EFFECTIVENESS OF A NEW METHOD OF PROVIDING FIRST AID FOR NON-GUNSHOT WOUNDS TO SOFT TISSUE

This study investigates the various methods of pain management during the insertion of intrauterine devices (IUDs) in nulliparous women. Currently, the only recommended method of pain management is 800 mg of ibuprofen taken one hour before insertion of the IUD. However, women continue to experience pain during the procedure. A scoping review was conducted using CINAHL, Medline, Web of Science, and Embase with inclusion criteria being English peer-reviewed articles from the last 10 years, involving nulliparous women of at least 18 years of age. The research reveals that management to minimize pain during IUD insertion can include oral analgesics, cervical blocks, and cervical softening and dilation with prostaglandins. The effect of pain management when using these techniques was further examined throughout the various steps of IUD placement, including cervical grasping, IUD insertion, and post IUD insertion. Ibuprofen is the current recommended analgesic; however, studies show that there was no significant reduction in pain found when ibuprofen is used. Alternatively, 500 mg of naproxen sodium taken prior to IUD insertion showed a significant reduction in post-IUD insertion pain (p=0.01) but did not show any significant reduction in pain during cervical grasping or during IUD insertion into the uterus. Cervical blocks using 1% lidocaine were shown to decrease pain during cervical gripping (p=0.002) and IUD insertion compared to the control group (p=0.005). The results of cervical blocks differed based on whether 1% lidocaine was injected or if a 2% lidocaine gel was used, but no significance was shown. Furthermore, cervical softening and dilation with dinoprostone 3 mg and misoprostol 3 mg demonstrated a reduction in pain during all stages of IUD insertion and after insertion (p<0.01). Pharmacological interventions with oral analgesics, lidocaine, and prostaglandins, such as dinoprostone and misoprostol, have all demonstrated some level of pain control during the IUD insertion procedure, but the use of prostaglandins and 2% lidocaine gel has been demonstrated to have the most clinically significant effect on pain control. Additionally, there has been some research examining the impact of verbal analgesics, which involves the provider using a calm, soothing voice and slow speech to put the patient at ease, and the role that anxiety about IUD insertion can influence pain, but further research is needed to determine its significance. This research provides valuable insight into enhancing the improvement of pain during and after the insertion of IUDs for nulliparous women.

Postoperative pain management is a challenging problem in the clinical practice of endodontics. The aim of this study was to assess and compare the efficacy of local intraligamentary injection of dexamethasone and piroxicam on postoperative pain in mandibular molars with symptomatic irreversible pulpitis. Forty-two patients were included and randomly assigned to three equal groups (n=14). After administration of standard inferior alveolar nerve block, each participant received intraligamentary injection of 0.4 ml of either 8 mg/2 ml dexamethasone, 20 mg/ml piroxicam or 2% mepivacaine. Standard endodontic treatment was performed in a single visit. The pain was assessed by means of the Numerical Rating Scale preoperatively and postoperatively after 4, 6, 12, 24 and 48 hours. All demographic, baseline and outcome data were collected and statistically analyzed.There was no significant difference between the three groups regarding age, gender and preoperative pain. There was a significant reduction in pain in all groups, however, there was a statistically significant reduction in postoperative pain in piroxicam group compared to the mepivacaine group at all time intervals. There was a statistically significant reduction in postoperative pain in the dexamethasone group when compared to the mepivacaine group only at 4, 24 and 48 hours. However, there was no significant difference found at 6 and 12 hours. There was no significant difference between dexamethasone and piroxicam groups. It was concluded that preoperative intraligamentary injection of dexamethasone and piroxicam show a significant success in reducing postoperative pain compared to mepivacaine with no preference regarding using either of them.

A multicenter, randomized, double-blind, placebo- controlled trial of intravenous ibuprofen 400 and 800 mg every 6 hours in the management of postoperative pain

Jellyfish envenomations are common amongst temperate coastal regions and vary in severity depending on the species. Stings result in a variety of symptoms and signs, including pain, dermatological reactions and, in some species, Irukandji syndrome (including abdominal/back/chest pain, tachycardia, hypertension, sweating, piloerection, agitation and sometimes cardiac complications). Many treatments have been suggested for the symptoms and signs of jellyfish stings. However, it is unclear which interventions are most effective. To determine the benefits and harms associated with the use of any intervention, in both adults and children, for the treatment of jellyfish stings, as assessed from randomised trials.

