Open Surgery Versus Ultrasound-Guided Corticosteroid Injection for Trigger Finger: A Randomized Controlled Trial With 1-Year Follow-up

2017 ◽  
Vol 42 (5) ◽  
pp. 359-366 ◽  
Author(s):  
Rehne L. Hansen ◽  
Morten Søndergaard ◽  
Jeppe Lange
Keyword(s):  
Randomized Controlled Trial ◽  
Open Surgery ◽  
Corticosteroid Injection ◽  
Controlled Trial ◽  
Trigger Finger ◽  
Ultrasound Guided ◽  
Randomized Controlled

Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up

2019 ◽  
Vol 47 (5) ◽  
pp. 1130-1137 ◽  
Author(s):  
Jane Fitzpatrick ◽  
Max K. Bulsara ◽  
John O’Donnell ◽  
Ming Hao Zheng
Keyword(s):  
Randomized Controlled Trial ◽  
Ultrasound Guidance ◽  
Platelet Rich Plasma ◽  
Corticosteroid Injection ◽  
Controlled Trial ◽  
Harris Hip Score ◽  
Randomized Controlled ◽  
Gluteal Tendinopathy ◽  
To Receive

Background: A previously published trial showed that patients with chronic gluteal tendinopathy achieved greater clinical improvement at 12 weeks when treated with a single platelet-rich plasma (PRP) injection than those treated with a single corticosteroid injection (CSI). Purpose: This follow-up study was conducted to determine whether there would be a sustained long-term difference in the modified Harris Hip Score (mHHS) at 2 years for a leucocyte-rich PRP (LR-PRP) injection in the treatment of chronic gluteal tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This trial included 80 patients randomized 1:1 to receive LR-PRP or CSI intratendinously under ultrasound guidance. Patients had a mean age of 60 years, a 9:1 ratio of women to men, a mean body mass index of 27, and a mean length of symptoms >15 months. No patients had full-thickness tears of the gluteal tendons. An open-labeled extension allowed patients to receive crossover treatment after 3 months. The main outcome measure was the mHHS. Results: The mean mHHS improved significantly at 12 weeks in the PRP group (74.05; SD, 13.92) as compared with the CSI group (67.13; SD, 16.04) ( P = .048). At 24 weeks, the LR-PRP group (77.60; SD, 11.88) improved further than the CSI group (65.72; SD, 15.28; P = .0003). Twenty-seven patients were deemed to have failed the CSI treatment at 16 to 24 weeks, with an exit score of 59.22 (SD, 11.54), and then had treatment with LR-PRP. The crossover group improved with the LR-PRP: from 59.22 (SD, 11.22) at baseline to 75.55 (SD, 16.05) at 12 weeks, 77.69 (SD, 15.30) at 24 weeks, and 77.53 (SD, 14.54) at 104 weeks. The LR-PRP group retained 38 of 39 patients to 52 weeks and continued to improve. Their baseline scores of 53.77 (SD, 12.08) improved to 82.59 (SD, 9.71) at 104 weeks ( P < .0001). Conclusion: Among patients with chronic gluteal tendinopathy and a length of symptoms >15 months, a single intratendinous LR-PRP injection performed under ultrasound guidance results in greater improvement in pain and function than a single CSI. The improvement after LR-PRP injection is sustained at 2 years, whereas the improvement from a CSI is maximal at 6 weeks and not maintained beyond 24 weeks. Registration: ACTRN12613000677707 (Australian New Zealand Clinical Trials identifier).

scholarly journals Continuous erector spinae plane block versus intercostal nerve block in patients undergoing video-assisted thoracoscopic surgery: a pilot randomized controlled trial

