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Background: Catheter-related bladder discomfort (CRBD) and pain commonly arises postoperatively in patients who undergo intra-operative urinary catheterization. The study aims to demonstrate the effectiveness of intravenous lidocaine to prevent CRBD and postoperative pain in complex lumbar spinal surgery., Methods: Eighty male patients, aged 20-79 years, scheduled for elective fusion spine surgery at least two levels were randomly assigned to receive either intravenous lidocaine (1.5 mg/kg followed by 2 mg/kg/h) (Group L) or a parallel volume of normal saline (Group C). The primary outcome was incidence of moderate to severe CRBD in a postanesthetic care unit (PACU) between the two groups. Secondary outcomes included postoperative pain, 24-hour post operative opioid requirement, mild and moderate to severe CRBD at 1, 2, 6 and 24 h postoperatively, patient satisfaction on Global Perceived Effect Scale (GPES), and the adverse effects of lidocaine and surgical complications., Results: Group L showed a significantly lower incidence of moderate-to-severe CRBD compared to Group C in the PACU (P = 0.002) and at 1 h postoperatively (P = 0.039). Additionally, Group L experienced a significantly lower average pain scores compared to Group C at all time points (P < 0.001, P < 0.001, P = 0.001, P < 0.001 and P < 0.001 at 0, 1, 2, 6 and 24 h, respectively) and demonstrated a significantly reduced postoperative morphine requirement across all time intervals (P < 0.05). Group L also reported significantly higher satisfaction on GPES compared to group C (P < 0.001). No adverse outcome was observed in either group., Conclusion: Intravenous lidocaine administration significantly reduced the incidence of moderate-to-severe CRBD at PACU and at 1 h postoperatively. Additionally, its use in complex spine surgery led to reductions in postoperative pain, opioid requirement, and improved patient satisfaction, without any observed side effects., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Institutional Review Board of the Royal Thai Army Medical Department (Code: S058h/64), with the approval granted on 24 January 2022. Consent to participate is provided in the attached file. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Continuous radiofrequency ablation (RFA) can effectively manage cervical facet joint pain related to neuropathic symptoms in the post-radiofrequency period. Additionally, pulse radiofrequency (PRF) provides relief of neuropathic symptoms. However, the effect of combined RFA and PRF has yet to be determined., Objectives: The study aimed to compare the effectiveness and safety of RFA (CRF group) and combined RFA and PRF (CPRF group)., Methods: The study retrospectively reviewed the charts of patients with cervical facet joint pain undergoing RFA between June 1, 2014, and June 1, 2017, or combined RFA and PRF between June 1, 2017, and June 1, 2020, at a pain research center. Thirty-nine consecutive patients identified from charts meeting the inclusion criteria were included and classified in CRF (n = 22) and CPRF groups (n = 17). The results were evaluated using a Visual Analog Scale (VAS) and neck pain disability index (NDI) before procedures and 1, 3, and 6 months after the injections. Successful treatment was expressed as at least 80% pain relief from baseline and NDI score <15 points. The duration of pain relief was expressed as the period between pain relief and pain reoccurrence to 50% of the preprocedural pain level. The primary outcome was successful treatment in the groups, and the secondary outcome was the duration of pain relief and post-cervical radiofrequency side effects in the groups., Results: Fourteen (66.7%) patients in the CRF group and 12 (66.7%) in the CPRF group experienced successful treatment at three and six-month follow-ups (P > 0.05). The median time to the reoccurrence of at least 50% of preprocedural pain level was 303.8 days in the CRF group and 270 days in the CPRF group (P = 0.395). However, the CPRF group showed significantly less postoperative numbness, dysesthesia, and hypersensitivity syndrome than the CRF group (P < 0.05)., Conclusions: Combined RFA and PRF can be complementary treatment for cervical facet joint pain, providing an adequate success rate and duration of pain relief as RFA alone but with significantly fewer post-radiofrequency side effects., Competing Interests: Conflict of Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022, Author(s).)

