Local anaesthetics and epidurals

Epidural steroid injection for nerve root compression

“…The patients recorded their pain intensity and pain relief following the injections daily for 35 days using the Oxford pain chart. 2 The unit of randomisation was the individual patient, and allocation was made by opening sequentially numbered sealed envelopes. These had been filled by someone not involved in the care of the patients using a random number table.…”

“…Few patients have been followed up for long periods after such treatment but some papers suggest that the longer the follow-up the less difference there is between patients in the treated and control groups. 1,2 The incidence of subsequent surgery may be low, 1,3,4 but there is controversy as to the ability of epidural steroid injection to reduce the need for operation in these patients. 1,4,5 We were not convinced that the long-term outcome was significantly altered by this treatment and therefore undertook a study to investigate its effect on pain and the rates of operation in patients with significant symptoms of nerve root compression.…”

Effects on hemodynamic variables and echocardiographic parameters after a stellate ganglion block in 15 healthy volunteers

“…The often longstanding analgesic action of local anesthetics cannot only be explained by their pharmacological effect, but also by various other mechanisms such as, for example, by indirectly reducing longterm potentiation (Kansha et al, 1999;Tan et al, 1999), by decreasing sympathetic sprouting (Chung and Chung, 2001;Takatori et al, 2006;Xie et al, 2007;Zhang et al, 2004), by decreasing the sympathetically mediated activity of WDR neurons (Roberts and Foglesong, 1988), and by temporarily disrupting the positive neuronal feedback loops ("reset") and subsequently re-organizing the systems involved (Fischer, 1998;Jänig, 2011;McQuay and Moore, 1999;Pfister and Fischer, 2009;Rosenquist and Vrooman, 2013). This is why injections of local anesthetic and the stellate ganglion block are gaining importance, especially in the context of diagnostic and therapeutic local anesthesia (neural therapy) and interventional pain therapy.…”

Tratamento farmacológico da dor musculoesquelética

“…Há, entretanto, poucos estudos metaanalíticos sobre a eficácia da aplicação de corticosteróides no compartimento epidural, no tratamento da lombociatalgia. Segundo McQuay & Moore (1999) 124 , de 11 trabalhos apropriados sobre o assunto, foi demonstrado que ocorreu melhora significativa de mais de 75% da dor em apenas 3 estudos. O número necessário para tratar, para se obter melhora, é superior a 7,3.…”