Average Visual Analogue Score Research Articles

Novel single-entry point injection technique for masseter hypertrophy treatment using botulinum neurotoxin based on patient-reported comfort.

Botulinum neurotoxin (BoNT) injections are widely used for the treatment of masseter muscle hypertrophy in Southeast Asia. However, there remains a lack of consensus regarding the optimal injection technique. This study aimed to compare the efficacy and patient discomfort associated with single-entry point injections versus multiple three-point injections for masseter muscle hypertrophy treatment with BoNT. Sixteen participants, comprising both male and female Korean adults aged 22-63, were enrolled in the study. On the left side of the face, single-entry point injections were administered, followed by multidirectional injections, while on the right side, three-point injections were given. Pain intensity during the procedure was assessed using visual analogue scale scores. Our results revealed that participants experienced lower levels of pain with single-entry point injections compared to three-point injections (average visual analogue scores of 3.31 and 5.19, respectively). These findings highlight the potential benefits of single-entry point injections in reducing patient discomfort during masseter muscle hypertrophy treatment with BoNT. We advocate for further research to validate these findings and encourage practitioners to consider single-entry point injections as a viable option for enhancing treatment outcomes in their clinical practice.

Opening Side of Unilateral Open-Door Laminoplasty Does Not Impact Improvement in Arm Pain or Space Available for the Spinal Cord.

Background/Objectives: There exists limited data guiding open-door laminoplasty. The objective of this study is to determine if open-door laminoplasty affects radiographic decompression or arm pain outcomes. Methods: Adult patients who underwent unilateral open-door laminoplasty cervical myelopathy were included. The side opened was dependent on surgeon discretion. We recorded preoperative side of symptoms, side of radiographic compression, arm pain scores, and canal diameter. Patients with open-side ipsilateral or contralateral to dominant symptoms or compression were compared to determine any effect on arm pain outcomes or spinal canal diameter. If the symptoms were equal bilaterally, patients were neutral. Results: A total of 167 patients were included, with an average age of 64 ± 11 years and average follow-up time of 64.5 ± 72 weeks. The average preoperative arm pain visual analog score (VAS) was 2.13 ± 2.86, and the average arm VAS after 6 months was 1.52 ± 2.68. For dominant symptoms, the ipsilateral, contralateral, and neutral groups had a significant improvement in arm VAS at >6 months postoperatively. For dominant compression, the ipsilateral and contralateral groups had a significant improvement in both arm VASs and canal diameter at >6 months postoperatively. No differences were seen between groups for either. We observed a significant correlation between size of plate and change in canal diameter; however, no differences were noted for arm pain. Conclusions: Laminoplasty may be effective in addressing radicular arm pain by increasing the spinal canal's diameter and space available for the cord. The laterality of open-door laminoplasty did not affect arm pain improvement or canal expansion.

The effect of acupressure on pain levels and physiologic indicator in patients undergoing laparoscopic cholecystectomy: A double-blind, randomized clinical trial

BackgroundPostoperative shoulder-tip pain (STP) is a common complication following laparoscopic cholecystectomy (LC). The study seeks to determine whether acupressure can be used as an alternative to medication for pain relief, as medications often come with side effects. This study aims to evaluate the effect of acupressure on pain levels and physiological indicators in patients undergoing LC. Materials and methodsThis double-blind, randomized clinical trial was conducted on 81 patients who underwent LC at Al-Zahra Hospital of Isfahan University of Medical Sciences, Isfahan, Iran, in 2022. The patients were divided into two groups: the intervention group, which received acupressure (42 participants), and the control group (39 participants). The selected pressure points were LI11, LI4, SJ5, HT7, P6, and K1. Demographic and clinical data were collected, and the pain level was evaluated using the visual analogue score (VAS). The data was analyzed using SPSS version 16 software with a significance level of p < 0.05. ResultsThe intervention and control groups were homogeneous in terms of age, gender, duration of surgery, and pethidine consumption (p > 0.05). The average VAS significantly decreased in both the intervention and control groups (p < 0.001). The intervention group had a significantly higher reduced score compared to the control group, 30 min and 72 h after applying acupressure (p < 0.001). Significant differences were observed between the two groups in terms of changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and breath rate (BR) (p < 0.05). Conclusionsacupressure can effectively improve STP and physiological indicators in patients undergoing LC. Trial registration noIRCT20150715023216N14 (Registration date: 2023-01-22, https://irct.behdasht.gov.ir/user/trial/68111/view).

