Lower Pain Levels Research Articles

Impact of Anti-Fatigue Floor Mat on Surgical Staff Comfort Levels in Head and Neck Surgery Cases.

Musculoskeletal symptoms are common among surgical staff and can have long-term implications on health and wellbeing. The purpose of this study is to evaluate the impact of anti-fatigue floor mat on the comfort level of surgical teams during head and neck surgeries lasting ≥ 3 h. Over 4 months, we prospectively randomized 34 major (≥ 3 h) head and neck procedures to the use or not of an anti-fatigue floor mat. Anonymous questionnaires measured the comfort levels in different subjects including the surgeons, assistant surgeons, and surgical scrub technicians (n = 57). Subjects completed questionnaires before, immediately after, and one day after surgery. Variables collected included demographics, overall discomfort level, overall energy level, discomfort level in different body parts, number of breaks taken during the case, time since last physical exercise, and frequency of physical exercise. The analysis of variance (ANOVA) technique was used for data analysis. The group that used anti-fatigue floor mats reported lower increases in discomfort from pre-op to immediately post-op and 24 h post-op compared to the group that did not (p = 0.009 and p < 0.001). Participants who used the mats reported significant lower levels of pain in the ankles and feet, knees, and shoulders immediately post-op compared to participants who did not. Participants who used the mats reported lower increases in discomfort in their back, hips, knees, neck, and shoulders from pre-op to post-op. Using anti-fatigue floor mats during surgery is an effective and low-cost intervention to decrease the musculoskeletal symptoms experienced by the surgical team. 2.

Laser excision of benign skin lesions: a comparative analysis of two CO&lt;sub&gt;2&lt;/sub&gt; laser systems

Lasers are common dermatological tools used for both clinical and aesthetic indications. The CO2 laser is the gold standard system used for ablative removal of benign lesions. Due to its high absorption in water and low ablation threshold, it can be used to remove, cut, and coagulate skin tissue. This retrospective analysis compared the 3-month safety and performance of the Alma Hybrid/Hylight 50 and Pixel CO2 Focus laser systems used to remove benign skin lesions in adult patients. Treatment tolerability was rated immediately after the procedure, while clearance and patient satisfaction with treatment outcomes were assessed at the 6-month follow-up visit. Overall, 37 lesions were excised with the Hybrid/Hylight 50 laser, and 41 lesions were excised with the Pixel CO2/Focus laser. In both cohorts, 70% of the lesions removed were intradermal nevi or skin tags, all lesions were nonvascular, and most were located on the face (Hybrid/Hylight: 75.7%; Pixel CO2/Focus: 61.0%). Median lesion size was 7.65 mm and 7.09 mm in the Hybrid/Hylight and Pixel/Focus cohorts, respectively. Complete removal of all lesions was achieved after a single treatment session, regardless of the laser system used. Patients reported very low pain levels and were highly satisfied with the treatment outcomes. Hypopigmentation was reported for two patients in the Hybrid/Hylight cohort and 1 patient in the Pixel cohort; 1 patient in each cohort developed post-inflammatory hyperpigmentation. All adverse events resolved within 5-10 months. Our findings indicate that CO2 lasers can safely and effectively remove benign skin lesions of varying sizes and locations on the body.

Evaluation of Covid-19-related musculoskeletal pain in healthcare workers during the pandemic

Aims: To investigate the prevalence, characteristics, and musculoskeletal distribution of pain, one of the most frequently encountered complications among healthcare professionals during the COVID-19 pandemic. Methods: The study included healthcare workers who had recovered from COVID-19 at least six months before their inclusion. Demographic data of the participants were collected. Pain levels were assessed with the Visual Analog Scale. The "Oswestry Low Back Pain Disability Questionnaire" was used to measure low back pain and disability levels, which aims to assess how pain affects activities of daily living. The "Douleur Neuropathique 4 Questionnaire" interview section was used to assess the level of neuropathic pain. Results: A total of 101 participants with a mean age of 37.72 ± 1.22 years were included in the study. Of these participants, 78 (77.2%) were female and 23 (22.8%) were male. Of the participants, 32 (31.7%) were physicians, 34 (33.7%) were nurses, and 35 (34.7%) were healthcare workers. The most common areas of pain reported in healthcare workers in our study were the head, lower back, and back. A statistically significant difference was observed in the analysis of Oswestry Scores between different occupational groups (p &lt;0.001). Subgroup analyses showed that there was no statistically significant difference between nurses and other healthcare personnel (p = 0.082). However, a significant difference was observed between doctors and nurses (p &lt;0.001) and also between doctors and other healthcare personnel (p = 0.008). The most frequently reported neuropathic symptoms were numbness, pinprick sensations, and tingling. Conclusion: Our study that examines the location and character of pain in the musculoskeletal system in healthcare workers can support fundamental strategies in the protection of healthcare workers and the continuity of healthcare system delivery. Developing necessary prevention strategies is crucial to prepare healthcare workers for managing future outbreaks.

