Difference In Numerical Rating Scale Scores Research Articles

Ultrasound-Guided Erector Spinae Plane Block in Elderly Patients Undergoing Total Hip Arthroplasty (THA): A Triple-blind, Randomized, Controlled Trial

BACKGROUNDTotal hip arthroplasty (THA) induces postoperative pain in elderly individuals. The erector spinae plane block (ESPB) is a novel analgesic approach for postoperative pain control. This randomized controlled trial evaluated the effectiveness of ultrasound-guided ESPB with ropivacaine in reducing pain in elderly patients undergoing THA METHODSPatients aged 60 to 80 years who had an American society of Aneshesiologists (ASA) physical status I to III were eligible for this study. There were 50 patients who were randomized into two groups: the ESPB group receiving ultrasound-guided ESPB with ropivacaine, and the control group receiving ESPB with normal saline. All patients underwent general anesthesia, and the mean arterial pressure (MAP), heart rate (HR), intraoperative opioid consumption, numerical rating scale (NRS) scores, and postoperative adverse reactions were recorded throughout the perioperative period. RESULTSA significant reduction in NRS scores was observed in the ESPB group compared to the control group at various time points, including in the recovery room and at 12 and 24 hours postoperatively (P < 0.05). When the observation period was extended to 48 hours, no significant difference in NRS scores was noted between the two groups (P > 0.05). No significant differences in MAP and HR were found between the two groups, but the ESPB group showed lower coefficients of variation (CV) for both MAP and HR. Moreover, the ESPB group demonstrated a significantly lower total remifentanil consumption than the control group. There was no significant difference in complications between these two groups (P < 0.05). CONCLUSIONSUltrasound-guided ESPB enhances the perioperative stability of mean arterial pressure and heart rate, providing effective analgesia within the initial 24 hours post-surgery, thereby reducing opioid requirements and improving overall postoperative recovery quality for elderly THA patients.

Comparison of Splanchnic Nerve Block with Ropivacaine/ Depo Medrol and Ropivacaine/Depo Medrol/Fentanyl in Patients Suffering from Abdominal Pain Due to Pancreatic Cancer

Background: This double-blind clinical trial aimed to investigate the effectiveness of splanchnic nerve blocks using different medication combinations on pain severity and duration of pain relief in patients with pancreatic cancer-related abdominal pain. Methods: Thirty eligible patients were randomly assigned to either a control group receiving splanchnic blocks with Ropivacaine/Depo Medrol/Saline or an intervention group receiving splanchnic blocks with Ropivacaine/Depo Medrol/Fentanyl. Pain severity was assessed using the Numeric Rating Scale (NRS) at 2, 6, and 24 hours and one week post-intervention. Statistical analysis included independent t-tests, Friedman tests, and False Discovery Rate (FDR) correction. Results: Prior to intervention, no significant difference in NRS scores was observed between groups (p = 0.0642). However, at the 6-hour and one-week intervals, the case group exhibited significantly lower NRS scores than the control group, indicating the efficacy of the intervention in reducing pain levels. The case group showed a substantial decrease in NRS scores from a pre-intervention mean of 7.8 to 0.5 at 2 hours, while the control group experienced a reduction from 9.083 to 2.583. The mean duration of pain relief was longer in the case group (5.429 days) compared to the control group (3.25 days). Friedman tests revealed significant differences in pain scores across time intervals within both groups (p &lt; 0.001). Conclusion: Splanchnic nerve blocks using Ropivacaine/Depo Medrol/Fentanyl combination demonstrated significant pain reduction effects, particularly at 6 hours and one-week post-intervention, compared to the control group. These findings showed that the addition of fentanyl in pharmaceutical combination as a opioid to the splanchnic block has reduced the pain score and increase the duration of pain relief in patients being involved in pancreatic cancer with abdominal pain.

Comparison of Analgesic Method in Laparoscopic Gastrectomy Using External Oblique Intercostal Block Versus Wound Infiltration: A Randomized Controlled Trial.

Background: External oblique intercostal block (EOIB) is effective in relieving pain in the T6 to T10 dermatomes; however, there is limited evidence comparing EOIB with conventional regional anesthesia. In this randomized controlled trial, it was hypothesized that EOIB would provide more effective analgesia than wound infiltration (WI) in laparoscopic gastrectomy. Methods: Thirty-two patients (aged 20-85 years) with American Society of Anesthesiologists Performance Status of 1 to 2, scheduled for laparoscopic gastrectomy, were randomly divided into EOIB and WI groups. Both procedures were performed using 40 mL of 0.25% levobupivacaine. The primary outcome was the numerical rating scale (NRS) score 12 h postoperatively. Secondary outcomes were NRS at 2, 24, and 48 h postoperatively, variation in quality of recovery-15 score on postoperative days 1 and 2 from preoperative baseline, postoperative fentanyl consumption, and variation in World Health Organization Disability Assessment Scale 2.0 scores between baseline and 3 months postoperatively. Plasma concentrations of levobupivacaine and pinprick sensation in the T4-11 dermatomes post-EOIB were evaluated to determine the exploratory endpoints. Results: There were no differences in the NRS scores 12 h postoperatively at rest and during movement between the EOIB and WI groups (mean standard deviation 1.3 [1.1] vs. 1.5 [1.4] and 3.1 [1.6] vs. 3.8 [1.7], respectively). Secondary outcomes did not differ significantly between the groups. The time to peak plasma concentration of levobupivacaine following EOIB was 45 min. Conclusions: No significant differences in NRS scores were observed between the analgesic effects of EOIB and WI at 12 h postoperatively.

