Lower Mean Visual Analog Scale Scores Research Articles

Comparison of the Clinical Outcomes of Percutaneous Vertebroplasty Using Different Surgical Approaches and Bone Cement Distribution

Objective: To compare clinical outcomes of percutaneous vertebroplasty (PVP) through different surgical approaches and bone cement distribution in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: The clinical data of 231 patients with OVCF who underwent PVP from June 2020 to June 2022 were retrospectively analyzed. Clinical characteristics and surgical data were collected for statistical analysis. The total patients were divided into a unilateral approach group (Group UA) and a bilateral approach group (Group BA) according to different surgical approaches. Then, patients in Group BA were divided into a continuous bone cement group (Group CBC) and a discontinuous bone cement group (Group DBC) according to the distribution of bone cement. Results: In each group, the postoperative visual analog scale (VAS) score and Oswestry disability index (ODI) score were significantly decreased (P < 0.001). The operation time and fluoroscopy times of Group UA were less than those of Group BA (P < 0.001). However, compared with Group BA, Group UA had a lower mean VAS score (P = 0.013) and ODI score (P = 0.004) at the last follow-up. The VAS (P = 0.032) and ODI (P = 0.024) scores in the CBC group were significantly lower than those in the DBC group at the last follow-up. Conclusions: Unilateral PVP presented several advantages over bilateral PVP, particularly in terms of shorter surgery time, less fluoroscopy frequency, and less trauma. Continuous bone cement was closely related to good clinical outcomes. In clinical practice, we suggest unilateral PVP is performed for patients and ensure the continuity of bone cement for better clinical outcomes.

Comparative Evaluation of Dexmedetomidine and Dexamethasone as Adjuvants in Supraclavicular Brachial Plexus Block.

Introduction Currently, peripheral nerve block has shown immense potential with effective patient satisfaction. In the event of upper limb surgeries, the supraclavicular brachial plexus approach under ultrasound guidance renders quick and dense anesthesia. In addition, the clinical utility of adjuvants with local anesthetics elicits a good quality of nerve block with improved duration and inset. So the aim of the present study was tocompare the block characteristics of dexmedetomidine and dexamethasone during supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Materials and methods The present study was conducted on 100 patients aged 20-60 years with the American Society of Anesthesiologists (ASA)-I and ASA-II classification who were scheduled for upper limb surgeries. These patients were divided equally into two groups, namely group D (who received 20mL of 0.5% bupivacaine + 50 mcg (0.5mL) of dexmedetomidine +1.5mL normal saline) and group X (who received 20mL of 0.5% bupivacaine +8mg of dexamethasone), ensuring a total volume of 22mL administered to both groups. The time of onset and duration of the sensory and motor blocks, as well as the quality of intraoperative analgesia, were assessed. Results The addition of dexmedetomidine (50mcg) and dexamethasone (8mg) to 0.5% bupivacaine ensured a faster onset and prolonged duration of the sensory and motor blocks. Additionally, dexmedetomidine resulted in more prolonged postoperative analgesia, a lower mean visual analogscale score in the first 24 hours, and lesser opioid consumption in 24 hours than dexamethasone. Conclusion Dexmedetomidine is superior to dexamethasone as an adjuvant to bupivacaine during supraclavicular brachial plexus block in patients undergoing upper limb surgeries.

