Analgesic Medication Consumption Research Articles

Lateral quadratus lumborum block vs acupuncture for postcesarean analgesia: a randomized clinical trial

BackgroundImproved pain control after cesarean section remains a challenging objective. Although both the lateral quadratus lumborum block (L-QLB) and acupuncture have been reported to provide superior postoperative analgesia after cesarean section when compared to placebo, the efficacy of these techniques has never been compared head-to-head. ObjectiveThis study was conducted to investigate the comparative analgesic efficacy of L-QLB and acupuncture following elective cesarean section. Study DesignIn this prospective, randomized, controlled clinical trial, a total of 190 patients with singleton-term pregnancies scheduled for cesarean section under spinal-epidural anesthesia were enrolled. Patients were randomized 1:1 to acupuncture group or L-QLB group. L-QLB group received bilateral L-QLB with 0.33% ropivacaine and sham acupuncture, acupuncture group received transcutaneous electrical acupoint stimulation and press needle therapy, and sham L-QLB. All patients received the standard postoperative pain treatment. The primary outcome was pain scores on movement at 24 hours. Secondary endpoints included pain scores in the first 48 hours postoperatively, patient-controlled intravenous analgesia (PCIA) demands, analgesia-related adverse effects, postoperative complications, QoR-15, the time to mobilization, and gastrointestinal function. ResultsMedian (interquartile range [range]) pain scores at 24 hours on movement were similar in patients receiving acupuncture or L-QLB (3 [2–4] vs 3 [2–4], respectively; P=.40). PCIA consumption and pain scores within 48 hours postoperatively also showed no difference between the two groups. The acupuncture improved QoR-15 scores at 24 and 48 hours postoperatively (P<.001), as well as shortened the time to first flatus (P=.03) and first drinking (P<.001) compared to L-QLB. In addition, the median time to mobilization in the L-QLB group was markedly prolonged compare with acupuncture group (17.0 [15.0–19.0] hours vs 15.3 [13.3–17.0] hours, estimated median difference, 1.5; 95% CI, 1–2; P<.001). ConclusionAs a component of multimodal analgesia regimen after cesarean section, acupuncture did not lower postoperative pain scores or reduce analgesic medication consumption compared to L-QLB.

Assessment of Surgical and Quality-of-Life Outcomes Between Laparoscopic Versus Open Inguinal Hernia Repair in Geriatric Patients.

Introduction: Inguinal hernia repair is a common surgery, especially in the elderly population. However, the decision to perform surgery in elderly patients can be challenging due to higher complication rates. Laparoscopic inguinal hernia surgery is less commonly used in the elderly population despite its advantages. In this study, we aimed to investigate the safety and advantages of laparoscopic inguinal hernia surgery in elderly patients. Methods: We retrospectively compared the preoperative and postoperative (PO) data and Short Form-36 (SF-36) forms of elderly patients who underwent laparoscopic transabdominal preperitoneal and open inguinal hernia surgery. The primary outcomes were PO pain scores and complication rates. Results: A total of 79 patients with an age range between 65 and 86 years, who presented with inguinal hernias to Cekirge State Hospital's General Surgery Department between January 2017 and November 2019, were included. Seventy-nine patients underwent laparoscopic transabdominal preperitoneal technique and Lichtenstein hernia repair. The laparoscopic group had a lower rate of PO complications and less analgesic medication consumption and usage time compared with the open group. Furthermore, compared with the open group, the laparoscopic group had lower PO pain scores and higher SF-36 scores for physical function, physical role, pain, and general health at the 30th and 90th days after surgery. Conclusion: Our study suggests that laparoscopic inguinal hernia surgery can be safely performed in elderly patients with lower complication rates and faster recovery times compared with open surgery. The advantages of laparoscopic surgery, such as lower PO pain scores and faster recovery times, were also observed in elderly patients.

