Effective Method Of Pain Management Research Articles

Efficacy of epidural anesthesia in minimally invasive cardiac surgery

Introduction: The most commonly performed minimally invasive cardiac surgery (MICS) is lateral minithoracotomy, which requires one of the most painful incisions. Adequate postoperative pain management is essential for cardiac surgery to prevent perioperative complications. Thoracic epidural analgesia (TEA) is the gold standard for thoracotomy; however, it is still controversial because of the risk of epidural hematoma following systematic heparinization. The objective of our study was to investigate the safety and efficacy of TEA following MICS. Methods: The clinical data of patients aged over 18 years who underwent elective MICS and received epidural analgesia along with general anesthesia between January 2014 and March 2019 were reviewed. Data were collected, including patient demographics, operative data, postoperative pain, postoperative course, and complications. Chronic pain was evaluated 6 months after discharge, and we defined it as a NRS score ≧3. Postoperative complications included epidural-related complications. Results: Seventy patients were included in the analysis. The mean NRS score was below 2. We collected chronic pain data from 52 patients and found that 11 patients had chronic pain. TEA-related complications were not observed. Conclusion: The current observational study revealed that TEA following lateral thoracotomy was effective for acute pain as well as chronic pain without causing any severe epidural-related complications. Protocols to prevent potential devastating complications, including epidural hematoma, should follow the American Society of Regional Anesthesia and Pain Medicine recommendation. If the rules are strictly followed, TEA can be a safe and effective pain management method for patients who undergo MICS.

Efficacy and safety of the serratus anterior plane block (SAP block) for pain management in patients with multiple rib fractures in the emergency department: a retrospective study.

Chest trauma is a severe and frequent cause of admission to the emergency department (ED). The serratus anterior plane (SAP) block seems to be an effective method of pain management; however, data on efficacy and safety of a single SAP block performed in the ED by emergency physicians (EP) are limited. This study aimed to compare SAP block performed by the EP in the ED plus standard therapy to standard therapy alone in terms of pain severity at 0-3-6-12-18 and 24h, total opioid consumption (milligrams of morphine equivalents, MME), respiratory function (SpO2/FiO2 ratio), and adverse events (i.e. pneumothorax, infections in the site of injection, or Local Anaesthetic Systemic Toxicity syndrome due to SAP block) in the first 24h. This retrospective, monocentric study included adult patients admitted to the Sub-intensive Care Unit (SICU) of the ED with multiple rib fractures between 01/2022 and 03/2023. 156 patients (65.4% male; median age 62 years; median injury severity score 16; median thoracic trauma severity score 8) were included. 75 (48.2%) underwent SAP block. Patients undergoing SAP block showed significantly less pain 3-6-18h after a single block, required less MME (0 [0-20] vs. 20 [0-40], p < 0.001), showed higher SpO2/FiO2 ratio, and no adverse events were reported. The SAP block, in combination with standard therapy, appeared to be more effective in providing pain relief than standard therapy alone in patients admitted to the SICU for traumatic rib fractures.

Rates and Clinical Implications of Transplacental Transfer of Neuraxial Fentanyl to Neonate

(Am J Obstet Gynecol. 2023;228(4):478–479) Epidural analgesia is widely used and accepted as a safe and effective method for pain management during labor and delivery. Though there is substantial research supporting this, there is also concern that some drugs can cross the placenta into the fetal blood stream. The main concern is the transmission of opioids across the placenta to the fetus during labor and before birth, thereby resulting in residual effects after birth. This study aimed to examine the frequency with which newborns test positive for fentanyl in their urine after the use of epidural analgesia, as well as assess factors that increase the likelihood of a positive test and the association between fentanyl positivity and clinical outcomes for the newborn.

