Thermocoagulation of the Gasserian ganglion in patients with trigeminal neuropathy resistant to pharmacotherapy

Indication for thermocoagulation of the Gasserian ganglion is trigeminal neuralgia resistant to pharmacologic treatment, which either is not effective or cannot be applied due to its side effects. In Pain Clinic of Clinic of Anaesthesiology and Intensive Care in Warsaw in the period from July of 2008 to June of 2011 there were 31 thermocoagulation procedures performed in 19 patients. Age of the patients varied between 46 and 86 years. The time of symptoms was between 2 and 30 years and pain was of intermittent character and its intensity in NRS was between 8 and 10 points. Thermocogulation was performed on ambulatory basis but in conditions of an operating room. Image of the foramen ovale was received through proper positioning of the patients and adjustment of the X-ray C-arm. Location of the tip of the electrode was verified by the C-arm, sensory and motor stimulation and injection of a dye. Time of the procedure was 60 seconds. In 18 patients a decrease in pain lasted from 7 to 24 months was reached. For one patient data has been missing. In none of the patients no serious adverse effects were noted.Indication for thermocoagulation of the Gasserian ganglion is trigeminal neuralgia resistant to pharmacologic treatment, which either is not effective or cannot be applied due to its side effects. In Pain Clinic of Clinic of Anaesthesiology and Intensive Care in Warsaw in the period from July of 2008 to June of 2011 there were 31 thermocoagulation procedures performed in 19 patients. Age of the patients varied between 46 and 86 years. The time of symptoms was between 2 and 30 years and pain was of intermittent character and its intensity in NRS was between 8 and 10 points. Thermocogulation was performed on ambulatory basis but in conditions of an operating room. Image of the foramen ovale was received through proper positioning of the patients and adjustment of the X-ray C-arm. Location of the tip of the electrode was verified by the C-arm, sensory and motor stimulation and injection of a dye. Time of the procedure was 60 seconds. In 18 patients a decrease in pain lasted from 7 to 24 months was reached. For one patient data has been missing. In none of the patients no serious adverse effects were noted

The effectiveness of neurolytic block of sphenopalatine ganglion using zygomatic approach for the management of trigeminal neuropathy

This study was performed to present the outcomes of trigeminal neuropathy management with the application of neurolytic block of sphenopalatine ganglion. This type of procedure is used in cases where pain is not well controlled with medical treatment. Twenty patients were treated with sphenopalatine ganglion neurolysis after their response to pharmacological management was not satisfactory. Significant pain relief was experienced by all but one patient and they were able to reduce or stop their pain medication. The time of pain relief was between a few months and 9 years during the study period. Number of procedures implemented varied as some of the patients have been under the care of our Pain Clinic for as long as 18 years, satisfied with this type of management and willing to have the procedure repeated if necessary. It appears that neurolytic block of sphenopalatine ganglion is effective enough and may be an option worth further consideration in battling the pain associated with trigeminal neuropathy

5% lidocaine medicated plasters vs. sympathetic nerve blocks as a part of multimodal treatment strategy for the management of postherpetic neuralgia: A retrospective, consecutive, case-series study

Introduction 5% lidocaine medicated plasters (5% LMP) have been appointed as a first-line treatment for post-herpetic neuralgia (PHN), while formerly used sympathetic nerve blocks (SNBs) were recently denied their clinical efficacy. The aim of this study was to compare the results of PHN management with the use of SNBs and 5% LMP as a first-line treatment. Material and methods This study was designed as a retrospective, consecutive, case-series study. Data of 60 consecutive PHN patients with allodynia treated with the use of SNBs and 60 subsequent patients managed with 5% LMP were analyzed. Pain severity after 8 weeks was assessed to recognize the results of the implemented therapy, with numeric rating scale (NRS) score <3 or =3 considered a success. Additionally, the number of pain-free patients (NRS=0) after 8 weeks were identified in both groups and compared. Results The rate of failures in SNBs and 5% LMP group was similar (18.9% vs. 27.1% of poor treatment results, respectively), with the average change in NRS of 5.88±2.41 in nerve blocks and 5.01±1.67 in lidocaine group (p=0.02). Significant difference was also noted in the rates of pain-free patients: 20 patients (34.4%) treated with SNBs and 8 (13.5%) using 5% LMP were pain-free after 8 weeks of treatment. Conclusion It may be concluded that SNBs may still be considered useful in PHN management, as it appears that in some cases this mode of treatment may offer some advantages over 5% LMP

Termolezja zwoju Gassera u pacjentów z neuralgią trójdzielną oporną na farmakoterapię

