Lower Visual Analogue Score Score Research Articles

Local Anesthetics Lidocaine and Bupivacaine as Pre-emptive Analgesia in Lumbar Region Degenerative Spinal Surgery Patients with Posterior Approach

BACKGROUND: Pain management with pre-emptive analgesia is a pain management strategy to reduce acute post-operative pain. AIM: This research aimed to determine the effectiveness of local anesthetics Lidocaine and Bupivacaine to reduce acute pain after the lumbar spine degenerative surgery using a posterior approach. METHODS: This study was observational research with a prospective cohort and was carried out in 2021 at RSUD Dr. Saiful Anwar Malang with a sample of 12 in each test. The samples obtained were in accordance with the inclusion and exclusion criteria. RESULTS: This assessment used was the Visual Analogue Score (VAS); an instrument for measuring the degree of pain experienced by patients with a value range of 0–10. Bupivacaine group achieved a lower VAS score more than lidocaine and the control group with VAS score 2; however, in another group, mostly was dominated by 3–5 VAS score during fullow-up periode. CONCLUSION: This research showed that pre-emptive analgesia administration using local infiltration of Lidocaine or Bupivacaine before incision in degenerative surgery of the lumbar spine with a posterior approach had a significant effect on the scale of acute post-operative pain. Bupivacaine reduces the post-operative pain scale more effectively than Lidocaine up to 48 h postoperatively.

Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis: A protocol for systematic review and meta-analysis.

Objective:Systematic evaluation of the efficacy and safety of unilateral biportal endoscopic decompression in the treatment of lumbar spinal stenosis.Methods:We conducted a systematic literature search and compared the randomized controlled trials (RCTs) and retrospective studies of unilateral biportal endoscopy (UBE) and microscopic decompression (MD) in the treatment of lumbar spinal stenosis from several databases.Results:Seven studies were included. The results of meta-analysis showed that the operation time of UBE was shorter than that of MD. [SMD = −0.443, 95% CI (−0.717, −0.169), P = .002]. Compared with MD, the patients’ back pain was slighter on the 1st day, 1–2 months and 6 months after UBE. During the long-term follow-up, there was no significant difference in back pain between MD and UBE [SMD = −0.519, 95% CI (−0.934, −0.104), P = .014]. There was no significant difference in lower limb visual analogue score (VAS) score between UBE decompression and MD [SMD = −0.105, 95% CI (−0.356, 0.146), P = .412]. The results of meta-analysis showed that the C-reactive protein (CRP) level of UBE was lower than that of MD [weighted mean difference = −1.437, 95% CI (−2.347, −0.527), P = .002]. There was no significant difference in other clinical effects between the 2 groups.Conclusion:The operation time of UBE was shorter than that of MD, and it was superior to micro decompression in early back VAS score, lower limb VAS score and early postoperative CRP level. There was no statistical difference between UBE and MD in other outcomes.

Evaluation of low dose hyperbaric bupivacaine with or without fentanyl in perianal surgeries: A prospective randomized double blind trial

Spinal anaesthesia should be ideal for perianal surgeries due to its quick onset, reliable anaesthesia with minimal supplies making it cost-effective technique with rapid turnover time.90 patients of ASA grade I-II scheduled for perianal surgeries divided into three groups of 30 each according to intrathecal dose of local anaesthetic: Group LB (Low dose bupivacaine): 0.6 ml of 0.5% hyperbaric bupivacaine (3mg), Group ULBF (ultralow dose bupivacaine plus fentanyl): 0.4 ml of 0.5% hyperbaric bupivacaine (2 mg) + 0.2 ml of fentanyl (10 µg) and Group ULB (ultra low dose of bupivacaine): 0.4 ml of 0.5% hyperbaric bupivacaine (2 mg) + 0.2 ml of normal saline. Three groups were compared in terms of success of block, time to first rescue analgesic from time of block, total rescue analgesic (tramadol) needed in 8 hours since time of block, visual analogue score (VAS) and patient satisfaction score.Successful saddle block was achieved in all patients in Group ULBF, 27 patients in Group LB and none in Group ULB. Group ULBF showed significantly lower mean VAS score when compared to Group ULB and Group LB, and Group LB when compared to Group ULB. Thus the group using fentanyl intrathecally had significantly lesser pain, so the requirement for the first dose of rescue analgesic was significantly earlier in Group ULB and delayed in Group ULBF. Patient satisfaction score was significantly higher in Group ULBF as compared to Group LB and Group ULB and in Group LB as compared to Group ULB.Use of hyperbaric bupivacaine in dose of 3 mg and 2 mg with fentanyl (10 μg) in saddle block are an effective method of achieving successful surgical anaesthesia in patients undergoing perianal surgeries. Hyperbaric bupivacaine (2mg) with fentanyl (10µg) is better than other in providing postoperative analgesia.

