Level Of Patient Discomfort Research Articles

Clinical Outcomes of Endonasal Dacryocystorhinostomy Using Fibrin Glue for Lacrimal Sac and Nasal Mucosal Flaps

Purpose: To assess the clinical outcomes of fibrin glue in endonasal dacryocystorhinostomy (DCR) for patients with primary nasolacrimal duct obstruction and to compare the surgical success rates between groups with the lacrimal sac flap using fibrin glue and without flap formation.Methods: In this prospective study, a total of 45 patients (63 eyes) underwent endonasal DCR. Fibrin glue was applied to the mucosal flap at the osteotomy site in the nasal cavity. The subjects were divided into two groups: group 1 (with lacrimal sac flap using fibrin glue), consisting of 20 patients (28 eyes), and group 2 (without flap), including 25 patients (35 eyes). To evaluate the two groups, subjective symptoms were asked to the patients, and endoscopic examinations were performed.Results: There were no statistically significant differences observed in terms of age, sex, timing of tube removal, or follow-up period between the groups. Group 1 showed significantly better results compared to the control group in terms of the degree of granuloma observed at 6 months postoperatively and the level of patient discomfort reported at 3 months postoperatively.Conclusions: Endonasal DCR with the lacrimal sac flap using fibrin glue achieves higher functional success, reduces patient discomfort at 3 months postoperatively, reduces granuloma formation at 6 months postoperatively, and improves membranous closure compared to flapless surgery.

Virtual reality tools for training in gastrointestinal endoscopy: A systematic review

BACKGROUND Virtual reality (VR) has emerged as an innovative technology in endoscopy training, providing a simulated environment that closely resembles real-life scenarios and offering trainees a valuable platform to acquire and enhance their endoscopic skills. This systematic review will critically evaluate the effectiveness and feasibility of VR-based training compared to traditional methods. AIM To evaluate the effectiveness and feasibility of VR-based training compared to traditional methods. By examining the current state of the field, this review seeks to identify gaps, challenges, and opportunities for further research and implementation of VR in endoscopic training. METHODS The study is a systematic review, following the guidelines for reporting systematic reviews set out by the PRISMA statement. A comprehensive search command was designed and implemented and run in September 2023 to identify relevant studies available, from electronic databases such as PubMed, Scopus, Cochrane, and Google Scholar. The results were systematically reviewed. RESULTS Sixteen articles were included in the final analysis. The total number of participants was 523. Five studies focused on both upper endoscopy and colonoscopy training, two on upper endoscopy training only, eight on colonoscopy training only, and one on sigmoidoscopy training only. Gastrointestinal Mentor virtual endoscopy simulator was commonly used. Fifteen reported positive results, indicating that VR-based training was feasible and acceptable for endoscopy learners. VR technology helped the trainees enhance their skills in manipulating the endoscope, reducing the procedure time or increasing the technical accuracy, in VR scenarios and real patients. Some studies show that the patient discomfort level decreased significantly. However, some studies show there were no significant differences in patient discomfort and pain scores between VR group and other groups. CONCLUSION VR training is effective for endoscopy training. There are several well-designed randomized controlled trials with large sample sizes, proving the potential of this innovative tool. Thus, VR should be more widely adopted in endoscopy training. Furthermore, combining VR training with conventional methods could be a promising approach that should be implemented in training.

The effect of a live music therapy intervention on critically ill paediatric patients in the intensive care unit: A quasi-experimental pretest–posttest study

