Efficacy and safety of ultrasound-guided interventional management in chronic pain patients: Cohort follow-up

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19 A – 40, Medellín, Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia y seguridad del manejo intervencionista guiado por ultrasonografía en pacientes con dolor crónico: seguimiento a una cohorte" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1244 "Ancho" => 1607 "Tamanyo" => 51413 ] ] "descripcion" => array:1 [ "en" => "Pain intensity behavior (VAS) during the three follow-up periods." ] ] ] "textoCompleto" => "IntroductionPain is a frequent cause of visits to the doctor and there is an increasing need to provide optimal and safe treatment. The use of ultrasonography in interventional analgesia has become increasingly relevant for pain management in the last 10 years.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Ultrasound guidance improves the safety of regional anesthesia because it reduces the volume of the local anesthetic agent required and hence lowers the incidence of systemic toxicity, shortens the time to perform the block, reduces the number of needle insertions and provides faster onset of action. Moreover, it reduces the risk of accidental puncture of other neighboring structures because it enables the visualization of the peripheral nerves, of the surrounding structures and the needle. The disadvantages are few but important, such as availability and the need for additional raining.<a class="elsevierStyleCrossRefs" href="#bib0010">2–6</a>There is increasing certainty about the importance of using ultrasonography in interventional analgesia to complement other more extensively used techniques – i.e. fluoroscopy – and about the need to promote ultrasound training in the anesthesia graduate programs and pain management subspecialties at various universities around the world and as a topic of general interest at international congresses.Consequently, a trial was designed to answer the question: Is ultrasound-guided interventional management effective and safe for chronic pain patients?Overall objectiveTo determine the clinical efficacy and safety of ultrasound-guided interventional management in chronic pain patients.Specific objectives<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•To describe the study population in terms of the socio-demographic characteristics.</li><li class="elsevierStyleListItem" id="lsti0010">•To determine the major blocks performed in chronic pain patients.</li><li class="elsevierStyleListItem" id="lsti0015">•To identify any changes in the pain intensity as described by the patients before and after treatment.</li><li class="elsevierStyleListItem" id="lsti0020">•To assess the efficacy of interventional therapy in terms of pain relief.</li><li class="elsevierStyleListItem" id="lsti0025">•To assess the association between pain relief and sex, diagnosis of fibromyalgia and prior oral pharmacological treatments.</li><li class="elsevierStyleListItem" id="lsti0030">•To determine the safety of the blocks in terms of the occurrence of complications.</li></ul>Materials and methodsWith the approval of the Ethics Committee, a descriptive follow-up trial of a cohort of chronic pain patients that received ultrasound-guided interventional therapy, using 0.5% bupivacaine without epinephrine plus 4mg of dexamethasone for a peripheral nerve block or an intra-articular block with 0.5% bupivacaine without epinephrine plus 40mg of methylprednisolone acetate, was undertaken. A portable General Electric LOGIQe® scanner was used, with linear transducers (7–12MHz) and convex transducers (2–5MHz). All patients were evaluated prior to the procedure and one month later. The procedures were done five to ten days following the initial evaluation. At every control the pain intensity was measured using the visual analog scale (VAS) and during the one-month follow-up visit the patients were asked about the VAS pain intensity two days after the procedure. Pain relief was defined as a drop of at least 50% in VAS. The sample was chosen from the patients that came to Instituto Colombiano del Dolor in Medellín city for pain consultation from May through December 2011 and met the inclusion and exclusion criteria. The data were collected form primary sources.The inclusion criteria were the following:<a class="elsevierStyleCrossRef" href="#bib0005">1</a> diagnosis of chronic pain (>6 months of evolution);<a class="elsevierStyleCrossRef" href="#bib0010">2</a> undergoing a single peripheral nerve or intra-articular block, and<a class="elsevierStyleCrossRef" href="#bib0015">3</a> use of ultrasonography to guide the block.The exclusion criteria were<a class="elsevierStyleCrossRef" href="#bib0005">1</a> indication for interventional management with multiple simultaneous blocks;<a class="elsevierStyleCrossRef" href="#bib0010">2</a> pain management with prolotherapy, radiofrequency or ultrasound-guided trigger points;<a class="elsevierStyleCrossRef" href="#bib0015">3</a> continued perineural infusion catheter insertion, and<a class="elsevierStyleCrossRef" href="#bib0020">4</a> able to quantify the pain intensity.The variables analyzed were gender – defined as phenotype, age in years at the time of the procedure; the type of procedure performed – the indication of the intervention to be made; the diagnosis of fibromyalgia present at the time of the procedure; the use of concomitant oral medicines – i.e., receiving acetaminophen in the last month –; a weak opioid; a tricyclic antidepressant and/or anti-neuropathic (pregabaline, gabapentin or carbamazepine); the pain score in terms of the subjective pain evaluation by the patient according to VAS and complications such as the occurrence of adverse events resulting from the intervention.The database was stored in Microsoft Excel® and the software used for the analysis of the information was SPSS 18 (licensed by CES University). A descriptive analysis was completed for all the variables studied, supported by the calculation of proportions and descriptive measurements. The association between the quantitative variables and Pearson's Chi-square test was also established, in addition to a paired analysis to establish the difference between pain intensity before and after the procedure, using Wilcoxon's test. The association between pain relief with a diagnosis of fibromyalgia and the concomitant use of oral medicines was evaluated using Pearson's Chi-square test and the relative risks were calculated. A <5% statistical significance was used, with 95% confidence intervals.ResultsA total of 426 ultrasound-guided interventional analgesic procedures were completed at Instituto Colombiano del Dolor, Medellín city, from May through December 2011. 