One year follow-up on a randomized study investigating serratus anterior muscle and pectoral nerves type I block to reduced neuropathic pain descriptors after mastectomy

Breast cancer is the second most common diagnosed type of cancer in women. Chronic neuropathic pain after mastectomy occurs frequently and is a serious health problem. In our previous single-center, prospective, randomized controlled clinical study, we demonstrated that the combination of serratus anterior plane block (SAM) and pectoral nerve block type I (PECS I) with general anesthesia reduced acute postoperative pain. The present report describes a prospective follow-up study of this published study to investigate the development of chronic neuropathic pain 12 months after mastectomy by comparing the use of general anesthesia alone and general anesthesia with SAM + PECS I. Additionally, the use of analgesic medication, quality of life, depressive symptoms, and possible correlations between plasma levels of interleukin (IL)-1 beta, IL-6, and IL-10 collected before and 24 h after surgery as predictors of pain and depression were evaluated. The results showed that the use of SAM + PECS I with general anesthesia reduced numbness, hypoesthesia to touch, the incidence of patients with chronic pain in other body regions and depressive symptoms, however, did not significantly reduce the incidence of chronic neuropathic pain after mastectomy. Additionally, there was no difference in the consumption of analgesic medication and quality of life. Furthermore, no correlation was observed between IL-1 beta, IL-6, and IL-10 levels and pain and depression. The combination of general anesthesia with SAM + PECS I reduced the occurrence of specific neuropathic pain descriptors and depressive symptoms. These results could promote the use of SAM + PECS I blocks for the prevention of specific neuropathic pain symptoms after mastectomy.Registration of clinical trial: The Research Ethics Board of the Hospital Sirio-Libanes/Brazil approved the study (CAAE 48721715.0.0000.5461). This study is registered at Registro Brasileiro de Ensaios Clinicos (ReBEC), and ClinicalTrials.gov, Identifier: NCT02647385.

Hypoechogenicity of the raphe nuclei as a biomarker of migraine: A case-control study, review, and meta-analysis.

Hypoechogenicity of the raphe nuclei (hR) has been related to major depression. Comorbidity between migraine and depression is bidirectional postulating a common mechanism of serotonergic dysfunction. We aimed to investigate the association between migraine and hR and its role as biomarker of migraine-associated depression and disease severity. This is a single-center cross-sectional descriptive study. We included consecutive patients with episodic (EM) and chronic migraine (CM). We collected their comorbidities, analgesic consumption, hospital anxiety and depression scale (HADS), disability, and impact on quality of life associated with migraine. We also included a group of control subjects, matched for age and sex with the patients. In both groups, hR was assessed by means of transcranial sonography. We performed a meta-analysis of the studies investigating the association between migraine and hR. A total of 107 subjects were included (57 cases and 50 controls). hR rate was lower in controls than in migraine patients(22.2% vs. 42.9%, p=.02) with a progressive increase in EM and CM groups respect to the control group (33.3% and 50% vs. 22.2%, respectively; p=.03). Among patients, hR was not associated with depression, higher HADS score, greater migraine-related disability, or higher consumption of analgesic medication. The meta-analysis showed a significant association between migraine and hR (odds ratio =2.16; 95% confidence interval: 1.42-3.29). hR is more prevalent in migraine patients than in controls and, in our population, its prevalence increases in a stepwise manner in patients with EM and CM. These findings support the role of raphe nuclei in migraine pathophysiology.

Medical Cannabis Use and Inflammatory Cytokines and Chemokines Among Adult Chronic Pain Patients.

Background: Utilizing cannabis as a therapeutic option for chronic pain (CP) has increased significantly. However, data regarding the potential immunomodulatory effects of cannabis in CP patients remain scarce. We aimed at exploring the relationship between cannabis use and inflammatory cytokines and chemokines among a cohort of CP patients. Methods: Adult patients with a CP diagnosis and medical authorization of cannabis were enrolled. Patients completed validated clinical questionnaires and self-reported the effectiveness of cannabis for symptom management. Patients' blood and cannabis samples were analyzed for the presence of four major cannabinoids, two major cannabinoid metabolites, 29 different cytokines/chemokines, and cortisol. The multivariable linear regression model was used to identify cannabis and patient factors associated with immune markers. Results: Fifty-six patients (48±15 years; 64% females) were included, with dried cannabis (53%) being the most common type of cannabis consumed. Seventy percent of products were considered delta-9-tetrahydrocannabinol (Δ9-THC)-dominant. The majority of patients (96%) self-reported effective pain management, and 76% reported a significant decrease in analgesic medication usage (p≤0.001). Compared with males, female patients had higher plasma levels of cannabidiol (CBD), cannabidiolic acid, Δ9-THC, and 11-hydroxy-Δ9-tetrahydrocannabinol but lower concentrations of delta-9-tetrahydrocannabinolic acid and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH). Females had significantly lower eotaxin levels (p=0.04) in comparison to male patients. The regression analysis indicated that high cannabis doses were related to increased levels of interleukin (IL)-12p40 (p=0.02) and IL-6 (p=0.01), whereas female sex was associated with decreased eotaxin (p≤0.01) concentrations. Blood CBD levels were associated with lower vascular endothelial growth factor (p=0.04) concentrations, and THC-COOH was a factor related to decreased tumor necrosis factor alpha (p=0.02) and IL-12p70 (p=0.03). Conclusion: This study provides further support for the patient-perceived effectiveness of cannabis in managing CP symptoms and reducing analgesic medication consumption. The results suggest a potential sex difference in metabolizing cannabinoids, and the varying immune marker concentrations may support a possible immunomodulatory effect associated with patient sex and cannabis product type. These preliminary findings provide grounds for further validation using larger, well-designed studies with longer follow-up periods.