Mid-term outcomes using a ‘kinematic retaining’ total knee replacement – A multicentre prospective study at five years follow-up

BackgroundAlthough total knee replacement (TKR) surgery has succeeded in improving pain and deformity, a proportion of patients remain incompletely satisfied with their outcome. This prospective study aims to assess the survivorship, clinical, and radiological outcomes using a novel ‘kinematic retaining’ (KR) implant. Methods156 patients underwent TKR surgery for primary osteoarthritis using the Physica KR implant at three European Centres. Patients were followed up for five years using both radiographic and clinical evaluations. ResultsWithin 6 months post-operatively, 79.4% and 85.9% had good-excellent clinical and functional KSS values, this was maintained to 76.9% and 79.5% at five years. Mean Knee Society Score (KSS) improvement at 5 years was 32.8 (from 23 to 40) and 37.4 (from 30 to 50) (p < 0.01). All Knee Injury and Osteoarthritis Outcome Score (KOOS) sub-scores showed statistically significant improvement from before surgery at a mean of 34.7 (SD ± 16.1) to a mean of 86.6 (SD ± 16.1) at five years. The mean Oxford Knee Score (OKS) was 43.7 (±5.6), with over 80% of the patients having a good-excellent outcome at five years. OKS improved significantly by six weeks after surgery (p < 0.01) and remained constant throughout the 5-year follow-up. Visual Analogue Score (VAS) Satisfaction scores improved significantly after the post-operative time point of six weeks. From 1 year to 5 years, the average VAS was over 85 mm. The Forgotten Joint Score (FJS) increased from 64.5 at 1 year to 79.2 at 5 years after surgery (p < 0.01). No progressive adverse radiographic features were noted. Two patients were revised during the study period: one for infection and the other for aseptic loosening. ConclusionsThis novel ‘kinematic retaining’ knee prosthesis has shown exceptional clinical and patient-reported improvements, with a remarkable 99.4% survivorship (95.5–99.9) at five years.

DAY-CASE TOTAL ANKLE ARTHROPLASTY

IntroductionDay Case Surgery (defined as same day discharge) is a priority within the National Health Service and has been shown to provide beneficial outcomes for patients and hospitals. We report our experience developing a Day Case Programme for Total Ankle Replacement (TAR).MethodsPrior to the introduction of a Day Case Programme, average length of stay following TAR in our unit was 3.5 days. Stakeholders were consulted about ways in which same day discharge could be facilitated. Patients' post-operative pain charts were reviewed prior to the introduction of this programme. Inclusion criteria included non-complex surgery (anticipated tourniquet &lt; 2hrs), friend or relative support and pre-operative walking-aid assessment. An enhanced recovery protocol included long-acting popliteal block and dexamethasone. Patients were discharged with opiate analgesia and written pain instructions. Patients were asked to complete a pain and satisfaction questionnaire. Patient Reported Outcome Measures (PROMs) were recorded.ResultsFrom September 2017 to April 2019 21 of 70 patients underwent TAR as a Day Case. Mean age was 67 years (43-85 years). Complications included two delayed wound healings and one representation on day three with urinary retention. No patients reported post-operative nausea or vomiting, 60% did not use Oramorph at home. Average Visual Analogue Score for pain was 23/100 on day one and 21/100 day three post-operatively. There was no significant difference in pre-operative or overall change in MOXFQ, VAS or EQ5D PROMS.ConclusionsEarly results suggest that Day Case Total Ankle Replacements are safe. Appropriate patient selection is necessary. Day Case Surgery relies on support and communication between multiple teams to organise and run effectively.

Adductor Canal Block + Local Infiltration Versus Local Infiltration Alone in Post-Operative Pain Management in Total Knee Replacement

Abstract Background: Adductor canal blocks (ACBs) are an emerging concept for post-operative pain management in total knee replacement (TKR). The present study was designed to evaluate the duration of analgesia, patient satisfaction, use of opioids, pain score, and ease of ambulation after ACB + intra-articular local infiltration for TKR surgery and compare it with local infiltration alone. Materials and Methods: This retrospective observational study included a total of 260 cases of TKR selected as per inclusion/exclusion criteria. All patients underwent surgery under spinal, epidural, or general anesthesia. For post-operative analgesia, intra-articular local infiltration of a cocktail [12.5 mL of 0.5% sensocaine + 2 mL ketorolac + 0.5 mg adrenaline + 95 mL normal saline] was administered to all patients, with some patients also receiving ACB (15 mL of 0.2% ropivacaine + 1 mcg/kg dexmedetomidine) by random selection. Thus, two groups of patients were formed: (i) those who received ACB and local infiltrative analgesia and (ii) those who received only local infiltrative analgesia. The two groups were matching in terms of demography, comorbidities, and complexity of osteoarthritis. Variables were compared between these two groups by using outcome measures, including (i) time to attain SLR (straight leg raise), (ii) the total amount of opioid doses given in 24 h, (iii) the pain score by visual analogue score (VAS) at 24 h, (iv) success of early ambulation, and (v) complications. Results: Out of the 260 cases of TKR, 126 were of Group 1 and 134 were of Group 2. In the local infiltration alone group, the average VAS at 24 h was 3.8, the average amount of opioid doses given in 24 h was 1.54, the average time of ambulation was 3 h post-surgery, and the average time to attain SLR was 3 h post-surgery. In the adductor canal plus local infiltration group, the average VAS was 3.32, the average amount of opioid use was 0.9, the average time for ambulation was 3 h post-surgery, and the average time to attain SLR was 3 h post-surgery. No major complications were noted in either group. Conclusion: According to our study, ACB is certainly a useful tool in reducing the post-operative pain and increasing ambulation and patient satisfaction. However, a larger study is required to establish its effectiveness conclusively.