BackgroundMusic therapy as a nonpharmacological means of managing patient pain, anxiety, and discomfort is a recognised technique, although it is not widely used in the paediatric intensive care unit (PICU). AimThe aim of this study was to assess the clinical effect of a live music therapy intervention on vital signs and levels of discomfort and pain for paediatric patients in the PICU. MethodsThis was a quasi-experimental pretest–posttest study. The music therapy intervention was carried out by two music therapists who were specifically trained, each possessing a master's degree in the field of hospital music therapy. Ten minutes before the start of the music therapy session, the investigators recorded the vital signs of the patients and assessed their levels of discomfort and pain. The procedure was repeated at the start of the intervention; at 2, 5, and 10 min during the intervention; and at 10 min following the conclusion of the intervention. ResultsTwo hundred fifty-nine patients were included; 55.2% were male, with a median age of 1 year (0–21). A total of 96 (37.1%) patients suffered a chronic illness. The main reason for PICU admission was respiratory illness, at 50.2% (n = 130). Significantly lower values were observed for heart rate (p = 0.002), breathing rate (p < 0.001), and degree of discomfort (p < 0.001) during the music therapy session. ConclusionsLive music therapy results in reduced heart rates, breathing rates, and paediatric patient discomfort levels. Although music therapy is not widely used in the PICU, our results suggest that using interventions such as that used in this study could help reduce patient discomfort.

32631 Survey-based study to understand HS patient experiences and perceptions about I&D procedures

Incision and drainage (I&D) procedures are frequently used to manage acutely painful abscesses in patients with hidradenitis suppurativa (HS). While previous literature shows that I&D results in high recurrence rates, the benefits, drawbacks, and various approaches to the procedure have not been well-characterized. Similarly, patient perceptions about I&D procedures have not been well-characterized. We sought to characterize patient perceptions and experiences with I&D procedures. We investigated aspects of the procedure and associated wound care that are linked to negative patient perceptions. We created an IRB-approved survey instrument to better characterize experiences with I&D procedures in HS patients, ages 7–99. Surveys were distributed online to HS support group moderators, who delegated surveys to eligible group members. No identifiable information was collected. A total of 110 participants with HS reported at least one I&D. Demographic data collected include age (41 ± 11), race (74% white), and average number of procedures per participant (12). The most common locations for I&D were groin (27%) and axillae (24%). Procedures were performed by a wide range of specialists. Many patients found I&D to be helpful for improving symptoms but found the procedures very painful and highly dread future I&D. Recurrence was common, though nearly 25% of lesions fully resolved with treatment. Notably, wound packing was frequent despite RCT data for nonHS abscesses demonstrating that wound packing is unlikely to be beneficial and adds to patient discomfort. Ongoing analysis will look for associations between level of patient discomfort and other aspects of the procedure and wound care.

Evaluation of Caries Removal Efficacy Using BRIX 3000 and Atraumatic Restorative Treatment in Primary Molars: A Clinical Comparative Study

The aim of the present study was to compare and evaluate the efficacy of two minimally invasive methods in the removal of infected carious dentin in primary molars. Eighty primary molars with class I occlusal caries involving dentin were selected and allocated to either of the two groups using convenient sampling. Group A (n = 40) caries were excavated using BRIX 3000 and in Group B (n = 40) atraumatic restorative treatment (ART) caries were excavated using hand instruments only. In both groups, caries removal efficacy was evaluated clinically using caries detection dye (Sable and Sleek), and the patient's discomfort level was noted using the Wong-Baker faces pain rating scale (WBFPS). The results indicated that BRIX 3000 was effective in the removal of caries from primary molars with a significant difference. While there was no statistically significant difference seen in pain perception on caries excavation using both the methods. Although, a mild discomfort was noted in Group B. Comparing the two minimally invasive techniques, the new chemomechanical solution (BRIX 3000) was an effective method for the removal of caries from primary molars. So, it can be considered an alternative to the conventional caries removal method in treating pediatric dental patients. BRIX 3000 gel is effective in the removal of caries in children who are anxious and apprehensive as it is a noninvasive method of treatment in the pediatric age group.