Suprathel Dressing at Split Thickness Skin Graft Donor Site for Pain Control and Wound Healing

Back ground: Split thickness grafting is a routinely done procedure in treatment of burn and coverage of other wounds. These patients require management of both donor site and grafted area. Donor site wound may be more painful and distressing as compared to the patient´s skin grafted area and there may be additional scarring. Different types of dressing are used for healing of SSG donor area. Aim: To compare conventional dressing and Suprathel dressing at SSG donor site in terms of total consumption of analgesic medication and duration of wound healing. Methods: Randomized control trial was conducted in the Department of Plastic and Reconstructive Surgery/ Burn unit of Mayo Hospital over a period of 1 year (Dec 20 – Dec 21). A total of 64 patients of skin grafting were included. They were divided into 2 groups, Group A (32) treated with conventional paraffin medicated gauze and in Group B (32) Suprathel dressing was used on graft donor site. Patients pain score was calculated using NVAS (Numeric visual analogue score) and healing time was recorded in both groups. Results: Total of 64 patients were included in study with 32 in each group. There were 35(54.7%) males and 29(45.3%) females. Pain score in Group A was: ≤ 5 in 11 patients (34.4%) and ≥ 5 in 21(65.5%). In Group B≤ 5 in 22 patients (68.85%) and ≥5 in 10(31.2%). Healing time in Group A was: ≤ 14 days in 17 patients (53.15%) and ≥14 days in 15(46.8%). In Group B ≤14days in 25(78.1%)and ≥ days 14 in 7( 21.9%). There was significant difference between patient pain score (.005) and healing time (p.0.03) in comparison of suprathel dressing and paraffin medicated treated donor site Conclusion: Suprathel represents a reliable epidermal skin substitute having an impact on wound healing and wound pain on donor site for graft. It enhances wound healing and decreases dose of analgesia. Keywodrs: Graft Donor site, Suprathel, Pain score, wound healing.

Analysis of Long-Term Results of Lumbar Discectomy With and Without an Interspinous Device.

Discectomy is the surgical treatment of choice for disc herniation. However, discectomy can lead to disc degeneration and vertebral instability over time. Interspinous devices (ISDs), added to conventional surgery, constitute a low-invasive alternative that attempts to prevent these complications. The aim of this study is to compare the long-term clinical and functional outcomes of patients undergoing conventional discectomy with those who had an ISD added during surgery. This analytical-descriptive, retrospective, and transversal studyinvestigated outcomes of 114 patients who underwent surgery for a lumbar disc herniation between 2008 and 2011. The results were evaluated with a minimum follow-up of 8 years (mean, 10 years) by means of different questionnaires: visual analog scale (VAS), Oswestry Disability Index (ODI), consumption of analgesic medication, work status, degree of satisfaction, and complications and reinterventions during the follow-up period. At the end of the follow-up, an overall improvement of VAS of 5 points (71%) and ODI of 36 points (77%) was observed, with a degree of satisfaction of 76% with disc surgery. The analysis between both groups showed a better behavior in VAS and ODI in the implant group, with a pre- and postsurgery difference of 73% and 79% compared to 66% and 77% in the control group, respectively, though this finding was not statistically significant. The current analgesic consumption and the degree of satisfaction were also better in the group with an implant. Compared with the non-implant group, the number of reinterventions at the end of the follow-up was lower (7% vs 15.5%) and the time until the second intervention was higher (81.5 vs 41 months) in the group with an implant, but the differences were not statistically significant. Lumbar discectomy proved to be a safe technique for the treatment of disc herniation, and results are maintained over time. The additional gesture of adding an ISD to conventional discectomy improves clinical outcomes overall, but not in a statistically significant way. The lower number of reinterventions and the longer period without surgery being required may mean a certain protective effect of the ISD on the intervertebral disc being operated on.

