Comparison of percutaneous intradiscal ozone injection with laser disc decompression in discogenic low back pain

Poupak Rahimzadeh,1 Farnad Imani,1 Mohammad Ghahremani,1 Seyed Hamid Reza Faiz2 1Pain Research Center, Iran University of Medical Sciences, Tehran, Iran; 2Anesthesiology Department, Iran University of Medical Sciences, Tehran, Iran Background: Intervertebral disc herniation with the pressure on the surrounding neural structures is one of the most important causes of chronic low back pain, which sometimes leads to open surgery. Reducing the pressure inside the disc with intradiscal intervention such as laser irradiation or ozone injection is a minimally invasive method and an alternative to surgery with satisfactory results. These two methods were compared with each other in this research. Patients and methods: In this clinical trial, 40 patients with back pain radiating to lower limb due to lumbar intervertebral disc herniation were selected. These patients were randomly divided into two equal groups for percutaneous intradiscal intervention. The Laser Disc Decompression Group (LDG) (n=20) was exposed to 1500 J of laser irradiation into the disc center. In the Ozone Injection Group (OZG) patients (n=20), 6 mL of ozone 30 μg/mL was injected into the center of the disc. Considering the level of neural root involvement, both groups received 20 mg of triamcinolone injection via transforaminal epidural. Patients were followed up for 12 months regarding score on visual analogue scale and life performance improvement based on Oswestry Disability Index (ODI) and satisfaction level. Results: According to the results, no difference was found between the two groups for ODI variable before intervention, whereas OZG showed better ODI scores in the measured time intervals. In LDG, only a significant difference in terms of ODI score was found between the times of before surgery and the first month. Conclusion: Intradiscal ozone injection could be an effective and cost-effective method for treatment of patients with discogenic back pain. Keywords: low back pain, laser disc decompression, ozone injection, visual analogue scale, Oswestry Disability Inde

An investigation into the effect of depth of anesthesia on postoperative pain in laparoscopic cholecystectomy surgery: a double-blind clinical trial

Seyed Hamid Reza Faiz,1 Seyed Alireza Seyed Siamdoust,2 Poupak Rahimzadeh,1 Leila Houshmand3 1Pain Research Center, Iran University of Medical Sciences, Tehran, Iran; 2Anesthesiology Department, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran; 3Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran Backgrounds and objective: Some studies have shown that deeper anesthesia is more effective on postoperative analgesia and reduces the need for sedative drugs. This study sought to ­investigate the effect of depth of anesthesia on postoperative pain in laparoscopic cholecystectomy. Materials and methods: In this double-blind clinical trial, 60 patients undergoing laparoscopic cholecystectomy were randomly divided into two groups: low bispectral index (L-BIS=35–44) and high bispectral index (H-BIS=45–55). Anesthesia protocol was the same for both groups (propofol and remifentanil). The pain intensity (at rest and during cough) was evaluated based on the visual analog scale scores in recovery and at 8, 16 and 24 hours after surgery. Results: The mean pain score was significantly lower in patients in the L-BIS group at all examined times at rest and during cough than that in the H-BIS group. The number of patients in need of additional sedative drug in the H-BIS group in recovery was significantly more than that in the L-BIS group (27 vs 18 patients, P=0.007). The incidence of nausea in the recovery room 8 hours after the surgery was significantly less in the L-BIS group than that in the H-BIS group, while at 16 and 24 hours, no case of nausea was reported in the two groups. Conclusion: Given the results of this study, it seems that general anesthesia with propofol and remifentanil with L-BIS causes less need for additional analgesic drug and less nausea and vomiting compared to anesthesia with H-BIS. Keywords: BIS, postoperative pain, depth of anesthesia, laparoscopic cholecystectom

A cross-sectional survey on the relationship between spirituality and posttraumatic growth during the COVID-19 pandemic: the mediating role of emotion regulation and self-compassion

