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Objective: To evaluate the minimal dose of intravenous lidocaine (0.25 mg/kg) administered before extubation to prevent post-operative cough and sore throat. Materials and Methods: The present study employed a prospective double-blinded randomized, control trial. Eighty-five patients scheduled for elective surgery were randomized to receive an intravenous lidocaine bolus of 0.25 mg/kg (treatment group), or 0.5 mg/kg (control group) at the end of anesthesia. The severity of cough and post-operative sore throat were evaluated by a blinded anesthesiologist. Results: Forty-two patients were assigned to the treatment group and 43 patients to the control group. According to the non- inferiority margin in the present study of 10% compared with the high-dose group, the coughing rate after extubation in the 0.25 mg/kg group was 42.9%, and in the 0.5 mg/kg group was 23.3%, a difference of coughing rate between both groups of 19.6% (95% CI 3.17% to 36.03%, p-value for non-inferiority=0.998). Conclusion: The treatment group (0.25 mg/kg of lidocaine) had less effective medicine than the control group (0.5 mg/kg of lidocaine) for preventing cough after extubation as well as the severity of cough. [ABSTRACT FROM AUTHOR]

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: Transforaminal epidural steroid injections (TFESI) are commonly employed to treat lumbosacral radiculopathy. Despite anti-inflammatory properties, the addition of 3% hypertonic saline has not been studied., Objective: Compare the effectiveness of adding 0.9% NaCl (N-group) vs. 3% NaCl (H-group) in TFESI performed for lumbosacral radiculopathy., Methods: This retrospective study compared TFESI performed with lidocaine, triamcinolone and 0.9% NaCl vs. lidocaine, triamcinolone and 3% NaCl. The primary outcome was the proportion of patients who experienced a ≥ 30% reduction in pain on a verbal rating scale (VRS; 0-100) at 3 months. Secondary outcome measures included the proportion of patients who improved by at least 30% for pain at 1 and 6 months, and who experienced ≥15% from baseline on the Oswestry disability index (ODI) at follow-up., Results: The H-group experienced more successful pain outcomes than the N-group at 3 months (59.09% vs. 41.51%; P = .002) but not at 1 month (67.53% vs. 64.78%; P = .61) or 6 months (27.13% vs 21.55%: P = .31). For functional outcome, there was a higher proportion of responders in the H-group than the N-group at 3 months (70.31% vs. 53.46%; P = .002). Female, age ≤ 60 years, and duration of pain ≤ 6 months were associated with superior outcomes at the 3-month endpoint. Although those with a herniated disc experienced better outcomes in general with TFESI, the only difference favoring the H-group was for spondylolisthesis patients., Conclusions: 3% hypertonic saline is a viable alternative to normal saline as an adjunct for TFESI, with randomized studies needed to compare its effectiveness to steroids as a possible alternative., Registration: Thai Clinical Trials Registry ID TCTR 20231110006., (Published by Oxford University Press on behalf of the American Academy of Pain Medicine.)

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.)

Purpose: The study aimed to determine the efficacy of lidocaine at different low doses to reduce fentanyl-induced cough (FIC)., Methods: Three hundred twenty patients aged from 18 to 60 years with ASA I and II scheduled for general anesthesia were randomly assigned to 4 groups to obtain peripheral intravenous 0.9%NaCl (Group I), lidocaine 0.25 mg/kg (Group II), 0.5 mg/kg (Group III) or 1.0 mg/kg (Group IV) 2 min before 3 μg/kg of fentanyl intravenously in a prospective randomized controlled fashion. The primary result was incidence of cough among comparison groups. The secondary results included severity of cough, hemodynamic response and risk factors of FIC., Results: Thirty-two, 15, 13 and 11 patients (40, 18.8, 16.3 and 13.8%) presented incidence of cough in Groups I, II, III and IV, respectively (P < 0.05 Group I vs. II, III and IV). No significant difference was observed in the incidence and severity of cough among the lidocaine groups (P > 0.05). Multivariate analysis showed that age ≤ 40 years, nonsmoking and patients not receiving the prior lidocaine injection were risk factors of FIC (P = 0.007, 0.013 and 0.001, respectively)., Conclusion: The study implied intravenous lidocaine 0.25 mg/kg for 2 min before fentanyl injection was the most effective dose to suppress FIC and could be applied in daily practice. Patients aged less than 40 years and nonsmoking were risk factors of FIC, regardless of sex and underlying disease., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Coughing and laryngospasm are undesirable consequences occurring when patients awaken from general anaesthesia. The objective of the study aimed to compare the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm., Methods: In all, 120 patients scheduled surgery under general anaesthesia were randomly assigned into three groups. Patients in the control group (C-group) received intravenous 0.9% NaCl, while patients in the propofol group (P-group) received intravenous 0.25mg/kg propofol and patients in the propofol combined with ketamine group (PK-group) received intravenous 0.25mg/kg of propofol plus 0.15mg/kg of ketamine. Drugs were administered before extubation. Incidence and severity of coughing and laryngospasm were recorded by a blinded anaesthesiologist., Results: Subjects of the PK-group (25%) experienced significantly reduced incidence of postoperative cough than that in the P-group (55%) and C-group (72.5%) (all P < 0.05). The severity of cough in the PK-group was significantly less than that in the P-group and C-group (P = 0.039 and P < 0.001, respectively). No significant difference was found in the incidence and severity of laryngospasm between comparison groups., Conclusion: Intravenous combination of propofol and low-dose ketamine significantly reduced the incidence and severity among patients awakening from general anaesthesia.

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.)