Percutaneous Laser Disc Decompression in the Treatment of Lumbar Radicular Pain

Lumbar radicular pain is defined as pain in the lumbar spine with propagation to the lower extremities. It is a major public health, social and economic problem in the modern society, and is one of the most common reasons for visits to the doctor. Lumbar radicular pain is often the reason for absenteeism and occupational disabilities. It is estimated that about 70-85% of the world’s population have experienced lumbar spine pain once in their lifetime. There are numerous modalities for the treatment of lumbar radicular pain, ranging from pharmacotherapy to surgery. In order to avoid systemic side effects of analgesics, anaesthesia and long-term and extensive surgery, minimally invasive procedures are increasingly used for treating lumbar radicular pain. Percutaneous laser disc decompression (PLDD) is one such procedure, first performed by Dr Choy and Dr Ascher in 1986. PLDD is an outpatient surgery performed under local anaesthesia, its success rate is high and the complication rate is low. This method therefore certainly attracts the attention of clinicians dealing with this issue. (Budrovac D, Radoš I, Tot OK, Haršanji Drenjančević I, Omrčen I. Percutaneous Laser Disc Decompression in the Treatment of Lumbar Radicular Pain. SEEMEDJ 2020; 4(2); 62-68

Perkutana laserska dekompresija diska zbog lumbalne radikularne boli: sistemski pregled PubMeda zadnjih pet godina

The most common causes of lumbar radicular pain are pathological changes in the intervertebral disc. Lumbar disc herniation (LDH) is the most common cause of lumbosacral radicular syndrome. It affects 1-2% of the general population, burdening health services and the economy worldwide. Excessive scar tissue after lumbar microdiscectomy can increase postoperative pain. Postoperative fibrosis is one of the most important causes of failed back surgery syndrome after lumbar disc surgery. Percutaneous laser disc decompression (PLDD) is a minimally invasive procedure in which thermal energy produced by a LASER probe is used to reduce the intervertebral disc herniation located within the annulus fibrosus. Evaporation of a small volume in a closed hydraulic space (nucleus pulposus) leads to decreased intradiscal pressure. It causes a thermal “shrinkage effect” with the retreat of the herniated disc and the decompression of the nerve root, which reduces lumbar radicular pain. Previous research has shown effective reduction of pain after PLDD and only a small number of complications of the procedure itself. PLDD is a safe and effective procedure in well-selected patients. Unfortunately, there is still a need for extensive, randomized prospective studies on PLDD in lumbar radicular pain in order to confirm or dispute the results obtained so far.Najčešći uzrok lumbalne radikularne boli su patološke promjene intervertebralnog diska. Lumbalna diskus hernija (LDH) je najčešći uzrok lumbosakralnog radikularnog sindroma i pogađa 1-2% opće populacije, stavljajući značajan teret na zdravstvene usluge i gospodarstvo u cijelom svijetu. Prekomjerna količina ožiljnog tkiva nakon lumbalne mikrodiscektomije može povećati postoperativnu bol. Postoperativna fibroza je jedan od najvažnijih uzroka sindroma neuspjele operacije leđa nakon operacije lumbalnog diska. Perkutana laserska dekompresija diska (PLDD) je vrsta minimalno invazivnog zahvata u kojem se toplinska energija proizvedena LASER sondom koristi za smanjenje hernije interverterbralnog diska koja se nalazi unutar fibroznog prstena. Isparavanje malog volumena u zatvorenom hidrauličkom prostoru (nucleus pulposus) dovodi do smanjenja intradiskalnog tlaka i implicira termički „učinak skupljanja“ sa povlačenjem hernije diska i dekompresiju živčanog korijena što ima za posljedicu smanjenja lumbalne radikularne boli. Dosadašnja istraživanja pokazala su učinkovito smanjenje boli poslije PLDD, te mali broj komplikacija samog zahvata. PLDD je siguran i djelotvoran zahvat kod dobro probranih bolesnika. Nažalost, ne postoje još velike, randomizirane prospektivne studije iz PLDD kod lumbalne radikularne boli, te su navedena istraživanja potrebna u budućnosti kako bi potvrdila ili osporila dosadašnje rezultate

