Reduction In Pain Levels Research Articles

The effect of erector spinae plane block on postoperative pain and quality of recovery in patients undergoing percutaneous nephrolithotomy

Percutaneous nephrolithotomy (PNL) is the preferred surgical procedure for treating renal stones larger than 2 cm. Patients may experience significant pain in the postoperative period due to factors such as the catheter entry site and tension in the renal capsule. Erector Spinae Plane (ESP) block provides perioperative muscle relaxation and reduces analgesic use. In this study, we investigated the effect of ESP block on postoperative pain scale and quality of recovery in patients undergoing PNL. The study was conducted with a total of 96 patients, with 45 patients receiving the ESP block and 51 patients not receiving the ESP block. Following the surgery, the visual pain scale (VAS) was completed at 0, 2, 6, 12, and 24 h, and the Quality of Recovery-15 (QoR-15) scale along with the willingness scale were completed at the 24-hour mark. The normal distribution of data was evaluated with the Kolmogorov-Smirnov test, histogram, and skewness-kurtosis coefficients. For comparing paired groups, the Student’s T-test was used for normally distributed variables, while the Mann-Whitney U test was used for parameters that did not have a normal distribution. The comparison of postoperative pain, as measured by VAS scores between the groups, revealed statistically significantly lower scores in the ESP block group at 0, 2, 6, 12, and 24 h (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.010, respectively). Our study results indicated that patients who received the ESP block experienced reduced pain levels and had higher QoR-15 scores compared to those who did not receive the ESP block.

Visual exposure to green light therapy reduces knee joint pain and alters the lipidome in osteoarthritic rats.

Visual exposure to dim, green, light has been found to reduce pain levels in patients living with migraine, low back pain, and fibromyalgia. Preclinical studies discovered that the analgesic effect of green light was due to the central release of endogenous opioids and a reduction in inflammatory cytokines in the cerebrospinal fluid. The present study assessed the effect of green light therapy (GLT) on joint pain in a rat model of osteoarthritis (OA) and investigated the role of endolipids. Male and female Wistar rats (207-318 g) received an intra-articular injection of sodium monoiodoacetate (3 mg in 50 μL saline) into the knee to induce OA. On day 9, animals were placed in a room illuminated by either white (neutral-white 4000K; 20 lux) or green (wavelength: 525 nm; luminance: 20 lux) light for 5 days (8 hours per day). Joint nociception was assessed by von Frey hair algesiometry, dynamic weight bearing, and in vivo single unit extracellular recordings from knee joint mechanonociceptors. Compared to white light, GLT significantly reduced secondary mechanical hypersensitivity in both sexes and improved hindlimb weight bearing in females only. There was no effect of GLT on joint nociceptor activity in either sex. Serum lipidomics indicated an increase in circulating analgesic endolipids in response to GLT, particularly the N-acyl-glycines. Partial blockade of the endocannabinoid system with the G protein receptor-18/cannabinoid-1 receptor antagonist AM281 (500 μg/kg i.p.) attenuated GLT-induced analgesia. These data show for the first time that GLT acts to reduce OA pain by upregulating circulating analgesic endolipids, which then engage the endocannabinoid system.

Effectiveness of Ultrasound In Tennis Elbow Patients: Literature Review

Lateral Epicondylitis, commonly known as Tennis Elbow, is caused by tension in the common extensor tendon, particularly at the origin of the extensor carpi radialis brevis tendon. This condition leads to pain and reduced hand grip strength, as well as impaired elbow function. This study aims to evaluate the effectiveness of Ultrasound therapy in managing pain, improving grip strength, and enhancing elbow functionality in patients diagnosed with Tennis Elbow. The method employed is a systematic literature review, analyzing relevant studies from various scientific databases. The results show that ultrasound therapy, applied consistently over several weeks, significantly reduces pain levels, improves hand grip strength, and enhances the functional movement of the elbow. The effectiveness of ultrasound treatment is supported by the statistical significance of p&lt;0.01, indicating a strong reduction in pain and improvements in physical function. The findings suggest that Ultrasound therapy is an effective, non-invasive modality for treating Tennis Elbow, offering substantial improvements in patient recovery.

