Lower Visual Analog Scale Scores Research Articles

Effectiveness analysis of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope for L4, 5 degenerative lumbar spondylolisthesis

To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope (OSE) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of L4, 5 degenerative lumbar spondylolisthesis (DLS). The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed, of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion (OSE group) and 32 were treated with PLIF (PLIF group). There was no significant difference between the two groups in terms of gender, age, body mass index, Meyerding grade, lower limb symptom side, decompression side, stenosis type, and preoperative low back pain visual analogue scale (VAS) score, leg pain VAS score, Oswestry disability index (ODI), and the height of the anterior and posterior margins of the intervertebral space (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were compared between the two groups. The low back pain and leg pain VAS scores and ODI before operation, at 1 month, 6 months after operation, and last follow-up, the height of anterior and posterior margins of the intervertebral space before operation, at 6 months after operation, and last follow-up, the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness; and the Bridwell method at last follow-up was used to evaluate the interbody fusion. Both groups successfully completed the operation. Compared with the PLIF group, the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay, but an increase in operation time, with significant differences (P<0.05). In the OSE group, no complication such as nerve root injury and thecal sac tear occurred; in the PLIF group, there were 1 case of thecal sac tear and 1 case of epidural hematoma, which were cured after conservative management. Both groups of patients were followed up 13-20 months with an average of 15.5 months. There was no complication such as loosening, sinking, or displacement of the fusion cage. The low back pain and leg pain VAS scores, ODI, and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation (P<0.05). Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation (P<0.05), there was no significant difference in all indicators between the two groups at all other time points (P>0.05). At last follow-up, both groups achieved bone fusion, and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups (P>0.05). OSE-assisted posterolateral approach lumbar interbody fusion for L4, 5 DLS, although the operation time is relatively long, but the postoperative hospitalization stay is short, the complications are few, the operation is safe and effective, and the early effectiveness is satisfactory.

Comparison between OLIF and MISTLIF in degenerative lumbar stenosis: an age-, sex-, and segment-matched cohort study

To compare outcomes after oblique lateral interbody fusion (OLIF) versus minimally invasive transforaminal lumbar interbody fusion (MISTLIF) with bilateral decompression via unilateral approach for treating mild to moderate symptomatic degenerative lumbar spinal stenosis (DLSS). We retrospectively compared patients who underwent single-level (L4/5) OLIF with an age-, sex-, and segment-matched MISTLIF with bilateral decompression via unilateral approach cohort. Perioperative data were collected for the operative time, intraoperative blood loss, drainage in the first postoperative day, postoperative hospital stay, cost, intraoperative fluoroscopy, and complications. Lumbar radiographs were measured for changes in posterior intervertebral space height (PISH), intervertebral space foramen height (IFH), intervertebral foramen area (IFA), and area of the spinal canal (ASC). Clinical and psychological outcomes included the visual analog scale (VAS), Oswestry Disability Index (ODI), and hospital anxiety and depression scale (HADS). 35 OLIF patients were compared with 35 MISTLIF patients in L4/5 DLSS. The OLIF group had shorter bedtime, postoperative hospital stays, less intraoperative and postoperative blood loss (all P < 0.05), but had more times of intraoperative fluoroscopy, longer operative time, and higher cost (all P < 0.05). The complication rates were equivalent (OLIF vs MISTLIF: 22.86% vs 17.14%). PISH (11.94 ± 1.78 mm vs 9.42 ± 1.94 mm, P < 0.05), IFH (23.87 ± 3.05 mm vs 21.41 ± 2.95 mm, P < 0.05), and IFA (212.14 ± 51.82 mm2 vs 177.07 ± 51.73 mm2, P < 0.05) after surgery were significantly increased in the OLIF group. The ASC was increased significantly after the operation in both groups, but the ASC in the MISTLIF group was increased significantly more than that in the OLIF group (450.04 ± 66.66 mm2 vs 171.41 ± 58.55 mm2, P < 0.05). The lumbar VAS scores at 1 month (1.89 ± 0.87 vs 2.34 ± 0.84, P = 0.028) and 6 months (1.23 ± 0.97 vs 1.80 ± 0.99, P = 0.018) after operation in the OLIF group were significantly lower. There were no significant differences in lower extremity VAS and ODI scores between the two groups. Compared with MISTLIF group, HADS scores on postoperative day 3 (2.91 ± 1.46 vs 4.89 ± 1.78, P < 0.05) and prior to hospital discharge (PTD) (2.54 ± 1.38 vs 3.80 ± 1.78, P = 0.002) in the OLIF group were decreased significantly. OLIF showed more advantages of less surgical invasion, lower incidence of postoperative low back pain, faster postoperative recovery, and less anxiety compared with MISTLIF. Regardless of cost, OLIF seems to be a better option to treat mild to moderate symptomatic DLSS.

