe under local anesthetic to nerve tissue using ultrasound guidance. The probe is then cooled to −88°C using nitrous oxide, which results in secondary Wallerian degeneration. Axonal and myelin regeneration occurs completely in 3–6 months.Design/MethodsVisualization of the superficial radial sensory and ulnar digital nerve were obtained under ultrasound. The skin was prepared in sterile fashion. A 22-gauge 1-½ inch needle was then advanced with ultrasound guidance, and local anesthetic was applied. Both treatment sites were marked with skin marker. Cryoneurolysis was employed using a 5 mm tip. 60-second treatment cycles were performed at each site. Each of the cycles resulted in a 5 × 7 mm lesion visible as hypoechoic signal.ResultsAll 3 players endorsed significant and prolonged relief and were able to return to an elite level of play.ConclusionsThis manuscript is subject to all of the limitations of a case series, and larger rigorous studies are needed to illuminate causal inferences. Novel, complex technologies may also be more susceptible to placebo effect. Nonetheless, we are able to report marked efficacy and safety from cryoneurolysis of the ulnar digital nerve and the superficial radial sensory nerve in a small group of elite baseball players with refractory digital neuralgia.

Ultrasound-Guided Lauromacrogol Injection for the Treatment of Active Bleeding After Renal Biopsy

Background: This study aimed to describe the technique and outcomes of hemostasis for ultrasound-guided lauromacrogol injection for active bleeding after renal biopsy.Methods: Data from patients with active bleeding after renal biopsy between January 2018 and December 2020 were retrospectively collected. Patients who still had active bleeding after 30 min of compression were then injected with lauromacrogol under ultrasound guidance. The patient’s symptoms before and after operation were collected to assess whether they had severe complications. Changes in hemoglobin and serum creatinine values were collected.Results: Data from a total of 15 patients with active bleeding after renal biopsy were collected, including data of 6 men and 9 women. After the operation, there were 11 cases of mild back pain; 1 case of chills, cold sweats, and back pain; 1 case of cold sweats and blood pressure reduction, and 2 cases with no obvious symptoms. No severe complications occurred in this study, and active bleeding was stopped in all patients. After the operation, compared with before the operation, there was no statistically significant difference in the hemoglobin value and serum creatinine value (p = 0.10 > 0.05, p = 0.78 > 0.05).Conclusion: Ultrasound-guided lauromacrogol injection is a relatively simple, safe and feasible method, which could be helpful in treating active bleeding in the immediate post-procedure period after renal biopsy.

Experience of Radiology Technologists Performing Peripherally Inserted Central Catheters (PICC)

Purpose We conducted this study to review our local experience of performing peripherally inserted central catheters by interventional radiology technologists. Materials and Methods This is a retrospective study of peripherally inserted central catheters performed by interventional radiology technologists. These procedures were performed using ultrasound guidance for venous puncture and fluoroscopy or electrocardiography guidance followed by chest X-ray to confirm tip location. Results We reviewed all peripherally inserted central catheters performed in interventional radiology between May 2017 and July 2020. The review process included the success rate, number of venous puncture attempts, method of guidance, procedure time, fluoroscopy time, catheter duration to removal, and complications. Conclusion Interventional radiology technologists can perform peripherally inserted central catheters safely with high success rate. Extending interventional radiology technologists' role to perform peripherally inserted central catheters allow interventional radiologists to do more complex procedures. This enhances the workflow, increases the interventional radiology team efficiency, and improves the waiting time.

Different Concentrations of Ropivacaine under Ultrasound Guidance on Quadratus Lumbar Muscle Nerve Block in Elderly Patients with Hip Replacement

Objective. To compare the effect of ropivacaine in different concentrations under ultrasound guidance on lumbar muscle nerve blocking in elderly patients undergoing hip replacement surgery. Methods. 60 elderly patients underwent hip replacement in our hospital over a period of April to December of 2019 were equally randomized into control and observation groups, with 30 each. Patients in the control group and observation group received 0.5% and 0.25% ropivacaine to block psoas muscle nerve, respectively. The anesthetic effect of ropivacaine at different concentrations was evaluated by time of sensory block onset and recovery and time of motor block onset and regression, blood pressure, heart rate, visual analogy scale, and postoperative nerve blocking degree. Results. The onset time of sensory and motor block in the observation group was dramatically higher than that in the control group ( P < 0.05 ), while the recovery time of sensory and motor was significantly shorter than that of the control group ( P < 0.05 ). The heart rate in the observation group was notably lower than that in the control group, while the average blood pressure was remarkably higher ( P < 0.05 ). After surgery, the degree of nerve block in the observation group was much lower compared with the control group ( P < 0.05 ), while no marked difference in the visual analogue scale in the control group before and after surgical intervention was observed ( P > 0.05 ). Conclusion. The 0.25% ropivacaine method has distinctive advantages over 0.50% ropivacaine psoas nerve anesthesia in hip replacement surgery in elderly patients.