152 patients were dismissed because they had undergone multiple procedures, 15 for radiofrequencies, 15 for prolotherapies, 46 for trigger points, 10 for perineural continuous infusion catheters and 39 because they had difficulty in quantifying pain. A total of 149 patients undergoing ultrasound-guided peripheral nerve block were analyzed.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the general characteristics of the patients evaluated. Prior oral treatment corresponds to the treatment received in the last month, with at least acetaminophen, a mild opioid, a tricyclic antidepressant and/or an anti-neuropathic drug (pregabaline, gabapentin or carbamazepine).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The primary block performed was the supra-scapular nerve, followed by the saphenous, the sacroiliac, the stellate ganglion, ilioinguinal, lateral femoral cutaneous and femoral. The intra-articular blocks were the knee, the shoulder, the elbow, the sacroiliac and the sternochondral joints. To a lesser extent, there were other blocks such as cervical facets, medial lumbar ramus, sciatic, obturator, posterior tibial, medial, cubital, axillary, genitofemoral, greater occipital and the rectus sheath. The most important percentages are shown on <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The percentage of patients that experienced pain reduction after two days and after one month of the procedure were 79.2% and 38.9%, respectively.The mean VAS score on the second day and after one-month follow-up was 2 and 6, respectively. The difference between the initial VAS and the second day means was 8, a statistically significant difference (p<0.0001). Similarly, statistically significant differences were found between the initial and one-month VAS means (p<0.0001). The pain intensity after one month of the procedure was higher on the second day but it was still less than before the block (<a class="elsevierStyleCrossRef" href="#fig2">Fig. 2</a>).<elsevierMultimedia ident="fig2"></elsevierMultimedia>In the sub-group analysis, equal results were found in the comparison of the pain intensity among patients with fibromyalgia and those who had not been receiving pharmacological treatment. In terms of the final result after two days and after one month of the block, there was no association between gender, a diagnosis of fibromyalgia and pain relief in both evaluation periods, or with having received treatment (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The incidence of complications was 2.6%, one case of intramuscular hematoma (0.6%) and three (2%) patients that fell at home on the same day of the procedure because of a lower limb motor block.DiscussionThere are few reports on the management of benign chronic pain, whilst there are many about malignant pain and perioperative regional anesthesia. Ultrasound-guided nerve blocks have been an effective and safe tool. This trial shows that pain relief was accomplished in 79.2% of the patients two days after the procedure and in 38.9% after one month of treatment with a low incidence of complications.The most frequent block was the supra-scapular nerve block – the most sensitive nerve of the shoulder. This approach has been effective, particularly in rheumatoid arthritis, osteoarthritis, and rotator cuff disorders, with complications such as pneumothorax, intravascular injection, residual block and local trauma.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> This trial included 34 supra-scapular blocks with a 79.4% efficacy after two days of the procedure and 35.3% after one month. There were no complications. A recent publication reported a 47.8% pain improvement in patients during the first month following the procedure.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Harmon and Hearty<a class="elsevierStyleCrossRef" href="#bib0045">9</a> reported a case of ultrasound-guided supra-scapular nerve block with a reduction in pain intensity and improved shoulder movement and function for 12 weeks. It is also possible to use continuous supra-scapular nerve block with a catheter,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> but this approach is beyond the scope of this trial.The saphenous nerve is a sensitive branch of the femoral nerve; it is easy to identify and its block provides analgesia in patients with chronic knee pain. The saphenous nerve innervates an extensive skin area on the medial aspect of the knee, the leg, the ankle and the foot,<a class="elsevierStyleCrossRefs" href="#bib0055">11–15</a> in addition to improving acute postoperative pain.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a> Tsai et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> reported a series of 39 cases of ultrasound-guided saphenous nerve blocks with a 77% success rate after four months; these results are similar to the results herein.The ilioinguinal nerve block has been used to control postoperative pain mainly in inguinal herniorrhaphy in children,<a class="elsevierStyleCrossRef" href="#bib0095">19</a> but the procedure has been extended to adult patients in whom the incidence of postoperative inguinal pain is 12%. More recently it has also been used for managing chronic central sensitization pain.