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

INTRODUCTION: Frozen shoulder is a very common musculoskeletal condition and the evidence related to the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in individuals with frozen shoulder is rare. Therefore, this study aims to compare and investigate the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in a frozen shoulder. METHODS: ) three sessions a week for 4 weeks. The placebo group (n = 30, age 53.56 ± 5.5 years) received lidocaine injection with placebo treatment (a special head that blocked the shock waves) three sessions a week for 4 weeks. Both groups received progressive resistance exercises (PRE) to the shoulder muscles. The primary outcome was pain intensity, measured with the visual analogue scale. The other outcome measures were the thickness of the coracohumeral ligament (CHL) measured by magnetic resonance imaging (MRI), abduction, and lateral rotation range of motion (ROM), functional disability, kinesiophobia, depression status, and quality of life. Participants were assessed at baseline, after 4 weeks, 8 weeks, and at 6-month follow-up. RESULTS: The post-intervention at 4 weeks showed an improvement of 2.0 (CI 95% 1.71-2.28) in the active group compared to the placebo group. Similar effects were noted after 8 weeks (2.2) (CI 95% 1.91-2.48) and at the 6-month (1.9) (CI 95% 1.61-2.18) follow-up. Similar improvements were also found in the thickness of the CHL ligament (0.6) (CI 95% 0.46-0.73), abduction and lateral rotation (ROM) (- 23.6) (CI 95% - 27.47 to -19.72), (- 18.10) (CI 95% - 19.72 to - 16.47), functional disability (16.2) (CI 95% 14.85-17.54), kinesiophobia (11.0 (CI 95% 10.21-11.98), depression status (4.4) (CI 95% 4.03-4.76) and quality of life (0.9) (CI 95% 0.79-1.00) (p = 0.001) at the 6-month follow-up period, where mean estimates and their confidence intervals all included worthwhile effects. There were no adverse reactions or side effects noted in either the active or placebo groups during and after the treatment. CONCLUSIONS: The study concluded that the addition of extracorporeal shockwave therapy after intra-articular lidocaine injection improves pain, functional disability, range of motion, kinesiophobia, depression status, and quality of life in people with frozen shoulder. TRIAL REGISTRATION: https://ctri.nic.in , identifier; CTRI/2020/04/024834 prospectively registered on 24/04/2020.

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Aim To evaluate the efficacy and safety of greater occipital nerve (GON) block combined with triple therapy versus triple therapy alone in the treatment of acute migraine in the emergency department for severe or refractory cases setting. Methods We conducted a prospective, randomized, controlled trial without use of placebo control in adult patients with migraine according to International Classification of Headache Disorders, 3rd editon criteria. Patients were randomly assigned (1:1), without blinding method, to receive either a GON block (methylprednisolone 80 mg + lidocaine 20 mg) plus triple intravenous therapy (ketorolac, paracetamol, metoclopramide) or triple therapy alone. The primary outcome was the proportion of patients achieving ≥50% reduction in headache intensity on a visual analog scale (VAS) two hours post-treatment. Secondary outcomes included changes in monthly migraine days, pain-free days, Headache Impact Test-6 (HIT-6) scores and hospital readmissions at 30-day follow-up. Results Forty-two patients were enrolled (21 per group). A ≥50% VAS reduction at two hours occurred in 95.2% of patients receiving the GON block versus 47.6% in the control group ( p = 0.0003). Median pain reduction was 6.0 vs. 3.0 points, respectively ( p < 0.001). At 30 days, the intervention group reported fewer migraine days (median 3.0 vs. 7.0 days; p = 0.0355), more pain-free days (14.0 vs. 5.0 days; p = 0.0379) and lower HIT-6 scores (59.0 vs. 65.0; p = 0.1584). Readmission rates were lower in the intervention group (9.5% vs. 23.8%) but not statistically significant. Adverse events associated with the GON block were mild and transient, including local pain (47.6%) and minor bleeding (14.3%). Conclusions GON block as an adjunct to triple therapy is effective and well tolerated for the acute treatment of migraine, providing significant short-term relief and improving outcomes at 30-day follow-up. Our failure to blind the outcome assessors limit the validity of our results, which supports the use of GON block as an adjunct to parenteral therapy for patients with migraine in the emergency department. Trial Registration This study was not registered in a public trial registry.

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Background Paresthesias 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. Methods In 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. Results A 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 < 0.05), and the 24-h postpartum serum Interleukin-6 (IL-6) level was significantly higher than that in the methylprednisolone group [26.1 (18.2–38.9) pg./mL vs. 15.4 (13.2–17.6) pg./mL, p < 0.05]. There were no significant differences between the two groups in postpartum hemorrhage, nausea and vomiting, instrumental delivery rate, Neonatal Intensive Care Unit (NICU) admission rate, or 24-h postpartum serum C-reactive protein (CRP) level ( p > 0.05). Conclusion In 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 registration https://www.chictr.org.cn/ , identifier ChiCTR2300078866

