Difference In Pain Scores Research Articles

The Effect of Epidural Analgesia on In-Hospital Outcomes in Patients with Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Acute pancreatitis (AP) can lead to severe complications and high mortality. Previous studies suggest that epidural analgesia (EA) may reduce AP severity and improve outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients. Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until mid-May 2024 for RCTs comparing EA with other pain management strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed a random-effects model and the Mantel-Haenszel method. Study heterogeneity was assessed using the I2 statistic. Five RCTs with 260 participants were included. Meta-analysis showed no significant differences in in-hospital mortality (RR = 0.69, 95% CI [0.29, 1.65], p = 0.40), mechanical ventilation (RR = 0.82, 95% CI [0.61, 1.10], p = 0.19), sepsis events (RR = 0.88, 95% CI [0.42, 1.86], p = 0.74), hospital/ICU stay (WMD = 0.49 days, 95% CI [-1.13, 2.10], p = 0.55), and pain score (WMD = 1.49, 95% CI [-0.42, 3.40], p = 0.13). However, opioid requirements were significantly lower, as reported by one study with morphine milligram equivalent of 15 mg/day compared to 52 mg/day in the control group (p = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score (I2 = 92%). The overall certainty of evidence was very low due to the small number of studies, risk of bias, and limited sample size. EA did not significantly improve in-hospital outcomes in AP patients. However, findings indicated reduced opioid consumption in the EA group, suggesting potential benefits in pain management. Further high-quality, large-scale randomized trials are needed to understand the potential benefits of EA in this population.

Evaluation of needle to nerve interaction for neurological complications in ultrasound-guided interscalene brachial plexus blocks

BackgroundThe use of regional anesthesia techniques carries a well-known risk of perioperative neurological complications. The interscalene approach to brachial plexus block (ISB) is associated with the largest risk of neurological complications of any peripheral nerve block. The reported incidence of nerve injury after ISB varies, with estimates ranging from 0.5 % to 3 % of cases. In this prospective study, we sought to correlate the needle-to-nerve interaction during ISB procedures with the development of post-operative neurological outcomes. MethodsA novel grading system was developed to categorize various needle tip positions during ISB procedures. De-identified ultrasound recordings were graded post-procedure by two independent radiologists. These video grades were correlated with the incidence of post-procedural numbness or paresthesia and post-operative pain scores in the PACU and 24 hours postoperatively. Results108 patient videos were included for analysis. Zero videos received grade 1 (intraneural injection), 20 % received grade 2 (injection with needle against nerve root), 68 % received grade 3 (injection inside brachial plexus sheath), and 12 % received grade 4 (injection external to sheath). There was no statistical difference in terms of post-operative neurological complications or pain scores across the grades. Only four patients experienced post-operative neurologic complications on day one, and seven patients had neurological symptoms on day two. All symptoms resolved by post-operative day five. ConclusionsOur scoring system did not reveal relationship between more aggressive needling techniques and adverse post-procedural neurological symptoms. There was also no difference in pain scores across video grades, indicating that injection within the nerve sheath did not lead to better postoperative pain scores compared to injection outside the sheath. Since no procedures were found to be intraneural by the reviewing radiologists, no relationship between intraneural needling and adverse neurological outcomes could be elucidated. Larger studies in diverse settings may be required to capture greater variation in the block grades for more statistical power.

Tympanic membrane repair using improved endoscopic ear canal flap dissection method

Objective:To investigate the clinical value of tympanic membrane repairment with modified ear canal flap under endoscope. Methods:A retrospective analysis was conducted on the clinical data of 62 patients who underwent simple tympanic membrane perforation repair surgery in our hospital from August 2019 to January 2023. All patients were divided into two groups: 37 cases in the otoscopy group and 25 cases in the microscope group. The surgical duration, postoperative pain response, and postoperative tympanic membrane healing and hearing recovery were compared between the two groups. Results:Compared with the microscope group, the total surgical duration of the otoscopy group was significantly shortened[（70.4±13.2） min vs. （102.8±17.5） min, P<0.001], and there was a statistically significant difference in postoperative VAS pain score[（3.1±1.2） vs. （6.5±1.4）, P<0.001]. The two groups achieved tympanic membrane healing and no infection occurred after operation. There was no significant difference in postoperative hearing recovery between the two groups（P>0.05）. Conclusion:Modified tympanic membrane repairment through otoscope can greatly shorten the operation time and reduce the hospitalization cost, which is more suitable for the application of primary hospitals.

