Interventional Pain Medicine and Neuromodulation
Volume:3 Issue: 1, Dec 2023

Percutaneous lumbar disc decompression (PLDD) has emerged as an effective and minimally invasive treatment option for lumbar disc herniation. This review aims to provide pain specialists with a comparative overview of Iran’s commonly utilized PLDD techniques: Laser, radiofrequency (RF), and quantum PLDD. The review discusses patient selection criteria, procedural characteristics, and outcomes to facilitate informed clinical decision-making.

The stability provided by the trunk is needed for normal shoulder function. This is also related to balance.

To examine the postural stability and balance status of individuals with shoulder pain and the relations of these parameters to each other. In addition, to investigate the effects of conventional shoulder pain treatment on postural instability and balance parameters.

Twenty patients with shoulder pain and twenty healthy individuals included in the study were assigned to the treatment (n = 20) and control group (n = 20). A conventional physiotherapy program was applied 3 times a week to individuals with shoulder pain in the treatment group for 8 weeks (24 sessions). Pain, shoulder range of motion, and balance were evaluated at the end of the program.

A statistically significant improvement was observed in the pre-and post-treatment values of pain and range of motion in the treatment group at the end of 8 weeks (P = 0.00; P = 0.02). In addition, statistically significant differences were found in all values in the results of the balance assessment between the groups, except for the dynamic balance scores of the medial-lateral balance (P = 0.014; P = 0.016).

Postural stability and balance status of individuals with shoulder painwere evaluated, and no statistically significant difference was found between them and healthy individuals. It was observed that therapeutic agents applied in addition to exercise in individuals with shoulder pain prove to be a safe method that can be implemented to improve the parameters of pain, mobility, balance, and postural stability.

Pelvic fractures are associated with a lot of pain.

This study aimed to compare pericapsular nerve and fascia iliaca block analgesia in the positioning of patients with femoral neck fractures for neuraxial anesthesia.

In this double-blind clinical trial study, 50 patients (each group as a pilot: 25 patients) who were candidates for femoral neck fracture surgery were referred to Imam Khomeini Hospital in Urmia. They were randomly assigned (using random allocation software) to 2 groups, including pericapsular block and fascia iliaca block. Visual Analogue Scale (VAS) was used to evaluate analgesia. The pain level of the patients was checked before the block, 10 minutes after the block, and before positioning for neuraxial anesthesia.

Regarding gender, 38% (N = 19) were female, and 62% (N = 31) were male. The mean age of the patients was 57.38 ± 8.49 years without a significant difference between the 2 groups (P = 0.315). The mean body mass index of the patients was 26.44 ± 3.77 kg/m2 without a significant difference between the 2 groups (P = 0.243). The mean pain 10 minutes after the block was 1.72 ± 0.73 in the pericapsular group and 3.92 ± 0.86 in the fascia iliaca group (P < 0.001). The mean difference in pain was investigated before and after the block in the pericapsular and fascia iliaca groups (P < 0.001). Ten minutes after the block, the pain intensity was different in the pericapsular group and in the fascia iliaca. Moreover, there was no pain in the moderate classification in the pericapsular treatment group, while 16 patients (64%) had moderate pain in the fascia iliaca group. The differences were statistically significant (P < 0.001).

This study shows that the pericapsular block may provide better analgesia for positioning in comparison to the fascia iliaca block in patients with femoral neck fractures.

Postoperative shivering (PS) is a mechanism to reduce heat loss and is the most frequent complication during the recovery period after general anesthesia. Shivering can lead to discomfort and is even risky in many patients; therefore, prevention is important.

Our study aims to determine the effect of dexmedetomidine on preventing shivering after general anesthesia in appendectomy patients.

The present double–blind, randomized clinical trial divided 90 appendectomy patients into two groups. Randomization was performed using thewww.random.org website from the numbers of sequence generator option. One group received 0.5 g/kg of dexmedetomidine before induction of general anesthesia, and another group received normal saline as a placebo. Shivering and other outcomes were checked in both groups. To find a 50% reduction of this incidence, based on alpha error of 5% and beta error of 20%, the sample size of 45 people was determined for each group. A P-value  0.05 was considered statistically significant.

In total, 63 (70%) patients were male, and 27 (30%) were female. There were no significant differences between the two groups in terms of age (P = 0.412), weight (P = 0.460), temperature of serum for fluid therapy (P = 0.315), fluid volume (P = 0.736), perioperative body temperature (P = 0.418), preoperative body temperature (P = 0.540), and room temperature (P = 0.310). The severity of shivering was significantly lower in the dexmedetomidine group (60%) than in the placebo group (P < 0.001). There was no significant difference according to gender and severity of shivering between the two groups (P > 0.05).

This study suggests that the administration of dexmedetomidine can prevent postoperative shivering.

Caesarean section (CS) is a common procedure, and spinal anesthesia is a safe method for inducing anesthesia during this procedure. The disadvantages of this technique are intraoperative pain sensation, the patient’s fear of injection, and remembering surgery.

The purpose of this study was to compare the effects of intravenous midazolam with intravenous dexmedetomidine on sedation and duration of spinal anesthesia during CS.

In this study, 70 parturients with ASA II were randomly divided into two groups of 35. All parturients underwent spinal anesthesia. One of the groups (i.e., group D) received intravenous dexmedetomidine, and for the other group (i.e., group M), midazolam was injected intravenously. The parturients were compared in terms of the pain score measured by visual pain scoring (VAS), duration of anesthesia, sedation, and hemodynamic stability.

The mean pain score in groupMwas significantly higher than in group D (P < 0.001). The time to the first rescue analgesia was significantly higher in group D than in groupM(P < 0.001). Also, the dose of the analgesic used in the postoperative period was significantly lower in group D (P < 0.001). No significant difference was found between the two groups in terms of sedation and hemodynamic status.

The use of dexmedetomidine in comparison with midazolam resulted in longer bupivacaine-induced spinal anesthesia and duration of analgesia during and after CS, suggesting this method as an appropriate strategy for establishing an appropriate level of intraoperative sedation in parturients undergoing CS. Neither dexmedetomidine nor midazolam caused significant hemodynamic changes.

Phantom limb pain (PLP) presents complex challenges in treatment, lacking standardized clinical approaches, and understanding its mechanisms remains elusive. Noninvasive brain stimulation (NIBS), specifically transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), seems promising in treating chronic pain, including PLP. These modalities can modulate neural activity, offering potential benefits by acting on interconnected neural networks beyond the stimulation site. Studies from Jan 1, 2003, to 2021 were reviewed on PubMed, Google Scholar, and the Web of Science using the keywords PLP, neuromodulation, transcranial direct current stimulation, transcranial magnetic stimulation, pain management, and their combinations. The language was limited to English. A single-session treatment has the potential to change the intensity of PLP for several hours. On the other hand, a multi-session treatment approach can decrease both the intensity and frequency of PLP for an extended period of several months. Additional research with a greater sample size and extended follow-up periods is necessary to determine the precedence of utilizing tDCS, rTMS and the potential for integration with other treatments for individuals with amputation experiencing PLP.