Difference In Pain Scores Research Articles

Gender differences in clinical presentations and sensory profiles in patients with fibromyalgia: implications of peripheral and central mechanisms.

Fibromyalgia has a high female predominance and research work has been focussing mainly on women. We aimed to answer (1) gender differences in pain scores and quality of life, (2) any gender-specific subgroups defined by quantitative sensory testing (QST), and (3) correlations of QST parameters with pain intensity and questionnaire scores. We evaluated clinical presentations and QST profiles from 38 male and 38 age-matched female patients. Women reported significantly higher scores in average daily pain, daily sleep interference score, average weekly pain, weekly sleep interference score, and revised fibromyalgia impact questionnaire (rFIQ). Based on LOGA classification, L0G2, mechanical allodynia or hyperalgesia without abnormal sensory loss, was the most common QST subtype which accounted for 28.9% of men and 26.3% of women. Approximately 34.2% of men and 26.3% of women displayed loss of function of small fibres with an increased cold or warm detection threshold. Cold detection threshold was negatively correlated with pain intensity and functional impairment, suggesting a peripheral mechanism. Central sensitization, defined as allodynia and hyperalgesia to thermal or mechanical stimuli, was found in two-thirds of male and female patients. Mechanical pain sensitivity was positively correlated with the severity of pain and associated symptoms in women, but not men. There was a marked gender difference in reported pain and quality of life. We have confirmed that central sensitization is a major mechanism for women. Our data suggested an important role of small fibre pathology in both men and women.

Cast-OFF 2: One Week Versus 3-5 Weeks of Plaster Cast Immobilization for Non- or Minimally Displaced Distal Radius Fractures-A Stepped Wedge Cluster Randomized Controlled Trial.

Implementation of 1 week of cast immobilization followed by gradually increasing wrist mobilization for non- or minimally displaced distal radius fracture (DRF) and comparison of the functional outcomes and pain scores with the usual care (3-5 weeks of cast immobilization). A randomized stepped wedge cluster design, prospective cohort. Academic and peripheral hospitals in levels 1, 2, and 3 trauma centers. All patients between 18 and 85 years old with an isolated non- or minimally and nonreduced DRF were eligible for inclusion. Participating hospitals were randomized to transition from usual care (3-5 weeks of cast immobilization) to 1 week of cast immobilization, following the stepped wedge design. Patient characteristics, secondary dislocation, surgical treatment, visual analog scale, Patient Rated Wrist Evaluation (PRWE), Patient Reported Outcomes Measurement Information System Pain Interference, Pain Catastrophizing Scale 4, and patient satisfaction were compared between control and intervention group at weeks 1, 3-5, 6, months 3, 6, and 12. A difference around 11 points on the PRWE scale was considered clinically significant. Four hundred two patients were included (control n = 197 vs. intervention n = 205, 267/135, female/male). There were no differences in age (53.7 ± 18.6 vs. 53.3 ± 19.5, P = 0.27), sex (66% vs. 67% female, P = 0.44), dominant hand fractured (44% vs. 53%, P = 0.39), and type of fracture (39% vs. 41% extra-articular, P = 0.44). After 6 weeks, the PRWE score showed no clinically significant differences (-4.5 [confidence interval -12.9 to 4.02], P = 0.30). No significant differences were observed for function, pain scores, and patient satisfaction between groups (all P > 0.05). Furthermore, there was no significant difference in secondary dislocation rate (control 1.5% vs. intervention 1.0%, P = 0.32) and operation rate (control 1.5% vs. 1.5% intervention, P = 0.92). This study compared 1 week of cast immobilization followed by gradually increasing wrist mobilization to the usual care of 3-5 weeks for nonreduced DRF. No clinically significant differences in function, pain scores, patient satisfaction, secondary dislocation, and operations were observed. Therefore, 1 week of plaster immobilization can be safely recommended for the non- or minimally displaced and nonreduced DRF treatment. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb in acute and subacute Stroke (RHOMBUS II): results of a feasibility randomised controlled trial

ObjectiveTo investigate the safety, feasibility and acceptability of the Neurofenix platform for upper-limb rehabilitation in acute and subacute stroke.DesignA feasibility randomised controlled trial with a parallel process evaluation.SettingAcute Stroke Unit...