Use of Various Doses of S-Ketamine in Treatment of Depression and Pain in Cervical Carcinoma Patients with Mild/Moderate Depression After Laparoscopic Total Hysterectomy.

BackgroundThis study investigated the effects of various doses of S-ketamine on depression and pain management of cervical carcinoma patients with mild/moderate depression.Material/MethodsThis randomized, double-blind, controlled study included 417 cervical carcinoma patients who received laparoscopic modified radical hysterectomy from April 2015 to July 2018 and who also had mild/moderate depression symptoms based on HAMD-17 scores (8~24). All patients were randomized into 4 groups: 1) the control group, 2) the racemic ketamine group, 3) the high-dose S-ketamine group; and 4) the low-dose S-ketamine group. Pain was assessed using the Visual Analogue Score (VAS), and depression was assessed using theHAMD-17 score. Serum levels of BDNF and 5-HT were measured.ResultsThe 4 groups of patients showed no significant differences in operation time, bleeding volume, hospitalization duration, or complications. The high-dose S-ketamine group showed significantly lower VAS and HAMD-17 scores than all other groups at 1 day and 3 days postoperatively, but no differences were observed in the low-dose S-ketamine group and the racemic ketamine group. The high-dose S-ketamine group showed significantly higher serum BDNF and 5-HT levels at 1 day and 3 days after surgery. However, 1 week after surgery, no difference was observed in any of the treatment groups.ConclusionsAt subanesthetic dose, both 0.5 mg/kg and 0.25 mg/kg S-ketamine improved short-term depression and pain for cervical carcinoma patients after surgery, and the effects were better than with the same dose of racemic ketamine.

Arthroscopic riveting with line versus lateral retinacular release plus medial patellofemoral ligament re-construction for habitual patellar dislocation

Objective To compare the clinical efficacy between arthroscopic riveting with line and lateral retinacular release plus medial patellofemoral ligament reconstruction in the treatment of habitual patellar dislocation. Methods A retrospective study was conducted of the 40 children with habitual patellar dislocation who had been treated at Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine from January 2016 to December 2016. They were divided evenly into an observation group and a control group according to the treatment methods (n=20). In the observation group which was treated by lateral retinacular release plus medial patellofemoral ligament reconstruction, there were 14 boys and 6 girls, with an age of 14.2±1.2 years and an average number of dislocations of 5.3±1.1 times. In the control group which was treated by arthroscopic riveting with line, there were 13 boys and 7 girls, with an age of 13.8±1.3 years and an average number of dislocations of 5.5±1.2 times. The 2 groups were compared in terms of visual analogue score (VAS), Q-angle, knee motion, Lysholm score and Kujala score of the knee at the last follow-ups. Results The 2 groups were comparable due to insignificant differences in preoperative general data between them (P>0.05). The observation and control groups were followed up for 13.3±1.2 months and 12.9±1.2 months, respectively, showing no significant difference between them(P>0.05). At the last follow-ups, the observation group had a significantly lower VAS score (2.2±0.8 pints), a significantly smaller Q-angle (14.5°±1.2°), significantly larger knee motion (30.3°±3.8°), and significantly higher Lysholm (91.6±5.3 points) and Kujala scores (93.2±2.8 points) than the control group (4.3±1.1 points, 17.8°±1.6°, 23.4°±3.4°, 81.4±4.4 points and 82.0±5.4 points, respectively) (all P<0.05). Conclusion In the treatment of habitual patellar dislocation, lateral retinacular release plus medial patellofemoral ligament reconstruction can lead to improvements in knee function and clinical symptoms and better clinical outcomes than arthroscopic riveting with line. Key words: Patellar dislocation; Arthroscopy; Bone nails; Lateral retinaculum; Medial patellofemoral ligament

Comparison of Pain Scores between Bamboo and Stainless Steel Finger Traps: An Experimental Study