Evaluation of the therapeutic effect of decompression with or without fusion on lumbar spinal stenosis caused by degenerative lumbar spondylolisthesis: a systematic review and meta-analysis

As a common clinical disease, lumbar spinal stenosis (LSS) is currently the preferred surgical treatment, and there are various opinions. We conducted a study on whether fusion should be performed simultaneously with decompression for lumbar spinal stenosis caused by low-grade degenerative lumbar spondylolisthesis and compared the efficacy and safety of the two surgeries. We conducted literature searches on Cochrane Library, Embase, PubMed, Scoups, and China National Knowledge Infrastructure databases to search for randomized controlled trials and observational studies that compared decompression alone and decompression plus fusion in the treatment of lumbar spinal stenosis with low-grade lumbar spondylolisthesis. We conducted a meta-analysis on surgical duration, hospital stay, incidence of complications, intraoperative blood loss, lower back and leg pain scores, and Oswestry disability index (ODI) scores. We ultimately included 8 articles, including 2 randomized controlled trials and 6 observational studies. Additional fusion did not benefit patients in relieving lower back pain (P=0.05) and leg pain (P=0.12), and there was no significant difference in ODI (P=0.12) and perioperative complication rate (P=0.10) between the two. However, Decompression alone was significantly better than the decompression plus fusion group in terms of surgical time (P=0.0008), hospital stay (P<0.0001), and intraoperative blood loss (P<0.00001). In this article, decompression alone has shorter surgical and hospitalization time, and less intraoperative bleeding compared to decompression plus fusion. And there was no significant difference in pain score and disability index between the two surgeries during follow-up. Therefore, we can say that for patients with lumbar spinal stenosis caused by low-grade lumbar spondylolisthesis, decompression alone is not inferior to decompression plus fusion.

Transcutaneous Electric Nerve Stimulation for Analgesia During Outpatient Endometrial Biopsy: A Randomized Controlled Trial.

To evaluate whether transcutaneous electric nerve stimulation (TENS) decreases pain at the time of outpatient endometrial biopsy. We conducted a randomized, double-blind trial of active TENS compared with placebo TENS at the time of endometrial biopsy. The primary outcome was pain measured on a 0- to 100-mm visual analog scale immediately after biopsy, with secondary outcomes including satisfaction and tolerability of TENS and pain scores at other procedural time points. To detect a 15-mm reduction in pain with a 30-mm SD, 80.0% power, and a significance level of 0.05, 64 participants were required in each arm. From December 2022 to December 2023, 135 participants were randomized with 67 in the placebo TENS arm and 68 in the active TENS arm. Baseline demographic and clinical characteristics were similar between groups. The median (interquartile range) pain score immediately after biopsy was 50 mm (20-80 mm) in the active TENS group and 60 mm (40-100 mm) in the placebo TENS group (P=.039). Pain scores at other time intervals were not statistically significantly different. In a subset analysis, participants with higher-than-median baseline anxiety had postprocedural pain scores (interquartile range) of 50 mm (40-80 mm) in the active TENS group compared with 80 mm (50-100 mm) in the placebo TENS group. Overall satisfaction (interquartile range) with pain control (with 100 mm representing completely satisfied) was 87.5 mm (60-100 mm) for active TENS and 70 mm (41-100 mm) for placebo TENS; 85.3% of active TENS participants would use TENS in a future endometrial biopsy. Minimal side effects were associated with TENS, with one participant reporting itching at the pad sites. Despite a statistical difference in pain scores, a clinical difference was not seen between active and placebo TENS for pain during endometrial biopsy. Satisfaction was higher in the active TENS group, and there were overall minimal side effects associated with TENS. ClinicalTrials.gov, NCT05472740.

Local anesthesia in 23-gauge vitreoretinal surgery: A comparison of efficacy between retrobulbar and sub-Tenon’s injection

This study aimed to compare sub-Tenon&amp;rsquo;s and retrobulbar blocks during vitreoretinal surgery in terms of postoperative pain and surgeon experience. This prospective study included 53 patients scheduled for 23-gauge pars plana vitrectomy under local anesthesia. Patients were nonrandomly assigned to receive a xylocaine injection through either the transconjunctival sub-Tenon&amp;rsquo;s or retrobulbar routes, supplemented with intravenous (IV) sedation (midazolam + fentanyl). A sharp needle was used for both techniques. In the sub-Tenon&amp;rsquo;s group, anesthetic injection was initiated through subconjunctival administration after prepping and draping. Pain was assessed immediately postsurgery and the following day using a standardized questionnaire. Patient and surgeon satisfaction levels, along with complications in each group, were recorded. Of the 53 patients, 42 (79%) received the sub-Tenon&amp;rsquo;s block and 11 (21%) received the retrobulbar block. No statistically significant differences in pain scores, patient satisfaction, or surgeon satisfaction were found between the groups. Postoperative pain and surgeon satisfaction were negatively correlated in both groups (B = &amp;minus;0.465; P &lt; 0.001), and a moderate-to-high correlation was observed between patient and surgeon satisfaction (B = 0.686; P &lt; 0.001). Overall, sub-Tenon&amp;rsquo;s and retrobulbar blocks showed comparable effectiveness in terms of postoperative pain and patient and surgeon satisfaction in vitreoretinal surgery, with no significant differences in outcomes or complication rates.

Methadone or buprenorphine: which is the better analgesic for feline ovariohysterectomy?

