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epidural injections

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https://www.readbyqxmd.com/read/27922950/a-prospective-randomized-comparative-trial-of-targeted-steroid-injection-via-epidural-catheter-versus-standard-c7-t1-interlaminar-approach-for-the-treatment-of-unilateral-cervical-radicular-pain
#1
Zachary L McCormick, Ariana Nelson, Meghan Bhave, Mikhail Zhukalin, Mark Kendall, Robert J McCarthy, Dost Khan, Geeta Nagpal, David R Walega
BACKGROUND AND OBJECTIVES: No study has compared cervical interlaminar epidural steroid injection (CIESI) with epidural catheter advancement to the side and level of pathology versus standard C7-T1 CIESI. This study investigated whether cervical radicular pain is more effectively treated by CIESI with a targeted epidural catheter versus a standard C7-T1 approach. METHODS: Prospective, randomized, single-blinded trial. PRIMARY OUTCOME: Numerical Rating Scale (NRS) pain at 1 month...
December 5, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27922949/the-neurological-safety-of-an-epidurally-administered-lipo-pge1-agonist-in-rats
#2
Eunjoo Choi, Sun Min Im, Hyung-Seok Yoo, Francis Sahngun Nahm, Yang Hyun Kim, Gheeyoung Choe, Pyung Bok Lee
BACKGROUND AND OBJECTIVE: Liposomal prostaglandin E1 (Lipo-PGE1) can inhibit platelet aggregation and vasodilatation and has been found to be therapeutic in ischemia and spinal diseases including stenosis. However, the neurologic safety of epidural administration of lipo-PGE1 requires further study. We investigated the neurotoxicity of epidurally administered lipo-PGE1 agonist in rats. METHODS: Twenty-seven rats were randomly divided into three groups: Epidural isotonic sodium chloride solution administration (negative control, group N, n = 9); epidural lipo-PGE1 agonist (group L, n = 9); and epidural alcohol (positive control, group A, n = 9)...
December 5, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27922581/pseudomeningocele-aspiration-and-blood-patch-effectively-treats-positional-headache-associated-with-post-operative-lumbosacral-pseudomeningocele
#3
Stephen Sandwell, Kevin Walter, Per-Lennart Westesson
STUDY DESIGN: Retrospective chart review with limited prospective follow-up survey. OBJECTIVE: To evaluate the efficacy and safety of blood patch injection for the treatment of positional headaches caused by postoperative lumbosacral pseudomeningoceles. SUMMARY OF BACKGROUND DATA: Pseudomeningocele is one of the most common complications after posterior lumbosacral spinal surgery. Common treatments include bedrest, abdominal binder use, subarachnoid lumbar drainage, and surgical re-exploration for durotomy closure...
December 2, 2016: Spine
https://www.readbyqxmd.com/read/27922167/cost-effectiveness-of-primarily-surgical-versus-primarily-conservative-treatment-of-acute-and-subacute-radiculopathies-due-to-intervertebral-disc-herniation-from-the-swiss-perspective
#4
Zanfina Ademi, Viktoria Gloy, Dominik Glinz, Heike Raatz, Joris Van Stiphout, Heiner C Bucher, Matthias Schwenkglenks
AIMS OF THE STUDY: To assess the cost-effectiveness of primarily surgical treatment (PST) versus primarily conservative treatment (PCT) in adults with intermediate severity, acute or subacute, lumbar radicular syndrome due to intervertebral disc herniation. METHODS: A decision analytic model from healthcare system and societal perspectives was used to compare outcomes and costs of PST with those of PCT (physiotherapy, epidural injection and medication). Treatment pathways and quality of life were obtained from published clinical trials...