Objective: The Chinese finger trap is a device used to aid in reduction of fractures, especially in distal end of radius fractures. The stainless steel finger trap is widely used but often causes fingers pain. We adapted a bamboo finger trap to reduce pain and also provide a lower cost alternative.Material and Methods: This was a cross-over study in healthy volunteers comparing bamboo and stainless-steel finger traps. Each participant underwent two tests, one with the stainless steel finger trap and another with the bamboo finger trap. For each trial, the participant lay supine on a bed, and the finger trap was attached to the index and middle fingers of the participant, with the arm suspended by a metal loop at the top of the trap to the elbow level of the patient on the bed. Weights were incrementally added to a weight bag suspended by a strap over the patient’s upper arm at one pound per minute until a maximum weight of 20 lbs. and the participant was asked to rate the degree of discomfort with the increasing weights using a visual analogue score (VAS)Results: Thirty volunteers were tested, all of whom were tested with both the bamboo and stainless steel traction devices. One patient developed a superficial skin injury while the stainless steel device was being applied. Overall, the bamboo finger trap group had lower VAS scores than the stainless steel group in the first fifteen minutes (p-value&lt; 0.001).Conclusion: The bamboo finger trap is an effective alternative to the stainless steel finger trap, causing less pain.

Meta analysis of effectiveness of high-viscosity and low-viscosity bone cement vertebroplasty for osteoporotic vertebral compression fractures

Objective To evaluate the efficacy and safety of high viscosity and low viscosity cement vertebroplasty for osteoporotic vertebral compression fractures (OVCF).Methods The Cochrane Library,Medline,Embase,PubMed,Ovid as well as the Wanfang database and the China Knowledge Network database were searched for all randomized controlled trials (RCTs) of vertebroplasty [percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP)] with high-viscosity bone cement (high-viscosity group) and low-viscosity bone cement (low-viscosity group) in the treatment of OVCF.Methodological quality of the included literature was assessed using the Cochrane Risk Assessment Tool.Stata 12.0 was used for meta analysis to compare the differences of bone cement injection volume,visual analogue score (VAS),Oswestry dysfunction index (ODI),Cobb angle and cement leakage rate between high and low viscosity groups.Subgroup analysis was used to investigate the cement leakage rate in PVP and PKP group.Results A total of nine articles were included,involving 637 patients (with 329 in the low-viscosity group and 308 in the high-viscosity group).Compared with Iow-viscosity group,high-viscosity group was associated with a lower VAS score (WMD =-0.53,95％ CI-0.75--0.30,P ＜0.05),ODI score (WMD =-3.58,95％ CI-5.80--1.36,P ＜ 0.05),Cobb angle (WMD =-2.78,95％CI-4.39--1.18,P ＜ 0.05),and cement leakage rate (RR =0.38,95％ CI 0.29-0.51,P ＜ 0.05).There was no significant difference in the bone cement volume between the two groups (WMD =-0.01,95 ％ CI-0.57-0.54,P ＞ 0.05).Subgroup analysis showed that the cement leakage rate in the high viscosity group was significantly lower than that in the low-viscosity group,regardless of the surgery method (PKP or PVP) (P ＜0.05).In terms of VAS score,ODI score and Cobb angle,the high viscosity group showed better results than the low-viscosity group only in PVP (P ＜ 0.05),not in PKP (P ＞ 0.05).Conclusion Compared with low-viscosity cemented vertebroplasty,high-viscosity cement vertebroplasty has better clinical effect and lower leakage rate in the treatment of 0VCF,which is worthy of further investigation.

All-arthroscopic anatomical reconstruction of anterior talofibular ligament using semitendinosus autografts

Category: Arthroscopy Introduction/Purpose: We introduced a new technique of all-arthroscopic anatomical anterior talofibular ligament (ATFL) reconstruction using semitendinosus autografts. Methods: From June 2012 to June 2013, 28 patients with chronic ATFL rupture underwent arthroscopic anatomic reconstruction of the ATFL. They were divided into the Broström group (n = 16) and reconstruction group (n = 12). The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue score (VAS) was recorded before the operation, 12 months after the operation and 30 months after the operation. Physical examination and radiographs were performed in follow-ups. Results: The patients had higher AOFAS score after the operation in both the Broströmgroup and the reconstruction group. 12 months after operation, the patients in the reconstruction group showed significantly higher AOFAS score and lower VAS score than those in the Broström group (P = 0.003 and 0.001, respectively), while the difference between the two groups was not statistically significant 30 months later (P = 0.425 and 0.323, respectively). Contemporary numbness of the lateral dorsal part of the foot appeared in one (8.3%) patient in the reconstruction group and two (12.5%) patients in the Broström group, and the symptoms diminished after neurotrophic treatment. No other complications, including recurrent instability, were encountered. No donor-side morbidity such as infection or delayed wound healing was observed. Conclusion: The novel surgical technique enhanced postoperative rehabilitation by providing better ankle joint function than modified Broström procedure at 12 months after operation, while the advantage was not statistically significant 30 months later. The long-term outcome requires further investigation. The technique of all-arthroscopic anatomical ATFL reconstruction using semitendinosus autografts proved to be a viable option for ATFL injuries.