Low-dose intranasal dexmedetomidine premedication improves epidural labor analgesia onset and reduces procedural pain on epidural puncture: a prospective randomized double-blind clinical study

BackgroundEpidural labor analgesia is a safe and effective method of pain management during labor with the drawbacks of delayed onset and maternal distress during epidural puncture. This study aimed to determine whether pretreatment with intranasal low-dose dexmedetomidine effectively shortens the onset of analgesia and reduces procedural pain.MethodsIn this prospective, randomized double-blind trial, nulliparous patients were randomly assigned to either the intranasal dexmedetomidine group or the control group. The intranasal dexmedetomidine group received 0.5 μg/kg dexmedetomidine intranasally, and the control group received an equal volume of normal saline intranasally. Both groups were maintained with a programmed intermittent epidural bolus. The primary outcome was the onset time of analgesia and scores of pain related to the epidural puncture.ResultsSeventy-nine patients were enrolled, and 60 completed the study and were included in the analysis. The time to achieve adequate analgesia was significantly shorter in the intranasal dexmedetomidine group than in the control group (hazard ratio = 2.069; 95% CI, 2.187 to 3.606; P = 0.010). The visual analogue scale pain scores during epidural puncture in the intranasal dexmedetomidine group were also significantly lower than those in the control group (2.0 (1.8–2.5) vs. 3.5 (3.3–4.5), P ≤ 0.001, Table 2). Pretreatment with intranasal dexmedetomidine before epidural labor analgesia was associated with improved visual analogue scale pain scores and Ramsay scores, less consumption of analgesics and higher maternal satisfaction (P < 0.05). No differences were observed for labor and neonatal outcomes or the incidence of adverse effects between the two groups.ConclusionsPretreatment with intranasal dexmedetomidine before epidural labor analgesia yielded a faster onset of analgesia and decreased epidural puncture pain without increasing adverse effects. Pretreatment with intranasal dexmedetomidine may be a useful adjunct for the initiation of epidural analgesia, and further investigation should be encouraged to determine its utility more fully.Trial registrationThis trial was prospectively registered at Chictr.org.cn on 29/05/2020 with the registration number ChiCTR2000033356 (http://www.chictr.org.cn/listbycreater.aspx).

Analgesic Role of Breastfeeding: Analysis of Effectiveness, Implementation Barriers, and Strategies to Promote Evidence-Based Practice

Objective:Exposure to painful stimuli serves as toxic stress for infants, increasing their subsequent pain sensitivity and resulting in neurodevelopmental impairments. Besides offering nutritional, psychological, immunological, and economic benefits, breastfeeding is reported as the most effective analgesia for the management of minor procedural pain in infants. Although breastfeeding holds several advantages, implementation of this nonpharmacological intervention is still uncommon in many clinical settings.Methods:This scoping review presents an analysis of 29 clinical trials that compare the effectiveness of breastfeeding with other nonpharmacological methods.Findings:Breastfeeding is an efficacious analgesia compared with sucrose, sweet solutions, and other nonpharmacological methods. When used alone or in combination with other nonpharmacological interventions, breastfeeding reduces infants’ biobehavioral responses to pain and promotes faster physiologic recovery after painful procedures. Breastfeeding is recommended as the first choice whenever feasible. Barriers to the uptake of this effective pain management method in clinical practice include misinformation/inconsistent use of evidence, an infant’s impaired sucking reflex, maternal–child separation, the workload of healthcare professionals, a lack of parental involvement, assumptions of healthcare providers, and a lack of adequate information/guidance for parents. Strategies to promote the uptake of breastfeeding for the management of procedural pain in infants include an effective partnership between healthcare providers and breastfeeding mothers, knowledge mobilization resources in multiple languages, informational support and media campaigns, and experiential learning opportunities for breastfeeding mothers.Conclusions:Successful implementation of baby-friendly hospital initiatives, a patient-centered approach, family-centered care, and the collaborative efforts of healthcare providers in all healthcare settings is recommended to promote the uptake of breastfeeding as analgesia.

Analgesic Role of Breastfeeding: Analysis of Effectiveness, Implementation Barriers, and Strategies to Promote Evidence-Based Practice

