Facial Pain Scores Research Articles

Complexity of arachnoid adhesions dictating the outcome of microvascular decompression for trigeminal neuralgia

Objective: Multiple techniques have been used to treat trigeminal neuralgia (TGN), including pharmacotherapy, radiosurgery, rhizotomy and microvascular decompression (MVD). Blood vessels are considered to be the most common cause of offense and compression to trigeminal nerve. We aimed to determine the causes of classic TGN and efficacy of MVD. Methods: This retrospective, cross-sectional study assessed the data of 53 patients, who underwent MVD at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan, from May, 2022 to December, 2023. Information regarding patient demographics, clinical presentation, Barrow Neurological Institute Facial Pain Score (BNI–FPS), intra-operative findings, and postoperative complications were analyzed. Results: The mean age at presentation was 44.33±11.71 years. Unilateral facial pain was the consistent clinical presentation among all patients, with right-sided involvement in 67.92% patients. All patients had involvement of at least two divisions of trigeminal nerve; maxillary and mandibular nerve in 84.91% and 71.70% cases, respectively. BNI–FPS Grade-IVb was found among 49.09% patients on presentation. Arachnoid adhesions, superior cerebellar artery and superior petrosal vein were the most common causes of compression in 71.70%, 50.94% and 43.40% cases, respectively. About 94% patients were discharged home on first post-operative day without complications and with BNI–FPS Grade-I. Conclusions: Microvascular decompression is highly advocated in classic cases of TGN. In the absence of grossly visible offending vascular structure, arachnoid adhesions should be the thorough focus of address. doi: https://doi.org/10.12669/pjms.40.12(PINS).11128 How to cite this: Khokar TI, Cheema ZA, Fatima I, Qadri HM, Bashir R, Bashir A. Complexity of arachnoid adhesions dictating the outcome of microvascular decompression for trigeminal neuralgia. Pak J Med Sci. 2024;40(12):S15-S19. doi: https://doi.org/10.12669/pjms.40.12(PINS).11128 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Propofol versus Dexmedetomidine for Sedation of Cancer Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: Randomized Single-Blinded Controlled Study

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a primary diagnostic and therapeutic option for pancreaticobiliary pathologies. Objectives: This study aimed to investigate the efficacy and safety of dexmedetomidine versus propofol during ERCP in cancer patients. Methods: This randomized controlled single-blinded trial was conducted with 202 cancer patients aged 21 to 60 years, of both sexes, with a body mass index of 18.5 to 30 kg/m2, and classified as American Society of Anesthesiologists (ASA) class II - III, who were undergoing ERCP. The patients were randomly assigned to two equal groups. The Propofol Group (n = 101) received a loading dose of propofol (1 - 2 mg/kg over 30 seconds) followed by an infusion (0.05 - 0.1 mg/kg/hour). The Dexmedetomidine Group (n = 101) received a loading dose of dexmedetomidine (1 μg/kg over 10 minutes) followed by an infusion (0.2 - 0.7 μg/kg/hour). The maintenance dose was adjusted during the procedure based on vital signs, Bispectral Index (BIS), and oxygen saturation. Results: The Dexmedetomidine group showed a significantly lower incidence of intra-procedural hypoxemic events (14.9% vs. 26.7%, P = 0.037) and a comparable incidence of hypotension (17.8% vs. 13.9%, P = 0.441). Dexmedetomidine also demonstrated significantly lower intraoperative pain scores according to the Facial Pain Score (P < 0.05), significantly lower postoperative Visual Analog Scale (VAS) scores (P < 0.05), and a lower frequency of postoperative nausea and vomiting (PONV) compared to the Propofol group. Additionally, there was a significantly higher frequency of endoscopist satisfaction in the Dexmedetomidine group compared to the Propofol group (P < 0.05). Conclusions: Dexmedetomidine can be used as a safe and effective alternative to propofol for deep sedation of cancer patients undergoing ERCP. It is associated with a lower incidence of hypoxemic events, effective intraoperative sedation, quicker recovery, and superior analgesic effects both intraoperatively and postoperatively compared to propofol.

Investigating the safety and feasibility of osteopathic manipulative medicine in hospitalized children and adolescent young adults with cancer.