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Dillon Horth ◽  
William Sanh ◽  
Peter Moisiuk ◽  
Turlough O’Hare ◽  
Yaron Shargall ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Open Surgery ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Intercostal Nerve ◽  
Erector Spinae ◽  
Sensory Blockade ◽  
Randomized Controlled ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background The optimal analgesia method in video-assisted thoracoscopic surgery (VATS) remains controversial. Intercostal nerve blockade (ICNB) is limited by its duration of action. The erector spinae plane (ESP) block has the potential to provide satisfactory analgesia for VATS; however, the effectiveness of continuous ESP versus surgeon-performed ICNB has not been investigated. The objectives of this study were to establish feasibility of patient recruitment and follow-up before undertaking a fully powered randomized controlled trial (RCT); and, secondarily, to compare opioid usage, pain control, and sensory blockade. Methods This feasibility RCT was undertaken at St Joseph’s Hospital, Hamilton, Ontario, Canada, and included 24 patients (>18 years) having elective VATS with at least one overnight stay. Exclusion criteria were patient refusal, body mass index >40 kg/m2, contraindications to neuraxial analgesia techniques as per the American Society of Regional Anesthesia and Pain guidelines, known allergy to local anesthetics, language or comprehension barriers, procedures with a higher chance of open surgery, and regular opioid use for ≥3 months preoperatively. Patients underwent either continuous ESP (n=12) or surgeon-performed ICNB (n=12). All patients received routine intraoperative anesthesia care and multimodal analgesia. Feasibility criteria were recruitment rate of two patients/week and full follow-up in all patients in-hospital. We compared opioid consumption, postoperative pain scores (0–10 numerical rating scale), adverse events, patient satisfaction, and distribution of sensory blockade as clinical outcomes (secondary). Results Feasibility of primary outcomes was successfully demonstrated. Five patients had an epidural in anticipation of open surgery. Mean opioid consumption as equivalent morphine units was less in the ESP group over the first 24 h (mean difference, 1.63 [95% CI –1.20 to 4.45]) and 48 h (mean difference, 2.34 [95% CI –1.93 to 6.61]). There were no differences in adverse effects. Conclusions A fully powered RCT is feasible with modifications. Our results also suggest that continuous ESP is safe and can decrease opioid needs. However, it is important to consider procedures to improve compliance to protocol and adherence to assigned interventions. Trial registration Clinicaltrials.gov identifier: NCT03176667. Registered June 5, 2017.

scholarly journals Methylprednisolone Acetate Versus Dexamethasone Injection for Trigger Finger: A Double-blind Randomized Controlled Trial

2021 ◽  
Author(s):  
Porames Suwanno ◽  
Chaiwat Chuaychoosakoon
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Trigger Finger ◽  
Methylprednisolone Acetate ◽  
Analog Scale ◽  
Short Term ◽  
Double Blind ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial

Objective: The study investigated the resolution of triggering by either a soluble methylprednisolone acetate or dexamethasone injection for idiopathic trigger finger at 24-week after injection.Material and Methods: One hundred and six patients were enrolled in a prospective randomized controlled trial (53 methylprednisolone acetate arms, 53 dexamethasone arms). The outcome was evaluated at 2, 6, 12 and 24-week follow-up.Results: The absence of triggering was documented in 32 of 43, 36 of 41 patients in the methylprednisolone cohort and in 20 of 43, 29 of 32 patients in the dexamethasone cohort at 6 and 24-week after injection. The methylprednisolone acetate cohort had significantly better satisfaction on a visual analog scale, tenderness, and locking at 2-week follow-up, and had significantly better satisfaction on resolution of triggering, tenderness, snapping, locking and the Disabilities of the Arm, Shoulder and Hand score at 6-week follow-up compared to those in the dexamethasone cohort.Conclusion: Methylprednisolone acetate is better in short term clinical outcomes than dexamethasone

scholarly journals Continuous Erector Spinae Plane Block versus Intercostal Nerve Block in Patients Undergoing Video-assisted Thoracoscopic Surgery: A Pilot Randomized Controlled Trial