Post-traumatic growth (PTG) refers to potential positive outcomes following exposure to trauma and may have been experienced during the COVID-19 pandemic. The present study investigated the mediating role of emotion regulation (cognitive reappraisal) and self-compassion in the relationship between spirituality and PTG. The sample comprised 700 patients with COVID-19 who were hospitalized during their illness at Hazrat-Rasoul Hospital in Tehran, Iran (395 males, mean age = 52 years, SD = 14, age range = 14–95 years). Data were collected using a questionnaire packet that included the Post-Traumatic Growth Inventory (PTGI), the Daily Spiritual Experience Scale (DSES), the Emotion Regulation Questionnaire (ERQ) and the Self-Compassion Scale (SCS). Structural equation modelling analysis supported the proposed model which indicated that spirituality both directly and indirectly associated with PTG through emotion regulation (cognitive reappraisal) and self-compassion. To test the indirect effects, bootstrap analysis was conducted with a 95% confidence interval and 5000 sample replacements. The results showed that spirituality influenced PTG through emotion regulation and self-compassion. The findings suggest that attention to these factors is crucial in facilitating the path to PTG

Comparison of the effects of stellate ganglion block and paroxetine on hot flashes and sleep disturbance in breast cancer survivors

Poupak Rahimzadeh,1 Farnad Imani,1 Nahid Nafissi,2 Behzad Ebrahimi,3 Seyed Hamid Reza Faiz1 1Pain Research Center, Iran University of Medical Sciences, Tehran, Iran; 2Department of Surgery, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran; 3Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran Background: The incidence of menopausal symptoms, including hot flashes and sleep disturbance, caused by drug treatment is a common problem in breast cancer survivors. Considering the limitations of hormone therapy in such patients, several studies have been conducted to find alternative methods. The aim of this study was to investigate and compare the effectiveness of stellate ganglion block (SGB) with that of paroxetine, which was approved by the US Food and Drug Administration (FDA) as a medicine for the treatment of hot flashes and ensuing sleep disturbance. Patients and methods: A total of 40 patients survived from breast cancer and complaining of these symptoms were equally assigned to two groups of 20 each. In the study group, SGB was performed successfully under sonography guidance using 10 mL of 0.5% bupivacaine, and in the control group (paroxetine), the daily administration of 7.5 mg of paroxetine was conducted for 6 weeks. The frequency and severity of hot flash attacks and sleep quality of patients were evaluated prior to the intervention and after 2, 4 and 6 weeks. The incidence of adverse events during treatment or follow-up was recorded. Results: A significant decrease in hot flash score and sleep disturbance index (SDI) was observed in both groups. Comparison of the results showed no noticeable difference between the two groups. Two participants in the control group had discontinued medication due to gastrointestinal symptoms, and only one case of mild headache was reported in the study group. Conclusion: SGB is as much effective as paroxetine in controlling hot flashes and sleep disturbances in breast cancer survivors and is associated with few complications. Keywords: paroxetine, breast cancer, hot flashes, stellate ganglion block, ultrasound guidanc

The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis

Poupak Rahimzadeh,1 Farnad Imani,1 Seyed Hamid Reza Faiz,2 Saeed Reza Entezary,3 Mahnaz Narimani Zamanabadi,4 Mahmoud Reza Alebouyeh3 1Pain Research Center, Iran University of Medical Sciences, Tehran, Iran; 2Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran; 3Anesthesia Department, Iran University of Medical Sciences, Tehran, Iran; 4Pain Fellowship, Iran University of Medical Sciences, Tehran, Iran Introduction: Osteoarthritis (OA) is a chronic joint disease that usually occurs in older people and leads to pain and disabilities. OA treatment ranges from drug therapy to surgery. Drug and rehabilitation therapy are preferred over surgery, and, especially, there is a tendency toward compounds causing regenerative changes in the knee joint. In the present study, the effects of platelet-rich plasma (PRP) injection and prolotherapy (PRL) were examined on the level of pain and function of the knee joint in patients with OA.Methodology: After fulfilling the inclusion criteria and signing the informed consent form, 42 patients with knee OA were scheduled for intra-articular injection in the present randomized, double-blind, clinical trial. Following admission to the operating pain room, the condition of the patient’s knee was evaluated first via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and, then, ultrasound-guided knee injection was done. Accordingly, patients in the PRP therapy group received 7 mL PRP solution and those in the PRL group received 7 mL 25% dextrose. Using the WOMAC, levels of pain and knee function were evaluated and recorded for each patient immediately prior to the first injection as well as at 1 month (immediately prior to the second injection), 2 months (a month after the second injection), and 6 months later. Data collected were analyzed using the SPSS v.20.Results: During the first and second months, a rapid decrease in the overall WOMAC score was observed in both groups. The overall WOMAC score increased at the sixth month, but was lower than the overall WOMAC score in the first month. Statistical analysis indicated that the overall WOMAC score significantly decreased in both groups of patients over 6 months.Conclusion: Results of the present study suggested a significant decrease in the overall WOMAC score of patients who undergo either PRP therapy or PRL. This positive change in the overall WOMAC score led to an improvement in the quality of life of patients with knee OA shortly after the first injection. PRP injection is more effective than PRL in the treatment of knee OA. Keywords: knee osteoarthritis, platelet-rich plasma, prolotherapy, ultrasoun

Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study

Seyed Hamid Reza Faiz,1 Mahmoud Reza Alebouyeh,2 Pooya Derakhshan,2 Farnad Imani,3 Poupak Rahimzadeh,3 Maryam Ghaderi Ashtiani2 1Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran; 2Anesthesia Department, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran; 3Pain Research Center, Iran University of Medical Sciences, Tehran, Iran Background: Due to the importance of pain control after abdominal surgery, several methods such as transversus abdominis plane (TAP) block are used to reduce the pain after surgery. TAP blocks can be performed using various ultrasound-guided approaches. Two important approaches to do this are ultrasound-guided lateral and posterior approaches. This study aimed to compare the two approaches of ultrasound-guided lateral and posterior TAP blocks to control pain after cesarean section. Materials and methods: In this double-blind clinical trial study, 76 patients scheduled for elective cesarean section were selected and randomly divided into two groups of 38 and underwent spinal anesthesia. For pain management after the surgery, one group underwent lateral TAP block and the other group underwent posterior TAP block using 20cc of ropivacaine 0.2% on both sides. Pain intensity was evaluated based on Numerical Analog Scale (NAS) at rest and when coughing, 2, 4, 6, 12, 24 and 36 hours after surgery. Results: The pain at rest in the posterior group at all hours post surgery was lower than the lateral group, especially at 6, 12 and 24 hours after the surgery and the difference was statistically significant (p=0.03, p<0.004, p=0.001). Conclusion: The results of this study show that ultrasound-guided posterior TAP block compared with the lateral TAP block was more effective in pain control after cesarean section. Keywords: posterior TAP block, lateral TAP block, ultrasound, ropivacaine, cesarean section, ultrasoun

A clinical trial comparing ultrasound-guided ilioinguinal/iliohypogastric nerve block to transversus abdominis plane block for analgesia following open inguinal hernia repair

Seyed Hamid Reza Faiz,1 Nader D Nader,2 Soraya Niknejadi,1 Sina Davari-Farid,2 Geoffrey G Hobika,2 Poupak Rahimzadeh3 1Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran; 2Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA; 3Pain Research Center, Iran University of Medical Sciences, Tehran, Iran Objective: To compare the efficacy of ilioinguinal/iliohypogastric (IINB) nerve block to transversus abdominis plane (TAP) block in controlling incisional pain after open inguinal hernia repair. Patients and methods: This was a prospective randomized clinical trial of 90 patients who received either IINB (N=45) or TAP block (N=45) using 0.2% bupivacaine 15 mL under ultrasound (US) guidance based on a random assignment in the postanesthesia care unit after having an open repair of inguinal hernia. Numeric Rating Scale (NRS) scores were recorded immediately following, 4, 8, 12, and 24 hours after completion of the block. NRS scores at rest and during movement were recorded 24, 36, and 48 hours after surgery. Analgesic satisfaction level was also evaluated by a Likert-based patient questionnaire. Results: NRS scores were lower in the IINB group compared to the TAP block group both at rest and during movement. The difference in dynamic pain scores was statistically significant (P=0.017). In addition, analgesic satisfaction was significantly greater in the IINB group than the TAP block group (mean score 2.43 vs 1.84, P=0.001). Postoperative opioid requirements did not differ between the two groups. Conclusion: This study demonstrated that compared to TAP block, local blockade of ilioinguinal and iliohypogastric nerves provides better pain control after open repair of inguinal hernia when both blocks were administered under US guidance. Greater satisfaction scores also reflected superior analgesia in patients receiving IINB. Keywords: US-guided nerve block, transversus abdominis plane, ilioinguinal, iliohypogastric nerve, inguinal hernia surger