Lower Visual Analog Scale Scores Research Articles

Impact of Intraspinal Nerve Block Anesthesia on Intrapartum Fever and the Neonate.

Objective To evaluate the impact of intraspinal nerve block anesthesia on intrapartum fever and the neonate. Methods In this prospective study, between October 2019 and December 2020, 90 eligible primiparous women enrolled in the obstetrics and gynecology department of our hospital for delivery were recruited and assigned via the random number table method at a ratio of 1 : 1 to either an analgesic group given intraspinal nerve block anesthesia for labor or a nonanalgesic group without anesthesia for labor. Outcome measures included intrapartum body temperature, cases of intrapartum fever, Apgar scores of neonates, visual analogue scale (VAS) scores, delivery mode, and indomethacin use. Results Intraspinal nerve block anesthesia was associated with a higher body temperature at 4 h and 5 h after analgesia and more cases of intrapartum fever versus no anesthesia (P < 0.05). There were no significant differences in the Apgar scores between the two groups (P > 0.05). Participants given intraspinal nerve block anesthesia had lower VAS scores during labor versus those without anesthesia (P < 0.05). The differences in the delivery mode between the two groups were not significant (P > 0.05). Intraspinal nerve block anesthesia resulted in a significantly higher demand for indomethacin versus no anesthesia (P < 0.05). Conclusion Intraspinal nerve block anesthesia is clinically effective in labor analgesia but may cause increased body temperature or even overt clinical fever, so close clinical observation of maternal temperature changes is required to mitigate the effects of anesthesia on the mothers. No adverse consequences of intraspinal nerve block anesthesia on the newborns were reported in this study.

The effects of combined microwave ablation and open surgery for the treatment of lung cancer-derived thoracolumbar metastases.

ObjectiveTo investigate the clinical effects of microwave ablation (MWA) in addition to open surgery for the treatment of lung cancer‐derived thoracolumbar metastases.MethodsThis was a single‐institution, retrospective, cohort study. From January 2019 to December 2020, a total of 47 patients with lung cancer‐derived thoracolumbar metastases underwent posterior spinal canal decompression and fixation surgery in our hospital. Two independent surgical teams treated these patients. One group underwent open surgery combined with MWA therapy, while the other had open surgery only (control). The pre‐ and post‐operative visual analog scale (VAS) scores and the overall survival (OS) were compared between the MWA and control groups. The Frankel Grade classification was applied for the evaluation of the post‐surgical spinal cord function. Improvement was defined as an increase of at least one rank from the pre‐operative scores. Each patient was evaluated pre‐ and post‐operatively at 48 h, 1 month, and 3‐month intervals. Data on surgical‐related complications were recorded.ResultsThirty men and 17 women were included, with an average age of 57.9 ± 11.4 years (range, 26–81 years). Twenty‐eight patients underwent MWA and were in the MWA group, and 19 patients were included in the control group. Post‐operatively all patients were followed up regularly; the median follow‐up time was 12 months (range, 3–24 months), and their median OS was 14 months. Patients in the MWA group had a lower VAS score than those in the control group at the 48‐h (1.75 ± 1.01 vs 2.47 ± 0.96, P = 0.01) and 1‐month (1.79 ± 0.92 vs 2.53 ± 1.35, P = 0.048) check‐ups. At the 3‐month evaluation, the VAS score differences between the two groups were not significant (P = 0.133). After surgery, spinal cord function improvement was not significantly different between the MWA and control groups (P = 0.515). MWA therapy combined with open surgery was not associated with increased OS compared with the control group (P = 0.492).ConclusionMWA can be an effective and safe pain‐relief method but may not extend the OS of patients with lung cancer.

Whether Out-of-Bed Activity Restriction in the Early Postoperative Period of PELD Is Beneficial to Therapeutic Efficacy or Reduce Recurrence.

