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https://www.readbyqxmd.com/read/28340495/residents-learning-curve-of-lumbar-transforaminal-epidural-steroid-injections
#1
Holger Joswig, Sarah Roberta Haile, Gerhard Hildebrandt, Martin Nikolaus Stienen
Background and Study Aims There is a paucity of literature on beginners' training and on its connection with patient safety for transforaminal epidural steroid injections (TFESIs). This study retrospectively assessed the learning curves and associated complications of neurosurgery residents never previously exposed to TFESI and compared them with experienced board-certified faculty neurosurgeons (BCFNs). Material and Methods Procedure time in minutes, dose-area product (DAP) in cGy*cm(2), periprocedural observations, and complications in 354 TFESIs for radicular pain secondary to lumbar disk herniation or lumbar spinal stenosis were extracted from operative notes and the electronic infiltration logbook in the per-injection format...
March 24, 2017: Journal of Neurological Surgery. Part A, Central European Neurosurgery
https://www.readbyqxmd.com/read/28340251/thermal-qst-phenotypes-associated-with-response-to-lumbar-epidural-steroid-injections-a-pilot-study
#2
Dermot P Maher, Weihua Ding, Sarabdeep Singh, Arissa Opalacz, Claire Fishman, Mary Houghton, Shihab Ahmed, Lucy Chen, Jianren Mao, Yi Zhang
Objective.:  Response to lumbar epidural steroid injection in lumbar radicular pain varies. The purpose of this study is to characterize the changes in quantitative sensory testing (QST) phenotypes of subjects and compare the QST characteristics in patients who do respond to treatment of radicular pain with a lumbar epidural steroid injection (ESI). Design.:  Prospective, observational pilot study. Setting.:  Outpatient pain center. Methods...
March 13, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28340163/does-cervical-interlaminar-epidural-steroid-injection-with-low-dose-lidocaine-cause-objective-upper-extremity-weakness-a-preliminary-study
#3
Zachary L McCormick, Ariana Nelson, Mark C Kendall, Robert J McCarthy, Geeta Nagpal, David R Walega
Objective. : Low-dose local anesthetic is often used in cervical interlaminar epidural steroid injections (CIESI), yet its effect on upper extremity strength has not been studied. The presence of consequent weakness has potential implications for postprocedure safety. This study aimed to determine whether low-dose lidocaine in a C7-T1 CIESI causes objective weakness. Design. : Prospective case series. Setting. : Academic pain center...
March 18, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28340088/does-pain-reduction-with-oral-steroids-predict-pain-reduction-after-a-first-time-cervical-epidural-steroid-injection-in-patients-with-cervical-radicular-pain-a-pilot-study
#4
Dana G Crovo, Wendy Y Craig, Craig S Curry, Janelle M Richard, James V Pisini
Objective.:  Oral and injected steroids are used commonly in the treatment of cervical radicular pain despite a paucity of data demonstrating their efficacy. The purpose of this study is to assess whether the response to orally administered steroids among patients with acute cervical radicular pain who develop recurrent pain is associated with their subsequent response to cervical epidural steroid injections. Methods.:  Patients referred to our center were evaluated and then referred for cervical epidural steroid injections at the clinical discretion of the provider; those who met inclusion criteria were offered participation in the study...
March 3, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28340013/implications-of-thoracic-epidural-analgesia-on-hospital-charges-in-rib-fracture-patients
#5
Courtney D Jensen, Jamie T Stark, Lewis E Jacobson, Jan M Powers, Kathy L Leslie, Jeffrey M Kinsella-Shaw, Michael F Joseph, Craig R Denegar
Objective.:  Rib fractures are present in more than 150,000 patients admitted to US trauma centers each year. Those who fracture two or more ribs are typically treated with oral analgesic drugs and are discharged with few complications. The cost of this care generally reflects its brevity. When a patient fractures three or more ribs, there is an elevated risk of complication. In response, treatments are often broadened and their durations prolonged; this affects cost. While health, function, and survival have been widely explored, patient billing has not...