Effectiveness and safety of motion-style acupuncture treatment using traction for inpatients with acute low back pain caused by a traffic accident: A randomized controlled trial.

Musculoskeletal symptoms, such as neck pain and low back pain (LBP) are common after a traffic accident (TA). While motion-style acupuncture treatment (MSAT) is effective in relieving pain, MSAT using traction (T-MSAT) has rarely been studied, and evidence for its efficacy and safety is lacking. To address this gap, this study aimed to assess the effectiveness and safety of T-MSAT for pain and functional disturbances in patients with acute LBP caused by a TA. This two-armed, parallel, assessor blinded randomized controlled trial, conducted at Jaseng Hospital of Korean Medicine, included 100 patients with acute LBP occurring within 1 week of a TA. The participants were randomly allocated (1:1 ratio) to receive either combined T-MSAT and integrative Korean medicine treatment (IKMT) or only conventional IKMT, applied for 3 consecutive days after admission. The primary outcome was the difference between numerical rating scale (NRS) scores for LBP at baseline and after treatment completion on day 4 after admission. At the primary endpoint, the difference in NRS scores for LBP between the T-MSAT and control groups was 0.94 (95% confidence interval [CI] 0.40-1.48). The T-MSAT group showed a significantly lower NRS score for LBP than the control group. Differences in visual analogue scale (VAS) scores between the T-MSAT and control groups were significant at baseline and discharge. The area under the curve of the VAS score showed a significant difference (-46.86 [95% CI -85.13 to -8.59]), indicating faster pain reduction in the T-MSAT group than in the control group. Recovery (30% pain reduction) was achieved more rapidly in the T-MSAT group than in the control group (log-rank test P = .005). Meanwhile, the NRS, VAS, Oswestry disability index, and quality of life scores at discharge or at the 12-week follow-up showed no significant difference. The rates of mild adverse events (AEs) were comparable between the groups. No severe AEs were reported, and none of the AEs were associated with the clinical trial. T-MSAT combined with IKMT is a safe treatment that can effectively and quickly reduce initial pain in patients with LBP.

Feasibility of hydromorphone PCA 10-day simple mode home management of patients in severe pain: A prospective multicenter study.

e24072 Background: Pain is a common symptom affecting patients with cancer. In clinical practice patients with advanced refractory cancer pain often face multiple anti-tumor treatments and prefer treatment at home or in community clinics versus hospitalization; thus, pain relief and drug management are challenging. Patient-controlled analgesia (PCA) is an essential component of analgesic treatment. However, difficulties associated with PCA configuration, unified pump configuration mode, and tube blockage may limit its use by both doctors and patients, negatively affecting large-scale promotion of PCA technology in hospitals and at home. In this study we optimized PCA parameters to resolve problems around cumbersome operation and tube blockage, thereby increasing pump utility and feasibility. We refer to this mode as the "10-day simple mode." The study objective is to evaluate the analgesic effect of the "10-day simple mode" of hydromorphone PCA and to explore its home-based convenience and use. Methods: A total of 100 patients with refractory cancer pain were included in this study. The pump configuration mode was divided into two stages. The first (titration) stage was: hydromorphone + normal saline with a total volume of 24 ml and pump speed of 1.0 ml/h. The second (maintenance) stage was: hydromorphone + normal saline with a total volume of 288 ml and pump speed of 1.2 ml/h with PCA of 2.4 ml. During the maintenance stage, if pain control was unsatisfactory the background dose was increased based on the number of PCA presses in the previous 24 hours. Patients' numeric rating scale (NRS) scores, quality of life scores, and adverse reactions were recorded before and after treatment. Results: Patients' average NRS score before treatment was 7.4 (7-10). Average time to successful titration was 49.6 minutes (35.6-56.9) and 40.7% of patients achieved successful titration within 30 minutes. After titration, the average NRS score was 3.2 (0-6). There was a statistically significant difference in NRS scores before and after titration (p &lt; 0.05). During maintenance, 56.0% of patients experienced breakthrough pain on day 1, when the average NRS score was 5.2. As background dosing continued breakthrough pain and average NRS score gradually decreased (p &lt; 0.05). Quality of life scores and patient satisfaction measured before and after 10 days of PCA pump use showed significant improvement (p &lt; 0.001). Conclusions: For patients with refractory cancer pain, the hydromorphone PCA "10-day simple mode" produces good analgesic effect, is easy to manage, and suitable for patients seeking home-based pain relief. These results warrant further clinical study. Clinical trial information: NCT05744089 .