2016: Swiss Medical Weekly
https://www.readbyqxmd.com/read/27920574/combined-epidural-morphine-and-bupivacaine-in-the-treatment-of-lumbosacral-radicular-neuropathic-pain-a-noncontrolled-prospective-study
#5
Simone Vigneri, Gianfranco Sindaco, Marco La Grua, Matteo Zanella, Laura Ravaioli, Valentina Paci, Gilberto Pari
OBJECTIVE: The aim of this study was to investigate the therapeutic effectiveness of epidural morphine and bupivacaine in patients with chronic lumbosacral radicular neuropathic pain after the cessation of treatment. METHODS: Twenty-two patients with chronic lumbosacral pain with neuropathic features were enrolled. An indwelling catheter was placed into the epidural space, and each patient received an epidural injection of morphine chlorhydrate and bupivacaine up to three times a day...
2016: Journal of Pain Research
https://www.readbyqxmd.com/read/27915069/systematic-review-of-the-efficacy-of-particulate-vs-non-particulate-corticosteroids-in-epidural-injections
#6
REVIEW
Priyesh Mehta, Isaac Syrop, Jaspal Ricky Singh, Jonathan Kirschner
OBJECTIVE: To systematically analyze published studies in regards to the comparative efficacy of particulate versus non-particulate corticosteroids for cervical and lumbosacral epidural steroid injections (ESI) in reducing pain and improving function. TYPE: Systematic Review LITERATURE SURVEY: MEDLINE (Ovid), EMBASE, and Cochrane databases were searched from the period of 1950 to December 2015. METHODOLOGY: Criteria for inclusion in this review were: 1) Randomized controlled trials and 2) Retrospective studies comparing particulate versus non-particulate medication in fluoroscopically guided injections using a transforaminal (TF) or interlaminar (IL) approach...
November 30, 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/27910253/a-computed-tomography-guided-demonstration-of-the-unilateral-distribution-of-low-volume-epidural-injectate
#7
Semih Gungor, Rohit Aiyer
The epidural space is frequently used for placement of the epidural needle, catheter, and various pharmacological agents. The presence of structures in the epidural space such as epidural fat, venous plexus, or ligaments that may lead to uneven distribution of agents within the epidural space have been described.(1-3) Whether these structures are anatomical (such as connective tissue) or functional (due to distortions of actual anatomy secondary to injection of agents epidurally) has been disputed.(2-5) We describe our management of a patient who presented with bilateral radicular symptoms and severe low back pain...
December 2, 2016: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/27910226/successful-treatment-of-post-dural-puncture-headache-using-epidural-fibrin-glue-patch-after-persistent-failure-of-epidural-blood-patches
#8
Kevin Wong, Brian R Monroe
OBJECTIVES: Epidural blood patch is the gold standard for the treatment of post-dural puncture headache (PDPH) when conservative treatments have failed to provide any relief. However, alternative therapies are lacking when epidural blood patch persistently fails to improve symptoms. Failure to treat PDPH may lead to significant functional impairment of daily living. Alternative therapies should be sought to accelerate recovery from PDPH. CASE REPORT: This case describes a woman who developed PDPH secondary to accidental dural puncture during a spinal cord stimulator trial...