Arthroscopic suprapectoral biceps tenodesis provided earlier shoulder function restoration compared with open subpectoral biceps tenodesis during the recovery phase

This study compared the clinical outcomes of open subpectoral biceps tenodesis and arthroscopic suprapectoral biceps tenodesis for symptomatic biceps tenosynovitis. Although both techniques have pros and cons, no studies have compared clinical and functional outcomes during the recovery phase. Previous studies show that suprapectoral tenodesis has a higher probability of Popeye deformity and postoperative bicipital pain and stiffness, whereas subpectoral tenodesis has a higher risk of nerve complications and wound infections. This study aimed for clinical comparison between arthroscopic suprapectoral biceps tenodesis and open subpectoral biceps tenodesis. This study is a retrospective review of institutional records of patients with biceps tendinitis who underwent open or arthroscopic biceps tenodesis. Surgical indications included biceps tenosynovitis, biceps partial tear, and biceps pulley lesion. Patients with prior shoulder surgery, preoperative shoulder stiffness, or full-thickness tear of rotator cuff were excluded. Tenodesis was considered when the pain recurs within 3 months despite conservative treatment including at least 2 triamcinolone injections on the biceps tendon sheath. Visual analog scale (VAS) score for pain, presence of the night pain, American Shoulder and Elbow Surgeons (ASES) score, Constant score, and range of motion were assessed preoperatively at 3, 6, 12, and 24 months postoperatively and the last follow-up. A total of 72 patients (33 with arthroscopic suprapectoral biceps tenodeses and 39 with open subpectoral biceps tenodeses) were included in analysis. At postoperative 6 months, lower VAS score (0.4±0.8 vs. 1.7±1.9, P<.001), and the presence of the night pain (2 [6%] vs. 14 [36%], P=.002), ASES score (89.6±9.2 vs. 81.4±14.6, P=.006), and Constant score (89.4±5.6 vs. 82.0±12.5, P=.003) compared with the subpectoral group. The mean number of postoperative steroid injections for pain control in the subpectoral group (0.51±0.80) was significantly higher than that in the suprapectoral group (0.18±0.40) (P=.031). However, postoperative clinical outcomes were restored similar between the 2 groups at 12 months and the last follow-up. Arthroscopic suprapectoral biceps tenodesis performed statistically better than the subpectoral biceps tenodesis for the VAS, ASES, night pain, and Constant score at postoperative 6 months. However, only night pain and the Constant score showed differences that exceeded minimum clinically important difference during the recovery phase. At postoperative 12 and 24 months, biceps tenodesis provided satisfactory clinical outcomes and pain relief regardless of the fixation technique and suture anchor location.

COMPARISON BETWEEN DIRECT ANTERIOR APPROACH AND MINIMALLY INVASIVE POSTEROLATERAL APPROACH FOR BIPOLAR HEMIARTHROPLASTY IN ELDERLY PATIENTS WITH FEMORAL NECK FRACTURE

Background: This study was performed to compare the clinical effect of bipolar hemiarthroplasty via the direct anterior approach (DAA) or minimally invasive posterolateral approach (MIPA) in elderly patients with femoral neck fracture. Methods: In total, 196 elderly patients with femoral neck fractures were divided into the DAA group ([Formula: see text]) and MIPA group ([Formula: see text]). The clinical data, postoperative pain and complications, time until able to remain seated for 1 hour and walk independently, postoperative Harris score of functional activity at 6 weeks and 2 years postoperatively, and mortality at 2 years postoperatively were compared between the groups. Results: The DAA group had a longer operation time but a lower incidence of pneumonia 72 hours postoperatively, lower visual analogue scale score 24 hours postoperatively, and earlier time until able to remain seated for 1 hour and walk independently ([Formula: see text]). Six weeks postoperatively, the Harris scores for putting on socks, tying shoelaces, sitting comfortably on a chair, and climbing stairs were better in the DAA than the MIPA group ([Formula: see text]). After 2 years, there was no significant difference in the Harris scores between the two groups ([Formula: see text]). Conclusion: In elderly patients undergoing bipolar hemiarthroplasty, the DAA can be more effective than the MIPA in reducing the incidence of complications associated with long-term bed rest, relieving early postoperative pain, and improving early postoperative hip function.