Agreement between children's, nurses’ and parents’ pain intensity reports is stronger before than after analgesic consumption: Results from a post-operative study

BackgroundIncluded in their extensive duties caring for hospitalized children, nurses are the frontline for pain assessment and treatment. Research has found that when nurses’ assessments are compared with independent reports by the children or their parents, there are often differences. However, no studies have considered the contribution of analgesic medication consumption to this difference. ObjectivesThe aim of this study, was to assess the concordance between the pain scores recorded independently by nurses, children, and their parents both before and 1 h after analgesic consumption. Design/SettingThe trial was registered at ClinicalTrials.gov (NCT04306679) and was conducted in a post-operative inpatient facility. Following surgery, at first request of analgesic, the clinical nurses recorded the child's pain, as part of routine clinical practice. Within 10 min, the child recorded their pain level in a pain diary. At the same time, the parents separately reported their assessment of their child's pain. This process was repeated again 1 h later, when the nurses, as part of the clinical routine, recorded the children's level of post-medication pain. ParticipantsForty-seven children ages 8–17 hospitalized for elective surgery in the General Pediatric Surgery, Orthopedics, Ear-Nose-Throat (ENT), and Oral and Maxillofacial (OM) Departments, and their parents, were included in the current report. ResultsThe mean pain scores reported by the children were significantly higher than those reported by the nurses, both before (5.77±2.51 vs. 3.90±3.12 [mean ±SD], p <0.001) and 1 h after (3.37±2.48 vs. 0.92±2.08, p <0.001) analgesic consumption. No significant differences were found either before or after analgesic consumption in the NPS reported by the child and parent. Agreement between the NPS scores reported by the child and nurses was good before (ICC = 0.754, p <0.001) and only moderate 1 h after (ICC = 0.504, p = 0.017) analgesic consumption. Similarly, agreement between the NPS scores reported by the child and parents was good before (ICC = 0.855, p <0.001) and only moderate 1 h after (ICC = 0.722, p <0.001) analgesic consumption. ConclusionsWhile self-report measures remain the gold standard for pediatric pain care, the results of this study suggest that after analgesic administration, agreement between children's and nurses’ assessments, and between children's and parents’ assessments of pain deteriorated. Our results further confirm that proxy assessments recorded by parents are closer to their children's assessments than are those of nurses and should consequently be preferred especially after analgesic consumption.

Pain and Disability of Conservatively Treated Distal Radius Fracture: A Triple-Blinded Randomized Placebo-Controlled Trial of Photobiomodulation Therapy.

Objective: Many patients with distal radius fracture (DRF) experience pain and disability after removal of the cast. The aim of this study was to investigate if photobiomodulation therapy (PBMT) applied after cast removal provides an add-on effect to a home-based exercise program in rehabilitation after DRF. Methods: In this triple-blinded placebo-controlled trial, 50 patients with conservatively treated DRF were randomized to receive either active PBMT or placebo PBMT after cast removal in addition to a home-based exercise therapy program. The outcome measures were the Patient-Rated Wrist and Hand Evaluation (PRWHE) questionnaire, night pain (NP), and consumption of analgesic medication (AM) and were evaluated after cast removal at 4 (baseline), 8, 12, and 26 weeks after injury. NP and AM were also evaluated 7 weeks after injury (end of active/placebo PBMT). Results: There was a significant between-group difference in PRWHE scores in favor of active PBMT 8, 12, and 26 weeks after DRF. NP and consumption of AM were significantly lower in the active PBMT group from 7 to 26 weeks. There was a minimum clinically important improvement between the groups in favor of active PBMT in total score at 12 weeks, in pain subscore at 8, 12, and 26 weeks, and in disability subscore at 8 and 12 weeks. Conclusions: PBMT is safe and has long-term positive effect on pain and disability in DRF patients, when applied in combination with a home-based rehabilitation exercise program. Clinical Trial registration number: NCT03014024.