Objective:Exposure to painful stimuli serves as toxic stress for infants, increasing their subsequent pain sensitivity and resulting in neurodevelopmental impairments. Besides offering nutritional, psychological, immunological, and economic benefits, breastfeeding is reported as the most effective analgesia for the management of minor procedural pain in infants. Although breastfeeding holds several advantages, implementation of this nonpharmacological intervention is still uncommon in many clinical settings.Methods:This scoping review presents an analysis of 29 clinical trials that compare the effectiveness of breastfeeding with other nonpharmacological methods.Findings:Breastfeeding is an efficacious analgesia compared with sucrose, sweet solutions, and other nonpharmacological methods. When used alone or in combination with other nonpharmacological interventions, breastfeeding reduces infants’ biobehavioral responses to pain and promotes faster physiologic recovery after painful procedures. Breastfeeding is recommended as the first choice whenever feasible. Barriers to the uptake of this effective pain management method in clinical practice include misinformation/inconsistent use of evidence, an infant’s impaired sucking reflex, maternal–child separation, the workload of healthcare professionals, a lack of parental involvement, assumptions of healthcare providers, and a lack of adequate information/guidance for parents. Strategies to promote the uptake of breastfeeding for the management of procedural pain in infants include an effective partnership between healthcare providers and breastfeeding mothers, knowledge mobilization resources in multiple languages, informational support and media campaigns, and experiential learning opportunities for breastfeeding mothers.Conclusions:Successful implementation of baby-friendly hospital initiatives, a patient-centered approach, family-centered care, and the collaborative efforts of healthcare providers in all healthcare settings is recommended to promote the uptake of breastfeeding as analgesia.

Virtual reality mobility for burn patients (VR-MOBILE): A within-subject-controlled trial protocol.

In the acute phase, burn patients undergo several painful procedures. Pediatric burn care procedures conducted in hydrotherapy have been known to generate severe pain intensity and moderate to high levels of anxiety. Hydrotherapy treatments are done with the use of opioids and benzodiazepines for pain and anxiety. Unfortunately, nonpharmacological methods are rarely combined with pharmacological treatments despite evidence showing that distraction can serve as an effective method for pain management and can potentially decrease analgesic requirements in other painful medical procedures. Virtual reality (VR) is a method that uses distraction to interact within a virtual environment. The use of VR is promising for pain reduction in varying settings. Considering the lack of optimal pain and anxiety management during burn wound care and the positive effect of an immersive distraction for painful procedures, using VR for burn wound care procedures may show promising results. This is a within-subject randomized controlled trial design in which each participant will serve as his/her own control. A minimum of 20 participants, aged 7 to 17 years old undergoing a burn care session, will receive both standard and experimental treatments during the same session in a randomized order. The experimental treatment will consist of combining VR distraction using the video game Dreamland® to the current standard pharmacological care as per unit protocol. The control group will only receive the unit's standard pharmacological care. The mean difference in both pain intensity scores and in anxiety between the two different sequences will be the primary outcomes of this study. This study evaluates the effect of VR on burn wound care. If results from this study show a positive effect of VR compared to standard care, this protocol may provide guidance on how to implement this type of immersive care as part of the tools available for distraction of painful procedures for acute burn victims.

Continuous Intravenous Ketamine for Pain Control After Tibial or Femoral Osteotomy.

The purpose of this case series is to evaluate the potential of continuous intravenous ketamine administration as part of a multimodal strategy to reduce opioid requirements after high tibial osteotomy (HTO) and distal femoral osteotomy (DFO). We examined the average postoperative numerical rating scale pain intensity score from admission to the postanesthesia care unit to 8am of the first postoperative day of four patients who underwent HTO or DFO. Pain scores were analyzed as the time-weighted sum of pain intensity differences using the trapezoidal rule of the curve, resulting in an area under the curve (AUC). Patient A had an AUC of 2,828 over 1,180 minutes with an average pain score of 2.4/10. Patient B had an AUC of 1,418 over 1,285 minutes with an average pain score of 1.1/10. Patient C had an AUC of 4,217 over 1,155 minutes with an average pain score of 3.7/10. Patient D had an AUC of 4,498 over 1,030 minutes with an average pain score of 4.4/10. All were able to go home on postoperative day 1. This novel perioperative pain pathway including multiple non-opioid pain adjuncts and a low-dose continuous ketamine infusion is an effective method for pain management in knee periarticular osteotomies. Level 4; Case Series.

