Decrease In VAS Research Articles

Effect of Pudendal Nerve Block versus Perineal Local Infiltration of Analgesia In Post Episiotomy Pain Relief A randomized Controlled Clinical Trial

Abstract Background Episiotomy or tearing of perineal tissues during childbirth is associated with significant pain in the postpartum period. Although the use of episiotomy is often debated, it remains the most common surgical procedure experienced by women. Pain from episiotomy is poorly treated, though it may be severe and can result in significant discomfort and interference with basic daily activities and adversely impact motherhood experiences. Local infiltration analgesia is the most commonly used method of analgesia during normal labor. This type of local analgesia is achieved by injecting the analgesic agent into the perineum just before delivery with crowning of the fetal head. It is also widely used just before an episiotomy. This study compares the efficacy and duration of pudendal nerve block versus local infiltration on post episiotomy pain relief. Aim of the Work: This study aims to compare the effect of Pudendal Nerve Block with perineal local infiltration of analgesia in post episiotomy pain relief. Study design:Prospectiverandomizedcontrolledclinicaltrial. Patients & Methods The current study was conducted in Ain Shams University Maternity Hospital in the period between August 2018 and Jan 2019. It included 100 primigravida women in labor meeting inclusion criteria attending the causality of Ain Shams Maternity Hospital. Results Our study showed statistically significant decrease mean of study group compared to control group according VAS score from after 1hr to after 6hrs. Also there was statistically significant decrease in patients' need for analgesia in study group compared to control group from after 1hr to after 6hrs. Patients were asked about episiotomy pain and were advised not to be distracted by pain of uterine contraction or any other pain she complains of as much as possible not to alter the study results Regarding the pudendal nerve block group none of the patients receiving effective bilateral pudendal nerve block asked for analgesia during the first hour post injection. Two patients representing 4.4% of the study group asked for analgesia after two hours post injection, by the 3rd hour 6 patients representing 13.3% of the study group asked for analgesia. After completing 6 hours post injection follow up only 21 patients asked for analgesia representing 46.7% of the study group while 24 patients (53.3%) did not require any analgesia for the first 6 hours after injection of pudendal nerve block Conclusion There is statistically significant decrease in mean VAS in pudendal nerve block compared to local perineal infiltration of analgesia from after 1hr to after 6hrs of injection. Also there is statistically significant decrease in patients' need for analgesia in case of pudendal nerve block compared to local perineal infiltration of analgesia from after 1hr to after 6hrs of injection. There is highly statistically significant increase mean of delivery time after injection (min) in pudendal nerve block compared to local perineal infiltration of analgesia but it has no clinical significance. There are no neonatal side effects or complications of pudendal nerve block.

The effects of Biofreeze and superficial heat on masticatory myofascial pain syndrome.

This study aims to assess the influence of superficial heat and Biofreeze on pain, mouth opening (mm), and quality of life in patients with masticatory myofascial pain syndrome (MPS). 52 patients with MPS were included in the study. They were randomly divided into two groups. Patients in the Biofreeze group (n = 26) applied 3.5% menthol gel to the masseter and temporal muscles twice a day for seven days, while the other group applied superficial heat. Baseline, 7th, and 21st days of VAS, mouth opening (mm), and Oral Health Impact Profile-14 (OHIP-14) scores of the patients were evaluated statistically. The mouth opening increased by 4.27 ± 3.80 mm in the Biofreeze group and 2.58 ± 2.16 mm in the superficial heat group. In each group, a significant decrease in VAS and OHIP-14 scores was observed on the 7th day compared to the baseline values (p<0.001). There was no statistically significant difference between the two applications on myofascial pain, mouth opening (mm), and OHIP-14 total score variables. The favorable effects of both applications on these parameters were limited to the duration of use. Biofreeze and superficial heat in MPS were found to increase the quality of life, but the limited effectiveness of these applications underlines the importance of the underlying factors.

Radiofrequency Denervation of Genicular Nerves for Advanced Knee Osteoarthritis Pain: A retrospective Observational Study