Return to work following traumatic hip dislocation: a prognostic outcome study.

Traumatic hip dislocations are associated with high morbidity and overall limitations of daily living activities. Residual disability inhibits returning to work after severe injuries and minimizes financial independence and social involvement, which are both related to well-being and good health. The aim of this study was to analyze epidemiological and socioeconomic status following traumatic hip dislocations to identify predictors for return to work. Patients with traumatic hip dislocations from three level one trauma centers from 2009 to 2021 were followed up in terms of epidemiological data, return to work, change of work, and predictors of socioeconomic outcome. Inclusion criteria were age ≥ 18 years, employed patients, and a minimum follow-up of ≥ 2 years. Patients with incomplete or missing medical records, including radiological imaging and retired patients, were excluded. 107 patients met the inclusion criteria and 67 (63%) patients were available for follow-up. A total of 81 male and 26 female patients with a mean age of 41.82 years (SD ± 15.65) were finally evaluated. A work-related accident was found in 28 patients (26%). Demographic data and treatment course did not differ significantly between the work-related and non-work-related accidents. Sixty-seven (63%) patients (51 male and 16 female) with a mean age of 42 years (SD ± 15.79) were included in the follow-up. Eighteen patients (27%) had not returned to their previous job and 12 patients (18%) had reduced income. Higher age and Body Mass Index (BMI) were significantly associated with a lower return rate to the pre-accident job (p < 0.05). Furthermore, lower Tegner Activity Scale, pain score, and modified Harris Hip Score were also significantly associated with lower return to work rate (p < 0.001) and reduced income. Traumatic hip dislocations are associated with high rates of work-related injury and unsatisfactory low rates of return to previous work. Younger age, lower BMI, higher Patient reported outcome measures and lower pain levels may predict a successful return to previous job and a reduced risk of reduction in earning capacity. Understanding the predictive factors is crucial to identify patients at risk of not returning to work and to develop strategies that may help improve their chances of successfully returning to their previous employment.

Assessing the relationship between low back pain and job stress on the work ability index among healthcare workers in an educational hospital in Tehran

Introduction: Considering that stress in the workplace for healthcare workers employees can adversely affect their work ability, diminish productivity, and lead to job dissatisfaction, burnout, as well as negative physical and mental outcomes, the present study was designed to assess the effect of low back pain and stress levels on the work ability index among healthcare workers in a tertiary hospital in Iran. Material and Methods: This cross-sectional study was conducted on healthcare professionals in one of the hospitals in Tehran City in 2022. The prevalence of musculoskeletal disorders among study participants was evaluated using the Nordic Musculoskeletal Questionnaire (NMQ). Additionally, the Work Ability Index (WAI) was employed to evaluate the participants' work ability, while the HSE Stress Questionnaire was used to measure their job stress levels. Results: A lower level of job stress among healthcare professionals was significantly associated with daily (P=0.02) and weekly (P=0.004) working hours. Moreover, healthcare professionals who did not experience low back pain in the past week were able to work more hours per day compared to others (P=0.01). In the linear regression model, the relationship between the Work Ability Index (WAI), job stress, and job position remained statistically significant (P&lt;0.05). Conclusion: Tackling job-related stress and enhancing employee well-being is essential to improve work productivity and overall health. Implementing specific interventions and conducting further research could effectively contribute to achieving these goals.

Multitargeting Pt(IV) Derivatives of Cisplatin or Oxaliplatin Inhibit Tumor Growth in Mice without Inducing Neuropathic Pain.