CONNECTION BETWEEN ACUPUNCTURE ANALGESIA IN CHRONIC PAIN WITH PAIN INTENSITY, BLOOD PRESSURE AND HEART RATE

Cilj rada: Utvrditi vezu između akupunkturnog liječenja i vrijednosti arterijskog krvnog tlaka, srčane frekvencije i intenziteta boli. Metode: Prospektivnim istraživanjem su obuhvaćena 64 pacijenta sa kroničnom boli, liječena farmakološkom terapijom i akupunkturom u Zavodu za liječenje boli KBC Osijek. Intenzitet boli, krvni tlak i srčana frekvencija mjereni su prije postavljanja i nakon uklanjanja akupunkturnih igala. Rezultati: Intenzitet boli iskazan na vizualno analognoj ljestvici značajno je viši kod prvih mjerenja prije insercije akupunkturnih igala, te neposredno nakon skidanja akupunkturnih igala (poslije akupunkture) (Friedmanov test, p<0,001). Prije akupunkture značajno su niže vrijednosti sistoličkog (Friedmanov test, p<0,001) i dijastoličkog (Friedmanov test, p=0,036) tlaka u zadnjim mjerenjima. Vrijednosti tlaka poslije akupunkture ne mijenjaju se značajno tijekom mjerenja. Srčana frekvencija prije i poslije akupunkture ne mijenja se značajno po mjerenjima, ali značajno je niža nakon akupunkture u prvih osam mjerenja. Zaključak: tijekom primjene prvih pet akupunkturnih terapija značajno je smanjen intenzitet boli i vrijednosti krvnoga tlaka nakon provedenoga tretmana, te su u zadnjih pet tretmana navedene niže vrijednosti održane. Srčana frekvencija prije i poslije akupunkture ne mijenja se značajno po mjerenjima, ali značajno je niža nakon akupunkture u prvih osam mjerenja.The aim of this study was to prove or disprove connection between acupuncture analgesia with the level of blood pressure and heart rate during implementation of acupuncture analgesia in patients with chronic pain. The secondary aim was to measure pain intensity during implementation of acupuncture analgesia. Patients with chronic pain receiving 10 acupuncture sessions with pharmacological analgesic therapy were included. The inclusion criteria were pain intensity due to chronic pain of at least 5 on the 0-10 visual analog scale (VAS) and patient age 18 to 65. Excluding criteria were age under 18 and over 65, unregulated arterial hypertension, heart rhythm disorders, signifi cant psychiatric comorbidity, pregnancy, allergy to acupuncture needles, anticoagulant therapy, and patients who refused to participate in monitoring and therefore did not sign the informed consent form. Pain intensity, blood pressure and heart rate were evaluated before and after acupuncture. The study included 64 patients, 11 (17%) male and 53 (83%) female. Wilcoxon test proved a signifi cantly lower pain intensity after acupuncture on the second (p=0.009), third (p=0.006), fourth (p=0.005) and seventh (p=0.013) measurement. Pain intensity on the VAS was signifi cantly higher on the initial measurement before acupuncture and after acupuncture (Friedman test, p<0.001). Systolic pressure was signifi cantly decreased on the fi rst two measurements (Wilcoxon test, p=0.003 and p=0.014), and on the fourth (Wilcoxon test, p=0.036) and fi fth (Wilcoxon test, p=0.002) measurements after acupuncture. Diastolic blood pressure was signifi cantly lower on the fi fth (Wilcoxon test, p=0.030) and the last two measurements (Wilcoxon test, p=0.041 and p=0.003). The 6-10 measurements showed signifi cantly lower systolic (Friedman test, p<0.001) and diastolic (Friedman test, p=0.036) pressure before acupuncture in relation to systolic and diastolic blood pressure on the fi rst fi ve measurements before acupuncture. The pressure values after acupuncture did not change signifi cantly during measurements. Heart rate before and after acupuncture did not change the measurements signifi cantly, but was signifi cantly lower after acupuncture on the fi rst eight measurements. This study demonstrated that the fi rst fi ve acupuncture sessions signifi cantly reduced pain intensity and blood pressure, thereafter aintaining the levels of pain intensity and blood pressure achieved (acupuncture sessions 6-10), which were lower compared to the fi rst five measurements (acupuncture sessions 1-5)