The clinical efficacy of ozone combined with steroid in the treatment of discogenic low back pain: a randomized, double-blinded clinical study.

This randomized double-blinded clinical study is to investigate the clinical efficacy of per-paravertebral disk ozone injection combined with steroids in the treatment of patients with chronic discogenic low back pain (CDLBP). Group A (N = 60) received a per-paravertebral injection of a steroid mixture of 10 mL with pure oxygen 20 mL, while group B (N = 60) received a per-paravertebral injection of a steroid mixture of 10 mL combined with ozone 20 mL (30 μg/mL). Injections were administered once a week for 3 weeks, with a follow-up of 6 months. Clinical outcomes were assessed at week 1, month 3, and month 6 with the help of Visual Analog Scale (VAS) scores and Macnab efficacy evaluation. The VAS score of both group A (1.65 vs. 6.87, p = 0.000) and group B (1.25 vs. 6.85, p = 0.000) at week 1 was significantly reduced compared to baseline. The effect was sustained at the 3- and 6-month follow-up periods (p < 0.05). Group B had significantly lower VAS scores at month 3 (1.53 vs. 3.82, p = 0.000) and month 6 (2.80 vs. 5.05, p = 0.000) compared to group A, respectively. Based on Macnab criteria, 95 and 96.7% of patients in groups A and B had good rates "excellent plus good" at week 1, respectively. Good rates were significantly higher in group B at month 3 (91.7 vs. 78.3%, p = 0.041) and month 6 (85.0 vs. 68.3%, p = 0.031) compared to group A, respectively. No serious adverse events were noted in both groups. Per-paravertebral injection of steroid and ozone combination resulted in better relief of CDLBP compared to pure oxygen plus steroid. ChiCTR2100044434 https://www.chictr.org.cn/showproj.html?proj=121571.

Risk Factors of Low Back Pain Aggravation After Tubular Microdiscectomy of Lumbar Disc Herniation

Although lumbar disc herniation (LDH) patients' sciatic symptoms such as leg pain can be improved by decompressive surgery, some patients report postoperative aggravated low back pain (LBP). However, the exact reason for this phenomenon remained unknown. We retrospectively analyzed the prospectively collected LDH data of patients who underwent tubular microdiscectomy between December 2015 and December 2020. The patients were divided into aggravated and non-aggravated group according to whether the postoperative LBP visual analogue scale (VAS) score was higher than the preoperative score. We analyzed the relationship of the clinical and radiologic parameters with aggravated LBP. Postoperative aggravated LBP cases accounted for 14.1% (57 of 404) of this series. Of the 57 patients, 88% (50 of 57) had mild postoperative LBP aggravation (1-2), and 12% (7 of 57) had severe LBP aggravation (>2). The preoperative LBP VAS score of the aggravated group was significantly lower than that of the non-aggravated group (P < 0.001), while the LBP VAS score and Oswestry Disability Index at final follow-up was significantly higher in the aggravated group (P < 0.05). Additionally, the proportion of preoperative moderate-to-severe multifidus fatty atrophy (MFA) and lumbar facet joint degeneration (LFJD) was significantly higher in the aggravated group. A multiple stepwise logistic regression analysis indicated that the preoperative LBP VAS score (P < 0.001, odds ratio 0.266, 95% CI 0.161-0.439) and MFA (P < 0.001, odds ratio 4.491, 95% CI 2.092-9.640) were the risk factors for postoperative aggravated LBP. A preoperative lower LBP VAS score and moderate-to-severe MFA were associated with postoperative aggravated LBP. This will provide important guidance for patient's preoperative assessment and education.

Comparison between peripheral nerve stimulator-guided serratus anterior plane block versus transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy under general anaesthesia: A double-blind randomised controlled trial.

Laparoscopic cholecystectomy (LC) is a widely accepted surgical procedure associated with postoperative pain. This study was done to compare peripheral nerve stimulator (PNS)-guided serratus anterior plane block (SAP) and transversus abdominis plane (TAP) block for postoperative analgesia for patients undergoing LC. Following approval from the ethical committee, 70 patients for LC were randomly assigned to Group S: SAP block and Group T: TAP block. The blocks were performed under PNS guidance, and 20 ml of 0.375% ropivacaine was administered. The severity of pain was measured using a visual analogue scale (VAS). The study's primary objective was the evaluation of the postoperative VAS score. The time of the first dose of rescue analgesia and total tramadol consumption for 24 h postoperatively were secondary objectives. All the statistical calculation was done using statistical analyses for Social Sciences for Windows version 23.0 (IBM Corp, NY, USA). Lower VAS score was seen in patients of TAP block at rest as well as movement at 6 h (P = 0.001), 12 h (P = 0.001) and 18 h (P = 0.001) postoperatively compared with SAP. The TAP group showed a significantly increased time of first rescue analgesic compared to the SAP group (7.97 ± 0.51 vs. 5.89 ± 1.45, P = 0.001). Tramadol usage was significantly higher in the SAP group than in the TAP group (128.9 ± 36.22 vs. 72.43 ± 44.80, P = 0.001). TAP block guided by the PNS improves postoperative pain with less tramadol consumption and during the postoperative period without significant complications.

