Publications by authors named "Nazir Noor"

7 Publications

  • Page 1 of 1

Oral Muscle Relaxants for the Treatment of Chronic Pain Associated with Cerebral Palsy.

Psychopharmacol Bull 2020 Oct;50(4 Suppl 1):142-162

Peck, MD, Noor, BS, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Crane, BS, McNally, BS, Georgetown University School of Medicine, Washington, DC. Patel, BS, University of Arizona College of Medicine-Phoenix, Phoenix, AZ. Cornett, MD, Louisiana State University Health Sciences, Department of Anesthesiology, New Orleans, LA. Kaye, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE.

Purpose Of Review: This is a comprehensive literature review of the available for treatment of oral muscle relaxants for cerebral palsy (CP) and associated chronic pain. It briefly describes the background and etiology of pain in CP and proceeds to review and weigh the available evidence for treatment for muscle relaxants.

Recent Findings: CP is a permanent, chronic, non-progressive neuromuscular and neurocognitive disorder of motor dysfunction that is diagnosed in infancy and is frequently (62% of patients) accompanied by chronic or recurrent muscular pain. Treatment of pain is crucial, and focuses mostly on treatment of spasticity through non-interventional techniques, surgery and medical treatment. Botulinum toxin injections provide temporary denervation, at the cost of repeated needle sticks. More recently, the use of oral muscle relaxants has gained ground and more evidence are available to evaluate its efficacy. Common oral muscle relaxants include baclofen, dantrolene and diazepam. Baclofen is commonly prescribed for spasticity in CP; however, despite year-long experience, there is little evidence to support its use and evidence from controlled trials are mixed. Dantrolene has been used for 30 years, and very little current evidence exists to support its use. Its efficacy is usually impacted by non-adherence due to difficult dosing and side-effects. Diazepam, a commonly prescribed benzodiazepine carries risks of CNS depression as well as addiction and abuse. Evidence supporting its use is mostly dated, but more recent findings support short-term use for pain control as well as enabling non-pharmacological interventions that achieve long term benefit but would otherwise not be tolerated. More recent options include cyclobenzaprine and tizanidine. Cyclobenzaprine carries a more significant adverse events profile, including CNS sedation; it was found to be effective, possible as effective as diazepam, however, it is not currently FDA approved for CP-related spasticity and further evidence is required to support its use. Tizanidine was shown to be very effective in a handful of small studies.

Summary: Muscle relaxants are an important adjunct in CP therapy and are crucial in treatment of pain, as well as enabling participation in other forms of treatments. Evidence exist to support their use, however, it is not without risk and further research is required to highlight proper dosing, co-treatments and patient selection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901132PMC
October 2020

Radiofrequency Ablation of the Splanchnic Nerve and Superior Hypogastric Plexus for Chronic Abdominal Pain Status Post-Abdominal Surgery.

Cureus 2020 Dec 20;12(12):e12189. Epub 2020 Dec 20.

Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA.

Gastrointestinal cancers, such as malignant carcinoid tumor and pancreatic cancer, are responsible for excruciating and debilitating abdominal pain. Too often, patients are placed on chronic high-dose opioids, but the pain remains poorly controlled. It is incumbent on the medical team to approach the patient's debilitating pain in a thorough multi-modal fashion. Opioids may play an important role, but they make up only a portion of available invasive and noninvasive management. We present a case of a patient who was serendipitously diagnosed with malignant carcinoid tumor after endoscopic polypectomy and Whipple procedure for pancreatic cancer. Her abdominal pain was refractory to opioid and non-opioid medications, and therefore we proposed radiofrequency ablation (RFA) of the splanchnic nerve and superior hypogastric plexus. This technique was preceded by a diagnostic block of these nerves. She experienced significant pain relief and an improved quality of life, and was able to stop all opioid medications. The preferred approach to pain management is a multi-modal one. This includes physical therapy, pharmacological management, and minimally invasive procedures such as RFA. The medical team must consider all available pain management modalities to provide the patient with proper care of such debilitating pain as that described in our case presentation. A systematic approach is important, as demonstrated by our team by first performing diagnostic blocks of the superior hypogastric plexus and splanchnic nerve to test the likelihood of a successful RFA. Only after achieving favorable results, we decided to proceed with RFA treatment of those same nerves. Ultimately, our RFA technique provided significant pain relief for our patient and she did not require any opioid medications.
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http://dx.doi.org/10.7759/cureus.12189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815302PMC
December 2020

Treatment and Management of Twelfth Rib Syndrome: A Best Practices Comprehensive Review.

Pain Physician 2021 Jan;24(1):E45-E50

Department of Anesthesiology, LSUHSC School of Medicine, Shreveport, LA; Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE; Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Pain Consultants-Envision Physician Services, Phoenix, AZ.

Background: Twelfth rib syndrome, or slipping of the 12th rib, is an often overlooked cause for chronic chest, back, flank, and abdominal pain from irritation of the 12th intercostal nerve. Diagnosis is clinical and follows the exclusion of other causes of pain. This syndrome is usually accompanied by long-suffering, consequent psychiatric comorbidities, and increased health care costs, which are secondary to the delayed diagnosis.

Objectives: This manuscript is a review of twelfth rib syndrome and its management options. The review provides etiology, pathophysiology, and epidemiology of twelfth rib syndrome. Additionally, diagnosis and current options for treatment and management are presented.