2021 ◽  
Author(s):  
Dillon Horth ◽  
William Sanh ◽  
Peter Moisiuk ◽  
Turlough O’Hare ◽  
Yaron Shargall ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Open Surgery ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Intercostal Nerve ◽  
Erector Spinae ◽  
Sensory Blockade ◽  
Randomized Controlled ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background: The optimal analgesia method in video-assisted thoracoscopic surgery (VATS) remains controversial. Intercostal nerve blockade (ICNB) is limited by its duration of action. The erector spinae plane (ESP) block has the potential to provide satisfactory analgesia for VATS; however, the effectiveness of continuous ESP versus surgeon-performed ICNB has not been investigated. The objectives of this study were to establish feasibility of patient recruitment and follow-up before undertaking a fully powered randomized controlled trial (RCT); and, secondarily, to compare opioid usage, pain control, and sensory blockade.Methods: This feasibility RCT was undertaken at St Joseph’s Hospital, Hamilton, Ontario, Canada, and included 24 patients (>18 years) having elective VATS with at least one overnight stay. Exclusion criteria were patient refusal; body mass index >40 kg/m2; contraindications to neuraxial analgesia techniques as per the American Society of Regional Anesthesia and Pain guidelines; known allergy to local anesthetics; language or comprehension barriers; procedures with a higher chance of open surgery; and regular opioid use for ≥3 months preoperatively. Patients underwent either continuous ESP (n=12) or surgeon-performed ICNB (n=12). All patients received routine intraoperative anesthesia care and multimodal analgesia. Feasibility criteria were recruitment rate of two patients/week and full follow-up in all patients in-hospital. We compared opioid consumption, postoperative pain scores (0–10 numerical rating scale), adverse events, patient satisfaction, and distribution of sensory blockade as clinical outcomes (secondary).Results: Feasibility of primary outcomes was successfully demonstrated. Five patients had an epidural in anticipation of open surgery. Mean opioid consumption as equivalent morphine units, was less in the ESP group over the first 24 h (mean difference, 1.63 [95% CI –1.20 to 4.45]) and 48 h (mean difference, 2.34 [95% CI –1.93 to 6.61]). There were no differences in adverse effects.Conclusions: A fully powered RCT is feasible with modifications. Our results also suggest that continuous ESP is safe and can decrease opioid needs. However, it is important to consider procedures to improve compliance to protocol and adherence to assigned interventions.Trial registration: Clinicaltrials.gov identifier: NCT03176667. Registered June 5, 2017, https://clinicaltrials.gov/ct2/show/NCT03176667

Ultrasound-Guided Hyaluronic Acid Injections for Trigger Finger: A Double-Blinded, Randomized Controlled Trial

2015 ◽  
Vol 96 (12) ◽  
pp. 2120-2127 ◽  
Author(s):  
Ding-Hao Liu ◽  
Mei-Wun Tsai ◽  
Shan-Hui Lin ◽  
Chen-Liang Chou ◽  
Jan-Wei Chiu ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hyaluronic Acid ◽  
Controlled Trial ◽  
Trigger Finger ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Double Blinded

scholarly journals Continuous Erector Spinae Plane Block versus Intercostal Nerve Block in Patients Undergoing Video-assisted Thoracoscopic Surgery: A Pilot Randomized Controlled Trial