Continuous local infiltration analgesia is equal to femoral and sciatic nerve block for total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. Pain control is crucial for rapid mobilisation and reduces side effects as well as the length of hospital stay. In this context, a variety of multimodal pain control regimes show good pain relief, including several nerve blocks, iPACK and local infiltration analgesia (LIA). To compare the analgesic potency of LIA and the combination of continuous femoral nerve block + sciatic single-shot nerve block under general anaesthesia, we conducted a prospective, randomized, controlled, non-blinded single-centre study.Method 139 ASA I-III Patients were enrolled in the study, randomised into two groups. The LIA group received an intra- and periarticular infiltration containing a mix of ropivacaine 0,2%, adrenaline and ketorolac, followed by an infusion of the same mixture for 48 h via an intraarticular catheter. The patients in the FEM group received a combination of continuous femoral nerve block with a catheter using 30 ml prilocaine 1% and ropivacaine 0,2% plus a single-shot sciatic nerve block via an antero-medial approach (landmark-based technique) with 20 ml ropivacaine 0,75%. Postoperative pain scores were analysed during the first two postoperative days, as well as opioid consumption, the degree of knee movement and the occurrence of infections in both groups applying the Wilcoxon-Mann-Whitney test, Friedman chi-square test and the Log-rank-test.ResultsNo significant difference in pain scores, opioid consumption, time to first rescue analgesia, knee range of motion, age, height, weight and ASA could be detected. No severe side effects, such as secondary bleeding or infections, were reported.ConclusionBoth techniques are well established, provide equal pain relief for TKA and support early postoperative mobilisation.Trial RegistrationDRKS 00027145 08/12/2021. “retrospectively registered”.

Efficacy of repetitive transcranial magnetic stimulation for phantom limb pain- a meta analysis of randomized controlled trials.

Phantom limb pain (PLP) is a neuropathic syndrome experienced by the majority of amputees. Various treatment options are available for amputees suffering from PLP including pharmacological, psychological and neuromodulation techniques. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has proven its efficacy in alleviating PLP. Hence, we aimed to conduct a meta-analysis to evaluate the effectiveness of rTMS in improving pain in patients with PLP. Literature search was carried out on 5 electronic databases from the inception of the paper till 13th August, 2024. Randomized Controlled Trials evaluating the efficacy of rTMS in patients with PLP against a control group were included in our study. The Visual Analogue Scoring (VAS) system was used to evaluate the severity of pain. Quality assessment was performed with the Cochrane bias assessment tool and data was pooled on Review manager using the Mantel-Haenszel Random-effects model. 5 RCTs included in this paper were included and consisted of 140 participants experiencing PLP. There was a significant reduction in pain score in the rTMS group at the end of treatment when compared to the control group (P = 0.00001). A drop out sensitivity analysis significantly improved the results by reducing the heterogeneity to null (P = 0.00001). After 30 days of treatment, there was a significant difference of pain score from baseline in rTMS groups. Our meta-analysis demonstrates the role of rTMS in significantly reducing VAS score in patients with PLP. In the future, larger clinical trials are required that evaluate the long-term efficacy profile of rTMS to establish it as a mainstay of therapy in patients with PLP.

Degenerative gluteal tears associated with hip arthroplasty

BackgroundUnrepaired chronic abductor tears may be a cause of residual pain and weakness after hip arthroplasty, but the current incidence is unclear.MethodsFrom 1994 to 2009, the senior surgeon performed 1628 hip resurfacing and 864 total hip arthroplasties without identifying any gluteal tears. We recognized our first case of concomitant abductor tear during a hip resurfacing procedure in April 2009. After this, we began following a protocol to identify and repair abductor tears in the next 5601 consecutive primary hip arthroplasties (5429 hip resurfacings and 172 total hips).ResultsWomen over 60 were the highest-risk group for abductor tear, with a 3.6% rate of tears identified. All tears were repaired. We found no differences in mean HHS and VAS pain score in patients with repair gluteal tears versus a control group of cases without a tear. Patients without a tear had higher postoperative UCLA activity scores at 2 years postoperative. The majority (98.1%) of hip arthroplasty patients with a gluteal tear repair at time of surgery presented with 4 or 5 abductor strength at their 2-year postoperative physical exam. Of our abductor tear cohort, 70.3% had no limp and 21.9% had a slight limp at 2 years postoperative.ConclusionsIn a large group of hip arthroplasty cases (n = 4507), we identified gluteal tears in 3.6% of women and 1.0% of men. All reported clinical outcomes (excluding mean HHS) in our cohort of hip arthroplasty patients did not differ significantly between cases without abductor tears and those that had gluteal repair at time of surgery. These results suggest abductor tears may be repaired at time of hip arthroplasty surgery without forgoing desirable functional outcomes.Level of evidenceLevel 3 Retrospective Cohort Study.