Effect of Intravenous Fentanyl to Prevent Radial Artery Spasm During Trans Radial Intervention

Background: Radial artery spasm (RAS), one of the commonest complications in trans radial cardiac intervention, leads a variety range of adverse events. Different prevention strategies had been introduced and the use of sedation is one of them. Use of Fentanyl is common in cardiac interventions to achieve sedation and analgesia and also offers a potent vasodilatory effect. Objective: This study aimed to explore the role of fentanyl in the prevention of RAS in trans radial intervention.&#x0D; Methods: This observational analytic study was conducted in National Institute of Cardiovascular Diseases (NICVD) for a period of 1 year following approval of the protocol in the total of 260 patients who underwent coronary intervention through trans radial approach (Coronary Angiogram and or Percutaneous Coronary Intervention). They were categorized in 2 group- group I patients received intravenous fentanyl and group II patients didn’t receive fentanyl. Besides this, each patient received all treatments according to standard protocol of NICVD. RAS was identified by subjective and objective evidence. Patient is discomfort was quantified with a visual analogue scale.&#x0D; Results: The frequency of RAS was 17.70% in group I versus 30.80% in group II (p =0.014). Intravenous use of fentanyl significantly reduced radial artery spasm (p&lt; 0.05). Bivariate logistic regression analysis showed use of fentanyl had lower odds to prevent radial artery spasm (odds ratio [OR]: 0.430, 95% confidence interval [CI]: 0.239 to 0.779). The number needed to treat to avoid 1 case of spasm was 8. Multivariate logistic regression analysis also revealed use of fentanyl was the strong predictor of RAS ([OR]: 0.370; 95% [CI]: .195-.703) as well as use of reprocessed sheath, smoking, catheter diameter 6Fr and visual analogue scale (VAS) Score during cannulation became independent predictaor of RAS. Patient discomfort in VAS score was 4.75±2.70 in Group I versus 5.33±2.64 in group II (p&lt; 0 .05).&#x0D; Conclusion: In this study, use of fentanyl reduced the frequency of radial artery spasm and the procedure related level of patient discomfort.&#x0D; University Heart Journal 2022; 18(1): 54-60

Oral Cutaneous Fistula, Therapeutic Challenge: Case Report

ABSTRACT: Oral Cutaneous fistula often leads to intensive level of patient discomfort and suffering. Due to its rarity and absence of dental symptoms considerable number of patients are usually misdiagnosed with results of inappropriate management. This case report represents two clinical cases of age 21yr and 26 yr with similar history of non healing persistent discharging lesion on right side of maxilla which was unpleasing from last 2 years, After clinical and radiographic analysis two different therapeutic modalities in two different patients with similar kind of history was used to treat oral cutaneous fistula, both treatment results in satisfactory outcome.

Patient discomfort levels during instrumentation procedure using nickel-titanium files with different kinetic movements.

This study evaluated the perceived vibration, noise and discomfort levels associated with two nickel-titanium file systems with different kinetics; reciprocating motion (REC) using WaveOne Gold and continuous rotation motion (CON) using ProTaper NEXT. Forty roots with two canals from maxillary premolar and molar of 40 patients were included. Root canals were instrumented using each system for each canal. Patients were surveyed about the vibration, noise and discomfort experienced using visual analogue scale, and their preference. The responses were statistically analysed using Wilcoxon Signed-Rank test, Mann-Whitney U test and Spearman's rank correlation test at the 95% of significance level. The vibration, noise and discomfort experienced were significantly greater in REC than CON (P < 0.05). In REC, male subjects reported significantly higher vibration than female (P < 0.05). Majority respondents (72.5%) preferred the CON method. The perceived vibration, noise and discomfort were less apparent from the CON than the REC.

EP.TH.447Simultaneous repair of bilateral Inguinal hernia under Local Anaesthetic - is it feasible?

