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Myofascial pain syndrome (MPS), a chronic musculoskeletal disorder characterized by myofascial trigger points (MTrPs). The objective is to explore the efficacy and safety of ultrasound-guided myofascial hydrodissection technique (UMHT) compared with trigger point injection of lidocaine (TPI) in the patients with MPS of upper trapezius. This randomized clinical trial was conducted at the rehabilitation medicine center of West China Hospital, Sichuan University, with 41 patients between May and October 2024. Patients were assigned to UMHT group (UMHT) or TPI group (1% lidocaine injection). Outcomes were measured at multiple time points using the Visual Analog Scale (VAS, primary), the short-form McGill pain questionnaire (SF-MPQ), and the neck disability index (NDI). Data were analyzed using SPSS v.29. The VAS scores was significantly decreased after receiving either UMHT (Effect sizes r  = 0.716; p  < 0.001) or TPI (Effect sizes r  = 0.604; p  < 0.001) during the 12-week follow-up period, while the SF-MPQ and the NDI showed similar positive results. There was no statistically significant difference between UMHT and TPI in pain reduction and function improvement ( p  > 0.05). No adverse events had been reported. Both UMHT and TPI demonstrate comparable efficacy and safety profiles in managing MPS of upper trapezius.

Computed tomography (CT) is increasingly used in clinical research for single-slice assessment of muscle mass to correlate with clinical outcome and evaluate treatment efficacy. The third lumbar level (L3) is considered as reference for muscle, but chest scans generally do not reach beyond the first lumbar level (L1). This study investigates if pectoralis muscle and L1 are appropriate alternatives for L3. CT scans of 115 stage IV non-small cell lung cancer patients were analyzed before and during tumor therapy. Skeletal muscle assessed at pectoralis and L1 muscle was compared to L3 at baseline. Furthermore, the prognostic significance of changes in muscle mass determined at different locations was investigated. Pearson's correlation coefficient between skeletal muscle at L3 and L1 was stronger ( =0.90, <0.001) than between L3 and pectoralis muscle ( =0.71, <0.001). Cox regression analysis revealed that L3 (HR 0.943, 95% CI: 0.92-0.97, <0.001) and L1 muscle loss (HR 0.954, 95% CI: 0.93-0.98, <0.001) predicted overall survival, whereas pectoralis muscle loss did not. L1 is a better alternative than pectoralis muscle to substitute L3 for analysis of muscle mass from regular chest CT scans.

Background Myofascial pain syndrome (MPS), a chronic musculoskeletal disorder characterized by myofascial trigger points (MTrPs), causes localized pain and dysfunction. The objective is to compare the immediate therapeutic effects of low-intensity focused ultrasound (LIFU) versus low-intensity planar ultrasound (LIPU) on pain and function in upper trapezius MPS. Method This study was designed as a single-blind, randomized controlled trial. The patients (20 ≤ aged ≤ 70) diagnosed with MPS of the upper trapezius were randomly allocated to either LIFU (study group; n  = 20; 9 men, 11 women) or LIPU (control group; n  = 20; 15 men, 5 women) treatments (1.5 W/cm 2 , 1 MHz, 5 min, once a day, 3 days). The primary outcome was pain severity, assessed immediately post-treatment using the Visual Analog Scale (VAS; 0 ~ 10 cm), and served as the central efficacy endpoint. Secondary outcomes comprised supplemental assessments including: (1) multidimensional pain characterization via the Short-Form McGill Pain Questionnaire (SF-MPQ); (2) functional disability quantification through the Neck Disability Index (NDI); and (3) neuromuscular biomarkers measured by surface electromyography (sEMG) parameters (root mean square [RMS], median frequency [MF]). The outcomes were assessed before treatment and 10 min, 72 h after completing the third and final session of treatment. Results Pain intensity, as measured by the VAS, decreased significantly immediately after treatment in both the LIFU group (median difference [MD] = -2.0 cm; 95% confidence interval [CI]: -2.5 to -1.5 cm; p  = 0.002) and the LIPU group (MD = -1.0 cm; 95% CI: -1.5 to -0.5 cm; p  = 0.001), with these reductions maintained at 72 h post-treatment. Both SF-MPQ and NDI scores showed significant improvements following treatment in both groups. A significant reduction in RMS parameters was observed in the LIPU group immediately after treatment (MD = -15.3 µV; 95% CI: -20.0 to -10.5 µV; p  = 0.028). No significant differences were observed between the groups in terms of pain alleviation, functional improvement, and alterations in neuromuscular electrophysiological activity ( p  > 0.05); however, moderate to large effect sizes suggest possible clinical relevance. No adverse events were reported. Conclusion Both LIFU and LIPU can be considered effective therapeutic options, offering immediate symptom relief in patients with upper trapezius MPS. Trial registration The protocol was registered at the Chinese Clinical Trial Register (ChiCTR2500097431) as a clinical trial on 19/02/2025 http://www.chictr.org.cn/ .

Background The most common cause of muscle pain is myofascial pain syndrome. Myofascial pain syndrome caused by sensitive areas called trigger points (TrP). Some physiotherapy modalities have acceptable effects for this disorder, but it is necessary to check the effects of placebo, appropriate dose, and long-term effects for each intervention. The aim of this study is to investigate the effect of intramuscular electrical stimulation (IMES) compared to dry needling (DN) on sonographic and clinical parameters in upper trapezius muscle TrP. Methods This is a randomized, single-blind control trial. The study period was from December 2, 2020, to April 10, 2021. Thirty volunteer patients with active upper trapezius TrP were randomly allocated into two groups: (1) IMES, (2) DN. Participants received interventions in three sessions. Primary outcome measurements were neck range of motion (ROM) and TrP circumference. Secondary outcome measurements were pain by visual analog scale (VAS), pain pressure threshold (PPT), disability, TrP longitudinal and transverse diameter, TrP stiffness, and muscle blood flow by vascular resistance index (RI). All outcome measurements were evaluated before, after, and one month after the intervention. If the data were normal, the repeated measure ANOVA test was used; if data were not normal, the Friedman test and the Kruskal-Wallis test was used. A significance level of 0.05 has considered. Results ROM increment was significantly more in the IMES group. TrP circumference decrement was significantly more in the IMES group. VAS changes did not show significant difference between two groups. The PPT improvement was significantly more in the IMES group. Disability changes were not significant. Longitudinal diameter changes were significantly more in the IMES group. TrP stiffness changes were not significant. The vascular RI decreased significantly in IMES group. Conclusion It seems that both IMES and DN have promising effects for improving upper trapezius TrPs. However, IMES is more effective in some clinical and ultrasound parameters. In order to investigate the effects of this intervention more precisely more studies are necessary. Trial registration This study was prospectively registered at Iranian registry of clinical trials (IRCT: IRCT20170616034567N2).

To the Editor Epidural analgesia is used after lung transplant but has failure rate of 32% [1–3]. A 66-year-old male patient ASA III with idiopathic pulmonary fibrosis was operated on for lung transplantation and evaluated for postoperative incisional pain and at the site of 3 chest tubes in the intensive care unit. A linear ultrasound probe was placed in the sagittal plane at the T5–6 level, just medial to the scapula, to identify the trapezius muscles, the rhomboid major muscles, and the intercostal muscles.

A 53-year-old female, weight 128 kg, height 165 cm, body mass index (BMI) 47 kg/m2, diagnosed as invasive ductal breast carcinoma presented for right modified radical mastectomy after a course of neoadjuvant chemotherapy. In this case, we have demonstrated that utilizing RISS block provided adequate and long-lasting analgesia between chest wall tissue planes and eliminated the need of opioid after radical mastectomy, in situations crucial to minimize the risk of respiratory compromise. [...]studies are required to compare interfascial plane blocks and achieve the gold standard analgesic technique for breast cancer surgery.Acknowledgments Approval and written informed consent were gained to publish this case.Financial support and sponsorship None.Conflict of interest None.

The purpose of this study was to compare the efficacy of bilateral ultrasound guided thoracic paravertebral catheters to a thoracic epidural after open pancreatic surgery. This was a prospective non-blinded randomized controlled trial. Academic hospital operating room, postoperative recovery area, and ward. 53 patients aged 18 and above who had open pancreatic surgery. Patients received either bilateral thoracic paravertebral block at T8 with an infusion of 0.2% ropivacaine or thoracic epidural analgesia at T7/8 with an infusion of 0.125% bupivacaine with hydromorphone 6 μg/mL. Pain scores, opioid use, length of recovery room and hospital stay, adverse events, and incidence of nausea and vomiting. There was no difference in baseline demographics between the two groups. There were no significant differences in pain scores between the two groups in each of the first five days after surgery. There was no difference in length of stay nor nausea and vomiting. There was significantly less modality related adverse events in the paravertebral group compared to the epidural group (p = 0.02). The use of thoracic paravertebral catheters provided comparable analgesia and less modality related adverse events when compared to a thoracic epidural in patients undergoing open pancreaticoduodenectomy. •Paravertebral catheters provide equivalent analgesia to epidurals for upper abdominal surgery.•Paravertebral catheters have less modality related adverse events when compared to epidurals.•Paravertebral catheters provide similar post-operative opioid use when compared to epidurals.•Length of stay after pancreatic surgery is similar between epidural analgesia and paravertebral catheters.