Sulcus-Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction Provide Good Clinical Outcomes in Addressing Patellar Instability at Mid-Term Follow-Up: A Retrospective Case Series.

To update previously published clinical and radiographic outcomes of Dejour sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction (MPFL-R), at mid-term follow-up, and monitor trends in patient reported outcome scores and satisfaction. Using the same cohort of patients from our previously published short-term series of 2-year follow up, interval follow-up was performed on 67 patients (76 knees) with severe trochlear dysplasia and recurrent patellar instability who were prospectively enrolled and underwent Dejour sulcus-deepening trochleoplasty and MPFL-R combined with other patellar-stabilization procedures. Patients with less than 2-year follow-up were excluded. Evaluation involved radiographic analysis, physical examination, clinical follow-up, and patient-reported outcome scores. 37 patients (45 knees) were included in the current study, with mean follow-up of 6.1 years postoperatively (Standard deviation [SD] 2.7 years). Two interval re-operations were performed (arthroscopic lysis of adhesions; hardware removal and arthroscopic shaving chondroplasty). There remained no occurrences of re-operation for recurrent patellar instability. Patient reported outcomes were largely stable from early (mean 3.6 years) to mid-term (mean 6.1 years) follow up with no statistically significant difference between early and mid-term International Knee Documentation Committee (IKDC) (P = 0.75), Kujala (P = 0.47) or VAS (Visual analog scale) pain (P = 0.06) scores. Compared to preoperative knee scores, there was a significant difference in IKDC (49.3 vs 82.0, P < 0.001, d = 1.85), Kujala (56.5 vs 89.3, P < 0.001, d = 2.03), and VAS pain (3.8 vs 1.9, P = 0.003, d = 0.33) scores at mid-term follow up (mean 6.1 years). Mean Kellgren-Lawrence grading of patellofemoral arthritis showed no statistically significant change from 0.56 to 0.52 (P = 0.511) on sunrise radiographs at the most recent follow-up. At mid-term follow-up, Dejour sulcus-deepening trochleoplasty and MPFL-R, combined with other patellar stabilization procedures, achieves durable resolution of patellar instability with maintained patient-reported outcome scores and satisfaction rates, and is without interval evidence of clinical or radiographic progression of patellofemoral arthritis. IV, Case Series.

Methadone for Surgical Patients

What Is the Issue? Opioids such as morphine and hydromorphone are commonly used to treat postoperative pain; however, they are associated with serious risks such as respiratory depression. Methadone (a synthetic opioid) has been proposed as a potential option for preoperative or postoperative analgesia that may improve pain relief and reduce overall opioid requirements. What Did We Do? We sought to identify and summarize studies of the clinical effectiveness and safety of oral methadone for preoperative or postoperative analgesia in adults as well as recommendations from evidence-based guidelines. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2019. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included publications, and narratively summarized the findings. What Did We Find? We identified 1 randomized controlled trial (RCT) that evaluated the use of preoperative oral methadone versus placebo in adults undergoing sternotomy for isolated coronary artery bypass graft surgery. We did not identify any studies that compared oral methadone to other analgesics that met our criteria. We did not identify any evidence-based guidelines that included recommendations on the use of oral methadone for preoperative and postoperative analgesia. There were no differences in pain scores 24, 48, and 72 hours postoperatively in patients who received oral methadone versus placebo. Postoperative morphine requirements were lower in the methadone group than the placebo group at 24 hours; however, there were no differences between groups at 48 or 72 hours. There were no differences in common side effects related to opioid use (nausea, vomiting, pruritus, constipation, urinary retention, hypoventilation, or hypoxia) between patients undergoing surgery treated with oral methadone versus placebo at 24, 48, or 72 hours. What Does It Mean? We identified very limited evidence on the use of oral methadone for preoperative or postoperative analgesia in patients undergoing surgery. There were no differences between patients undergoing surgery treated preoperatively with oral methadone versus placebo in most of the pain outcomes measured in the included RCT. Additional evidence may be necessary to aid decision-making around the use of oral methadone as preoperative or postoperative analgesia for adult patients undergoing surgery.