Background: Knee joint osteoarthritis is a degenerative disorder resulting in pain and disability. The treatment of knee osteoarthritis pain includes the use of oral analgesics, oral glucosamine and chondroitin sulfate, intra-articular steroid, and viscous supplementation, but with limited efficacy. Aim of the work: This retrospective observational study aimed to evaluate the efficacy of radiofrequency thermocoagulation of genicular nerves for control of the pain of knee joint osteoarthritis. Material and methods: This study included patients with knee pain of Kellgren Lawrence grade 3 and 4 osteoarthritis who underwent radiofrequency neurotomy of the knee joint from July 2015 to July 2018. The 68 joints of 60 patients were evaluated for knee pain VAS score [0–10 mm], oxford knee score [12–60] and development of any adverse effect at pre and post-procedure at 1, 3, 6 and 12 months. Results: The mean± SD values of Visual analog scale [VAS] [0–10] for knee joint pain were 7.93±1.21, 3.38±1.59, 4.10±2.30, 4.90±1.88, and 5.80±1.71 at pre-procedure and at 1, 3, 6 and 12 months post-procedure. The mean ± SD values for Oxford Knee Score [OKS] [12–60] were 40.87±7.66, 23.90±5.60, 25.93±5.48, 27.93 ± 5.48, and 31.43±5.62 at pre-procedure and at 1, 3, 6 and 12 months post-procedure. One-way repeated measures of ANOVA test showed a significant decrease in VAS and OKS scores between pre and post-procedure at 1, 3, 6 and 12 months [p <0.001]. Conclusion: Radiofrequency thermocoagulation of genicular nerves provides significant pain relief and functional improvement in advanced knee joint osteoarthritis patients for a duration of one year.

Ultrasound Guided Serratus Anterior Plane Block versus Thoracic Epidural Analgesia in Breast Surgery

Background: Breast Surgery is becoming more and more common. Patients are often middle-aged women and with high public awareness around issues of breast cancer. The numbers are increasing. Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. Objective: To assess the efficacy and safety of ultrasound-guided serratus anterior plane block (SAPB) compared with thoracic epidural analgesia (TEA) for breast surgery. Patients and methods: This is a prospective randomized clinical study done at Aswan University Hospitals. The present study was conducted on sixty female patients ASA I-II, their ages ranged from 20-50 years and scheduled for unilateral breast surgery. The patients were allocated randomly into three groups (n=20 each) according to type of regional anesthesia administrated. Results: There was no significant difference between the studied groups in age, body weight, height and BMI. VAS pain scores throughout the first 24 hrs postoperative showed that there was highly statistically significant decrease in VAS in immediate till 6 hrs postoperative in SAPB group (VAS in group C was less than in groups A and B, P-value < 0.001). As regard to side effects, no complications in the studied groups were recorded such as pneumothorax, vascular puncture, or local anesthetic toxicity. Conclusion: Serratusanterior plane blockmaintained hemodynamic stability as compared to TE and it produced low pain scores and less total morphine consumption in the early postoperative period after unilateral breast cancer surgery. These advantages, suggest the usefulness of SAPB especially in outpatient surgery.

Evaluation of results of percutaneous vertebroplasty at a tertiary centre among north Indian population

Objective: To evaluate the results of percutaneous vertebroplasty at a tertiary centre among north Indian population. Methods: The study was a prospective observational study conducted in the Department of Orthopaedic Surgery, Prasad Institute of Medical Sciences, Lucknow. Patients with painful vertebral compressions involving Dorsal and Lumbar vertebrae due to osteoporosis, metastatic secondary of spine, multiple myeloma, benign conditions like hemangioma, specific traumatic spinal injuries who were admitted and treated by percutaneous vertebroplasty in the Department. The pain was assessed by Visual Analogue Score. Results: A total of 32 (12 male and 20 females) patients were included in the study. Osteoporotic cause was in more than half of patients (65.6%). Females were more affected (66.7%) than males (33.3.3%). Post traumatic cause was in 34.4% patients. Females were more affected (54.5%) than males (45.5%). However, there was no significant (p>0.05) difference in causes between male and females. Pre-op VAS was 5.94±0.92 which decreased to 0.87±1.35 at 6 months. The decrease in VAS from pre-op to 6 month was statistically significant (p=0.0001). Conclusion: Percutaneous Vertebroplasty is a simple, effective, reliable, easy to perform and minimally invasive procedure in patients with vertebral compressions, who have excessive pain and/or surgery has great risks. Key words: Vertebral compressions, percutaneous vertebroplasty, Visual Analogue Score

278. Allograft reconstructed iliac bone graft donor site remodels to viable bone and its preliminary clinical effectiveness in revision fusion

