Methylprednisolone 40mg/1ml / Lidocaine 10mg/1ml (1%) suspension for injection vials

Hiccups are caused by involuntary spasms of the diaphragm and external intercostal muscles. When persistent, they can significantly reduce the quality of life. However, comprehensive reviews of available treatments and their corresponding evaluation metrics remain scarce. This scoping review aimed to comprehensively map the interventions used to treat hiccups in adults and clarify the current state of outcome measures employed in existing research. We conducted a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) -ScR guidelines and the framework of Arksey and O'Malley. Using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ichushi-web databases, we identified studies published up to June 3, 2024. The search terms included "HICCUP," "HICCOUGH," and "SINGULTUS." A total of 3248 articles were identified, with 499 duplicates removed. After screening 2749 titles and abstracts, 2708 articles were excluded. Full-text reviews of 41 articles led to the exclusion of 18, resulting in 23 that met the inclusion criteria. Of these, 17 studies focused on pharmacological interventions, including baclofen, metoclopramide, methylprednisolone, and Shitei-to, while 6 studies examined nonpharmacological interventions, such as acupuncture, infrared therapy, rebreathing techniques, and cervical epidural block. Outcome measures were categorized into objective and subjective evaluations. Objective measures included complete cessation, partial cessation, frequency reduction, and time to complete cessation. Subjective measures assessed the distress caused by hiccups using patient-reported scales, such as the numerical rating scale. This scoping review identified 23 studies on hiccup interventions, including five randomized controlled trials on pharmacological agents and one study on a nonpharmacological approach. Studies included both Western and Eastern medicine, offering new perspectives on hiccup management. The outcome measures were primarily objective, with some patient-reported assessments. These findings provide a foundation for future research on hiccup treatment and evaluation methods.

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BackgroundPostoperative delirium (POD) is an acute neuropsychiatric syndrome that occurs following surgery, characterized by inattention and broader cognitive deficits. This study aimed to synthesize randomized evidence on perioperative strategies that prevent POD in elderly patients undergoing orthopaedic surgery.MethodsWe conducted a Bayesian network meta-analysis of randomised controlled trials (RCTs) retrieved from PubMed, Embase, Web of Science, and Cochrane Library from inception to March 2026. Eligible trials enrolled adults aged 60 years or older undergoing orthopaedic surgery and reported POD incidence with validated assay assessments. Risk ratios (RR) and mean differences with 95% Credible Interval (CrI) were estimated. The risk of bias was assessed using the Cochrane tool, and the certainty of the evidence was evaluated with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation).Results79 RCTs comprising 16,012 patients were included. Compared with placebo, dexmedetomidine (RR 0.49, 95% CrI 0.39-0.61) has the most consistent evidence for reducing the risk of POD incidence, while ketamine (RR 0.39, 95% CrI 0.23-0.64), rivastigmine (RR 0.33, 95% CrI 0.16-0.65), olanzapine (RR 0.35, 95% CrI 0.17-0.71), and lidocaine (RR 0.41, 95% CrI 0.21-0.77) showed promising but heterogeneous benefits across current literature. Evidence for analgesic and anaesthetic interventions was limited.ConclusionDexmedetomidine offers the most substantial evidence for lowering POD incidence after orthopaedic surgery in elderly; ketamine, rivastigmine, olanzapine, and lidocaine warrant further evaluation. High-quality, low-bias RCTs are needed to verify the effects of specific analgesic or anaesthetic regimens on POD occurrence.Translational potential statementThis network meta-analysis highlights the promising translational potential of dexmedetomidine in preventing POD for elderly orthopaedic patients. Dexmedetomidine emerges as the most reliable option for immediate clinical adoption, while ketamine, rivastigmine, olanzapine, and lidocaine show promise but require confirmatory trials before routine use. The findings set the stage for personalized anaesthetic protocols that minimize POD and its associated morbidity and healthcare costs.

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BackgroundThere is inadequate evidence of the efficacy of greater occipital nerve block (GONB) for the preventive treatment of cluster headaches. We assessed the efficacy and tolerability of GONB injections as a transitional preventive treatment for episodic cluster headaches (ECH).MethodsThis randomized, double-blind, placebo-controlled, parallel-group trial conducted at GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India, included ECH patients diagnosed by ICHD-3 criteria, aged 18-65, with one or more attacks per 24 h for seven days before randomization (baseline). ECH patients were either not on preventive medications or on stable doses for at least three months. ECH patients were randomized to receive active GONB (2 ml methylprednisolone (80 mg) and 2 ml lignocaine (2%)) and placebo (4 ml saline injections). Before giving GONB, lignocaine jelly was applied topically to mask the effect of numbness following the GONB. The primary efficacy endpoint was the mean change in weekly attack frequency from baseline to Week 4. Efficacy analyses were performed in a modified intention-to-treat population that included all patients who received at least one injection of GONB and had a follow-up for one week following GONB. The safety analysis included treatment-emergent adverse effects (TEAE) in all patients who received at least one dose of investigational product. The trial was registered with the Clinical Trials Registry of India (CTRI/2021/21/038397).ResultsForty ECH patients were randomized between December 2021 and January 2023. Thirty-nine patients (19 in the active and 20 in the placebo groups) were available for efficacy analysis. The change in weekly attack frequency from baseline to Week 4 was -11.1 (95% CI: -8.5 to -4.4) for the active group compared to -7.7 (95% CI: -11.8 to -9.8) for placebo (mean difference -3.4 (95% CI: -5.2 to -1.7, p p = 0.38). The common TEAE were local site bleeding and pain, which were mild and transient. No serious adverse events were reported.ConclusionThis study found that GONB with methylprednisolone and lignocaine significantly reduced the weekly attack frequency from baseline to Week 1 through Week 4 in ECH patients compared to a placebo. GONB was well tolerated.