Peripheral Nerve Block Combined with Low-Dose General Anaesthesia in Elderly Patients Receiving Hip Arthroplasty.

The study assessed the effectiveness and safety of nerve block combined with low-dose general anaesthesia in elderly hip arthroplasty patients, conducted by a meta-analysis of RCTs. Six trials involving 403 patients were identified from databases such as Cochrane, MEDLINE, and PubMed. The results demonstrated a statistically significant difference in pain scores at postoperative 12hours (95% CI, -2.39 to -0.35, p = 0.008) and 24hours (95% CI, -1.86 to -0.50, p = 0.0007). Nerve block in combination with general anaesthesia holds a significant advantage over conventional general anaesthesia regarding perioperative opioid consumption (95% CI, -38.32 to -7.48, p = 0.004). This combined approach was superior in reducing the incidence of complications (95% CI, 0.11 to 0.55, p = 0.0007). However, between the two groups, there was no statistically significant difference in the 48hour pain score (95% CI, -2.58 to 0.62, p = 0.23). Essentially, this approach effectively reduces early post-surgical pain and it minimises anaesthetic use, whilst simultaneously lowering the risk of complications. Key Words: Nerve block, Elderly patients, Hip arthroplasty, Pain, Postoperative complication.

Pharmacological and non-pharmacological interventions for pain control in outpatient hysteroscopy: A systematic review.

Outpatient hysteroscopy (OPH) is an important diagnostic and therapeutic intervention in gynaecology. However, the most common reason for failure is pain. Currently, there is no consensus regarding analgesia for OPH amongst the literature. The aim of this systematic review was to assess the efficacy of pharmacological and non-pharmacological interventions for pain control during OPH. Randomised controlled trials (RCT) from January 2017 to February 2024 assessing efficacy of pharmacological and non-pharmacological methods for analgesia in OPH were included. MEDLINE, Embase and CENTRAL databases were used to search papers for inclusion. Two independent reviewers selected eligible studies for systematic review. The primary outcome was pain assessed via a subjective pain screening tool. Secondary outcomes included adverse events. 16 RCTs were included with the majority being 'low risk' of bias. Tramadol, vaginal misoprostol and cervical lidocaine flushing significantly reduced pain. Hyoscine-N-butyl Bromide (HBB) with diclofenac and lidocaine in distension media produced conflicting results. Oral misoprostol and diclofenac alone failed to show significant differences in pain scores. Regarding non-pharmacological interventions, vocal distraction, transcutaneous electrical nerve stimulation and video-based multimedia information all significantly reduced pain. The effect of warmed distension media and virtual reality for pain control is unclear. Only one study found the treatment group (HBB and diclofenac) was associated with significantly higher adverse events. This study highlights potential use of both pharmacological and non-pharmacological methods as safe and effective forms of analgesia for OPH. We hope the results of this systematic review will help improve clinical practice and assist with developing future pain management protocols for OPH while also highlighting areas of interest for future research.

Validation of the Korean version of Defense and Veterans Pain Rating Scale for assessment of postoperative pain: a prospective observational cohort study.