Intravenous ibuprofen in postoperative pain and fever management in adults: A systematic review and meta-analysis of randomized controlled trials.

This study aims to evaluate the efficacy and safety of multiple or single-dosage intravenous ibuprofen (IVIB) in managing postoperative pain and fever in adults who are unable to take oral medications. A systematic review and meta-analysis was conducted based on randomized controlled trials (RCTs) comparing IVIB with placebo or other analgesic and antipyretic medications for postoperative pain and fever management. Data were collected from 8 main databases from the inception to June 2022. Risk of bias assessment was performed, and the GRADE methodology was used to assess the certainty of pooled evidence. Primary outcomes included visual analogue scale (VAS) scores within 24 h postoperative and reduction of temperature. Meta-analyses were conducted to calculate the mean difference (MD) or risk ratios (RR) and 95% CIs. As a result, a total of twenty-three RCTs with 3716 participants were included. For postoperative pain, with moderate-to-low certainty evidence, IVIB was associated with lower postoperative VAS scores than placebo, with MD ranging from -3.53 (95% CI, -4.32 to -2.75) at 0 min to -0.96 (95% CI, -1.35 to -0.57) at 24 h. Compared with intravenous acetaminophen, IVIB demonstrated lower VAS scores (MD, -1.54 at 0 min; -0.36 at 24 h). For fever, IVIB showed satisfactory antipyretic efficiency in a short period of time, but no difference was observed between IVIB and intravenous acetaminophen. IVIB was well-tolerated for both pain and fever management. In conclusion, moderate-to-low certainty evidence supports the use of IVIB for adults with postoperative pain and fever who are unable to take oral medications.

Impact of recurrent ischaemic and bleeding events on quality of life in patients with acute coronary syndrome: Insights from the FORCE-ACS registry

ObjectivePatients with acute coronary syndrome (ACS) remain at high risk for recurrent ischaemic and bleeding events during follow-up. Our study aimed to quantify and compare the impact of these adverse...

Effect of OPRM1/COMT gene polymorphisms on sufentanil labor analgesia: a cohort study based on propensity score matching.

Background: This study investigated the use of COMT G1947A and OPRM1 A118G polymorphisms as predictive markers for sufentanil epidural analgesia. Methods: The visual analogue scale (VAS) score, andsufentanil consumption of 136 pairs of parturients using sufentanil with lidocaine and ropivacaine for epidural analgesia were used for analysis. Results: OPRM1 AG/GG had lower VAS score difference between fifthand 0 min (1.55 vs 1.87; p =0.012) and higher consumption (19.65μg vs 17.11μg; p =0.049) than AA carriers. COMT GA/AA had higher VAS score difference than GG carriers (1.86 vs 1.55; p =0.021). Conclusion: Sufentanil may provide better epidural labor analgesia in OPRM1 AA and COMT GA/AA carriers compared with OPRM1 AG/GG and COMT GG carriers. Clinical Trial Registration: ChiCTR1900026897(Chinese Clinical Trial Center Registry).

Utilization of deep neuromuscular blockade combined with reduced abdominal pressure in laparoscopic radical gastrectomy for gastric cancer: An academic perspective.