Abstract Introduction Local Anaesthetic repair of unilateral Inguinal hernia is well reported in the literature, as a safe, well tolerated and effective operation. However, there is not much literature on simultaneous repair of bilateral inguinal hernias under local anaesthetic. We are reporting our experience with simultaneous repair of bilateral inguinal hernias under local anaesthetic. Methods We did a retrospective analysis of prospectively collected data of patients, who had bilateral inguinal hernia repaired under local anaesthetic over a period of 2009 - 2019, looking at the patient demographics, patient reported pain score, operating time, volume of local anaesthetic used, patient satisfaction and complication rates.All the patients had Lichtenstein's hernioplasty. The LA mixture was made up of 30ml 0.5% Bupivacaine with adrenaline, 20 ml 2% Lignocaine with adrenaline, 50 ml of 0.9% Saline and 6 ml of 8.6% Sodium Bicarbonate. All these surgeries were performed on a day case basis. Results There were 24 patients, who underwent local anaesthetic repair of bilateral inguinal hernias, 22 Males and 2 Females. Age range was 35 - 81 years. The BMI varied from 18 - 30, with a mean of 24. The average operating time was 66.8 minutes (38 - 120 minutes, median 60 min). The mean pain score was 24, on a 0-100 scale. Patient satisfaction scores varied from 50-100 (Median 90, Mean 88.1) Conclusion We conclude that successful simultaneous repair of bilateral inguinal hernia under local anaesthetic is feasible, with a low level of patient discomfort, high satisfaction rate and using safe quantities of local anaesthetic

668 Fixation of Split-Thickness Skin Grafts with Liquid Adhesive and Fibrin Glue in Place of Staples

Abstract Introduction A critical component of split-thickness skin grafting is the fixation of the skin graft to the wound site. Graft displacement can result in graft failure, especially during the initial 48–72 hours following application. The most common method of securing grafts is with the use of staples, sometimes with the addition of fibrin glue in order to aid both graft adhesion and homeostasis. The use of staples, however, is associated with significant levels of patient discomfort, especially during staple removal. A possible alternative to staples is the use of liquid adhesives, in combination with steri-strips, to anchor the edges of skin grafts to intact skin. Certain liquid adhesives, such as gum-based resins, are cheaper to use than staples and offer the potential to secure small split-thickness skin grafts without the associated pain of staples. In this pilot study, we examined the effectiveness of using a combination of gum-based resin (Gum Mastic-Storax-Msal-Alcohol), fibrin glue, and steri-strips to secure partial-thickness grafts in 8 patients without the use of staples or sutures. Methods Patients were included in the study who required split-thickness skin grafts to treat wounds involving less than or equal to 15% total surface body area and whose wounds were not located in areas prone to graft displacement, such as the axilla and groin. For each patient, skin grafts were secured using fibrin glue (sprayed over the entire wound), and a combination of liquid adhesive and steri-strips applied around the wound perimeter. The success of each graft was determined by the percentage of graft take. Results From January 1st, 2020 to April 30th, 2020, 8 patients were identified who fit the inclusion criteria. Five of the patients received grafts to their lower extremities, two patients received grafts to their upper extremities, and one of the patients received a graft to the torso. The average wound site that was grafted was 116.7 cm2. Average graft take among the 8 patients was 96.9%, with a range of 90%-100%. No complications at the graft site were noted, such as hematomas or any other event that resulted in graft displacement or failure. Conclusions The results of the study demonstrate that a combination of liquid adhesive, fibrin glue, and steri-strips, can be used as an effective alternative to staples in small split-thickness skin grafts. The use of liquid adhesive in place of staples was advantageous because it eliminated to need for staple removal, which resulted in less discomfort for the patient and less work for the nursing staff.

Anesthetic efficacy of single buccal infiltration of 4% articaine compared to routine inferior alveolar nerve block with 2% lidocaine during bilateral extraction of mandibular primary molars: a randomized controlled trial.