Effect of Kangfuxin liquid combined with triamcinolone acetonide in oral submucosal fibrous degeneration

Purpose: To investigate the effect of Kangfuxin liquid combined with triamcinolone acetonide in the treatment of oral submucous fibrous degeneration. Methods: A total of 140 patients with oral submucosal fibrous degeneration admitted to the outpatient clinic of Haiyan County Stomatological Hospital, China from June 2020 to June 2023 were divided equally into study and control groups. The study group received Kangfuxin liquid in addition to 1 mL triamcinolone acetonide (40 mg/mL) while the control group received 1 mL triamcinolone acetonide; therapeutic effects were compared after 4 weeks of treatment. Visual analogue scale (VAS) score, serum transforming growth factor (TGF-β1), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels were determined. Also, whole blood viscosity (WBV), plasma viscosity (PV), erythrocyte sedimentation rate (ESR), and incidence of adverse reactions were evaluated. Result: The study group showed significantly reduced pain levels compared to the control group, as well as lower mucosal damage areas and improved mouth opening after 4 weeks of treatment compared to control group (p &lt; 0.05). Also, the study group showed significantly lower TGF-β1, TNF-α and IL-6 compared to control group after treatment (p &lt; 0.05). It showed significantly lower WBV, PV, and ESR compared to control group (p &lt; 0.05). Furthermore, the study group showed significantly lower incidence of adverse reactions than the control group (p &lt; 0.05). Conclusion: Kangfuxin liquid, when combined with triamcinolone acetonide, lowers pain, reduces the levels of STGF-β1, improves hemorheology, and produces minimal adverse effects compared to triamcinolone alone. Future studies should focus on long-term outcomes to better assess the therapeutic potential of this combined regimen.

A meta-analysis of ultrasound-guided stellate ganglion block on the quality of recovery after cancer surgery.

Pain is a prevalent symptom among patients with cancer, significantly impacting their health and quality of life. Stellate ganglion block (SGB) has been employed as a diagnostic, prognostic, or therapeutic intervention for various pain syndromes. This systematic review and meta-analysis aimed to examine the effects of ultrasound-guided SGB on postoperative recovery quality and other functional indicators following cancer surgery. Data were sourced from PubMed, PEDro, CINAHL, SportDiscus, and Scopus. Inclusion criteria followed the population-intervention-comparison-outcome principle. The evaluation process involved meticulous screening, judicious data extraction, and rigorous assessment of trial methodology quality, conducted independently by 2 researchers. Standardized mean differences with corresponding 95% confidence intervals were pooled using either a random-effects or fixed-effects model. Ultrasound-guided SGB exhibited potential for improving postoperative pain scores after cancer surgery (RR, 7.81 [95% confidence interval (CI), 5.43-10.19]), reducing daily consumption of oxycodone (RR, 0.78 [95% CI, -1.37 to 2.93]) and pregabalin (RR, -22.26 [95% CI, -91.37 to 46.85]), enhancing physical health (RR, -2.50 [95% CI, -11.00 to 6.00]) and mental health (RR, -5.10 [95% CI, -13.45 to 3.25]), and influencing mean arterial pressure (RR, -10.60 [95% CI, -17.92 to -3.27]), mean pulmonary artery pressure (RR, -1.02 [95% CI, -2.83 to 0.79]), heart rate (RR, -11.18 [95% CI, -17.91 to -4.46]), and central venous pressure (RR, -0.05 [95% CI, -1.53 to 1.43]) as effective treatment modalities. This systematic review and meta-analysis suggests that ultrasound-guided SGB therapy is effective in reducing pain levels and improving mobility and quality of life compared to conventional treatments. Therefore, clinicians should consider administering SGBs to patients with chronic cancer pain, emphasizing sensory exercise to achieve a balance between movement and rest.