Few studies have examined the specific efficacy of deep neuromuscular blockade (NMB) combined with pneumoperitoneal pressure reduction in laparoscopic radical gastrectomy (LRG) in the elderly. To investigate the application effect of deep neuromuscular blockade (NMB) combined with reduced pneumoperitoneum pressure in LRG for gastric cancer (GC) in elderly patients and its influence on inflammation. Totally 103 elderly patients with GC treated in our hospital between January 2020 and January 2022 were retrospectively analyzed. Among them, 45 patients treated with surgery based on deep NMB and conventional pneumoperitoneum pressure were assigned to the control group, while the rest of the 58 patients who underwent surgery based on deep NMB and reduced pneumoperitoneum pressure were assigned to the observation group. The two groups were compared in the changes of the Leiden-surgical rating scale score, serum tumor necrosis fact-α (TNF-α) and interleukin 6 (IL-6) before and after therapy. The visual analogue scale (VAS) was adopted for evaluating the shoulder pain of patients at 8 h, 24 h and 48 h after the operation. The driving pressure of the two groups at different time points was also compared. Additionally, the operation time, pneumoperitoneum time, infusion volume, blood loss, extubation time after surgery, residence time in the resuscitation room, TOF% = 90% time and post-anesthetic recovery room (PACU) stay time were all recorded, and adverse PACU-associated respiratory events were also recorded. The postoperative hospitalization time and postoperative expenses of the two groups were counted and compared. No significant difference was found between the two groups at the time of skin incision, 60 minutes since the operation and abdominal closure after surgery (P > 0.05). The observation group exhibited significantly lower VAS scores than the control group at 24 and 48h after surgery (P < 0.05). Additionally, the observation group had significantly lower driving pressure than the control group at 5 min and 60 min after the establishment of pneumoperitoneum (P < 0.05). Additionally, the two groups were similar in terms of the operation time, pneumoperitoneum time, infusion volume, blood loss, extubation time after surgery, residence time in the resuscitation room and TOF% = 90% time (P > 0.05), and the observation group showed significantly lower TNF-α and IL-6 Levels than the control group at 24 h after therapy (P < 0.05). Moreover, the incidence of adverse events was not significantly different between the two groups (P > 0.05), and the observation group experienced significantly less hospitalization time and postoperative expenses than the control group (P < 0.05). Deep NMB combined with reduced pneumoperitoneum pressure can decrease the VAS score of shoulder pain and inflammatory reaction, without hindering the surgical vision and increasing adverse PACU-associated respiratory events, and can thus shorten the hospitalization time and treatment cost for patient.

Comparison of dental anesthetic efficacy between the periodontal intraligamentary anesthesia and other infiltration anesthesia: a systematic review and meta-analysis.

Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of clinical anesthesia techniques, we conducted a systematic review and meta-analysis to compare the efficacy of intraligamentary anesthesia with other infiltration anesthesia. The search was carried out in PubMed Central, Cochrane Central Register of Controlled Trials, MEDLINE (via OVID), Embase (via OVID), and Scopus from the inception to March 26, 2023. Seven eligible randomized controlled trials were included in the meta-analysis. The results indicated no significant difference in the success rate (RR = 0.96; 95% CI [0.81-1.14]; p = 0.65; I2= 73%) and visual analog scale (VAS) during dental procedures (MD = 3.81; 95% CI [-0.54-8.16]; p = 0.09; I2= 97%) between intraligamentary anesthesia and other infiltration anesthesia. However, intraligamentary anesthesia exhibited a higher VAS score during injection than other infiltration anesthesia (MD = 8.83; 95% CI [4.86-12.79]; p<0.0001; I2= 90%). A subgroup analysis according to infiltration techniques showed that supraperiosteal anesthesia had a lower VAS score during dental procedures than intraligamentary anesthesia. Intraligamentary anesthesia and other infiltration anesthesias have the same success rate and pain during dental procedures. However, the pain during injection of intraligamentary anesthesia is heavier than that of other infiltration anesthesia.

Comparison of the Efficacy of Opioid-Free Anesthesia With Conventional Opioid-Based Anesthesia for Nasal Surgeries - A Prospective Randomized Parallel Arm Triple-Blinded Study.