BackgroundInferior alveolar nerve block (IANB) using lidocaine 2% is commonly used for anesthetizing primary mandibular molars; however, this technique has the highest level of patient discomfort compared to other local anesthesia techniques. Therefore, alternative anesthesia techniques are necessary. The aim of this study was to evaluate the efficacy of a single buccal infiltration of 4% articaine with IANB using 2% lidocaine, for the bilateral extraction of primary mandibular molars.MethodsThe present study was conducted on 30 patients aged between 6 and 9 years, who required the extraction of bilateral primary mandibular molars. The patients were randomly divided into two groups as follows: In the first session, Group A received IANB with lidocaine 2% and group B received infiltration with articaine 4%. In the second session, another injection method was performed on the opposite side. The Wong-Baker Facial Pain scale (WBFPS), Face Leg Activity Cry, and Consolability (FLACC), and physiologic parameters were used to assess pain perception.ResultsThe independent t-test showed no statistically significant difference in blood pressure and heart rate before and after extraction (P > 0.05). The mean FLACC index in the lidocaine and articaine groups was 0.89 and 1.36, respectively; there was no statistically significant difference between them (P > 0.05). According to the results of the chi-square test, there was no statistically significant difference between the groups for WBFPS (P > 0.05).ConclusionThe articaine infiltration technique may be an alternative to the IANB for the extraction of primary mandibular molars.

Electromagnetic-guided versus endoscopic placement of post-pyloric feeding tubes: a systematic review and meta-analysis of randomised controlled trials

BackgroundCurrent evidence supporting the utility of electromagnetic (EM)-guided method as the preferred technique for post-pyloric feeding tube placement is limited. We conducted a meta-analysis to compare the performance of EM-guided versus endoscopic placement.MethodsWe searched several databases for all randomised controlled trials evaluating the EM-guided vs. endoscopic placement of post-pyloric feeding tubes up to 28 July 2020. Primary outcome was procedure success rate. Secondary outcomes included reinsertion rate, number of attempts, placement-related complications, tube-related complications, insertion time, total procedure time, patient discomfort, recommendation scores, length of hospital stay, mortality, and total costs.ResultsFour trials involving 536 patients were qualified for the final analysis. There was no difference between the two groups in procedure success rate (RR 0.97; 95% CI 0.91–1.03), reinsertion rate (RR 0.84; 95% CI 0.59–1.20), number of attempts (WMD − 0.23; 95% CI − 0.99–0.53), placement-related complications (RR 0.78; 95% CI 0.41–1.49), tube-related complications (RR 1.08; 95% CI 0.82–1.44), total procedure time (WMD − 18.09 min; 95% CI − 38.66–2.47), length of hospital stay (WMD 1.57 days; 95% CI − 0.33–3.47), ICU mortality (RR 0.80; 95% CI 0.50–1.29), in-hospital mortality (RR 0.87; 95% CI 0.59–1.28), and total costs (SMD − 1.80; 95% CI − 3.96–0.36). The EM group was associated with longer insertion time (WMD 4.3 min; 95% CI 0.2–8.39), higher patient discomfort level (WMD 1.28; 95% CI 0.46–2.1), and higher recommendation scores (WMD 1.67; 95% CI 0.24–3.10).ConclusionsNo significant difference was found between the two groups in efficacy, safety, and costs. Further studies are needed to confirm our findings.Systematic review registrationPROSPERO (CRD42020172427)

Late implant placement following ridge preservation versus early implant placement: A pilot randomized clinical trial for periodontally compromised non-molar extraction sites.

To compare late implant placement following alveolar ridge preservation (LP/ARP) and early implantation (EP) in periodontally compromised non-molar extraction sites with respect to soft tissue levels, aesthetics, and patient-reported outcomes. Sixteen patients were randomly allocated to groups LP/ARP (n=9) or EP (n=7). Group LP/ARP received ARP using deproteinized bovine bone mineral containing 10% collagen and a native bilayer collagen membrane, and group EP received only extraction. Implant placement was performed 4-8weeks post-extraction in group EP and 4months post-alveolar ridge preservation in group LP/ARP. The soft tissue levels, pink/white esthetic scores, and periodontal parameters were evaluated at 1 year post-loading. Patient's discomfort level was evaluated in terms of extraction/ARP and implant placement. No implant failure or biologic complications occurred. There was no statistically significant difference in the median change of the midfacial mucosal margin (0.03 for group LP/ARP, -0.19mm for group EP) and the mesial/distal papilla (0.62/0.25mm for group LP/ARP, 0.29/-0.5mm for group EP), pink/white esthetic scores, periodontal parameters, and patient's discomfort between the two groups. Both implant placement protocols led to comparable outcomes in soft tissue levels, periodontal parameters, and patient's discomfort level.