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PurposeKeloids are unaesthetic benign dermatosis characterized by a disorganized proliferation of collagen. Treatment of keloids constitutes a therapeutic challenge. The aim of this study was to evaluate the efficacy and effectiveness of topical imiquimod associated with surgical excision in the treatment of keloid.MethodsA randomized, double blind, matching-lesion (self-paired manner) clinical trial. Ten patients with two keloid lesions each in similar anatomical and contralateral areas (paired lesions) had their keloids excised, and the operative site treated with the application of 5% imiquimod cream or 0.1% methylprednisolone aceponate cream (gold standard) for eight weeks.ResultsEight patients (total = 16 lesions) completed the study. Four of the total eight keloids (50%) in the methylprednisolone group vs. 3/8 keloids (37.5%) in the imiquimod group recurred in the first post-treatment year (p 0.05).ConclusionSurgical removal plus application of topical imiquimod was shown as safe, and its efficacy was not statistically inferior for the treatment of keloids as compared to methylprednisolone. Due to the lack of efficacy in most therapeutic modalities, surgical removal plus topical imiquimod could be recommended as an additional first line therapy and especially for recurrent keloids. Studies with larger samples are necessary to evaluatre therapies for keloids.

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BackgroundParesthesias occurring during combined spinal-epidural labor analgesia due to needle puncture or epidural catheter placement may lead to nerve injury. We compared the effects of epidural dexamethasone versus methylprednisolone on neurological outcomes.MethodsIn this prospective, randomized, double-blind clinical trial conducted at a Chinese obstetrics hospital, parturients who developed paresthesias during combined spinal-epidural labor analgesia due to needle puncture or epidural catheter placement were randomized to receive an epidural injection of dexamethasone (5 mg) or methylprednisolone (40 mg). The primary outcome was neurological function at 14 days postpartum, including impaired skin sensation, decreased muscle strength, or other neurological symptoms. Secondary outcomes included adverse events and changes in inflammatory biomarkers.ResultsA total of 315 parturients were randomized and completed the study. At 14 days postpartum, the neurological function outcomes did not differ significantly between the two groups (p > 0.05). Among the secondary outcomes, the dexamethasone group had a higher incidence of epidural-related maternal fever (ERMF) (7.6% vs. 2.5%, p p p > 0.05).ConclusionIn parturients who developed paresthesia during combined spinal-epidural labor analgesia, epidural administration of dexamethasone or methylprednisolone resulted in comparable neurological outcomes at 14 days postpartum.Clinical trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2300078866.

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This article was originally published in ACR Open Rheumatology. The version of record is available at: https://doi.org/10.1002/acr2.11596. © 2023 The Authors. ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.Objective To quantify the effect of corticosteroids compared to lidocaine-only injections over 12 weeks among patients with knee osteoarthritis (KOA). Methods Participants with KOA were randomized to receive a knee injection of methylprednisolone acetate 1 mL (40 mg) plus 2 mL lidocaine (1%) or 1 mL saline and 2 mL lidocaine. Participants and providers were blinded to treatment allocation using an opacified syringe. The outcome was the average change from baseline of the total Knee Injury and Osteoarthritis Outcome Score (KOOS) (range 0-100) assessed at 2-week intervals over 12 weeks. Participants received KOOS questionnaires on their smartphones through a web-based platform. We used linear mixed-effects regressions with robust variance estimators to evaluate the association between the intervention and change in KOOS total and subscales (ClinicalTrials.gov identifier NCT03835910; registered 2019-02-11). Results Of the 33 randomized participants, 31 were included in the final analysis. The predicted mean (SE) change in total KOOS over the 12-week follow-up was 9.4 (3.2) in the corticosteroids arm versus −1.3 (1.4) in the control arm (P = 0.003). Of participants, 47% achieved change as large as the minimal clinically important difference (16 units) in the intervention arm compared to 6% of participants in the lidocaine arm. Further, there were greater improvements in the intervention arm for KOOS subscales and for Patient Reported Outcomes Measurement Information System (PROMIS) assessments of pain intensity, behavior, and interference. Conclusion Corticosteroid injections demonstrated clinically meaningful improvements in KOA symptoms over 12 weeks of follow-up. These data support larger studies to better quantify short-term benefits.Dr. Baker would like to acknowledge funding through a Veterans Affairs Clinical Science Research & Development Career Merit Award (I01 CX001703) a Rehabilitation Research & Development Merit Award (I01 CX003644) and SPiRE Award (I21 RX003157). The contents of this work do not represent the views of the Department of the Veterans Affairs or the United States Government

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