Effects of combined spinal–epidural analgesia on first stage of labor: a cohort study

Background: Neuraxial anesthesia is considered as the gold standard in the control labor of pain. Its variants are epidural analgesia and combined spinal–epidural analgesia. Few studies, as yet, have investigated the duration of labor as a primary outcome. Some authors have suggested that combined spinal–epidural analgesia may reduce labor duration but at the moment the benefit of shortening labor is uncertain. The main aim of this study was to compare combined spinal–epidural with epidural analgesia in terms of their effect on duration of stage I labor, maternal, and neonatal outcomes.Methods: A prospective cohort study was conducted. Parturients who requested analgesia at cervical dilatation <6 cm were included. Analgesia was either epidural with low concentration levobupivacaine or combined spinal epidural with subarachnoid sufentanil. The primary outcome was the length of stage I labor. Onset and quality of analgesia, mode of delivery, effects on uterine activity and use of oxytocin, fetal heart rate abnormalities and uterine hyperkinesia, maternal, and neonatal complications were also considered.Results: We enrolled 400 patients: 176 in the combined spinal–epidural group and 224 in the epidural group. Patients in the two treatment groups were similar with regard to demographic characteristics, parity, and incidence of obstetric comorbidities, labor induction, oxytocin infusion, Bishop score, and Visual Analogue Score (VAS) at analgesia request. Duration of stage I labor did not differ, at 195 (120–300) minutes for both the groups (p = .7). Combined spinal–epidural was associated with less reduction in uterine contractility after initial administration: 15.34 versus 39.73%, (p < .001) and with delayed need for oxytocin, at dilations of 7 ± 2.5 cm versus 6. ± 2.7, (p = .002). Onset of analgesia was quicker for combined spinal–epidural analgesia: 31 versus 20%, with VAS <4 after 5 minutes, (p < .001); and lower VAS scores after initial analgesia administration. No differences were found in the other outcomes.Conclusions: Combined spinal–epidural with subarachnoid sufentanil may not reduce the duration of stage I labor, but in our study it appeared to affect uterine contractility less. It also had a more rapid onset and was more effective, without any concomitant increase in maternal or neonatal complications.

Comparative Prospective Study Between Platlete Rich Plasma and Steroid Injection in Treatment of Chronic Planter Fasciitis

Purpose:Compare the results of injection of steroid and PRP in cases of chronic plantar fasciitis INTRODUCTION: plantar fasciitis can be a difficult condition to treat. results of platelet rich plasma (PRP) injection have been promising. We compared PRP to cortisone injection in the treatment of chronic plantar fasciitis resistant to conservative management. METHODS:38 heels (20 heels in the steroid group and 18heels in the PRP group) with plantar fasciitis failed conservative treatment were included to receive either PRP or Steroid injection. All patients were assessed by Visual Analogue Score (VAS) for pain, at 2 weeks 1 month and 3months post injection . RESULTS:Our study included 38 patients; 20 in the steroid arm and 18 had PRP injections. The average age of the steroid injection group was 43.1±9.7 years and in the PRP was 43.1±8.4 years (P= 0.698). The starting average pain scores were 8.6 for both groups (P= 0.712). Then our patients were followed up clinically at 2 weeks, 1 month and 3 months following the injections. There was statistically significant lower VAS scores for the steroid injection group at all follow up visits (P< 0.001 in all follow ups). The average pain scores were 4.9 and 6.7 at 2 weeks follow up for the steroid injection versus the PRP respectively, it was 2 and 4.2 at 1 month and last 0.6 and 1.2 after 3 months respectively. CONCLUSIONS:PurposThe purpose of this study was to assess the safety and preliminary clinical results of platelet-rich plasma (PRP) injections for treating chronic plantar fasciitisMethods Fourteen consecutive patients with chronic plantar fasciitis receiving three injections of PRP into the plantar fascia were assessed 12 months after the procedure. The modified Roles and Maudsley score and a visual analogue scale (VAS) for pain were used to evaluate the clinical results. Results According to criteria of the Roles and Maudsley score, at 12 months of follow-up, results were rated as excellent in nine (64.3 %), good in two (14.3 %), acceptable in two (14.3 %) and poor in one (7.1 %) patient. VAS for pain was significantly decreased from 7.1 ± 1.1 before treatment to 1.9 ± 1.5 at the last follow-up (p < 0.01). Conclusions In this single-centre, uncontrolled, prospective, preliminary study, results indicate that treating chronic plantar fasciitis with PRP injections is safe and has the potential to reduce pain. This study demonstrates that both steroid and PRP injections are highly effective in treatment of chronic plantar fasciitis but improvement in pain was more rapid with steroid injection. This study recommends for follow up for a longer period than three months to compare long term benefits of steroids and PRP.