Children and adolescents young adults (AYAs) undergoing treatment for oncologic diagnoses are frequently hospitalized and experience unwanted therapy-induced side effects that diminish quality of life. Osteopathic manipulative treatment (OMT) is a medical intervention that utilizes manual techniques to diagnose and treat body structures. Few studies have investigated the implementation of OMT in the pediatric oncology outpatient setting. To date, no studies have investigated the safety and feasibility of OMT in the pediatric oncology inpatient setting. The objective of this study is to investigate the safety and feasibility of OMT in the pediatric oncology inpatient setting. This is a prospective, single-institution pilot study evaluating children and AYAs aged≥2 years to≤30 years with a diagnosis of cancer hospitalized at Riley Hospital for Children (RH) from September 2022 to July 2023. Approval was obtained from the Indiana University Institutional Review Board (IRB). Patients were evaluated daily with a history and physical examination as part of routine inpatient management. Patients who reported chemotherapy side effects commonly encountered and managed in the inpatient setting, such as pain, headache, neuropathy, constipation, or nausea, were offered OMT. Patients provided written informed consent/assent prior to receiving OMT. OMT was provided by trained osteopathic medical students under the supervision of a board-certified osteopathic physician and included techniques commonly taught in first- and second-year osteopathic medical school curricula. Safety was assessed by a validated pain (FACES) scale immediately pre/post-OMT and by adverse event grading per Common Terminology Criteria for Adverse Events (CTCAE) 24 h post-OMT. All data were summarized utilizing descriptive statistics. A total of 11 patients were screened for eligibility. All patients met the eligibility criteria and were enrolled in the study. The majority of patients were male (n=7, 63.6 %) with a median age of 18.2 years at time of enrollment (range, 10.2-29.8 years). Patients had a variety of hematologic malignancies including B-cell acute lymphoblastic leukemia (ALL) (n=5, 45.5 %), T-cell ALL (n=1, 9.1 %), acute myeloid leukemia (AML) (n=2, 18.2 %), non-Hodgkin's lymphoma (n=2, 18.2 %), and Hodgkin's lymphoma (n=1, 9.1 %). All patients were actively undergoing cancer-directed therapy at the time of enrollment. There were 40 unique reasons for OMT reported and treated across 37 encounters, including musculoskeletal pain (n=23, 57.5 %), edema (n=7, 17.5 %), headache (n=5, 12.5 %), peripheral neuropathy (n=2, 5.0 %), constipation (n=2, 5.0 %), and epigastric pain not otherwise specified (n=1, 2.5 %). Validated FACES pain scores were reported in 27 encounters. Of the 10 encounters for which FACES pain scores were not reported, 8 encounters addressed lower extremity edema, 1 encounter addressed peripheral neuropathy, and 1 encounter addressed constipation. The total time of OMT was documented for 33 of the 37 encounters and averaged 9.8 min (range, 3-20 min). Hospitalized children and AYAs with cancer received OMT safely with decreased pain in their reported somatic dysfunction(s). These findings support further investigation into the safety, feasibility, and efficacy of implementing OMT in the pediatric oncology inpatient setting and to a broader inpatient pediatric oncology population.

Clinical impact of diagnostic image-guided injections for musculoskeletal pain work-up in adolescent and adult patients at a children's hospital: initial results.

To assess the clinical impact of diagnostic musculoskeletal (MSK) injections on treatment decision-making in adolescent and adult patients at a children's hospital. Retrospective study in patients who underwent diagnostic MSK injections by fluoroscopy or ultrasound (US) between 8/2020 and 3/2023 at a children's hospital. Patients received ropivacaine and triamcinolone acetonide at pain site, reporting quantitative FACES pain score prior to, immediately following, and 2-3days following injection. Impact on patient care was subsequently assessed. A total of 109 diagnostic fluoroscopic or US MSK injection referrals (mean: 17.6years old) were included, most commonly hip (76.2%), ankle (9.2%), and iliopsoas tendon sheath (8.3%). Pain improvement occurred in 89.0% immediately and 67.9% 2-3days after MSK injection, with net 84.4% exhibiting improvement based on pain scores and clinical exams. When there was pain improvement at the site of injection, there was a statistically higher incidence of operative intervention or additional therapeutic injections compared with the cohort that did not have symptom improvement (88% versus 35.3%, P < 0.0001). For the 15.6% (N = 17) of referrals that did not have pain improvement, 17.6% (n = 3) ultimately had an operative intervention at a separate site from the diagnostic injection, as an alternative etiology for the pain was found. Image-guided MSK injections play an important role in the management of musculoskeletal disorders. 84.4% of referrals experienced symptom relief, improving confidence for treatment decision-making. Importantly, 15.6% of patients were found to have an alternative etiology for symptoms, altering management altogether.

Comparison of intravenous ibuprofen and paracetamol for peri-operative analgesia in paediatric day care tonsillectomy.