Cisplatin and oxaliplatin are Pt(II) anticancer agents that are used to treat several cancers, usually in combination with other drugs. Their efficacy is diminished by dose-limiting peripheral neuropathy (PN) that affects ∼70% of patients. PN is caused by selective accumulation of the platinum drugs in the dorsal root ganglia (DRG), which overexpress transporters for cisplatin and oxaliplatin. To date, no drug is recommended for the prevention of PN. We report that Pt(IV) prodrugs of cisplatin or oxaliplatin do not induce neuropathic pain in mice, likely due to the lower accumulation of platinum in the DRG compared with Pt(II) drugs. Moreover, the multitargeting prodrug that combines cisplatin with paclitaxel, both strong inducers of PN, efficiently inhibited tumor growth in vivo without inducing neuropathic pain. The high antitumor efficacy of Pt(IV) prodrugs and their micellar counterparts and the low level of neuropathic pain associated with them make them ideal candidates for clinical use in cancer therapy.

Minimum 10-Year Clinical and Functional Outcomes, and Return to Sport After Sternoclavicular Joint Reconstruction for Sternoclavicular Joint Instability

Background: Sternoclavicular joint (SCJ) instability can lead to pain, reduced function, and an inability to perform sports and activities of daily living. Reconstruction of the SCJ using hamstring autograft in a figure-of-8 configuration has demonstrated good outcomes at short- and midterm follow-ups, but there is a paucity of literature on long-term outcomes. Purpose: To evaluate the long-term clinical and functional outcomes after SCJ reconstruction, with a focus on return to sport, instability recurrence, and revision surgery. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent SCJ reconstruction with a hamstring autograft for the treatment of SCJ instability between December 2010 and June 2013 by a single surgeon with a minimum 10-year follow-up were eligible for inclusion. Patient-reported outcome measures, including the American Shoulder and Elbow Surgeons (ASES) Score, short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and patient satisfaction (1-10 scale, with 10 indicating maximum satisfaction), rates of return to sport, instability recurrence, and revision surgery, were evaluated at short- (2-3 years), mid- (5-8 years), and long-term (minimum 10 years) follow-ups. Results: Eleven patients (13 shoulders) were evaluated at a median of 10.0 years (IQR, 10.0-11.0 years) postoperatively. SCJ instability was chronic in 12 shoulders (92.3%) and acute in 1 shoulder (7.7%). One shoulder underwent revision SCJ reconstruction and was excluded from further analysis (survivorship: 92.3%). Significant pre- to postoperative improvements in shoulder function and pain were observed at short-term follow-up and were either maintained or further improved at mid- and long-term follow-ups. At a minimum of 10 years postoperatively, shoulder function (median ASES score: 95.0 [IQR, 86.2-97.5]; median QuickDASH: 12.5 [IQR, 6.8-15.9]; median SANE: 89.0 [IQR, 81.5-96.3]) was excellent, pain levels were low (median VAS for pain: 0.5 [IQR, 0-1.8]), and patient satisfaction was high (median, 9.0 [IQR, 8.0-10]). All patients returned to sport (n = 10; 100%) at levels equal to or above (n = 3; 30.0%) or slightly below (n = 7; 70.0%) their preinjury level. Two of these patients (20.0%) reported instability-related modifications in activity. One patient had recurrent instability 2.5 years postoperatively but had excellent shoulder function at the final follow-up. The overall rate of instability recurrence was 36.4% (4/11 patients). Conclusion: SCJ reconstruction using a hamstring autograft for the treatment of SCJ instability resulted in significant improvements in shoulder function, low levels of pain, and high return-to-sport rates at long-term follow-up. Revision surgery rates were low.

A Comprehensive Analysis of Moist Versus Non-Moist Dressings for Split-Thickness Skin Graft Donor Sites: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis evaluate the efficacy of moist versus non-moist dressings for split-thickness skin graft (STSG) donor sites, focusing on time to healing, pain management, and adverse events to guide clinical practice. A comprehensive literature search was conducted across databases including Ovid/MEDLINE, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and Scopus up to November 28, 2023. The study adhered to PRISMA guidelines. Eligible randomized controlled trials (RCTs) were assessed for quality using the Newcastle-Ottawa Scale and Cochrane risk-of-bias tool, with meta-analysis performed using the DerSimonian and Laird random-effects model. Out of 464 identified studies, 16 RCTs involving 1129 patients were included. Moist dressings such as Tegaderm, Hydrocolloid, Alginate, polyurethane, and hydrofiber showed a faster mean time to healing compared to non-moist dressings like Mepitel and paraffin-impregnated gauze. Hydrocolloid dressings were particularly effective in accelerating wound healing. Additionally, moist dressings were associated with lower pain levels during dressing removal and had comparable rates of adverse events. The evidence strongly supports the use of moist dressings, particularly Hydrocolloid, for STSG donor site coverage. These dressings promote faster healing and superior pain management. The study highlights the need for further research to address existing limitations and refine recommendations for optimal wound care interventions.