Reliability of an intraoral extension for intraoral palpation and assessment of mechanical sensitivity of the temporal tendon.

The temporal tendon is a structure often compromised in patients suffering from temporomandibular disorders (TMD), yet its intraoral location makes a standardised assessment difficult. To evaluate the variability and accuracy to target force of a newly designed intraoral extension for a palpometer device (Palpeter, Sunstar Suisse) when compared to manual palpation, in addition to clinically assessing the mechanical sensitivity and referred sensations of the temporal tendon in healthy individuals. Experiment 1: 12 individuals were asked to target on a scale 0.5, 1 and 2 kg, for 2 and 5 s by using five different methods (Palpeter, Palpeter with three different extension shapes and manual palpation). Experiment 2: 10 healthy participants were recruited for a randomised double-blinded assessment by applying pressure of 0.5, 1 and 2 kg to the right temporal tendon with the three extensions and manual palpation. Participants rated the intensity of their sensation/pain on a 0-50-100 numeric rating scale (NRS), unpleasantness on a 0-100 NRS, and if present, they rated and drew the location of referred sensations. Repeated measures analysis of variance (ANOVA) was used in both experiments to compare differences between palpation methods. Tukey's HSD tests were used for the post hoc comparisons, and p values below .05 were considered significant. Experiment 1: The extensions showed no significant differences between them regarding reliability and accuracy for all forces and durations (p > .05). The manual method was significantly less reliable and accurate when compared to the other methods (p < .05). Experiment 2: There were no significant differences between the Palpeter extensions regarding pain intensity or unpleasantness NRS scores (p > .05), but all the extensions had significantly increased pain intensity and unpleasantness when compared to manual palpation (p < .05). Similarly, the frequency of referred sensations was similar between extensions but increased when compared to manual palpation. The new Palpeter extensions proved to be significantly more accurate and have lower test-retest variability than the manual method in a non-clinical setting. Clinically, they showed no significant differences in NRS scores for pain intensity nor unpleasantness, with no major differences in referred sensations, making any of the extensions suitable for clinical testing of the temporal tendon in future studies.

Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

Postpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother and infant. To investigate the efficacy of perioperative adjunctive esketamine administration after cesarean deliveries in the prevention of PPD. A single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to January 1, 2023, at Fujian Provincial Hospital among 298 women aged 18 to 40 years, with an American Society of Anesthesiologists grade I to III classification and singleton full-term pregnancies who were scheduled for elective cesarean deliveries. Primary analyses were performed on a modified intention-to-treat basis. Patients were randomly assigned to the esketamine (n = 148) and control (n = 150) groups. Those in the esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after fetal delivery, followed by 50 mg of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the control group of patients. The primary outcome was assessments of PPD symptoms by using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7. Positive screening for PPD was defined as a score of 10 or more points on the EPDS. In addition, the EPDS was analyzed as a continuous variable to evaluate depressive symptoms. Secondary outcomes included the Numeric Rating Scale (NRS) of postoperative pain, along with safety evaluations including adverse events and clinical assessments at postpartum days 14, 28, and 42. A total of 298 pregnant women were included, with 150 in the control group (median age, 31.0 years [IQR, 29.0-34.0 years]) and 148 in the esketamine group (median age, 31.0 years [IQR, 28.0-34.0 years]). The prevalence of depression symptoms was significantly lower among patients given esketamine compared with controls (23.0% [34 of 148] vs 35.3% [53 of 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P = .02) on postpartum day 7. In addition, the esketamine group also showed a significantly lower change in EPDS scores (difference of least-squares means [SE], -1.17 [0.44]; 95% CI, -2.04 to -0.31; effect size, 0.74; P = .008). However, there were no differences between the groups in the incidence of positive screening results for PPD or in changes from the baseline EPDS scores at postpartum days 14, 28, and 42. There were no differences in NRS scores at rest and on movement except on movement at 72 hours postoperatively, when scores were significantly lower in the esketamine group (median, 3.0 [IQR, 2.0-3.0] vs 3.0 [IQR, 3.0-3.5]; median difference, 0 [95% CI, 0-0]; P = .03). These results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period. However, this antidepression effect may not be universally applicable to patients with low EPDS scores. Chinese Clinical Trial Registry Identifier: ChiCTR2100054199.

Percutaneous Stylomastoid Foramen Pulsed Radiofrequency Combined with Steroid Injection for Treatment of Intractable Facial Paralysis After Herpes Zoster.