March 7, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28339551/anticoagulant-and-antiplatelet-management-for-spinal-procedures-a-prospective-descriptive-study-and-interpretation-of-guidelines
#6
Bradly S Goodman, L McLean House, Sridhar Vallabhaneni, Srinivas Mallempati, Matthew R Willey, Matthew Thomas Smith
Setting.:  Epidural hematoma rarely complicates interventional spine procedures. While anticoagulant and antiplatelet drugs increase bleeding risk, cessation may precipitate serious thromboembolic events. The Spine Intervention Society (SIS) and American Society of Regional Anesthesia and Pain Medicine (ASRA) put forth guidelines that dissent with regard to management of hemostatically active agents during commonly performed spinal injections. Objective.:  To validate an antiplatelet/anticoagulant management table based on modifications of the SIS 2013 and ASRA 2015 guidelines...
October 6, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28339542/cervical-epidural-contrast-spread-patterns-in-fluoroscopic-antero-posterior-lateral-and-contralateral-oblique-view-a-three-dimensional-analysis
#7
Jatinder Gill, Jyotsna Nagda, Moris Aner, Thomas Simopoulos
Objective.:  To describe and to analyze cervical epidural contrast patterns seen in antero-posterior (AP), contralateral oblique (CLO), and lateral view. To identify factors that might help in predicting contrast distribution pattern and extent. Method.:  Spread of contrast in the cervical epidural space was prospectively studied in AP, lateral, and three CLO views. Results.:  CLO view showed contrast spread of variable thickness with its posterior margin overlying the ventral interlaminar line (VILL)...
October 7, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28339455/response-to-letter-optimal-angle-of-contralateral-oblique-view-in-cervical-interlaminar-epidural-injection-safety-or-precision
#8
Jeong Hun Suh
No abstract text is available yet for this article.
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28339454/optimal-angle-of-contralateral-oblique-view-in-cervical-interlaminar-epidural-injections-safety-or-precision
#9
Jatinder S Gill, Thomas T Simopoulos
No abstract text is available yet for this article.
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28339450/reliability-and-safety-of-contra-lateral-oblique-view-for-interlaminar-epidural-needle-placement-standardization-of-the-appropriate-angle
#10
Jatinder S Gill, Thomas T Simopoulos
No abstract text is available yet for this article.
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28339449/reversal-of-progressive-conscious-disturbance-with-epidural-blood-patch-for-cerebrospinal-fluid-leakage-at-c2-level
#11
Yi-Chen Lai, Yuan-Yi Chia, Wei-Hung Lien
Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF) leakage. Complications include bilateral subdural hygroma or haematoma and herniation of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative treatment is ineffective. We reported the case of a 46-year-old man with a history of postural headache and dizziness. The patient was treated with bed rest and daily hydration with 2000 mL of fluid for 2 weeks. However, dizziness and headache did not resolve, and he became drowsy and disoriented with incomprehensible speech...
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28339445/transforaminal-endoscopic-decompression-for-a-giant-epidural-gas-containing-pseudocyst-a-case-report-and-literature-review
#12
Bin Zhu, Liang Jiang, Xiao Guang Liu
The isolated epidural gas-containing pseudocyst is an uncommon pathogenic factor for severe pain of the lower limb as a result of nerve root compression. After reviewing these rare cases reported in the literature, we found that the name, pathogenesis, and treatment strategy of this pathology remained controversial. The most common treatment is conservative treatment or percutaneous aspiration which might result inpoor pain relief and high recurrence rates. Moreover, the patient who received open surgery had good clinical outcome; however, he or she might experience a significant soft tissue injury...
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28339431/perioperative-ketamine-administration-for-thoracotomy-pain
#13
Daniel W Moyse, Alan D Kaye, James H Diaz, Muhammad Y Qadri, David Lindsay, Srinivas Pyati
BACKGROUND: Of all the postsurgical pain conditions, thoracotomy pain poses a particular therapeutic challenge in terms of its prevalence, severity, and ensuing postoperative morbidity. Multiple pain generators contribute to the severity of post-thoracotomy pain, and therefore a multimodal analgesic therapy is considered to be a necessary strategy. Along with opioids, thoracic epidural analgesia, and paravertebral blocks, N-Methyl-D-Aspartate (NMDA) receptor antagonists such as ketamine have been used as adjuvants to improve analgesia...