Effect of Hyaluronic Acid on Socket Healing After Lower Impacted Third Molar Tooth Extraction in 40 Dental Patients.

BACKGROUND Surgical extraction of impacted mandibular third molars is the most commonly performed procedure in oral surgery; its associated complications include sensory nerve damage, swelling, and trismus. This study aimed to evaluate the effects of hyaluronic acid (HA) on healing of the socket following extraction of the lower impacted third molar tooth in 40 dental patients. MATERIAL AND METHODS This prospective, double-blind, randomized, controlled study was carried out on 40 adult healthy patients indicated for surgical removal of bilateral impacted mandibular third molars with equal surgical difficulty (moderate surgical difficulty according to the Koerner index. Patients with right mandibular third molars were included into the study (HA) group and those with left mandibular third molars were included into the control group. Surgical removal of impacted teeth was performed at different times for each patient for proper measurement of postoperative clinical variables, including pain, swelling, and mouth opening. RESULTS Postoperative pain evaluation results using the visual analog scale (VAS) showed reduced pain levels at all observation periods. Postoperative swelling peaked in intensity within 12-48 hours, resolving between the 5th and 7th days, and there was no significant difference in pre- and postoperative measurements of interincisal opening between both groups (P>0.05). CONCLUSIONS We found that intra-socket application of hyaluronic acid after surgical extraction of impacted mandibular third molars promoted normal wound healing, and there was a clinical benefit of reduced postoperative pain and swelling.

Efficacy of a Religious-Based Slow Deep Breathing Technique in Reducing Postoperative Pain: A Quasi-Experimental Study

Non-pharmacological methods offer a noninvasive solution for postoperative pain reduction, enhancing patient quality of life, and expediting recovery post-surgery. The aim of this study was to analyze differences in pain scale reduction in postoperative patients after administering slow deep breathing distraction-relaxation techniques with a religious approach. The design was experimental with pre- and post-tests by providing treatment to respondents using slow deep breathing exercises with a religious approach (the activity related to relaxation using sentences and special treatment explained in the data collection section) to postoperative patients. Pain scale scores ranged from 0 to 10. The total number of participants was 60 (laparotomy, mastectomy, or fracture surgery). A dependent t-test was used to analyse data . The pain scale score for patients after slow deep breathing surgery with a religious approach ranged from 4 to 10 on a numerical rating scale. The average reduction in pain scale score for patients after slow deep breathing surgery with a religious approach was 2.17 with a standard deviation of 0.994. The results of the statistical tests with the dependent t-test obtained a p-value of 0.000. This shows a significant reduction in pain levels among postoperative patients who perform slow deep breathing exercises with a religious approach. These findings suggest that this method is an effective and accessible way to manage postoperative pain. In conclusion, slow deep breathing with a religious approach is effective in reducing postoperative pain

Surgical Applications for Bone Marrow Aspirate Concentrate

Bone marrow aspirate concentrate (BMAC) is an autologous orthobiologic agent that may be of benefit in specific surgical scenarios. Composed of elements isolated from bone marrow, including mesenchymal stromal cells, bone marrow–derived platelets, red and white blood cells, and hematopoietic precursors, BMAC has gained appeal for its potential to slow the progression of chondral degeneration, improve function, and provide symptomatic relief. BMAC is typically prepared during the final stages of a surgical procedure, beginning with bone marrow aspirate harvested from the iliac crest, distal femur, body of the ilium, or proximal humerus and then centrifuged to yield concentrated marrow cells. In a published technique for BMAC use in arthroscopic acetabular labral repair, 120 mL of BMA is harvested from the body of the ilium and then centrifuged to yield approximately 4 to 6 mL of BMAC. The biologic activity of BMAC is 2-fold: (1) mesenchymal stromal cells are pluripotent stem cells that stimulate a robust tissue response for cartilage repair through their potential to differentiate into chondrocytes that induce chondrogenesis, and (2) bone marrow–derived platelets produce growth factors, cytokines, and chemokines that promote collagen synthesis, wound healing, and suppression of proinflammatory cytokines. To date, BMAC has shown promise as an efficacious adjuvant therapy. When comparing patient outcomes, studies have found that patients receiving BMAC achieved lower rates of revision rotator cuff repair, higher functional outcome scores following arthroscopic acetabular labral repair, and significant reductions in pain levels in the context of knee cartilage defects. These findings, however, must be interpreted with caution, as there remains a paucity of randomized controlled trials investigating the mid- and long-term efficacy of BMAC. Overall, as treatments for patients with both progressive chondral degeneration and acute orthopaedic injuries continue to evolve, BMAC serves as promising orthobiologic therapy to improve outcomes.