We investigated the safety and efficacy of percutaneous facial nerve pulsed radiofrequency combined with drug injection for treatment of intractable facial paralysis of herpes zoster. The authors provide a detailed description of percutaneous facial nerve pulsed radiofrequency combined with steroid injection for treatment of intractable facial paralysis after herpes zoster, and they examine its clinical efficacy. This is the first time in the literature to our knowledge that this procedure has been applied in facial paralysis after herpes zoster. A total of 43 patients with a history of facial paralysis after herpes zoster for > 1 month were enrolled in this retrospective study. The patients were subjected to percutaneous stylomastoid foramen pulsed radiofrequency of the facial nerve under computed tomography (CT) guidance combined with drug injection. The House-Brackmann grades and NRS (Numerical Rating Scale) data collection were performed at different time points (preoperatively, 1day post-procedure, and 2, 4, and 12weeks postoperatively). The occurrence of complications was also assessed. The 43 participants successfully completed the CT-guided percutaneous stylomastoid foramen pulsed radiofrequency of the facial nerve combined with drug injection. Both approaches [posterior approach of the ear (7 cases) and anterior approach of the ear (36 cases)] were efficacious and safe. The House-Brackmann grades (I, II, III, IV, V, VI) were 4 (3-4), 2 (2-3), 1 (1-2), and 1 (0-2) at different operation times (T0, T1, T2, T3, T4); patients felt significant recovery at T1 after operation and had gradually recovered at each time point but had no significant recovery after T3. The NRS scores at different operation times were 2.690 ± 2.213, 0.700 ± 0.939, 0.580 ± 1.006, 0.440 ± 0.908, and 0.260 ± 0.759, respectively. Differences in NRS scores between T0 and T1/2/3/4 were significant while differences between T1 and T2/3/4 were not significant. Six patients developed mild numbness, nine patients exhibited muscle tension, while one patient exhibited facial stiffness. During surgery, there was no intravascular injection of drugs, no nerve injury was reported, and there was no local anesthetic poisoning or spinal anesthesia. Percutaneous stylomastoid foramen pulsed radiofrequency combined with drug injection of the facial nerve for treatment of intractable facial paralysis after herpes zoster is a minimally invasive technique with high rates of success, safety, and effective outcomes. It is a potential therapeutic option for cases of facial paralysis of herpes zoster with a > 1 month history even for those with severe facial paralysis and whose treatment has failed after oral medication and physiotherapy.

Anterior Quadratus Lumborum Block for Total Laparoscopic Hysterectomy: A Randomized, Double-Blind, Placebo-Controlled Trial.

This study aimed to investigate the perioperative analgesic effects of anterior quadratus lumborum block (QLB) for total laparoscopic hysterectomy (TLH). One hundred patients undergoing TLH were randomized to receive an anterior QLB or placebo before general anesthesia. The primary and secondary outcomes were postoperative sufentanil consumption, intraoperative remifentanil demand, time to first opioid demand, numeric rating scale (NRS) pain scores, heart rate, mean arterial pressure, and complications within 24 h after surgery. No significant intergroup differences were observed in sufentanil consumption within 24 hours after surgery. Remifentanil consumption during surgery was lower in the QLB group than that in the placebo group. At 1 h after surgery, the NRS scores of abdominal visceral pain at rest and during activity were 1.26 and 1.41 points lower than those in the placebo group. In other time points, the differences of abdominal visceral pain were neither statistically significant nor clinically significant (pain difference <1) or both. No significant differences in NRS scores of shoulder pain, abdominal incisional pain and perineal pain were observed between the two groups, no matter at rest or during activity. There were no significant differences in other secondary outcome variables between the two groups. Preoperative bilateral anterior QLB only reduced intraoperative opioid demand and postoperative abdominal visceral pain scores at 1 h after surgery. The clinical significance of anterior QLB in TLH may be limited.

Femoral nerve block using lower concentration ropivacaine preserves quadriceps strength while providing similar analgesic effects after knee arthroscopy

PurposeFemoral nerve block (FNB) is widely used in patients undergoing knee arthroscopy. However, the most commonly used concentration of ropivacaine (0.2% or above) may cause an unexpected decrease in the muscle strength of the quadriceps. Therefore, a lower concentration of ropivacaine (0.1%) for FNB was administered to investigate the effect on quadriceps strength and postoperative pain after knee arthroscopy.MethodsThis was a double-blind, randomized, controlled trial (ChiCTR2000041404). A total of 83 patients scheduled for elective knee arthroscopy were randomized to receive 0.1% or 0.2% ropivacaine for FNB under ultrasound guidance. The primary outcomes were quadriceps strength and numerical rating scale (NRS) pain score. Quadriceps strength was measured before surgery and 6 h and 24 h after surgery, while NRS score was recorded before surgery, at the postanaesthesia care unit (PACU), and 6 h and 24 h after surgery. Multiple linear regression tests were used to compare the differences in quadriceps strength and NRS score between the two groups. Two-factor analysis of variance, using the factors group and time of measurement, was used for repeated NRS scores. Secondary outcomes included knee mobility, side effects, patient satisfaction, and length of hospital stay.ResultsThe mean (SD) quadriceps strength at 6 h after surgery was 7.5 (5.7) kg for the 0.1% ropivacaine group and 3.0 (4.4) kg for the 0.2% ropivacaine group. The mean difference adjusted for baseline characteristics was − 5.2 (95% CI − 7.2 to − 3.1) kg (P < 0.001). There was no significant difference between the two groups in quadriceps strength at 24 h after surgery. The mean differences in the average NRS score and maximum NRS score in the PACU were − 0.6 (P = 0.008) and − 1.0 (P < 0.001), respectively. There was no significant difference in NRS score at 6 h or 24 h after surgery. Two-factor analysis of variance showed no significant difference in the interaction factors of time and group for average NRS score and maximum NRS score.ConclusionsCompared with 0.2% ropivacaine, 0.1% ropivacaine for FNB preserved quadriceps strength at 6 h after knee arthroscopy while providing similar analgesic effects.Level of evidenceI.