Efficacy of supra-inguinal fascia iliaca compartment block in proximal femoral nail antirotation internal fixation for patients with intertrochanteric fractures.

To evaluate the efficacy of supra-inguinal fascia iliaca compartment block (S-FICB) in patients undergoing proximal femoral nail antirotation (PFNA) internal fixation surgery for intertrochanteric fracture (ITF). Retrospective analysis of 95 patients with ITF undergoing PFNA internal fixation surgery in the First People's Hospital of Yong Kang from March 2021 to August 2023 was performed. Among them, 49 patients received general anesthesia (GA; GA group) and 46 patients received S-FICB combined with general anesthesia (S-FICB group). Mean arterial pressure (MAP), heart rate (HR), anesthesia effect, pain, stress index levels, functional recovery, and adverse reactions were compared between two groups. Perioperative MAP and HR, extubation time, anesthesia recovery time, and dosage of remifentanil and propofol were significantly lower compared to the GA group (P<0.05). Perioperative pain level in the S-FICB group was significantly lower than in the GA group (P<0.05). On the first day after the surgery, stress response of the S-FICB group was significantly lower than that of the GA group (P<0.05). Patients who underwent S-FICB required significantly shorter time for getting out of bed and for straight leg elevation, and lower hospitalization time (P<0.05). Compared to GA, S-FICB for ITF internal fixation surgery is associated with more stable hemodynamics, lower pain levels, less consumption of opioids, lower perioperative stress response, reduced postoperative complications, and shorter hospital stay in patients during the perioperative period.

EFFECTS OF DIFFERENT CALCIUM-SILICATE BASED MATERIALS ON FRACTURE RESISTANCE OF IMMATURE PERMANENT TEETH WITH REPLACEMENT ROOT RESORPTION AND OSTEOCLASTOGENESIS

Immature permanent teeth with replacement root resorption pose challenges in dental treatment due to compromised structural integrity. Calcium-silicate based materials show promise in promoting dentin genesis and tissue repair, but their effects on fracture resistance in such teeth remain unclear . Objective: This study aimed to investigate the impact of different calcium-silicate based materials on fracture resistance and osteoclast genesis in immature permanent teeth with replacement root resorption. Methods: A prospective experimental study was conducted on 60 patients at Lahore medical and dental college, Lahore from September 2023 to March 2024. Patients were divided into three groups receiving Bio dentine, White MTA, or Bio-C Repair as part of their endodontic treatment. Fracture resistance was assessed using mechanical testing, while osteoclast genesis was evaluated histologically. Patient-reported outcomes and radiographic findings were also recorded. Results: Bio dentine exhibited the highest fracture resistance and lowest osteoclast activity, followed by White MTA and Bio-C Repair. Patients treated with Bio dentine reported lower postoperative pain levels and higher treatment satisfaction. Radiographic evaluation showed favorable periapical healing and dentin formation in all groups. Conclusion: The study concludes that Bio dentine may offer superior fracture resistance and biocompatibility compared to White MTA and Bio-C Repair in immature permanent teeth with replacement root resorption. These findings support Bio dentine’s potential as an effective therapeutic agent for enhancing the durability and functionality of compromised dental structures. Further research is needed to validate these results and optimize treatment strategies for managing such clinical scenarios.