Influence of the apical limit of instrumentation and photodynamic therapy on the postoperative pain of lower molars with asymptomatic apical periodontitis

IntroductionThe aim of present study was to evaluate the influence of apical limit of instrumentation and PDT on the postoperative pain of lower molars with asymptomatic apical periodontitis. MethodsForty patients were included in the present study and were divided into 4 groups (n=10), according to apical limit of instrumentation and use of PDT: instrumentation at 0.0 measurement; instrumentation at 0.0 measurement+PDT; instrumentation 1mm beyond 0.0 measurement; instrumentation 1mm beyond 0.0 measurement+PDT. In the PDT, the root canals were filled with 0.01% methylene blue, remaining for 5 min. The low-intensity laser was used with 100 mW, 660–690 nm wavelength), using intra-canal fibre. Root canals were irradiated for 90 s, delivering total dose of 9 J and energy density of 320 J/cm2. After root canal preparation and PDT protocols, root canals were filled with gutta-percha and AH Plus endodontic sealer, being sealed with composite resin.The evaluation of postoperative pain was performed by visual analog scale after 24, 48, 72 hours and 7 days. Data were analysed by specific statistical tests, at level of 5%. ResultsNo statistical significant difference was observed among experimental groups in all evaluation periods, as well as in the intragroup analysis over time, regarding postoperative pain and analgesic medication consumption (p>0.05). ConclusionsApical limit of instrumentation and PDT have no influence on the postoperative pain of lower molars with asymptomatic apical periodontitis.

Prolonged Medical Cannabis Treatment is Associated With Quality of Life Improvement and Reduction of Analgesic Medication Consumption in Chronic Pain Patients.

Introduction: Chronic non-cancer pain (CNCP) is one of the most prevalent indications for medical cannabis (MC) treatment globally. In this study, we investigated CNCP parameters in patients during prolonged MC treatment, and assessed the interrelation between CNCP parameters and the chemical composition of MC chemovar used. Methods: A cross-sectional questionnaire-based study was performed in one-month intervals for the duration of six months. Subjects were adult patients licensed for MC treatment who also reported a diagnosis of CNCP by a physician. Data included self-reported questionnaires. MC treatment features included administration route, cultivator, cultivar name and monthly dose. Comparison statistics were used to evaluate differences between the abovementioned parameters and the monthly MC chemovar doses at each time point. Results: 429, 150, 98, 71, 77 and 82 patients reported fully on their MC treatment regimens at six one-month intervals, respectively. Although pain intensities did not change during the study period, analgesic medication consumption rates decreased from 46 to 28% (p < 0.005) and good Quality of Life (QoL) rates increased from 49 to 62% (p < 0.05). These changes overlapped with increase in rates of (-)-Δ9-trans-tetrahydrocannabinol (THC) and α-pinene high dose consumption. Conclusion: Even though we observed that pain intensities did not improve during the study, QoL did improve and the rate of analgesic medication consumption decreased alongside with increasing rates of high dose THC and α-pinene consumption. Understanding MC treatment composition may shed light on its long-term effects.

Prospective, Multicenter Evaluation of a Polyherbal Supplement alongside Standard-of-Care Treatment for Mild Knee Osteoarthritis.

Background This study aimed to provide clinical information on general and joint performance from individuals taking Tregocel® (containing curcuminoid and extracts of the herbs Harpagophytum procumbens, Boswellia serrata, Apium graveolens, and Zingiber officinale) alongside a standard therapy of symptomatic mild knee osteoarthritis (OA). Methods This was a multicenter, open-label, prospective, single-arm study, in which Tregocel® was supplemented for 36 weeks. Participants with symptomatic mild knee OA requiring pharmacologic treatment for pain were enrolled. Physical performance (6-minute walk test, WOMAC-pain and functional domain, and heel-thigh distance flexion test), general performance (WOMAC questionnaire), and VAS (Visual Analogue Scale) assessment of knee pain, as well as anti-inflammatory and analgesic medication consumption, were assessed. Results Between January and April 2019, 107 participants were enrolled and analysed in per protocol population. Mean age was 59.7 (SD 10.8) years, and there were 68.2% women. Mean observation time was 291.1 (SD 7.7) days. Mean increase in 6MWT result observed at the end of the study was 26.0 (SD 30.4) m (p < 0.001). Median VAS score decreased from 60.0 (IQR 50–72) mm at the beginning of the study to 21.0 (IQR 14–30) mm after 36 weeks of product administration (p < 0.001). Regular knee OA medications were taken in 99.1% of subjects at baseline decreasing to 55.1% at the end of the Tregocel® supplementation. Conclusions During Tregocel® supplementation, participants observed improved functional capacity confirmed in the distance in 6MWT and in the heel-thigh distance flexion test, decreased level of pain, and improved WOMAC scores for all domains.