BACKGROUND CONTEXT Bone autograft options may be limited for revision spinal fusion, particularly in long deformity cases where iliac fixation or prior IBG harvest are present. Contralateral IBG may not be available or was previously harvested. Alternatives such as bone morphogenic protein, BMP, at some facilities is not available for off-label use or due to expense. Nonviable alternatives have inconsistent ability to obtain arthrodesis in revision cases. Allograft reconstructed iliac bone graft donor site has been used to decrease donor site pain; it may also be a source of bone graft in patients with multiple prior fusions who need another fusion. PURPOSE The purpose of this study was to assess the viability of bone graft donor sites reconstructed with bone allograft. A secondary purpose of this prospective cohort study was to ascertain whether the reconstructed iliac bone graft, RIBG, sites could be reharvested for successful arthrodesis in revision fusion. STUDY DESIGN/SETTING Histologic and two cohort clinical prospective study. PATIENT SAMPLE Consecutive patients who had secondary thoracolumbar spinal fusion (pseudarthrosis repair or fusion extension) using RIBG. All these patients had their initial fusion with IBG and reconstruction of the bone graft donor site with cancellous allograft. OUTCOME MEASURES Histology of RIBG biopsies (lacunae and marrow) vs controls; clinical VAS, ODI outcomes. METHODS Revision spinal fusion patients, n=16, who had their iliac bone graft donor site backfilled with allograft bone at their initial fusion and subsequently had secondary fusion surgery for a pseudarthrosis repair or fusion extension had biopsies obtained at the time of secondary fusion. Histology analyzed the RIBG biopsies for viability and was compared to controls. One-year postop CT scans and 2+ yr outcomes measures (LBP VAS & ODI) evaluated the clinical success of the secondary fusion surgery using RIBG and compared to revision fusion controls using contralateral IBG. RESULTS Histology found filled lacunae average 83%, SD 14%, and the bone marrow was hypocellular in 2/3 of cases. Control patients had average 87%, SD; 8% and no hypocellularity. CT scans of the lumbar fusions utilizing RIBG, often combined with bone growth stimulator or bone morphogenic protein (BMP), demonstrated solid fusions in 15 of 16 patients. CT scan fusion rates of the IBG or BMP control cohorts were approximately 80%. Clinical improvement was significant (3.8 VAS decrease, p CONCLUSIONS RIBG using cancellous bone allograft remodels into viable bone autograft. This study is the first to report the histological viability of RIBG site and assess the feasibility of its use in revision fusion. RIBG may be useful in secondary fusion procedures if IBG or BMP are of limited availability. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The effect of lengthening the gastrocnemius muscle in chronic therapy resistant plantar fasciitis

BackgroundThe aetiology of chronic therapy resistant plantar fasciitis (CTRPF) is multifactorial with more focus in recent times on the gastroc-soleus complex. This study evaluates the effect of lengthening the gastrocnemius muscle in CTRPF. MethodsAll patients with CRTPF complaints for at least one year underwent the same standard conservative treatment prior to surgery. 32 patients failed this treatment and underwent gastrocnemius recession. Silfverskiöld test, questionnaires and plantar pressure measurements were obtained at 5 visits. ResultsOne year follow up showed a significantly increase in dorsiflexion of the ankle (16 degrees), a decrease in VAS; 78 (SD: 19) to 20 (SD: 24) and significant improved functional scores. Plantar pressure measurements showed an increase of pressure under the medial proximal part of the midfoot and the 1 st metatarsal and a decrease under the hallux. ConclusionsA gastrocnemius recession results in a significant gain in dorsiflexion, altered loading of the foot and good clinical outcome in patients with CTRPF. Level of EvidenceLevel 2

Enhanced recovery after surgery (ERAS) pathway for microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion

ObjectivesEnhanced recovery after surgery (ERAS) principle and minimally invasive surgery allow patients to recover faster and better postoperatively. Due to a paucity of their integration, this retrospective study aims to assess clinical outcomes of ERAS pathway in microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Patients and methodsA total of 72 consecutive cases were enrolled. According to their inclusion order, the former 21 cases received microendoscopy-assisted MIS-TLIF without any ERAS approach (control group), while the latter 51 participants underwent the same surgery with ERAS protocol (observation group). Perioperative parameters, including operative duration, intraoperative estimated blood loss (EBL), length of stay, postoperative analgesic usage and ambulatory time, were recorded. Visual analogue scale (VAS, back and leg), Barthel index were obtained before and at three days, one month, six months postoperatively. Modified MacNab criteria and Bridwell grading were used to assess surgical outcome and interbody fusion at one week and two years after surgery, respectively. ResultsObservation group had statistically improved perioperative parameters (operative duration, intraoperative EBL, length of stay, postoperative analgesic usage and ambulatory time) in comparison with control group. Remarkable decreases in VAS (back and leg) were observed continuously at three days, one month and six months post-surgery in both groups when compared with scores prior to the surgery. More significant improvement of VAS (back and leg) was found in observation group at both three days and one month postoperatively. Regarding Barthel index, despite its transient decrease at three days after surgery in control group, it showed statistical increase at postoperative one month when compared with preoperative values in both groups; moreover, its inter-groups comparison revealed much more improvement in patients receiving ERAS recommendations; while at final follow-up, it continued further increase in either group. Marginally higher proportion of patients in observation group showed perfect or good clinical outcome, as well as solid interbody fusion. ConclusionsERAS pathway in microendoscopy-assisted MIS-TLIF has advantages of decreased operative time, reduced intraoperative haemorrhage, increased initial back pain relief, decreased length of stay, lowered analgesic usage and earlier daily activity recovery and thus, benefit postoperative rehabilitation further.