Study Design: This is a narrative review of twelfth rib syndrome.

Setting: A database review.

Methods: A PubMed search was conducted to ascertain seminal literature regarding twelfth rib syndrome.

Results: Conservative treatment is usually the first line, including local heat or ice packs, rest, and oral over-the-counter analgesics. Transcutaneous stimulation and 12th intercostal nerve cryotherapy have also been described with some success. Nerve blocks can additionally be tried and are usually effective in the immediate term; there is a paucity of evidence to suggest long-term efficacy. Surgical removal of all or part of the 12th rib and possibly the 11th rib, as well as the next line of therapy, may provide long-lasting relief of pain.

Limitations: Further large scale clinical studies are needed to assess the most effective management of twelfth rib syndrome.

Conclusions: Twelfth rib syndrome is usually diagnosed late and causes significant morbidity and suffering. The actual epidemiology is unclear given the difficulty of diagnosis. Nerve blocks and surgical rib resection appear to be effective in treating this syndrome, however, further evidence is required to properly evaluate them. Familiarity with this syndrome is crucial in reaching a prompter diagnosis.
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January 2021

Correction: Synergistic Effect of Perineural Dexamethasone and Dexmedetomidine (Dex-Dex) Prolong Analgesic Effect of a Preoperative Interscalene Block.

Cureus 2020 Nov 16;12(11):c40. Epub 2020 Nov 16.

Anesthesiology and Pain Medicine, Portsmouth Anesthesia Associates, Portsmouth, USA.

[This corrects the article DOI: 10.7759/cureus.9473.].
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http://dx.doi.org/10.7759/cureus.c40DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7668427PMC
November 2020

Fascia Iliaca Block Successfully Prolonged With Dexmedetomidine and Dexamethasone for Pain Control in a Patient Undergoing Total Hip Arthroplasty.

Cureus 2020 Oct 11;12(10):e10897. Epub 2020 Oct 11.

Anesthesiology and Pain Medicine, Portsmouth Anesthesia Associates, Portsmouth, USA.

Regional anesthesia has found many advocates as enhanced recovery after surgery continues to become a more popular option for procedures such as total hip arthroplasty. Among the many benefits is the better pain control with a reduction or complete elimination of the need for opioids for perioperative pain management. With aims to improve the multi-modal approach to pain management, we present a case demonstrating further improvements in the regional anesthetic technique with the addition of a dexamethasone and dexmedetomidine adjuvant to the local anesthetic injectate. Our case is that of a 65-year-old woman with a history of hypertension, hyperlipidemia, and right hip osteoarthritis undergoing a right total hip arthroplasty who received a preoperative ultrasound-guided fascia iliaca block with the adjuvants dexamethasone and dexmedetomidine added to the injectate. The surgery was uneventful. She did not require any postoperative opioid or non-opioid analgesics, denying any pain for the first three postoperative days.
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http://dx.doi.org/10.7759/cureus.10897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654983PMC
October 2020

Basivertebral Nerve Ablation for the Treatment of Vertebrogenic Pain.

Pain Ther 2020 Oct 31. Epub 2020 Oct 31.

Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.

Chronic low back pain affects a significant portion of patients worldwide and is a major contributor to patient disability; however, it is a difficult problem to diagnose and treat. The prevailing model of chronic low back pain has presumed to follow a discogenic model, but recent studies have shown a vertebrogenic model that involves the basivertebral nerve (BVN). Radiofrequency ablation of the BVN has emerged as a possible nonsurgical therapy for vertebrogenic low back pain. The objective of this manuscript is to provide a comprehensive review of vertebrogenic pain diagnosis and our current understanding of BVN ablation as treatment.
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http://dx.doi.org/10.1007/s40122-020-00211-2DOI Listing
October 2020

Synergistic Effect of Perineural Dexamethasone and Dexmedetomidine (Dex-Dex) Prolong Analgesic Effect of a Preoperative Interscalene Block.

Cureus 2020 Jul 30;12(7):e9473. Epub 2020 Jul 30.

Anesthesiology and Pain Medicine, Portsmouth Anesthesia Associates, Portsmouth, USA.

The brachial plexus is often a target of regional anesthesia for procedures involving the upper extremities. These include the supraclavicular, infraclavicular, interscalene, and axillary blocks. The cases we present involve the use of an ultrasound-guided interscalene block using 20 mL 0.2% ropivacaine with dexamethasone and 25 mcg dexmedetomidine as the injectate. This particular block technique has proven to be a very useful adjunct to the perioperative anesthetic care and enhanced recovery after surgery (ERAS) protocol for these patients. The series of cases we present include patients receiving the dexamethasone and dexmedetomidine (Dex-Dex) combination in their local anesthetic injectate for the ultrasound-guided interscalene block. Two of the patients underwent arthroscopic shoulder procedures and one underwent a shoulder total arthroplasty with biceps tenodesis. None of the patients required any postoperative opioids for analgesia. Though the technique is fairly new, with only a limited number of case studies described its efficacy, the understanding of the benefits of ERAS has helped it gain some traction in the field of regional anesthesia. Conduction of further large clinical trials is the next step in providing a better understanding of the Dex-Dex adjuvant method as it moves towards becoming a commonly used component of ERAS protocols in the perioperative period.
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http://dx.doi.org/10.7759/cureus.9473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455378PMC
July 2020