Pengaruh Kombinasi Neck Calliet Exercise dan Neuromuscular Taping terhadap Penurunan Nyeri Cervical Root Syndrome pada Penjahit di Sragen

Cervical root syndrome (CRS) is a clinical condition caused by compression of the nerve roots in the neck area, often experienced by workers in static positions for long periods such a tailors. CRS can cause significant pain symtomps, affecting daily activities and quality of life. This study aims to determine the effect of a combination of neck calliet exercise and Neuromuscular taping on reducing pain in suffers of cervical root syndrome among tailors in Sragen. This research uses a design quasi-exsperimental with pre-test and post-test. the research subjectsw ere 26 tailor in sragen who where selected based on inclusion and exclusion criteria. The invertion provided is a combination of neck caliet exercise and Neuromuscular taping. pain levels were measured using NRS scale before and after the intervention. Before the intervention 76.9% of respondens experienced moderate pain (NRS score 4-6). while 23.1% experienced mild pain (NRS score 1-3). After the intervention 69.2% of respondents experienced in pain to the mild category, and only 30.8% still felt moderate pain. data analysis shows a significant reduction in pain levels after being given this combination intervention.The combination of neck calliet exercise and Neuromuscular taping is effective in reducing pain in sufferers of cervical root syndrome among tailors. this intervention can be an afficient pharmacological alternative treathment for chronic neck pain.

Dry needling as adjuvant therapy for post-operative pain: a systematic review of randomized clinical trial

The prolonged post-operative pain often associated with myofascial trigger point which also contribute to reduction of range of motion (ROM). State Boards of Physical Therapy defined dry needling as an ‘intramuscular procedure involving the isolated treatment of myofascial (muscle) trigger point. The purpose of this systematic review was to determine if the addition dry needling to a rehabilitation protocol is more effective in reducing pain levels and improving prognosis of the post-operative patient of extremity when compared to a rehabilitation protocol alone based on current study evidence. Three electronic databases were used; PubMed, Cochrane Library, and ProQuest. Studies included were randomized clinical studies that written in English and published from last 10 years (2014). Post operative patient, any type of extremity surgery, any sex, any age, getting rehabilitation procedure with or without dry needling. Data collection was conducted using standard agreed form by two independent reviewers. The risk of bias and quality were assessed using Revised Cochrane risk-of-bias tool for randomized trials (RoB2). Three studies were selected for this systematic review, include total of 103 patients. Two of selected studies had some concern, and one study were deemed to have high risk of bias. Overall both group shown reduced pain levels, and improvement of other criteria (ROM, functionality, activity of daily living) over time, with dry needling on top of rehabilitation protocol have advantage in prognosis of the patient. Looking at the data collected, although there is still a lot of bias in this review. Even though there was no evidence of superiority in reducing the pain level, we support dry needling as the adjuvant therapy for post-operative pain (extremity surgery) alongside with physical therapy rehabilitation protocol because the procedure has better prognosis than physical therapy rehabilitation protocol alone (ROM, functionality, activity of daily living).