Labor pain during the active phase of the first stage of labor is a major challenge that can affect both the comfort and progress of the birthing process. Non-pharmacological interventions such as the use of a birth ball and hypnobirthing techniques are widely employed as safe and effective alternatives for pain relief. This study aimed to analyze the effect of birth ball and hypnobirthing interventions on reducing labor pain during the active phase of the first stage of labor among mothers delivering at PMB Mira Dahlia, Toboali District, South Bangka Regency, in 2025. A quantitative study was conducted using a quasi-experimental design with a pre-test–post-test non-equivalent control group approach. A total of 46 respondents were selected through purposive sampling. Pain levels were measured using a combination of the Visual Analogue Scale and Wong-Baker Scale before and after the interventions. Data were analyzed using univariate and bivariate analysis with the Wilcoxon Signed Rank Test and Mann-Whitney U Test. The results showed a significant reduction in labor pain after the birth ball intervention, with all respondents experiencing decreased pain levels (Wilcoxon test p = 0.000; p &lt; 0.05). The hypnobirthing intervention also resulted in a significant reduction in pain (Z = -4.260; p = 0.000). However, the Mann-Whitney test showed no significant difference in effectiveness between the birth ball and hypnobirthing interventions (p = 0.061 &gt; 0.05), although the average pain reduction was greater in the birth ball group. It can be concluded that both birth ball and hypnobirthing interventions are effective in reducing labor pain during the active phase of the first stage of labor. While no significant difference was found between the two methods, birth ball showed a slightly higher average reduction in pain compared to hypnobirthing.

Background:Treatments for cosmetically unpleasing periocular and lateral temporal veins are limited. The purpose of this study was to test the hypothesis that the application of topical lidocaine before the cosmetic treatment of periorbital and lateral temporal veins with a neodymium-doped yttrium aluminum garnet (ND:YAG) laser will result in a significant reduction in subjective pain compared with placebo as assessed using a visual analogue scale.Methods:Twenty patients who required bilateral treatment of facial veins were randomly assigned to receive either placebo or 30% lidocaine gel applied topically over the veins, a split-body design. Both the investigator and the patient were blinded to the treatment. An ND:YAG laser was used to treat the veins. Patients completed a visual analogue scale to assess the pain on each side of the face. Data were analyzed using nonparametric data testing.Results:There was a 64.0% reduction in pain on the treatment side compared with the placebo side (P < 0.001). There was no significant difference in patient-assessed subjective efficacy between sides (P = 0.2). Complications were minimal and mild.Conclusions:Patients undergoing periorbital and temporal vein ablation using ND:YAG laser should be offered topical lidocaine as the pain levels are moderate. The use of topical 30% lidocaine results in a significant reduction in pain levels.

