Background: Piriformis syndrome (PS) is a painful musculoskeletal condition characterized by a deep gluteal pain that may radiate to the posterior thigh and leg. This study was designed to compare the effectiveness of ozone and BTX to lidocaine injection in treating piriformis syndrome that was resistant to medication and/or physical therapy. Study design: Between November 2018 and August 2019, we involved eighty-four subjects diagnosed with piriformis syndrome in a double-blinded, prospective, randomized comparative study to receive an ultrasound-guided injection of lidocaine (control group), botulinum toxin A, or local ozone (28 patients each group) in the belly of the piriformis muscle. Pain condition evaluated by the visual analog score (VAS) was used as a primary outcome, and the Oswestry Disability Index (ODI) as a secondary outcome, before, at one month, two months, three months, and six months following the injection. Results: The majority (58.3%) of patients were male, while (41.7%) were female. At one month, a highly significant decrease occurred in VAS and ODI in the lidocaine and ozone groups compared to the botulinum toxin group (p < 0.001). At six months, there was a highly significant decrease in VAS and ODI in the botulinum toxin group compared to the lidocaine and ozone groups (p < 0.001). Conclusion: Botulinum toxin may assist in the medium- and long-term management of piriformis syndrome, while lidocaine injection and ozone therapy may help short-term treatment in patients not responding to conservative treatment and physiotherapy.

Background: Abdominoplasty is a popular aesthetic procedure. Both patients and doctors are concerned about post-operative pain and discomfort. erector spinae plane block (ESP) with ultrasound guidance (UG) was an excellent analgesic technique in bariatric surgery. Objectives; to evaluate the intensity and duration of analgesia (ESP) technique to that provided by the transversus abdominis plane (TAP) technique were done bilaterally with (UG) post abdominoplasty. Study Design; A single-blinded, clinical, prospective, randomized study. Patients and Methods; 51 patients received bilateral (UG) block: (ESP) group (n = 25), and (TAP) group (n = 26), Using the same dosage and volume of local anesthetics. Pain intensity using VAS score at first 30 minutes, and then at 2, 4, 6, 8, 12, 16, 20, and 24 hours postoperatively, IV boluses of pethidine (rescue analgesic) were administrated if VAS ≥ 4, The primary outcome considered as the duration of effective analgesia for each block. While the Secondary outcome measured the over-all pethidine usage, patient satisfaction and the incidence of harmful effects from the techniques. RESULTS; VAS score in the ESP group was significantly lower at 8hrs and 12hrs. There was significant prolonged time to the first analgesic dose in ESP group (9.16±1.07 hours) than TAP group (7.65±0.75 hours). Also, a significant reduction in to the overall pethidine intake in 24 hours (110.40±12.74mg.) in the ESP group. Conclusion: Especially in comparison to the TAP block, the ESP block enables more reliable alleviation of pain, longer analgesic period, extends the time to initial analgesic requirements, reduces pethidine usage.

Background: We led this study to investigate the effect of injection of Dexmedetomidine as an additive to Lidocaine in the inferior alveolar nerve for patients undergoing lower bilateral impacted tooth extraction regarding postoperative pain, duration of postoperative analgesia, the over-all quantity of analgesia demanded in the first 24 h postoperatively, and the surgeon and the patient satisfaction. Patients and methods: Sixty patients were included, so that 30 patients were in the Dexmedetomidine group and the other 30 in the Adrenaline group. The inferior alveolar nerve block was done bilaterally after general anaesthesia using Lidocaine with Dexmedetomidine or Adrenaline. The primary outcome was analgesia quality (pain intensity, the duration of postoperative analgesia, and the patient's whole demanded amount of analgesia), the haemodynamic parameters, patients and surgeon’s satisfaction as secondary outcomes. Results: The mean postoperative analgesia time in Group (D) is 362.3±12.3 min, which is higher than Group (A) 231.4±13.1 min. 83.3% of the Group (D) received no analgesics, and 16.7% received one dose, while in the Group (A), 50% received two doses, 33.3% received one dose, and 16.7% received no doses. The VAS score was lower for Group (D) than Group (A) except for zero, where there was no difference between them. The satisfaction was higher in Group (D) than the Group (A) for both the patients and the surgeons. Conclusion: Adding 12.5μ/ml of Dexmedetomidine is an excellent additive to Lidocaine in Inferior alveolar nerve block regarding analgesia quality, patient and surgeon satisfaction in bilateral third molar teeth surgery.