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

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

Pengaruh Effleurage Massage dan Teknik Relaksasi Nafas dalam terhadap Nyeri Punggung Bawah Ibu Hamil Trimester III

Lower back pain is a common complaint among pregnant women in the third trimester. It is estimated that approximately 70% of pregnant women experience some form of back pain during pregnancy, childbirth, or postpartum. Non-pharmacological therapies such as deep breathing relaxation techniques and effleurage massage therapy can effectively reduce pain levels in these women. This study employs a quantitative approach using a quasi-experimental research method and employs purposive sampling with a sample size of 37 participants. Data analysis includes both univariate and bivariate analyses. Most respondents (64.9%) were aged between 20 and 35 years old. Additionally, the majority (64.9%) were experiencing their first pregnancy. All respondents (100%) were confirmed to have no comorbidities. Furthermore, 73% of the participants had tertiary education (Diploma, Bachelor's, Master's, or Doctorate degrees), and 62.2% continued working during pregnancy. The results of the Wilcoxon test indicated a significant effect (p = 0.000 &lt; 0.05), confirming that effleurage massage and deep breathing relaxation techniques effectively reduce lower back pain in pregnant women. This reduction is attributed to the stimulation of tactile fibers in the skin by effleurage massage, which inhibits pain signals. In conclusion, the findings suggest that implementing effleurage massage and deep breathing relaxation techniques is beneficial for alleviating lower back pain in pregnant women. Public health advice advocates for the application of these techniques to manage such pain effectively.

PENGARUH TEKNIK RELAKSASI PERNAFASAN TERHADAP PENURUNAN NYERI PADA PASIEN PASCA OPERASI FRAKTUR

Introduction:Pain management is one of the methods used in the health field to deal with the pain experienced by patients. Relaxation techniques are a non-drug alternative in pain management strategies. The aim of the research was to determine the effect of deep breathing relaxation techniques on reducing pain levels in post-operative fracture patients. The research design uses a quasi-experiment with a one group pretest-posttest design. The population in this study was 36 patients and the research sample consisted of 18 respondents using an accidental sampling technique according to the inclusion criteria for post-operative fracture patients. The variables in this study were deep breathing relaxation and pain scores for post-fracture surgery patients. Data analysis used the Wilcoxon statistical test with a significant value of p&lt;0.05. The results of the Wilcoxon statistical test analysis of the attitude variable showed p = 0.001, so H1 was accepted. : research shows that before being given deep breathing relaxation therapy 9 (50%) respondents had severe pain scores and after being given deep breathing therapy the majority of 15 (83%) respondents had moderate pain scores. There is an influence of deep breathing relaxation techniques on reducing pain levels in post-operative fracture patient

Double Mini TightRope Suture Suspensionplasty with FCR to APL Imbrication for Thumb Basilar Joint Arthritis: Intermediate Outcomes

Abstract Background We sought to evaluate the intermediate term outcomes of trapeziectomy with double Mini TightRope suture suspensionplasty and flexor carpi radialis to abductor pollicis longus imbrication for the treatment of basilar thumb joint arthritis. Case Description We performed a retrospective review of patients from 2012 to 2021 at a single institution within a standardized protocol. Thirty-nine patients (46 thumbs) with a mean age of 61 years and clinical follow-up of 2.8 years met our inclusion criteria. Grip strength increased from 13.8 kg preoperatively to 20.3 kg postoperatively. Appositional pinch strength increased from 3.7 to 5.7 kg, while oppositional pinch strength also increased from 2.8 to 4.4 kg. Trapezial space ratio was well maintained at 0.36 postoperatively compared with 0.46 preoperatively at a mean radiographic follow-up of 2.2 years. Literature Review and Clinical Relevance Results from our series demonstrate predictable outcomes with reduced pain levels, increased grip and pinch strengths, improved function, and preserved range of motion with few complications. Level of Evidence III therapeutic. Trial Registration Not applicable.

The effects of conventional treatment in addition to Pilates on biopsychosocial status in chronic neck pain: A randomized clinical trial.