The Defense and Veterans Pain Rating Scale (DVPRS) is a pain assessment tool combining a numerical rating scale (NRS) with descriptive words, colors, and facial expressions. This study aimed to validate the Korean version of the DVPRS (K-DVPRS) for postoperative pain assessment. This study included patients who underwent elective laparoscopic or robotic abdominal surgery. The original DVPRS was translated into Korean using a forward-backward method. Pain intensities at rest and during coughing were assessed at 24 and 48 hours postoperatively using the NRS and K-DVPRS, respectively. The EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire was also used. The validity, reliability, and responsiveness of the K-DVPRS were evaluated. Of the 174 patients screened, 150 were enrolled, and 148 completed the study. The K-DVPRS had strong convergent validity with the NRS at 24 and 48 hours postoperatively (ρ: 0.75 to 0.78, all P < 0.001). Construct validity was confirmed by significant differences in pain scores based on surgical extent and duration. The internal consistency was acceptable (Cronbach's alpha: 0.77 and 0.85 at 24 and 48 hours, respectively), and test-retest reliability at 24 hours was excellent (intraclass correlation coefficient: 0.90 at rest and 0.95 during coughing). Responsiveness, measured by Cliff's effect size, was high from preoperative to 24 hours postoperatively and moderate from 24 to 48 hours. At 48 hours, the K-DVPRS had stronger correlations with the EQ-5D-5L index and EQVAS than with the NRS. The K-DVPRS is a valid, reliable, and responsive tool for assessing postoperative pain in Korean patients.

Impact of Virtual Reality on Perception of Dental Pain Associated With Dental Scaling in Healthy Adults: A Split Mouth Design Randomised Controlled Study.

The aim of the study is to investigate the effectiveness of virtual reality (VR) in mitigating pain associated with dental scaling procedures. Furthermore, the study aims to evaluate individuals' tolerance levels to VR during dental scaling sessions. A randomised split-mouth design study was conducted on 29 systemically healthy adult patients aged 18 years and above. Dental scaling was performed in two quadrants while wearing VR glasses, with the remaining quadrants undergoing the procedure without VR. The sequence of procedures was determined by random allocation. Patients were provided with VR glasses loaded with a mobile phone. After the procedure, patients were asked to complete a VR questionnaire. The primary outcome variables included pain scores with and without VR, while secondary variables included VR experience scores, baseline heart rate (HR), difference in HR, systolic blood pressure (BP), diastolic BP, difference in systolic BP, and difference in diastolic BP. All 29 subjects successfully completed the study. Paired analysis of outcome variables with and without VR glasses revealed a statistically significant difference in pain scores (two-tailed p < 0.001). Additionally, a strong positive correlation was observed between VR experience score and difference in pain score (γ = 0.78, p < 0.001). While positive correlations between modified dental anxiety scale (MDAS) score and pain scores were observed, they were not highly significant (without VR: γ = 0.31 p = 0.097, with VR: γ = 0.34 p = 0.072). The VR environment significantly diminished pain perception during dental scaling. Participants who experienced the VR setting more positively reported an even greater decline in pain scores, highlighting the profound impact of immersive technology on patient comfort.

The Efficacy of Transversus Abdominis Plane (TAP) Blocks When Completed by Anesthesiologists Versus by Surgeons: A Systematic Review and Meta-Analysis.

Background/Objectives: Current literature has demonstrated the benefits of transversus abdominis plane (TAP) blocks for reducing postoperative pain and opioid consumption for an array of surgical procedures. Some randomized controlled trials and retrospective studies have compared ultrasound guidance TAP blocks completed by anesthesiologists (US-TAP) to laparoscopic guidance TAP blocks completed by surgeons (LAP-TAP). However, the findings of these studies have not been consolidated to improve recommendations and patient outcomes. Our objective is to consolidate and summarize current literature regarding the efficacy of TAP blocks for postoperative pain control and opioid consumption when performed with ultrasound guidance (US-TAP, compared to laparoscopic guidance (LAP-TAP). Methods: We performed a systematic review and meta-analysis of RCTs and retrospective studies to evaluate US-TAP versus LAP-TAP blocks for postoperative pain control and opioid consumption. We searched PubMed/MEDLINE, CINAHL, Cochrane, and Web of Science databases for all articles meeting the search criteria until the time of article extraction in February 2024. The primary outcome variables were postoperative pain scores and opioid consumption. The secondary outcome variables were complications, time taken to perform the block, length of stay (LOS) in the hospital, and cost of performing the block. Results: Of the 1673 articles initially identified, 18 studies met the inclusion criteria for evaluation. Of the included studies, 88.9% and 77.8% found no significant difference in postoperative pain scores or opioid consumption, respectively, between US-TAP and LAP-TAP groups. Six studies (33.3%) found that LAP-TAP was faster to perform than US-TAP. Meta-analysis demonstrated no statistically significant differences in postoperative pain scores or opioid consumption between groups but showed that block times were significantly longer in the US-TAP group. Conclusions: US-TAP and LAP-TAP blocks may be equivocal in terms of reducing postoperative pain and opioid consumption. LAP-TAPs may be less time-consuming and more cost-effective and viable alternatives to US-TAP blocks in the perioperative setting.