Dr Scott has raised some interesting issues and I think these are worth exploring. Firstly, I refer Dr Scott to a review done the same year on the same topic with very similar references [1] to the one that he has quoted. It found very little benefit of epidural analgesia in colorectal surgery. The authors in the reference quoted by Dr Scott state that they were unable to comment on the increase or decrease in anastomotic dehiscence using thoracic epidural analgesia and also comment on the fact that many of the proposed benefits to epidural analgesia were unable to be proven [2]. So we do not believe that the evidence that he has provided supports the safety or efficacy of epidural analgesia in patients who have had colorectal surgery. Regarding the use of the study by Gould et al. [3], we chose this as it is the only study that we are aware of that has clearly demonstrated the relationship between cardiac output, blood pressure and gastro-intestinal tract perfusion. Gould et al. clearly showed that gut perfusion is not related to cardiac output but is related to an increase in perfusion pressure. Most therapies used to treat epidural induced hypotension are based on either fluid loading or decreasing the epidural infusion rate. Fluid loading will optimise cardiac output but will do very little to improve vascular resistance and relying on pain driven catecholamines to increase the blood pressure seems somewhat perverse. It is, of course, very difficult for us to comment on Dr Scott’s 3500 cardiac patients who have had thoracic epidural analgesia. As far as we are aware he has not published any data regarding these patients. This is not the group that we were addressing and they will have different levels of post operative monitoring and therapy to standard laparotomy patients. Without knowing Dr Scott’s definitions, therapy and completeness of the data set, it is impossible to draw any conclusions on the safety of epidurals from his data. The review quoted earlier found an odds ratio of 13.5 for hypotension with epidural analgesia compared to opioid techniques [1]. We would therefore say there is quite a high level of concern. Thirdly we reiterate our point made in the editorial about the MASTER study. We did not say it was a perfect study. We said that it was the most credible study in this area that has been performed. It demonstrates a number of important points but most significantly, how difficult it is to provide adequate epidural analgesia in these patients. Regarding the significant reduction in pulmonary morbidity and pain, we commented in our editorial that there was a statistically significant reduction in pain scores, but that in both groups the pain scores were low. We still feel that a reduction in pain score of 1 cm on a visual analogue score was not clinically significant. Our comment on the MASTER study being a victim of its own success refers to the fact that it is very difficult to prove benefit in terms of pain scores if your background pain score is so low. Failure rates for post-operative epidurals are high. The failure rate in the MASTER study was 42.5%. This is in the context of a study with enthusiasts involved. It is difficult to see that it will be any less in the UK. The study that you quoted suggesting a 20% failure rate in UK hospitals is not reflective of normal UK practice [4]. This survey was performed when patients with epidural analgesia were routinely admitted to High Dependency Unit for post operative care. This, as you pointed out, is no longer the case. The authors also only looked at epidural analgesia for 48 h which we consider to be inadequate. We therefore stand by our figures of 50% of epidurals failing and possibly even higher. We do however agree with Dr Scott that if you are going to provide an epidural service you must have the ability to adequately assess the effect of your epidural analgesia, strive for total dynamic analgesia and be able to rapidly resite or adjust the epidural. This is both costly and time consuming to provide this service on a 24 h basis. Considering both the decrease in the numbers and experience of junior trainees, it is likely that this role is going to fall to consultants. We are not sure that the cost of providing this service is justified.

Famciclovir is a guanine analog antiviral drug used commonly for herpes zoster. Efficacy of famciclovir treatment has been reported to be comparable to valacyclovir treatment. Both of these medications reduce the time to complete cessation of zoster-associated pain including post-herpetic neuralgia, as compared to acyclovir. We conducted a multicenter, randomized, open clinical trial in order to evaluate the extent of pain relief afforded by these two antiviral drugs during the acute disease phase of herpes zoster. The study group comprised 86 immunocompetent adult patients suffering from herpes zoster, who were treated with either famciclovir or valacyclovir for 7 days. Of these, 55 patients enrolled in this study within 72 h of the onset of the rash and 31 patients after 72 h of the onset. There was a significant reduction in acute herpes zoster pain with famciclovir on day 7 and at 2-3 weeks in both of these patient groups, while with valacyclovir, there was not significant reduction in pain on day 7. Of patients aged 50 years or older, there was a significantly earlier reduction in pain with famciclovir than with valacyclovir. In addition, a significant reduction in the number of patients with pain was observed as early as days 3-4 with famciclovir treatment as compared with valacyclovir treatment. We conclude that famciclovir was superior to valacyclovir in the relief of acute pain of herpes zoster. Accordingly, famciclovir is recommended for herpes zoster patients with moderate symptoms and a visual analog scale score of under 50 mm.

Pain reduction is a common goal of the treatment of upper limb spasticity with botulinum toxin (BoNT-A). ULIS-III was a large international, observational, longitudinal study (N = 953) conducted in real-life clinical practice over two years. In this secondary post hoc analysis, we examine whether goals for pain reduction were met over repeated injection cycles. We report serial changes in pain severity and explore predictors of pain reduction and injection frequency. Patients were selected if pain reduction was a primary/secondary goal for at least one cycle (n = 438/953). They were assessed at the start and end of each cycle using the goal attainment T-score alongside a self-report of pain severity (range 0-10). Across all cycles, pain-related goals were set for 1189/1838 injections (64.7%) and were achieved in 839 (70.6%). Patients continued to show a significant reduction in pain (p < 0.001) for each injection up to seven cycles, with some cumulative benefit (p < 0.001). Those requiring more frequent injections tended to have higher starting pain scores and a smaller reduction in pain score, but these differences were not significant when other covariates (age, previous injection history, time since onset, severity and distribution of spasticity) were taken into account (p > 0.713). Conclusion: Repeated BoNT-A administration continued to result in a significant reduction in upper limb spasticity-related pain, regardless of patient-related factors.