Wskazaniem do termolezji zwoju Gassera jest neuralgia trójdzielna, oporna na leczenie farmakologiczne, występowanie działań niepożądanych lub powikłań uniemożliwiających prowadzenie skutecznej farmakoterapii. W Poradni Leczenia Bólu Kliniki Anestezjologii i Intensywnej Terapii w Warszawie w okresie od lipca 2008 roku do czerwca 2011 roku przeprowadzono 31 zabiegów termolezji zwoju Gassera u 19 pacjentów. Pacjenci poddani zabiegowi mieli od 46 do 86 lat. Czas trwania objawów bólowych w badanej grupie wynosił od 2 do 30 lat. Pacjenci zgłaszali ból o charakterze napadowym, którego natężenie wynosiło od 8 do 10 punktów w skali numerycznej Numerical Rating Scale (NRS). Zabiegi termolezji zwoju Gassera przeprowadzano w trybie ambulatoryjnym, w warunkach sali operacyjnej. Otwór owalny uwidoczniano po odpowiednim ułożeniu głowy pacjenta i ustawieniu ramienia C aparatu rentgenowskiego. Właściwe umiejscowienie końca elektrody czynnej weryfikowano przy pomocą aparatu RTG z ramieniem C, wykonując stymulację ruchową i czuciową, oraz podaniem kontrastu. Czas trwania lezji wynosił 60 sekund. U 18 pacjentów uzyskano całkowite ustąpienie dolegliwości bólowych, które utrzymywało się od 7 do 24 miesięcy. Danych dotyczących jednego pacjenta nie udało się uzyskać. U żadnego z pacjentów nie wystąpiły poważne działania niepożądane

Fibromyalgia – etiology, diagnosis and treatment including perioperative management in patients with fibromyalgia

Fibromyalgia (FM) is considered a multifactorial disorder/syndrome with not fully understood etiology. Chronic generalized pain is the main symptom. A broad spectrum of factors is proposed to ex-plain the etiology. Its multifactorial nature is inherently associated with challenges in diagnosis and therapy. Various evidence of etiology has been evaluated with the aim of establishing a novel therapeutic approach. The main issue in the diagnosis and management is to focus on the evaluation of strict diagnostic criteria to minimize under- and overdiagnosis. Fibromyalgia is a challenge for perioperative management because of the increased risk of possible complications and poorer out-comes, including postoperative pain chronification. The authors have proposed an up-to-date evaluation of perioperative management considering the current guidelines. Multimodal analgesia combined with tailored perioperative care is the most appropriate assessment. Interdisciplinary research with special interest in pain management, including perioperative medicine, seems to be the main theme for the future

Ocena wysokości przestrzeni międzykręgowej na podstawie punktów anatomicznych w celu wykonania nakłucia lędźwiowego zawodzi w ponad 30% przypadków

BACKGROUND: The anatomical landmark which is used to identify the correct level for lumbar puncture is the line connecting both iliac crests. This crosses the vertebra column at the level of the L4–L5 intervertebral space or L4 vertebra. It can be difficult to determine in a group of orthopaedic patients due to chronic orthopaedic disorders, chronic pain, overweight, or difficulties with positioning for lumbar puncture. The objective of this study was to determine if identification of intervertebral space by a physical exam differs from that of an ultrasound assessment.METHODS: Adult patients scheduled for lower limb surgery under spinal block were enrolled in this study. The intervertebral space suitable for lumbar puncture was determined by physical exam by an anaesthetist in the sitting or lateral position. This was followed by a lumbar ultrasound. Primarily, a transducer was placed in paramedian sagittal view followed by transverse interlaminar view to confirm the identification of the interlaminar spaces. The ‘counting-up’ approach starting with the L5–S1 space was applied.RESULTS: One hundred and twenty two patients (122) were included in this study. Lumbar intervertebral spaces were identified by ultrasound in all cases. There was concordance of intervertebral space identification (between clinical and ultrasound examination) in 78 cases (64%). Mean deviation of inacuracy was one intervertebral space with no statistical difference among cephalad and caudal direction. There were no statistically significant differences found in terms of demographic data (sex, age, height, weight, or BMI), positioning for lumbar puncture, or intervertebral space chosen for the puncture between the concordant and the nonconcordant identification groups. The only statistically significant difference found was the difference in the years of experience of the anaesthetist performing the clinical assessment and puncture.CONCLUSIONS: The concordance rate between clinical examination and using assessment of intervertebral space identification for lumbar puncture is 64% among patients undergoing lower limb surgery. No special parameters were found which could make an anaesthetist aware that a patient is at greater risk of inadequate intervertebral space level assessment. Spinal ultrasound can reduce the incidence of inappropriate lumbar puncture level in orthopaedic patients.  BACKGROUND: The anatomical landmark which is used to identify the correct level for lumbar puncture is the line connecting both iliac crests. This crosses the vertebra column at the level of the L4–L5 intervertebral space or L4 vertebra. It can be difficult to determine in a group of orthopaedic patients due to chronic orthopaedic disorders, chronic pain, overweight, or difficulties with positioning for lumbar puncture. The objective of this study was to determine if identification of intervertebral space by a physical exam differs from that of an ultrasound assessment.METHODS: Adult patients scheduled for lower limb surgery under spinal block were enrolled in this study. The intervertebral space suitable for lumbar puncture was determined by physical exam by an anaesthetist in the sitting or lateral position. This was followed by a lumbar ultrasound. Primarily, a transducer was placed in paramedian sagittal view followed by transverse interlaminar view to confirm the identification of the interlaminar spaces. The ‘counting-up’ approach starting with the L5–S1 space was applied.RESULTS: One hundred and twenty two patients (122) were included in this study. Lumbar intervertebral spaces were identified by ultrasound in all cases. There was concordance of intervertebral space identification (between clinical and ultrasound examination) in 78 cases (64%). Mean deviation of inacuracy was one intervertebral space with no statistical difference among cephalad and caudal direction. There were no statistically significant differences found in terms of demographic data (sex, age, height, weight, or BMI), positioning for lumbar puncture, or intervertebral space chosen for the puncture between the concordant and the nonconcordant identification groups. The only statistically significant difference found was the difference in the years of experience of the anaesthetist performing the clinical assessment and puncture.CONCLUSIONS: The concordance rate between clinical examination and using assessment of intervertebral space identification for lumbar puncture is 64% among patients undergoing lower limb surgery. No special parameters were found which could make an anaesthetist aware that a patient is at greater risk of inadequate intervertebral space level assessment. Spinal ultrasound can reduce the incidence of inappropriate lumbar puncture level in orthopaedic patients.