Question In female cats undergoing routine ovariohysterectomy, is using methadone in the anaesthetic protocol associated with lower post-operative pain scores, compared to buprenorphine? Clinical bottom line The category of research question was: Treatment. The number and type of study designs that were critically appraised were: Four assessor-blinded randomised controlled trials. Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation: Moderate. The outcomes reported are summarised as follows… Two studies found methadone to be associated with significantly lower postoperative pain scores than buprenorphine; one showed significantly different pain scores over the entire 8-hour postoperative period and one only at 10 minutes postextubation. One study found buprenorphine to be associated with lower postoperative pain scores at some time points postsurgery. One study found no significant difference in pain scores between methadone and buprenorphine. In view of the strength of evidence and the outcomes from the studies the following conclusion is made… It can be concluded that using methadone in the anaesthetic protocol may provide better analgesia for cats undergoing ovariohysterectomy compared to buprenorphine. The two papers that used validated pain scoring both concluded that methadone was associated with lower pain scores at some points postoperatively. Although one of the studies concluded that buprenorphine is associated with lower postoperative pain scores, this paper provides only very weak evidence because an unvalidated pain scoring method was used. More evidence is needed to confidently recommend using one opioid over another.

Abstract 4143239: Extracorporeal Shockwave Therapy Improves Physical Outcomes and Quality of Life In Patients With Symptomatic Peripheral Arterial Disease: Results from a Meta-analysis of Randomized Controlled Trials

Introduction: Extracorporeal shockwave therapy (ESWT) is a non-invasive procedure that may be useful to treat symptomatic peripheral arterial disease (PAD). Trials comparing ESWT with control groups have shown promising results. Methods: PubMed, Cochrane, EMBASE, and Google Scholar were searched for randomized controlled trials reporting the efficacy of extracorporeal shockwave therapy versus control in patients with symptomatic PAD. Data from eligible studies was analyzed using the Review Manager 5.4 software. Mean difference (MD) and 95% Confidence intervals (CI) were calculated for continuous outcomes. Inverse variance method and a random effects model were used for pooled estimates. A p-value &lt; 0.05 (Z-test) was considered significant. Results: 5 randomized controlled trials with 264 patients were included in our analysis. A significant increase in the mean walking distance (MD: 54.13, 95% CI 9.34 to 98.92, p=0.02), pain-free walking distance (MD: 54.13, 95% CI 14.19, 57.88, p= 0.001), SF-36 physical component summary (MD: 11.97, 95% CI 0.26 to 23.69, p=0.05), EQ-5D-3L index score (MD; 0.08, 95% CI: 0.00 to 0.15, p=0.05) and VascuQoL index ((MD: 0.48, 95% CI 0.03 to 0.92, p= 0.04) was seen with ESWT. A slightly higher ankle brachial pressure index was seen in the control group (MD: -0.01, 95% CI: -0.02 to -0.00, p=0.04). There was no difference in SF-36 physical functioning domain score (MD: 18.58, 95% CI: -0.29 to 37.45, p=0.05) and SF-36 bodily pain score (MD: 9.17, 95% CI: -2.885 to 21.19, p=0.13). Conclusions: There was significant improvement in walking distances, exertional symptoms, and quality of life with ESWT. However, ESWT did not translate to an increase in post-treatment ankle-brachial index which was slightly higher in the control group. There is a need for larger randomized controlled trials to substantiate the efficacy of ESWT in treating symptomatic PAD.

Safety and reliability of ultrasound-assisted reduction in the conservative management of completely displaced paediatric distal radius fractures.

To assess the efficacy of ultrasound-assisted reduction in the conservative management of completely displaced pediatric distal radius fractures. The efficacy of ultrasound-assisted reduction versus conventional reduction was compared in a single-centre, retrospective, cross-sectional study involving 51 consecutive paediatric patients with completely displaced distal radius fractures, following manual reduction, from May 2021 to May 2023. The study group received ultrasound-assisted reduction (n = 24), while the control group underwent conventional blind manual reduction (n = 27). Comparative analysis included general clinical data, initial reduction success rates, frequency of exposure to radiation during reduction, post-reduction alignment rates, post-reduction angulation, re-displacement rates, conservative treatment failure rates, pain scores, and wrist joint scores at the last follow-up. All enrolled cases underwent manual reduction and conservative management. In the study group, all 24 patients underwent successful initial reduction procedures, with only one exposure to radiation during the entire process. Notably, no patient experienced re-displacement while in plaster, and the conservative treatment proved effective. The reduction and positioning rates were impressive, with success rates of 86.63 ± 3.65% in the coronal plane and 94.79 ± 3.06% in the sagittal plane. Furthermore, the post-reduction angulation was only 3.58 ± 0.65 degrees in the coronal plane and 8.70 ± 1.45 degrees in the sagittal plane. By contrast, within the control group comprising 27 patients, only 15 achieved successful initial reductions. Unfortunately, 12 patients required multiple exposure to radiation throughout the procedure. Furthermore, nine patients underwent re-displacement while in plaster and seven did not achieve successful conservative treatment. The alignment rates of the control group were similar to those of the study group (84.67 ± 4.35% in the coronal plane and 82.56 ± 5.45% in the sagittal plane). Similarly, the post-reduction angulation remained consistent, measuring 3.93 ± 0.87 degrees in the coronal plane and 12.03 ± 1.32 degrees in the sagittal plane. There were no statistically significant differences in pain scores during the process of fracture reduction and in wrist joint function scores at the final follow-up (P > 0.05). Ultrasound-assisted reduction in the conservative management of completely displaced paediatric distal radius fractures can enhance the initial reduction success rate, decrease the risk of subsequent redisplacement, minimize patient exposure to radiation, and yield favorable clinical outcomes. It is a safe and reliable approach.