To determine the effectiveness of intravenous ibuprofen and acetaminophen as perioperative analgesics in paediatric patients undergoing day- care tonsillectomy with general anaesthesia. The quasi-experimental stud y was conduc ted at the Ana esthe sia D epartment of Pa k Emirates M ilitary Hospital, Rawalpindi , Pak ist an, from July 20 21 to June 2022, and comp rised paediatric pa t ients aged 5-12 yea r s undergoing day- care tonsil lec tomy with gen era l anaesthesia. The sub jec ts were divid ed into two equa l groups. Patients in Group I received intravenous ibuprofen 7mg/kg and patients in Group P received intravenous paracetamol 10mg/kg im media t ely after induction of anaesthesi a. All patients recei ved standard general anaesthesia with endotracheal intubation. The primary outcome measured was revised faces pain score immediately after recovery and at the time of discharge 6 hours later. Adverse events were also noted. Data was analysed using SPSS 26. Of the 100 patients, there were 50(50%) in Group I; 21(42%) boys and 29(58%) girls with mean age 7.82±1.903 years. The remaining 50(50%) subjects were in Group P; 25(50%) boys and 25(50%) girls with mean age 7.68±1.812 years. At baseline, 44(88%) patients in Group I and 42(84%) in Group P reported no pain, while 6(12%) and 8(16%) patients in the two groups, respectively, reported pain (p=0.56). At discharge, 35(70%) patients in Group I and 18(36%) in Group P reported no pain (p<0.001). Adverse events were not significantly different between the groups (p>0.05). I ntravenous ibuprofen was found to b e a superior pain-killer than intravenous paracetamol for perioperative care of paediatric patients in day- care tonsillectomy.

Fully automated deep learning models with smartphone applicability for prediction of pain using the Feline Grimace Scale

This study used deep neural networks and machine learning models to predict facial landmark positions and pain scores using the Feline Grimace Scale© (FGS). A total of 3447 face images of cats were annotated with 37 landmarks. Convolutional neural networks (CNN) were trained and selected according to size, prediction time, predictive performance (normalized root mean squared error, NRMSE) and suitability for smartphone technology. Geometric descriptors (n = 35) were computed. XGBoost models were trained and selected according to predictive performance (accuracy; mean square error, MSE). For prediction of facial landmarks, the best CNN model had NRMSE of 16.76% (ShuffleNetV2). For prediction of FGS scores, the best XGBoost model had accuracy of 95.5% and MSE of 0.0096. Models showed excellent predictive performance and accuracy to discriminate painful and non-painful cats. This technology can now be used for the development of an automated, smartphone application for acute pain assessment in cats.

The Efficacy and Safety of a Combination of Thiocolchicoside and Etoricoxib in Low Back Pain (ESCoTEL): A Randomized Active-Controlled Trial.

Background Low back pain (LBP) is a global health concern. Management of LBP aims at pain relief facilitating improvement of functional ability. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line of therapy. However, the selection of NSAIDs is challenging given the range of underlying etiologies and severity. The current study aimed to compare the efficacy and safety of two available fixed-dose combinations (FDCs), namely, a dual FDC (DFC) of etoricoxib (60 mg) and thiocolchicoside (4 mg) versus a triple FDC (TFC) of chlorzoxazone (500 mg), diclofenac (50 mg), and paracetamol (325 mg). Methodology A total of 200 eligible adult subjects aged 18-70 years with a history of LBP and muscle spasm for ≤14 days and Wong-Baker Faces Pain score >4 were enrolled after obtaining written informed consent and randomized in a 1:1 allocation ratio to be treated with either DFC or TFC for 28 days. Efficacy was assessed based on the change in score from baseline (before treatment) to day 28 on the Wong-Baker Faces Pain Scale and the Oswestry Disability Index (ODI) questionnaire, as well as the proportion of subjects who improved upon treatment. Safety was assessed based on adverse events and clinical laboratory test results. Results A significant decrease in pain intensity (p < 0.001) and significant improvement in functional ability (p < 0.001) was observed after treatment with either DFC or TFC. The decrease in Wong-Baker Faces Pain score and ODI, from baseline, was comparable between the treatment groups. However, more subjects with very severe pain at baseline showed ≥30% improvement upon treatment with DFC than with TFC (~25% versus ~12%; p = 0.172). Also, significantly more crippled subjects with very severe functional disability showed improvement in the DFC group compared to the TFC group (~26% versus ~4%; p = 0.008). No adverse events or clinically relevant laboratory test results were evident. Conclusions Both DFC and TFC were comparable in efficacy and safety for the management of recent-onset LBP. However, significantly more subjects with very severe pain or functional disability showed improvement after 28 days when treated with DFC compared to TFC.

Caudal Epidural Block versus Combined Ilioinguinal and Iliohypogastric Nerve Block for Post-Operative Analgesia in Pediatric Surgeries Below the Umbilicus