Analysis of Anxiety, Depression and Aggression in Patients Attending Pain Clinics

The aim of the study was to measure the frequency of such emotional disturbances as anxiety, depression and aggression among patients treated in a pain clinic, as well as assess the factors contributing to such disorders. Research was conducted from January 2014 to April 2018 and involved patients treated in two pain clinics in the city of Warsaw, Poland. The study used the Hospital Anxiety and Depression Scale—Modified Version (HADS-M) and the Numerical Rating Scale (NSR). 1025 patients were recruited. The main reasons for their attending the pain clinic were osteoarticular pain (43.61%) and neuropathic pain (41.56%). Emotional disturbances in the form of anxiety were diagnosed in 32.39% of all the patients, depression in 17.85%, and aggression in 46.15%. The factors determining the level of anxiety in the study group were: sex, age, pain intensity and the lack of pharmacological treatment. Depression was determined by sex, pain intensity and the time of treatment in the clinic, while aggression by age and pain intensity

The substantial impact of ultrasound-guided regional anaesthesia on the clinical practice of peripheral nerve blocks

BACKGROUND: Ultrasound-guided (US-guided) regional anaesthesia has gained worldwide popularity in recent years owing to the benefits the method offers to patients. The 1st Department of Anaesthesiology and Intensive Care of Warsaw Medical University was one of the first centres in Poland to employ US-guided peripheral nerve blocks (PNB) on a routine basis. The technique was incorporated into the institution’s clinical practice from 2007. The purpose of this study was to retrospectively assess changes in the clinical practice of US-guided versus non US-guided PNBs over six years of experience with the technique.METHODS: Retrospective analysis assessing the prevalence of PNB methods, local anaesthetic (LA) injection techniques (i.e. single injection vs. multiple), LA volumes used, success rates and the incidence of complications.RESULTS: This study included 4,066 PNBs performed between January 2006 and June 2012. The results showed systematic growth in the prevalence of US-guided blocks in the total number of PNBs, from 8.6% in 2007 up to 53.3% in 2012. The mean LA volume used in PNB was significantly lower in US-guided blocks compared to traditional PNB techniques (respectively, 21.83 mL vs. 31.41 mL, P < 0.05) without a decrease in the success rate (respectively, 76% vs. 74%, P > 0.05). A shift in the prevailing block technique from single injection to multiple injections was observed, regardless of the nerve location technique employed (from 29% up to 84% of PNBs performed using multiple injection technique).CONCLUSIONS: The use of ultrasound optimizes the technique of peripheral blocks and the amount of local anaesthetic used. Ultrasonography does not affect the safety of peripheral blocks.BACKGROUND: Ultrasound-guided (US-guided) regional anaesthesia has gained worldwide popularity in recent years owing to the benefits the method offers to patients. The 1st Department of Anaesthesiology and Intensive Care of Warsaw Medical University was one of the first centres in Poland to employ US-guided peripheral nerve blocks (PNB) on a routine basis. The technique was incorporated into the institution’s clinical practice from 2007. The purpose of this study was to retrospectively assess changes in the clinical practice of US-guided versus non US-guided PNBs over six years of experience with the technique.METHODS: Retrospective analysis assessing the prevalence of PNB methods, local anaesthetic (LA) injection techniques (i.e. single injection vs. multiple), LA volumes used, success rates and the incidence of complications.RESULTS: This study included 4,066 PNBs performed between January 2006 and June 2012. The results showed systematic growth in the prevalence of US-guided blocks in the total number of PNBs, from 8.6% in 2007 up to 53.3% in 2012. The mean LA volume used in PNB was significantly lower in US-guided blocks compared to traditional PNB techniques (respectively, 21.83 mL vs. 31.41 mL, P < 0.05) without a decrease in the success rate (respectively, 76% vs. 74%, P > 0.05). A shift in the prevailing block technique from single injection to multiple injections was observed, regardless of the nerve location technique employed (from 29% up to 84% of PNBs performed using multiple injection technique).CONCLUSIONS: The use of ultrasound optimizes the technique of peripheral blocks and the amount of local anaesthetic used. Ultrasonography does not affect the safety of peripheral blocks