2020 ◽  
Author(s):  
Dillon Horth ◽  
William Sanh ◽  
Peter Moisiuk ◽  
Turlough O’Hare ◽  
Yaron Shargall ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Open Surgery ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Intercostal Nerve ◽  
Erector Spinae ◽  
Sensory Blockade ◽  
Randomized Controlled ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background: The optimal analgesia method in video-assisted thoracoscopic surgery (VATS) remains controversial. Intercostal nerve blockade (ICNB) is limited by its duration of action. The erector spinae plane (ESP) block has the potential to provide satisfactory analgesia for VATS; however, the effectiveness of continuous ESP versus surgeon-performed ICNB has not been investigated. The objectives of this study were to establish feasibility of patient recruitment and follow-up before undertaking a fully powered randomized controlled trial (RCT); and, secondarily, to compare opioid usage, pain control, and sensory blockade.Methods: This feasibility RCT was undertaken at St Joseph’s Hospital, Hamilton, Ontario, Canada, and included 24 patients (>18 years) having elective VATS with at least one overnight stay. Exclusion criteria were patient refusal; body mass index >40 kg/m2; contraindications to neuraxial analgesia techniques as per the American Society of Regional Anesthesia and Pain guidelines; known allergy to local anesthetics; language or comprehension barriers; procedures with a higher chance of open surgery; and regular opioid use for ≥3 months preoperatively. Patients underwent either continuous ESP (n=12) or surgeon-performed ICNB (n=12). All patients received routine intraoperative anesthesia care and multimodal analgesia. Feasibility criteria were recruitment rate of two patients/week and full follow-up in all patients in-hospital. We compared opioid consumption, postoperative pain scores (0–10 numerical rating scale), adverse events, patient satisfaction, and distribution of sensory blockade as clinical outcomes (secondary).Results: Feasibility of primary outcomes was successfully demonstrated. Five patients had an epidural in anticipation of open surgery. Mean opioid consumption was less in the ESP group over the first 48 h (mean difference, 1.63 [95% CI –1.20 to 4.45] morphine units). There were no differences in adverse effects. Conclusions: A fully powered RCT is feasible. Our results also suggest that continuous ESP is safe and can decrease opioid needs. However, it is important to consider procedures to improve compliance to protocol. Trial registration: Clinicaltrials.gov identifier: NCT03176667. Registered June 5, 2017, https://clinicaltrials.gov/ct2/show/NCT03176667

Efficacy Comparison of Hyaluronic Acid and Corticosteroid Injection in Treatment of Trigger Digits: A Randomized Controlled Trial

2020 ◽  
Vol 25 (01) ◽  
pp. 76-81 ◽  
Author(s):  
Thepparat Kanchanathepsak ◽  
Picharn Pichyangkul ◽  
Sorasak Suppaphol ◽  
Ittirat Watcharananan ◽  
Panithan Tuntiyatorn ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hyaluronic Acid ◽  
Controlled Trial ◽  
P Value ◽  
Dash Score ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Group 1

Background: Although the current nonsurgical treatment for trigger digits is corticosteroid (CS) injection, it often comes with adverse effects that may cause some limitations. Currently, Hyaluronic acid (HA) has been successfully used in tendinopathy and may be used in stenosing tenosynovitis. The aim of this study is to compare the efficacy of ultrasound-guided injection between the HA and CS in trigger digits treatment. Methods: Double-blind randomized controlled trial was conducted. Fifty patients with 66 trigger digits were randomly assigned into an intervention group (1 ml of low-molecular weight HA) and a control group (1 ml of 10mg/ml triamcinolone acetate). The ultrasound-guided injection and local anesthesia (0.5 ml of 1% lidocaine without adrenaline) were used. The Quinnell grading, Visual Analog Scale (VAS) score of pain, Disabilities of the Arm, Shoulder and Hand (DASH) score and complications were collected at 1-, 3-and 6-month follow-up. Results: The mean age of HA group (33 digits) and CS group (33 digits) were 58.3 years and 54.7 years respectively. Nine patients were loss of follow-up (7 in HA group and 2 in CS group). The Quinnell grades have shown an improvement in both group. The CS group had a significant better improvement at 1-month (p-value < 0.001) and there was no significant difference at 3-and 6-month follow-up between the two groups. The median of VAS and DASH score were significantly improved by time in both groups (p-value < 0.01). The CS group showed a better significant improvement in early period of follow-up (p-value < 0.05). However, there was no significant difference between the two groups in the last follow-up. Conclusions: HA and CS injection has a comparable therapeutic effect in treatment of trigger digits. However, CS injection has higher efficacy of pain and inflammation reduction in the early phase of the disease.

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