Ultrasound-guided injection versus landmark-guided injection using corticosteroids for the treatment of lateral epicondylitis

Abstract Purpose To compare the clinical results of corticosteroid injection using landmark-guided injection (LMGI) and ultrasound-guided injection (USGI) techniques. Patients and methods We injected corticosteroids in 55 patients with extraarticular tennis elbow using LMGI and USGI techniques. All patients suffered from lateral elbow pain for more than 3 months with a tender point on the lateral epicondyle. This pain was exaggerated by wrist extension and specific physical activity. For postprocedural evaluation, in a randomized controlled assessor-blinded clinical trial, visual analog score (VAS), pain-free grip strength (PFGS), and the Nirschl staging system were assessed at 1, 6, 24 weeks, and 12 months. Results Only 48 participants were included in the final analysis (seven were excluded). Preoperatively, the average VAS scores, tenderness over lateral epicondyle, PFGS values, and Nirschl stages were almost the same (P=0.620, 0.505, 0.784, and 0.455). After 1 week of injection, there was no significant difference noticed in the VAS for pain at rest, tenderness during palpation, the PFGS and Nirschl stages between group 1 and group 2 (P=0.947, 0.724, 0.484, and 0.677, respectively). A statistically significant difference between the two groups was observed from 6 to 48 weeks. At the final follow-up, group 2 had a statistically significant better outcome when compared to group 1 (P&lt;0.05). Conclusion USGI had a better long-term outcome than LMGI in the treatment of lateral epicondylitis.

Correlation between spinal cord stimulation analgesia and cortical dynamics in pain management.

Spinal cord stimulation (SCS) is an effective method to treat neuropathic pain. It is necessary to identify the responders of SCS analgesia before implantation. The aim of this study is to investigate the relationship between the cortical dynamics and SCS analgesia responders in pain management. Resting-state EEG recording was performed in patients who underwent short-term implantation of spinal cord stimulation for pain therapy. We then did spectral analysis to capture the pattern of cortical oscillation between neuromodulation therapy analgesia responders and nonresponders. About 58.3% (14 out of 24) of participants were considered as analgesia responders, with average visual analogue scores reduction of 4.8 ± 1.0 after surgery, and 2.1 ± 0.7 for the nonresponder subgroup, respectively. The alpha oscillation was significantly enhanced in responder cohort compared with nonresponders. We also observed an increasing spectral power of gamma band in responders. Furthermore, the attenuation of pain severity was significantly correlated with the global alpha oscillation activity (r = 0.60, P = 0.002). Likely, positive and significant correlation was found between the pain relief and gamma activity (r = 0.58, P = 0.003). Distinct pattern of neural oscillation is associated with the analgesic effect of spinal cord stimulation in pain management, enhancement of cortical alpha and gamma oscillation may be a predictor of analgesia responders.

Overactive Bladder in Late Pregnancy to 1 Year After First Vaginal Delivery.

Understanding overactive bladder (OAB) during pregnancy and postpartum may increase our knowledge of pathophysiology. The purpose of this study was to understand the prevalence and severity of OAB during pregnancy through 1 year postpartum as well as the associated factors. This is a secondary analysis of a prospective cohort study evaluating primiparous women with a singleton term vaginal delivery assessed at the third trimester, 8 weeks postpartum, and 1 year postpartum. Overactive bladder was defined as urinary urgency plus nocturia or frequency, or urgency urinary incontinence (UUI). Overactive bladder severity was defined using average visual analog scores (0-100) from OAB symptoms on the Epidemiology of Prolapse and Incontinence Questionnaire. We evaluated associations with OAB at each time point using logistic regression. Among 579 participants, mean age was 29 years. Overactive bladder prevalence was higher at 8 weeks postpartum (23%) than at the third trimester (18%, P = 0.03) and 1 year postpartum (19%, P = 0.03). Overactive bladder severity was higher at the third trimester (42.2) than at 8 weeks postpartum (23.3, P = 0.008), but not at 1 year postpartum (29.1, P = 0.1). In those with OAB, UUI severity was higher at 1 year postpartum compared with that at the third trimester ( P = 0.02). Younger age was associated with third trimester OAB. At 8 weeks postpartum, OAB was associated with older age, urinary tract infection after delivery, birth weight ≥3,500 g, and third trimester OAB. At 1 year postpartum, OAB was associated with birth weight ≥3,500 g and third trimester OAB. Overactive bladder affects 1 in 5 primiparous women during pregnancy or after vaginal delivery. The increased severity of UUI postpartum and the association between higher birth weight and OAB postpartum suggest an effect of delivery.