The technique of three-component regional blockade of the anterior neck region as a component of anesthesia during operations on the thyroid and parathyroid glands

Introduction. The use of various regional blockades as a component of general anesthesia reduces the risk of postoperative complications such as intense pain syndrome, postoperative nausea and vomiting, and postoperative cognitive dysfunction. The study is devoted to the development and description of the technique of regional anesthesia of the anterior surface of the neck during operations on the thyroid and parathyroid glands under ultrasound navigation.The objective was to develop a safe and effective technique of regional anesthesia for operations on the thyroid and parathyroid glands under ultrasound navigation.Materials and methods. The trial involved 60 patients operated on for thyroid and parathyroid gland diseases. All patients were randomized into two groups: group 1 – combined anesthesia: general anesthesia + three-component blockade of the anterior surface of the neck; group 2 – general anesthesia. In group 1, intermediate cervical plexus blockade, pericapsular thyroid blockade, and Berry’s ligament blockade were performed under the control of ultrasound navigation. The patients’ condition was evaluated preoperatively, intraoperatively and in the postoperative period (after 3 and 12 hours) according to the following parameters: hemodynamic variability, pain intensity according to the numerical rating scale, frequency of postoperative nausea/vomiting and postoperative cognitive dysfunction (MOCA, MMSE), terms of postoperative activation of patients, need for prescription of opioid and non-opioid analgesics after surgery.Results. The combination of general anesthesia and the technique of three-component regional neck blockade allowed to limit the use of opioid analgesics: opioid consumption in group 1 was 3.12 [2.68; 3.75] μg/kg, in group 2 – 5.93 [4.48; 7.21] μg/kg (p &lt; 0.0001). A higher rate of cognitive recovery was noted in group 1 compared to patients in group 2 (p = 0.0114). Combined anesthesia provided a long pain-free period after surgery: 12 hours after extubation, patients in group 1 had a very low level of pain according to numerical rating scale – 0 [0; 6.0] mm, patients in group 2 had higher values – 14 [10; 18] mm. The use of regional blockade allowed to reduce ketoprofen consumption in the postoperative period (consumption in group 1 amounted to 1.85 [1.30; 2.02] mg/kg, in group 2 – 3.19 [2.58; 5.97] mg/kg (p = 0.0015)).Conclusion. General anesthesia with three-component regional blockade of the anterior surface of the neck during operations on the thyroid and parathyroid glands under ultrasound navigation is effective and safe technique.

Examining the impact of rhythmic breathing and progressive muscle relaxation on acute pain following inguinal hernia repair: a parallel randomized clinical trial

BackgroundAcute postoperative pain is often reported after repair of inguinal hernia and can negatively impact patient satisfaction and clinical outcomes. This includes delayed wound healing, longer hospitalization, and increased health care costs. Non-pharmacological techniques like Progressive Muscle Relaxation (PMR) and Rhythmic Breathing (RB) have been suggested as possible interventions for managing this type of pain. The purpose of this study was to examine the effects of PMR and RB on postoperative pain following repair of inguinal hernia.MethodsThis parallel randomized controlled trial was conducted to examine 120 patients in the age range of 18 to 75 years with inclusion criteria: Repair of Inguinal Hernia under general anesthesia and no addiction to drugs and narcotics. These patients were randomly assigned to one of three groups: the RB group, PMR group, or the control group (which received standard care). The RB and PMR interventions were administered at 3, 6, 12, and 24 h after surgery. The primary outcome measure was the intensity of pain at the surgical site, assessed using the Visual Analog Scale (VAS). The secondary outcome measure was the amount of rescue analgesic (Pethidine). The one-way analysis of variance, Chi-square, post-hoc test, and repeated measures ANOVA were used for data analysis.ResultsFollowing the interventions, participants in both the RB and PMR groups exhibited significantly lower levels of acute pain after inguinal hernia repair compared to the control group across all four time periods, except at 12 h postoperatively in the RB group. However, there was no statistically significant difference between the RB and PMR groups. Additionally, the amount of pethidine consumed in the control group was significantly higher compared to the two experimental groups.ConclusionsBased on the results, both RB and PMR were found to be effective techniques in reducing patients’ pain. Therefore, it is recommended that healthcare team members, particularly nurses, actively learn and teach both RB and PMR.Trial registrationRegistered in the Iranian registry of clinical trials (www.irct.ir) in 31/01/2023 with the following code: IRCT20200206046395N2.

Comparison of the Efficacy and Safety of Thyroid Microwave Ablation and Radiofrequency Ablation versus Open Surgery for the Treatment of Benign Thyroid Nodules: A Propensity Score Matching Study.