Objective: To compare the duration and effectiveness of postoperative analgesia provided by caudal block versus combined Ilioinguinal and Iliohypogastric nerve block in pediatric infra-umbilical surgeries.Study Design: Quasi-experimental.Place and Duration of Study: The study was carried out at the Anesthesia Department of Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan, from June 2021 to December 2021.Materials and Methods: Sample size was calculated from the WHO sample size calculator using the population size received in 6 months. The sample size was filtered down by purposive sampling to 80 (children aged 5-10 years) using a pre-defined inclusion/exclusion criterion scheduled for below umbilicus surgeries. They were alternatively divided into two equal groups (n=40) where Group-C received a caudal block and Group-I received ultrasound-guided Ilioinguinal and Iliohypogastric nerve block. Both groups underwent the same general anesthesia technique with I-gel and similar medications at inductions. Our primary outcome measure was the duration of analgesia using the Revised Faces Pain Scale, where p-value &lt;0.05 was considered significant. The secondary outcomes measured were motor block and urinary retention.Results: Median revised Faces Pain Score (FPS-R) immediately after surgery was 1.50(1) for Group-C and 0.00(1) for Group I, respectively. At 4 hours postoperatively, the median FPS-R in Group-C was 4.00(2), and in Group I, it was 2.00(0). After 8 hours, Group-C had a median FPS-R of 6.50(1) and Group-I had pain scores of 3.00(1). Median pain scores of Group-C and Group-I at 12 hours postoperatively were 8.00(1) and 5.00(1), respectively. The demographic characteristics of the patients were comparable in both groups with similar duration of surgery. Group-C reported some cases of side effects, such as motor block and urinary retention, while Group-I did not have any of these effects. All anesthetic procedures did not otherwise have any adverse events.Conclusion: Our study demonstrated that combined Ilioinguinal and Iliohypogastric nerve block furnished efficient post-operative analgesia while requiring smaller amounts of local anesthetics and avoiding the adverse effects of the caudal block. It is an ideal regional block technique for infra-umbilical surgeries in pediatric populations at busy centres.

443 Bilateral Facial Pain With Simultaneous Onset in Trigeminal Neuralgia

INTRODUCTION: Bilateral TN (BTN) represents a non-negligible disease burden. BTN is often sequential in nature, meaning pain develops on one side before developing on the contralateral side. The few cases of simultaneous onset BTN are often indiscriminately considered or not specified from sequential onset BTN cases. METHODS: A retrospective analysis was conducted to identify patients with simultaneous onset of bilateral TN. Demographic characteristics and comorbidities were assessed. Treatment plans and modalities were recorded, and procedural outcomes and treatment durability was assessed by determining median time pain recurrence in patients with at least 30 days of follow-up. Pharmacotherapy treatment and Barrow Neurological Institute pain intensity scores were compared at last follow-up with index treatment. RESULTS: Between 1996 and 2021, 17 out of 1723 patients with trigeminal neuralgia presented with simultaneous onset of bilateral trigeminal orofacial pain which underwent bilateral surgical intervention. Patients were followed for 3 to 148 months, during which 63 procedures were performed: 20 glycerin rhizotomies, 25 glycerin-radiofrequency rhizotomies, and 18 microvascular decompressions. 16 of 17 patients experienced pain recurrence after undergoing treatment: 12 with bilateral pain and 4 with unilateral recurrence. Glycerin-radiofrequency rhizotomy provided the greatest recurrence free interval (median = 15.4 months) compared to glycerin rhizotomy (median = 0.9 months; p = 0.02) and microvascular decompression (median = 7.8 months; p = 0.25). Over the course of treatment, the number of pharmacotherapy agents increased from 2 to 3 (p = 0.05). Overall facial pain scores improved from a median of 6 to 4 bilaterally. CONCLUSIONS: Patients with simultaneous bilateral trigeminal neuralgia represent a rare disease population who tend to have early pain recurrence after surgical treatment. Nevertheless, many experience overall pain improvement with re-treatment.

The Effect of Analgesia in Fast Track Pediatric Cardiac Patient

Background: Rapid tracheal extubation after cardiac surgery is not novel. "Fast-track management" has gained popularity in recent years, and the provision of cost-effective treatment is now included in with other factors as a means of assessing the success of various surgical procedures. Objective: In this study our main goal is to evaluate the effect of Analgesia in fast track pediatric cardiac patient. Method: This retrospective study was done at Bangladesh Shishu Hospital and Institute, Bangladesh, from January 2021 to January 2022. A total of 100 patients considered suitable for fast-track care were selected prior to surgery. The criteria for the selection of fast-track patients included low- risk cardiac surgery and the absence of other associated complex defects, either a weight over 10 kg or at least 6 months of age, the absence of complex non-cardiac issues and no significant history of repeat chest infections or obstructive airway disease. Results: during the study, mean age group was 5.7 years, followed by 55 cases were male, mean weight was 15.5 kg. 50% had a trial septal defect followed by 15% Ventricular septal defect, 11% Partial anomalous pulmonary, 9% congenital sabaortic stenosis, 10% had Atrioventricular septal defect. While reviewing post-operative faces pain score in day-1, 15% had no hurts followed by 60% had hurts a little bit, 10% had hurts more, 5% had hurts even more, 5% had hurts whole lot, 5% had hurts worst In day-2 25% had no hurts, 50% had hurts a bit, 12% had hurts a little more, 6% had hurts even more. In day-3 40% had no hurts, 40% had hurts a little bit, 20% had hurts little more. However, in day-4 15% had hurts little bit and 10% had hurts little more. In addition, 90% of the patients had between excellent and satisfactory analgesia. Moreover, 48% had vomiting and 2% had itching. Conclusion: The treatment of congenital heart disease after surgery is projected to become more reliant on "fast-track" care as the healthcare system ....