Immediate Weight Bearing after Modified-Brostrom Reconstruction: A Retrospective Review of an Accelerated Rehab Protocol

Category: Ankle; Sports Introduction/Purpose: Majority of injuries to the anterior talofibular ligament (ATFL) will go on to heal with non-operative management. Nearly a third of these injuries, however, will go on to develop chronic pain and instability; in these cases, operative reconstruction is indicated. An anatomic modified Broström reconstruction has replaced a traditional tenodesis as the standard of care. This reconstruction is often limited by damage to the native tissue and the time required for ligamentous healing, restricting the benefits of early weight bearing. In order to maximize the benefits of early range-of-motion exercises and weight bearing while protecting the repair, a suture-tape augmented Broström procedure has been suggested. We hypothesized that a suture-tape augmented Broström procedure would allow early weightbearing while preventing early failure. Methods: A retrospective chart review of patients who underwent a suture-tape augmented Broström procedure from August, 2020 to January, 2023 was conducted. Our inclusion criteria consisted of MRI confirmation of ATFL injury, a positive anterior drawer, failure of non-operative management, and post-operative physical exam consisting of a single leg hop and single leg heel raise at six weeks. Patients who had concomitant cartilage injuries with allograft repair, posterior arthroscopic debridement, peroneal tendon repair, syndesmosis repair, or calcaneal osteotomies were excluded. All patients participated in our accelerated rehab protocol which included immediate post-operative weightbearing as tolerated (WBAT) in a boot for two weeks followed by WBAT in an ankle brace for four weeks. Physical therapy was initiated two weeks post-op. Our primary outcome was the ability of patients to perform a single leg hop and single leg heel rise at six weeks. Secondary outcomes included visual analog scores (VAS) and post-operative complications. Results: 128 patients met our inclusion criteria. Our mean follow up was 11 (range, 6-52) weeks. At 6 weeks postoperatively, 88 (90%) of the patients asked could perform a single-leg heel raise and 73 (80%) of the patients asked could perform a single-leg hop. The average VAS at the final follow up visit was 1.03+1.9 (range, 0-8). No patients required a revision surgery. Post-operative complications were peroneal or sural neuritis (6 patients) and persistent pain (4 patients). There was no difference in primary and secondary outcomes in patients who had concomitant cartilage injuries not treated with grafting. Male patients were more likely to be able to complete a single leg hop at 6 weeks postoperatively (p = .04). No difference was found amongst other demographic factors. Conclusion: This study demonstrated that a modified-Broström procedure with suture-tape augmentation allowed for immediate weight bearing without reconstruction failure. The vast majority of patients had an excellent functional outcome at six weeks post- operative with minimal complications being recorded. There were no cases of revision surgery, DVTs, post-operative infections, and no patients reported residual instability.

Does kyphoplasty affect the global sagittal alignment in patients with osteoporotic vertebral fractures? A systematic review and meta-analysis.

Osteoporotic vertebral compression fractures (OVCF) are common in elderly patients and may cause local kyphosis due to the vertebral collapse and wedging. Balloon kyphoplasty (BKP) with polymethyl methacrylate is widely used to relieve back pain and restore the height and kyphosis of the destroyed vertebra Johnell (Osteoporos Int 17(12):1726-33, 2006); Wasnich (Bone 18: 179S-183S, 1996); Finnern (Osteoporos Int 14:429-436, 2003). However, the influence of BKP on global sagittal alignment (GSA) in patients with OVCF remains unclear. To systematically evaluate the relevant literature regarding the influence of BKP on the global spinal sagittal alignment using the following radiological parameters: Pelvic Incidence (PI), Pelvic Tilt (PT), Lumbar Lordosis (LL), Thoracic Kyphosis (TK), Sagittal Vertical Axis (SVA) and Spinosacral Angle (SSA). Visual Analogue Score (VAS) was also recorded. A systematic review of the English language literature dating up until August 2022, was undertaken utilising the PRISMA guidelines. Of a total of 548 articles, 4 studies met the inclusion criteria (4 level III evidence) and were analyzed. Overall, 201 patients of mean age 73.8years (69-77) had acute OVCF of one or more vertebra. The male to female ratio was 51:128. The number of fractured vertebrae was 235 (average of 1.17 fractured vertebrae per patient). Their pre-operative radiological parameters on standing x-rays showed a mean PI of 56°, PT 24.1°, LL 44.4°, TK 42.3°, PI-LL 11.7°, SVA 4.9cm, LL/TK 1 and SSA 114.8°. The average VAS was 7.6 (2.6-10). All the patients underwent BKP and their radiological parameters on standing x-rays post operatively showed a mean PI of 55.3°, PT 23.1°, LL 45.1°, TK 41.4°, PI-LL 10.3°, SVA 4.29cm, LL/TK 1.07 and SSA 116.8°. Their average VAS post BPK was 2.36 (0-4.8).A statistical analysis comparing the pre/post-operative GSA (111 patients, 3 studies with standard deviations) showed no statistical difference in PT (24.1° vs. 23.5°, P = 0.93), TK (42.3° vs. 42.4°, P = 0.57), PI-LL (14.4° vs.12.4°, P = 0.4), SVA (6.1cm vs. 5.5cm, P = 0.19) SSA (114.8° vs. 116.7° P = 0.36). VAS was significantly reduced post BKP (7.1 vs. 2.5 P = 0.004). Performing BKP procedures does not significantly affect the global sagittal alignment in patients with osteoporotic vertebral compression fractures. There was however, a significant improvement in pain scores in patients undergoing BKP at 1 or more levels.

Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis

BackgroundSkipped multifocal spinal tuberculosis (TB) is an atypical presentation of spinal TB. Surgical treatment for these unusual cases remains a challenge for spine surgeons. In our institute, we used single-stage circumferential debridement and anterior reconstruction with fibular allograft followed by posterior instrumentation through posterior-only approach for these patients. This study aimed to determine the efficacy and feasibility of this technique.MethodsTwelve patients with skipped multifocal spinal TB who received our treatment method from January 2012 to June 2020 were enrolled in this study. The visual analog score (VAS), laboratory data, comorbidities, complications, and neurologic status based on Frankel scale were recorded. The patients’ clinical conditions were evaluated based on modified Brodsky’s criteria and Oswestry Disability Index (ODI).ResultsAll the patients were infection free at the end of the treatment. The average VAS score was 7.5 (range, 7–8) before surgery and decreased to 2.1 (range, 1–3) one year postoperatively. No one experienced any severe complications such as neurologic deterioration, fixation failure, or bone graft dislodgement. Out of the three patients requiring debridement surgery, two had wound infection and one had seroma formation. The ODI score improved from 76.8 (range, 70–84) preoperatively to 25.5 (range, 22–28) one year after surgery. All patients achieved good or excellent outcome based on modified Brodsky’s criteria one year postoperatively.ConclusionsIn our study, the patients could achieve a good clinical outcome. This technique could be an alternative for patients with skipped spinal TB.

Clinical effects of injectable collagen in lower-lid pretarsal fullness rejuvenation

BackgroundLower-lid pretarsal fullness rejuvenation is a popular surgery for Asian women. However, the current procedures have clinical complications and are not stable in the long-term. Here, we analyzed the effect of injectable collagen on lower-lid pretarsal fullness rejuvenation. MethodsTo investigate the clinical effect of injectable collagen in lower-lid pretarsal fullness rejuvenation, we observed 32 Chinese Han female patients aged 18–55 years with non-distinctive lower-lid pretarsal fullness and no history of lower eyelid surgery or trauma. The injectable collagen products were used for local filling correction. After surgery, the patients were followed up for 12 months. A correction effect was evaluated through an analysis of volume changes using a visual analog scale. Adverse reactions were also recorded. ResultsAll patients achieved good aesthetic outcomes and strong stereoscopic impressions of lower-lid pretarsal fullness. Complications, such as edema and bruising, were not observed after the injection. Immediately after the operation, the average visual analog score was 2.65 ​± ​0.56. Six months after the operation, the average visual analog score was 2.96 ​± ​0.41. The patients reported high satisfaction levels. Immediately after the operation, the average lower-lid pretarsal fullness volume increase was 0.19 ​± ​0.04 ​mL on the left side and 0.21 ​± ​0.03 ​mL on the right side. After a 12-month follow-up, the average residual volume was 0.17 ​± ​0.06 ​mL on the left side and 0.19 ​± ​0.04 ​mL on the right side, suggesting that the injected collagen impact was stable. ConclusionInjectable collagen promotes a vivid, natural appearance and is highly effective in rejuvenating lower-lid pretarsal fullness with low absorption rates in later stages. Therefore, injectable collagen should be considered in correcting congenital, non-distinctive, lower-lid pretarsal fullness in clinical practice.