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> This trial included 13 patients treated with ilioinguinal nerve block, of which after the second day only one patient continued to experience pain and after one month follow-up 61.5% were still improving.Neck and chest blocks may have a high risk of esophageal, tracheal, and thyroid injury, intravascular or epidural injection and pneumothorax if not performed under real time visualization. Kapral et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> described the ultrasound-guided stellate ganglion block in 1995, while the intercostal nerve block technique was described in 2004 by Eichenberger et al.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> A high frequency transducer was used in this trial that enabled the identification of these structures and adequate positioning of the needle;<a class="elsevierStyleCrossRef" href="#bib0115">23</a> 13 stellate ganglion blocks were performed and there were no complications. Likewise, five intercostal blocks were administered with no pneumothorax reports, but there was one episode of hematoma in the dorsal paravertebral musculature reported 24h after the block, in a patient that was anti-coagulated up to five days before the procedure. The patient received medical treatment and there were no sequels later.Intra-articular blocks are traditionally performed “blindly”, but ultrasonography is increasingly being used to be able to approach any joint.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> 6% of our intra-articular blocks were in the shoulder and the knee with good results.Due to the few chronic pain management reports, the recommendations are low evidence, except for the celiac plexus block,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> for which the ultrasound-guided technique was described in 1983.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Cochrane published recently a systematic review<a class="elsevierStyleCrossRef" href="#bib0020">4</a> with 18 clinical trials and 1344 acute pain patients and reported an incidence of minor complications below 10% – a higher value than the number reported in this trial with one hematoma and three falls due to residual motor block of a lower limb, following a femoral block. The risk of falling after a lower limb block is high.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> Muraskin et al.,<a class="elsevierStyleCrossRef" href="#bib0130">26</a> reported two cases of falls following peripheral nerve blocks.The limitations described were a short follow-up period and the possible bias of the patients’ memory when retrospectively rating pain 48h after the block.The data contribute valuable information for the specialists in the area because of the broad range of ultrasound-guided blocks performed at a pain management referral center, with favorable and safe results. The blocks excluded from the trial are also relevant and should be the object of future research.ConclusionsUltrasonography-guided interventional pain management is a treatment option indicated for acute or chronic pain patients. This approach does not replace fluoroscopy-guided procedures, but offers some benefits such as lower cost, no radiation exposure and a lower rate of complications. All of the above considerations make this an effective and safe choice.Conflicts of interestThe authors have no conflicts of interest to declare.FundingNone.Ethical disclosuresThe authors declare that they have followed the protocols of their work center on the publication of patient data Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this study. Right to privacy and informed consent. The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres573611" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec590550" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres573612" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec590549" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Overall objective" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Specific objectives" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Materials and methods" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "sec0075" "titulo" => "Ethical disclosures" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-10-20" "fechaAceptado" => "2014-09-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec590550" "palabras" => array:5 [ 0 => "Chronic pain" 1 => "Ultrasonography" 2 => "Peripheral nerves" 3 => "Nerve block" 4 => "Pain" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec590549" "palabras" => array:5 [ 0 => "Dolor crónico" 1 => "Ultrasonografía" 2 => "Nervios periféricos" 3 => "Bloqueo nervioso" 4 => "Dolor" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionChronic pain is a highly prevalent condition and its treatment includes multiple measures, including ultrasound-guided analgesic blocks. There are no reports available including different types of blocks in chronic pain patients. ObjectiveTo determine the clinical efficacy and safety of ultrasound-guided interventional management in chronic pain patients that consulted at Instituto Colombiano del Dolor in 2011. Materials and methodsDescriptive follow-up trial of a cohort of 149 chronic pain patients undergoing ultrasound-guided interventional therapy at Instituto Colombiano del Dolor in Medellín city, from May through December 2011. Data were collected prior to the procedure, at day two and then one month later. Pain intensity was measured with the visual analog scale. Results149 patients were analyzed. The most common block was the supra-scapular nerve. The efficacy of the blocks was 79.2% and 38.9% after two days and one month, respectively, with a statistically significant difference between the intensity of the initial pain and pain at follow-up. The incidence of complications was low. There were no differences in the outcomes between the patients with a diagnosis of fibromyalgia and those who had not been receiving any prior pharmacological therapy. ConclusionsUltrasound-guided interventional pain management is an effective and safe technique." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl dolor crónico es una enfermedad de alta prevalencia, su tratamiento incluye múltiples medidas, entre ellas los bloqueos analgésicos guiados por ultrasonido, no existen reportes que incluyan diferentes tipos de bloqueos en pacientes con dolor crónico. ObjetivoDeterminar la eficacia clínica y seguridad del manejo intervencionista guiado por ultrasonografía en pacientes con dolor crónico atendidos en el Instituto Colombiano del Dolor durante el año 2011. Materiales y métodosEstudio de tipo descriptivo de seguimiento a una cohorte de 149 pacientes con dolor crónico sometidos a tratamiento intervencionista guiado por ultrasonografía en el Instituto Colombiano del Dolor en la ciudad de Medellín entre los meses de mayo y diciembre del año 2011. Se obtuvieron datos antes del procedimiento, a los dos días y un mes después. La intensidad del dolor se midió con la escala visual análoga. ResultadosSe analizaron 149 pacientes, el bloqueo más frecuente fue del nervio supraescapular. La eficacia de los bloqueos fue del 79,2% y 38,9% a los dos días y al mes respectivamente, con una diferencia estadísticamente significativa entre la intensidad del dolor inicial y el de los seguimientos. La incidencia de complicaciones fue baja. No hubo diferencias en los resultados finales entre los pacientes con diagnóstico de fibromialgia y en quienes no venían recibiendo tratamiento farmacológico previo. ConclusionesEl manejo intervencionista del dolor guiado por ultrasonografía es una técnica eficaz y segura." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Arcila-Lotero MA, Mejía-Aguilar MA. Eficacia y seguridad del manejo intervencionista guiado por ultrasonografía en pacientes con dolor crónico: seguimiento a una cohorte. Rev Colomb Anestesiol. 2015;43:263–268." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1101 "Ancho" => 3101 "Tamanyo" => 123304 ] ] "descripcion" => array:1 [ "en" => "Frequency distribution of ultrasound-guided blocks." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1244 "Ancho" => 1607 "Tamanyo" => 51413 ] ] "descripcion" => array:1 [ "en" => "Pain intensity behavior (VAS) during the three follow-up periods." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "SD, standard deviation; VAS, visual analog scale.Source: Authors." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">n=149 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age in years (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (16.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Female gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Oral treatment in the past month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diagnosis of fibromyalgia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pain intensity (VAS mean) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab936418.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Overall characteristics of the patients evaluated." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Source: Authors." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comparison \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">RR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex versus 2-day relief \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3–2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex versus one-month relief \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5–2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fibromyalgia versus 2-day relief \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7–3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fibromyalgia versus 1-month relief \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5–1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Oral treatment versus 2-day relief \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5–3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Oral treatment versus 1-month relief \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7–4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab936419.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Association of sex, fibromyalgia, oral pharmacological therapy and pain relief." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonography in pain medicine: a critical review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. 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Scientific and Technological Research

Eficacia y seguridad del manejo intervencionista guiado por ultrasonografía en pacientes con dolor crónico: seguimiento a una cohorte

Mario Andrés Arcila-Loteroa, María Adelaida Mejía-Aguilarb,

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tatamejia28@gmail.com

Corresponding author at: Instituto Colombiano del Dolor, Carrera 48 # 19 A – 40, Medellín, Colombia.

a Anesthesiologist, Professor of Anesthesia and Pain, Master in Epidemiology, CES University, Instituto Colombiano del Dolor, Colombia

b Physician, Instituto Colombiano del Dolor, Master in Epidemiology, CES University, Medellín, Colombia

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pain is a frequent cause of visits to the doctor and there is an increasing need to provide optimal and safe treatment&#46; The use of ultrasonography in interventional analgesia has become increasingly relevant for pain management in the last 10 years&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Ultrasound guidance improves the safety of regional anesthesia because it reduces the volume of the local anesthetic agent required and hence lowers the incidence of systemic toxicity&#44; shortens the time to perform the block&#44; reduces the number of needle insertions and provides faster onset of action&#46; Moreover&#44; it reduces the risk of accidental puncture of other neighboring structures because it enables the visualization of the peripheral nerves&#44; of the surrounding structures and the needle&#46; The disadvantages are few but important&#44; such as availability and the need for additional raining&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">There is increasing certainty about the importance of using ultrasonography in interventional analgesia to complement other more extensively used techniques &#8211; i&#46;e&#46; fluoroscopy &#8211; and about the need to promote ultrasound training in the anesthesia graduate programs and pain management subspecialties at various universities around the world and as a topic of general interest at international