All-arthroscopic anatomical reconstruction of anterior talofibular ligament using semitendinosus autografts.

We introduced a new technique of all-arthroscopic anatomical anterior talofibular ligament (ATFL) reconstruction using semitendinosus autografts. From June 2012 to June 2013, 28 patients with chronic ATFL rupture underwent arthroscopic anatomic reconstruction of the ATFL. They were divided into the Broström group (n = 16) and reconstruction group (n = 12). The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue score (VAS) was recorded before the operation, 12months after the operation and 30months after the operation. Physical examination and radiographs were performed in follow-ups. The patients had higher AOFAS score after the operation in both the Broström group and the reconstruction group. 12months after operation, the patients in the reconstruction group showed significantly higher AOFAS score and lower VAS score than those in the Broström group (P = 0.003 and 0.001, respectively), while the difference between the two groups was not statistically significant 30months later (P = 0.425 and 0.323, respectively). Contemporary numbness of the lateral dorsal part of the foot appeared in one (8.3%) patient in the reconstruction group and two (12.5%) patients in the Broström group, and the symptoms diminished after neurotrophic treatment. No other complications, including recurrent instability, were encountered. No donor-side morbidity such as infection or delayed wound healing was observed. The novel surgical technique enhanced post-operative rehabilitation by providing better ankle joint function than modified Broström procedure at 12months after operation, while the advantage was not statistically significant 30months later. The long-term outcome requires further investigation. The technique of all-arthroscopic anatomical ATFL reconstruction using semitendinosus autografts proved to be a viable option for ATFL injuries.

The analgesic efficacy of continuous transversus abdominis plane block in renal transplant recipients.

Background and Aims:Transversus abdominis plane (TAP) block is suitable for operations where parietal pain is a major cause of pain. Renal transplant recipients are ideally suited to gain maximum benefit from TAP block as the incision classically involves the lower abdomen. This study was conducted to evaluate the analgesic efficacy of continuous TAP block in transplant recipients.Material and Methods:In a prospective double-blind study, 40 chronic renal failure patients undergoing open renal transplant were randomly divided into two groups. At the end of surgery during closure, a multiorifice epidural catheter was placed in TAP plane. Study group (Group S) received Inj bupivacaine bolus 1 mg/kg (0.25%) followed by infusion 0.25 mg/kg (0.125%) through the catheter, whereas control group (Group C) received normal saline through the catheter. Inj pentazocine (0.3 mg/kg) was given as rescue analgesic at visual analogue score (VAS) > 3 in any group at rest or on movement. The analgesic efficacy was judged by VAS, time of first rescue analgesic, and total analgesic consumption in 24 h.Results:Patients in Group S had significant lower VAS scores, longer time to first rescue analgesic (270 ± 347.96 vs. 42.85 ± 32.27 min) and lower pentazocine consumption (9.75 ± 13.95 vs. 56.42 ± 12.46 mg) in 24 h. There was significant sedation in Group C.Conclusion:The TAP catheter technique for postoperative pain control after renal transplant has proved to be effective in relieving the postoperative pain after renal transplant with less pentazocine requirement and less sedation.