Background: Propofol-sparing effect of lidocaine has not been fully elucidated because propofol is usually mixed with many medications in anesthetic practice. Therefore, the study aimed to verify the additive effect of intravenous lidocaine to propofol without other sedative medications and control the depth of anesthesia using the bispectral index (BIS) during colonoscopy in a prospective, randomized, double-blinded controlled trial., Methods: Sixty-eight patients scheduled and undergoing colonoscopy were randomly allocated to receive intravenous lidocaine (1.5 mg/kg then 4 mg/kg/h) (Group L) or a similar volume of normal saline (Group C) with propofol administration guided by BIS monitoring. The primary outcome was total propofol requirements between group comparisons. The secondary outcomes included the number of hypoxemic periods, hemodynamic changes, duration in returning of BIS > 85, sedation scores, pain scores, postoperative opioid requirement, and patient satisfaction between group comparisons., Results: Intravenous lidocaine showed significantly reduced total propofol use (151.76 ± 50.78 mg vs 242.06 ± 50.86 mg, Group L vs Group C, respectively, P < .001). Duration in returning to BIS > 85, sedation scores, and patient satisfaction scores were significantly superior in Group L (P < .05). The number of hypoxemic episodes, changes of hemodynamic response, pain scores, and postoperative opioid requirement were similar in both groups. No adverse effects were detected in both groups., Conclusion: Intravenous lidocaine produced a definitely effective reduced propofol requirement without other sedative agents and improved outcomes including patient satisfaction, duration in returning to BIS > 85, and sedation score during colonoscopy without adverse effects., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background:  Epidural steroid injection (ESI) has been used in managing chronic radicular pain. Regarding various techniques of ESI, the synergistic effect of caudal ESI (CESI) on transforaminal ESI (TFESI) in chronic lumbosacral radicular pain in prospective randomized controlled trial has not been determined.  Methods :  A total of 54 eligible patients with lumbosacral radicular pain were randomly allocated to undergo TFESI plus CESI (TC group) or TFESI alone (T group).  The effective response to treatment was predefined by at least a 30% reduced verbal numerical rating scale (VNRS) from baseline between group comparison and the functional outcomes as measured by improved Oswestry Disability Index by least 15 points from baseline. All participants were evaluated using a single blinded outcome assessor before the  procedure and at 1, 3 and 6 months after the procedure. P <0.05 was considered as statistically significant.  Results :  Average VNRS reduced significantly from baseline after receiving procedure at 1, 3 and 6 months in both groups (P-value <0.05). The TC group exhibited more effective and showed significant pain relief compared with the T group at 3 months (P=0.01). However, no statistical difference was observed between sub group analysis in pain relief and insignificant difference between group comparisons of functional outcomes. Conclusions : A treatment combining TFESI and CESI showed significant pain relief over TFESI alone at 3 months. No effect was found concerning functional evaluation. Registration:  Thai Clinical Trials Registry ID TCTR20171101002 01/11/2017F., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Munjupong S and Kumnerddee W.)

Background: Epidural steroid injection (ESI) has been used in managing chronic radicular pain. Regarding various techniques of ESI, the synergistic effect of caudal ESI (CESI) on transforaminal ESI (TFESI) in chronic lumbosacral radicular pain in prospective randomized controlled trial has not been determined. Methods :  A total of 54 eligible patients with lumbosacral radicular pain were randomly allocated to undergo TFESI plus CESI (TC group) or TFESI alone (T group).  The effective response to treatment was predefined by at least a 50% reduced verbal numerical rating scale (VNRS) from baseline between group comparison and the functional outcomes as measured by improved Oswestry Disability Index by least 15 points from baseline. All participants were evaluated using a single blinded outcome assessor before the  procedure and at 1, 3 and 6 months after the procedure. P <0.05 was considered as statistically significant. Results :  Average VNRS reduced significantly from baseline after receiving procedure at 1, 3 and 6 months in both groups (P-value <0.05). However, the TC group showed significant pain relief compared with the T group in spondylolisthesis and failed back surgery syndrome at 1 month. No statistical difference was observed between group comparisons of functional outcomes. Conclusions : A treatment combining TFESI and CESI showed significant pain relief over TFESI alone in spondylolithesis and failed back surgery syndrome at 1 month. No effect was found concerning functional evaluation. Registration: Thai Clinical Trials Registry ID TCTR20171101002 01/11/2017., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Munjupong S and Kumnerddee W.)