Systematic Review and Meta-Analysis of Application of Ultrasound-Guided Thoracic Paravertebral Block in Clinical Surgical Treatment.

There is a lack of consensus regarding the efficacy of thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) for postoperative pain in randomized controlled trials (RCTs). The comparison of TPVB and ESPB was explored through a systematic review and meta-analysis (MA) of relevant RCTs. A comprehensive search of relevant literature was conducted using databases such as PubMed, Embase, and MEDLINE, from 2019 to June 2024. The search utilized keywords such as "TPVB", "ESPB", and "postoperative analogy". Following the search, quality evaluation and extraction of outcome indicators were implemented. The software RevMan5.3 was employed for data analysis and evaluation. The analysis included 18 articles. In patients at rest, a significant difference in pain scores was observed between the TPVB group and the ESPB group at 1 h postoperatively, with a standardized mean difference (SMD) of -0.52 [95% confidence interval (CI): -0.88 to -0.16, p = 0.005]. In non-resting patients, there were significant differences in pain scores between TPVB and ESPB at 24 and 48 h postoperatively. At 24 h postoperatively, the SMD was -0.37 (95% CI: -0.69 to -0.05, p = 0.02), and at 48 h postoperatively, in the visual analog scale (VAS) subgroup, the SMD was -0.38 (95% CI: -0.65 to -0.11, p = 0.006). Furthermore, notable statistical variations were identified in the frequency of rescue analgesia required following surgery between TPVB and ESPB. The meta-analysis indicated that lower clinical pain scores in non-resting states at 24 and 48 h post-surgery were associated with TPVB rather than ESPB. This finding was accompanied by a more discernible and accurate analgesic effect, as well as a significant reduction in the need for rescue analgesia following surgical procedures.

Comparative Retrospective Study of PLLA and PLLA/HA Pins for Osteochondral Fragment Fixation in Osteochondral Lesion of the Talus.

Postoperative osteolysis may be observed around poly-l-lactic acid (PLLA) pins in osteochondral fragments fixation for an osteochondral lesion of the talus (OLT). Hydroxyapatite (HA) improves biocompatibility, osteoconductivity, and mechanical strength when added to PLLA. This study aimed to compare the characteristics of osteolysis and clinical outcomes of fixation for OLT with PLLA pins vs PLLA/HA pins. Thirty-one ankles undergoing fixation with bioabsorbable pins for OLT were included. Fourteen ankles were fixed with PLLA/HA pins and 17 ankles with PLLA pins. Magnetic resonance imaging (MRI) was taken pre- and postoperatively at 1 year. Osteolysis around pins, bone marrow edema (BME) in the talus, and pin insertion angle on MRI, the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the visual analog scale (VAS) pain score were compared between the 2 groups pre- and postoperatively at 1 year. AOFAS score at the final follow-up was also compared between the 2 groups. The osteolysis area was significantly smaller in the PLLA/HA group in both coronal and sagittal planes on MRIs obtained 1 year postoperatively. There were no significant differences in osteolysis frequency, BME area, AOFAS score, and VAS pain score. Lower pin insertion angles measured on either sagittal or coronal planes were generally associated with greater amounts of osteolysis. We did not find superiority using PLLA/HA pins compared with PLLA pins to fixate talar osteochondral fragments. However, PLLA/HA pin use was associated with less osteolysis around pins compared with PLLA pins.