Introduction In the setting of nasal surgeries, the use of opioid-free anesthesia involving the use ofdexmedetomidine,and lignocaine is being investigated as a potential alternative to opioids. This combination of drugs provides sympatholysis, pain relief, and sedative properties, thereby aiming at reducing the negative effects commonly associated with opioid usage. The objective of this study is to evaluate and compare the effectiveness of opioid-free anesthesia using dexmedetomidineand lignocaineversus conventional opioid anesthesia with fentanylfor nasal surgeries. The comparison will be based on the primary outcome of postoperative visual analog scale(VAS) scores. Secondary outcomes assessed were the amount of rescue analgesic consumption, intraoperative sevoflurane usage, intraoperative blood loss, hemodynamic stability, postoperative nausea and vomiting (PONV) scores, and postoperative Ramsay Sedation Scores. Methods A triple-blind, prospective, randomized, parallel arm study in which 48 patients planned for elective nasal surgery were allocated randomly to one of two groups. In the study, the population labeled as Group D, comprising 24 participants, received dexmedetomidine at a dosage of 1 mcg.kg-1 via intravenous infusion lasting for a duration of 10 minutes prior to the induction of anesthesia. This was followed by a continuous infusion of 0.6 mcg.kg-1 h-1 throughout the intraoperative period, and intravenous Lignocaine 1.5 mg.kg-1 was administered three minutes prior to induction, subsequently an intraoperative infusion of 1.5 mg.kg-1 h-1. In Group F, consisting of 24 participants,intravenous fentanyl of 2 mcg.kg-1was administered three minutes before the induction. This was subsequently followed by a fentanyl infusion of 0.5 mcg.kg-1h-1in the intraoperative period. Results The study findings indicate that Group D had considerably lower postoperative VAS scores from 30 minutes to two hours compared to Group F (p<0.05). The utilization of sevoflurane during the intraoperative period was comparatively reduced in Group D in order to achieve the desired bispectral index (BIS) range of 40-60 (p<0.01). Mean intraoperative blood loss was also lower in Group D (85 ml) compared to Group F (115 ml )(p<0.01). Additionally, Group D had significantly lower rescue analgesic consumption and lower incidence of PONV up to 60 minutes compared to Group F (P-value <0.01).A statistically significant difference was observed between Group D and Group F in terms of lower mean values of both mean arterial pressure (MAP) and heart rate in Group D(p<0.01). The results indicate that the postoperative sedation scores within the first two hours were significantly greater in Group D compared to Group F(p<0.01). Conclusion The usage of opioid-free anesthesia has been found to be superior to a traditional opioid-based approach in various aspects, including the provision of sufficient pain relief after surgery, maintenance of stable hemodynamics during the operation, and reduction in occurrences of postoperative nausea and vomiting.

Disentangling the cascade of seizure precipitants: A prospective observational study

BackgroundThe management of epilepsy includes appropriate antiseizure medication (ASM) treatment and careful avoidance of seizure precipitating factors. Seizure precipitants may be multiple occurring with low intensity adding to each other, thus leaving essential elements unrecognized. The aim of this study was to reveal the patients’ subjective perceptions of the most important factors and to compare them with standardized measurements. MethodsThe study included 152 acute hospital admissions for seizures. The patients were asked to score the impact of various seizure precipitants as perceived by themselves on a visual analogue scale (VAS). The following items related to seizure occurrence were quantified: sleep deprivation by sleep diaries, ASM adherence by therapeutic drug monitoring, the Alcohol Use Identification Test, and the Hospital Anxiety and Depression Scale. Statistical analyses, including multiple regression, were performed to discover relationships between various parameters. ResultsThe interaction of the various factors was high. The association between lack of sleep and hazardous drinking and anxiety was highly significant. Perceived stress correlated well with anxiety and depression. Relatively low VAS scores for missed medication in patients with identified non-adherence suggest that insufficient patient awareness is common. Low VAS-scores for alcohol in patients with harmful drinking also suggest low acknowledgment of alcohol-related seizures. High alcohol scores were associated with sleep deprivation, anxiety and depression. ConclusionThe circumstances leading to an epileptic seizure are complex. Stress, sleep loss, alcohol intake, and missed medication are among the most commonly reported seizure precipitants. They are often combined, and various facets of the same underlying cause may be at play. Their sequence and relative impact are often difficult to establish. Improved understanding of the cascade of events preceding a seizure can improve comprehensive personalized management of uncontrolled epilepsy.

Evaluation of Efficacy of Ultrasound Guided Ilioinguinal and Iliohypogastric Nerve Block for Post Operative Analgesia after Addition of Dexamethasone in Adult Patients Undergoing Unilateral Inguinal Hernioplasty under Subarachnoid Block

Background: We assessed postoperative analgesic effect of ultrasound guided ilioinguinal and iliohypogastric nerve block, duration of action of the said block as well as the overall analgesic consumption in the first 24 hours of postoperative period after addition of dexamethasone.&#x0D; Methods: After approval from the institutional ethics committee, hospital based randomized prospective study was carried out in patients of age group 40-60 years by dividing them into two groups A and B, posted for unilateral inguinal hernioplasty, comparing ilioinguinal and iliohypogastric block with ropivacaine 0.375% and ropivacaine 0.375% with dexamethasone 4mg respectively. The aim of the study was to assess the postoperative analgesia with visual analogue scale (VAS) and satisfactory score and total analgesic consumption and time till rescue analgesia. Statistical Analysis: We used Chi-square test and paired t test and P&lt;0.05 was considered statistically significant.&#x0D; Results: Mean of duration of analgesia was significantly prolonged in group B (14.13±3.461 h) as compared to group A (5.77±2.161 h). Patients in group B had significantly lower VAS score and less number of rescue analgesic requirements in first 24 hours (h) postoperatively. No adverse effects recorded in any group.&#x0D; Conclusion: Dexamethasone as an adjuvant with ropivacaine in ultrasound guided ilioinguinal and iliohypogastric block provided profound prolongation of duration of postoperative analgesia and reduces analgesic consumption of patients undergoing subarachnoid block for unilateral inguinal hernioplasty.