PD28-03 THE PENOSCROTAL APPROACH TO PENILE IMPLANTATION RESULTS IN INCREASED PENILE, NOT SCROTAL PAIN: IMPORTANT CONSIDERATIONS FOR PROSTHETIC UROLOGISTS

You have accessJournal of UrologyCME1 May 2022PD28-03 THE PENOSCROTAL APPROACH TO PENILE IMPLANTATION RESULTS IN INCREASED PENILE, NOT SCROTAL PAIN: IMPORTANT CONSIDERATIONS FOR PROSTHETIC UROLOGISTS Avery Braun, Daniel Swerdloff, Hira Chaudry, Alice Xiang, Michelle Chen, Martin Gross, and Jay Simhan Avery BraunAvery Braun More articles by this author , Daniel SwerdloffDaniel Swerdloff More articles by this author , Hira ChaudryHira Chaudry More articles by this author , Alice XiangAlice Xiang More articles by this author , Michelle ChenMichelle Chen More articles by this author , Martin GrossMartin Gross More articles by this author , and Jay SimhanJay Simhan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002576.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Increased postoperative scrotal pain following inflatable penile prosthesis (IPP) implantation is a principal argument of many detractors of the penoscrotal approach. However, there remains a paucity of work assessing severity, location and duration of pain following IPP surgery. We thoroughly characterize postoperative pain following penoscrotal IPP in patients managed with a standardized multimodal analgesia (MMA) protocol. METHODS: This is a single-center, prospective analysis of 98 virginal penoscrotal IPP patients utilizing MMA (a standardized protocol of acetaminophen, gabapentin, and NSAIDs) from 9/2019 to 9/2021. Patients with chronic pain, those ineligible for MMA, alternative surgical approaches, concomitant surgeries or infections were excluded. Follow-up was executed on POD 2, 7, 14, and 30 with a standard questionnaire (Figure 1A). Pain scores were stratified based by visual analogue score (VAS) to none/mild (VAS=0-3), moderate (VAS=4-6) & severe (VAS=>7). RESULTS: Pain locations/trends are found in Figure 1B. Most “area of most bother” following IPP was external to the scrotum throughout recovery (70% vs 30% POD2; 65% vs 35%, POD7; 62% vs 38% POD14; & 70% vs 30% POD30, p=<0.001) with only the penile shaft and glans significantly increasing in bother from 20% POD2; 28% POD7; 27% POD14; to 38% POD30 (p=0.023). Patients reporting no to mild pain increased from 23.1% to 70.4% while those reporting severe pain decreased from 46.2% to 11.1% from POD2 to 30 (p=0.05). In those with severe pain, “area of most bother” was incisional on POD2 (35.7%) and POD7 (37.5%), glanular on POD14 (50%) and on the shaft on POD30 (50%). 7/98 (7.1%) patients required narcotic refills and all experienced severe pain with higher average VAS scores compared to the rest of the cohort (7.0 vs 5.2 POD2, 7.3 vs 5.3 POD7, 7.0 vs 3.6 POD14, and 5.4 vs 2.3 POD30, p=0.019). CONCLUSIONS: We report a thorough assessment of the pain profile experienced by penoscrotal IPP recipients in the first postoperative month. While proponents of infrapubic and subcoronal approaches anecdotally postulate decreased postoperative pain due to reduced scrotal manipulation, we objectively demonstrate that most penoscrotal IPP patients complain of penile shaft and glans penis pain. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e499 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avery Braun More articles by this author Daniel Swerdloff More articles by this author Hira Chaudry More articles by this author Alice Xiang More articles by this author Michelle Chen More articles by this author Martin Gross More articles by this author Jay Simhan More articles by this author Expand All Advertisement PDF DownloadLoading ...

Mobility-Maintaining Facet Arthroplasty of the Lumbar Spine With the Second-Generation TOPS System: A Case Series.

BACKGROUND:Lumbar spinal stenosis results from spinal canal narrowing and can lead to pain and dysfunction. Until recently, surgical treatment for lumbar spinal stenosis requiring an extensive decompression, with or without spondylolisthesis, had to balance pain relief with the long-term risks of spinal instability after decompression and adjacent segment disease (ASD) after spinal fusion. Spinal motion-preserving devices aim to reduce the incidence of ASD after posterolateral fusion and consequent need for revision surgery.OBJECTIVE:To present a single-center experience with a facet replacement implant (TOPS System [TOtal Posterior Spine System], Premia Spine) designed to stabilize the spine and prevent further degeneration while maintaining a normal range of motion (ROM).METHODS:Seventeen patients received the implant after a laminotomy. Clinical assessments included surgery duration, complication rates, and visual analog score for back pain. Radiographs were used to measure ROM changes from flexion to extension and assess for any repositioning of a degenerative spondylolisthesis and segment lordosis.RESULTS:The average operative time was 102 minutes. The average visual analog score reduction was 7.5 at 3 months, 6.8 at 12 months, and 6.7 at the longest follow-up (average: 51 months, range: 26-77), demonstrating an average improvement of 81%. The preoperative and postoperative average ROMs were 8.2° and 7.4°, respectively.CONCLUSION:This series shows that the TOPS System has the potential to relieve back pain and maintain close-to-normal ROM over longer time periods without inducing ASD. The TOPS System is the first to allow the patient to settle into physiological lordosis adjustment thus presenting new treatment possibilities with mobility-maintaining dorsal instrumentation.