Musculoskeletal manifectations of the new coronavirus infection: focus on arthralgia and myalgia

The new coronavirus infection (COVID-19) is associated with a wide spectrum of various clinical manifestations including involvement of the musculoskeletal system which can persist for a long time after the infection. Supposedly, pathogenesis of musculoskeletal manifestations of COVID-19 is primarily caused by systemic inflammation accompanied by cytokine hyperexpression (interferon γ, interleukins 1β, 6, 8, 17, tumor necrosis factor α), as well as hypoxia leading to overproduction of inflammatory cytokines, activation of bone reabsorption by osteoclasts and subsequent decrease of mineral bone density and osteonecrosis in some cases. Additionally, some drugs prescribed to patients with COVID-19 (some antiviral drugs and glucocorticoids) should also be taken into account as they can lead to development of musculoskeletal pathology. In the acute period of COVID-19, myalgias are common, but in rare cases myositis with proximal muscular weakness and increased levels of creatine phosphokinase, lactate dehydrogenase can occur. Arthralgias in the acute period of COVID-19 are rarer than myalgias. In the studies of clinical manifestation of COVID-19, frequency of arthralgias and myalgias in the acute period is between 15.5 and 50 %. After COVID-19, frequency of arthralgias and myalgias gradually decreases, however there are cases of long-term joint and muscle pains, as well as post-viral arthritis, development of arthritis in the context of various autoimmune disorders. Myalgias and arthralgias during COVID-19 usually regress spontaneously and in most patients do not require prescription of antipain medications, but in some cases pain management is necessary. Use of non-steroid anti-inflammatory drugs and vitamin D during COVID-19 is a safe and effective method of pain management, including myalgia and arthralgia. Rehabilitation programs play an important role in improvement of functional state and patient recovery after moderate and severe COVID-19.

Greater occipital nerve block efficacy in COVID‑19 associated headache: a preliminary study

COVID‑19 is an infection caused by the new coronavirus SARS‑CoV‑2. Headache is one of the most common neurological findings. In the treatment of various chronic headaches, the greater occipital nerve (GON) block is often used as a safe and effective method. The aim of our study was to investigate the effectiveness of the GON block in the treatment of headaches observed in COVID‑19 patients. Between March and May 2020, 27 patients (with laboratory‑confirmed 2019‑nCoV infection by next‑generation sequencing confirmation of real‑time PCR) that had moderate or severe headache associated with COVID‑19 and treated with a single session of GON block were retrospectively analyzed. The visual analogue scale (VAS) values and the number of analgesic usage of patients were recorded before and after the blockade on the 1st and 10th days. Fifteen (55.6%) patients included in the study were male and twelve (44.4%) were female. In terms of VAS values, the difference between pre‑treatment and post‑treatment values on the 1st and 10th days was found statistically significant. Likewise, the difference between analgesic use before and after the procedure was statistically significant. GON block appears to be an effective pain management method in COVID‑19 related headache, and it revealed promising reductions in pain scores and analgesic usage. As well as we know, this is the first study of "COVID‑19 associated headache treated with GON blockade". More long term and well‑designed prospective studies with more participants are needed to better define this headache and develop effective treatment strategies.

Fascia Iliaca Compartment Block for Hip Fractures: Improving Clinical Practice by Audit.

BackgroundHip fractures are the most frequently occurring serious injury in older people. They are the most common reason for people over the age of 65 to need emergency anaesthesia and surgery, and account for the most cause of death following an accident. A fascia iliaca compartment block (FICB) is the injection of anaesthetic agents into the fascia iliaca compartment with the effect of blocking the lumbar plexus via an anterior approach. FICB targets nerves that are in the fascia iliaca compartment that include the femoral nerve and the lateral femoral cutaneous nerve. A FICB is clinically safe and efficient providing consistent analgesic effects irrespective of the performing doctor's experience in managing hip fractures. Clinical audits and feedback are a veritable tool for quality improvement.MethodsData from the National Hip Fracture Database (NHFD) for all patients admitted with a hip fracture between October 2018 and May 2019 at a District hospital was interrogated and audited. Results of this audit were discussed in the department's and the Trust's mortality review meetings. In addition, teaching sessions on the safe administration of FICB using the Loss of Resistance (LOR) technique were held for junior doctors. A re-audit was carried out in May 2020 where a retrospective study of patients admitted with a hip fracture over six months from October 2019 to April 2020 was done to assess improvement in compliance rates in the administration of fascia iliaca blocks.ResultsThis study showed a statistically significant increase in the number of patients who got a fascia iliaca block on presentation with a fractured neck of the femur from after our second audit (p < 0.00001). There were no complications associated with the administration of FICB to patients with hip fractures.ConclusionsThe administration of FICB for patients with hip fractures by admitting junior doctors using the loss of resistance (LOR) technique is a safe, simple, and rapidly effective pain management method that reduces the need for excessive systemic analgesia and provides consistent simultaneous blockade of the lateral cutaneous femoral and femoral nerves. This study showed that clinical practices could be improved through audits, staff education and by enforcing the proper utilization of clinical proformas to ensure compliance.