Comparison of the effects of transcutaneous electrical nerve stimulation and interferential current therapies in central sensitization in patients with knee osteoarthritis.

This study is primarily aimed to determine whether transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) treatments have any effect on central sensitization (CS) in patients with knee osteoarthritis (OA) and to investigate which treatment is more effective. In this randomized controlled trial, 80 patients were randomized into four treatment groups: TENS, Plasebo-TENS, IFC, and Plasebo-IFC. All interventions were applied 5 times a week for 2 weeks. Primary outcome was pressure pain threshold (PPT), which is accepted as the objective indicator of CS, at the painful knee and at the shoulder as a painless distant point. Other outcome measures were the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index, Timed Up and Go Test, pain catastrophizing scale, Beck Depression Inventory, and Tampa Scale of Kinesiophobia. All assessment parameters were improved, without a significant difference among the groups except PPT. PPT scores were significantly improved in TENS and IFC groups when compared with the sham groups at 2 weeks and 3 months. In addition, this improvement was even more pronounced in the TENS group. Multivariable logistic regression analysis showed that the patient's inclusion in the TENS group, an initial high PPT, and an initial low VAS score were independent risk factors for improvement in the PPT. This study shows that TENS and IFC reduced pain sensitivity as compared to placebo groups in patients with knee OA. This effect was more pronounced in the TENS group.

Post OP Analgesic Effect of Transabdominal Block in Patients Undergoing Elective Ceaserian Section

Background: The management of postoperative pain, especially following abdominal surgeries, remains a pivotal challenge in clinical practice. The utilization of a transabdominal plane (TAP) block has recently emerged as a promising technique in achieving effective postoperative pain control. This study aimed to rigorously evaluate the analgesic efficacy of the TAP block in comparison with a control group not receiving the block, employing standardized Visual Analog Scale (VAS) scores and additional postoperative analgesic requirements as the primary outcome measures. Methods: A total of 50 patients undergoing abdominal surgery were randomly assigned to two groups: TAP block (n=25) and control (n=25). The TAP group received a specific dose of bupivacaine, while the control group received n/saline. Pain intensity was quantitatively assessed using VAS scores at 2, 6, 12, and 24 hours postoperatively. The requirement for additional postoperative analgesics was also recorded and compared between groups. Results: The TAP block group demonstrated consistently and significantly lower VAS scores across all time intervals measured, with mean differences ranging from 1.7 to 2.7 (p&lt;0.001). Additionally, the TAP block group required additional analgesics in only 20% of cases (95% CI: 7-33%), as opposed to 68% in the control group (95% CI: 49-87%), signifying a significant reduction of 48 percentage points (p&lt;0.01, 95% CI of the difference: 28-68%). Conclusion: The research presented here illustrates the heightened effectiveness of the TAP block in managing pain compared to traditional methods for patients having abdominal surgery. The noteworthy decrease in VAS scores, along with the reduced requirement for extra post-surgery pain relief, highlights the TAP block's potential as an efficient method for controlling pain. Continued investigation is recommended to determine the best techniques and identify the specific patient groups that might gain the most from this innovative method, aiming to improve both comfort and recovery following surgery. Keywords: Elective C-section, VAS score, Abdominal surgery, Effectiveness

A retrospective study comparing open and percutaneous trigger finger release in the Thai population

Background: Over the years, open surgery has been the primary treatment for trigger finger, a prevalent issue among hand illnesses. There has been some resistance to the technique's routine use, despite the fact that the percutaneous release of triggers provides a quicker recovery than surgery. As a result, the study proposed that the percutaneous release technique outperforms open surgery. The objective of this study was to compares the trigger finger surgery's open and percutaneous releases in terms of short-term results. Methods: From 2014 to 2020, 166 patients who underwent open or percutaneous release surgery for the trigger finger at Naresuan University Hospital were the subjects of this retrospective analysis. For one, three, and six weeks, the initial characteristics and post-operative hemorrhage, digital nerve and artery injury, surgical site pain, inability to flex the finger, and other outcomes were compared. The visual analog scale (VAS) score and the impairments of the arm, shoulder, and hand (DASH) score were also compared between the two groups. Results: The age, sex, and number of patients in both groups were statistically comparable. Before the procedure, there was no difference between the groups in terms of DASH and VAS scores for pain; however, at six weeks, the percutaneous release group showed a substantial difference and low VAS scores. There were no differences between the groups in terms of consequences, including wound pain, damage to digital nerves and arteries, and others. Conclusion: Based on the patients' short-term outcomes, the study found that percutaneous release of the trigger finger is just as successful as traditional open surgery.