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Background: Knee osteoarthritis is a chronic degenerative condition often viewed as an inevitable aspect of aging. It leads to the progressive deterioration of articular cartilage, resulting in pain and significant limitations in global movement. Intra-articular steroid injections are effective for pain control and functional improvement. This study focuses on Betamethasone Dipropionate and Methylprednisolone Acetate, both of which have shown promising outcomes, evaluated at the Korle Bu Teaching Hospital. Objective: The study aimed to compare the effectiveness of betamethasone dipropionate and methylprednisolone acetate in managing Kellgren Lawrence (KL) stage 2 to 4 primary knee osteoarthritis. Design: This was a single-blinded comparative study conducted at the Orthopaedic Clinic of a tertiary hospital. Participants: Patients with osteoarthritis in one or both knees, presenting with a pain score of ≥4 on a 0-10 Visual Analogue Scale (VAS), were included. Main Outcome Measure: Effectiveness in controlling pain and improving function. Results: The average age of participants was 60 years. At two weeks, the P-values for VAS and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between groups A and B were 0.495 and 0.927, respectively. At four weeks, these values were 0.810 and 0.372. However, by twelve weeks, the P-values for VAS and WOMAC scores were 0.026 and 0.0235, indicating significant differences. Conclusions: Both steroid injections provided symptom relief; however, Betamethasone Dipropionate demonstrated superior long-term effectiveness compared to Methylprednisolone Acetate, offering better sustained pain relief beyond eight weeks. Funding: None declared.

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Background: The greater occipital nerve block (GON-B) is used in clinical practice for treating different forms of headache. There is no standardized procedure to perform GON-B. This study evaluates the efficacy and feasibility of a low-volume GON-B protocol utilizing a pre-mixed solution of lidocaine (10 mg) and methylprednisolone (40 mg) across various headache disorders. Methods: This observational case series included patients receiving their first GON-B from November 2019 to February 2021. Participants were diagnosed with migraine, cluster headache, cervicogenic headache, or paroxysmal hemicrania. The primary outcome was the degree of response to the GON-B. Results: Thirty-nine patients with migraine underwent a first GON-B. Regarding headache frequency, 26% achieved substantial response and 33% partial response. For headache intensity, 26% reported substantial and 49% partial improvement. Migraine patients experienced a significant reduction in median monthly headache days from 25 to 13 (p=0.001) and in headache intensity from a median of 8 to 6 on the Numerical Rating Scale (NRS) scale (p<0.001). Of the 27 patients receiving a second GON-B, 33% had a substantial response, 48% a partial response, and 19% no response. Results from subsequent sessions were consistent with these findings. Ten patients with cluster headache underwent GON-B, showing a significant reduction in pain intensity from a median NRS score of 10 to 5 (p=0.008). Two patients with cervicogenic headache showed a partial response to GON-B, with pain intensity decreasing from 8 to 6 and 8 to 7 over 30 monthly episodes. A patient with paroxysmal hemicrania received seven GON-B injections, reducing daily attacks from 30 to 10 and pain intensity from 7 to 6 on the NRS scale. Conclusions: These outcomes affirm GON-B potential in interrupting pain pathways, even at a low dose, in a wide range of headache disorders.

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Red ear syndrome (RES) is a rare condition of unknown etiology characterized by episodic attacks of unilateral ear pain, redness, and burning sensation. A 31-year-old male patient was admitted to our clinic with a severe headache reaching up to 5 h, presenting with short bursts of electric shock-like sensation, burning, and tingling in the left side of his face. The patient was unresponsive to previous medical treatments. Lidocaine 10% through the intranasal route for sphenopalatine ganglion and stellate ganglion blockade under the guidance of fluoroscopy also failed. Given that the Red-Ear syndrome shares similar pathophysiological pathways with trigeminal autonomic cephalalgias, the patient was treated with high-dose intravenous methylprednisolone, and since then, he has been symptom-free for 6 months. High-dose steroid therapy might be a good alternative in late-onset RES as a transition treatment.

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Background: Local anesthetics (LAs) are widely used, but true immune-mediated allergies are rare. Most adverse events are toxic or autonomic, yet patients are frequently mislabeled as allergic. This study aims to determine the prevalence of allergy evaluation and testing following suspected reactions to LAs. Methods: A cross-sectional retrospective study was conducted with a total of 126 patients. The study collected medical records from tertiary care hospitals in Saudi Arabia from 2016 to 2022, analyzing patients with reported allergic reactions to LA. The analysis included demographics, occurrences, medical procedure type, and allergy testing history. Results: Lidocaine was the most common agent, involved in over 90% of cases. Reactions primarily followed injections, with symptoms ranging from rash and itching to anaphylactic shock. Despite these events, only 10 patients (7.94%) were referred for further investigation. Allergy testing was performed in only three patients (2.38%). Among those tested, one was negative, while two tested positive (one for lidocaine and one for a lidocaine-bupivacaine combination). Conclusion: The study highlights a low prevalence of follow-up allergy testing despite reported adverse reactions. Systematic testing is essential to confirm or rule out true LA allergies, ensuring patient safety and identifying viable anesthetic alternatives for future procedures.

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