Pre-induction checklists and discomfort in patients. An observational study.

Since the WHO release of the Safe Surgery Saves Lives Program in 2008, peri-operative checklists minimise errors and improve patient safety worldwide. Anaesthesia professionals are often reluctant to use these checklists in front of patients because they fear causing patients' discomfort before anaesthesia and surgery. To assess and compare the subjective level of patient discomfort caused by the use of pre-induction checklists with the patient discomfort estimated by anaesthesia providers. Prospective observational study. The current single-centre trial included 110 anaesthesia providers and 125 nonpremedicated ear, nose and throat or maxillofacial surgery patients in Switzerland from June to August 2016. Inclusion criterion: signed general research consent. received premedication, less than 18 years old, day-care patients, dementia or other mental illnesses. Anaesthesia healthcare providers and patients before surgery and on the first postoperative day were asked to rate three statements: MAIN OUTCOME MEASURES: All statements were rated on a 100-mm visual analogue scale, where 0 meant no agreement and 100 meant total agreement. Patients overwhelmingly agreed that anaesthesia providers should use checklists in front of them. Anaesthesia providers rated the patient discomfort much higher than actually perceived by patients. Both, patients and anaesthesia providers rated the possibility of reducing the risk of errors high. Patients experience far less discomfort observing the use of pre-induction checklists than anaesthesia providers expect. Patients value the potential safety benefit significantly higher than anaesthesia providers. These results further support the implementation of peri-operative checklists in the operating room environment. The current observational study had no intervention, therefore, was not registered.

Sciatic Nerve Block in Single Nerve Block Technique for Unilateral Foot Surgery - an Alternative to Spinal Anaesthesia

Background: In lower extremity surgeries, central neuraxial block or peripheral regional anesthesia technique can be used, mainly in elderly patients. This study investigates the efficiency of spinal anesthesia and sciatic nerve block techniques in lower extremity surgery. Spinal anesthesia may impair hemodynamic stability; peripheral nerve blocks targeting the sciatic nerve may be a useful alternative.&#x0D; Objective: To compare Unilateral Spinal Anesthesia versus Popliteal Block in patients undergoing elective foot surgery to determine the method of better outcome.&#x0D; Patients and Methods: This randomized comparative study was carried out on fifty co-operative patients of both sexes who were scheduled for elective foot surgeries. According to the used method of regional anesthesia, patients were divided into: (S) group unilateral intrathecal block with low-dose (7.5mg) of hyperbaric bupivacaine plus intrathecal fentanyl (25 mcg) and (P) group in which the sciatic nerve at the popliteal fossa was blocked via posterior approach by injecting 20ml 0.5% bupivacaine (100mg). The difficulty of the block performance, level of patient discomfort, block performance time, onset of sensory and motor blocks, time in hours to the first request for supplemental systemic analgesia postoperatively, its total consumption for 24 hours postoperatively and associated side effects were recorded in each group.&#x0D; Results: Statistically, it was found no significant differences between the demographic characteristics as well as the duration of surgery between the groups. The groups did differ significantly in the difficulty of the block performance. However, a longer duration for performing the block was observed in the P group. The level of patient discomfort was significantly lesser in the P group. The onset of complete sensory block was significantly longer in the P group. Hemodynamic profiles of our patients were found to be remarkably stable throughout the intraoperative period. In the P group, the time to first pain medication was significant longer. Moreover, the total dosage of analgesics during the first 24 hours postoperatively in group P was highly significant lesser compared to the other groups.&#x0D; Conclusion: Sciatic nerve block at the popliteal fossa is an ideal alternative where it is preferable to avoid spinal anesthesia for foot surgeries in haemodynamicaly unstable patients.&#x0D; J Bangladesh Coll Phys Surg 2019; 37(4): 181-185