Efficacy of Hyoscine Butylbromide Versus Drotaverine in Relieving Acute Nonspecific Abdominal Pain in Children- A Non - Randomized Trial

Introduction: Acute abdominal pain is a very common complaint for children presenting to the emergency department (ED). The purpose of this study was to compare efficacy of hyoscine and drotaverine for relieving acute nonspecific abdominal pain in children presenting to ED. Methods: Total of 52 children aged six years to 16 years were enrolled in a non-randomized trial at Paediatric ED of TUTH from Dec 2017 to June 2018, and randomly allocated to drotaverine or hyoscine groups; 26 in each group. Face pain score-revised tool was used to measure the efficacy of the drug. The primary outcome was to measure the reduction of face pain score (Self-reported) by at least 2 / 10 at 60 minutes after ingestion of study intervention. Other outcomes were requirement of rescue analgesia and adverse effects of drugs. Results: A total of 20 (77%) in hyoscine and 21 (81%) in drotaverine group responded to oral medication at the end of 60 minutes of oral administration and the difference was not statistically significant (p=0.808). Vomiting was only adverse event present in five (19%) in drotaverine and two (8%) in hyoscine groups, respectively. Conclusions: In this single center randomized controlled trial, both hyoscine and drotaverine were found to be equally efficacious for relieving acute non-specific abdominal pain in children.

The Effect of Humanized Nursing Intervention Guided by Computed Tomography Images on Elderly Patients Undergoing Anesthesia for Femur Intertrochanteric Fractures under Intelligent Reconstruction Algorithm.

This research was aimed at analyzing the effect of humanized nursing intervention combined with computed tomography (CT) imaging in the surgical anesthesia of femur intertrochanteric fractures (FIF) in the elderly. An image reconstruction algorithm was proposed based on nonlocal mean (NLM) algorithm, which was named as ONLM, and its performance was analyzed. A total of 114 elderly patients with FIF were equally and randomly divided into a humanized nursing group (57 cases) and a routine nursing group (57 cases). They were performed with CT imaging scan based on the ONLM algorithm, and the clinical indicators of the two groups of patients were recorded. The root mean square error (RMSE) and mean absolute error (MAE) of the CT images constructed using the ONLM algorithm were significantly lower than those using NLM algorithm, edge filtering algorithm, and total variation model, while the peak signal-to-noise ratio (PSNR) was the opposite (P < 0.05). The operation time, hospitalization days, intraoperative blood loss, postoperative drainage, and anesthesia preparation time of patients in the humanized nursing group were significantly lower than those in the routine nursing group. The number of patients with excellent Harris scores in the humanized nursing group was higher than that in the routine nursing group, and the number of patients with poor Harris scores was lower (P < 0.05). The language pain score, facial pain score, and visual analog simulation (VAS) scores of patients in the humanized nursing group were significantly lower than those in the routine nursing group. The numbers of postoperative hip varus and fracture nonunion cases in the humanized nursing group were significantly more than those in the routine nursing group. In short, CT images constructed by the ONLM showed higher performance than those by the traditional algorithm. In addition, CT images constructed by ONLM combined with humanized nursing intervention could more effectively improve the cooperation of patients with surgical anesthesia, reduce surgical pain and fear of patients, improve the prognosis of patients, and lower the occurrence of adverse events.

A propensity sore-matched study: Applying a modified chest tube drainage strategy in rapid rehabilitation following uni-portal thoracoscopic pulmonary wedge resection.

PurposeThis study aimed to compare the value of a modified chest tube drainage strategy to a traditional drainage strategy in single‐port thoracoscopic pulmonary wedge resection.MethodsFrom January 2019 to July 2021, we collected clinical data on 405 patients who underwent single‐port thoracoscopic pulmonary wedge resection in the No.1 Department of Thoracic Surgery at Fujian Medical University Union Hospital, with 121 (29.9%) cases in the modified drainage strategy group and 284 (70.1%) cases in the traditional drainage strategy group. The propensity score matching method (Match Ratio = 1:1) was used to reduce differences in clinical characteristics between the two groups.ResultsFollowing 1:1 propensity score matching, 120 matched pairs (240 patients) were included in the study. There was no significant difference in general clinical characteristics between the two groups. There was no statistical difference in intraoperative factors except for operative times (71.42 ± 22.98 min vs. 86.80 ± 36.75 min, p < 0.001). In terms of postoperative factors, there were significant differences in postoperative chest tube duration (0.00 ± 0.00 h vs. 32.68 ± 18.51 h, p < 0.001), total drainage volume (143.03 ± 118.33 ml vs. 187.73 ± 140.82 ml, p = 0.008), postoperative hospital stay (2.61 ± 0.70 days vs. 3.27 ± 1.88 days, p < 0.001), number of additional pain relief (0.14 ± 0.40 vs. 0.42 ± 0.74, p < 0.001), facial pain score (2.7 ± 1.8 vs. 3.6 ± 2.7, p = 0.005) and adverse events (p = 0.046). Furthermore, there was a statistical difference between the two groups regarding CTCAE grade‐1 complication, but no statistical difference in CTCAE grade‐2 complication.ConclusionsA modified drainage strategy in single‐port thoracoscopic pulmonary wedge resection is safe and feasible, allowing for less postoperative rehabilitation time, pain relief, reduced postoperative pleural effusion, and reduced clinical workload.