Application of unilateral rhomboid intercostal and subserratus plane block for analgesia after laparoscopic cholecystectomy: a quasi-experimental study.

BackgroundInterfascial plane block can be used to treat postoperative pain after laparoscopic surgery. This study aimed to investigate the effect of ultrasound-guided unilateral rhomboid intercostal and subserratus plane (RISS) block after laparoscopic cholecystectomy on the amount of analgesic consumption.Methods Fifty patients who underwent laparoscopic cholecystectomy were included in this quasi-experimental study. Patients fulfilling the inclusion criteria were analyzed in two groups: RISS group (RISS block with 20 ml of 0.25% bupivacaine + intravenous patient-controlled analgesia [IV-PCA] tramadol [n = 25]); and Control group (IV-PCA tramadol [n = 25]). The primary outcome was the total amount of tramadol used over 24 h. Secondary outcomes included side effects, additional analgesic use, and postoperative pain (at rest and during activity) at 2, 6, 12, and 24 h according to numerical rating scale (NRS) scores.Results Postoperative tramadol consumption at 24 h was significantly lower in the RISS group than in the Control group (P < 0.001). Resting NRS scores at 2 h and 6 h were significantly lower in the RISS group. NRS scores during movement in the RISS group were significantly lower at 2, 6, and 12 h postoperatively. There was no statistically significant difference in the rate of side effects and additional analgesic use between the groups (P > 0.05).Conclusions Unilateral RISS block was an effective method for pain management after laparoscopic cholecystectomy and can be used as a part of multimodal analgesia.

Efficacy of Dexmedetomidine Versus Morphine as an Adjunct to Bupivacaine in Caudal Anesthesia for Pediatric Thoracic Surgeries: A Randomized Controlled Trial.

BackgroundCaudal anesthesia is an effective method of pain management, which can be successfully employed to minimize post-thoracotomy pain in pediatric patients. However, its main disadvantage is the short postoperative analgesic period, which can be prolonged by the concurrent administration of one of many adjuvants.ObjectivesThis prospective randomized, blinded study aimed to compare the efficacy of dexmedetomidine versus morphine as adjuvants to bupivacaine in caudal anesthesia for thoracic surgeries in pediatric patients.MethodsFifty patients were randomly allocated into two equal groups. To achieve caudal epidural block anesthesia, the patients in group M (n = 25) were administered morphine and bupivacaine, while group D (n = 25) received a mixture of dexmedetomidine and bupivacaine. The primary outcome of this study was the postoperative analgesic duration achieved. The secondary outcomes included morphine administration in the first 24 hours following caudal block anesthesia, the face, legs, activity, cry, consolability (FLACC) scale scores, and adverse effects, including vomiting, itching, bradycardia, hypotension, and respiratory depression.ResultsThe results showed that patients who had received dexmedetomidine achieved a longer postoperative analgesia as compared to those who had received morphine (P < 0.001). Postoperatively, the heart rate, blood pressure, pain score, and mean consumption of morphine were lower in group D as compared to the group M. There was no significant difference in the adverse effects between the two groups.ConclusionsThe use of dexmedetomidine as an adjuvant to bupivacaine for caudal anesthesia during pediatric thoracic surgeries induced better and prolonged postoperative analgesia as compared to morphine.

Comparative effects on pain arising from injury to the knee meniscus in adults: A systematic review and network meta-analysis

Objective: To identify the most effective pain management method for meniscus injuries by comparing pain relief observed with several common interventions including combined different combinations of surgery and exercise, surgery alone, supervised exercise alone and home exercise alone. Methods: PubMed, Embase, CINAHL, Cochrane Library, Web of Science, SportDiscus, and PEDro were searched from database inception through October 15, 2020. Randomized controlled trials investigating the effect of surgery and exercise for meniscus injuries by using the visual analogue scale (VAS) assessment were eligible for inclusion. Primary outcome was mean change in VAS score from baseline. Comparisons between interventions were made through use of random-effects network meta-analysis over the short-term (three months) and mid-term (12 months). Relative ranking of therapies was assessed by the surface-under-the-cumulative ranking possibilities. All reference lists of included studies were hand-searched. Results: We investigated six RCTs (total n = 796 patients). No significant difference was found between different treatments of pain control in three months and 12 months. The surface under the cumulative ranking curves suggested that supervised exercise combined with surgery was considered most likely to overshadow other treatments in reducing short-term pain (surface under cumulative ranking curve (SUCRA) values: 98.1; mean ranks: 1.1) and mid-term pain (SUCRA values: 97.2; mean rank: 1.1). Conclusion: There is not sufficient evidence to identify any preferred or more effective surgical and/or exercise-based treatment program.

