Background: Local anesthetic systemic toxicity (LAST) is rare, but fatal; the current widely used treatment is lipid emulsion (LE). The goal of this study was to analyze and review case reports on LE treatment for LAST in pediatric patients. Methods: We performed a systematic review using case reports on LE treatment for LAST in pediatric patients, searching PubMed and Scopus databases to March 2023 using the following keywords: (“local anesthetic toxicity” OR “local anesthetic systemic toxicity” OR LAST”) AND (“newborn” OR “infant” OR “child” OR “children” OR “adolescent” OR “pediatric”) AND (“lipid emulsion” OR “Intralipid”). Results: Our search yielded 21 cases, revealing that nearly 43% patients with LAST were less than 1 year old, and most cases were caused by bupivacaine (approximately 67% cases). “Inadvertent intravascular injection” by anesthesiologists and “overdose of local anesthetics” mainly by surgeons were responsible for 52% and 24% cases of LAST, respectively. LAST occurred in the awake state (52%) and under general anesthesia (48%), mainly causing seizures and arrhythmia, respectively. Approximately 55% of patients received LE treatment in <10 minutes after LAST, mainly improving cardiovascular symptoms. A 20% LE (1.5 mL/kg) dose followed by 0.25 mL/kg/minutes dose was frequently used. LE and anticonvulsants were mainly used in the awake state, whereas LE with or without vasopressors was mainly used under general anesthesia. LE treatment led to full recovery from LAST in 20 cases; however, 1 patient died due to underlying disease. Conclusion: Consequently, our findings reveal that LE is effective in treating pediatric LAST.

Background: This study aimed to evaluate the association between chronic low back pain (CLBP) and chronic diseases, such as hypertension, diabetes, and dyslipidemia. Methods: This study was a retrospective analysis using data from the Korea National Health and Nutrition Examination Survey (KNHANES) between 2010–2012 and included women who answered a questionnaire in the KNHANES asking whether they had low back pain for ≥3 months. Participants were divided into non-CLBP and CLBP groups. For statistical analysis, the Student’s t-test, chi-square test, Fisher’s exact test, and logistic regression analysis were performed using SPSS. Results: Of 5961 participants, the non-CLBP group comprised 4098 women and the CLBP group comprised 1863. Adjusted logistic regression model revealed that dyslipidemia was positively associated with CLBP (odds ratio, 1.32; 95% confidence interval, 1.140, 1.530; p < 0.001). However, hypertension and diabetes were not associated with CLBP. Conclusions: Our results suggest that proper treatment of dyslipidemia may contribute to lowering the risk of CLBP later in life.

Percutaneous epidural adhesiolysis (PEA) is an effective treatment for patients with lumbar radiculopathy unresponsive to single steroid injections. Various approaches and instruments have been developed to access these lesions. This study aimed to evaluate the utility of a retrodiscal approach for epidural adhesiolysis using a WHIP catheter®. This retrospective study was conducted at Bundang Seoul National University Hospital, reviewing cases from January to December 2022. Forty-seven patients diagnosed with lumbar radiculopathy, aged 20 to 80 years, who underwent PEA with the WHIP catheter® were included. Outcomes assessed Numeric Rating Scale (NRS) for pain, Patients’ Global Impression of Change (PGIC) scores, and the incidence of procedure-related complications. Follow-up evaluations occurred at 1, 3, and 6 months post-procedure. Among 47 patients, 41 completed the study, showing significant pain reduction at all follow-up points: 1 month (N = 41, 1.32 ± 1.68, P < .001), 3 months (N = 31, 1.90 ± 2.14, P < .001), and 6 months (N = 30, 2.50 ± 2.30, P < .001). PGIC scores indicated that 40% of the patients reported substantial improvement at one-month post-procedure. The complications were minimal, with only one case of intradiscal injection and 2 cases of vascular uptake. The retrodiscal approach PEA using the WHIP catheter® demonstrated significant efficacy in pain reduction with minimal safety concerns for patients with lumbar radiculopathy. These findings suggest that this procedure is a viable option for patients who are unresponsive to conservative treatment. However, the retrospective nature of this study and its small sample size necessitate further prospective controlled studies to confirm our results and establish long-term outcomes.

Purpose: Lumbar transforaminal epidural steroid injection (TFESI) can be technically challenging in patients with complex spinal anatomy. This pilot study aimed to evaluate whether patient-specific three-dimensional (3D) virtual reality (VR) rehearsal generated from pre-procedural CT images improves procedural performance during anatomically challenging lumbar TFESI. Patients and Methods: This prospective, single-center, randomized controlled trial included 30 patients scheduled for technically challenging lumbar TFESI. Participants were randomly assigned to either the control group (n = 15) or the VR group (n = 15). In the VR group, patient-specific 3D models were generated from pre-procedural lumbar CT images and the operator performed VR rehearsal one day before the procedure. In the control group, pre-procedural CT images and, when available, magnetic resonance imaging findings were reviewed before the procedure. All procedures were performed by a single experienced pain specialist. The primary outcomes were procedure time and the number of fluoroscopic image acquisitions. Secondary outcomes included needle-bone contacts, intravascular contrast uptake, patient satisfaction, and procedure completion. Results: All patients received the allocated intervention and were included in the final analysis. Procedure time was shorter in the VR group than in the control group (215.7 ± 46.8 sec vs 254.5 ± 50.3 sec; mean difference, − 38.9 sec; 95% CI, − 75.2 to − 2.5; p = 0.037). The number of fluoroscopic image acquisitions was also lower in the VR group (10.27 ± 2.74 vs 13.27 ± 3.65 images; mean difference, − 3.00 images; 95% CI, − 5.41 to − 0.59; p = 0.017). The number of needle-bone contacts was numerically lower in the VR group, although this difference was not statistically significant (1.3 ± 1.1 vs 2.1 ± 1.3, p = 0.081). Patient satisfaction and intravascular contrast uptake did not differ significantly between groups. All procedures were completed as planned. Conclusion: In this pilot study, patient-specific VR rehearsal before technically challenging lumbar TFESI was associated with shorter procedure time and fewer fluoroscopic image acquisitions. These preliminary findings support further evaluation of patient-specific VR rehearsal as a useful pre-procedural planning tool for anatomically challenging TFESI cases.