Effects of ultrasound-guided erector spinae plane block on postoperative acute pain and chronic post-surgical pain in patients underwent video-assisted thoracoscopic lobectomy: a prospective randomized, controlled trial

ObjectiveTo investigate the effects of ultrasound-guided erector spinae plane block (ESPB) on acute and chronic post-surgical pain in patients underwent video-assisted thoracoscopic lobectomy.MethodsA total of 94 patients, who underwent elective unilateral video-assisted thoracoscopic lobotomy from August 2021 to December 2021 were randomly divided into general anesthesia group (group A, n = 46) and ESPB combined with general anesthesia group (group B, n = 48) by computer. Patient controlled intravenous analgesia(PCIA) was performed in both groups after operation. The numerical rating scale(NRS) of rest and cough pain at post anesthesia care unit(PACU), 2 h, 6 h, 12 h, 24 and 48 h after operation, frequency of PCIA in 24 h after operation, frequency of rescue analgesia, patient satisfaction, adverse reactions and complications were recorded in the two groups. Incidence of chronic pain at 3 months and 6 months after operation, the effect of daily life and rating of chronic pain management measures were recorded in the two groups.ResultsCompared with group A, rest and cough NRS score at 2 h, 6 h, 12 h, 24 and 48 h after surgery, frequency of PCIA use at 24 h after surgery, frequency of rescue analgesia were significantly decreased in group B (P < 0.05). There was no significant difference in NRS scores of rest and cough at PACU after operation between 2 groups after surgery at post anesthesia care unit (P > 0.05). There were no significant differences in the incidence of postoperative chronic pain between the 2 groups(P > 0.05);The effect of postoperative chronic pain on daily life and pain management measures in group B were significantly lower than those in group A(P < 0.05). Compared with group A, patients in group B had higher satisfaction degree, lower incidence of postoperative nausea and vomiting(PONV), and lower incidence of agitation during anesthesia recovery (P < 0.05). There were no pneumothorax, hematoma and toxicity of local anesthetic in the 2 groups.ConclusionUltrasound-guided erector spinae plane block can significantly reduce acute post-surgical pain, can not reduce the incidence of chronic post-surgical pain, but can significantly reduce the severity of chronic pain in patients underwent video-assisted thoracoscopic lobectomy.Trial registrationChiCTR2100050313,date of registration:26/08/2021

Effectiveness and Safety of Acupotomy Treatment on Shoulder Pain: 25 Multicenter Retrospective Study.

Shoulder pain is a common complaint in outpatient clinics and can result in an inability to work or perform household activities, leading to significant socioeconomic burden. Acupotomy, as one kind acupuncture that has flat knife-shaped tip, has been widely used for treating shoulder pain. However, despite the widespread use of acupotomy in primary medical institutions, large sample size clinical trials have not sufficiently been performed. In this respect, this multi-center retrospective study aimed to investigate the effectiveness and safety of acupotomy in reducing shoulder pain and disability using data from multi-center primary care clinics. This study was conducted in 25 Korean medicine clinics affiliated with the Korean Medical Society of Acupotomology, Republic of Korea, from August 2021 to December 2021. The medical records of patients who visited the clinics complaining of shoulder pain were gathered, and among them were those of patients who underwent acupotomy treatment and those who received acupuncture combined therapy. The Numeric Rating Scale (NRS), SPADI (Shoulder Pain and Disability Index), Range of Motion (ROM) and adverse event were evaluated at each visit. A linear mixed-effects models and paired t-test were used to identify the effectiveness of the treatment. Overall analysis showed that the NRS score of patients decreased from 4.95 ± 1.97 before treatment to 3.78 ± 2.03 after treatment (n = 332, difference in NRS score, 1.17; 95% CI: 0.96-1.38, t = 10.89 p < 0.001). SPADI score decreased from 19.05 ± 20.44 at baseline before treatment to 12.12 ± 17.26 after the last visit, which was statistically significant (n = 332, mean difference in SPADI score, 6.93; 95% CI: 4.71-9.15, t = 6.150, p < 0.001). No serious adverse event was reported in both groups. This study showed the effectiveness of acupotomy therapy for shoulder pain, and as the treatment sessions increased, the effect of pain reduction and shoulder function improvement were also increased.