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28333819/practice-bulletin-no-177-obstetric-analgesia-and-anesthesia
#14
(no author information available yet)
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor...
April 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28333811/practice-bulletin-no-177-summary-obstetric-analgesia-and-anesthesia
#15
(no author information available yet)
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor...
April 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28332374/comparison-of-dexmedetomidine-and-fentanyl-as-an-adjuvant-to-ropivacaine-for-postoperative-epidural-analgesia-in-pediatric-orthopedic-surgery
#16
Sang Jun Park, Seokyung Shin, Shin Hyung Kim, Hyun Woo Kim, Seung Hyun Kim, Hae Yoon Do, Yong Seon Choi
PURPOSE: Opioids are commonly used as an epidural adjuvant to local anesthetics, but are associated with potentially serious side effects, such as respiratory depression. The aim of this study was to compare the efficacy and safety of dexmedetomidine with that of fentanyl as an adjuvant to epidural ropivacaine in pediatric orthopedic surgery. MATERIALS AND METHODS: This study enrolled 60 children (3-12 years old) scheduled for orthopedic surgery of the lower extremities and lumbar epidural patient-controlled analgesia (PCA)...
May 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28332251/measuring-the-depth-of-the-caudal-epidural-space-to-prevent-dural-sac-puncture-during-caudal-block-in-children
#17
Hyun Jeong Lee, Ji Young Min, Hyun Il Kim, Hyo-Jin Byon
BACKGROUND: Caudal blocks are performed through the sacral hiatus in order to provide pain control in children undergoing lower abdominal surgery. During the block, it is important to avoid advancing the needle beyond the sacrococcygeal ligament too much to prevent unintended dural puncture. This study used demographic data to establish simple guidelines for predicting a safe needle depth in the caudal epidural space in children. METHODS: A total of 141 children under 12 years old who had undergone lumbar-sacral magnetic resonance imaging were included...
March 23, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28331936/ultrasound-guidance-for-difficult-lumbar-puncture-in-children-pearls-and-pitfalls
#18
REVIEW
Prakash Muthusami, Ashley James Robinson, Manohar M Shroff
Pediatric lumbar puncture can be challenging or unsuccessful for several reasons. At the same time, the excellent sonographic window into the pediatric spine provides a distinct opportunity for ultrasound-guided lumbar puncture. Minimal cerebrospinal fluid and thecal displacement by subdural or epidural hematomas are common after failed clinical attempts. Ultrasound is useful for determining a safe infraconal level for subarachnoid access. Real-time guidance increases not only the success rate but also the safety of diagnostic lumbar puncture and injections for chemotherapy and myelography...
March 22, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28331261/bilateral-traumatic-intracranial-hematomas-and-its-outcome-a-retrospective-study
#19
Sharad Pandey, Vivek Sharma, Kulwant Singh, Deepa Pandey, Mukesh Sharma, Deepak Bhanudas Patil, Neeraj Shende, Richa Singh Chauhan
The objective of this study was to evaluate the age distribution, mode of injury, type of hematomas, and their surgical outcome in patients with bilateral traumatic head injuries. The present study included 669 cases of traumatic head injury who presented at the neurosurgery emergency out of which 94 cases had bilateral head injuries from the period of August 2009 to April 2014. The data from the hospital computerized database were retrospectively analysed. Cases of bilateral traumatic head injury included 94 patients out of which 88...
February 2017: Indian Journal of Surgery
https://www.readbyqxmd.com/read/28329751/conservative-management-of-large-traumatic-supratentorial-epidural-hematoma-in-the-pediatric-population
#20
Pierre-Olivier Champagne, Kevin Xiaho He, Claude Mercier, Alexander G Weil, Louis Crevier
BACKGROUND/AIMS: Conservative management of traumatic epidural hematomas is being recognized as a safe alternative to surgical treatment in asymptomatic children. There is still debate about the maximal size of epidural hematoma that should be tolerated before deciding for surgery. METHODS: We report - through a retrospective cohort study from a single institution - a series of 16 conservatively managed traumatic epidural hematomas of more than 15 mm thickness. RESULTS: 14 patients (88%) were successfully treated using conservative management...
March 23, 2017: Pediatric Neurosurgery
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