ABSTRAC. Background : Plantar fasciitis or recently called plantar fasciopathy, generally observed with heel spurs because of the deposition of calcium, although the definite pathology is still unknown. Ultrasound-guided injection of conventional corticosteroids was the primary treatment modality, with other emerging substances (e.g. Ozone or Platelet Rich Plasma PRP). Aim of the study: This study was conducted to evaluate the effect of ultrasound-guided injection of local Ozone or Platelet Rich Plasma (PRP) versus conventional corticosteroid in the management of plantar fasciitis. Patient and methods: this a randomized Prospective comparative study has done Al-Azhar university hospitals (Al-Hussein and Sayed Galal), where fifty-one patients have been diagnosed to have plantar fasciitis were included and allocated into one of three groups (17 patients in each group) to receive an ultrasound-guided injection of corticosteroid (control group), platelet-rich plasma (PRP) or Ozone O2-O3. Clinical evaluation and ultrasonographic measurement of the plantar fascia thickness was done before, at one, three and six months next to the injection. Primary outcome included: pain score using the visual analogue score (VAS). While secondary outcomes were plantar fascia thickness and foot quality health status. Results: There was a highly significant decrease in VAS score and plantar fascia thickness, and an increase in foot pain domain of the foot health status (FHSQ) score in corticosteroid and Ozone groups (p < 0.01 respectively) in one month. Regarding 3-month results, there was a highly significant decrease in VAS score plantar fascia thickness, and an increase in FHSQ score in the corticosteroid group (p < 0.01 respectively). Regarding long-term 6-month results, there was a highly significant decrease in VAS score, plantar fascia thickness, and an increase in FHSQ score in the PRP group (p < 0.01 respectively). Conclusion: Corticosteroid and Ozone injections were effective at short-term assessment, but PRP was more valuable at long-term assessment regarding pain management in plantar fasciitis patients.

Background: Inadequately managed acute pain following abdominal surgery can lead to patient discomfort, anxiety, respiratory issues, delirium, myocardial ischemia, prolonged hospital stays, and persistent pain. Objectives: This research compares the quadratus lumborum (QL) block to intraperitoneal and periportal bupivacaine infiltration for postoperative analgesia after laparoscopic cholecystectomy. Methods: This randomized double-blind study included seventy patients aged 21 to 60 years, randomly selected from Ain Shams University Hospital between March 2022 and March 2023, scheduled for elective laparoscopic cholecystectomy. The patients were divided into two groups of 35 based on postoperative pain management: Group A received intraperitoneal and periportal infiltration, while group B underwent the QL block, with details on placement and duration. Results: The results indicated a substantial decrease in Visual Analogue Scale (VAS) scores at 6 hours postoperatively, with group B exhibiting a median pain level of 3 [IQR 3 - 5] compared to group A's median of 5 [IQR 5 - 6], yielding a P-value of less than 0.001. The data indicate that group B had significantly enhanced postoperative analgesia within the initial 6 hours, both in a static condition and during movement. Moreover, patients in group B required fewer postoperative analgesics during the first 24 hours following surgery compared to group A. Conclusions: Following laparoscopic cholecystectomy, the QL block proved more effective than intraperitoneal and periportal bupivacaine infiltration in reducing postoperative pain scores for 6 hours and in reducing total opioid and analgesic use for 24 hours postoperatively.

S suitable for arthroscopic shoulder surgery, but many complication may affect the respiratory system. Ultrasound-guided supraclavicular with suprascapular nerve block may be a safe alternative for arthroscopic shoulder surgery. Levobupivacaine is a local anesthetic. It is the S enantiomer of bupivacaine with long duration of action, motor block, and onset time. Aims The primary outcome of the study is the quality of the block (sensory and motor), whereas the postoperative analgesia and patient satisfaction are the secondary outcomes in arthroscopic rotator cuff surgery. Settings and design This was a prospective randomized comparative clinical study. Patients and methods A total of 60 patients between 25 and 55 years were included in this study. The patients scheduled for elective arthroscopic rotator cuff surgery were randomized into two groups: group A patient received ultrasound-guided interscalene brachial plexus block with levobupivacaine, and group B patient received ultrasound-guided supraclavicular with suprascapular brachial plexus block with levobupivacaine. Results The mean age of all arthroscopy patients was 43.1±8.8 years, and most patients were males (60%), whereas 40% were females. On comparing the two groups, we found no statistically significant difference regarding basic preoperative, hemodynamic, and intraoperative data. Regarding the primary outcome, there was a significant increase in success rate (block quality) in group B (93.3%) compared with group A patients (70%) (P=0.02) and nonsignificant difference regarding sensory and motor block onset (P>0.05). Regarding secondary outcomes, there was a highly significant decrease in rescue analgesia in B group (average 1.9±0.7 ampoules) compared with group A patients (average 2.5±0.7 ampoules) (P=0.008), a significant decrease in complications rate in group B (0%) compared with group A patients (26.7%) (P=0.026), and a highly significant increase in patient satisfaction rate in group B (100%) compared with group A patients (70%) (P=0.004). Conclusions Suprascapular brachial plexus block can be performed as an alternative to interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery....