Introduction: Knee osteoarthritis is a common cause for consultation around the world. Many patients with mild symptoms respond to conservative treatment, while others require interventional therapy including peripheral nerve blocks. Objective: To establish the clinical efficacy and safety of interventional management with ultrasound-guided saphenous nerve block in patients with chronic keen pain. Materials and methods: Descriptive, retrospective trial in chronic keen pain patients who underwent ultrasound-guided interventional therapy at the pain clinic in the country, between September 2011 and June 2012, to determine the clinical efficacy and safety of the procedure. Data were obtained from all patients prior to the procedure, and then at two days, one month and three months later. The pain intensity was measured using the visual analog scale. Results: 25 saphenous nerve blocks were performed. 68% of the patients experienced pain relief within two days. 56% and 40% exhibited relief one and three months after the procedure, respectively, with a statistically significant difference (p < 0.0001) between the baseline visual analog scale and the follow-up evaluation. Patients with a history of fibromyalgia, neuropathic characteristics and previous knee surgery exhibited variable analgesic responses to the procedure. Conclusions: Interventionist chronic knee pain management with ultrasound-guided saphenous nerve block was an effective and safe approach for these patients. Introducción: La osteoartritis de rodilla es una causa común de consulta en el mundo. Muchos pacientes con síntomas leves responden a los tratamientos conservadores, y otros requieren de tratamiento intervencionista, como bloqueos de nervios periféricos. Objetivo: Determinar la eficacia clínica y la seguridad del manejo intervencionista con bloqueo del nervio safeno guiado por ultrasonografía en pacientes con dolor crónico de rodilla. Materiales y métodos: Estudio de tipo descriptivo retrospectivo en pacientes con enfermedad dolorosa crónica de rodilla que recibieron tratamiento intervencionista guiado por ultrasonografía en una clínica de dolor del país entre los meses de septiembre de 2011 y junio de 2012, para determinar su eficacia clínica y su seguridad. Se obtuvieron datos de todos los pacientes antes del procedimiento, a los 2 días, un mes y 3 meses después. La intensidad de dolor se midió con la escala visual analógica. Resultados: Se realizaron 25 bloqueos del nervio safeno. El 68% de los pacientes presentaron alivio del dolor a los 2 días. El 56 y el 40% presentaron alivio al mes y a los 3 meses de realizado el procedimiento, respectivamente, con una diferencia estadísticamente significativa (p < 0,0001) entre las medianas de la escala visual analógica inicial y la escala visual analógica de los seguimientos. No se presentaron complicaciones. Los pacientes con antecedente de fibromialgia, dolor de características neuropáticas y cirugía previa de rodilla presentaron respuestas analgésicas variables con el bloqueo. Conclusiones: El manejo intervencionista del dolor crónico de rodilla con el bloqueo del nervio safeno guiado por ultrasonografía de los pacientes observados fue una opción de tratamiento eficaz y segura.
Knee osteoarthritis is a common cause for consultation around the world. Many patients with mild symptoms respond to conservative treatment, while others require interventional therapy including peripheral nerve blocks. To establish the clinical efficacy and safety of interventional management with ultrasound-guided saphenous nerve block in patients with chronic keen pain. Descriptive, retrospective trial in chronic keen pain patients who underwent ultrasound-guided interventional therapy at the pain clinic in the country, between September 2011 and June 2012, to determine the clinical efficacy and safety of the procedure. Data were obtained from all patients prior to the procedure, and then at two days, one month and three months later. The pain intensity was measured using the visual analog scale. 25 saphenous nerve blocks were performed. 68% of the patients experienced pain relief within two days. 56% and 40% exhibited relief one and three months after the procedure, respectively, with a statistically significant difference (p < 0.0001) between the baseline visual analog scale and the follow-up evaluation. Patients with a history of fibromyalgia, neuropathic characteristics and previous knee surgery exhibited variable analgesic responses to the procedure. Interventionist chronic knee pain management with ultrasound-guided saphenous nerve block was an effective and safe approach for these patients. La osteoartritis de rodilla es una causa común de consulta en el mundo. Muchos pacientes con síntomas leves responden a los tratamientos conservadores, y otros requieren de tratamiento intervencionista, como bloqueos de nervios periféricos. Determinar la eficacia clínica y la seguridad del manejo intervencionista con bloqueo del nervio safeno guiado por ultrasonografía en pacientes con dolor crónico de rodilla. Estudio de tipo descriptivo retrospectivo en pacientes con enfermedad dolorosa crónica de rodilla que recibieron tratamiento intervencionista guiado por ultrasonografía en una clínica de dolor del país entre los meses de septiembre de 2011 y junio de 2012, para determinar su eficacia clínica y su seguridad. Se obtuvieron datos de todos los pacientes antes del procedimiento, a los 2 días, un mes y 3 meses después. La intensidad de dolor se midió con la escala visual analógica. Se realizaron 25 bloqueos del nervio safeno. El 68% de los pacientes presentaron alivio del dolor a los 2 días. El 56 y el 40% presentaron alivio al mes y a los 3 meses de realizado el procedimiento, respectivamente, con una diferencia estadísticamente significativa (p < 0,0001) entre las medianas de la escala visual analógica inicial y la escala visual analógica de los seguimientos. No se presentaron complicaciones. Los pacientes con antecedente de fibromialgia, dolor de características neuropáticas y cirugía previa de rodilla presentaron respuestas analgésicas variables con el bloqueo. El manejo intervencionista del dolor crónico de rodilla con el bloqueo del nervio safeno guiado por ultrasonografía de los pacientes observados fue una opción de tratamiento eficaz y segura.
