Efficacy of local anaesthetic and steroid combination in prevention of post-herpetic neuralgia: A meta-analysis

Objective: The objective was to provide synthesized evidence on the efficacy of local anaesthetics and steroid injections for prevention and management of PHN, compared to the standard treatment using anti-viral and analgesic medications. The primary outcomes of interest were incidence of PHN and duration of neuralgic pain. Methods: Comprehensive searches were done systematically through PubMed, Scopus, Cochrane Central Register of Controlled Trials and Google scholar databases. Randomized controlled trials that compared the efficacy of local anaesthetics and steroid injections for preventing and managing PHN were included for this meta-analysis. A comprehensive search was done for papers published until 15th July 2021. Results: A total of 10 RCTs were included in the meta-analysis. In the overall pooled analyses, compared to standard care/placebo, those receiving a combination of local anaesthetic and steroid injection had 55% lower risk of PHN at 3 months from onset of rash (RR 0.45; 95% CI, 0.29; 0.70). Out of the different modes of intervention delivery i.e., intravenous, subcutaneous and nerve block, maximum beneficial effect in reducing the incidence of PHN was noted in nerve block (RR 0.55; 95% CI, 0.34, 0.89). Conclusions: The meta-analysis provides some evidence to support the use of combined local anaesthetic and steroids in reducing risk of post-herpetic neuralgia and duration of neuralgic pain in patients with herpes zoster rash. doi: https://doi.org/10.12669/pjms.38.3.5140 How to cite this:Zhang X, Wang Z, Xian Y. Efficacy of local anaesthetic and steroid combination in prevention of post-herpetic neuralgia: A meta-analysis. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5140 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Englische Zusammenfassungen der Kapitel 1–9

ZusammenfassungAs a whole the effect of an explorative tympanoscopy with sealing the round/oval window(s) in cases of a profound idiopathic unilateral sudden hearing loss (ISSNHL) has been analyzed (data: own study cases and review of literature) and the results have been compared to that of intratympanal steroid injections published elsewhere. In detail the topics of the chapters focused on: Comparison of epidemiologic data, anamnestic and clinical findings including hearing results of our study group with those published Time course of hearing improvement after explorative tympanoscopyand sealing of the round/oval window Compilation of parameters influencing the extent of the initial hearing loss and the hearing gain after surgical therapy Perilymphatic fistulas as an etilogical factor causing a sudden profound hearing loss Comparison of those cases which have been treated by obliteration of the round/oval window with and without corticoid-soaked connective tissue Comparison of patients (data sampled by literature and own cases) treated with intratympanal corticoid injections on the one side or explorative tympanscopy with sealing of the round/oval window on the other side.

Epidural Steroid Injections for Low Back Pain: A Narrative Review

Low back pain represents a significant socioeconomic burden. Several nonsurgical medical treatments have been proposed for the treatment of this disabling condition. Epidural steroid injections (ESIs) are commonly used to treat lumbosacral radicular pain and to avoid surgery. Even though it is still not clear which type of conservative intervention is superior, several studies have proved that ESIs are able to increase patients’ quality of life, relieve lumbosacral radicular pain and finally, reduce or delay more invasive interventions, such as spinal surgery. The aim of this narrative review is to analyze the mechanism of action of ESIs in patients affected by low back pain and investigate their current application in treating this widespread pathology.

Association Between the Number of Intratympanic Steroid Injections and Hearing Recovery in Sudden Sensorineural Hearing Loss

The frequency of intratympanic (IT) steroid injection varies from once daily to once weekly or less among studies and does not reach a uniform standard. This study investigated the potential association between the number of IT steroid injections and hearing recovery to determine the optimal number in sudden sensorineural hearing loss (SSNHL) patients. A retrospective study involving 233 SSNHL patients receiving IT steroids plus batroxobin within 7 days of onset was performed. Patients were followed up for 3 months. More than 15 dB of HL improvement in the pretreatment pure tone average (PTA) was defined as effective. The effective group had a higher IT injection numbers than the ineffective group (≥ 6 times: 84.6 vs. 61.1, p < 0.001). Regardless of the unadjusted model or adjusted model, patients who received more frequent IT steroid injections seemed more likely to recover hearing (unadjusted model, OR, 95% CI: 1.25, 1.06–1.48; p = 0.007; adjusted model, OR, 95% CI: 1.21, 1.01–1.45; p = 0.044). Six IT injections had the highest rate of hearing recovery (79.1%). In conclusion, IT injection number was an independent factor that was positively associated with hearing recovery, and the optimal number of IT steroid injections was 6. Batroxobin plus higher number of IT steroid injections showed more effective for treating SSNHL.

Clinics in Surgery 1Remedy Publications LLC., | http://clinicsinsurgery.com/ 2021 | Volume 6 | Article 3380 The Effect of Spinal Steroid Injections on COVID-19 Infection and Its Severity

Aim: This paper is to determine the incidence of COVID-19 infection and severe symptoms following spinal steroid injections for pain control. Methodology: This a retrospective observational study based in the department of neurosurgery, Salford Royal Foundation Trust. Study period is from March 23rd, 2020 till December 31st, 2020. 222 patients had these injections during the time period. Data was collected by telephonic interview and online questionnaire. Data was analyzed to find out how many of the people who received steroid injection got COVID infection and how many had severe infection. It was then compared with local infection rates. Results: Out of 222 patients found, 130 patients opted to take part in the survey. Six patients among them had tested positive after the injection and two more patients had symptoms of COVID who have been considered to be positive. Overall, 6.15% of patients who received steroid injections had positive COVID-19 results. 3.85% patients had the infection within 3 months of injection. One patient (0.77%) needed hospital admission due to COVID. The incidence of COVID during this time period in Salford was 6.17% and rate of hospital admission due to COVID was 0.77%. Conclusion: The rate of COVID-19 infection after steroid injection are lower than the local incidence of COVID in Salford during that time period and equivalent to the rate of hospital admission due to COVID. This suggests that a steroid injection in the spine for pain management does not increase the incidence of COVID or cause severe infections.

Treatment of cystoid macular oedema secondary to pentosan polysulfate maculopathy using anti-VEGF and intravitreal steroid injections

Background Pentosan polysulfate-related maculopathy is a recently described clinical entity, related to dose and long term use of this medication, and may progress despite drug cessation. Cystoid macular oedema (CMO) has been reported in some cases, but there are few reports of treatment outcomes in the literature. Aims We present the case of a 55 year old female, with CMO secondary to pentosan polysulfate maculopathy, that was responsive to treatment with both intravitreal anti-VEGF and steroid injections, stabilising vision over a four year follow up period. Conclusions This is the first report, to our knowledge, of CMO related to pentosan polysulfate maculopathy responding to intravitreal steroid injections, broadening the therapeutic options for preserving vision in these patients.