Cortical Bone Trajectory Screw Fixation of Lumbar Spine in Adult Patients with Degenerative and Traumatic Spine Disorders

Abstract Background the CBT for placing lumbar pedicle screws is a technique used to improve fixation during instrumented fusion of the lumbar spine. In comparison with traditional trajectory (TT) for pedicle screws, CBT screws (otherwise known as pars screws or cortical screws) have a more medial starting point and are aimed in a medial to lateral, caudal to cranial direction. First reported in 2009 as a method to increase the purchase of lumbar pedicle screws within bone.(1) Aim of the Work to perform a systematic review and meta-analysis to determine whether traditional Pedicles Screw Fixation (PS Fx) or Cortical Bone Trajectory Screw Fixation (CBT Fx); has been successful for the treatment and fixation of lumbar spine in adult patients with degenerative and traumatic spine disorders; and to compare the 2 techniques to identify risk factor for unfavorable outcome through the recent researches about that issue. Methodology this review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Results meta-analysis study showed that; Successful fusion rate in fixed and random-effects models were (92.24% respectively); in SP group.Successful fusion rate in fixed and random-effects models were (92.44% respectively); in CBT group.Fixed and random-effects models showed non-significant difference in successful fusion rate; between the 2 groups of studies (p &amp;gt; 0.05). We calculated safety for each technique through post-operative (failed fusion rate). Conclusion Although there were insignificant p-values in the most of the comparative items but the CBT showed lower average of intraoperative blood loss, operation time and higher average of decrease in VAS &amp; increase in ODI, slightly higher fusion rate in comparison with PS. So we recommend, the use of CBT as an acceptable alternative of PS in lumbar spine fixation.

Analysis of effectiveness and drug related problems of pain reliever for knee osteoarthritis: weighing clinical risk and benefit.

Background Osteoarthritis (OA) is a chronic degenerative joint disease, characterized by physiological disorders, such as cartilage degradation, bone remodeling, osteophyte formation, and joint inflammation, which results in pain. Several studies have reported problems with the use of pain medications in OA, such as the use of a combination of many drugs and their long-term use. Therefore, this study was designed to evaluate the use of pain medications in OA patients. The study focused on the analysis of effectiveness and drug related problems (DRPs) with the category of drug interactions and adverse drug events (ADEs) in knee OA patients in Orthopedic and Traumatology Clinic, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia. Methods The study used a retrospective approach through tracking and recording of the medical data from the period of 1st January to 30th June, 2018. The potential of drug interactions was determined by analyzing data based on literature. The actual side effects of the drug were identified based on the patient's medical record through clinical data, laboratory data, and therapeutic data received by the patient. The study involved 143 subjects who met the inclusion criteria of 871 visits to the hospital. Results The results showed that women as much as 80.42% with an age distribution of at most 46-65 years are the most affected by OA cases. The predominant history of illness and comorbidities in OA patients was hypertension in 58.74% of patients. The use of analgesic meloxicam had a percentage of 26.06%, sodium diclofenac 20.21%, mefenamic acid 4.36% and paracetamol 4.25%. The effectiveness of the use of pain reliever was characterized by a decrease in VAS in each patient at the beginning and at the end of the study, where a decrease in pain intensity occurred in 79.72% of patients who received pain medications. Based on drug interactions, we were able to identify pharmacodynamic interactions of 43 events (4.94%) and onine events of pharmacokinetic interactions (1.03%), with a minor severity of 7 events (0.80%),44 moderate events (5.05%), and one major event (0.11%). Mostly identified side effects of the drugs were those due to the use of non-steroid anti inflammatory drugs, which occurred in 42 events (4.82%). Conclusions It can be concluded that OA therapy with a number of pain relievers shows an adequate therapeutic response with some side effects and interactions both pharmacokinetically and pharmacodynamically.

Transforaminal Epidural Injection of Local Anesthetic and Dorsal Root Ganglion Pulsed Radiofrequency Treatment in LumbarRadicular Pain: A Randomized, Triple-Blind, Active-Control Trial.