Association between postoperative intravenous methylprednisolone and surgical site infection in posterior lumbar fusion surgery: a retrospective single-center study

PurposeTo investigate the association between intravenous methylprednisolone administration and the risk of surgical site infection (SSI) following posterior lumbar fusion (PLF) surgery.MethodsThis retrospective, single-center study analyzed data from 800 adult patients who underwent elective PLF surgery at our institution. Patients were classified according to postoperative intravenous methylprednisolone administration. Univariate and multivariable logistic regression, and subgroup analysis were used to assess the association between methylprednisolone administration and SSI risk, as well as its impact on postoperative pain management.ResultsOur analysis showed no significant association between intravenous methylprednisolone administration and the development of a SSI after PLF. Subgroup analyses suggested that methylprednisolone was potentially protective in patients with a body mass index (BMI) < 25 kg/m2. In addition, patients treated with methylprednisolone had significantly lower pain scores in the early postoperative period, and lower incidence of postoperative nausea and vomiting (PONV) compared to patients not treated with methylprednisolone. However, there was no significant difference in pain scores between the 2 groups at 4 weeks postoperatively.ConclusionsThis study suggests that intravenous methylprednisolone administration may not increase the risk of SSI after single-level PLF. In addition, it appears to have a beneficial effect on postoperative pain management and PONV, especially during the early recovery phase.

The Effect of Perineural Adjuvants on Superficial Parasternal Intercostal Plane Blocks in Cardiac Surgery: A Triple-Blinded Randomized Controlled Feasibility Trial.

Background and aim The study aimed to investigate the effect of adding perineural adjuvants, clonidine and dexamethasone, to local anesthetic in Superficial Parasternal Intercostal Plane (SPIP) blocks. It was designed as a prospective, randomized, triple-blinded, feasibility trial, conducted at a single-center university hospital. The participants included adult patients who were undergoing cardiac surgery via median sternotomy. Methodology Following skin closure, patients were randomized to receive either SPIP with 0.25% bupivacaine and 2.5 mcg/mL epinephrine (control group, n= 12) or SPIP with 0.25% bupivacaine, 2.5 mcg/mL epinephrine, 1.67 mcg/mL clonidine, and 0.1 mg/mL preservative-free dexamethasone (adjuvant group, n= 8). Results No significant difference was found between the adjuvant and control groups for the primary outcome of the area under the curve of longitudinal pain scores with incentive spirometry use measured at four timepoints during the first 24 hours following surgery (96.5 ± 58.4 vs. 94.3 ± 39.6, P= 0.93, respectively).Additionally, no difference was found for secondary outcomes, including opioid consumption in morphine milligram equivalents (120, interquartile range [IQR] 93-150vs. 120, IQR 82-158; P= 0.88), time to extubation (232.02 ± 68.69 vs. 276.82 ± 78.61 min, P= 0.25), intensive care unit length of stay (31.4 vs. 38.2 hours, P= 0.64), or pain satisfaction scores between the adjuvant and control groups (P= 0.46), respectively. The adjuvant group demonstrated higher incentive spirometry volumes at the six-hour postoperative timepoint (1333.33 ± 857.97 mL vs. 525.00 ± 338.56 mL, P= 0.003), with a trend towarda difference at 12 and 18 hours (P= 0.24 and P= 0.10, respectively). Conclusions The addition of perineural adjuvants to SPIP was not associated with any difference in pain scores within the first 24 hours after cardiac surgery. Given the small nature of this feasibility study, further investigation is warranted.

Comparative effectiveness totally endoscopic thyroidectomy via completely submental tri-hole approach and transoral endoscopic thyroidectomy without insufflation