The creation of the Asian Infrastructure and Investment Bank (AIIB) was one of the lasts movements that confirmed the new found place of People’s Republic of China not only as major exporter, but as a new pillar of the world economy. This instalment comes at a time where Asia and other powers come to terms not only of trove of opportunity out of incredibly robust economic ties, but the anxiousness from facing a new found rival for other powers, or the revival of old disputes in the eyes of neighbours. Beijing has ensured that its dominance upon the bank’s structure and decisions since this bodies often need a major power as guarantor of its functionality. Plus, other similar institutions have been relatively successful but no immune to criticisms and risks like decision-making deadlock out of diverging interests from constituents. To prevent this, the AIIB must be able to produce tangible results, grant a membership worthy of being universal, develop a set of core specific policies and prove to be able to adapt in wake of a traumatic situation. Despite of this, the bank has been in existence for little over a year and the fulfillment of the prior challenges remains to be seen.
Abstract: A subcostal transversus abdominis plane ( TAP ) phenol injection was performed on a patient with refractory cancer pain due a metastatic involvement of the abdominal wall. A diagnostic block with local anesthetic was performed under ultrasound guidance ( USG ), resulting in a decrease of 80% and 100% in dynamic and static visual analog scale ( VAS ) for pain, respectively, for 20 hours. A phenol injection was then performed under USG . The patient reported 70% and 100% reduction in the dynamic and static VAS for pain and had a 50% decrease in the opioid requirement that was maintained for 2 months. TAP blocks offer an interesting tool for either diagnosis or therapeutic purpose in chronic pain management. USG provides an optimal approach to soft‐tissue lesions where fluoroscopy techniques are not useful.
Dear Editor,
Cancer pain is still a major issue despite the World Health Organization ladder. Up to 30% of the patients experience poor pain control, especially at late stages and during the last year of life [1]. While opioids are the gold standard for treatment of moderate to severe cancer pain, at least 10–15% may benefit from interventional procedures [2,3].
The main reason to advocate interventional pain management (IPM) is either a lack of efficacy of the opioids and the co-adjuvant therapy or intolerable side effects of such therapy.
IPM includes neurolytic procedures (celiac plexus neurolysis, superior hypogastric neurolysis, and impar ganglion neurolysis), continuous epidural and intrathecal analgesia radiofrequency, and vertebral or bone cement augmentation [4]. Most of the IPM experience has been done on adult population, and the information in pediatric population is limited.
Neurolytic injection on the impar ganglion is reported since 1990. This ganglion is a single retroperitoneal structure, marking the end of the paired paravertebral sympathetic chains. It is responsible for visceral-perineal pain that is sympathetically maintained [5]. There are no reports of neurolytic impar ganglion injection in …
With the beginning of the Reiwa era in May 2019, the high complexity of Japan's relations with its neighbors has become a matter of consideration. Most of these relationships are highly intricate, driven by intense and pragmatic economic exchanges amid disputes over past aggressions and territorial demarcations. This leads to a state that has made waiver of war a pillar of its post-war consensus, must find a way to strengthen its capabilities and question how and why it will use force. Japan has the need to intensify its exchanges with its neighborhood and with other regions, in order to support broader economic reforms and support the most important social changes.