“Investigating the combined effects of scapular-focused training and Mulligan mobilization on shoulder impingement syndrome” a three-arm pilot randomized controlled trial

ObjectivesTo assess whether the combination of scapular-focused training and mulligan mobilization (SFTMM) improves pain and proprioception compared to scapular-focused training (SFT) and a control group in female rock climbers with shoulder impingement syndrome (SIS).DesignThree-arm randomized controlled trial (RCT).SettingOutpatient setting.SubjectsIndividuals were randomly assigned to SFTMM, SFT alone, and control group.Interventions8 weeks of SFTMM and SFT.Main measuresOutcome measures were pain and proprioception.ResultsThe results revealed significant differences in pain scores and proprioception among female rock climbers with SIS who participated in SFTMM, SFT, and a control group (F(2, 32) = 81.01, p = 0.001, η2 = 0.83 for pain scores; F(2, 32) = 178.2, p = 0.001, η2 = 0.91 for proprioception scores). Post-hoc tests via the Bonferroni test indicated that both SFTMM and SFT significantly reduced pain levels (p = 0.001) and improved proprioception levels (p = 0.001) compared with the control group. There was no significant difference in pain scores and proprioception between the SFTMM group and the SFT group (p > 0.05).ConclusionsIn conclusion, the study indicates that SFTMM significantly reduces pain and improves proprioception in female rock climbers with SIS, as shown by notable changes compared to the control group. However, no statistically significant difference was found between the SFTMM (combined intervention) and SFT alone. Therefore, while the incorporation of SFT and MM shows promise; further research is needed to fully understand its long-term benefits and clinical implications.Ethical Code RegistrationThe study was approved at Ethics.research.ac.ir, code: IR.SSRC.REC.1402.170 on 2023-10-22.

Effect of Cryotherapy and Occlusal Reduction on Postoperative Endodontic Pain in Mandibular First Molars with Symptomatic Apical Periodontitis: A Prospective, Parallel, Double-Blinded Randomized Controlled Trial.

This study aimed to compare the intensity of postoperative pain following the final rinse using cold saline compared with room temperature saline and occlusal reduction. A prospective, parallel, double-blinded randomized controlled trial was conducted on 69 first mandibular molars diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. Single-visit root canal treatment was performed; access cavity preparations and chemomechanical preparations were carried out using the ProTaper Gold rotary system under copious irrigation using 3% sodium hypochlorite and 17% EDTA. The patients were divided into three groups (n = 23): control group: room temperature saline (25°C) final rinse without occlusal reduction; cryotherapy group: cold saline (2.5-4°C) final rinse without occlusal reduction; and occlusal reduction group: room temperature saline with occlusal reduction. Pain scores were recorded using the visual analog scale preoperatively and postoperatively via telephone at 6, 24, 48, 72 hours, and 7 days intervals. Age data were analyzed using one-way analysis of variance followed by Tukey's post hoc test. Pain score data were analyzed using Kruskal-Wallis' test followed by Dunn's post hoc test for intergroup comparisons and Friedman's test followed by Nemenyi's post hoc test for intragroup comparisons. Correlations were analyzed using Spearman's rank-order correlation coefficient. The significance level was set at p < 0.05 within all tests. Cryotherapy reduced postoperative pain compared with the control group with a statistically significant difference at 24 hours only (p = 0.016). At other intervals, no statistically significant difference in pain score was measured between all three groups (p > 0.05). After 7 days, all patients recorded a zero pain score. Cryotherapy was as effective as the occlusal reduction in reducing postoperative pain in cases of symptomatic irreversible pulpitis with symptomatic apical periodontitis, significantly more than the control group.

Efficacy comparison of the S8 navigation-assisted correction versus manual correction in adolescent congenital scoliosis