Although guidelines and systematic reviews recommend the use of exercise in the treatment of chronic pain and neck pain, there are no clear recommendations for conservative treatments frequently used in clinics. The effect of supporting clinical Pilates exercises with passive physiotherapy methods on biopsychosocial status is still unknown. The objective was to investigate the effects of conventional treatment (CT) in addition to clinical Pilates on pain levels, physical condition, functional status, and psychosocial status in individuals with chronic neck pain. Fifty women were randomly divided into 2groups, the clinical Pilates group (Pilates, n= 25), and the group receiving CT in addition to clinical Pilates (Pilates-CT, n= 25). Both groups received treatment 3days a week for 6weeks. The CT program involved the implementation of hot pack (HP) application, Transcutaneous Electrical Nerve Stimulation (TENS), and therapeutic ultrasound (US) to the cervical area. CT in addition to Pilates was more effective in reducing the Visual Analog Scale (at rest and during activity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, NeckPix Scale, Hospital Anxiety and Depression Scale-depression, and Cognitive Exercise Therapy Approach-Biopsychosocial questionnaire scores (p< 0.05) and in increasing the degree of change in the extension range of motion (ROM) and cervical flexor endurance values and scores in the energy parameter of Short Form-36 (p< 0.05). CT provided in addition to Pilates was more effective in reducing pain levels, disability, fear of movement, depression levels, and negative biopsychosocial status and improving extension ROM and cervical flexor endurance, neck awareness, and the energy/vitality parameter of quality of life in individuals with chronic neck pain.

Senam Birth Ball dalam Mengatasi Nyeri pada Persalinan Kala I

Physiologically, pain is generally felt by all mothers who face the birth process. Pain arises due to uterine contractions which are useful for opening the cervix. However, intense pain can disturb comfort and can affect psychological conditions. As many as 46% of primigravida mothers experienced severe pain, 64% experienced mild to moderate pain. In multigravida mothers, 37% experienced severe pain and 63% experienced moderate and mild pain. One way to overcome severe pain in the first stage is birth ball exercises. The aim of the research was to determine the effect of using a birth ball on first stage labor pain. The design of this research was a quasi-experimental one group with control group. The population in this study were all mothers giving birth at PMB Dewi Anggraini in March-April 2024, totaling 28 respondents. The sampling technique used is total sampling. Statistical tests use the Independent Sample T Test. The average pain in the intervention group was 3.52 and the average labor pain in the control group was 5.52, meaning there was a reduction in pain levels of 2.00. The significant value was found to be p: 0.001 &lt; 0.05, meaning that there was a difference in the pain scale of the first stage of labor in the groups that used a birth ball and those that did not use a birth ball. It is hoped that health workers can improve maternal care during childbirth, one of which is by inviting mothers to use a birth ball.

Financial Performance Analysis And Stock Valuation of PT Kimia Farma Tbk.

Laparoscopic cholecystectomy is the surgical method of choice for gallbladder removal. Enhanced Recovery After Surgery (ERAS) is a program designed to accelerate patient recovery after surgery by reducing length of stay, pain, and accelerating initial mobilization. This study aims to evaluate the effectiveness of the ERAS nursing program on pain levels, initial mobilization, and length of hospitalization of post-laparoscopic cholecystectomy patients at Pluit Hospital Jakarta. A total of 65 patients undergoing laparoscopic cholecystectomy were sampled, with 40 patients in the ERAS group and 25 patients in the control group. Data were collected using questionnaires and observation sheets, and analyzed using the ANCOVA test. The results showed that the ERAS group had lower numerical scale scores for pain (1.87 vs 5.72, p &lt; 0.001), earlier mobilization (3.45 hours vs 9.12 hours, p &lt; 0.001), and shorter length of stay (27.13 hours vs 74.84 hours, p &lt; 0.001) compared to the control group. The implementation of the ERAS nursing program has proven to be effective in reducing pain levels, accelerating initial mobilization, and reducing the length of stay of patients after laparoscopic cholecystectomy at Pluit Hospital Jakarta. This study supports the use of ERAS protocol to improve the quality of surgical care in Indonesia.