Comparison of Postoperative Analgesic Effect of Ultrasound-guided Erector Spinae Plane Block and Local Anaesthetic Infiltration with 0.375% Ropivacaine in Percutaneous Nephrolithotomy Patients: A Randomised Clinical Study

Introduction: The Erector Spinae Plane Block (ESPB) is a novel procedure that has shown benefits in postoperative pain management for various surgeries. It involves the systemic infiltration of anaesthesia into the surrounding tissues, which helps to suppress local pain responses. Aim: To compare the efficacy of Ultrasound-guided (USG) ESPB with local anaesthetic infiltration in postoperative pain management for patients undergoing Percutaneous Nephrolithotomy (PCNL). The comparison was based on the Numeric Rating Scale (NRS) score and the time taken for the first rescue analgesic requirement, along with its total consumption within 24 hours. Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesia at Velammal Medical College and Hospital, Madurai, Tamil Nadu, India. The duration of the study was two months, from September 2022 to October 2022. A total of 70 patients were randomly assigned to either group L (n=35) (local anaesthetic infiltration) or group E (n=35) (USG-guided ESPB). Demographic details, NRS pain scores, time taken for the first rescue analgaesia, and total consumption within 24 hours were noted and analysed. Descriptive analysis was performed, and a comparison between the groups was made using the Mann-Whitney U test or Chisquare test. Analysis was conducted using coGuide V1.0.3. Results: The mean age (mean±SD) of the study participants in group L and group E was found to be 49.31±13.96 years and 46.37±13.72 years, respectively. A total of 35 patients were included in each group, consisting of 16 (45.71%) females and 19 (54.29%) males in both groups. The difference in NRS scores was significant at 30 minutes, one hour (p-value &lt;0.001), and six hours (p-value &lt;0.011). The median time required for the first rescue analgesic was found to be 480 and 30 minutes in group E and group L, respectively (p-value &lt;0.001). The median total consumption within 24 hours was 50 mg in both groups. Conclusion: The USG-guided ESPB provided a longer-lasting analgesic effect in postoperative pain management for PCNL patients, as evidenced by the NRS pain scale, postoperative opioid consumption, and time for the first rescue analgesia

A Comparative Study of Effectiveness between Myofascial Release and Pressure Release on Pain and Ankle Range of Motion in Adults with Soleus Myofascial Trigger Points

Study Design: Experimental study design.&#x0D; Background: Myofascial release and Pressure release are the two techniques used for the treatment of active myofascial trigger points. To our knowledge there are no prospective, randomized studies in the literature investigating the comparison between the effects of 2 different manual therapy techniques (myofascial release and pressure release) on myofacsial trigger points of soleus.&#x0D; Purpose of the study: To determine the effects of Myofascial release and Pressure release techniques on pain and ankle range of motion in patient with soleus myofascial trigger point.&#x0D; Method: 30 subjects having active myofascial trigger points in soleus muscle were randomly assigned to either control group or experimental group. Readings were taken for Pain using Numeric Rating Scale (NRS) and ankle dorsiflexion range of motion (ROM) with goniometer before treatment and immediately after treatment.&#x0D; Results: Data analysis was performed using SPSS software 17 version. In both the group significant improvement occurred in NRS score and ROM. Between groups analysis revealed that there was no significant difference in NRS score and ROM between both groups.&#x0D; Conclusion: Both manual therapy techniques i.e. Myofascial release and Pressure release were found to be effective in reducing pain and increasing ankle dorsiflexion range of motion. However the subjects treated with myofascial release and pressure release showed similar benefit in terms of reduction of pain on NRS and improved ROM. Hence it’s concluded that Myofascial release and Pressure release both are effective therapeutic option in the treatment of myofascial trigger point.

Comparison of the Analgesic Efficacy of Opioid-Sparing Multimodal Analgesia and Morphine-Based Patient-Controlled Analgesia in Minimally Invasive Surgery for Colorectal Cancer.