Transpapillary Injection Technique as a Substitute for Palatal Infiltration: A Split-mouth Randomized Clinical Trial.

ABSTRACTAim and objectiveTo assess and compare the degree of pain during local anesthesia administration and to evaluate the efficacy of transpapillary injection as a substitute for palatal injection in simple maxillary tooth extractions.Materials and methodsA split-mouth study was conducted among children aged 7–11 years who required bilateral extraction of maxillary molars. The individuals were subjected to conventional buccal and palatal infiltration for the first extraction. The transpapillary injection was administered for the subsequent extraction in place of palatal administration. 2% lignocaine with 1:100,000 adrenaline was used for both techniques. Faces pain score scale and visual analog scale were utilized to record pain during injection administration and during the extraction process. A p < 0.05 was considered to be statistically significant.ResultsThe difference in pain scores was observed during injection administration and was found to be statistically significant (p < 0.05) whereas pain scores for extraction were insignificant (p > 0.05).ConclusionThe transpapillary injection technique was efficacious in eliminating the pain of the palatal injection technique for maxillary extractions.Clinical significanceOwing to the results of this study, the transpapillary injection technique can be used as a distinguished substitute for conventional palatal infiltration, thereby lessening the level of distress experienced by a pediatric patient during local anesthesia administration.How to cite this articleSruthi MA, Ramakrishnan M. Transpapillary Injection Technique as a Substitute for Palatal Infiltration: A Split-mouth Randomized Clinical Trial. Int J Clin Pediatr Dent 2021;14(5):640–643.

Effectiveness of analgesia with hydromorphone hydrochloride for postoperative pain following surgical repair of structural congenital malformations in children: a randomized controlled trial

BackgroundEffective postoperative analgesia is needed to prevent the negative effects of postoperative pain on patient outcomes. To compare the effectiveness of hydromorphone hydrochloride and sufentanil, combined with flurbiprofen axetil, for postoperative analgesia in pediatric patients.MethodsThis prospective randomized controlled trial included 222 pediatric patients scheduled for repair of a structural congenital malformation under general anesthesia. Patients were randomized into 3 groups: hydromorphone hydrochloride 0.1 mg/kg (H1), hydromorphone hydrochloride 0.2 mg/kg; (H2) or sufentanil 1.5 µg/kg (S). Analgesics were diluted in 0.9% saline to 100 ml and infused continuously at a basic flow rate of 2 mL per h. The primary outcome measure was the Face, Legs, Activity, Cry, and Consolability (FLACC) pain score. Secondary outcomes included heart rate (HR), respiration rate (RR), SpO2, Ramsay sedation scores, scores on the Paediatric Anaesthesia Emergence Delirium (PAED) scale, adverse reactions, parent satisfaction with analgesia.ResultsThe FLACC score was significantly lower in H1 and H2 groups compared to S. The Ramsay sedation score was significantly higher in H1 and H2 groups compared to S. Recovery time was shorter in H1 group compared to patients H2 group or S group. There were no significant differences in the PAED scale, HR, RR, SpO2, adverse reactions, satisfaction of parents with analgesia, or length and cost of hospital stay.ConclusionsHydromorphone hydrochloride is a more effective analgesic than sufentanil for postoperative pain in pediatric patients following surgical repair of a structural congenital malformation, however, hydromorphone hydrochloride and sufentanil had similar safety profiles in this patient population.Trial registrationChinese Clinical Trial Register ChiCTR-INR-17013935). Clinical trial registry URL: Date of registration: December 14, 2017.