PTERYGIUM;

Objectives: To compare graft stability, patient discomfort and surgical time between autologus blood and sutures for autologus conjunctival graft adherence in pterygium surgery. Study Design: Prospective interventional study. Setting: Department of Ophthalmology, Pak Red Crescent Medical and Dental College, Dina Nath. Period: January 2017 to December 2017. Materials and Methods: Fifty eyes of fifty patients requiring pterygium surgery were enrolled. The patients were divided in two groups (A and B). Under peribulbar anesthesia pterygium was excised in all patients. Bare sclera was covered with conjuctival autograft using autologus blood as adhesive agentin Group A while in Group B conjuctival autograft was fixed with 10/0 Nylon sutures. The patients were examined postoperatively on day 1, day 7, day 14 and day 30. The groups were compared in terms of surgical time, graft displacement and patient discomfort. Results: Mean surgical time was (20.96 ±2.05 minutes) in Group A and (30.04±3.38 minutes) in Group B. There was nasal displacement of conjunctival autograft in 3 (12%) of patients on 1stpost-operative day in Group A whereas no graft displacement was seen in any case of Group B. Level of patient discomfort measured on visual analogue scale in Group A was (0.56 ± 0.92 on day 1, 0.40 ± 0.71 on day 7, 0.04 ± 0.20 on day 14 and 0 ± 0 on day 30). In Group B level of patient discomfort was (3.92 ± 1.12 on day1, 1.24 ± 1.09 on day 7, 0.12 ± 0.33 on day 14 and0 ±0 on day 30). Conclusions: The use of autologus blood to affix the conjuctival autograft in pterygium surgery is a reliable method. It is associated with less patient discomfort post operatively and requires shorter surgical time, as compared to conjunctival autograft with sutures.

Buccal infiltration versus inferior alveolar nerve block in mandibular 2nd premolars with irreversible pulpitis.

The purpose of this study is to compare the success rates of inferior alveolar nerve block (IANB) and buccal infiltration anesthesia of mandibular second premolar with irreversible pulpitis and to evaluate the level of patient discomfort with these methods. Forty patients, who had irreversible pulpitis in the mandibular 2nd premolar teeth, were included in the study. Patients were randomly distributed in two groups. In one group IANB, in the other group buccal infiltration anesthesia were performed. The efficacy of these two different anesthesia techniques on the related teeth was investigated with the Heft-Parker visual analog scale. In addition, with a pulse oximetry device, the changes in the patients' heart rates were compared between the groups. The obtained data were evaluated statistically. Both anesthesia techniques reduced the pain significantly in patients before the administration (P < 0.05), but there was no significant difference among the groups regarding the pain control and success rates of anesthesia (P > 0.05). Both of the anesthesia techniques increased the heart rate (P < 0.05). The increase in the heart rate of the patients was significantly higher in the buccal infiltration anesthesia group than the other anesthesia group (P < 0.05). Within the limitation of this in vivo study, there was no difference between the efficacies of the buccal infiltration anesthesia and IANB anesthesia in the mandibular 2nd premolar teeth with irreversible pulpitis. Buccal infiltration anesthesia caused more discomfort in the patients compared with the IANB during the administration.