A multimodal analgesia (MMA) protocol has shown the effect of postoperative pain control and reduced the postoperative opioid consumption. However, it was questionable whether MMA could replace opioid-based patient-controlled analgesia (PCA) for postoperative pain control. Therefore, this study aimed to investigate whether an MMA protocol is non-inferior to opioid-based PCA for pain management after a minimally invasive colorectal cancer surgery. A randomized, open-label, non-inferiority clinical trial was conducted on patients undergoing laparoscopic or robotic resection of colorectal cancer. The patients were randomly assigned to either the PCA or MMA group. The MMA protocol included pregabalin, tramadol, wound infiltration, and transversus abdominis plane block. The primary outcome was the numeric rating scale (NRS) score for pain at rest 24h postoperatively. Ninety-seven patients were included in the intention-to-treat analysis. The mean difference in NRS score at rest at 24h was 0.25 (95% confidence interval, - 0.61 to 1.11). This result demonstrated the non-inferiority of MMA to PCA in our non-inferiority margin (- 1). Compared with the PCA group, the median remifentanil dose (996 vs. 654μg; p < 0.001) and time in the post-anesthesia care unit (35 vs. 25min; p < 0.001) were significantly less in the MMA group. Our MMA protocol successfully controlled postoperative pain and was non-inferior to morphine-based PCA based on patient-reported pain intensity, with no significant increase in adverse events. These results will help construct a strategy to reduce conventional opioid prescriptions for pain management after a minimally invasive colorectal cancer surgery. Trial Registration Number Trial Registration Clinical Research Information Service Identifier: KCT0002593.

Efficacy of Different Ibuprofen Formulations with Two Prescription Methods on Post Endodontic Pain of Teeth with Irreversible Pulpitis: A Randomized Clinical Trial.

Pain management during root canal therapy and after that is of great importance in endodontics. This study aimed to compare the effect of two non-steroidal anti-inflammatory drugs (NSAIDs); ibuprofen and ibuprofen lysine with two methods of prescription on pain after single-visit root canal treatment of first and second mandibular molar teeth with irreversible pulpitis. This randomized study recruited subjects experiencing moderate to severe pain from a tooth diagnosed with symptomatic irreversible pulpitis (n=120). Subjects were randomized to receive 400 mg ibuprofen acid or 400 mg ibuprofen lysine regularly or on demand. The primary objective was to measure changes in pain scores at post-operative time frames of 6, 12, 18, 24, 48 and 72 hours after the root canal treatment on a 0-10 numerical rating scale (NRS). Independent T-test, Non-parametric Kruskal-Wallis Test and Friedman Test were used to analyze the data. Kruskal-Wallis analysis showed a significant difference in NRS score between on-demand ibuprofen group and regular ibuprofen group and also between regular ibuprofen lysine group and regular ibuprofen group at 6 hours after the treatment (P<0.05). But no remarkable difference was observed in the recorded mean pain intensity of four study groups in the other time frames (P>0.05). Based on this randomized clinical trial, there was no significant difference in the pain intensity of patients using ibuprofen and ibuprofen lysine. Additionally, there was no significant difference in the degree of pain between the on-demand and regular groups, despite the fact that patients in the on-demand group used less medications. Due to the multiple negative effects of NSAIDs, it would be wise to prescribe ibuprofen on demand.

Efficacy of early interdisciplinary palliative care based on WARM model in non-small-cell lung cancer

Objective: To assess the therapeutic effect of the early interdisciplinary palliative care based on WARM model (whole, assessment, revaluation, management) on the quality of life, psychological state, pain and nutritional status in patients with non-small-cell lung cancer (NSCLC). Methods: A total of 60 patients from Chongqing University Cancer Hospital with newly diagnosed advanced NSCLC from Oct 15, 2019 to Jun 12, 2020 were enrolled. According to the method of random number table, the patients were divided into two groups: standard oncologic care group (SC, n=30) and early palliative care group (EPC, n=30). SC group only received standard oncological care, while EPC group received standard oncological care and additional comprehensive treatment from a MDT consisted of medical oncologists, palliative care nurses, dietitians and psychologists. The quality of life [functional assessment of cancer therapy-lung (FACT-L) scale], psychological state [hospital anxiety and depression scale (HADS) and patient health questionnaire-9 (PHQ-9)], nutritional status [patient-generated subjective global assessment (PG-SGA)], and cancer pain status [numerical rating scale (NRS)] were observed and compared between the two groups before and after the 6 months treatment, respectively. Results: A total of 45 patients completed 6 months treatment, including 24 males and 21 females, aged 38-82 (60.5±1.7), with 23 patients in the EPC group and 22 patients in the SC group. Patients assigned to EPC group had a better quality of life than those assigned to SC group [FACT-L scale: (122.3±1.6) vs (111.8±2.1), P<0.001]. Fewer patients had anxiety and depressive symptoms in the EPC group than those in the SC group [HADS anxiety subscale: (1.1±0.3) vs (2.9±0.4), P<0.001; HADS depression subscale: (0.7±0.3) vs (3.6±0.4), P<0.001]. The PHQ-9 results showed that 100.0% (23/23) patients were free of depression in the EPC group, while 45.5% (10/22) patients were free of depression in SC group (P<0.001). Furthermore, patients in the EPC group had a better nutritional status [moderate malnutrition: 60.9% (14/23); no malnutrition: 39.1% (9/23)] than those in the SC group [severe malnutrition: 40.9% (9/22); moderate malnutrition: 50.0% (11/22); no malnutrition: 9.1% (2/22)] (P<0.001). There was no significant difference in NRS score between EPC group and SC group (P=0.140). Conclusion: Early interdisciplinary palliative care based on WARM model can improve the quality of life, psychological state and nutritional status in NSCLC patients.