Scarf osteotomy for hallux valgus surgery: determining indications for an additional Akin osteotomy

IntroductionThere is a lack of clear indications to carrying out an Akin osteotomy in addition to scarf osteotomy. Recent studies have shown that a proximal distal phalangeal articular angle (PDPAA) of > 8° as an indication to carrying out additional Akin osteotomy correlates with better radiological outcomes with lesser risk of recurrence. Our study aimed to validate carrying out the additional Akin osteotomy at a PDPAA > 8° while looking into functional outcomes which have not been studied.MethodsPatients who underwent scarf and combined scarf and Akin osteotomy in our institutional registry was identified. Patient reported outcome measures were compared between patients who underwent scarf and combined scarf and Akin osteotomy. The Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Score (AOFAS), Short Form-36 Physical Component Score (PCS) and Mental Component Score (MCS) were measured pre-operatively and across a follow up period of 2 years.ResultsA total of 212 cases were identified. At a PDPAA > 8, there was no difference in VAS, AOFAS, PCS and MCS between patients that had isolated scarf osteotomy and those that received combined scarf and Akin osteotomy pre-operatively, and at 6 months. However, at 2 years post-operatively, patients that received scarf and Akin osteotomy had a significantly better AOFAS score as compared to patients with isolated scarf osteotomy (82.3 ± 15.3 vs 88.4 ± 13.0, p = 0.0224). On the contrary, at a PDPAA < 8, patients who underwent combined scarf and Akin osteotomy had a significantly lower VAS score at 6 months (1.16 ± 2.16 vs 0.321 ± 1.09, p = 0.00633) and 2 years (0.698 ± 1.73 vs 0.333 ± 1.46, p = 0.0466). They also had a higher AOFAS score at 6 months (80.7 ± 14.3 vs 85.4 ± 12.5, p = 0.0123) and 2 years (83.0 ± 14.0 vs 90.7 ± 9.9, p < 0.0001).ConclusionPDPAA > 8° can serve as a valid indication to carrying out additional Akin on top of scarf osteotomy based on functional outcomes. However, further studies should investigate a PDPAA threshold that is lower than 8°, which can potentially allow more patients to receive the additional Akin osteotomy that can bring better functional outcomes.

Effect of duloxetine on pain and opioid consumption after total knee and hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

Although duloxetine has shown a positive effect on pain relief with hip and knee osteoarthritis, there is no pooled analysis of duloxetine for pain relief and opioid consumption in patients after total hip or knee arthroplasty. This systematic review and meta-analysis aimed to analyze pain control, opioid consumption, and associated adverse events of perioperative administration of duloxetine after total hip or knee arthroplasty. After being registered with PROSPERO (CRD42022323202), the databases of MEDLINE, PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched from inception until March 20, 2023, for randomized controlled trials (RCTs). Primary outcomes were the visual Analog Scale (VAS) pain scores at rest (rVAS) and upon ambulation (aVAS). Secondary outcomes were postoperative opioid consumption quantified as oral morphine milligram equivalents (MMEs) and adverse effects of duloxetine. Nine RCTs with 806 cases were included. Duloxetine was associated with lower VAS scores at different times after surgery (24h, two weeks, and ≥ 3months). Compared to placebo, perioperative daily duloxetine use significantly reduced daily opioid MMEs at 24h (standard mean deviation [SMD] -0.71, 95% confidence interval [95% CI] -1.19 to -0.24,P = 0.003), three days (SMD -1.10, 95% CI -1.70 to -0.50,P = 0.0003), and one week (SMD -1.18, 95% CI -1.99 to -0.38,P = 0.004) after surgery. The duloxetine group had a significantly lower rate of nausea (odds ratio 0.62, 95% CI [0.41 to 0.94], P = 0.02) and a higher rate of drowsiness and somnolence (odds ratio 1.87, 95% CI [1.13 to 3.07], P = 0.01) compared to the placebo group. No significant differences were observed in the rates of other adverse events. Perioperative duloxetine significantly decreased postoperative pain and opioid consumption with good safety profiles. Further high quality designed and well-controlled randomized trials are warranted.