Continuous bilateral erector spinae plane analgesic block for an adolescent with Nuss repair of pectus excavatum

Abstract Thoracic epidural analgesia has been proven to be an effective method for pain management following Pectus excavatum repair. However, because of the accompanying thoracic spinal deformities, thoracic epidural analgesia may not always be a feasible option in all cases. If ineffective, there could be increased opioid administration in order to adequately manage any post operative pain. Studies have shown that early exposure of adolescents to opioids is associated with increased risk of persistent opioid use. This is because adolescents have larger reward centers and underdeveloped prefrontal cortex, hence an immature inhibitory system. An alternative regional technique for post operative pain management in these patients is thus valuable. Erector spinae plane (ESP) block has been explored and found to be a useful alternative for pain management in this group of patients. Although there are a few case reports showing the effectiveness of ESP blocks in Ravitch repair, we present, for the first time, the effectiveness of ESP in Nuss repair.

Psychological Profiles of Patients in a Multidisciplinary Chronic Pain Management Program in Central Taiwan

Many studies have suggested that multidisciplinary care is an effective pain management method; however, this care mode is still not commonly seen in Taiwan. The current study focused on patients within the first multidisciplinary pain management program in Taiwan. The first aim of this study was to investigate the effectiveness of the first multidisciplinary pain management program in Taiwan in terms of improving chronic pain patients' mood, sleep quality, and pain. The second aim was to determine whether improvement in mood or sleep quality was predictive of improvement in pain, and vice versa. Patients from a pain clinic were invited to join a multidisciplinary pain management program. They were assessed each month for improvement in mood, pain, and sleep quality. This study reviewed the medical records of these patients. Twenty male and thirteen female chronic non-malignant pain patients aged between 23 and 64 from a pain clinic. During the first visit, a clinical psychologist assessed the mental health of patients before patients undertook education delivered by nine other professionals in the program. Participants' mood, pain, and sleep quality were assessed monthly. The study used repeated measures analysis of variance to identify changes in patients' mood, pain, and sleep quality after three months of multidisciplinary care. We used linear regression to assess whether changes in mood or sleep quality could predict improvement in pain, and vice versa. The level of anxiety decreased, and sleep quality improved significantly, over the duration of care. The severities of depression and sleep disturbance decreased as the least pain experienced in the past week showed improvement. Improvement in sleep quality was predictive of improvement in least pain. The multidisciplinary pain management program was effective in improving patients' anxiety and sleep quality. Decreased pain brought about improvement in mood. We also found a reciprocal association between improvements in the least pain experienced in the past week and sleep quality.

CE: Original Research: Errors in Postoperative Administration of Intravenous Patient-Controlled Analgesia: A Retrospective Study.

Relevant data were collected from the medical records of all patients who received IV PCA at a large academic medical center in South Korea during a three-year period. The study sample comprised 45,104 patients who used one of four types of IV PCA delivery devices. Errors occurred in 406 cases (0.9%). Operator error was the most common type of error (54.7%), followed by device malfunction (32.3%), prescription error (12.3%), and patient error (0.7%). Of the 222 operator errors, the most frequent type was failure to begin IV PCA drug administration (28.8%), followed by programming errors by non-anesthesia providers who weren't authorized to program the device (24.8%) and wrong infusion rates set by anesthesia providers who were so authorized (24.8%). The findings provide valuable information that can aid in the development of policy and procedures for safer, more effective postoperative administration of IV PCA. They also suggest that it's necessary not only to improve the operation of acute pain services teams, but also to ensure ongoing provider and patient education specific to IV PCA use.