December 2, 2016: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/27906952/conus-medullaris-infarction-after-a-right-l4-transforaminal-epidural-steroid-injection-using-dexamethasone
#9
Christopher G Gharibo, Michael Fakhry, Sudhir Diwan, Alan D Kaye
BACKGROUND: For decades, epidural steroid injections have been an effective tool in the management of many pain related conditions, including lumbar radiculopathy. Transforaminal epidural steroid injections in particular have been reported to potentially result in central nervous system infarctions which have not been reported with interlaminar epidural steroid injections, while providing comparable efficacy. This rare, catastrophic complication has been attributed by some authors to be due to vascular injury secondary to vasospasm, thrombus formation, dissection, as well as concerns with placing the needle at the so-called "safe triangle...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27906948/cervical-interlaminar-epidural-injections-at-high-doses-do-not-increase-optic-nerve-sheath-diameter-on-a-long-term-basis
#10
Hyunzu Kim, Joo Hyeon O, Sung-Jun Hong, Keun Man Shin, JungChan Park, Sang Soo Kang
BACKGROUND: Cervical epidural injection (CEI) is widely performed on patients with pain originating from the cervical spine. Studies have shown a good relationship between the optic nerve sheath diameter (ONSD) and the intracranial pressure (ICP). OBJECTIVE: The aim of this study was to evaluate the changes in the ONSD as a non-invasive surrogate marker of ICP after CEI. STUDY DESIGN: Prospective observational study. SETTING: Hospital and ambulatory pain clinic...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27906944/the-safety-of-ct-guided-epidural-steroid-injections-in-an-older-patient-cohort
#11
Andrew J Fenster, Kevin Fernandes, Alan L Brook, Todd Miller
BACKGROUND: Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult US population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure's safety profile in an older patient population. OBJECTIVE: This retrospective study analyzed safety data among a single-center cohort of patients > 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27906941/epidural-blood-patch-for-the-treatment-of-spontaneous-and-iatrogenic-orthostatic-headache
#12
Yun So, Jung Min Park, Pil-Moo Lee, Cho Long Kim, Cheolhan Lee, Jae Hun Kim
BACKGROUND: The cerebrospinal fluid (CSF) leakage could be happened spontaneously or related to the procedures such as spinal anesthesia, epidural anesthesia, CSF tapping, intrathecal chemotherapy or other spinal procedures. The leakage of CSF leads to intracranial hypotension of which distinguishing clinical feature is orthostatic headache. The epidural blood patch is a gold-standard treatment for intracranial hypotension-related orthostatic headaches. OBJECTIVE: We conducted this study to compare the efficacy and number of epidural blood patches for spontaneous and iatrogenic orthostatic headaches...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27903338/-ultrasound-imaging-increases-first-attempt-success-rate-of-neuraxial-block-in-elderly-patients
#13
J Geng, X L Chen, X D Wang, X Y Guo, M Li
Objective: To verify whether preprocedural ultrasound of the lumbar spine could improve first-attempt success rate (defined as a successful neuraxial anesthesia with only one skin puncture) of neuraxial block in elderly patients. Methods: From septemble 2015 to February 2016, 200 elderly patients undergoing lower-limb surgery with neuraxial block at the Peking Universty Third Hospital were enrolled in this study.RandA 1.0 software was used to randomize patients into two groups: conventional surface landmark-guided group (group LM) and ultrasound-assisted group (group US)...
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27898479/the-effect-of-skin-pressure-on-needle-entry-point-accuracy-during-fluoroscopically-guided-lumbar-transforaminal-epidural-injections-a-randomized-clinical-trial
#14
Soon Young Yun, Duck Mi Yoon, Kyung Bong Yoon, Ji Ae Moon, Shin Hyung Kim
OBJECTIVE: The aim of this study was to investigate the effect of skin pressure on needle entry point accuracy during fluoroscopically guided lumbar transforaminal epidural injection. DESIGN: This study is a prospective randomized clinical trial; 64 patients with a body mass index of 25 kg/m or greater were enrolled. For patients in the pressing group, the operator marked the needle entry point on the patient's back while pressing the patient's skin with the tip of an indicator...
November 24, 2016: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/27891040/inadvertent-injection-of-potassium-chloride-instead-of-sodium-chloride-during-treatment-of-chronic-low-back-ache-with-epidural-injection-leading-to-paraplegia
#15
Rahul Ranjan, Naiyer Asif, Sohail Ahmad, Syed Ifthekar
Epidural injection of steroid is given for back pain resistant to other conservative management. Normal saline (NS) is used as diluent in 80 mg methylprednisolone and a local anesthetic. Due to a similar looking ampoule of NS and potassium chloride (KCl), there is a probability of accidental use of KCl instead of NS. We present a case of a 50-year-old male patient having low back ache refractory to other conservative treatments. Epidural injection of steroid was given, but accidently KCl was mixed with methylprednisolone instead of NS...