O-226 Effects of preventive uterine artery occlusion during laparoscopic myomectomy on ovarian reserve markers: a randomized controlled trial

Abstract Study question Does definitive occlusion of uterine arteries have a short or long term impact on anti-Müllerian hormone (AMH) levels in reproductive age women undergoing laparoscopic myomectomy? Summary answer Preventive uterine artery occlusion during laparoscopic myomectomy does not impact AMH levels in reproductive age women. What is known already Uterine leiomyoma are the most common benign tumours in women of reproductive age. For symptomatic women willing to retain their uterus, especially for a future pregnancy, the current gold standard is the myomectomy for subserous/intramural leiomyoma. Temporary or definitive occlusion of uterine arteries can be performed to control bleeding during surgery but its impact on ovarian reserve markers is still unknown. A single randomized trial with a one-year follow-up demonstrated that temporary bilateral uterine artery occlusion during laparoscopic myomectomy slightly decreased AMH levels at day-2 after surgery but has no impact thereafter 3, 6 and 12 months postoperatively. Study design, size, duration We conducted a randomized controlled trial with a two-year follow-up evaluating the effect of definitive occlusion of uterine arteries on ovarian reserve via sequential measures of anti-Müllerian hormone (AMH) levels. Fifty-eight women with symptomatic leiomyoma type FIGO 3-6 scheduled for laparoscopic myomectomy at were included between July 2015 and October 2021. Participants/materials, setting, methods Patients were randomized into: the intervention group (laparoscopic myomectomy with preventive occlusion of uterine arteries) and the control group (laparoscopic myomectomy without occlusion of uterine arteries) ). AMH evaluated at T0 and followed at 1 month (T1), 3 months (T3), 6 months (T6), 12 months (T12) and 24 months (T24) after surgery. Intraoperative blood loss, leiomyoma recurrence and adenomyosis occurrence were also evaluated comparing pre- and post-operative findings. Finally, pregnancies and live births were monitored. Main results and the role of chance Women in both groups did not differ in their baseline characteristics in terms of age, body mass index, ethnicity, parity, wish to become pregnant, hormonal treatment, leiomyoma number and size, baseline haemoglobin levels, bleeding symptoms baseline AMH levels and antral follicular count (AFC). The mean operative time was similar in between both groups. Mean blood loss during surgery was on average 138 (±104)ml in the intervention group versus 436 (±498)ml in controls (p &amp;lt; 0.001). The difference in haemoglobin between before and after surgery was significantly higher in the control group 21.8 (±12.7)g/l compared with the intervention group 14.8 (±8.9)g/l (p = 0.02). Regarding clinical symptoms, most patients had decreased menstrual flow at the last follow-up visit (24 months) compared to baseline in both group improvement of dysmenorrhea followed the same trend with a reduction in pain levels in both groups. Risk of leiomyoma recurrence was found similar between both groups. Most importantly, AMH levels were similar between groups at all times (T1, T3, T6, T12 and T24) and non-inferiority of preventive occlusion was demonstrated with a non-inferiority margin of -3.5pmol/L (0.5 ng/ml). The pregnancy rate was not different between groups. Limitations, reasons for caution Our sample size was calculated to detect a clinically relevant difference of at least two-third of the standard deviation in AMH levels, but we cannot exclude a smaller impact on AMH with a different sample size. Wider implications of the findings Preventive uterine artery occlusion during laparoscopic myomectomy does not impact ovarian reserve markers and can be safely used to control perioperative bleeding. Trial registration number NCT02563392