Ultrasound-Guided Quadratus Lumborum Block for Postoperative Pain in Abdominoplasty: A Randomized Controlled Study.

Postoperative pain after abdominoplasty can delay postoperative ambulation, leading to life-threatening complications. Previous reports have shown the utility of quadratus lumborum block in providing adequate pain relief and avoiding side effects after numerous abdominal operations. The purpose of this randomized controlled trial was to demonstrate the efficacy of the quadratus lumborum block in abdominoplasty. Patients were randomly allocated to receive a bilateral quadratus lumborum block with either ropivacaine or normal saline. Postoperative cumulative analgesic medication consumption, pain severity at rest and on movement, and quality of recovery were evaluated and compared in both groups. Twenty patients were allocated to each group. Total morphine dose received in the postanesthesia care unit was lower in the ropivacaine group than in the control group, with a mean of 3.4 mg and 6.6 mg, respectively. Cumulative tramadol consumption per patient in the first 48 hours postoperatively was significantly lower in the ropivacaine group compared with the control group (42.5 mg versus 190 mg; p = 0.0031). The Numeric Rating Scale both at rest and with effort was significantly lower in the ropivacaine group compared with the control group. The median quality of recovery for the ropivacaine group was 133 compared with 112 for the control group (p < 0.0001). Quadratus lumborum block in abdominoplasty reduces postoperative pain and opioid consumption and improves the quality of recovery. Further studies are needed to compare the quadratus lumborum block to more traditional blocks. Therapeutic, II.

Multicenter, randomized, double-blind, controlled trial of transcutaneous electrical nerve stimulation for pancreatic cancer related pain.

Background:Up to 80% of patients with pancreatic cancer experience abdominal and back pain. Although pharmacologic medications provide some relief, many report inadequate analgesia and adverse effects. Transcutaneous electrical nerve stimulation (TENS) is a non-invasive physical modality and had been widely applied for pain relieving, yet no study has investigated the effectiveness of TENS for pain in pancreatic cancer.Methods:Eligible patients were randomly assigned in a 1:1 ratio to TENS group or control group. The primary outcome was percentage change of numerous rating scale (NRS) after treatment. Secondary outcomes included percentage change of analgesic medication consumption and effect on constipation and poor appetite.Results:One hundred seventy-one patients were recruited (84 to control group and 87 to TENS group). NRS in TENS group has been largely decreased 77.9% right after treatment and 27.1% in 2 hours, before applying any analgesic medication, while that in control group was slightly downregulated right after treatment but gave a trend to increase at 1, 2, and 3 hours. When comparing both groups, pain was significantly well controlled without analgesic medication supplement in TENS group at 0 hour (difference in mean percent change in NRS = 50.0 [95% CI, 50–51.4], P < .01) and 3 hours (difference in mean percent change in NRS = 134.0 [95% CI, 130.0–142.7], P < .01) after treatment, and this analgesic effect last to 3 weeks after treatment cycle (difference in mean percent change in NRS = 22.5 [95% CI, 17.6–27.3], P < .01) without increase of analgesic medication consumption.Conclusions:TENS reduces pain without increase analgesic medication consumption in patients with pancreatic cancer pain. It provides an alternative therapy for pain in pancreatic cancer.Clinical Trial Registration:This study was registered at ClinicalTrials.gov, identifier NCT03331055.

A Double-blind, Placebo-controlled, Randomized Comparison of Analgesic Efficacy of Oral Ketorolac Versus Intramuscular Tramadol After Third Molar Surgery

Background: Pain due to dental extraction, particularly after the third molar extraction causes discomfort to patients. Different types of analgesics used to manage pain in such cases include nonsteroidal anti-inflammatory drugs and opioids. Objectives: To evaluate the pre-emptive analgesic effectiveness of oral ketorolac and intramuscular (IM) tramadol following lower third molar surgeries. Materials and Methods: A total 60 subjects with impacted mandibular third molars were included in our study. They were randomized into two treatment groups, each with 30 patients. Group A: oral ketorolac 10 mg and IM placebo (1 mL saline solution); Group B: oral placebo (tablet similar to oral ketorolac) and IM tramadol 50 mg diluted in 1 mL saline solution. The treatment regimen were given half an hour before the start the surgery. The parameters evaluated were pain intensity, the time of first analgesic rescue medication and total analgesic consumption. Results: We found that the time of first rescue analgesic medication was longer in oral ketorolac group than IM tramadol group (P=0.01). Group A patients experienced less pain than Group B patients. Conclusion: We found that oral ketorolac group of patients had an enhanced analgesic effectiveness and a longer time of first rescue analgesic than those taking intramuscular tramadol.