October 2016: Journal of Craniovertebral Junction and Spine
https://www.readbyqxmd.com/read/27891035/intradiscal-and-intra-articular-facet-infiltrations-with-plasma-rich-in-growth-factors-reduce-pain-in-patients-with-chronic-low-back-pain
#16
Fernando Kirchner, Eduardo Anitua
CONTEXT: Low back pain (LBP) is a complex and disabling condition, and its treatment becomes a challenge. AIMS: The aim of our study was to assess the clinical outcome of plasma rich in growth factors (PRGF-Endoret) infiltrations (one intradiscal, one intra-articular facet, and one transforaminal epidural injection) under fluoroscopic guidance-control in patients with chronic LBP. PRGF-Endoret which has been shown to be an efficient treatment to reduce joint pain...
October 2016: Journal of Craniovertebral Junction and Spine
https://www.readbyqxmd.com/read/27885425/intrathecal-morphine-versus-intravenous-opioid-administration-to-impact-postoperative-analgesia-in-hepato-pancreatic-surgery-a-randomized-controlled-trial
#17
Sara Dichtwald, Menahem Ben-Haim, Laila Papismedov, Shoshana Hazan, Anat Cattan, Idit Matot
PURPOSE: Inadequate analgesia following abdominal surgery may affect outcome. Data in patients undergoing liver surgery suggested that postoperative coagulopathy might delay epidural catheter removal. Thus, alternative analgesic techniques should be evaluated. METHODS: We compared the analgesic efficacy of intraoperative intrathecal morphine [single injection 4 µg/kg before skin incision (ITM group, n = 23)] to intravenous opioids [iv remifentanil infusion during surgery followed by i...
November 24, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27882818/comparison-of-lumbosacral-transforaminal-epidural-steroid-injection-techniques-in-terms-of-radiation-safety
#18
Duygu Tecer, Evren Yasar, Emre Adiguzel, Mehmet Ali Taskaynatan, Birol Balaban, Arif Kenan Tan
AIM: To investigate the difference in radiation exposure to the patients between oblique and posteroanterior view, initial approach techniques in fluoroscopy-guided lumbosacral transforaminal epidural steroid injections. PATIENTS & METHODS: Total amount of Kerma area product, elapsed time of the procedure and fluoroscopy time were obtained from medical records retrospectively. RESULTS: 28 patients were included in each group. Fluoroscopy time was significantly lower in group 1, but there was no statistically significant difference in terms of procedure time and Kerma area product...
November 24, 2016: Pain Management
https://www.readbyqxmd.com/read/27878902/a-retrospective-comparison-of-intrathecal-morphine-and-epidural-hydromorphone-for-analgesia-following-posterior-spinal-fusion-in-adolescents-with-idiopathic-scoliosis
#19
Rebecca A Hong, Kathleen M Gibbons, G Ying Li, Ashlee Holman, Terri Voepel-Lewis
BACKGROUND: Posterior spinal fusion to correct idiopathic scoliosis is associated with severe postoperative pain. Intrathecal morphine is commonly used for analgesia after adolescent posterior spinal fusion; however, anticipating and managing the increase in pain scores after resolution of analgesic effect of intrathecal morphine analgesia is challenging. In 2014, we developed a clinical protocol detailing both the administration of intrathecal morphine intraoperatively and the transition to routine, scheduled oral analgesics at 18 h postoperatively...
November 22, 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27877098/accidental-epidural-injection-of-rocuronium-in-a-pediatric-patient-a-case-report-and-literature-review
#20
Ting-Ting Wu, David S Hoff
Accidental administration of non-epidural drugs into the epidural or subarachnoid spaces may be associated with unexpected pain, morbidity, adverse effects, increased level of care, prolonged hospital stay, and mortality. We describe a 12-month-old admitted for secondary-stage hypospadias reconstruction. General anesthesia was induced with sevofiurane and a peripheral catheter was placed. Instead of ropivacaine, rocuronium (80 mg; 6.3 mg/kg) was injected into the epidural space by the caudal route. Surgery was uneventful and was completed 160 minutes after rocuronium was given...
September 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
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