Salim Taner Gözükızıl

Background: This study aims to compare the clinical and procedural outcomes of transforaminal epidural steroid injections (TFESIs) and parasagittal interlaminar epidural steroid injections (P-ILESIs) in patients with unilateral radicular pain secondary to lumbar disc herniation (LDH). Patients and Methods: Between January 2024 and June 2025, a total of 162 patients with unilateral radicular pain caused by single-level LDH were included in this retrospective, observational cohort study. The patients were divided into the two groups based on the technique as the TFESI group (n = 82) and the P-ILESI group (n = 80). Pain, disability, sleep quality, and health-related quality of life were assessed using the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Pittsburgh Sleep Quality Index (PSQI), and Short Form-12 (SF-12), respectively at baseline, one month, and six months. Fluoroscopy time and cumulative radiation dose were also recorded. Results: Of the patients, 120 were male and 42 were female with a median age of 47 (range 22 to 65) years. Both techniques significantly improved pain, disability, sleep quality, and quality of life at one and six months ( p < 0.001). The reduction in NRS from baseline was greater with TFESI at one month ( p = 0.008), but not at six months ( p = 0.545). The ODI scores were lower with TFESI at one month, although the magnitude of improvement from baseline did not significantly differ and no difference was observed at six months. Quality of life outcomes were comparable between the groups. The P-ILESI required longer fluoroscopy time and higher radiation exposure than TFESI ( p < 0.001 for both). No major complications occurred, and minor adverse events were infrequent and comparable between the groups ( p = 0.764). Conclusion: Both TFESI and P-ILESI appear to be effective and safe approaches for the treatment of radicular pain associated with LDH. The choice of epidural approach should be individualized according to clinical and anatomical considerations, as well as operator experience.

Background: This study aims to investigate whether moderate sedation (MOAA/S 3-4) affects procedural efficiency, radiation exposure, patient–physician satisfaction, and clinical outcomes during lumbar transforaminal epidural steroid injections (L-TFESI). Patients and Methods: Between January 2021 and January 2024, a total of 201 patients with unilateral, single-root compression who underwent L-TFESI either with (Group S, n = 99) or without sedation (Group NS, n = 102) were retrospectively analyzed. In the sedation group, midazolam and fentanyl were titrated to a target Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of 3-4. The primary outcomes were cumulative radiation dose (mGy), fluoroscopy time, and procedural complications. Additional outcomes included Numeric Rating Scale-11 (NRS-11) scores (baseline, Day 4, Week 4) and Likert satisfaction scales. Results: Of a total of 201 patients, 143 were male and 58 were female with a mean age of 47.22 ± 10.03 (range, 22 to 65) years. Both groups were comparable in terms of baseline demographics and pain scores. The sedation group had significantly lower cumulative radiation exposure (3.92 ± 0.30 mGy vs. 4.31 ± 0.40 mGy) and shorter fluoroscopy times (28.13 ± 2.79 sec vs. 33.13 ± 3.95 sec). Minor procedural complications (commonly vasovagal reactions and hypertension) were more frequent in the non-sedated group (21.6% vs. 2.0%). Group S reported lower pain scores on Day 4 (1.11 ± 1.29 vs. 1.88 ± 1.25), although outcomes were similar at Week 4. Patient and physician satisfaction were higher in the sedation group. Conclusion: Moderate sedation (MOAA/S 3-4) during L-TFESI is associated with lower radiation exposure, shorter procedure times and fewer minor complications, while improving both patient satisfaction and procedural conditions. These findings suggest that sedation is a potentially useful adjunct in selected patients that may contribute to improved procedural quality in interventional pain management.

Objectives: To evaluate the clinical impact and treatment adaptations during the immediate-release oxycodone hydrochloride shortage. Methods: This retrospective, observational study was conducted during the oxycodone shortage period (May 2024–March 2025) in patients with cancer pain. Pain intensity was assessed using the Numerical Rating Scale (NRS) at baseline (prior to switching, while receiving oxycodone) and at follow-up (after switching to alternative analgesics). Changes in pain intensity were evaluated using within-patient differences (ΔNRS), with clinically meaningful worsening defined as an increase of ≥2 points. Descriptive and inferential statistics were used to summarize patient characteristics and outcomes. Results: Of 300 patients screened, 55 met inclusion criteria (mean age 65.2 ± 11.0 years; 63.6% male). Pain intensity increased significantly following treatment modification during the period of oxycodone unavailability, with mean NRS scores rising from 4.3 ± 1.7 to 5.9 ± 2.5 (p < 0.001). The mean ΔNRS was +1.56 (95% CI 0.79–2.34), with clinically meaningful worsening observed in 36 patients (65.5%). No statistically significant association was observed between substitute analgesic type and clinically meaningful worsening (p = 0.11). Conclusions: The oxycodone shortage was associated with worsened pain control and increased need for treatment modifications in cancer patients, highlighting the importance of uninterrupted access to essential opioids.