BACKGROUND AND OBJECTIVESFascial plane blocks are rapidly emerging to provide safe, feasible alternatives to epidural analgesia for thoracic and abdominal pain. We define a new option for chest wall and upper abdominal analgesia, termed the rhomboid intercostal and subserratus plane (RISS) block. The RISS tissue plane extends deep to the erector spinae muscle medially and deep to the serratus anterior muscle laterally. We describe a 2-part proof-of-concept study to validate the RISS block, including a cadaveric study to evaluate injectate spread and a retrospective case series to assess dermatomal coverage and analgesic efficacy. METHODSFor the cadaveric portion of the study, bilateral ultrasound-guided RISS blocks were performed on 6 fresh cadavers with 30 mL of 0.5% methylcellulose with india ink. For the retrospective case series, we present 15 patients who underwent RISS block or RISS catheter insertion for heterogeneous indications including abdominal surgery, rib fractures, chest tube–associated pain, or postoperative incisional chest wall pain. RESULTSIn the cadaveric specimens, we identified staining of the lateral branches of the intercostal nerves from T3 to T9 reaching the posterior primary rami deep to the erector spinae muscle medially. In the clinical case series, dermatomal coverage was observed in the anterior hemithorax with visual analog pain scores less than 5 in patients who underwent both single-shot and continuous catheter infusions. CONCLUSIONSOur preliminary cadaveric and clinical data suggest that RISS block anesthetizes the lateral cutaneous branches of the thoracic intercostal nerves and can be used in multiple clinical settings for chest wall and upper abdominal analgesia.

Background Low back pain (LBP) is one of the most common musculoskeletal conditions. People with LBP often display changes of neuromuscular control and trunk mechanical properties, including trunk stiffness. Although a few individual studies have examined back muscle stiffness in individuals with LBP, a synthesis of the evidence appears to be lacking. Therefore, the aim of this systematic review with meta-analysis was to synthesize and evaluate the available literature investigating back muscle stiffness in association with LBP. Methods We conducted a systematic review of the literature according to the PRISMA guidelines. We searched Pubmed, Scopus, Web of Science and ScienceDirect for studies, that compared back muscle stiffness, measured either by ultrasound-based elastography or myotonometry, between individuals with and without LBP. Pooled data of the included studies were presented descriptively. Additionally, we performed two meta-analyses to calculate the standardized mean difference between the two groups for resting stiffness of the multifidus and erector spinae muscle. For both meta-analyses, the random effect model was used and the weight of individual studies was calculated using the inverse-variance method. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional studies. Furthermore, the certainty of evidence was evaluated using the GRADE approach. Results Nine studies were included in our systematic review. Our results suggest that individuals with LBP have higher stiffness of the multifidus (SMD = 0.48, 95% CI: 0.15 – 0.81, p < 0.01; I 2 = 48 %, p  = 0.11) and erector spinae at rest (SMD = 0.37, 95% CI: 0.11 – 0.62, p < 0.01; I 2 = 39 %, p  = 0.14) compared to asymptomatic controls. On the other hand, the evidence regarding muscle stiffness during submaximal contractions is somewhat contradictory. Conclusions Based on the findings of this systematic review we conclude that people with LBP may have higher back muscle stiffness compared to asymptomatic controls. Addressing muscle stiffness might represent an important goal of LBP treatment. Nevertheless, our findings should be interpreted with extreme caution due to a limited quality of evidence, small number of included studies and differences in measurement methodology.

AbstractUltrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before becoming overtaken with enthusiasm for these new techniques, a deeper understanding of fascial tissue anatomy and structure, as well as precise targets for needle placement, is required. Many factors may influence the ultimate spread and quality of resulting interfascial plane blocks, and these must be understood in order to best integrate these techniques into contemporary perioperative pain management protocols.