Department of Anaesthesiology, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India.
Department of Pain Medicine, Indian Spinal Injuries Centre, New Delhi, India.
Pain Med. 2018 Dec 1;19(12):2348-2356. doi: 10.1093/pm/pnx244.
Chronic nononcological perineal pain has been effectively managed by ganglion Impar block. Chemical neurolysis, cryoablation, and radiofrequency ablation have been the accepted methods of blockade. Recently, pulsed radiofrequency, a novel variant of conventional radiofrequency, has been used for this purpose.
This was a prospective, randomized, double-blind study.
Two different interventional pain management centers in India.
To compare the efficacy of conventional radiofrequency and pulsed radiofrequency for gangliom Impar block.
The patients were randomly allocated to one of two groups. In the conventional radiofrequency (CRF) group (N = 34), conventional radiofrequency ablation was done, and in the PRF pulsed radiofrequency (PRF) group (N = 31), pulsed radiofrequency ablation was done. After informed and written consent, fluoroscopy-guided ganglion Impar block was performed through the first intracoccygeal approach. The extent of pain relief was assessed by visual analog scale (VAS) at 24 hours, and at the first, third, and sixth weeks following the intervention. A questionnaire to evaluate subjective patient satisfaction was also used at each follow-up visit.
In the CRF group, the mean VAS score decreased significantly from the baseline value at each follow-up visit. But in the PRF group, this decrease was insignificant except at 24-hour follow-up. Intergroup comparison also showed significantly better pain relief in the CRF group as compared with the PRF group. At the end of follow-up, 28 patients (82%) in the CRF group and four patients (13%) in the PRF group had excellent results, as assessed by the subjective patient satisfaction questionnaire. There was no complication in any patient of either study group, except for short-lived infection at the site of skin puncture in a few.
Ganglion Impar block by conventional radiofrequency provided a significantly better quality of pain relief with no major side effects in patients with chronic nononcological perineal pain as compared with pulsed radiofrequency.
The short-term follow-up period of only six weeks was a major drawback associated with this study.
坐骨神经丛阻滞已被有效用于治疗慢性非肿瘤性会阴疼痛。化学神经松解术、冷冻消融术和射频消融术已被接受为阻滞方法。最近，脉冲射频，一种常规射频的新型变体，已被用于此目的。
这是一项前瞻性、随机、双盲研究。
印度的两个不同的介入性疼痛管理中心。
比较常规射频和脉冲射频用于坐骨神经丛阻滞的效果。
患者被随机分配到两组之一。在常规射频 (CRF) 组（N=34）中，进行常规射频消融术，而在脉冲射频 (PRF) 组（N=31）中，进行脉冲射频消融术。在获得知情和书面同意后，通过第一尾骨内入路进行荧光镜引导的坐骨神经丛阻滞。通过视觉模拟量表 (VAS) 在 24 小时、干预后第一、第三和第六周评估疼痛缓解程度。还在每次随访时使用评估主观患者满意度的问卷。
在 CRF 组，VAS 评分从基线值在每个随访时显著降低。但在 PRF 组，这种降低在除 24 小时随访外均不显著。组间比较还显示，CRF 组的疼痛缓解明显优于 PRF 组。在随访结束时，CRF 组的 28 名患者（82%）和 PRF 组的 4 名患者（13%）根据主观患者满意度问卷评估结果为优秀。除少数患者皮肤穿刺部位短暂感染外，两组患者均无任何并发症。
与脉冲射频相比，常规射频坐骨神经丛阻滞可显著改善慢性非肿瘤性会阴疼痛患者的疼痛缓解质量，且无主要副作用。
这项研究的主要缺点是只有 6 周的短期随访期。