Comparison the treatment of anterior inferior tibiofibular ligament anatomical repair and syndesmosis screw fixation for syndesmotic injuries in ankle fracture

BackgroundThe fixation method of syndesmotic injuries in ankle fractures remains controversial. The goal of the study was to compare radiographic and clinical outcomes between anterior inferior tibiofibular ligament (AITFL) anatomical repair with syndesmosis screw fixation in syndesmotic injuries.MethodsWe analyzed 62 patients who were treated with AITFL anatomical repair or syndesmosis screw fixation for syndesmotic injuries in an advanced teaching hospital between March 2016 and March 2019. Fixation was performed with AITFL anatomical repair in 30 patients (AAR group) and syndesmosis screw in 32 patients (SS group). Radiographic evaluations were the differences in mean anterior and posterior (A difference and P difference) tibiofibular distance between injured and uninjured ankle computed tomography (CT) scan at 6 months postoperatively. Clinical evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score, the Olerud-Molander Ankle (OMA) score and visual analogue scale (VAS) score at 1, 3, 6 months and 1, 2 years postoperatively.ResultsThe A difference and P difference on CT was no differences (1.6 ± 0.8 mm, 1.3 ± 0.7 mm vs. 1.5 ± 0.7 mm, 1.2 ± 0.7 mm) between the two groups (All of P > 0.05). The AAR group had higher mean AOFAS score (65.6 ± 5.9, 82.3 ± 4.2, 87.6 ± 5.6 vs. 61.8 ± 5.2, 79.1 ± 4.0, 83.8 ± 4.9; P = 0.008, 0.003, 0.007) and higher mean OMA score (45.7 ± 8.7, 79.2 ± 6.5, 84.1 ± 5.3 vs. 40.4 ± 7.3, 74.8 ± 6.3, 80.3 ± 5.8; P = 0.012, 0.009, 0.010)) at 1, 3 and 6 months postoperatively. The AAR group had lower mean VAS scores (2.6 ± 1.2, 1.7 ± 0.7 vs. 3.4 ± 1.2, 2.2 ± 1.1; P = 0.018, 0.038) at 1 and 3 months postoperatively.ConclusionsThe results of this study suggest that the AITFL anatomical repair technique could effectively improve ankle function during daily activity. Therefore, AITFL anatomical repair technique is expected to become a better fixation method for syndesmotic injuries.

Comparison of Postoperative Pain After the Utilization of Different File Systems in Single Visit Endodontics.

This prospective single-blind, parallel-group, randomized clinical trial was aimed to compare the effect of three different rotary instrumentation systems ProTaper Next (PTN), Self-Adjusting File (SAF) and XP-endo Shaper (XPS) on postoperative pain and analgesic intakes. A total of 159 molars diagnosed with symptomatic irreversible pulpitis were randomly divided into three study groups according to the instrumentation techniques: PTN (n = 54), SAF (n = 52), and XPS (n = 53). The preoperative pain scores were taken before the onset of treatment in the groups. After a single appointment for root canal treatment, the patients were asked to rate the level of their pain according to the Visual Analog Scale (VAS) of 100 mm at 6, 24, 48, and 72-hour post-treatment intervals. Ibuprofen was prescribed to be taken while experiencing pain; patients were requested to note the number of pills consumed at intervals after treatment. The patients in SAF and XPS groups had lower mean VAS scores than the PTN group at 24-, 48-, and 72-hour intervals (p < 0.05). The most common analgesic intake was optimally seen in the PTN group at a 6-hour interval. All shaping procedures caused postoperative pain, whose intensity decreased with time. The SAF and XPS groups had a lesser intensity of pain as well as minimum analgesic intakes as compared to the PTN group. All instrumentation systems moderately caused pain, and the PTN group experienced the highest pain among others.

Oral Ketorolac as an Adjuvant Agent for Postoperative Pain Control following Arthroscopic Rotator Cuff Repair: A Prospective, Randomized, Controlled Study. (113)