Efficacy of the split-thickness labial flap method for soft tissue management in anterior ridge horizontal augmentation procedures: A clinical prospective study in the anterior maxilla

ObjectiveTo introduce a novel method of split-thickness labial flap in maxillary anterior ridge horizontal augmentation and to evaluate its efficacy and morbidity. Materials and methods230 patients were selected to receive either particulate or onlay grafting. A split-thickness labial flap was applied to cover the grafted area and close the wound. The incidence of postsurgical complications and the level of patient discomfort were evaluated. A visual analog scale was used to quantify the amount of pain and swelling in the patients. ResultsIn all 375 surgical sites, passive primary closure was achieved with the split-thickness labial flap method. Membrane exposure after surgery was seen in 6 cases in the onlay group and in 4 in the particulate group. No long-lasting pain (>1 week), paresthesia, or signs of infection occurred during the follow-up period of 6 months. The mean pain and swelling scores in the particulate graft group (2.75 ± 3.01 and 2.02 ± 2.51, respectively) were lower than the scores in the onlay graft group (3.18 ± 2.79 and 3.85 ± 2.25, respectively). ConclusionsThe flap advancement technique presented in this study facilitates clinically passive primary closure. This technique can be used successfully in both particulate and onlay horizontal graft procedures.

Comparative study of steristrips and subcuticular suture for wound closure after thyroid surgery

Background: Any skin closure technique aims at opposing the skin edges precisely without tension for sufficient time to allow healing to take place. The ease and speed with which the skin closure is completed, the level of patient discomfort, the complication rate, and the final cosmetic result are the factors which has to be considered in making a comparison of different types of wound closure. This study aims at comparing steristrips and subcuticular sutures for wound closure after thyroid surgery based on assessment of post-operative pain, neck mobility and cosmetic appearance.Methods: A comparative study was carried out among 90 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 10 months. Subjects of either sex undergoing thyroidectomy will be randomized to had their wounds closed by steristrips or subcuticular sutures using a simple randomization table. Patients who underwent previous neck irradiations, secondary neck surgeries, and patients with poor compliance were excluded from the study. Descriptive statistics, unpaired t-test and chi-square test were used to analyse the results.Results: The mean age group of the study subjects was 48.6 (range 24-76) years. The gender distribution showed a higher number of females (82) as compared to males (8). 70 patients were diagnosed with multinodular goitre, 16 patients were of thyroid neoplasms and 4 were of inflammatory thyroid conditions. 12 patients underwent subtotal thyroidectomy and 78 patients underwent total thyroidectomy. Wound closure by steristrips had less post-operative pain, acceptable neck mobility and excellent scar appearance as compared to subcuticular sutures.Conclusions: The choice of materials for wound closure will depend on the surgeon's preference. However, this study does show that steristrips sutures can be removed more quickly and is more acceptable method of wound closure as compared to subcuticular sutures after thyroid surgery.

Cutaneous analgesia before transradial access for coronary intervention to prevent radial artery spasm.

Transradial access (TRA) for coronary intervention is increasingly used in current clinical practice. The aim of the present study was to evaluate the hypothesis that cutaneous analgesia before TRA for coronary intervention at a puncture site 30 minutes before puncture can reduce patient discomfort and the incidence of radial artery spasm (RAS). Patients (n=104) undergoing planned coronary interventions using TRA were prospectively randomized to receive either 1 mL of 1% lidocaine subcutaneously (n=52) (control group) or subcutaneous lidocaine plus 5% lidocaine cream (n=52) cutaneously 30 minutes before puncture (treatment group). The primary endpoint was angiographically or clinically confirmed RAS. Secondary endpoints were the occurrence of patient discomfort in the forearm during the procedure and access-site crossover to the femoral artery. Patient discomfort was quantified with a visual analogue scale (VAS) score. Fifty-two patients in the treatment group (60.5±9.4 years of age and 16 female) and 52 patients in the control group (60.4±9.7 years of age and 16 female) were included in the final analysis. Radial artery spasm occurrence decreased in the treatment group compared to the control group (26.9% vs 9.6%; p=0.04) accompanied by a VAS score of 3.7±1.8 in the treatment group and 4.9±2.0 in the control group; p=0.02. The access site crossover rate did not differ between the groups (7.6% vs 21.1%; p=0.09). Cutaneous analgesia before TRA for coronary interventions is associated with a substantial reduction in the RAS and the procedure-related level of patient discomfort.