Objective: Comparison of the efficacy of S8 navigation system-assisted correction versus manual correction in the treatment of adolescent congenital scoliosis (ACS). Methods: A cohort study. A retrospective analysis was conducted on the clinical and imaging data of 48 patients with congenital scoliosis who were treated at the Honghui Hospital Affiliated with Xi'an Jiaotong University between May 2021 and January 2023. Based on the auxiliary systems, the patients were divided into two groups: the S8 navigation system-assisted correction group (navigation group, n=20) and the C-arm-assisted manual correction group (manual group, n=28). The primary outcome measures were coronal balance (CB), sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch (PI-LL), and the Scoliosis Research Society-22 (SRS-22) questionnaire. The secondary outcome measures included surgery-related conditions and postoperative complications. Results: Of the 48 patients, there were 21 males and 27 females, with a mean age of (13.3±3.0) years. There was no statistically significant differences in preoperative distance of C7 plumb line to center sacral vertical line (C7PL-CSVL), SVA, LL, PI, PT, PI-LL mismatch, or SRS-22 scores between the two groups (all P>0.05). Postoperatively, the C7PL-CSVL and SVA in the navigation group were both better than in the manual group [(12.51±11.86) mm vs (19.64±1.33) mm, (15.72±3.64) mm vs (25.42±2.53) mm, both P<0.05]. There was no statistically significant differences in postoperative LL, PI, PT, PI-LL mismatch, or SRS-22 scores between the two groups (all P>0.05). The accuracy rates for Grade 0 and Grade 0+1 screw placements were 91.17% (93/102) and 95.09% (97/102) in the navigation group, respectively, which were higher than those in the manual group [84.45% (125/148) and 91.89% (136/148), respectively] (both P<0.05). The rates of adjacent facet joint violation in Grades A, B, and C were 88.23% (90/102), 11.76% (12/102), and 0 (0/102) in the navigation group, respectively, which were all better than those in the manual group [83.44% (121/145), 8.96% (13/145), and 7.58% (11/145)] (P=0.015). The navigation group had shorter operative time, single screw placement time, and total screw placement time, and the distance between the screws and the cortex was closer compared to the manual group (all P<0.05). Intraoperative blood loss in the manual group was higher than that in the navigation group (P<0.05). The average curve correction rate in the navigation group (74.68%±10.70%) was better than that in the manual group (59.60%±6.90%) (P<0.001). The intraoperative fluoroscopy dose in the navigation group was higher than that in the manual group [(416±70) mGy vs (360±81) mGy, P=0.015]. The incision length in the navigation group was longer than that in the manual group (P<0.05). There was no statistically significant difference in preoperative VAS pain score between the two groups (P>0.05). The postoperative visual analogue scale scores of pain on day 3 was better in the navigation group [(2.60±0.22) vs (3.10±0.32), P<0.001], while there was no statistically significant differences at other time points between the two groups (all P>0.05). No complications occurred in either group. Conclusion: The S8 navigation system demonstrates good corrective outcomes, high screw placement accuracy, low facet joint violation, and favorable clinical results in the treatment of adolescent congenital scoliosis, making it an ideal auxiliary tool.

Is the Use of a Buprenorphine Transdermal Patch More Effective Than Oral Medications for Postoperative Analgesia After Arthroscopic Rotator Cuff Repair? A Randomized Clinical Trial.

Appropriate analgesic protocols for patients following arthroscopic rotator cuff repair remain controversial. Although transdermal buprenorphine patches might potentially provide better pain control and fewer side effects, it is worth noting that there is limited evidence for this given a lack of direct comparisons with oral pain regimens. Among patients undergoing arthroscopic rotator cuff repair, and compared with an analgesic approach using oral tramadol plus celecoxib: (1) Does perioperative use of buprenorphine patches provide better pain relief by a clinically important margin? (2) Does perioperative use of buprenorphine patches improve shoulder joint function recovery? (3) Does perioperative use of buprenorphine patches have a lower frequency of adverse reactions? This was a prospective, single-center, randomized controlled trial. We included patients who underwent arthroscopic rotator cuff repair for partial- or full-thickness rotator cuff tears < 3 cm in size in the anterior to posterior direction as estimated by preoperative MRI and excluded those who had obesity, were pregnant, had opioid dependence, had history of cardiac bypass surgery or ipsilateral rotator cuff repair, had allergies to trial medications, were taking anticoagulants or antidepressants, were being treated with other postsurgical pain management methods, or had severe liver or kidney dysfunction. Based on these criteria, 64% (72 of 112) of patients were eligible. The patients were randomly assigned into either the control group (oral tramadol and celecoxib) or the experimental group (buprenorphine patches). The control group received 100 mg of tramadol and 200 mg of celecoxib every 12 hours for 2 weeks after surgery. The experimental group received buprenorphine patches about 48 hours before surgery without any oral medication. A medication journal was given to the patients to self-report their compliance in taking the drugs. The dosage regimen adhered strictly to protocol. After enrollment, 11% (4 of 36) of patients in the control group and 17% (6 of 36) of patients in the experimental group could not be fully analyzed because of loss to follow-up or missing data. The surveillance period was 3 months, and there was no crossover between groups. The groups did not differ at baseline in terms of demographic parameters and relevant clinical characteristics, including age, gender, BMI, American Society of Anesthesiologists classification, tear size, concomitant procedures, and number of anchors. The outcomes were (1) numeric rating scale (NRS) for pain score at rest or with movement, which ranges from 0 to 10, where 0 indicates no pain, and 10 indicates the worst pain; (2) the American Shoulder and Elbow Surgeons (ASES) score for joint function, which ranges from 0 to 100, with higher scores indicating better shoulder joint function; and (3) the incidence of postoperative adverse reactions. We defined the minimum clinically important difference on the NRS as 2 of 10 points and on the ASES score as 15 of 100 points, based on anchor-based approaches reported in other studies. We found no clinically important between-group differences in NRS pain scores at any time point, either at rest or with movement. Likewise, we found no clinically important between-group differences in ASES scores at any time point. Postoperative dizziness or drowsiness (20% [6 of 30 patients] versus 44% [14 of 32 patients]; p = 0.04) and nausea (10% [3 of 30 patients] versus 34% [11 of 32 patients]; p = 0.02) during the hospital stay were slightly lower in the experimental group compared with the control group. In this randomized trial, we found no clinically important advantages in pain or function to the use of buprenorphine patches after arthroscopic rotator cuff repair, and insufficient evidence exists to confirm whether the minor differences in transient side effects could justify the use of a new and largely untested analgesic approach in this context. That being so, we recommend against the routine use of buprenorphine patches for this indication. In general, we found that pain levels were low after the procedure in both groups. Future studies, therefore, should focus on the efficacy of buprenorphine patches for more invasive or more painful procedures. Level I, therapeutic study.