Objectives:Arthroscopic rotator cuff repairs are associated with substantial postoperative pain. Traditionally, oral narcotic agents have been the preferred analgesic postoperatively in orthopaedic surgery. However, these agents are associated with several side effects and a significant potential for abuse. This study evaluates the efficacy of ketorolac, a non-steroidal anti-inflammatory drug with analgesic properties, as an adjunctive agent for postoperative pain control following arthroscopic rotator cuff repair.Methods:Adult patients undergoing an arthroscopic rotator cuff repair were prospectively enrolled. Patients who met inclusion and exclusion criteria were randomized into one of two groups. The control group received our standard of care pain protocol, including oxycodone-acetaminophen 5-325 on discharge. Patients in the ketorolac group additionally received a dose of IV ketorolac intraoperatively and were prescribed a scheduled dose of oral ketorolac (10mg by mouth every six hours for three days) along with omeprazole (20mg by mouth every day for three days) for acid reflux. Visual Analogue Scale (VAS), functional outcome scores, and total narcotic utilization were recorded three times per day for the first five days after surgery. Statistically significant differences in patient demographics and comorbidities between groups were determined initially with univariate analysis. Linear mixed-effect models were then fitted for each outcome variable to evaluate the main effects of treatment group and follow-up times.Results:In our study, 39 patients were included for final analysis; the mean age of the cohort was 55.7±10.6 years and 66.7% of patients were male. There were no differences in preoperative demographics, comorbidities, cuff tear morphology, and functional scores between the two groups. (Table 1) Patients in the Ketorolac group had lower mean VAS scores and opioid utilization at all time points. (Figure 1, 2) On multivariate analysis that controls for confounding variables, patients in the ketorolac group had a mean 9.67 decrease in VAS scores in comparison to the control group, though these results were not statistically or clinically significant (Coefficient estimate= -9.67, 95% CI -25.13-5.79, p=.2202; MCID 13). (Table 3) Patients in the ketorolac group utilized significantly less narcotics, with a mean of 0.7 fewer pills of oxycodone-acetaminophen per time interval in comparison to the control group (Coefficient estimate=-0.70, 95% CI -1.005 -0.389, p<.001). Over the first five days after surgery, patients in the ketorolac group consumed a mean 10.6 fewer narcotic pills, a consumption reduction of 54.6% (19.42 vs. 8.82, p<.001). There was no difference in functional outcome scores at up to six-weeks postoperative between the two groups, (Table 2) as well as no difference in adverse events between the two groups with no reported cases of gastritis or gastrointestinal bleeding. (Table 4).Conclusions:In this prospective, randomized, controlled study, the use of adjunctive intravenous and short-term oral ketorolac substantially reduced narcotic utilization following arthroscopic rotator cuff repair.

Comparison of analgesic efficacy of paracetamol and tramadol for pain relief in active labor

Study ObjectiveTo evaluate the efficacy and safety profile of paracetamol in comparison with tramadol for pain relief during active labor. DesignProspective, randomized, double-blind study. SettingMaternity Wing of the Postgraduate Institute of Medical Education and Research, Chandigarh. PatientSixty laboring, primiparous, full-term parturients with uncomplicated, singleton pregnancy in spontaneous labor and cervical dilatation of 3-5 cm. InterventionParturients were randomized into 2 groups to receive either 1 mg/kg of tramadol intramuscularly (group T; n = 29) or 1 g of paracetamol intravenously (group P; n = 30). Same doses of the drugs were repeated after 4 hours of initial dose. MeasurementPrimary outcome of the study was to assess the analgesic efficacy of the 2 drugs as measured by visual analog scale (VAS) score. Secondary outcome recorded was duration of labor, presence of any maternal, or fetal adverse events during the study. ResultsBoth the groups showed comparable VAS scores at all times of observation. Lower mean VAS scores were reported in both the groups till 120 minutes only. The duration of first stage of labor was shorter in group P (248.00 ± 98.171 vs 340.63 ± 111.592 minutes; P = .003). The duration of second stage of labor was comparable between the 2 groups. Higher incidence of maternal side effects such as nausea/vomiting and sedation was associated with the use of tramadol. Neonatal outcome was comparable. ConclusionIntravenous paracetamol provides comparable analgesia as intramuscular tramadol during active labor.