congresses&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Consequently&#44; a trial was designed to answer the question&#58; Is ultrasound-guided interventional management effective and safe for chronic pain patients&#63;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Overall objective</span><p id="par0025" class="elsevierStylePara elsevierViewall">To determine the clinical efficacy and safety of ultrasound-guided interventional management in chronic pain patients&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Specific objectives</span><p id="par0030" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">To describe the study population in terms of the socio-demographic characteristics&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0040" class="elsevierStylePara elsevierViewall">To determine the major blocks performed in chronic pain patients&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0045" class="elsevierStylePara elsevierViewall">To identify any changes in the pain intensity as described by the patients before and after treatment&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">To assess the efficacy of interventional therapy in terms of pain relief&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">To assess the association between pain relief and sex&#44; diagnosis of fibromyalgia and prior oral pharmacological treatments&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">To determine the safety of the blocks in terms of the occurrence of complications&#46;</p></li></ul></p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Materials and methods</span><p id="par0065" class="elsevierStylePara elsevierViewall">With the approval of the Ethics Committee&#44; a descriptive follow-up trial of a cohort of chronic pain patients that received ultrasound-guided interventional therapy&#44; using 0&#46;5&#37; bupivacaine without epinephrine plus 4<span class="elsevierStyleHsp" style=""></span>mg of dexamethasone for a peripheral nerve block or an intra-articular block with 0&#46;5&#37; bupivacaine without epinephrine plus 40<span class="elsevierStyleHsp" style=""></span>mg of methylprednisolone acetate&#44; was undertaken&#46; A portable General Electric LOGIQe<span class="elsevierStyleSup">&#174;</span> scanner was used&#44; with linear transducers &#40;7&#8211;12<span class="elsevierStyleHsp" style=""></span>MHz&#41; and convex transducers &#40;2&#8211;5<span class="elsevierStyleHsp" style=""></span>MHz&#41;&#46; All patients were evaluated prior to the procedure and one month later&#46; The procedures were done five to ten days following the initial evaluation&#46; At every control the pain intensity was measured using the visual analog scale &#40;VAS&#41; and during the one-month follow-up visit the patients were asked about the VAS pain intensity two days after the procedure&#46; Pain relief was defined as a drop of at least 50&#37; in VAS&#46; The sample was chosen from the patients that came to Instituto Colombiano del Dolor in Medell&#237;n city for pain consultation from May through December 2011 and met the inclusion and exclusion criteria&#46; The data were collected form primary sources&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The inclusion criteria were the following&#58;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> diagnosis of chronic pain &#40;&#62;6 months of evolution&#41;&#59;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> undergoing a single peripheral nerve or intra-articular block&#44; and<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> use of ultrasonography to guide the block&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The exclusion criteria were<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> indication for interventional management with multiple simultaneous blocks&#59;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> pain management with prolotherapy&#44; radiofrequency or ultrasound-guided trigger points&#59;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> continued perineural infusion catheter insertion&#44; and<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> able to quantify the pain intensity&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The variables analyzed were gender &#8211; defined as phenotype&#44; age in years at the time of the procedure&#59; the type of procedure performed &#8211; the indication of the intervention to be made&#59; the diagnosis of fibromyalgia present at the time of the procedure&#59; the use of concomitant oral medicines &#8211; i&#46;e&#46;&#44; receiving acetaminophen in the last month &#8211;&#59; a weak opioid&#59; a tricyclic antidepressant and&#47;or anti-neuropathic &#40;pregabaline&#44; gabapentin or carbamazepine&#41;&#59; the pain score in terms of the subjective pain evaluation by the patient according to VAS and complications such as the occurrence of adverse events resulting from the intervention&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The database was stored in Microsoft Excel<span class="elsevierStyleSup">&#174;</span> and the software used for the analysis of the information was SPSS 18 &#40;licensed by CES University&#41;&#46; A descriptive analysis was completed for all the variables studied&#44; supported by the calculation of proportions and descriptive measurements&#46; The association between the quantitative variables and Pearson&#39;s Chi-square test was also established&#44; in addition to a paired analysis to establish the difference between pain intensity before and after the procedure&#44; using Wilcoxon&#39;s test&#46; The association between pain relief with a diagnosis of fibromyalgia and the concomitant use of oral medicines was evaluated using Pearson&#39;s Chi-square test and the relative risks were calculated&#46; A &#60;5&#37; statistical significance was used&#44; with 95&#37; confidence intervals&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">A total of 426 ultrasound-guided interventional analgesic procedures were completed at Instituto Colombiano del Dolor&#44; Medell&#237;n city&#44; from May through December 2011&#46; 152 patients