Lumbar radicular pain (LRP) results from inflammation and irritation of lumbar spinal nerves and the dorsal root ganglion (DRG). Our study is a prospective, triple-blind, randomized, activecontrol trial (CTRI/2016/02/006666) comparing transforaminal epidural local anesthetic (LA) injection and pulsed radiofrequency treatment of DRG in patients with chronic LRP. Patients with LRP after failed conservative management for >3months received selective diagnostic nerve root block with 1mL 2% lidocaine. Fifty patients showing positive responses were divided into groups of 25 each. The LA group received transforaminal epidural injection of 1mL 0.5% bupivacaine. The lumbar pulsed radiofrequency (LPRF) group received transforaminal epidural injection of 1mL 0.5% bupivacaine with 3 cycles of pulsed radiofrequency of the DRG for 180seconds RESULTS: Both groups were compared by observing pain intensity on a 0- to 100-point VAS and improvement in functional status by the Oswestry Disability Index (ODI version 2.0) at 2 weeks and 1, 2, 3, and 6 months. All baseline variables were comparable between the 2 groups. Statistically significant reduction in both outcomes was seen in the LPRF group compared to the LA group from 2weeks to 6months. One hundred percent of patients in the LPRF group had a ≥20- point decrease in VAS and significant percentage reduction in ODI at all time intervals up to 6 months, whereas it was seen in 80% and 28% of patients in the LA group at 3 and 6months, respectively. No complications were seen in any patients CONCLUSION: Pulsed radiofrequency of the DRG applied for longer duration results in long-term pain relief and improvement in the functional quality of life in patients with chronic LRP.

Comparison of two methods of cervical spine pain manual therapy using clinical and biochemical pain markers

Background. Sedentary lifestyle, often associated with faulty posture is a widespread facilitating factor for cervical spine dysfunction (CSD). Objective. The purpose of our study was to compare two methods of physical therapy for CSD: the McKenzie method and suboccipital relaxation. We investigated the effect of these methods on pain level perceived by patients and their physical fitness. The levels of biochemical stress indicators were assessed. Materials and methods. Eighty-six adult patients divided into two groups: A and B. Group A included 42 patients treated with the McKenzie method. Group B consisted of 44 patients, who underwent suboccipital relaxation. The treatment in both groups comprised 3 treatment sessions over a 6-week period. To assess salivary sIgA concentration, the ELISA technique was used. The alpha-amylase activity was determined using static method. Pain assessment was performed using the VAS scale. Disability level was evaluated with the NDI scale. Results. Significant decrease of VAS and NDI scores were observed in both groups. An increase of sIgA concentration was observed in both groups. No difference in amylase activity between the groups was observed, however, time and group effects the interaction was found to be significant. A significant correlation between both biochemical markers and VAS score was observed in group B and in the general population. Conclusions. Both therapies improve patient outcomes, however, at present we cannot indicate the advantage any method.

Effect of alcohol consumption on patient-reported outcomes in hip arthroscopy: a matched controlled study with minimum 2-year follow-up.

There is a paucity of literature examining the effects of alcohol consumption on patient-reported outcomes (PROs) after hip arthroscopy. The purpose of this study was to report 2-year outcomes of hip arthroscopy in patients who consume alcohol compared to patients who abstain. Registry data were prospectively collected and retrospectively reviewed to identify heavy drinkers at the time of primary hip arthroscopy. Patients were matched 1:1 (heavy drinkers:non-drinkers) based on age, sex, BMI, acetabular Outerbridge grade, and capsular treatment. All patients were assessed with 4 validated PROs: mHHS, NAHS, HOS-SSS, and iHOT-12. Pain was estimated with VAS. 42 patients were pair matched in each group (heavy drinkers:non-drinkers). Both groups demonstrated significant improvement for all PROs and VAS. Heavy drinkers reported lesser improvement in HOS-SSS (p = 0.0169), smaller decrease in VAS (p = 0.0157), and lower final scores on iHOT-12 (p = 0.0302), SF-12 mental (p = 0.0086), and VR-12 mental (p = 0.0151). Significantly fewer patients in the heavy-drinking group reached PASS for mHHS (p = 0.0464). Odds of achieving PASS for mHHS was 2.5 times higher for patients who abstain from alcohol. The rates of revision hip arthroscopy and conversion to total hip arthroplasty were not statistically different between groups. While hip arthroscopy may still yield clinical benefit in drinkers, patients who consume heavy amounts of alcohol may ultimately achieve an inferior functional status and should be counselled on drinking cessation to optimise their results.