Obstetric analgesia: A comparison of intranasally or subcutaneously administered fentanyl with intramuscularly administered pethidine during childbirth

To evaluate the efficacy and safety profile of paracetamol in comparison with tramadol for pain relief during active labor.Prospective, randomized, double-blind study.Maternity Wing of the Postgraduate Institute of Medical Education and Research, Chandigarh.Sixty laboring, primiparous, full-term parturients with uncomplicated, singleton pregnancy in spontaneous labor and cervical dilatation of 3-5 cm.Parturients were randomized into 2 groups to receive either 1 mg/kg of tramadol intramuscularly (group T; n = 29) or 1 g of paracetamol intravenously (group P; n = 30). Same doses of the drugs were repeated after 4 hours of initial dose.Primary outcome of the study was to assess the analgesic efficacy of the 2 drugs as measured by visual analog scale (VAS) score. Secondary outcome recorded was duration of labor, presence of any maternal, or fetal adverse events during the study.Both the groups showed comparable VAS scores at all times of observation. Lower mean VAS scores were reported in both the groups till 120 minutes only. The duration of first stage of labor was shorter in group P (248.00 ± 98.171 vs 340.63 ± 111.592 minutes; P = .003). The duration of second stage of labor was comparable between the 2 groups. Higher incidence of maternal side effects such as nausea/vomiting and sedation was associated with the use of tramadol. Neonatal outcome was comparable.Intravenous paracetamol provides comparable analgesia as intramuscular tramadol during active labor.

Effect of home exercise program performance in patients with osteoarthritis of the knee or the spine on the visual analog scale after discharge from physical therapy

The aim of our study was to assess the effect of the frequency of home exercise program (HEP) performance on pain [10-point visual analog scale (VAS)] in patients with osteoarthritis of the spine or knee after more than 6 months discharge from physical therapy (PT). We performed a retrospective chart review of 48 adult patients with a clinical diagnosis of knee or spine osteoarthritis and had been discharged from PT of the spine or the knee for at least 6 months with provision of HEP from a physical therapist. Adult patients who were younger than 50 years of age, taking more than one medication to control pain, participating in worker's compensation, or had a history of drug abuse were excluded from the study. We recorded patient demographics, pain level (10-point VAS scale), and the number of days that a HEP was performed per week. The mean VAS score of patients who performed 0 days of HEP per week was 6.90. The mean VAS score of patients who performed HEP 1-3 times per week was 6.36. The mean VAS score of patients who performed HEP 4-7 times per week was 5.00. Single-factor analysis of variance analysis indicated a P-value of less than 0.01. Post-hoc comparison of the mean VAS using Fisher's least significant difference test showed a significant difference between the mean VAS score of 4-7 days per week of HEP versus 0 days per week (P<0.01) and 1-3 days per week (P<0.01) of HEP. There was no significant difference in the mean VAS score between 0 days of HEP and 1-3 days of HEP (P>0.05). Patients who performed 4-7 days per week of HEP had statistically significant lower mean VAS scores than patients who performed 0 days per week of HEP and 1-3 days per week of HEP. Therefore, after 6 months of discharge from PT, patients should be encouraged to perform at least 4 days of HEP per week.

Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block

Summary Aim and Objective: To evaluate the effect of penile block vs caudal epidural on the quality of analgesia and surgical outcome following hypospadias repair. Background: Intraoperative penile engorgement because of caudal epidural may result in tension on surgical sutures and alter surgical outcome. Methods: Fifty-four ASA I and II children were randomly allocated to group P (penile block, 0.25% bupivacaine, 0.5 mg·kg−1; n = 27) and group C (caudal epidural, 0.25% bupivacaine, 0.5 ml·kg−1; n = 27), respectively. Quality of analgesia was assessed by visual analog scale (VAS) score recorded at 0, 0.5, 3, 6, 12, 24 h, and once a day for the next 4 days. Duration of analgesia was calculated from the institution of block to the first analgesic demand by child or VAS > 5. Total morphine consumption in the first 48 h and oral paracetamol consumption till 5th day were recorded. Children were regularly followed up in their respective outpatient clinic for early or late complications. Results: In group P, lower mean VAS scores were seen from 0.5 h after surgery till day 3 and analgesia lasted for significantly longer duration (82 min) when compared with caudal epidural, P < 0.001. Incidence of urethral fistula formation after primary hypospadias repair was 19.2%, and all had received caudal epidural. An increase of 27% in penile volume from baseline value was observed 10 min after caudal epidural placement, P < 0.05. Conclusion: Penile block provided better analgesia when compared with caudal epidural in children undergoing primary hypospadias repair. Postoperative urethral fistula formation was more likely in children who received caudal epidural.

Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block

To evaluate the effect of penile block vs caudal epidural on the quality of analgesia and surgical outcome following hypospadias repair. Intraoperative penile engorgement because of caudal epidural may result in tension on surgical sutures and alter surgical outcome. Fifty-four ASA I and II children were randomly allocated to group P (penile block, 0.25% bupivacaine, 0.5 mg·kg(-1) ; n = 27) and group C (caudal epidural, 0.25% bupivacaine, 0.5 ml·kg(-1) ; n = 27), respectively. Quality of analgesia was assessed by visual analog scale (VAS) score recorded at 0, 0.5, 3, 6, 12, 24 h, and once a day for the next 4 days. Duration of analgesia was calculated from the institution of block to the first analgesic demand by child or VAS > 5. Total morphine consumption in the first 48 h and oral paracetamol consumption till 5th day were recorded. Children were regularly followed up in their respective outpatient clinic for early or late complications. In group P, lower mean VAS scores were seen from 0.5 h after surgery till day 3 and analgesia lasted for significantly longer duration (82 min) when compared with caudal epidural, P < 0.001. Incidence of urethral fistula formation after primary hypospadias repair was 19.2%, and all had received caudal epidural. An increase of 27% in penile volume from baseline value was observed 10 min after caudal epidural placement, P < 0.05. Penile block provided better analgesia when compared with caudal epidural in children undergoing primary hypospadias repair. Postoperative urethral fistula formation was more likely in children who received caudal epidural.

Ultrasound-guided continuous infraclavicular brachial plexus block using bupivacaine alone or combined with adenosine for pain control in upper limb surgery

Introduction:The infraclavicular brachial plexus block (ICB) is designed to deposit anesthetic high in the plexus, achieving anesthesia of the hand, forearm, elbow, and distal arm. Adenosine is a metabolic intermediate that is involved in nearly all aspects of cell function, including neurotransmission and signal transduction.This study was aimed to show whether addition of adenosine to bupivacaine in ultrasound-guided ICB had an analgesic effect.Methods:Sixty adult patients were divided into two equal groups, each group included 30 patients. Group I received infraclavicular bupivacaine 0.325% in a volume of 30 ml. Group II received 30 ml of 0.325% bupivacaine + 12 mg adenosine. The block was maintained with an infusion of 10 ml/h. The following parameters were assessed: Success rate, time of the sensory onset, motor block, visual analog scale (VAS), and amount of i.v. pethidine needed.Results:This study showed an analgesic effect of infraclavicular adenosine as evidenced by a statistically significant shorter mean time of onset of the sensory block (16 vs. 20 min, P < 0.05), lower mean VAS score over 48 h (1.7 vs. 2.7, P < 0.05), longer mean time of first parenteral analgesic requirement (299 vs. 255 min, P < 0.05), and lower mean total dose of pethidine needed over 48 h after surgery (25.5 vs. 56.6 mg, P <0.05). All patients got successful infraclavicular block and recovered uneventfully without any sensory or motor deficit.Conclusion:Adenosine may provide valuable addition to the therapeutic options in anesthesia and pain management. Further research is required to figure out its exact role