were dismissed because they had undergone multiple procedures&#44; 15 for radiofrequencies&#44; 15 for prolotherapies&#44; 46 for trigger points&#44; 10 for perineural continuous infusion catheters and 39 because they had difficulty in quantifying pain&#46; A total of 149 patients undergoing ultrasound-guided peripheral nerve block were analyzed&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the general characteristics of the patients evaluated&#46; Prior oral treatment corresponds to the treatment received in the last month&#44; with at least acetaminophen&#44; a mild opioid&#44; a tricyclic antidepressant and&#47;or an anti-neuropathic drug &#40;pregabaline&#44; gabapentin or carbamazepine&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The primary block performed was the supra-scapular nerve&#44; followed by the saphenous&#44; the sacroiliac&#44; the stellate ganglion&#44; ilioinguinal&#44; lateral femoral cutaneous and femoral&#46; The intra-articular blocks were the knee&#44; the shoulder&#44; the elbow&#44; the sacroiliac and the sternochondral joints&#46; To a lesser extent&#44; there were other blocks such as cervical facets&#44; medial lumbar ramus&#44; sciatic&#44; obturator&#44; posterior tibial&#44; medial&#44; cubital&#44; axillary&#44; genitofemoral&#44; greater occipital and the rectus sheath&#46; The most important percentages are shown on <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The percentage of patients that experienced pain reduction after two days and after one month of the procedure were 79&#46;2&#37; and 38&#46;9&#37;&#44; respectively&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The mean VAS score on the second day and after one-month follow-up was 2 and 6&#44; respectively&#46; The difference between the initial VAS and the second day means was 8&#44; a statistically significant difference &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; Similarly&#44; statistically significant differences were found between the initial and one-month VAS means &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; The pain intensity after one month of the procedure was higher on the second day but it was still less than before the block &#40;<a class="elsevierStyleCrossRef" href="#fig2">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">In the sub-group analysis&#44; equal results were found in the comparison of the pain intensity among patients with fibromyalgia and those who had not been receiving pharmacological treatment&#46; In terms of the final result after two days and after one month of the block&#44; there was no association between gender&#44; a diagnosis of fibromyalgia and pain relief in both evaluation periods&#44; or with having received treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The incidence of complications was 2&#46;6&#37;&#44; one case of intramuscular hematoma &#40;0&#46;6&#37;&#41; and three &#40;2&#37;&#41; patients that fell at home on the same day of the procedure because of a lower limb motor block&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">There are few reports on the management of benign chronic pain&#44; whilst there are many about malignant pain and perioperative regional anesthesia&#46; Ultrasound-guided nerve blocks have been an effective and safe tool&#46; This trial shows that pain relief was accomplished in 79&#46;2&#37; of the patients two days after the procedure and in 38&#46;9&#37; after one month of treatment with a low incidence of complications&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The most frequent block was the supra-scapular nerve block &#8211; the most sensitive nerve of the shoulder&#46; This approach has been effective&#44; particularly in rheumatoid arthritis&#44; osteoarthritis&#44; and rotator cuff disorders&#44; with complications such as pneumothorax&#44; intravascular injection&#44; residual block and local trauma&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This trial included 34 supra-scapular blocks with a 79&#46;4&#37; efficacy after two days of the procedure and 35&#46;3&#37; after one month&#46; There were no complications&#46; A recent publication reported a 47&#46;8&#37; pain improvement in patients during the first month following the procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Harmon and Hearty<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> reported a case of ultrasound-guided supra-scapular nerve block with a reduction in pain intensity and improved shoulder movement and function for 12 weeks&#46; It is also possible to use continuous supra-scapular nerve block with a catheter&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> but this approach is beyond the scope of this trial&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The saphenous nerve is a sensitive branch of the femoral nerve&#59; it is easy to identify and its block provides analgesia in patients with chronic knee pain&#46; The saphenous nerve innervates an extensive skin area on the medial aspect of the knee&#44; the leg&#44; the ankle and the foot&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;15</span></a> in addition to improving acute postoperative pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> Tsai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> reported a series of 39 cases of ultrasound-guided saphenous nerve blocks with a 77&#37; success rate after four months&#59; these results are similar to the results herein&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The ilioinguinal nerve block has been used to control postoperative pain mainly in inguinal herniorrhaphy in children&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> but the procedure has been extended to adult patients in whom the incidence of postoperative inguinal pain is 12&#37;&#46; More recently it has also been used for managing chronic central sensitization pain&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> This trial included 13 patients treated with ilioinguinal nerve block&#44; of which after the second day only one patient continued to experience pain and after one month follow-up 61&#46;5&#37; were