With the advantage of preserving thyroid function while minimizing intervention-related morbidity, minimally invasive thermal ablation techniques such as microwave ablation (MWA) and radiofrequency ablation (RFA) have emerged as alternatives to traditional open surgery. This study compares the efficacy and safety of MWA and RFA with that of open surgery for the treatment of benign thyroid nodules by utilizing a propensity score matching study design to improve comparability. This retrospective study included patients with benign thyroid nodules treated at the North China Electric Power University (Baoding) School Hospital between May 2020 and May 2023. Following propensity score matching, the patients were equally divided into three treatment groups: MWA, RFA, and open surgery. Data on demographic characteristics, thyroid function, treatment outcomes (including nodule size reduction, postoperative pain, cosmetics, hospital stay, and quality of life (QoL)), and postoperative complications were analyzed. A total of 160 patients, including 55 patients who received MWA, 58 patients treated with RFA and 47 patients operated with open surgery, were initially included. Propensity score matching, aimed at minimizing baseline differences among the groups, was conducted, leaving behind 105 patients, who were equally distributed with 35 persons per group. Compared to open surgery, both MWA and RFA significantly reduced intraoperative blood loss, operation time, length of hospital stay, and pain scores (p < 0.05). The incidence of complications, such as hypothyroidism, hematoma, wound pain, and incision adhesion, was also significantly lower (p < 0.05). In addition, the MWA and RFA were superior to open surgery in terms of cosmetic satisfaction and overall QoL scores (p < 0.05). No significant differences were observed between the MWA and RFA groups in terms of treatment efficacy, complication rates, cosmetic satisfaction, and QoL scores (p > 0.05). At the 6-month follow-up, no significant differences in thyroid function were observed among the three treatment modalities (p > 0.05). MWA and RFA exhibit comparable outcomes, in terms of efficacy and safety, for the treatment of benign thyroid nodules, with advantages over open surgery including shorter hospital stays, lower level of postoperative pain, better cosmetic outcomes, higher QoL scores, and lower rates of certain complications.

Bidirectional links between sleep and pain among heavy-drinking Veterans with insomnia

Abstract Study Objectives Military veterans often suffer from chronic pain and sleep issues at a greater frequency than the general population, leading some to self-medicate with alcohol. While research shows a connection between sleep and pain, few studies have examined bidirectional links between sleep and pain at the daily level–or the extent to which alcohol use may moderate these associations. Methods Heavy-drinking veterans seeking treatment for insomnia (N=109, 82.5% male, mean age 38.9y) completed 14 days of morning diaries documenting sleep patterns, pain intensity, and alcohol consumption. Multilevel modeling examined within- and between-person associations between sleep (quality, duration, and efficiency) and next-day pain as well as pain and same-night sleep. Results Individuals with longer sleep duration, better sleep quality, and higher sleep efficiency reported lower pain levels compared to those with shorter sleep, poorer sleep quality, and lower sleep efficiency (p-values &amp;lt;.001 to .01). Additionally, on days when individuals experienced better sleep quality compared to their own average, they reported lower pain levels the following day (p=.01). In contrast to hypotheses, daily pain levels did not predict sleep outcomes at the daily within-person level, although significant between-person correlations were noted. Daily alcohol intake did not affect these relationships. Conclusions Sleep quality is associated with the daily experience of pain among heavy-drinking veterans with insomnia. Daily variations in sleep quality significantly impact pain, irrespective of alcohol consumption, highlighting a predominantly unidirectional influence from sleep to pain. These findings underscore the importance of optimizing sleep to mitigate pain in this population.

Ultrasound-Guided Thermal Ablation Versus Thyroidectomy in the Treatment of Benign Thyroid Nodules: Systematic Review and Meta Analysis.

Ultrasound-guided thermal ablation (TA) is a minimally invasive intervention for treating benign thyroid nodules (BTNs). This meta-analysis aims to systematically compare the safety and efficacy of ultrasound-guided TA with surgery in treating BTNs. Relevant studies were identified through searching electronic databases. Included studies focused on comparing TA for BTNs with surgical resection. Primary endpoints encompassed length of hospital stay, procedure time, symptom improvement, cosmetic score, and excellent cosmetic results. Other outcomes include all complications (hypothyroidism, hoarseness, hematoma, blood loss, wound infection, parathyroid injury, chocking, or cough), recurrence, postoperative pain, visual analog scale (VAS) score, scar length, thyroid hormone levels, and finally stress response outcomes. Twenty-six studies (7 randomized controlled trials and 19 cohort studies) were included. Our findings revealed that TA was associated with shorter hospital stays (MD = -3.30, 95% CI [-3.82, -2.79], P < .00001), reduced procedure time (MD = -47.75, 95% CI [-54.89, -40.61] P < .00001), superior cosmetic outcomes (RR = 1.11, 95% CI [1.00, 1.22], P = .04), lower postoperative pain levels, and lower VAS score. Additionally, surgical resection was linked to a higher incidence of hoarseness, hypothyroidism, parathyroid injury, and blood loss. However, no significant differences were observed in rates of wound infection, hematoma, or recurrence between the two treatment modalities. Our meta-analysis suggests that ultrasound-guided TA represents a viable alternative to surgery for treating BTNs, especially for patients unwilling or unable to undergo surgical intervention. This technique was found to be safe and effective. However, future evidence is mandatory to establish TA to a specific type of nodule, to preserve patients from second interventions.

