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This manuscript aims to report the successful treatment of a patient with fibromyalgia using a novel approach to vagus nerve (VN) stimulation. The patient reported significant pain relief and improved performance after almost 3 months of follow-up. VN stimulation has been Food and Drug Administration approved for epilepsy and depression, but recent studies have shown its usefulness for pain management. Our novel approach is minimally-invasive compared to surgical techniques; it provides long-lasting analgesia within a single session and is cheaper than current methods. This technique should be evaluated in clinical trials to clarify the optimal parameters and treatment intervals. [ABSTRACT FROM AUTHOR]

Arthroscopic joint lavage was proposed as a treatment option for different joint conditions such as septic or inflammatory arthritis. Ultrasound (US) is today considered a fundamental tool in musculoskeletal diseases as for diagnostic and guide for interventional procedures such as synovial fluid sampling and drug injections. To enable faster recovery and to have an alternative to surgery, to reduce risks and costs, we performed an US-guided double-needle lavage of the shoulder joint. Here, we present two different clinical cases, the first with septic arthritis and the second with recalcitrant gouty arthritis, successfully treated with this technique. [ABSTRACT FROM AUTHOR]

The pandemic of COVID-19 requires rapid and easy access to reliable imaging modalities for diagnosis and follow up. Considering the cost-effectiveness of the imaging used, ultrasound is a non-ionizing, portable and bedside imaging modality with a high diagnostic impact in emergencies and intensive care units in pandemics, but it is operator dependent. In our article, we provide a comprehensive review of the role of point-of-care ultrasound in the diagnosis of COVID-19 infection and its impact on the lungs, cardiovascular system, eyes and abdominal organs. Moreover, ultrasound can provide real-time diagnostic and therapeutic interventions, such as the placement of a central catheter and aspiration of pericardial effusion. Awareness of health care professionals in the front-line fighting COVID-19 infection in emergency rooms, clinics, and in intensive care units is important and will help rapid and targeted management decisions. [ABSTRACT FROM AUTHOR]

• To define pericapsular nerve group block for postoperative shoulder pain • Pericapsular distribution of injectate • Blockade of the articular branches that innervate the glenohumeral joint [ABSTRACT FROM AUTHOR]

• PENG block • Explanation of anatomical structures in hip joint • Contrast distribution on cadavers with prosthetic hip [ABSTRACT FROM AUTHOR]

• To define Axillary Circumflex Nerve Block • The sensory block extension of the Axillary Circumflex Nerve Block • Axillary Circumflex Nerve Block for arthroscopy of the shoulder [ABSTRACT FROM AUTHOR]

Introduction: The shoulder is one of the joints most affected by osteoarthritis, with a prevalence of almost 20% in adults over 65 years of age. Various treatments have been proposed to control osteoarthritis pain, including radiofrequency, pulsed and thermal, and recently cryoanalgesia. We propose in this series of cases a new approach to analgesic therapy with chemical denervation with phenol., Materials and Method: Patients who underwent phenolysis for shoulder osteoarthritis at our institutions in Italy and Australia between August 2022 and May 2023 were included. All patients included in our report provided written consent for publication. This chemical neurolysis technique consisted of two injections. First, the anterior shoulder capsule was denervated by a modified deep SHAC (Shoulder Anterior Capsule) approach to cover the anterior terminal articular branches of the axillary nerve, lateral pectoral nerve, and subscapularis nerve. Second, the posterior shoulder capsule was denervated by a posterior glenoid approach to cover the terminal articular branches of the suprascapular nerve (SSN).  Results: We included a total of 11 patients in this case series. Ten of 11 patients were affected by shoulder osteoarthritis, of which three had rotator cuff tendinopathy and three had full-thickness cuff tears. One patient had chronic subluxation of a shoulder prosthesis. After treatment, all patients significantly reduced pain immediately after treatment and, two weeks later, recovered joint movement and improved quality of life. No adverse events or loss of motor function following treatment., Conclusion: We presented a novel chemical approach to shoulder denervation, which was shown to be another effective way of improving pain and function in advanced glenohumeral arthritis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Galluccio et al.)

In recent years, there has been an increase in demand for gluteal augmentation and reshaping surgeries with intramuscular implants which are becoming increasingly popular. Until now, this surgery was mainly performed under general anesthesia, but recently locoregional anesthesia techniques, such as tumescent local anesthesia, are being applied more and more. Today, the use of ultrasound for locoregional anesthesia and analgesia allows us to perform techniques that are increasingly precise and burdened with lower risks. In this report, we present a novel two-step ultrasound-guided technique combining a botox injection in the gluteus maximus four weeks before surgery and tumescent anesthesia with a cluneal nerve block. Furthermore, the combination of anesthetic and analgesic techniques can guarantee a better result both in terms of surgical execution of the intervention and in reducing pain and improving patient comfort in the postoperative period., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Fajardo Perez et al.)