Reduced pain and analgesic use after acoustic binaural beats therapy in chronic pain - A double-blind randomized control cross-over trial.

Binaural Beats (BB) consist of two artificial acoustic stimuli with different frequency, presented simultaneously but independently to each ear. The human brain perceives and synchronizes to this frequency difference (entrainment). Aim of this study was to test the hypothesis that brain entrainment to a lower function rhythm, with BB application, can decrease pain perception and analgesic medication use, in chronic pain patients. In a double blind, randomized, cross-over trial, BB at 5Hz (theta rhythm) were applied for 30 minutes, under simultaneous electroencephalogram recordings, followed by liberal, on demand use by chronic pain patients for a week, compared to sham stimulation (SS). Pain as the main outcome (numeric scale, NRS), stress (STAI) and medication usage (defined daily doses, DDD) were assessed at baseline, 30 minutes and week's end. Perceived pain (NRS) was significantly reduced in BB intervention (5.6±2.3 to 3.4±2.6, p<0.001), compared to SS (5.2±2.1 to 4.8±2.3, p=0.78), during the first 30-minute phase, as well as at the week's end (to 3.9±2.5 compared to 5.5±2.6 respectively, p<0.001). The mean EEG theta power at 5Hz was significantly increased only during BB application. Stress was significantly reduced at 30 minutes in both interventions but remained reduced only in the BB group at the week's end. Analgesic medication consumption (DDD, g) during the week was significantly less in the BB intervention (3.9±3.7 vs. 4.6±4.1, p<0.05), while reporting equal to SS mean levels of pain. Acoustic BB reduced pain intensity, stress and analgesic use, compared to SS, in chronic pain patients. This study provides evidence that theta rhythm binaural beats can alleviate pain intensity, both after a brief 30 minute and a longer one week on-demand intervention. The subsequent significant reduction in analgesic medication consumption in chronic pain patients' daily living could offer a valuable tool, augmenting the effect of existing pain therapies.

Long-Term Multicolumn-Lead Spinal Cord Stimulation Efficacy in Patients with Failed Back Surgery Syndrome: A Six-Year Prospective Follow-up Study

The use of multicolumn-lead spinal cord stimulation (SCS) to control back pain (BP) and leg pain (LP) in patients with failed back surgery syndrome (FBSS) in the short term and mid-term has been well documented. Our study investigated whether SCS remained efficient after 72 months. In an observational, single-center study, we assessed SCS efficacy in 62 patients with FBSS patients. BP, LP, and magnitude of daily activity limitation (DAL) were graded using a 0-10 visual analog scale (VAS) preoperatively and at 2, 6, 12, 24, 36, and 72 months after SCS implantation. Sleep quality, use of medications, and complications were also recorded. Of the 62 patients, 15 with complete follow-up data available were still using their SCS device at 72 months (SCS+). For these patients, the VAS scores for BP, LP, and DAL had changed from a median of 9 (interquartile range [IQR], 8.5-10), 7 (IQR, 6-8), and 8 (IQR, 8-9) preoperatively to a median of 4 (IQR, 3-4.5), 3 (IQR, 1.5-3.5), and 3 (IQR, 2-4) at 72 months. Their quality of sleep and analgesic medication consumption had also improved. In a subset of patients no longer using the SCS device after 72 months (SCS-), the VAS scores for BP, LP, and DAL, quality of sleep, and medication consumption were comparable to those for the SCS+ group. The SCS- group was less satisfied with the technique and were less professionally active than were the SCS+ group. The SCS device provides sustained beneficial effects on BP, LP, DAL, sleep, and medication consumption in patients with FBSS still using it at 72 months postoperatively. Further studies are needed to identify the factors of adherence to the technique and the chances of success compared with the natural evolution of FBSS.