Background: Knee osteoarthritis is a major cause of chronic pain and functional limitation, particularly in advanced stages. Intra-articular steroid injections and genicular nerve interventions are commonly used for pain control; however, these methods mainly target the anterior knee and may not sufficiently relieve pain originating from the posterior capsule. The infiltration between the popliteal artery and the capsule of the knee (IPACK) block is a regional anesthesia technique that provides posterior knee analgesia without causing motor weakness. Evidence regarding its effectiveness in chronic, non-surgical knee osteoarthritis is limited. This study aimed to evaluate whether adding an ultrasound-guided IPACK block to intra-articular steroid injection improves pain and functional outcomes in patients with advanced knee osteoarthritis. Methods: This retrospective observational cohort study included 98 patients with Kellgren–Lawrence stage 3–4 knee osteoarthritis who had persistent pain despite conservative treatment. Patients received either intra-articular steroid injection alone (IASI group, n = 50) or intra-articular steroid injection combined with an IPACK block (IASI+IPACK group, n = 48). Pain severity was assessed using the Numeric Rating Scale (NRS), and functional status was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Evaluations were performed at baseline, 1 month, and 6 months after the procedure. Non-parametric tests were used for statistical analysis, and p < 0.05 was considered significant. Results: Both groups showed significant improvement in NRS and WOMAC scores at 1 and 6 months compared with baseline ( p < 0.05). The IASI+IPACK group demonstrated greater pain reduction at 1 month and significantly better WOMAC Function and Total scores at both follow-up visits compared with the IASI group ( p < 0.05). Although scores increased slightly between 1 and 6 months in both groups, outcomes remained improved compared with baseline. No major complications were observed during the follow-up period. However, minor adverse events were not systematically recorded due to the retrospective nature of the study. Conclusions: Adding an IPACK block to intra-articular steroid injection may provide additional benefit in early pain relief and functional improvement in patients with advanced knee osteoarthritis. This combined approach appears to be a safe and useful option for patients who are not surgical candidates or are awaiting arthroplasty. Trial registration: ClinicalTrials.gov, NCT07269444. Retrospectively registered on 20 November 2025.

Introduction: Adhesive capsulitis causes severe pain and limited movement, particularly in older adults. Treating this condition in elderly patients is difficult because standard therapies can carry risks due to age-related health issues and multiple medications. Suprascapular nerve pulsed radiofrequency provides a potentially safer, minimally invasive option. This study assessed the effectiveness and safety of this method in patients aged 65 and older. Materials and Method: Thirty-two patients with adhesive capsulitis received ultrasound-guided suprascapular nerve pulsed radiofrequency. The primary outcome was the Shoulder Pain and Disability Index; secondary outcomes included Numeric Rating Scale scores for activity and rest pain. Assessments occurred at baseline, 4, and 12 weeks. Results: Post-procedure assessments at 4 and 12 weeks demonstrated statistically significant reductions in Shoulder Pain and Disability Index scores and Numeric Rating Scale scores compared to baseline. While Shoulder Pain and Disability Index pain scores stayed consistent between weeks 4 and 12, a small but statistically significant rise in resting pain was observed at week 12 compared to week 4; however, pain levels remained significantly lower than pretreatment levels. No serious procedure-related adverse events were reported. Conclusion: Ultrasound-guided Suprascapular nerve pulsed radiofrequency seems to be an effective and safe treatment for chronic shoulder pain in elderly patients with adhesive capsulitis. Besides pain relief, long-lasting functional improvements may help reduce the social and psychological challenges linked to the condition. Due to its good safety profile, this method offers a valuable option for vulnerable patients with few other treatment choices. Keywords: Pulsed Radiofrequency Treatment; Shoulder Pain; Aged; Ultrasonography; Bursitis.