Local Infiltration Analgesia Versus Adductor Canal Block for Managing Pain After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Adductor canal block (ACB) and local infiltration analgesia (LIA) are frequently used to manage pain in patients after anterior cruciate ligament reconstruction (ACLR). To compare the difference in pain scores and opioid consumption between ACB and LIA for ancillary pain management in patients after ACLR. Systematic review; Level of evidence, 3. A literature search was conducted using PubMed, MEDLINE, and Embase databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that compared pain scores at 2, 6, 12, or 24 hours after ACLR or provided information on 24-hour opioid consumption were included. Of 240 publications initially screened by abstract and title, 4 studies were included, and data related to participant characteristics, anesthetic technique, and pain-related outcomes were extracted. The standardized mean difference (MD) in pain scores and morphine milligram equivalents consumed in 24 hours was compared using a random-effects model. In all studies, ropivacaine was the primary anesthetic used for LIA and ACB, with 1 study also employing bupivacaine as an alternative. The difference in pain scores between LIA and ACB was not significant at 2 hours (MD, 0.04 [95% CI, -0.22 to 0.29]; P = .79), 6 hours (MD, 0.16 [95% CI, -0.20 to 0.52]; P = .39), 12 hours (MD, 0.54 [95% CI, -0.49 to 1.56]; P = .31), or 24 hours (MD, 0.12 [95% CI, -0.10 to 0.34]; P = .28). The difference in morphine milligram equivalents was also not statistically significant (MD, -0.07 [95% CI, -0.25 to 0.11]; P = .68). From this review, the authors suggest considering LIA over ACB because of its potential to offer comparable pain relief and opioid consumption while being less time intensive. However, the study results should be interpreted with caution, given the limited number of studies included.

Impact of Erector Spinae Plane Blocks on Pain Management and Postoperative Outcomes in Patients with Chronic Pain Undergoing Spine Fusion Surgery: A Retrospective Cohort Study.

To evaluate the impact of bilateral ultrasound-guided erector spinae plane blocks (ESPBs) on pain and opioid-related outcomes in a surgical population with chronic pain. A retrospective, observational cohort study. Clinical data were extracted from the electronic medical records of patients who underwent lumbar fusion (February 2018 - July 2020). Eligible patients had a confirmed history/diagnosis of chronic pain starting >3 months before surgery and received either bilateral ESPBs or no ESPBs. Patients were matched on demographic variables (sex, age, race, BMI, ASA Classification, and preoperative opioid use) in a 1:1 ratio. The primary outcome was median opioid consumption (morphine equivalent dose, MED) 24hours post-surgery (hydromorphone iv-PCA and oral). Secondary outcomes included Numeric Rating Scale (NRS) pain scores, opioid consumption up to 48hours post-surgery, and hospital length of stay (LOS). Group differences were analyzed using bivariable and multivariable regression. Of 72 patients, 36 received ultrasound-guided ESPBs and 36 did not. Baseline demographics showed no significant differences. On bivariable analysis, ESPBs were associated with significantly lower 24-hour opioid consumption (79 mg MED vs 116 mg MED, p=0.024) and shorter LOS (82hours, 95% CI 51-106 vs 126hours, 95% CI 101-167, p<0.001). No significant differences in NRS pain scores were found up to 48hours post-surgery. Multivariable analysis confirmed significant reductions in 24-hour opioid consumption (-44, 95% CI -1.06 - -87.55, p=0.044), IV-PCA use (-22, 95% CI -1.59 - -56.77, p=0.038), and LOS (-38, 95% CI -10.074 - -66.22, p=0.008) in the ESPB group without differences in NRS pain scores. ESPBs were associated with statistically and clinically significant reductions in 24-hour opioid consumption and LOS, without differences in NRS pain scores after spinal fusion in a chronic pain surgical cohort. Given these effects, patients with chronic pain may disproportionately benefit from ESPBs for spine surgery.

Postoperative Opioid Reduction Using a Multimodal Pain Protocol for Outpatient Orthopaedic Sports Medicine Surgery.