still improving&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Neck and chest blocks may have a high risk of esophageal&#44; tracheal&#44; and thyroid injury&#44; intravascular or epidural injection and pneumothorax if not performed under real time visualization&#46; Kapral et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> described the ultrasound-guided stellate ganglion block in 1995&#44; while the intercostal nerve block technique was described in 2004 by Eichenberger et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> A high frequency transducer was used in this trial that enabled the identification of these structures and adequate positioning of the needle&#59;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> 13 stellate ganglion blocks were performed and there were no complications&#46; Likewise&#44; five intercostal blocks were administered with no pneumothorax reports&#44; but there was one episode of hematoma in the dorsal paravertebral musculature reported 24<span class="elsevierStyleHsp" style=""></span>h after the block&#44; in a patient that was anti-coagulated up to five days before the procedure&#46; The patient received medical treatment and there were no sequels later&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Intra-articular blocks are traditionally performed &#8220;blindly&#8221;&#44; but ultrasonography is increasingly being used to be able to approach any joint&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> 6&#37; of our intra-articular blocks were in the shoulder and the knee with good results&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Due to the few chronic pain management reports&#44; the recommendations are low evidence&#44; except for the celiac plexus block&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> for which the ultrasound-guided technique was described in 1983&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Cochrane published recently a systematic review<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> with 18 clinical trials and 1344 acute pain patients and reported an incidence of minor complications below 10&#37; &#8211; a higher value than the number reported in this trial with one hematoma and three falls due to residual motor block of a lower limb&#44; following a femoral block&#46; The risk of falling after a lower limb block is high&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Muraskin et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> reported two cases of falls following peripheral nerve blocks&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The limitations described were a short follow-up period and the possible bias of the patients&#8217; memory when retrospectively rating pain 48<span class="elsevierStyleHsp" style=""></span>h after the block&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The data contribute valuable information for the specialists in the area because of the broad range of ultrasound-guided blocks performed at a pain management referral center&#44; with favorable and safe results&#46; The blocks excluded from the trial are also relevant and should be the object of future research&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0170" class="elsevierStylePara elsevierViewall">Ultrasonography-guided interventional pain management is a treatment option indicated for acute or chronic pain patients&#46; This approach does not replace fluoroscopy-guided procedures&#44; but offers some benefits such as lower cost&#44; no radiation exposure and a lower rate of complications&#46; All of the above considerations make this an effective and safe choice&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0185" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical disclosures</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data Protection of human and animal subjects&#46; The authors declare that no experiments were performed on humans or animals for this study&#46; Right to privacy and informed consent&#46; The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span>"
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    "fechaRecibido" => "2013-10-20"
    "fechaAceptado" => "2014-09-03"
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          "clase" => "keyword"
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            1 => "Ultrasonography"
            2 => "Peripheral nerves"
            3 => "Nerve block"
            4 => "Pain"
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            0 => "Dolor cr&#243;nico"
            1 => "Ultrasonograf&#237;a"
            2 => "Nervios perif&#233;ricos"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chronic pain is a highly prevalent condition and its treatment includes multiple measures&#44; including ultrasound-guided analgesic blocks&#46; There are no reports available including different types of blocks in chronic pain patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine the clinical efficacy and safety of ultrasound-guided interventional management in chronic pain patients that consulted at Instituto Colombiano del Dolor in 2011&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Descriptive follow-up trial of a cohort of 149 chronic pain patients undergoing ultrasound-guided interventional therapy at Instituto Colombiano del Dolor in Medell&#237;n city&#44; from May through December 2011&#46; Data were collected prior to the procedure&#44; at day two and then one month later&#46; Pain intensity was measured with the visual analog scale&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">149 patients were analyzed&#46; The most common block was the supra-scapular nerve&#46; The efficacy of the blocks was 79&#46;2&#37; and 38&#46;9&#37; after two days and one month&#44; respectively&#44; with a statistically significant difference between the intensity of the initial pain and pain at follow-up&#46; The incidence of complications was low&#46; There were no differences in the outcomes between the patients with a diagnosis of fibromyalgia and those who had not been receiving any prior pharmacological therapy&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ultrasound-guided interventional pain management is an effective and safe technique&#46;</p></span>"