Application Effect of Case Management Mode Combined with ERAS in Elderly Patients with Hip Fracture.

Objective To explore the effect of the case management mode combined with enhanced recovery after surgery (ERAS) in elderly patients with hip fracture. Methods A total of 102 elderly hip fracture patients admitted to our hospital from June 2018 to December 2019 were selected. The patients with hip fracture were divided into the control group (n = 51) and the observation group (n = 51) by the random number table method. The control group adopts the conventional nursing mode, and the observation group adopts the case management mode combined with ERAS. The bed activity time, hospitalization time, total hospitalization expenses, and the satisfaction of patients were observed. The numeric rating scale (NRS) was used to assess the patient's pain before treatment and at 1, 3, and 5 days after treatment. The Harris score was used to assess the patient's joint motor function before treatment and at the 8th week after treatment. The perioperative complications of the two groups were compared. Result After treatment, the observation group was better than the control group in terms of out of bed activity time, hospitalization time, total hospitalization expenses, and the satisfaction of patients (P < 0.05). Before treatment, there was no significant difference in NRS scores between the two groups (P > 0.05). After treatment, the NRS scores of the two groups were lower than before treatment, and on days 1, 3, and 5 after treatment, the NRS scores of the observation group were lower than those of the control group (P < 0.05). Before treatment, there was no difference in the Harris score between the two groups (P > 0.05). At the 8th week after treatment, the Harris scores of the two groups were higher than those before treatment, and the Harris scores of the observation group were higher than those of the control group (P < 0.05). The total incidence of perioperative complications in the observation group (4/51) was lower than that in the control group (13/51) (P < 0.05). Conclusion The application of the case management mode combined with ERAS nursing in elderly patients with hip fracture can improve the clinical symptoms of patients, improve the therapeutic effect, and reduce the occurrence of complications, which is worthy of clinical application.

A Retrospective Study of Traffic Accident Inpatients in a Korean Medicine Hospital: Correlation of STAI-Ⅰ, STAI-Ⅱ, BDI, and CSEI-s scores with Pain Improvement

Objectives: The objective of this study was to investigate the correlation of the scores on the State-Trait Anxiety Inventory-Ⅰ (STAI-Ⅰ), State-Trait Anxiety Inventory-Ⅱ (STAI-Ⅱ), Beck’s Depression Inventory (BDI), and Core Seven Emotions Inventory-short form (CSEI-s) scales with pain improvement. Methods: We retrospectively investigated the medical records of 66 traffic accident inpatients who satisfy the selection criteria. They had received Korean medical treatment including acupuncture, electroacupuncture, pharmacopuncture, herbal medicine, and Chuna during hospitalization. STAI-Ⅱ, BDI, and CSEI-s scores on hospital day 1, and STAI-Ⅰ and numerical rating scale(NRS) scores on hospital day 1, 4, 7, and 10 were used for analysis. Pain improvement was evaluated by difference in NRS scores between hospital day 1 and hospital day 4, 7, 10. Results: The STAI-Ⅰ, BDI, and CSEI-s scores showed significant correlations with pain or pain improvement. Conclusions: This study may be used in the research on psychological state and pain management of traffic accident patients and for patient education. Large-scale, well-designed studies need to be conducted in future to strengthen the results in this regard.

Retrolaminar versus epidural block for postoperative analgesia after minor video-assisted thoracic surgery: a retrospective, matched, non-inferiority study.

BackgroundThe role of thoracic epidural analgesia (TEA) for postoperative analgesia after video-assisted thoracic surgery (VATS) is still controversial. Some studies have reported the efficacy of ultrasound-guided retrolaminar block (RLB) for the postoperative management of pain after chest wall surgery. The purpose of this study was to compare the postoperative analgesic efficacy and adverse effects of ultrasound-guided RLB with those of TEA in patients undergoing minor VATS procedures.MethodsA total of 192 relevant records of patients were enrolled in this study. We reviewed electronic medical records of patients undergoing minor VATS procedures under general anesthesia. The primary outcome was the median differences in the numerical rating scale (NRS) scores during rest between the groups at the morning of postoperative day 1 (POD 1m). A propensity-matched analysis incorporating preoperative variables was used to compare the efficacy of postoperative analgesia in two groups.ResultsOverall, 94 patients were identified for analysis. Propensity score matching resulted in 47 patients in each group. There were no significant differences in the NRS scores between the two groups. The median differences in NRS scores during rest between the two groups at POD 1m were under 1, which indicates non-inferiority of RLB. There were no significant differences in the incidence of adverse effects and rescue dose of analgesic consumption between the two groups.ConclusionsThe analgesic effects of continuous ultrasound-guided RLB were non inferior to those of TEA for minor VATS procedures.