Priya Agrawal

All Publications

• The Use of a New Device-Assisted Needle Guidance versus Conventional Approach to Perform Ultrasound Guided Brachial Plexus Blockade: A Randomized Controlled Study LOCAL AND REGIONAL ANESTHESIA Vydyanathan, A., Agrawal, P., Shetty, N., Nair, S., Shilian, N., Shaparin, N. 2022; 15: 61-69

  View details for DOI 10.2147/LRA.S363563

  View details for Web of Science ID 000833829400001

• Incidence of vocal cord paresis following ultrasound-guided interscalene nerve block: An observational cohort study. Best practice & research. Clinical anaesthesiology Gritsenko, K., Polshin, V., Agrawal, P., Nair, S., Shaparin, N., Gruson, K., Tan-Geller, M. 2019; 33 (4): 553-558

  Abstract

  Interscalene brachial plexus block (IBPB) has become a standard practice for perioperative analgesia for shoulder procedures. However, several side effects may occur owing to its anatomic location. We have chosen to evaluate vocal cord paresis and dysphonia following interscalene blocks.After IRB approval, eight patients undergoing arthroscopic shoulder procedures were recruited into this prospective cohort study. Following informed consent, vocal cords were assessed by standardized fiberoptic evaluation. Subsequently, IBPB was performed under ultrasound (US) guidance. Patients were re-evaluated for vocal cord changes by a repeat fiberoptic assessment one hour following IBPB. Our primary outcome measure was incidence of vocal cord immobility.No patients had diminished vocal cord motion, dysphonia, or dysphagia.Although larger studies are required to determine the true incidence of vocal cord paresis following US-guided IBPB, our results suggest that incidence of unwanted nerve blockade other than brachial plexus is much lower than that previously described.

  View details for DOI 10.1016/j.bpa.2019.05.006

  View details for PubMedID 31791570

• A Retrospective Case Series of a Novel Spinal Cord Stimulator Trial Technique with Less Displacement and Migration of the Trial Leads. Pain research & management Shaparin, N., Gritsenko, K., Agrawal, P., Kim, S., Wahezi, S., Gitkind, A., Hascalovici, J., Vydyanathan, A., Bernstein, J., Dizdarevic, A., Mehta, N., Kaufman, A. 2019; 2019: 1236430

  Abstract

  Spinal cord stimulation is an established treatment option for certain chronic pain conditions which have been previously unresponsive to conservative therapies or potentially for a subset of patients who have not improved following spine surgery. Prior to permanent lead implantation, stimulator lead trials are performed to ensure adequate patient benefit. During these trials, one of the most common complications and reasons for failure is the displacement and migration of the trial leads, resulting in lost therapeutic coverage. Other complications include infection and dislodged bulky dressings. There is a paucity of literature describing an adequate procedural method to prevent these common complications.This study utilizes a series of 19 patients to evaluate a new technique for securing percutaneous spinal cord simulator trial leads, which may minimize dislodgement and migration complications and improve the rate of trial success.Retrospective case series.New Jersey Medical School, Department of Anesthesiology, Pain Management Division.A retrospective chart review was conducted on 19 consecutive patients undergoing placement of the percutaneous thoracic spinal cord stimulator trial leads for pain associated with lumbar spine pathology over a two-year period (2010-2012).Of the 19 patients in our cohort, there was one trial lead displacement, no lead migrations, and no site infections. Thirteen patients went on to permanent lead implantation. This improved trial lead placement technique had a high success rate with a low number of complications.Small sample size, retrospective case series, and no control group for comparison.This case series was able to demonstrate that our described novel spinal cord stimulator trial lead placement and dressing technique can decrease the incidence of lead displacement and migration, thus improving trial success.