The transversus abdominis plane block may reduce early postoperative pain after laparoscopic ventral hernia repair: A matched pair analysis

PurposePatients suffering from a ventral hernia can be treated by laparoscopic ventral hernia repair (VHR) with the intraperitoneal onlay mesh (IPOM) technique. To reduce early postoperative pain and the analgesic cumulative need for medication (CNM), the transversus abdominis plane (TAP) block has recently been investigated and implemented in hernia surgery. We aimed to investigate its impact when conducting a VHR in IPOM technique. MethodsA single center retrospective observational matched pair analysis has been conducted from March to April 2020. The data of patients who underwent VHR in IPOM technique with prior TAP block administration were enrolled. The matching was performed using the variables age ( ±5 years), gender, type of surgery, BMI and ASA stage. Results52 patients were enrolled. Among the individuals of the TAP block group, (18 males, 8 females) the average age was 52.4 (15.9). The average BMI was 29.0 (3.95) kg/m2. 14 patients suffered from an umbilical, 9 from an incisional, and three from an epigastric hernia. Except for COX-2-inhibitors, (TAP group: 41.9 mg (31.0), Control group 9.23 (22.1), p < 0.001) the analgesic CNM of both groups did not statistically differ from each other. The literature review yielded four relevant publications (n = 100). The authors stated a positive impact of the TAP block on early postoperative pain and analgesic medication consumption. ConclusionThe TAP block prior to laparoscopic ventral hernia repair may reduce early postoperative pain and analgesic medication consumption in selected patients. More randomized clinical trials are needed to confirm these findings.

Comparative study of conventional and topical heparin treatment in second degree burn patients for burn analgesia and wound healing

ObjectiveTo compare clinical outcome of topical conventional with topical heparin treatment in 2nd degree or partial thickness (PTB) burn patients. MethodsPatients, between the ages of 14 and 60 years with 2nd degree burns involving <20%. Total body surface area (TBSA) on front of chest, abdomen and upper limbs excluding hands and lower limbs were enrolled from September 2015 to August 2016. Patients were randomized to conventional or heparin treatment groups. Clinical outcome measured were healed wound size, pain scores and total consumption of analgesic medication required to relieve pain. Safety of the treatment and adverse events were also measured ResultsOut of 66 patient included in study mean (SD) age of participants was 27 (10) years, of which 59% were males. Mean (SD) TBSA burn was 14% (3) [23 (35%) had SPTB, and 43 (65%) had DPTB]. The burn injury was caused by flames in 68% and by hot liquids in 32% patients. There was no statistically significant difference in distribution of patients according to age, gender, TBSA burn, etiology or depth of burns in the two treatment groups. As compared to conventional treatment group, heparin treatment group had significantly better outcomes. Number of days needed for wound healing was significantly lower in the heparin group than the conventional group (SPTB 14±1 vs. 20±4 days; P-value <0.000 and for DPTB, 15±3 vs. 19±2 days; P-value <0.003). Mean pain score was also lower in the heparin group (for both SPTB and DPTB 3±1 vs. 7±1; P-value <0.000). Similarly, total consumption of analgesic medication was significantly less in the heparin group (53±27 vs. 119±15mg; P-value <0.000 for SPTB and 46±6 vs. 126±12mg; P-value <0.000 for DPTB). In both groups, no patient had wound infection, skin necrosis, leucopenia, thrombocytopenia, worsening renal function, or abnormal liver enzymes ConclusionTreatment of second degree or partial thickness burns (PTB) with topical heparin is superior to conventional treatment in terms of wound healing as well as for pain control. The treatment with topical heparin is well-tolerated and is without higher adverse effects.

Effect of the transversus abdominis plane block on postoperative pain and recovery in patients with hepatic echinococcosis.

ObjectivesHepatic echinococcosis (HE) is a severe parasitic disease that occurs worldwide, and radical surgery is the recommended therapy. This study was performed to investigate the efficacy of using a transversus abdominis plane (TAP) block during surgery on postoperative pain and recovery of patients with HE under the guidelines of an enhanced recovery after surgery (ERAS) protocol.MethodsFifty-eight patients from the Tibetan plateau who underwent surgery for treatment of HE by the same surgeons under the guidance of ERAS were included in the present study. A TAP block was conducted before closing the abdominal cavity.ResultsThe consumption of sufentanil was significantly lower in patients of the TAP than control group. Patients had a significantly shorter time to first flatus in the TAP than control group. Other parameters showed no significant differences between the two groups.ConclusionsUse of the TAP block could reduce the consumption of analgesic medication and promote recovery of patients from the Tibetan plateau under the guidance of an ERAS protocol.