Efficacy of Articaine versus Lignocaine as Local Anesthetic Agents Using Buccal Infiltration Technique for Extraction of Mandibular Premolars

ABSTRACT Introduction: Lignocaine, commonly used for local anesthesia, often results in discomfort during mandibular premolar extractions due to limited tissue diffusion with the buccal infiltration technique. Articaine, with better lipid solubility, promises improved diffusion and patient comfort. This study compares the efficacy of 2% Lignocaine and 4% Articaine in reducing pain during mandibular premolar extractions. Methodology: A split-mouth, randomized, controlled trial included 40 patients, aged between 18 and 40 years, undergoing bilateral mandibular premolar extractions. Each patient received 4% Articaine with adrenaline and 2% Lignocaine with adrenaline on opposite sides at separate appointments. Pain was assessed using the Visual Analog Scale (VAS) and Faces Pain Scale (FPS). Results: Patients in the Articaine group reported significantly lower pain levels (mean FPS: 0.2) compared to the Lignocaine group (mean FPS: 3.6) (P &lt; 0.001). In the Articaine group, 34 out of 40 patients experienced no pain, whereas all patients in the Lignocaine group reported mild to severe pain. Mild pain was reported by 23 patients in the Lignocaine group, and moderate pain by 12 (P &lt; 0.05). No severe pain was recorded in the Articaine group. Conclusion: Articaine demonstrated superior pain control, making it a more effective choice over Lignocaine for mandibular premolar extractions using the buccal infiltration technique.

Peritraumatic C-reactive protein levels predict pain outcomes following traumatic stress exposure in a sex-dependent manner.

Chronic pain following traumatic stress exposure (TSE) is common. Increasing evidence suggests inflammatory/immune mechanisms are induced by TSE, play a key role in the recovery process versus development of post-TSE chronic pain, and are sex specific. In this study, we tested the hypothesis that the inflammatory marker C-reactive protein (CRP) is associated with chronic pain after TSE in a sex-specific manner. We utilized blood-plasma samples and pain questionnaire data from men (n=99) and (n=223) women enrolled in AURORA, a multi-site emergency department (ED)-based longitudinal study of TSE survivors. We measured CRP using Ella/ELISA from plasma samples collected in the ED ('peritraumatic CRP', n=322) and six months following TSE (n=322). Repeated measures mixed-effects models were used to assess the relationship between peritraumatic CRP and post-TSE chronic pain. Peritraumatic CRP levels significantly predicted post-TSE chronic pain, such that higher levels of CRP were associated with lower levels of pain over time following TSE, but only in men (men:β=-0.24, p=0.037; women:β=0.05, p=0.470). By six months, circulating CRP levels had decreased by more than half in men, but maintained similar levels in women (t(290)=1.926, p=0.055). More men with a decrease in CRP levels had decreasing pain over time versus women (men:83% women:65%; Z=2.21, p=0.027). In men but not women, we found circulating peritraumatic CRP levels predict chronic pain outcomes following TSE and resolution of CRP levels in men over time might be associated with increased pain recovery. Further studies are needed to validate these results.