Background Economic evaluation has become an essential decision-making tool for health systems worldwide. This study was aimed at estimating the difference in the use of healthcare resources, days on sick leave, and costs between patients undergoing a standard-volume versus a low-volume ultrasound-guided interscalene brachial plexus block. Methods This is a post-hoc cost analysis of a double-blind, randomized, and controlled clinical trial. Forty-eight patients undergoing ultrasound-guided interscalene block received either 10 ml or 20 ml of levobupivacaine 0.25%. Analyses involved the public healthcare payer perspective (including visits to general practitioners, nursing staff, physiotherapy facilities, hospital admissions, outpatient diagnostic tests, etc.) and the limited societal perspective, including productivity losses (days on sick leave). Measurements were made at one-month and one-year follow-ups post-intervention. Differences in costs were estimated using two-part models adjusted by the costs incurred in the previous year. Results Subjects in the 10 ml group made greater use of general practitioner visits (mean difference [95% CI]: 3.35 [0.219 to 6.49]; p=0.036) and diagnostic tests (2.43 [0.601 to 4.26]; p=0.009), but less use of physical therapy (-12.9 [-21.7 to -4.06]; p=0.004). Mean (SD) cost differences from the public healthcare payer's perspective were 1,461.34 $ (1,541.62) and 1,024.08$ (943.83) for the 10 ml and 20 ml groups, respectively (p=0.293). From the limited societal perspective, the differences were as follows: 7,036.53$ (8,077.58) and 8,666.56$ (9,841.10), respectively (p=0.937). While there were no differences in the above parameters at the one-month follow-up. Conclusion The volume reduction proposed following interscalene block resulted in meaningful, albeit not statistically significant, clinical benefits and lower costs from a limited societal perspective for shoulder surgery. Thus, healthcare use and days on sick leave are variables to be taken into consideration when calculating the economic impact of surgical procedures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Oliver-Fornies et al.)

Objective Viscosupplementation by hyaluronic acid (HA) is well established non-surgical treatment of knee osteoarthritis (KOA). This registry-based study investigated the booster effect of a quarterly intra-articular single knee injection (30mg/2ml) for five years. Methods Sixty patients, including 29 males and 31 females, with a mean ± SD age 61.07 ± 9.15 with Kellgren-Lawrence grade I-III KOA, have been selected from a registry of interventional treatments for musculoskeletal pain conditions. To be eligible, patients had to be treated with a single quarterly intraarticular injection of HA with a follow-up of at least five years and assessed with Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Numeric Rating Scale (NRS) at baseline and after each HA injection in the first 24 months and at 36, 48, and 60 months. Results Sixty of 63 patients enrolled in this study completed the 60 months of follow-up. Patients had a marked improvement in knee function and pain, expressed by the significant reduction in WOMAC (T0 48.62±8.95 vs. T11 10.75±4.36; p<0.0001) and NRS scores (6.38±1.06 vs. T11 0.95±0.89 p<0.0001) from the baseline to the end of the follow-up period. Conclusion A quarterly injection of HA provides a rapid, safe, and stable long-term reduction of pain and improvement of function in elderly people with mild to moderate knee osteoarthritis along a five-year period of treatment and follow-up. Further investigations are necessary to confirm these findings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Galluccio et al.)

Palliative care involves patients with a high incidence of chronic pain and inadequate treatment related to opioid abuse. In terminal patients, the side effects of opioids may result in lower quality of life due to their deleterious immunosuppression and gastrointestinal effects. In our routine clinical practice, we consider the ultrasound-guided PENG block as a palliative analgesic technique to improve end-of-life care to terminal patients.

Introduction: The PENG block is a recently described ultrasound-guided technique for the blockade of the sensory nerve branches to the anterior hip joint capsule. It was described as an analgesic block for the acute pain management after hip fracture, while subsequent studies expanded the original indication. The aim of this narrative review was to summarize the existing knowledge about the PENG block from the anatomical bases and to provide an up-to-date description of the technique, applications and effects., Evidence Acquisition: We reviewed the following medical literature databases for publications on PENG block: PubMed, Google Scholar, EMBASE, and Web of science until August 31st, 2020. Data regarding anatomy, indications, drugs and technique were also collected, reported and discussed., Evidence Synthesis: From our search result we selected 57 relevant publications. Among them, 36 were case reports or case series and 12 publication were letters or correspondence; no RCT was identified. The main indication is the hip-related analgesia. The most commonly injected drug is a 20ml long-acting local anesthetic. There are some cases of femoral and obturator nerve block, but no major complication such as hematoma/bleeding or needle-related organ injury has been reported yet., Conclusions: The PENG block is a promising technique. Randomized controlled trials of high methodological quality are required to further elaborate the role of this block.

Competing Interests: Competing interests: None declared.