CONNECTION BETWEEN ACUPUNCTURE ANALGESIA IN CHRONIC PAIN WITH PAIN INTENSITY, BLOOD PRESSURE AND HEART RATE

Cilj rada: Utvrditi vezu između akupunkturnog liječenja i vrijednosti arterijskog krvnog tlaka, srčane frekvencije i intenziteta boli. Metode: Prospektivnim istraživanjem su obuhvaćena 64 pacijenta sa kroničnom boli, liječena farmakološkom terapijom i akupunkturom u Zavodu za liječenje boli KBC Osijek. Intenzitet boli, krvni tlak i srčana frekvencija mjereni su prije postavljanja i nakon uklanjanja akupunkturnih igala. Rezultati: Intenzitet boli iskazan na vizualno analognoj ljestvici značajno je viši kod prvih mjerenja prije insercije akupunkturnih igala, te neposredno nakon skidanja akupunkturnih igala (poslije akupunkture) (Friedmanov test, p<0,001). Prije akupunkture značajno su niže vrijednosti sistoličkog (Friedmanov test, p<0,001) i dijastoličkog (Friedmanov test, p=0,036) tlaka u zadnjim mjerenjima. Vrijednosti tlaka poslije akupunkture ne mijenjaju se značajno tijekom mjerenja. Srčana frekvencija prije i poslije akupunkture ne mijenja se značajno po mjerenjima, ali značajno je niža nakon akupunkture u prvih osam mjerenja. Zaključak: tijekom primjene prvih pet akupunkturnih terapija značajno je smanjen intenzitet boli i vrijednosti krvnoga tlaka nakon provedenoga tretmana, te su u zadnjih pet tretmana navedene niže vrijednosti održane. Srčana frekvencija prije i poslije akupunkture ne mijenja se značajno po mjerenjima, ali značajno je niža nakon akupunkture u prvih osam mjerenja.The aim of this study was to prove or disprove connection between acupuncture analgesia with the level of blood pressure and heart rate during implementation of acupuncture analgesia in patients with chronic pain. The secondary aim was to measure pain intensity during implementation of acupuncture analgesia. Patients with chronic pain receiving 10 acupuncture sessions with pharmacological analgesic therapy were included. The inclusion criteria were pain intensity due to chronic pain of at least 5 on the 0-10 visual analog scale (VAS) and patient age 18 to 65. Excluding criteria were age under 18 and over 65, unregulated arterial hypertension, heart rhythm disorders, signifi cant psychiatric comorbidity, pregnancy, allergy to acupuncture needles, anticoagulant therapy, and patients who refused to participate in monitoring and therefore did not sign the informed consent form. Pain intensity, blood pressure and heart rate were evaluated before and after acupuncture. The study included 64 patients, 11 (17%) male and 53 (83%) female. Wilcoxon test proved a signifi cantly lower pain intensity after acupuncture on the second (p=0.009), third (p=0.006), fourth (p=0.005) and seventh (p=0.013) measurement. Pain intensity on the VAS was signifi cantly higher on the initial measurement before acupuncture and after acupuncture (Friedman test, p<0.001). Systolic pressure was signifi cantly decreased on the fi rst two measurements (Wilcoxon test, p=0.003 and p=0.014), and on the fourth (Wilcoxon test, p=0.036) and fi fth (Wilcoxon test, p=0.002) measurements after acupuncture. Diastolic blood pressure was signifi cantly lower on the fi fth (Wilcoxon test, p=0.030) and the last two measurements (Wilcoxon test, p=0.041 and p=0.003). The 6-10 measurements showed signifi cantly lower systolic (Friedman test, p<0.001) and diastolic (Friedman test, p=0.036) pressure before acupuncture in relation to systolic and diastolic blood pressure on the fi rst fi ve measurements before acupuncture. The pressure values after acupuncture did not change signifi cantly during measurements. Heart rate before and after acupuncture did not change the measurements signifi cantly, but was signifi cantly lower after acupuncture on the fi rst eight measurements. This study demonstrated that the fi rst fi ve acupuncture sessions signifi cantly reduced pain intensity and blood pressure, thereafter aintaining the levels of pain intensity and blood pressure achieved (acupuncture sessions 6-10), which were lower compared to the fi rst five measurements (acupuncture sessions 1-5)