ObjectiveThis study aims to evaluate the therapeutic effectiveness of totally endoscopic thyroidectomy via the completely submental tri-hole approach and transoral endoscopic thyroidectomy without insufflation.MethodsA total of 60 patients with thyroid tumors who were admitted to Panyu College Affiliated Hospital from August 2022 to August 2023 were collected in this study. The patients were divided into two groups, the transoral endoscopic thyroidectomy group (20 cases) and the totally endoscopic thyroidectomy via the completely submental tri-hole approach group (40 cases). Then, we evaluated the difference of surgical data, operative details, postoperative complications, duration of postoperative swelling, cosmetic satisfaction, discomfort during eating, and pain scores between two groups.ResultsThere were no significant differences between two groups in terms of operation time, intraoperative blood loss, postoperative drainage, extubation time, length of hospital stay, autotransplantation of parathyroid glands, or postoperative swelling. And neither group experienced voice hoarseness, postoperative bleeding, or lymphatic leakage. The incidence of hypocalcemia did not differ significantly between two groups, although the transoral endoscopic thyroidectomy group had a significantly higher incidence of chin numbness (p<0.01). Futhermore, there was no obvious differences in neck pain scores or cosmetic satisfaction scores at 3 days, 7 days, 2 weeks, and 1 month postoperatively. However, the discomfort during eating score was markedly lower in the totally endoscopic thyroidectomy group compared to the transoral endoscopic thyroidectomy group (P < 0.05).ConclusionTotally endoscopic thyroidectomy via the completely submental tri-hole approach offers advantages in reducing postoperative discomfort during eating compared to transoral endoscopic thyroidectomy, indicating promising prospects for clinical application.

Effect of Laser Photobiomodulation on Postoperative Pain After Single-Visit Endodontic Treatment in Children: A Randomized Control Trial.

This study aimed to assess the effectiveness of laser photobiomodulation (PBM) in reducing postoperative pain following single-visit endodontic treatment in children aged 5-9 years. Forty children aged 5-9 years with acute irreversible pulpitis in deciduous molars requiring single-visit pulpectomy were included in the study. Pulpectomy was performed according to a standard endodontic protocol. The participants were randomly allocated to two groups: group A received laser photobiomodulation using an 810 nm diode laser applied to the periapical area of the treated tooth postoperatively, and group B received blue light LED, applied at similar points to the control teeth. This was a placebo intervention. Pain scores were measured using a 10-point Visual Analog Scale (VAS) at 4, 12, 24, and 48 h post-treatment. The Friedman test was used to compare the VAS scores within groups over time, and the Mann-Whitney U-test was used to compare the VAS scores between the two groups. The significance level was fixed at p < 0.05. The mean VAS scores were significantly lower in the PBM group compared to the placebo group at the 4th h, 12th h, and 24th h post-treatment (p ≤ 0.05). The pain levels remained stable over time in the PBM group, with no significant difference in pain scores from 4 h to 48 h (p = 0.57). In the placebo group, the pain gradually decreased from the 4th h to the 48th h, with a significant reduction in pain observed between the 12th h and 48th h (p = 0.05). Laser photobiomodulation (PBM) was found to be effective in reducing postoperative pain following single-visit endodontic treatment in children. This non-invasive approach could offer a valuable alternative for pain management in pediatric endodontics, particularly given its effectiveness without the need for systemic medications.

The Effect of Myofascial Release Iliotibial Band on Reducing Pain and Increasing Functional Activity in Knee Osteoarthritis

Background: Knee osteoarthritis is the most common case suffered by elderly women. The population at high risk of experiencing knee osteoarthritis is women at 18% compared to men at around 9.6% worldwide, older age, excessive body weight, and having had a knee injury or having had previous knee surgery. Methods: The design of this study was a two-group pre-and post-test design. The research compares the effect of the myofascial release of the iliotibial band on reducing pain and increasing functional activity in knee osteoarthritis. The research subjects were all clients who had been diagnosed with osteoarthritis by a doctor. Results: The results of the test for the difference in pain scores with VAS before and after treatment in group 1 showed a value of p = 0.000 or a value of p &lt; 0.05, while the functional ability scores with WOMAC before and after group 1 treatment showed a p-value = 0.000 or a p-value &lt; 0.05, which means that there was an effect of standard therapy on reducing pain and increasing functional activity in osteoarthritis knees in group 1 so that the hypothesis was accepted. Conclusion: There is a difference in effect between standard therapy and standard therapy plus myofascial release of the iliotibial band to increase functional activity in knee osteoarthritis. There is a difference in the effect of standard therapy and standard therapy plus myofascial release iliotibial band on increasing functional activity (p = 0.00) in knee osteoarthritis.