Posterior cervical fusion utilizing cages placed bilaterally in the facets for the treatment of the upper cervical adjacent segment disease in the elderly

This is a retrospective review of 24 elderly patients with upper cervical adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF), treated with posterior cervical fusion (PCF) and stabilized with cages placed bilaterally in the facets. Eight out of 24 patients had PCF with laminectomy (PCLF). Length of stay for PCF alone cohort was 30 ± 11 h, operative time was 44 ± 11 min and estimated blood loss was 46 ± 26 cc. In the PCLF cohort, hospital length of stay was 73 ± 32 h, operative time was 92 ± 18 min, and blood loss was 155 ± 58 cc. The pooled sample showed significant decreases in mean NDI and VAS for neck and arm pain at each follow-up visit (6 weeks, 3, 6, 12 months) compared to baseline (p < 0.0001). All 19 patients that returned for an additional visit, after 12 months visit, continued to report an improvement over the baseline VAS and NDI scores. For those patients treated with PCLF, Nurick scores improved by more than one point in 62% of patients. The overall fusion rate was 96%, including all 16 patients treated with PCF alone (fusion defined as less than 2 mm interspinous movement on dynamic X-ray), and in 7 out of 8 patients treated with PCLF (fusion defined as less than 3 degrees angulation). There was one asymptomatic non-union. There were no significant changes in the overall cervical lordosis (p = 0.436) or segmental lordosis (p = 0.449), and no device-related complications.

Longitudinal Changes of Impairments in Health-Related Quality of Life in Lower-Risk MDS Patients: A European Leukemianet Study

Introduction Patient perception and perspective have become relevant in individualised therapy planning in MDS. Thus, integration of patient-reported outcomes (PRO), including health-related quality of life (HRQoL), in studies and in clinical practice is essential. We demonstrated recently pronounced impairments in HRQoL in patients with MDS (Stauder et al., Leukemia 2018). However, longitudinal data on aspects of HRQoL in MDS are rare.Objectives 1. To describe longitudinal changes of HRQoL in MDS and 2. To compare the time course in different patient subgroups to define patients at high risk of deterioration of HRQoL.Methods The EUMDS Registry is a prospective, non-interventional longitudinal study, enrolling newly diagnosed patients with IPSS low or intermediate-1 MDS from 143 haematology centres in 17 European countries and Israel. HRQOL was assessed by EQ-5D questionnaire. Patients were selected, if they fully completed the EQ-5D score (five dimensions and VAS) at baseline and at 6 and 12 months, resulting in a total of 743 subjects at 86 centres in 15 countries. Differences in response for the five EQ-5D dimensions between patients subgroups were evaluated using chi-squareMcNemar tests. For EQ-VAS, the mean score with standard deviation was calculated. Wilcoxon's signed ranks tests were conducted to identify changes over time between HRQOL values at baseline and at 6, 12 months.Results•Moderate/severe impairments at initial diagnosis were observed in the dimensions mobility (39.4%), self-care (10.2%), usual activities (32.6%), pain discomfort (46.6%) and anxiety/depression (36.7%).•As compared with baseline a pronounced increase in moderate/severe problems was observed at 12 months in the dimensions self-care (10.2% (baseline) vs 15.5% (12 mo); p=0.003) and in usual activities (32.6% vs 40.6%; p=0.001). In contrast, self-reported mobility, pain and anxiety/depression did not change significantly. Decrease in VAS over time revealed a trend toward significance (75 vs. 70; p=0.056).•More pronounced impairment of HRQOL was most significantly observed in patients of advanced age: 60-75 yrs in self-care 8.3% vs 14.3% (p=0.016) and in usual activities 28% vs 35.7% (p=0.032); in persons 75+ years in self-care 14.2% vs 19.8% (p=0.058) and in usual activities 48.7% vs 50.3% (p=0.003). Similarly, VAS significantly decreased in the latter group from 70 to 66 (p=0.038).•Increases in impairments were most prominent in male patients in self-care (9.7 vs 16.7%; p=0.002) and in usual activities (29.4 vs 38.7%; p=0.003), whereas in women HRQoL at the different time points was not significantly different.•Pronounced decreases in HRQoL aspects was observed in anemic patients (Hb-levels <10g/dl) at initial diagnosis: mobility 47.4 vs 55.2% (p=0.06), self-care 13.5 vs 21.1% (p=0.015), usual activities 41.3 vs 52.7% (p=0.006), pain/discomfort 43.3 vs 55.6% (p=0.058) and VAS (70 vs 68; p=0.051). A reduction in HRQoL was observed even in patients with a Hb-level ≥10 g/dl in the dimension self-care (7.9 vs 12.1%; p=0.042).•Pronounced decreases in problems in HRQoL were observed in anemic patients (Hb<10 g/dL) who received transfusions in self-care (18.1% vs 25.6%; p=0.029), in usual activities (43.6% vs 61.5%; p=0.038), and in VAS (67.3 vs 61.9; p=0.003).•Transfusion dependent patients were at high risk to develop impairments in VAS (70 vs 64; p=0.006) and in most dimensions of EQ-5D (mobility 50.2 vs 62%, p=0.017), self-care (8.8 vs 11.5%, p=0.017), usual activities (41.6 vs 62.9%, p=0.01) and pain/discomfort (48.3 vs 58.5%, p=0.038).Conclusions Low-risk MDS patients report relevant restrictions in distinct dimensions at initial diagnosis. A relevant drop in HRQoL is observed at 12 months particularly in self-care and in usual activities. Patients of advanced age, males and those with initial low Hb-levels most frequently reported declines in HRQoL. Transfusion-need represents a relevant predictor of deterioration of HRQoL. These analyses form the basis to identify vulnerable patients and to tailor individualized interventions and treatment approaches. Analyses are planned to unravel the role of intervention therapies on observed changes in HRQoL. DisclosuresStauder:Teva: Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees. Fenaux:Celgene: Honoraria, Research Funding; Jazz: Honoraria, Research Funding; Roche: Honoraria; Otsuka: Honoraria, Research Funding; Janssen: Honoraria, Research Funding. Garelius:novartis: Honoraria. Efficace:Incyte: Consultancy; Amgen: Consultancy; TEVA: Consultancy; Bristol Meyers Squibb: Consultancy; Orsenix: Consultancy; Seattle Genetics: Consultancy; Lundbeck: Research Funding; TEVA: Research Funding; AMGEN: Research Funding. de Witte:Amgen: Consultancy, Research Funding; Celgene: Honoraria, Research Funding; Novartis: Research Funding.