The Influnce of Epidural Steroids Injections with Transforaminal and Interlaminal Approaches on Quality of Sleeping, Anxiety, and Depression in Patients With Chronic Lumbal Radicular Pain - Prospective, Randomized Research

Chronic lumbar radicular pain is connected with the anxiety, depression and sleep disorders. The aims of this study are to compare the effect of pain on sleep quality, anxiety and depression in patients receiving interlaminar and transforaminal epidural steroids injections. The study is an original scientific-research work, a prospective randomized controlled clinical trial that included 70 patients with lumbar radicular pain at the Clinical Hospital Centre Osijek. The selected patients were divided into two groups considering the approach of administration of epidural steroids, the interlaminar (IL) and transforaminal group (TF). The anxiety, depression and sleep disorders were evaluated with questionnaires "Hospital Anxiety and Depression Scale (HADS)" and "Questions for assessing sleep in chronic pain". In the end 64 patients completed the study, 41 women (64.1%) and 23 men (35.9%). Significantly lower values were recorded during the assessment of the sleep quality in the group with the interlaminar injection of steroids (ANOVA, p = 0.030), compared to the group with the transforaminal injection of steroids (ANOVA, p = 0.002), but there is no difference between the groups. In both groups, there is an improvement in anxiety and depression, but only in the sixth measurement a significantly lower evaluation value of the HADS questionnaire was obtained in transforaminal (TF) group (Mann Whitney test, p = 0.025). Within the TF group, the values of anxiety (Friedman\u27s test, p <0.001) and depression (Friedman\u27s test, p = 0.007) are significantly reduced. In patients who received epidural steroids injection with a transforaminal approach, lower levels of depression and anxiety were observed as there was a greater reduction in pain, compared to an interlaminar group. Sleep quality was higher in patients who received steroids via transforaminal compared to the interlaminar approach

Serratus anterior plane blok za analgeziju kod mastektomije

The incidence of breast cancer in women is on the rise, but the survival rate has increased due to the progress of medicine, especially if the disease is detected early. One of the imperatives is the patient’s quality of life after treatment. Inadequately treated acute postoperative pain leads to a worse treatment outcome and the development of chronic pain. The incidence of chronic pain after surgical treatment of breast cancer is high and negatively affects the quality of life of patients in the long term. Serratus anterior plane block (SAPB) is a relatively new ultrasound-guided regional analgesia technique. SAPB represents an alternative to an epidural, and to paravertebral and intercostal blocks. This review aims to describe serratus anterior plane block for breast surgery and emphasize their short- and long-term benefit. For this review, we searched MEDLINE in November 2022 to identify metanalyses, randomized controlled trial systemic reviews, and reviews published in the last five years. The search for metanalyses yielded 4 results; 12 results were found for randomized controlled trials; 5 results for reviews; and 4 results for systematic reviews. When employing SAPB in patients after mastectomy, good analgesia is achieved in the early postoperative period and the incidence of chronic pain is reduced, thus improving quality of life.Incidencija karcinoma dojke kod žena je u porastu ali napretkom liječenja povećana je stopa preživljena naročito ako se bolest otkrije u ranom stadiju. Jedan od imperativa je kvaliteta života bolesnice nakon liječenja. Neadekvatno liječena akutna poslijeoperacijska bol dovodi do lošijeg ishoda liječenja i razvoja kronične boli. Incidencija kronične boli nakon operativnog liječenja karcinoma dojke je visoka i dugoročno negativno utječe na kvalitetu života bolesnica. Serratus anterior plane block (SAPB) je relativno nova ultrazvukom vođena tehnika regionalne analgezije a predstavlja alternativu epiduralnim, paravertebralnim i interkostalnim blokovima.Cilj ovog pregleda je opisati serratus anterior plane block za mastektomiju i naglasiti njegovu kratkoročnu i dugoročnu korist. Za potrebe ovog rada proveli smo pretragu MEDLINE baze do studenog 2022. kako bismo identificirali meta-analize, sistemske preglede, randomizirana kontrolirana ispitivanja i preglede objavljene u posljednjih pet godina. Pretraživanjem meta-analiza dobili smo 4 rezultata, za randomizirano kontrolirano ispitivanje 12 rezultata, za preglede 5 rezultata i za sustavni pregled 4 rezultata. Primjenom SAPB kod bolesnica nakon mastektomije postiže se dobra analgezija u ranom poslijeoperacijskom periodu te se smanjuje pojavnost kronične boli i na taj način poboljšava se kvaliteta života