Orthopaedic surgery regularly employs opioids for postoperative pain management. Multimodal pain protocols have been shown to reduce opioid prescriptions in orthopaedic surgery. To analyze the impact of a division-level multimodal pain protocol for orthopaedic sports medicine surgery on opioid prescription reduction and pain level postoperatively. Cohort study; Level of evidence, 3. All orthopaedic sports medicine procedures at a military treatment facility were categorized into 1 of 3 pain tiers. A pain protocol emphasizing multimodal pain control was implemented for each tier. A retrospective cohort study compared pre- and postprotocol pain groups for each respective tier (n = 40 in each) for visual analog scale (VAS) for pain scores 2 weeks postoperatively, postoperative opioid prescription, and time to discontinuation of postoperative opioids. The mean number of opioid pills prescribed for all tiers decreased by 43.6% (preprotocol 35.7 ± 3.1; postprotocol 20.1 ± 1.5; P < .0001) after pain protocol implementation. Of the total opioids prescribed in the postprotocol cohort, a mean of 64.1% were consumed. There was no significant difference in overall visual analog scale for pain scores at 2 weeks postoperatively (preprotocol 2.72 ± 0.41; postprotocol 2.99 ± 0.43; P = .40). At 2 weeks postoperatively, only 1 patient continued opioids in the postprotocol group compared with 20 patients with continued opioid use in the preprotocol group (P < .001). A division-level multimodal pain protocol applied to orthopaedic sports medicine procedures led to decreased opioid prescription postoperatively with no significant difference in 2-week postoperative pain scores compared with more opioid reliant and variable protocols in a cohort of military service members. Despite the reduced prescription, patients consumed a mean of 64.1% of pills, indicating continued overprescription.

Comparison of two treatment modalities in the management of gingival enlargement during orthodontic treatment: a randomized clinical trial.

This clinical trial aimed to evaluate and compare the effectiveness of diode laser gingivectomy, conventional gingivectomy, and nonsurgical periodontal treatment (NSPT) in the management of gingival enlargement (GE) during orthodontic treatment. forty-five healthy, orthodontic patients with labial gingival enlargement on the 6 anterior teeth were selected and randomly assigned to one of the groups (Conventional, Laser, and NSPT). Clinical parameters including clinical crown length (CCL) , periodontal pocket depth (PPD), and vertical gingival overgrowth index (vGOi) were recorded at baseline, 1 month, 3 months, and 6 months. Postoperative pain was evaluated at 1,3, and 7 days. Esthetic satisfaction and acceptance of the procedure were recorded on day 10 and repeated after 6 months. Statistically significant results were obtained for mean reduction in PPD for conventional, laser, and NSPT groups (-1.43, -.1.75, and -0.9 mm, respectively; P < 0.001), CCL gain (1.45, 1.7, and 0.38 mm, respectively; P<0.001) and mean vGOi score (-1.14, -1.29 and -0.76, respectively; P<0.001) over 6 months. Both test groups showed greater statistically significant changes in clinical parameters over 6 months compared to NSPT (P<0.001). There was a gradual decrease in postoperative pain for all three groups over 7 days, with conventional group showing statistical difference in mean pain score on days 1 and 3 compared to other groups. Both conventional and laser gingivectomies were more effective in controlling enlargement over non-surgical periodontal treatment alone at 1, 3, and 6 months. laser and conventional gingivectomies as adjunctive treatments achieved superior results when compared to NSPT alone in the treatment of GE and gingival inflammation during orthodontic treatment, with no significant clinical differences between the two treatments.

Randomized Clinical Trial Comparing Mixed Liposomal Bupivacaine versus Continuous Catheter for Interscalene Block during Shoulder Arthroplasty: A Comparison of Analgesia, Patient Experience, and Cost

BackgroundContinuous interscalene catheters extend analgesia beyond 24 hours but are resource-intensive, while the efficacy of liposomal bupivacaine for single-injection interscalene blocks remains uncertain. The purpose of this investigation was to examine the analgesic efficacy, quality of recovery, and treatment costs between interscalene nerve block using either an indwelling catheter or single shot block using liposomal bupivacaine, in patients undergoing shoulder arthroplasty. MethodsIn this single-center, parallel, unblinded, randomized clinical trial, 83 patients undergoing primary shoulder arthroplasty were assigned to either a continuous interscalene catheter group (n=44) or a single-injection liposomal bupivacaine interscalene block group (n=39). The interscalene catheter group received a 15-20 mL bolus of 0.5% bupivacaine HCl followed by continuous infusion at 8 mL/h for 69 hours. The single-injection interscalene group received 10 mL (133 mg) liposomal bupivacaine with 5 mL of 0.5% bupivacaine HCl. The primary outcome was pain at rest 24 hours post-surgery. Secondary outcomes included pain scores, opioid consumption, complications, quality of recovery, and a time-driven activity-based cost analysis through postoperative day 3. ResultsThere was no significant difference in median pain scores at 24 hours between the continuous interscalene catheter group and the single-injection liposomal bupivacaine group (1.0 [0.0, 2.0] vs. 1.0 [0.0, 3.0]; P=0.433). Comparable analgesia was observed through postoperative day 3, with no differences in opioid consumption or quality of recovery. No serious adverse events were reported; however, 16% of patients in the continuous catheter group experienced dislodgement or leakage. Liposomal bupivacaine was associated with a 28% reduction in costs compared to the continuous catheter approach. ConclusionSingle-injection interscalene block with liposomal bupivacaine provides comparable analgesia to continuous interscalene catheters through postoperative day 3 while offering better value in the perioperative management of shoulder arthroplasty patients.