Background and Objectives:With advances in laparoscopic surgery, the goal of surgeons and patients is to minimize pain to allow for faster recovery and return to normal daily activities. One of these advances is single-site surgery. In this study, we compared postoperative pain in laparoendoscopic single-site surgery (LESS) to that in traditional multiple-incision hysterectomy.Methods:Seventy patients were selected for this prospective cohort study, with 35 undergoing multiple-incision and 35 undergoing LESS hysterectomy. All patients were included who were undergoing hysterectomy with the primary surgeon. All multiport hysterectomies were performed laparoscopically. Six patients underwent LESS hysterectomy and 29 underwent robotic single-site surgery (rLESS). Patients recorded pain levels for 3 weeks after surgery on a variety of measures, including overall and incisional pain. Linear mixed effects models for repeated measures were used for all multivariate analyses, with an unstructured covariance matrix accounting for correlation between time points.Results:Overall, across all time points, there was an average reduction in pain by 1.26 (SD 0.69) points in the single-site group (P = .06). Days 3 and 14 had a marginally significant reduction in pain (P = .06 and 0.058, respectively). On days 4 and 7 there was a significant reduction in overall pain (P = .04 and .04, respectively).Conclusion:Based on the results, it is likely that single-site hysterectomy leads to less postoperative pain and achieves a lower pain score faster than multiport surgery. A randomized control trial is necessary to confirm these results before accepting them in clinical practice.

ObjectiveThe aim of this study was to evaluate the efficacy and safety of a 60‐day peripheral nerve stimulation (PNS) treatment targeting the occipital nerves for reducing pain and improving function in individuals diagnosed with cervicogenic headache or occipital neuralgia.BackgroundHeadache conditions are prevalent and commonly disabling, and conventional therapeutic strategies are often insufficient. Development of a percutaneous 60‐day PNS treatment has created new opportunities to evaluate PNS of the occipital nerves.MethodsThis study was an institutional review board‐approved, multicenter, prospective, single‐arm study that enrolled participants from October 2022 to March 2024. Participants with cervicogenic headache or occipital neuralgia received a 60‐day PNS treatment targeting the occipital nerves. The primary endpoint was the proportion reporting clinically significant (≥30%) reductions in average pain and/or pain interference at end of treatment (EOT). Additional analysis included the proportion of participants with ≥50% reduction in average pain intensity and/or pain interference and additional outcomes including Patient Global Impression of Change, six‐item Headache Impact Test, and Neck Disability Index.ResultsAt EOT, 90% of participants (18/20) met the primary endpoint. Further, 85% (17/20) and 83% (15/18) reported ≥50% reductions in pain and/or pain interference at EOT and 3 months, respectively. Clinically meaningful improvements were observed in functional and headache‐related disability and quality‐of‐life measures. All study‐related adverse events were non‐serious.ConclusionMost participants reported significant reductions in pain and/or pain interference following 60‐day PNS targeting the occipital nerves. Outcomes through 3 months demonstrate how 60‐day PNS offers an effective approach for the treatment of headache.