Minimum of 10-year follow-up of V-rod technique in lumbar spondylolysis.

To describe and analyze the use of the V-rod technique described by Gillet to repair spondylolysis in both early and late postoperative periods. Patients submitted to surgical correction of lumbar spondylolysis with a V-rod system were selected upon exclusion of adjacent disk degenerative changes and high-grade spondylolisthesis. A preoperative clinical (ODI and VAS) and radiological evaluation was performed, along with assessments on the early (clinical evaluation-up to 1year) and late (clinical and radiological-at least 10years) postoperative periods. Twenty-two patients were included, 21 with L5 spondylolysis. Fifty percent had grade I spondylolisthesis. A significant decrease in ODI and VAS was observed from pre- to early and late post-op evaluation (all p < 0.05) but not during post-op evaluations. Changes from pre- to postoperative of both ODI and VAS were significantly higher than the minimal clinically important difference. Preoperative ODI and VAS were significantly higher in overweight/obese but similar postoperatively. No additional instability was found in late postoperative X-rays. Three patients needed revision surgery, with a survival rate of 81.8% for Gillet instrumentation at a mean follow-up of 687.7 ± 60.0weeks. Surgical treatment with V-rod system is associated with a significant improvement in ODI and VAS and radiologic stability, with an equal benefit in obese/overweight patients. This study reports for the first time an improvement that is maintained even 10years after the initial intervention, associated with a low rate of failure. These slides can be retrieved under Electronic Supplementary Material.

Clinical outcome of single intra articular injection of triamcinolone acetonide depot preparation on knee osteoarthritis

Oral pharmacological agents are not effective for long term and have many side effects if used for longer period of time. Intraarticular injection of hyaluronic acid injections and other biological agents like bone marrow aspiration concentrate are of still questionable value. Hence till today intraarticular steroid are routinely used in practise in the world all over. Hence we decided to carry out a retrospective review study to assess if the steroids were effective after 24 weeks. A retrospective review study was performed at MIMER Medical College and BSTR Hospital from Jan 2008 to December 2017. Patients with osteoarthritis of knee joint aged 50 years to 80 years of both sexes were included in the study. One thousand and twelve patients were included. We collected data of patients from hospital records. 40 mg of triamcinolone acetonide which is a long acting depot preparation of triamcinolone (potent synthetic corticosteroid which is having selective glucocorticoid activity) was used for intraarticular injection into knee joint under strict antiseptic and aseptic precautions. There was a statistically significant decrease in the initial VAS and WOMAC scores at 3 weeks,12weeks and 24 weeks after intraarticular injection (p

The Effect of Adding Ketamine or Midazolam to Bupivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block for Upper Extremity Surgeries