        "secciones" => array:5 [
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Materials and methods"
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          3 => array:2 [
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El dolor cr&#243;nico es una enfermedad de alta prevalencia&#44; su tratamiento incluye m&#250;ltiples medidas&#44; entre ellas los bloqueos analg&#233;sicos guiados por ultrasonido&#44; no existen reportes que incluyan diferentes tipos de bloqueos en pacientes con dolor cr&#243;nico&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Determinar la eficacia cl&#237;nica y seguridad del manejo intervencionista guiado por ultrasonograf&#237;a en pacientes con dolor cr&#243;nico atendidos en el Instituto Colombiano del Dolor durante el a&#241;o 2011&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio de tipo descriptivo de seguimiento a una cohorte de 149 pacientes con dolor cr&#243;nico sometidos a tratamiento intervencionista guiado por ultrasonograf&#237;a en el Instituto Colombiano del Dolor en la ciudad de Medell&#237;n entre los meses de mayo y diciembre del a&#241;o 2011&#46; Se obtuvieron datos antes del procedimiento&#44; a los dos d&#237;as y un mes despu&#233;s&#46; La intensidad del dolor se midi&#243; con la escala visual an&#225;loga&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 149 pacientes&#44; el bloqueo m&#225;s frecuente fue del nervio supraescapular&#46; La eficacia de los bloqueos fue del 79&#44;2&#37; y 38&#44;9&#37; a los dos d&#237;as y al mes respectivamente&#44; con una diferencia estad&#237;sticamente significativa entre la intensidad del dolor inicial y el de los seguimientos&#46; La incidencia de complicaciones fue baja&#46; No hubo diferencias en los resultados finales entre los pacientes con diagn&#243;stico de fibromialgia y en quienes no ven&#237;an recibiendo tratamiento farmacol&#243;gico previo&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El manejo intervencionista del dolor guiado por ultrasonograf&#237;a es una t&#233;cnica eficaz y segura&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Arcila-Lotero MA&#44; Mej&#237;a-Aguilar MA&#46; Eficacia y seguridad del manejo intervencionista guiado por ultrasonograf&#237;a en pacientes con dolor cr&#243;nico&#58; seguimiento a una cohorte&#46; Rev Colomb Anestesiol&#46; 2015&#59;43&#58;263&#8211;268&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age in years &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;16&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Female gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Oral treatment in the past month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diagnosis of fibromyalgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Pain intensity &#40;VAS mean&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comparison&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sex versus 2-day relief&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&#8211;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sex versus one-month relief&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fibromyalgia versus 2-day relief&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&#8211;3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fibromyalgia versus 1-month relief&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&#8211;1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Oral treatment versus 2-day relief&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&#8211;3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Oral treatment versus 1-month relief&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&#8211;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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Article information

ISSN: 22562087
Original language: English

DOI:10.1016/j.rcae.2014.11.003

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Year/Month	Html	Pdf	Total

2024 November	8	1	9
2024 October	22	3	25
2024 September	23	5	28
2024 August	16	7	23
2024 July	23	8	31
2024 June	20	1	21
2024 May	17	4	21
2024 April	17	5	22
2024 March	19	8	27
2024 February	35	19	54
2024 January	23	4	27
2023 December	17	13	30
2023 November	25	14	39
2023 October	35	22	57
2023 September	34	8	42
2023 August	25	3	28
2023 July	20	13	33
2023 June	34	4	38
2023 May	76	4	80
2023 April	93	2	95
2023 March	25	3	28
2023 February	16	4	20
2023 January	7	1	8
2022 December	12	4	16
2022 November	20	8	28
2022 October	10	2	12
2022 September	14	7	21
2022 August	15	7	22
2022 July	26	6	32
2022 June	71	5	76
2022 May	38	10	48
2022 April	23	11	34
2022 March	35	4	39
2022 February	17	4	21
2022 January	22	4	26
2021 December	37	10	47
2021 November	20	9	29
2021 October	24	11	35
2021 September	13	10	23
2021 August	15	6	21
2021 July	15	7	22
2021 June	24	7	31
2021 May	11	3	14
2021 April	45	29	74
2021 March	13	4	17
2021 February	23	10	33
2021 January	15	7	22
2020 December	13	5	18
2020 November	14	4	18
2020 October	10	4	14
2020 September	11	5	16
2020 August	12	8	20
2020 July	14	8	22
2020 June	9	3	12
2020 May	15	8	23
2020 April	4	2	6
2020 March	9	2	11
2020 February	9	5	14
2020 January	5	4	9
2019 December	13	7	20
2019 November	6	5	11
2019 October	8	5	13
2019 September	0	3	3
2019 August	1	0	1
2019 July	1	11	12
2019 June	3	11	14
2019 May	1	15	16
2018 September	1	0	1
2018 June	6	0	6
2018 May	16	11	27
2018 April	80	6	86
2018 March	24	7	31
2018 February	18	5	23
2018 January	39	3	42
2017 December	24	4	28
2017 November	25	6	31
2017 October	18	15	33
2017 September	24	5	29
2017 August	26	5	31
2017 July	24	4	28
2017 June	36	13	49
2017 May	42	14	56
2017 April	52	11	63
2017 March	27	38	65
2017 February	13	7	20
2017 January	14	10	24
2016 December	34	8	42
2016 November	40	7	47
2016 October	26	5	31
2016 September	33	11	44
2016 August	40	9	49
2016 July	23	6	29
2016 June	1	0	1
2016 May	2	19	21
2016 April	0	17	17
2016 March	4	18	22
2016 February	7	20	27
2015 December	10	11	21
2015 November	35	1	36
2015 October	5	2	7

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