PURPOSE: The outcomes of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) in oncologic amputees have been limited to small series. Herein, we report the MD Anderson experience with the surgical and postamputation outcomes of TMR and RPNI in the oncologic population. METHODS: We conducted a retrospective cohort study of consecutive patients who underwent oncologic amputation followed by TMR or RPNI from November 2018 to May 2022. Patient-reported Outcomes Measurement System (PROMIS) and Numerical Rating Scales for residual limb pain (RLP) and phantom limb pain (PLP) were obtained and compared with published benchmarked outcomes. RESULTS: We compared 68 patients with oncologic amputation at our institution with 727 patients with benchedmarked outcomes. Patients had mean follow-up period of 10.9±8.7 months. Oncologic amputees experienced significant reductions in pain intensity (-5.39; 95%CI,-4.28, -6.50; p<0.001), interference (-11.98; 95%CI, -8.19, -15.8; p<0.001), behavior (-32.95; 95%CI, -25.5,-40.4; p<0.001) and global health (-26.25; 95%CI, -22.09, -30.42; p<0.001) following TMR or RPNI from baseline to final follow-up. Delayed wound healing was the most common complication (14.7%) and tumor recurrence occurred in 36.8% of patients. Compared with benchedmarked outcomes, oncologic amputees who underwent TMR or RPNI demonstrated significantly lower median PLP (0.0 vs. 4.0, p<0.001), RLP (1.0 vs. 4, p<0.001), pain intensity (6.0 vs. 46.6, p<0.001), pain interference (9.5 vs. 55.9, p<0.001), and pain behavior (36.0 vs. 56.7, p<0.001) scores. CONCLUSION: Oncologic amputees who underwent TMR and RPNI demonstrated significant reductions in postamputation pain compared with their baseline and benchedmarked outcomes with relatively low postoperative complications rate.

Subtenons lidocaine injection for postoperative pain relief after strabismus surgery in children: A prospective randomized controlled trial

Background: Pulsed radiofrequency (PRF) applied to the dorsal root ganglion (DRG) has been proposed as an effective neuromodulator treatment for persistent radicular pain. Autologous conditioned serum (ACS) therapy, derived from the patient’s own blood, offers a conservative approach. This study aims to evaluate the efficacy of ACS applied to the DRG as an adjunct in treating lower limb radicular pain (LLRP). Methods: A prospective, randomized, double-blind, placebo-controlled clinical trial was conducted comparing PRF combined with ACS versus PRF with physiological saline (PhS) on the DRG. Seventy patients (35 per group) with radicular pain lasting ≥6 months and refractory to previous treatments were enrolled. The primary outcome measure was the Numeric Pain Rating Scale (NPRS); secondary measures included the Oswestry Disability Index (ODI), Mood Assessment Scale (MOAS), SF-12 quality of life questionnaire, and DN4 neuropathic pain scale. Assessments occurred at baseline, 1 month, 3 months, 6 months, and 12 months post-intervention. Results: A total of 70 patients were included. The ACS group showed a significant reduction in pain compared to controls at 30 days (p < 0.05). Additionally, neuropathic symptoms such as tingling, numbness, stubbing, and burning decreased significantly in the ACS group during this period (p < 0.05). While both groups experienced pain reduction over time, no significant differences persisted at 6 months. No adverse effects were reported. Conclusions: The addition of ACS to PRF provides a short-term, statistically significant reduction in radicular pain at 30 days, suggesting it is a safe and effective adjunct therapy for lower limb radicular pain.

Background:Postoperative pain can occur because of residual infection even after effective chemomechanical preparation. This study aimed to compare postoperative pain after chemomechanical preparation with placebo and laser irradiation in nonvital teeth having symptomatic apical periodontitis.Materials and Methods:Sixty (n = 30) participants after obtaining written consent were enrolled in the study. In Group 1, chemomechanical preparation followed by mock laser therapy was carried out in which laser tip was applied but not activated. In Group 2, chemomechanical preparation followed by a laser irradiation was applied and activated. Postoperative pain scores were evaluated at baseline, 24 h, 48 h, and 72 h using the Visual Analog Scale. Preoperative and postoperative percussion pain scores were also recorded. Subjects needing rescue medication were recorded as well. Mann–Whitney U test and Wilcoxon test were used for intergroup comparison and intragroup comparison. The Chi-square test was used for comparing rescue medication.Results:There was significant reduction in pain scores in the laser group as compared to placebo group at all time points. There was also significant difference in the preoperative and postoperative percussion pain scores. 9 and 3 subjects required rescue medication in Groups 1 and 2, respectively.Conclusion:Laser irradiation following chemomechanical preparation led to significant reduction in postoperative pain and can be considered as a valuable adjunct.