A Prospective Observational Study on Prescription Pattern and Its Efficacy in the Management of Osteoarthritis at Multispecialty Teaching Care Hospital

Background: osteoarthritis is a severe clinical condition in elderly patients. Almost any bone can fracture as a result of the increased bone fragility of osteoarthritis.&#x0D; Aim and Objective of study: The principle aim of drug utilization research is to facilitate the rational use of drugs in an individualized patient. To Study current prescription pattern and its efficacy to manage osteoarthritis.&#x0D; Methodology: This study was a prospective observational study and conducted over a period of six month from October 2015 to March 2016. Patients diagnosed with arthritis with or without co-morbidities were enrolled in the Study considering the inclusion and exclusion criteria. The main sources of data collection were OPD file and case sheets of patients.&#x0D; Results: In this study 148 patients were enrolled, 105 (70.9%) female patients and 43 (29.1%) male patients were participated. Out of 148 study participants 60 (40.54%) patients from age group 51-65 years, followed by 54 (36.48%) patients from age group 36-50 years. In the study population 94 (63.51%) patient were suffering osteoarthritis of both knee, 29 (19.59%) patients were suffering osteoarthritis of right knee and 25 (16.89%) patients were having osteoarthritis of left knee. X-ray report were representing in study population, in 44 patient reports were shows degenerative change seen in both knee, 08 patient report were shows degenerative change seen in right knee. In our study out of 148 patients, 92 (62.16%) patients prescribed NSAIDs, 25 (16.89%) patients prescribed Analgesic, 05 (03.37%) patients were prescribed Opioid analgesic, 11 (07.43%) patients were prescribed supplements and 15 (10.13%) patients received other class of drugs. Among the study population 112 (75.67%) patients were received oral route of drugs and 36 (24.32%) Patients were prescribed topical preparation. The visual analogue scale has been categorized as follows 0-3 Mild pain, 4-7 Moderate pain and 8-10 severe pain. In visual analogue scale initially 16 patients were suffering mild pain, but after treatment it was 93 patients suffering mild pain. The facial pain scale has been categorized as follow 0 = very happy, no hurt, 2 = hurts just a little bit, 4 = hurts a little more 6 = hurts even more, 8 = hurts a whole lot, 10 = hurts as much as you can imagine. Among 148 study participants 14 patients were having final Facial pain score 0, 67 patients were having a final Facial pain score 2 and 3 patients having Initial Facial Pain score 2, 42 patients were having a final Facial pain score 4 and 42 patients having Initial Facial pain score 4, 19 patients were having a final Facial pain score 6 and 63 patients having Initial Facial pain score 6, 06 patients were having final Facial pain score 8 and 33 patients having Initial Facial pain score 8, 07 patients having Initial Facial score 10.&#x0D; Conclusion: The principal aim of drug utilization research is to facilitate the rational use of drugs in an individualized patient. For the individual’s patients, the rational use of a drug implies the prescription of the well documented drug at optimal dose, together with the correct information, at an affordable price.

Improved Bowel Function With Oral Methylnaltrexone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

Methylnaltrexone, a peripheral opioid antagonist, is used to decrease opioid-induced constipation; however, there is limited evidence for its use in children. The primary objective of the study is to assess the efficacy of per os (PO) methylnaltrexone in inducing bowel movements (BMs) in patients with adolescent idiopathic scoliosis who underwent a posterior spinal fusion and instrumentation (PSFI). Secondary outcomes include hospital length of stay, postoperative pain scores, and postoperative opioid usage. Retrospective chart review identified all adolescent idiopathic scoliosis patients above 10 years of age who underwent PSFI with a minimum of 24 hours of postoperative opioid analgesia after the initiation of the new bowel regimen protocol. The bowel regimen included daily administration of PO methylnaltrexone starting on postoperative day 1 until BM is achieved. A case-matched cohort was obtained with patients who did not receive PO methylnaltrexone and otherwise had the same bowel function regimen. Case-matched controls were also matched for age, sex, body mass index, and curve severity. t Tests and Pearson χ2 tests were used for statistical analysis. Fifty-two patients received oral methylnaltrexone (14±2.6 y) and 52 patients were included in the case-matched control group (14±2.1 y). The methylnaltrexone group had a significantly shorter hospital length of stay (3.09±0.66) compared with controls (3.69±0.80) (P<0.01). 59% (31 of 52) of the methylnaltrexone group had a BM by postoperative day postoperative day 2, compared with 30% (16 of 52) of the control group (P<0.01). In the methylnaltrexone group, 44% (23 of 52) of the patients required a Dulcolax (bisacodyl) suppository and 11% (6 of 52) required an enema, compared with 50% (26 of 52) and 33% (12 of 52) of the control group respectively (P=0.43 and 0.12). In addition, significantly less patients had abdominal distension during their postoperative stay in the methylnaltrexone group (17%, 9 of 52) compared with the control group (40%, 21 of 52) (P<0.01). There was no significant difference in self-reported average FACES pain score (P=0.39) or in opioid morphine equivalents required per hour (P=0.18). Patients who received PO methylnaltrexone after PSFI had decreased length of stay and improved bowel function. Administration of methylnaltrexone did not increase maximum self-reported FACES pain values or opioid consumption compared with controls. The use of oral methylnaltrexone after PSFI reduces postoperative constipation, which has implications for reducing hospital length of stay and overall morbidity. Level III-retrospective comparative study.