Chinese herbal medicine for atopic eczema

Chinese herbal medicine (CHM) has been increasingly usedfor atopic eczema. A previous version of this Cochrane review published in 2004 found some evidence of a possible benefit for oral ingestion of CHMfor eczema, but the results were inconclusive and the evidence needs to be updated. We have expanded the scope of this review to include an assessment of the topical and oral effects of CHM for eczema. To assess the effects of oral ingestion and topical applications of CHM for the management of eczema in children and adults. We searched the following databases up to September 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 8), MEDLINE (from 1946), EMBASE (from 1974), AMED (from 1985), LILACS (from 1982), and CINAHL (from 1981). We searched the following from inception: SCOPUS, HERBMED, ProQuest, CQVIP, CNKI, and Wanfang Data. We also searched trials registers, handsearched conference proceedings, checked the reference lists of all included and excluded studies and review articles for further references to relevant trials, and contacted experts in Chinese medicine for unpublished studies. All randomised controlled trials (RCTs) in children and adults with eczema comparing CHM to placebo; no intervention; active controls, including acupuncture; or conventional medicines. Two authors selected the RCTs, extracted data, and assessed quality independently. We contacted study authors for missing data. We collected adverse events from the included studies. We included 28 studies, with a total of 2306 participants. We assessed most of the studies at high 'risk of bias', particularly in blinding of participants and personnel, and there was substantial inconsistency between studies, so any positive effect of CHM must be treated with caution. We did not include the four studies from the previous version in this review, because they investigated a CHM product that has been withdrawn from the market since 2004.Four studies (three oral and one topical) compared CHM to placebo. Pooled data from 2 studies showed the total effectiveness rate in the CHM group was higher (by risk ratio (RR) 2.09, 95% confidence interval (CI) 1.32 to 3.32; 2 studies; n = 85), and the itching visual analogue score (VAS) in the CHM group was 1.53 lower (by standardised mean difference (SMD), 95% CI 2.64 to 0.41; 2 Studies; n = 94) than the placebo group, where a lower VAS score indicates reduceditch. One study of 85 participants with moderate to severe eczema who received an oral CHM formula for 12 weeks reported a quality of life (QoL) score 2.5 lower in the CHM group (by difference in means (MD), 95% CI 4.77 to 0.23; 1 study; n = 85) than the placebo group, where a lower score indicates better QoL. Twenty-two studies and 1 arm from a study with a 4-arm parallel controlled design compared CHM (5 oral, 6 topical, and 12 mixed oral and topical) to conventional medicines. The total effectiveness rate in the CHM groups was superior (RR 1.43, 95% CI 1.27 to 1.61; 21 studies; n = 1868; very low quality evidence), and the itching VAS in the CHM groups was 0.83 lower (SMD, 95% CI 1.43 to 0.22; 7 studies; n = 465) than the comparators.Two studies compared combined oral and topical CHM to the same oral CHM formula alone. The total effectiveness rate in 1 study was not statistically significant (RR 1.13, 95% CI 0.78 to 1.63; 1 study; n = 20). In the other study, the itching VAS in the CHM group was 1.05 lower (MD, 95% CI 1.75 to 0.35; 1 study; n = 23) than the control group.With regard to side-effects, four studies did not give any report of adverse events. The other 24 studies reported minor adverse events, which were reversed soon after stopping CHM. One participant withdrew from one trial because of exacerbation of their condition after using the CHM intervention.Eight studies received government funding. We could not find conclusive evidence that CHM taken by mouth or applied topically to the skin could reduce the severity of eczema in children or adults.Well-designed, adequately powered RCTs are needed to evaluate the efficacy and safety of CHM for managing eczema.

Comparison of general anaesthesia versus regional anaesthesia with sedation in selected maxillofacial surgery: a randomized controlled trial