Efficiency of a biodegradable gel containing hyaluronic acid and berberine hydrochloride in endoscopic sinus surgery (ESS): A prospective comparative study

PurposeTo evaluate the efficiency of a biodegradable gel containing hyaluronic acid and berberine hydrochloride in endoscopic sinus surgery. MethodsSixty-six chronic rhinosinusitis patients with or without nasal polyps who underwent bilateral endoscopic sinus surgery (ESS) were randomly received a biodegradable gel containing hyaluronic acid and berberine hydrochloride or merocel in both middle meatal spacers at the end procedure of ESS. Lund–Kennedy endoscopic score (LKES) was used to examine status of nasal cavity on preoperative day and postoperative day 1 to 7. The LKES ratio was calculated as the LKES on postoperative day divided into the LKES on preoperative day. Visual analogue score (VAS) was used to assess patient's status from the first postoperative day to the hospital discharge day. The average VAS during hospital stays was calculated by the sum of VAS in each examination day divided into the number of examined day. The LKES ratio, the average of VAS during hospital stays and length of hospitalized day of the patients were used as clinical outcome indices in early stage after surgery. A general linear model adjusted for confounding factors was used for data analysis. ResultsAdjusted mean of LKES ratio were lower in group used biodegrable gel of hyaruloic acid and berberin hydrochlode (study group) than those in merocele group in the postoperative day 1 to day 7. However, significant difference was found in the adjusted mean of LKES ratio on the postoperative day 2 to 6. Similarly, the adjusted mean of VAS during hospital stays and length of hospitalized day after surgery in study group were significantly decreased as compared with those in merocele group. ConclusionsBiodegradable material containing hyaluronic acid and berberine hydrochloride was more effective than merocel in length of hospital stay, post-operative symptoms, and sinus cavity's status in early stage after ESS.

Thumb fingertip injuries reconstruction using a dorsoulnar flap of the thumb combined with relay V-Y flaps for donor site repair.

To assess the clinical value and feasibility of the dorsoulnar flap of the thumb combined with relay V-Y flaps for reconstruction of the thumb fingertip injuries. In this retrospective study, we retrospectively reviewed 20 patients (13 men, 7 women; June 2014-June 2016) with thumb fingertip defects who underwent reconstructive procedures with transfer of the dorsoulnar flap of the thumb. The average size of the defects ranged from 1.8 cm × 2.0 cm to 2.0 cm × 3.0 cm, whereas the reconstructed dorsoulnar flap of the thumb ranged in size from 2.0 cm × 2.2 cm to 2.2 cm × 3.0 cm. A V-Y flap was used to repair the donor site at the same time. Sensation within the reconstructed thumb, the aesthetic appearance of both the donor and recipient sites, functional recovery, and return-to-work (RTW) time were measured. All 40 flaps survived without necrosis. The follow-up period ranged from 6 to 24 months. There were no complications reported. The mean static two-point discrimination values at the reconstructed thumb fingertip and donor site were 8.5 mm (range 8-10 mm) and 12.5 mm (range 12-14 mm), respectively. The average visual analog scores for the aesthetic appearance of the recipient and donor sites were 8.4 (range 8-9.5) and 9.6 (range 9-10), respectively. The average Michigan Hand Outcome Questionnaire score for the reconstructed hand was 9.4 (range 6-16). The average RTW time was 9.8 weeks (range 6-13 weeks). All patients were satisfied with the aesthetic outcome. The dorsoulnar flap of the thumb is an ideal alternative for reconstruction of the thumb fingertip injuries, and a V-Y flap was suitable for repairing the donor site with a reduced incidence of complications.

Results of in situ fixation of Andersson lesion by posterior approach in 35 cases.

Due to the rarity of the Andersson lesion (AL), the literature is ambiguous regarding the type of surgical fixation, need for debridement and deformity correction. The purpose of this retrospective study is to evaluate the efficacy, feasibility and functional outcome of posterior fixation in AL. This study included 35 patients having thoracolumbar AL operated for in situ fixation and fusion with minimum of 24-month follow-up. VAS (Visual Analogue Score) back pain, ODI (Oswestry Disability Index), Frankel's grade were compared and analyzed. Union status was noted with complications. The mean age of 35 patients was 56.34(± 11.3)years with average follow-up of 51.49months. Two patients had AL at two levels. 27/37 AL were at discal level. Average estimated blood loss (EBL) was 276.43ml and duration of surgery was 130.43min. On an average, operated segments needed 7.77 screws. There were ten minor complications without long-term sequel. Neurological improvement was noted in 30 patients. Average preoperative VAS score improved from 8.69 to 3.14, ODI score improved from 68.76 to 18.77 at final follow-up which were significant (p < 0.05). There was significant improvement in Frankel's grading (Z = - 4.354, P = 0.00). Surgical management of AL by posterior approach and posterior stabilization can give satisfactory results without the need of extensive anterior reconstruction, bone grafting or deformity correction procedures without added morbidity and complications.