Unilateral Acupuncture Reduces Postoperative Pain Scores in Children Undergoing Adenotonsillectomy: A Randomized Controlled Trial.

PurposeAcupuncture ameliorates several pain disorders including postoperative pain. This can help to decrease the need for postoperative analgesics. We aimed to evaluate the effectiveness of acupuncture as an adjuvant scheme reduce both intraoperative and postoperative analgesia needs in children undergoing adenotonsillectomy.MethodsThis was a randomized controlled single-blinded trial that was performed over sixty children scheduled for adenotonsillectomy. They were randomly allocated to either an intervention group that received general anesthesia plus acupuncture or a control group which received general anesthesia alone. The primary outcome was the measurement of postoperative pain scores. Secondary outcomes included measurement of time to the first request of postoperative analgesia, the number of children requesting postoperative analgesics in the first 2 hours, the incidence of postoperative complications including postoperative nausea and/or vomiting (PONV), and emergence agitation (EA).ResultsAThe Wong-Baker FACES pain scores at rest and on swallowing were significantly lower in the intervention group than in the control group postoperatively. The time to the first request of postoperative analgesia was delayed in the intervention group versus the control group, with less number of patients who have requested additional analgesia during the first 2 hours postoperatively. Postoperative agitation was lower in the intervention group versus the control group patients. However, the incidence of PONV was not statistically different between study groups.ConclusionCombined acupuncture with general anesthesia in children undergoing adenotonsillectomy provided better postoperative pain control with no adverse effects.

The Application of Geometric Morphometrics to Explore Potential Impacts of Anthropocentric Selection on Animals' Ability to Communicate via the Face: The Domestic Cat as a Case Study

During their domestication via artificial selection, humans have substantially modified the morphology and thus visual appearance of non-human animals. While research highlights the negative impact of these modifications on physical functioning, little is known about their impact on behavior and signaling, either toward humans or conspecifics. Changes in the appearance of the face, such as those associated with, but not limited to, facial expressions, form an important part of non-verbal communication. In companion animals, the face is one of their most visually diverse features (due to human-driven selection), which may impact the visual clarity of expressions and other forms of signaling. Using the domestic cat as our model, we applied a new analytical technique in order to understand the impact of breed variation on relative positioning of facial landmarks, chosen specifically for their association with the production of various facial movements, and the expression of affect. We then assessed the extent to which facial appearances known to be associated with a specific underlying state (i.e., pain, assessed via a validated, facial pain score), could be reliably detected in a morphologically diverse population. Substantial baseline variation in landmarks was identified at both the cephalic (e.g., brachycephalic, dolichocephalic, mesocephalic) as well as breed levels. While differences in facial pain scores could successfully differentiate between “pain” and “no pain” in the facial appearance of domestic shorthaired cats (DSH), these differences were no longer detectable when assessed within a larger more morphologically diverse population, after corrections for multiple testing were applied. There was also considerable overlap between pain scores in the DSH “pain” population and the neutral faces of other breeds. Additionally, for several paedomorphic breeds, their neutral face shapes produced scores indicative of greater pain, compared to most other breeds, including the DSH cats actually in pain. Our findings highlight the degree to which anthropocentric selection might disrupt the communicative content of animals' faces, in this case the domestic cat. These results also suggest a potential human preference for features extending beyond the infantile, to include negatively-valenced facial forms such as pain.

Objective assessment of chronic pain in donkeys using the donkey chronic pain scale (DCPS): A scale-construction study

Assessment of chronic pain is very important for monitoring and improving welfare and quality of life in donkeys. Freedom from disease and pain is one of the ‘five freedoms’ underlying animal welfare. The aim of the current study was to develop a pain scale for assessment of chronic pain in donkeys (Donkey Chronic Pain Scale; DCPS), including behavioural and facial expression-related parameters. The scale was applied to 77 donkeys (38 donkeys diagnosed with chronic health problems by means of clinical examination and additional diagnostic procedures and 39 healthy control animals). Animals were assessed twice daily for three consecutive days by two observers that were not masked to the condition of the animals but were unaware of the analgesic treatment regimens. Both composite, facial expression-based and combined DCPS pain scales showed excellent inter-observer reliability (Cronbach’s alpha = 0.98, 0.96 and 0.98 respectively; P < 0.001). Individual composite and facial expression-based pain scores and the resulting combined DCPS showed significant differences between donkeys with chronic conditions and control donkeys at all time points (P < 0.001). A DCPS cut-off of 6 showed good sensitivity and specificity (92% and 82.5% respectively) for presence of a chronic painful condition. Facial expression-related parameters separately showed low sensitivity. In conclusion, it is possible to use a composite pain scale for assessment of chronic pain in donkeys, based on behavioural and facial expression-based parameters. Further studies are needed to validate this pain scale before it can be used in veterinary practice.