Open surgical correction is the current standard of care, but is not without risks. Blood loss, infection, prolonged hospital stay, and postoperative pain may occur regardless of surgical approach. Posterior cervical decompression requires subperiosteal stripping of the paraspinal muscles, which can result in postoperative pain, muscular spasms, and loss of function [ 15 ]. Anterior approaches are also frequently used, but carry significant risk of esophageal or neurovascular injury and damage to tissues along the plane of section, including major organs [ 16 ].
Bauer et al (2014) noted that pain following TKR is a challenging task for healthcare providers. Concurrently, fast recovery and early ambulation are needed to regain function and to prevent post-operative complications. Ideal post-operative analgesia provides sufficient pain relief with minimal opioid consumption and preservation of motor strength. Regional analgesia techniques are broadly used to answer these expectations. Femoral nerve blocks are performed frequently but have suggested disadvantages, such as motor weakness. The use of lumbar epidurals is questioned because of the risk of epidural hematoma. Relatively new techniques, such as local infiltration analgesia or adductor canal blocks, are increasingly discussed. The present review discussed new findings and weighted between known benefits and risks of all of these techniques for TKR. Femoral nerve blocks are the gold standard for TKR. The standard use of additional sciatic nerve blocks remains controversial. Lumbar epidurals possess an unfavorable risk/benefit ratio because of increased rate of epidural hematoma in orthopedic patients and should be reserved for lower limb amputation; peripheral regional techniques provide comparable pain control, greater satisfaction and less risk than epidural analgesia. Although motor weakness might be greater with FNBs compared with no regional analgesia, new data pointed towards a similar risk of falls after TKR, with or without peripheral nerve blocks. Local infiltration analgesia and adductor canal blockade are promising recent techniques to gain adequate pain control with a minimum of undesired side-effects. The authors concluded that FNBs are still the gold standard for an effective analgesia approach in knee arthroplasty and should be supplemented (if needed) by oral opioids. An additional sciatic nerve blockade is still controversial and should be an individual decision. Moreover, they stated that large-scale studies are needed to reinforce the promising results of newer regional techniques, such as local infiltration analgesia and adductor canal block.
I also knew that many of the patients I was treating were suffering not only from pain stemming from degeneration, but also pain from inflammation. The two were often combined. This became very obvious to me after treating several cases in which the patients had been previously treated with injectable corticosteroids. The previous use of steroids not only did not interfere with ozone therapy, in some cases it actually seemed to help the process along. So I made a homeopathic dilution of methylprednisolone, and began adding it to the pre-injection mixture. To this I also added an anti-inflammatory homeopathic combination called Traumeel™. My results continued to improve. But something else also occurred to me.