Surgical Management of Painful Digital Neuroma: A Systematic Review

Abstract Background Neuromas of the digits can be a mentally and physically disabling condition for patients in this systematic review, the authors discuss a variety of surgical techniques for digital neuroma management. Aim of the Work This systematic review aims to analyze and combine the results of relevant studies on surgical treatment for digital neuroma. It aims to determine the overall success of the surgical procedure and identify which techniques are more effective. Patients and Methods Four databases, including Embase, Scopus, PubMed, and Google Scholar, were searched for relevant studies. The search spans the years 1990 to 2022. Out of 1490 initial studies, 672 remained after removing duplicates. After screening the Abstracts, 647 were excluded for various reasons, leaving 12 eligible studies for inclusion in the systematic review, which included a total of 309 patients. Outcomes reporting included the visual analogue scale (VAS) to report pain, patient satisfaction, the Semmes-Weinstein Monofilament Test, The two-point discrimination test, a non-standard ordinal scale and the mean follow-up duration. Results The studies included neuroma excision, neuroma excision (and implantation into adjacent tissues), centro-central union, proximal relocation, interdigital direct neurorrhaphy, nerve allograft reconstruction, regenerative peripheral interface, dorsal transposition and epineural coaptation, collagen conduits, and muscle-in-vein conduits (MVCs).The results show that a majority of patients achieved pain relief after surgery, with high levels of satisfaction reported in some studies. The most successful surgical approach was not determined since there were no statistically significant differences between the various surgical techniques. However, neuroma excision followed by nerve repair/reconstruction (centro-central union, proximal relocation, direct neurorrhaphy, nerve allograft, regenerative peripheral interface, dorsal transposition and nerve conduit )show magnificent results compared to neuroma excision alone with or without implantation. Factors such as old age, smoking, and high PROMIS Depression scores were found to be independently associated with higher levels of pain interference. Conclusion The results suggest that surgical treatment is effective in reducing pain levels, with most patients reporting complete pain relief or improvement. Neuroma excision followed by nerve repair/reconstruction was found to result in better outcomes compared to neuroma excision alone with or without implantation.

The role of TENS therapy in reducing the incidence of post-Caesarean section wound infection.

The occurrence of wound infection following a Caesarean section procedure poses a substantial clinical obstacle. Transcutaneous Electrical Nerve Stimulation (TENS) has been identified as a promising supplementary treatment option for improving the healing process and decreasing the incidence of infections. This study assessed the efficacy of TENS therapy in the postoperative care of patients who have had Caesarean section. We randomly assigned a total of 108 women who had Caesarean sections to either a TENS group (n = 54) or control (n = 54). The TENS therapy was provided twice daily for a duration of 30 min for the period of 14 days following the surgery. The main measure of interest in this study was the occurrence of wound infection during 30-day period. Additionally, secondary measures included the rate of wound healing, levels of pain experienced and level of patient satisfaction. In comparison to the control (22.2%, p < 0.05), the TENS group had notably reduced occurrence of wound infection, with the rate of 7.4%. TENS group had superior wound healing results, as measured by REEDA scale, at 7 days (2.1 ± 0.8 vs. 2.5 ± 1.0, p < 0.04), 14 days (1.2 ± 0.5 vs. 1.9 ± 0.7, p < 0.05) and 30 days (0.3 ± 0.5 vs. 0.7 ± 0.6, p < 0.05). Furthermore, TENS group had reduced pain levels on the Visual Analog Scale (VAS) at all evaluation intervals (p < 0.05). TENS group exhibited significantly higher levels of patient satisfaction, as evidenced by 64.8% of participants rating high satisfaction, in contrast to 40.7% in the control group (p < 0.05). The incidence of adverse effects was found to be minor, as indicated by a skin irritation rate of 3.7% and reported discomfort rate of 1.9% at the electrode location. TENS therapy effectively decreased the occurrence of post-Caesarean wound infections, expedited the healing process and enhanced pain control. This treatment was well-received by patients and had little negative consequences. The aforementioned results provided evidence in favour of incorporating TENS into post-Caesarean care regimens, which may have significant consequences for improving patient outcomes and maximizing healthcare resources.