Utjecaj različitih minimalno invazivnih metoda na ishod liječenja lumbalne radikularne boli

Lumbar radicular pain is a major public health, social and economic problem and is often the cause of professional disability. The aim of this study was to compare pain intensity, disability and neuropatic pain depending on the method of treatment (epidural steroid injection or percutaneous laser disc decompression) in the treatment of lumbar radicular pain caused by intervertebral disc herniation with or without discoradicular contact. Data were collected from 28 patients at 3 measurement points (before the procedure and at examinations on the 15th and 30th day after the procedure) using the Numeric Rating Scale (NRS), Oswestry Disabilitiy Indeks (ODI) and Pain Detect. The reduction of the pain after the procedure was statistically significant only in the group of patients with discoradicular contact in whom PLDD was performed (P=0.04). From the obtained results, it can be concluded that percutaneous laser disc decompression (PLDD) led to a greater reduction in disability (P=0.009) in patients with discorradicular contact, whereas lumbar transforaminal epidural steroid injection (ESI TF) led to greater reduction in patients without discorradicular contact (P=0.02). The results indicate that there was a significant (P=0.01) reduction in neuropathic pain in patients without discorradicular contact who were treated with ESI TF and in patients with discoradicular contact who were treated with PLDD (P=0.04).Lumbalna radikularna bol je veliki javnozdravstveni, društveni i ekonomski problem i često je uzrok profesionalne nesposobnosti. Cilj ovog istraživanja bio je usporediti intenzitet boli, onesposobljenost i neuropatsku bol ovisno o načinu liječenja (epiduralna injekcija steroida ili perkutana laserska dekompresija diska) u liječenju lumbalne radikularne boli uzrokovane hernijom intervertebralnog diska sa ili bez diskoradikularnog kontakta. Podaci su prikupljeni od 28 pacijenata u 3 točke mjerenja (prije zahvata i na pregledima 15. i 30. dana nakon zahvata) pomoću Numeric Rating Scale (NRS), Oswestry Disabilitiy Indeks (ODI) i Pain Detect. Smanjenje boli nakon zahvata bilo je statistički značajno samo u skupini bolesnika s diskoradikularnim kontaktom kod kojih je učinjen PLDD (p = 0,04). Iz dobivenih rezultata može se zaključiti da je PLDD doveo do većeg smanjenja onesposobljenosti (p = 0,009 ) u bolesnika s diskoradikularnim kontaktom a ESI u bolesnika bez diskoradikularnog kontakta (p = 0,02 ). Rezultati pokazuju da je došlo do značajnog (p = 0,01) smanjenja neuropatske boli u bolesnika bez diskoradikularnog kontakta koji su liječeni ESI i u bolesnika s diskoradikularnim kontaktom koji su liječeni PLDD (p = 0,04)