AbstractBackground: The use of supraclavicular brachial plexus block is one of the most effective anesthetic techniques in operations for the upper extremity. The use of ultrasound guidance for regional anesthesia became popular owing to detection of anatomical variants, painless performance and correct needle placement. Aim of the study is to evaluate the value of adding ketamine or midazolam to bupivacaine when used for ultrasound guided supraclavicular brachial plexus block in upper extremity surgical procedures as regard the quality of surgical anesthesia and post-operative analgesia.Patients and Methods: Seventy adult patients of both sexes aged (18-60) years with ASA physical status I/II sched-uled for elective surgical procedure of the elbow, forearm, wrist and hand. Patients divided into two groups thirty-five patients were given 30ml total volume of 0.5% bupivacaine with midazolam 50μg/kg injected around brachial plexus cluster (Group A) and thirty-five patients were given 30ml general volume contained 0.5% bupivacaine with ketamine 2mg/kg injected around brachial plexus cluster (Group B).Results: There was no significant difference among both groups according to demographic data, hemodynamic changes, onset of motor and sensory block, sedation score, total doses of rescue analgesia and incidence of complications. There was significant prolongation in duration of sensory and motor block, significant decrease in VAS and significant delay in first request of rescue analgesia in Group A.Conclusion: The addition of midazolam (50μg/kg) when used as adjuvants to bupivacaine in ultrasound guided brachial plexus block produced prolongation of sensory and motor block, providing desirable sedation, improved quality of postoperative analgesia and decreased necessities of rescue analgesics in post-operative period.

Chemical lumbar sympathectomy in the treatment of recalcitrant erythromelalgia

ObjectiveErythromelalgia is highly disabling and treatment is often very challenging. There have been solitary case reports that it might benefit from sympathectomy. This study sought to evaluate the short-term and long-term efficacy of chemical lumbar sympathectomy (CLS) for treatment of recalcitrant erythromelalgia and try to identify a CLS-responsive subset. MethodsPatients with recalcitrant erythromelalgia were recruited from a tertiary hospital over a 10-year period. L3 to L4 CLS was performed using 5% phenol. The pain intensity score (visual analog scale [VAS] 0-10) was assessed before CLS and at 1 day, 1 week, 3 months, 6 months, 1 year, and 2 years after CLS. A VAS decrease of 90%-100% is defined as complete response, 60%-89% as major partial response. Relapse was defined by a return of a VAS score of 5 or higher. SCN9A gene mutations were screened. ResultsThirteen patients were enrolled, with a median age of 15 years. The mean follow-up was 6.2 ± 3.8 years. SCN9A gene mutation was identified in five patients having family histories. The VAS was 8.2 ± 2.0 at baseline; it decreased to 4.9 ± 2.7 at 1 day and 1.9 ± 3.0 at 1 week after CLS. Nine patients (69.2%) achieved complete response at 1 week after CLS, including three patients with SCN9A gene mutation. Among the three complete response patients having the gene mutation, two reverted to major partial response and one relapsed at 2 years after CLS. Among the six complete response patients without mutation, five maintained complete response and one relapsed. Among the four patients who did not achieve complete response, one patient died at 3.5 months and one patient had an amputation performed at 4 months after CLS. ConclusionsCLS provides a valid option for the treatment of recalcitrant erythromelalgia. It takes about 1 week to achieve full efficacy. Relapse may occur, especially in patients with an SCN9A gene mutation.

Meniscal allograft transplantation combined with anterior cruciate ligament reconstruction provides good mid-term clinical outcome.

Aim of this study is to document if combined meniscal allograft transplantation (MAT) and ACL reconstruction can improve knee function, reduce pain and allow patients with meniscal defect and ACL lesion to resume sport activities. Fifty MAT, arthroscopically performed without bone plugs and combined with one-stage primary or revision ACL reconstruction, with or without high tibial osteotomy (HTO), were included. Patients (aged 38.2 ± 10.6 years, 87% males) were evaluated at a mean follow-up of 5years with Lysholm, Tegner and VAS scores. Patient satisfaction was also recorded, together with complications and failures. VAS and Lysholm scores improved significantly (from 63.7 to 24.5 and from 60.6 to 82.7, respectively, p < 0.001), while the Tegner score did not reach pre-injury values (p < 0.001), but it improved significantly compared to pre-surgery values (from 2.8 to 4.6, p < 0.001). Medial MAT reported significantly better results compared to lateral MAT. Patients undergoing concomitant HTO reported a significantly higher decrease of VAS. Younger patients with higher pre-operative pain and lower activity level presented higher satisfaction. Eight patients needed a reoperation. Three patients were considered surgical failures while four were considered clinical failures, for a total of 15% failures. Meniscal allograft transplantation combined with ACL reconstruction represents a safe and suitable treatment, which should be considered as a suitable option in the clinical practice. All evaluated patient profiles, ACL injury in a patient with post-meniscectomy syndrome, failed ACL reconstruction in patients with a meniscus defect, and ACL reconstruction in patients with malalignment due to meniscal defect, benefited from the combined MAT procedure at medium-term follow-up. IV.