Reduction of Preoperative Anxiety Using Virtual Reality vs Midazolam: A Randomized Controlled Trial

More than 50% of pediatric patients experience significant stress and anxiety prior to surgery.1 High anxiety can result in increased postoperative pain, analgesic consumption, and delayed recovery.2 To reduce this preoperative anxiety, multiple therapeutic modalities have been developed, including the use of distraction, such as playing video games, watching movies, and listening to music. In severe cases of anxiety, anxiolytic and sedative medications like midazolam are used. However, given the acknowledged drawbacks of medications, including the risk of paradoxical reactions to the drug, alternatives to medication for reducing preoperative anxiety in patients may be useful. We aim to compare the use of virtual reality (VR) to midazolam in reducing preoperative anxiety in surgical patients and assess differences in induction compliance, emergence delirium, pain scores, and opioid use in VR vs. midazolam-treated patients. Methods This study was approved by the Phoenix Children’s Hospital Institutional Review Board. First-time surgical patients (N = 36) between the ages of 5 and 11 years undergoing tonsillectomy or tonsillectomy/adenoidectomy procedures were randomly assigned to either receive midazolam (0.5 mg/kg up to 25 mg) or play an interactive underwater-themed game using VR. The Modified Yale Preoperative Anxiety Scale (mYPAS) was administered by a single child life specialist preoperatively, and only patients who reached a threshold of &gt;40 on mYPAS scoring were enrolled (scale range: 23 - 100). Additional anxiety measurement was tested using the adult and child State-Trait Anxiety Inventory (STAI). Midazolam or VR was administered prior to transport to the OR, and mYPAS was scored again at the time of separation from the family. The Induction Compliance Checklist (ICC) was utilized for assessment at the time of anesthesia induction. The VR-treated patients continued use of the VR headset through mask induction. A standardized anesthesia induction protocol was used for all patients. The Pediatric Anesthesia Emergence Delirium (PAED) scale was administered at emergence, postoperatively. Postoperative nurses scored pain and administered IV pain medication as needed. Group means and standard deviations were reported and compared with two-sided t tests. Results Interim results show the mYPAS anxiety scores dropped 20.1 ± 11.7 points following midazolam treatment (p&lt;0.001) and dropped 28.3 ± 7.3 points following VR treatment (p &lt; 0.001). There was a significant difference in mYPAS scores between groups following treatment (midazolam = 32.0 ± 4.9; VR = 25.4 ± 4.7; p = 0.04). There were no significant differences between midazolam- and VR-treated groups in the Induction Compliance Checklist, PAED scale, peak postoperative pain scores, and medication use for pain control postoperatively. This study is currently ongoing. Conclusion VR appears to reduce preoperative anxiety similarly to midazolam in anxious first-time surgical pediatric patients. Limitations include patient population. Further studies should be conducted for greater generalizability.

Topical Anesthesia in Cutaneous Head and Neck Surgery: A Randomized Controlled Trial.

Cutaneous head and neck surgery can safely and effectively be performed using local anesthetic (LA). However, optimizing pain management during LA administration is paramount for patient comfort and procedural efficacy. The primary objective of this study was to investigate the comparative effectiveness of EMLA cream and ethyl chloride (EC) spray in mitigating pain associated with LA administration in cutaneous head and neck surgery. Randomized controlled trial. University-affiliated tertiary head and neck oncology center. Sample size calculation was performed followed by computer randomization into the following groups: EMLA, EMLA placebo (aqueous cream), EC, and a control group (no topical agent). Demographics, pain, and procedural experience scores were recorded perioperatively. Statistical analysis was performed to analyse differences between groups utilizing the Mann-Whitney U test, Kruskall-Wallis test, Chi-square test, and Spearman's Rho. 121 cutaneous lesions with a median patient age of 76 were analyzed. There were no statistically significant differences in pain scores (median [IQR]) between patients receiving EMLA (4 [3.75]), EMLA placebo (4.8 [3.6]), EC (5.8 [2.8]), and no treatment (5 [4.1], P = .19). Procedural experience scores were clinically similar (P = .02). Risk factors associated with elevated nociceptive sensitivity were surgical site (scalp, P = .01), malignant lesions (P < .01) and lesion surface area (rs = 0.22, P = .01). EMLA and EC did not mitigate LA-associated pain in patients undergoing cutaneous head and neck surgery and as such practitioners should reconsider their use of these in this regard. Patients' operative experience remains excellent regardless of topical anesthetic use. Ib.