Thermal Microcautery, a Form of Peripheral Nerve Field Stimulation for Treatment of Painful Knee Osteoarthritis: Non-Randomized Controlled Trial

Background: Thermal Microcautery (TMC) is a form of peripheral nerve field stimulation and is a technique used in Traditional Indian Medicine (Agnikarma) to manage chronic pain. The aim was to asses TMC in painful knee osteoarthritis (PKO). Methods: A non-randomized controlled trial was employed. All PKO patients on a waiting list for knee replacement were offered PNFS-TMC. Patients in the intervention group received 4 sessions (2 weeks apart) of PNFS-TMC by a pin-point tip of a metal rod. The rod was heated over a flame for 5 minutes before being used to induce a single 1 mm second-degree burn over points of tenderness. The control group was selected from the same waiting list. The primary outcome was assessed by Visual Analogue Scale (VAS) scores. The secondary outcomes were changes in levels of physical day to day activity, sleep and analgesics. Results: 16 PNFS-TMC intervention group patients and 15 control group patients were subject to analysis. Baseline VAS score was higher in PNFS-TMC group [9 ± 1.23 (95% CI 8.38 - 9.61) versus 5.93 ± 2.11 (95% CI 4.81 - 7.06) in the control, P < 0.0001]. VAS scores after 8 weeks (i.e. 4 sessions) were lower in the PNFS-TMC group [4.64 ± 2.08 (95% CI 3.57 - 5.72) versus 6.73 ± 2.01 (95% CI 5.61 - 7.85) respectively with P = 0.0058]. In the PNFS-TMC group, VAS score decreased from 9 ± 1.23 (95% CI 8.38 - 9.61) at baseline to 4.64 ± 2.08 (95% CI 3.57 - 5.72) after 4 sessions (P < 0.0001). In control group, VAS score showed a non-significant increase in VAS score from 5.93 ± 2.11 (95% CI 4.81 - 7.06) to 6.73 ± 2.01 (95% CI 5.61 - 7.85) (P = 0.2844). Results indicate reduction of pain VAS scores in the PNFS-TMC group (P < 0.0001). Eleven patients (68.7%) experienced increased capacity to perform daily physical activities P < 0.0001 and 5 (31.2%) showed no change in activity P < 0.0418. 5 (33.3%) of the patients in the control group became worse and 10 (66.7%) experienced no change. Conclusions: PNFS-TMC could offer a simple, safe, cheap and effective method of pain management in chronic PKO patients.

Erratum: Effect of music (Brahms lullaby) and non-nutritive sucking on heel lance in preterm infants: A randomized controlled crossover trial.

[This corrects the article DOI: 10.1093/pch/pxy072.].

Effect of music (Brahms lullaby) and non-nutritive sucking on heel lance in preterm infants: A randomized controlled crossover trial.

ObjectivesThis study examined a more effective pain management method, without sucrose, on heel lance in preterm infants using the Premature Infant Pain Profile (PIPP).DesignIn a nonblinded, randomized controlled, two-period, two-sequence crossover trial, 25 infants were randomly allocated to intervention (a Brahms lullaby with non-nutritive sucking, facilitated tucking and holding) or standard care (facilitated tucking and holding).SettingLocal Perinatal Medical Centre’s NICU in Japan, July 2014 until June 2015.Outcome measuresThe primary outcome variable was PIPP, and secondary outcomes were heart rate (HR), oxygen saturation, and abnormal HR (> baseline mean plus 2 SDs, or <120 minus 2 SDs).ResultsThe infants were 33.8 weeks gestational age at birth, 1,983.7 g birth weight, and 32 to 35 weeks postconceptual age. At all 10 measurement points, constructed of every 30 seconds postheel lance, mean PIPP of infants during the intervention (3.6 to 2.4) was significantly lower than during the standard care (8.0 to 4.6) (range, P=0.0039 to P<0.0001). All PIPP reduction rates from the 30 seconds point were similar between the two groups. The HR of preterm infants at the 120 seconds points were significantly lower (P=0.0151), and the HRs of 6 points were considerably lower during the intervention than during the standard care (range, P≤0.0879 to P≥0.049). The abnormal HR total number was significantly lower during the intervention (2) than the standard care (23) (frequency ratio=0.087, P<0.0001).ConclusionThis method demonstrated stronger analgesia, early pain relief, and maintenance of homeostasis on heel lance in preterm infants.