  View details for DOI 10.1155/2019/1236430

  View details for PubMedID 31281554

  View details for PubMedCentralID PMC6590507

• Spinal Cord Stimulation 50 Years Later: Clinical Outcomes of Spinal Cord Stimulation Based on Randomized Clinical Trials-A Systematic Review. Regional anesthesia and pain medicine Mekhail, N., Visnjevac, O., Azer, G., Mehanny, D. S., Agrawal, P., Foorsov, V. 2018; 43 (4): 391-406

  Abstract

  To assess the efficacy of spinal cord stimulation (SCS) for each indication, one must critically assess each specific clinical outcome to identify outcomes that benefit from SCS therapy. To date, a comprehensive review of clinically relevant outcome-specific evidence regarding SCS has not been published. We aimed to assess all randomized controlled trials from the world literature for the purpose of evaluating the clinical outcome-specific efficacy of SCS for the following outcomes: perceived pain relief or change pain score, quality of life, functional status, psychological impact, analgesic medication utilization, patient satisfaction, and health care cost and utilization. Interventions were SCS, without limitation to the type of controls or the type of SCS in the active arms. For each study analyzed, a quality assessment was performed using a validated scale that assesses reporting, external validity, bias, confounding, and power. Each outcome was assessed specific to its indication, and the primary measure of each abovementioned outcome was a summary of the level of evidence. Twenty-one randomized controlled trials were analyzed (7 for trunk and limb pain, inclusive of failed back surgery syndrome; 8 for refractory angina pectoris; 1 for cardiac X syndrome; 3 for critical limb ischemia; 2 for complex regional pain syndrome; and 2 for painful diabetic neuropathy). Evidence assessments for each outcome for each indication were depicted in tabular format. Outcome-specific evidence scores were established for each of the abovementioned indications, providing both physicians and patients with a summary of evidence to assist in choosing the optimal evidence-based intervention. The evidence presented herein has broad applicability as it encompasses a breadth of patient populations, variations of SCS therapy, and comparable controls that, together, reflect comprehensive clinical decision making.

  View details for DOI 10.1097/AAP.0000000000000744

  View details for PubMedID 29481371

• A Comprehensive Outcome-Specific Review of the Use of Spinal Cord Stimulation for Complex Regional Pain Syndrome. Pain practice : the official journal of World Institute of Pain Visnjevac, O., Costandi, S., Patel, B. A., Azer, G., Agarwal, P., Bolash, R., Mekhail, N. A. 2017; 17 (4): 533-545

  Abstract

  Complex regional pain syndrome (CRPS) is a painful, debilitating affliction that is often difficult to treat. It has become common international practice to use spinal cord stimulation (SCS) for the treatment of CRPS as other therapies fail to provide adequate relief, quality of life, or improvement in function. This comprehensive outcome-specific systematic review of the use of SCS for CRPS was performed to elucidate the available evidence with focus on clinically relevant patient-specific outcomes.A systematic review of the literature was conducted to evaluate the effects of SCS on patients with CRPS for the following outcomes and provide summary levels of evidence in regard to each outcome: perceived pain relief, pain score, resolution of CRPS signs, functional status, quality of life, psychological impact, sleep hygiene, analgesic medication utilization, and patient satisfaction with SCS therapy. Search terms included "complex regional pain syndrome," "spinal cord stimulation," and "reflex sympathetic dystrophy," without restriction of language, date, or type of publication, albeit only original data were included in analyses. Of 30 studies selected, seven systematic reviews were excluded, as were four studies reporting combination therapy that included SCS and other therapies (ie, concurrent peripheral nerve stimulation, intrathecal therapy) without clear delineation to the effect of SCS alone on outcomes. A total of 19 manuscripts were evaluated.Perceived pain relief, pain score improvement, quality of life, and satisfaction with SCS were all rated 1B+, reflecting positive high-level (randomized controlled trial) evidence favoring SCS use for the treatment of CRPS. Evidence for functional status improvements and psychological effects of SCS was inconclusive, albeit emanating from a randomized controlled trial (evidence level 2B±), and outcomes evidence for both sleep hygiene and resolution of CRPS signs was either nonexistent or of too low quality from which to draw conclusions (evidence level 0). An analgesic sparing effect was observed in nonrandomized reports, reflecting an evidence level of 2C+.Spinal cord stimulation remains a favorable and effective modality for treating CRPS with high-level evidence (1B+) supporting its role in improving CRPS patients' perceived pain relief, pain score, and quality of life. A paucity of evidence for functional improvements, resolution of CRPS signs, sleep hygiene, psychological impact, and analgesic sparing effects mandate further investigation before conclusions can be drawn for these specific outcomes.

  View details for DOI 10.1111/papr.12513

  View details for PubMedID 27739179