Role of psychological distress screening in predicting the outcomes of epidural steroid injection in chronic low back pain

BackgroundThere is a paucity of studies investigating relationship between psychological distress and effectiveness of epidural steroid injection in patients with chronic lower back pain (CLBP). AimsThis prospective cohort study assessed whether the outcome can be predicted in CLBP patients undergoing epidural injection by pre-treatment psychological stress stratification using objective screening methods. Methods96 patients with CLBP were recruited to this prospective cohort study. Preoperative level of psychological distress was measured using Modified Zung Index (MZI) and Modified Somatic Perception Questionnaire (MSPQ); pain with Visual Analogue Score (VAS) and McGill Pain Questionnaire (MPQ) and back pain related disability with Oswestry Disability Index (ODI). Fluoroscopic caudal epidural steroid injection comprising 80 mg methylprednisolone and 8 mg of lignocaine was performed. Scores were repeated at 6, 12, and 26 weeks. Successful outcome was Minimal Clinically Important Change (MCIC) in any given measure. ResultsThere were 60 (62.5%) not-distressed patients, 3(3.1%) purely somatising, 15(15.6%) depressed and 18(18.8%) with mixed distress. Preoperative VAS was 82.4, MPQ 18.2 and ODI 51.6. Average VAS and MPQ improved significantly at 6 and 26 weeks. Average magnitude of change of VAS and ODI did not differ between distressed and not-distressed. MPQ improved significantly more in the distressed. MZI was negatively associated with VAS MCIC at 6 weeks and 6 months but it failed to predict the outcome independently. MSPQ was the only individual predictor of MPQ-MCIC at any time; MSPQ≥8 could predict MPQ-MCIC at 6 months with 53%-sensitivity and 78%-specificity. None of psychological measures used showed a significant predictive value of ODI at any follow-up point ConclusionsPsychological distress may predict response only in certain outcome measures in patients suffering from nonspecific CLBP. If the interest lied primarily in pain and functional improvement, the psychological distress failed to discriminate the results at 6 months.

Comparison of the Analgesic Effectof Intramuscular Pethidine andIntramuscular Morphine on anOrthopedic Population in a CaribbeanTerritory

Introduction: Comparison of the analgesic effect of Intramuscular Pethidine and Intramuscular Morphine on an Orthopedic Population. Settings and Design: 1) Single Blinded Randomized Controlled study: Patients were divided into Morphine group or Pethidine group 2) Patient Satisfaction survey was administered to patients at the end of stay. Material and Methods: 1) Visual Analogue Scores (VAS) were taken at eight hourly intervals for three consecutive days or until the day of discharge. Incidence of opioid related complications was noted 2) A patient satisfaction survey was administered at the end of stay. Statistical Analysis: Average VAS during movement on day one during the 8am to 4pm period was calculated for both the morphine group and pethidine group. The percentage decrease in VAS was calculated for morphine vs. pethidine group on movement on Day 1. Pearson’s correlation was used to assess the relationship between opioid, side effects and overall patient satisfaction. T-test was used to evaluate the relationship between morphine, pethidine and twenty-four-hour pain relief.A one-way ANOVA test was used to evaluate the statistical significance between the morphine and the pethidine group and patient satisfaction. Results: The morphine group as compared with the pethidine group experienced an 18.5% decrease in Visual Analogue Score for pain on movement on day 1 (8 am-4 pm period). The morphine group was associated more drowsiness and prolonged time to first bowel action compared to the pethidine group. Only 1.4% (1) of patients experienced desaturation during the study which occurred in the morphine group. Overall, opioids were associated with minimal side effects and were generally safe to use. Patients who underwent regional anaesthesia used more morphine equivalents compared to those undergoing general anaesthesia. The morphine group was associated with overall increased patient satisfaction when compared to the Pethidine group. Conclusion: The study demonstrated a notable 18.5% decrease in VAS on movement with the morphine group as compared to pethidine group. Statistical significance was placed at 15%. Opioids were found to have a limited adverse side effect profile, with drowsiness and time to first bowel action being the most predominant. Only one patient representing 1.4% of the population had an episode of desaturation (Sp02 < 90%). Due to the minimal side effect profile opioids should be considered safe to use.