The use of ozone therapy for the treatment and post-surgical management of patients treated with bilateral extraction of the included third mandibular molars

The use of ozone in medicine and dentistry is well-supported in the scientific literature, particularly for its antibacterial, antiviral, anti-inflammatory, and anti-edema effects. These benefits are achieved through reductions in pro-inflammatory substances, stimulation of neoangiogenesis, and enhanced production of antioxidant enzymes. Additionally, ozone is pain-relieving by inactivating algogenic mediators and inducing endorphin release. Although ozone application devices are standard in conventional medicine, they are less so in dentistry and often have reduced performance. This study aims to evaluate the effectiveness of a specific ozone therapy device in managing postoperative pain and promoting healing in patients undergoing impacted third-molar extractions. Materials and methods: Patients scheduled for the extraction of impacted third molars were enrolled in a randomized split-mouth study to receive either ozone therapy or conventional antibiotic treatment. The Visual Analog Scale (VAS) assessed pain intensity and healing progress. Results: Patients treated with ozone therapy reported significantly lower pain levels and demonstrated qualitatively improved healing compared to the control group, with statistical significance. Conclusions: The study supports the use of ozone therapy in routine dental surgical practice, highlighting its favorable cost/benefit profile. Ozone therapy can be beneficial for impacted third-molar surgeries and broader applications in oral surgery. Keywords: Ozone therapy in dentistry, OZONE DTA equipment, Third molar extraction and soft tissue healing.

Postoperative Pain Comparison Between Alcohol-Assisted and Transepithelial Photorefractive Keratectomy Using Nepafenac Treatment: A Novel Study.

The study aimed to compare postoperative pain between alcohol-assisted and transepithelial photorefractive keratectomy in patients who received the novel analgesic preoperative nepafenac treatment 2days preoperatively and 3days postoperatively. Pain, stinging, tearing, light sensitivity, and stress levels were evaluated. The study included a retrospective analysis of 55 patients divided into two groups: bilateral alcohol-assisted photorefractive keratectomy (aa-PRK) and transepithelial photorefractive keratectomy (transepithelial-PRK). Nepafenac was administered for pain control for all patients, with patients receiving four drops for 2 days before the surgery and 3 days postoperatively per clinical instructions. Patients completed questionnaires on the day of the surgery and for the first 5 days postoperatively. Statistical analysis was performed using XLSTAT (version 2023.1.2). t-Test was used to analyze and compare pain and symptom levels and Fisher's exact test for categorical data. p-Values less than 0.05 were considered statistically significant. The study examined 55 patients (49% female) with a mean age of 25.11 ± 6.81years who had undergone bilateral surface refractive surgery to correct myopic errors. The mean baseline standard error (SE) was -3.16 ± 2.20 D. Among these patients, 27 patients underwent aa-PRK and 28 patients underwent transepithelial-PRK. Higher levels of pain were significant in the aa-PRK group (p = 0.003). However, there was no significant difference between the groups in the average levels of stinging, tearing, or light sensation. Additionally, stress levels decreased over time in both groups, with levels becoming almost equal after 5 days, and there was no significant difference in the average stress levels between the two groups. The study found that patients who underwent the transepithelial-PRK procedure had significantly lower pain levels compared with those who underwent aa-PRK after being treated with nepafenac per protocol. However, there was no significant difference between the two groups in terms of stinging, tearing, light sensation, and stress levels.

The functional outcomes of tibia fractures treated with intramedullary tibia nail: A retrospective study

Background: The tibia nailing system is a type of implant used to stabilize a broken tibia bone. It is intended for long bone fracture fixation of tibia fractures, which include transverse, oblique, spiral, segmental, comminuted fractures, open and closed fractures etc. There is different nailing system available each with its own advantages and limitation. The type of system that is used will depends on the severity of the fracture, location of the fracture and the patient individual anatomy. In this study the Tibia Nail was to treat the fracture. Materials and Methods: Total 14 patients having age ranging from 26-57 years were treated by Tibia nails. Retrospective analysis of patients who underwent Tibia nail fixation having tibial shaft fractures was performed. Clinical evaluation was done for all patients with a mean follow-up of 1.5 years. Radiological images taken at the follow up after surgery were utilised to assess the outcome. VAS Score was used for analysis. Results: The patients that are included in the current study were available for evaluation after a mean of 12 months of follow-up. Radiological union in all patients were achieved in 6.1-7.2 weeks. Apart from this, the patients stay in clinical hospital for the 12.2 days of mean duration. The result reveals that overall, VAS Score at the final follow up was satisfactory. In addition, the full weight-bearing with low level of pain was reported after 9-12 month of surgery. Conclusion: The tibia nail is an effective treatment of fractures of the tibia bone.