BackgroundThe airway is the foremost challenge in maxillofacial surgery. The major concerns are difficulty in managing the patient's airway and sharing it between the anaesthetist and surgeons. General anaesthesia, with endotracheal intubation, is the commonly used technique for maxillofacial procedures.We assessed the efficacy and safety of a regional block with sedation technique in certain maxillofacial operations, specifically temporomandibular joint (TMJ) ankylosis and mandibular fracture cases, and compared it with conventional general anaesthesia. We compared the time to discharge from the post anaesthesia care unit (PACU) and the occurrence of side effects, as well as surgeon and patient satisfaction with the anaesthetic technique, between the two groups. Materials & MethodsWe enrolled 50 patients of ASA grade 1 or 2, aged 15–50 years, scheduled for maxillofacial surgery (mandibular fracture or TMJ ankylosis). The patients were divided into two groups of 25 each, to receive sedation with a regional block with the use of a peripheral nerve stimulator in group I and general anaesthesia in group II. We observed haemodynamic parameters, intraoperative and postoperative complications and the amount of surgical bleeding in the two groups. Total anaesthesia time, patient and surgeon satisfaction, time to rescue analgesia, the number of rescue doses required, and the time to discharge from the PACU were compared. ResultsThe groups were comparable with respect to demographic profile, intraoperative haemodynamic parameters, surgical time, and amount of blood loss. Postoperative pain was assessed using the visual analogue score (VAS). Patients in group I had lower VAS scores after surgery and remained pain-free for longer than those in group II. The mean pain-free interval in group I was 159.12 ± 43.95 min and in group II was 60.36 ± 19.77 min (p < 0.005). Patients in group I required lower doses of rescue analgesia than those undergoing the surgery under general anaesthesia (p < 0.005). Patients receiving regional blocks also had fewer episodes of postoperative nausea and vomiting (p = 0.005). These results led to earlier discharge of patients in group I from the PACU. ConclusionsRegional block with sedation is a safe alternative technique for patients undergoing surgery for mandible fracture or TMJ ankylosis, with clear advantages over general anaesthesia.

Use of Blue Citrus, a Chinese herbal remedy, to reduce side effects of aromatase inhibitors.

170 Background: Aromatase inhibitors are widely used in treatment of estrogen receptor positive breast cancer. Many patients experience significant arthralgias, which may lead to early cessation of therapy. Blue Citrus, a mix of Chinese herbs formulated in our community, had anecdotal reports of success in alleviating these symptoms. We objectively evaluated its activity in symptomatic patients. Methods: Breast cancer patients with significant arthralgia on aromatase inhibitors were enrolled in a prospective fashion to a double blind crossover placebo controlled trial. Each patient received either Blue Citrus (BC+P) or a placebo (P+BC) for three months and then crossed over to the opposite treatment for an additional three months. Symptoms were measured over the course of treatment. Results: A total of 37 patients enrolled on the study. There were 6 early withdrawals, which left 31 evaluable patients. Visual Analogue Score (VAS) for both groups was similar at baseline at 4.9 and 5.1 for the BC+P and P+BC groups, respectively. At 30 days the BC+P score was 3.4 vs. the P+BC of 4.7 showing clearly improved symptom control in the BC+P group. The P+BC group did however approach the BC+P group by 90 days. At crossover the BC+P group experienced a spike in symptomology when changed to placebo that didn’t appear for the P+BC group. When compared to baseline, mean VAS score on Blue Citrus was 2.98 (p=0.001) versus mean VAS score on placebo 3.92 (p=0.0203). By study end (180 days) the VAS scores for both groups were closer at 2.6 BC+P vs. 3.0 for P+BC but BC+P still maintained lower VAS scores. Conclusions: Blue Citrus improved symptoms associated with aromatase inhibitor use. Patients who received Blue Citrus in the first arm had rapid improvement in symptoms and experienced return of symptoms when converted to placebo. All patients averaged lower VAS scores on Blue Citrus however at 6 months the difference between the arms became less pronounced.

Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine.

For treatment of intra and postoperative pain, no drug has yet been identified that specifically inhibits nociception without associated side effects. Magnesium has antinociceptive effects in animal and human models of pain. The current prospective randomised double-blind study was undertaken to establish the effect of addition of magnesium or clonidine, as adjuvant, to epidural bupivacaine in lower abdominal and lower limb surgeries. A total of 90 American Society of Anesthesiology (ASA) grade I and II patients undergoing lower abdominal and lower limb surgeries were enrolled to receive either magnesium sulphate (Group B) or clonidine (Group C) along with epidural bupivacaine for surgical anaesthesia. All patients received 19 ml of epidural bupivacaine 0.5% along with 50 mg magnesium in group B, 150 mcg clonidine in Group C, whereas in control group (Group A), patients received same volume of normal saline. Onset time, heart rate, blood pressure, duration of analgesia, pain assessment by visual analogue score (VAS) and adverse effects were recorded. Onset of anaesthesia was rapid in magnesium group (Group B). In group C there was prolongation of duration of anaesthesia and sedation with lower VAS score, but the incidence of shivering was higher. The groups were similar with respect to haemodynamic variables, nausea and vomiting. The current study establishes magnesium sulphate as a predictable and safe adjunct to epidural bupivacaine for rapid onset of anaesthesia and clonidine for prolonged duration of anaesthesia with sedation.