Halil İbRahim Altun

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.

Objective: The role of sedation during cervical interlaminar epidural steroid injections remains controversial in terms of patient comfort and procedural safety. This study aimed to present the early clinical outcomes of cervical interlaminar epidural steroid injections performed under sedation in patients with cervical radiculopathy. Methods: This retrospective observational study included 44 patients who underwent cervical interlaminar epidural steroid injections under sedation. Pain intensity was assessed before the procedure and at 4 hours after the procedure using the NRS-11, and post-procedural patient satisfaction was evaluated using a Likert scale. Cumulative radiation dose, fluoroscopy time, and intra-procedural complications were analyzed. Mild-to-moderate sedation was targeted, and the Modified Observer’s Assessment of Alertness/Sedation Scale (MOAA/S) was used to assess the level of sedation. Results: At 4 hours post-procedure, a significant decrease in NRS-11 scores was observed compared with pre-procedure scores. Most patients reported high post-procedure satisfaction. No major complications were observed during the study period, and the minor side effects were transient. However, due to the retrospective nature of the study and the absence of a comparison group without sedation, the findings cannot be considered to definitively reflect the effect of sedation. Conclusion: Cervical interlaminar epidural steroid injections administered with mild-to-moderate sedation were associated with early pain reduction and high patient satisfaction. However, given the limitations of the present study, these findings should be interpreted with caution, and prospective, controlled studies are required to determine the true contribution of sedation.

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.

Background: Postherpetic neuralgia (PHN) is a neuropathic pain syndrome that can be resistant to traditional therapies and severely impairs quality of life. The serratus posterior superior intercostal plane block (SPSIPB) is a recently described regional anesthesia technique conducted under ultrasound guidance, thought to provide analgesia for thoracic neuropathic pain. This research analyzed the effectiveness and safety of SPSIPB in patients with thoracic PHN. Methods: Thirty-four thoracic PHN patients who underwent SPSIPB between June 2023 and February 2025 were retrospectively evaluated. Pain intensity was evaluated utilizing the Numerical Rating Scale (NRS-11), neuropathic pain symptoms using the Douleur Neuropathique 4 (DN4) questionnaire, and quality of life using the 12-item Short Form Health Survey (SF-12). Measurements were taken before the procedure and at 1 month and 3 months post-procedure. Results: Thirty-four patients were included. Mean patient age was 68.4 ± 7.1. Among all patients, 50% were female. The NRS-11 scores decreased from 7.6 ± 1.1 before the procedure to 2.8 ± 1.3 at 3 months ( p < 0.001). The DN4 scores also decreased from 6.4 ± 1.0 before the procedure to 3.1 ± 1.2 at 3 months after the procedure ( p < 0.001). Significant increases were observed in both the physical and mental component scores of the SF-12 ( p < 0.001). No severe complications were encountered. Conclusion: SPSIPB administered under ultrasound guidance is associated with a reduction in pain intensity and an improvement in quality of life in patients with thoracic postherpetic neuralgia. However, given the study’s retrospective design and the absence of a control group, these outcomes should not be considered indicative of a causal effect; instead, they should be interpreted as hypothesis-generating. Prospective, randomized controlled trials are needed to demonstrate the efficacy of SPSIPB and its comparative benefits relative to other interventions. Trial registration: This retrospective single-center study was conducted in accordance with the Helsinki Declaration. It was registered on clinicaltrials.gov (NCT07067892).

Background/Objectives: Fibromyalgia is a painful syndrome with biopsychosocial components that predominantly affects middle-aged women. This study aimed to evaluate changes in sleep quality and quality of life following intravenous (IV) lidocaine treatment in patients with fibromyalgia (FM). Methods: This retrospective observational study included patients diagnosed with fibromyalgia who underwent intravenous lidocaine treatment at a tertiary pain clinic between June 2023 and June 2024 and had a Pittsburgh Sleep Quality Index (PSQI) score > 5. The patients’ demographic data, Fibromyalgia Impact Questionnaire (FIQ) scores at baseline and at 1 and 3 months post-treatment, Numerical Rating Scale (NRS-11) scores, Short Form-12 (SF-12) mental and physical component scores (MCS-12, PCS-12), and PSQI scores were recorded. Results: Overall, 51 patients were included. 92.2% of the patients were women, with a mean age of 41.6 ± 9.5 years. Statistically significant reductions in NRS-11, FIQ, and PSQI scores and increases in SF-12 component scores were observed at 1 and 3 months compared with baseline (p < 0.001). Negative correlations were found between NRS-11 and PCS-12 and MCS-12, and a positive correlation was found between FIQ and PSQI. Sleep quality showed a marked improvement at 1 month; however, attenuation of this benefit was observed at the 3-month follow-up. Conclusions: Sleep quality appeared to be associated with short-term functional outcomes, whereas pain intensity was associated with mid-term clinical status in patients with fibromyalgia. Prospective randomized controlled trials are required to confirm these findings and to determine optimal dosing and treatment schedules.

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.