ObjectiveTo detect the influences of postoperative out-of-bed activity restriction on recurrence rate, low back and leg pain, functional rehabilitation after percutaneous endoscopic lumbar discectomy (PELD).MethodsIn this research, 213 patients with lumbar intervertebral disc herniation (LDH) who underwent PELD were divided into the out-of-bed activity restriction group and out-of-bed activity non-restriction group. The visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate postoperative clinical efficacy at 1 and 3 months after the operation, and to count the recurrence rates. All of these operations were performed between August 2017 and July 2020, and they were followed in the outpatient department for 12 months at least.ResultsBoth of the groups showed significantly lower VAS and higher ODI scores at 1 month and 3 months post-operation, respectively, when compared with pre-operation. At 1 month after the operation, the restriction group performed lower VAS scores of low back pain compared with the non-restriction group, but this advantage disappeared at 3months post-operation. However, there was no statistical difference in the VAS scores of leg pain and ODI scores between the two groups, neither at 1 nor 3 months after the surgery. The recurrence rate is significantly lower in the restriction group than in the non-restriction group at a 12-month follow-up after the surgery.ConclusionOut-of-bed activity restriction in the early postoperative period of PELD could reduce LDH recurrence effectively, and it may relieve the low back pain to some extent. It has no benefit in the recovery of leg pain and functional rehabilitation.

Paper 03: Multimodal Pain Regimen is Equivalent to Opioid Analgesia Following Arthroscopic Rotator Cuff Surgery: A Prospective Randomized Controlled Trial

Objectives:To evaluate the efficacy of a multimodal non-opioid analgesic protocol in controlling postoperative pain compared to opioids following a primary arthroscopic rotator cuff repair.Methods:Seventy consecutive patients undergoing a primary rotator cuff repair were assessed eligibility. A prospective randomized controlled trial was designed in accordance with the Consolidated Standards of Reporting Trials 2010 (CONSORT) statement. The two arms of the study included a multimodal non-opioid pain regimen for the experimental group, and a standard of care narcotics for the control group. The primary outcome was visual analog scale (VAS) pain scores for the first ten postoperative days. Secondary outcomes included PROMIS-PI, patient satisfaction, and adverse drug events. Patients were randomized using a random number generator. Whiles patients were not blinded to their treatment group, all reported outcomes were collected by blinded observers.Results:Twenty-six patients either declined to participate or were excluded from the study. Forty-four patients were included in the final analysis. A total of 27 patients were in the traditional group and 17 patients were in the nonopioid group. Patients in the traditional pain control group reported a significantly lower VAS pain score on post-operative day 1 (opioid: 5.7 ± 2, nonopioid: 3.7 ± 2.2, p=0.011) and post-operative day 4 (opioid: 4.4 ± 2.7, nonopioid: 2.4 ± 2.2, p=0.023). No significant difference was seen on any other postoperative day. When mixed measured models were used to control for confounding factors the non-opioid group demonstrated significantly lower VAS and PROMIS-PI scores (p<0.01) at every time point. The most commonly reported side effects for patients in both groups were drowsiness (opioid: 2.7 ± 3.3 days, nonopioid: 1.9 ± 3.3 days) and constipation (opioid: 2.2 ± 2.9 days, nonopioid: 0.2 ± 0.6 days). Patients in the traditional analgesia group reported significantly greater average number of days with constipation (opioid: 2.2 ± 2.9, nonopioid: 0.2 ± 0.6, p=0.003) and days with upset stomach (opioid: 1.3 ± 2.5, nonopioid: 0.0 ± 0.0, p=0.020) than those in the nonopioid group.Conclusions:This study found that a multimodal nonopioid pain protocol provided at least equivalent pain control compared to traditional opioid analgesics in patients undergoing primary arthroscopic rotator cuff repair. Minimal side effects were noted with some improvement in the multimodal nonopioid pain cohort, and all patients reported satisfaction with their pain management.

The effect of different anaesthesia techniques on postoperative pain and hospital discharge in varicose vein surgery.

Venous insufficiency caused by varicose veins, especially in the lower extremities, is widespread and can cause severe complications. Anaesthesia is essential for any surgical approaches in varicose vein surgery. This study evaluated the effect of single-dose epidural anaesthesia on postoperative pain scores and length of hospitalisation after varicose vein surgery, comparing it with general anaesthesia. The study was conducted on a total of 100 patients, aged 18 years and older, with the American Society of Anesthesiologists (ASA) physical status classification I-III, undergoing unilateral lower-extremity stripping due to varicose veins within a six-month period at the Prof Dr Cemil Taşçioğlu City Hospital Anesthesiology and Reanimation Service. Fifty patients with single-dose epidural anaesthesia were consecutively included in the EA group. For comparison, 50 patients who were operated on under general anesthesia were included in the GA group. The groups showed statistically significant differences between the 30th-minute and first-, second-, fourth- and sixth-hour visual analogue scale (VAS) scores (p = 0.001; p < 0.01). Patients with epidural anaesthesia had lower 30th-minute VAS scores compared to those administered general anaesthesia. There were statistically significant differences identified between the groups for the additional analgesia requirements of patients (p = 0.001; p < 0.01). Subjects with epidural anaesthesia had lower additional analgesic requirements than those administered general anaesthesia. Epidural anaesthesia provided adequate anaesthesia with more effective postoperative analgesia compared to patients operated on under general anaesthesia and receiving multimodal analgesia for postoperative analgesia.

Health-Related Quality of Life and Its Related Factors in Survivors of Stroke in Rural China: A Large-Scale Cross-Sectional Study.

BackgroundStroke is a major health threat and the leading cause of mortality and disability in China. The aims of this study were to identify the possible influencing factors of health-related quality of life (HRQoL) and its domain-specific contents in stroke patients in rural areas in China.MethodsA total of 1,709 stroke patients aged 36–79 years from the baseline data of Henan Rural Cohort study (n = 39,259) were included in the cross-sectional study. The Chinese version of the European Quality of Life Five Dimension (including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) Five Level Scale (EQ-5D-5L) and visual analog scale (VAS) were used to evaluate HRQoL in stroke patients. Tobit regression models, generalized linear models and binary logistic regression models were constructed to determine potential influencing factors of the EQ-5D utility index, as well as influencing factors of each domain and VAS score.ResultsThe mean utility index and VAS scores of stroke patients were 0.885 (SD, 0.204), and 68.39 (SD, 17.31), respectively. Pain/discomfort (PD, 35.2%) and mobility (MO, 30.4%) were the most frequently reported issues. Regression models revealed that illiterate; a low monthly income; low physical activity intensity; and diabetes, anxiety, depression, or poor sleep quality were significantly associated with lower utility index and VAS scores among stroke patients. In addition, patients with stroke who were older, female, drinking, smoking, and consuming a high-fat diet, had a higher BMI, and lived with a stroke for a longer time, were also significantly associated with different dimensions of the EQ-5D.ConclusionPatients with stroke in rural areas in China had a low HRQoL. Factors associated with the EQ-5D utility index as well as each domain and VAS score, need to be considered by health providers in rural areas. Patients with stroke in rural areas need to be included in national basic public medical services and managed systematically by medical institutions.

Efficacy of Transversus Abdominis Plane Block in Patients After Laparoscopic Radical Cervical Cancer Surgery

ObjectiveThis study aimed to evaluate the efficacy of transversus abdominis plane block (TAPB) in patients after laparoscopic radical cervical cancer surgery.MethodsA total of 120 patients with cervical cancer who underwent laparoscopic radical resection in the hospital from January 2019 to January 2020 were selected and concurrently assigned to either patient-controlled intravenous analgesia (PCIA) (Control group) or PCIA plus TAPB (Observation group) according to different methods. The visual analogscale (VAS), Bruggemann comfort scale (BCS), immune function indicators, hemodynamics, analgesia indicators, and postoperative recovery time were recorded and compared.ResultsThe Observation group had a lower VAS score and a higher BCS postoperatively compared with the Control group, and the difference was statistically significant. After the operation, immune function indexes of patients in the two groups were declined, and the difference was statistically significant. At 76 h after operation, the immune function indexes of the Control group were lower than the Observation group, and the difference was statistically significant. After the operation, the Control group obtained a higher mean arterial pressure (MAP) at extubation, and the difference was statistically significant. The Observation group outperformed the Control group in terms of analgesia indicators and postoperative recovery time, and the difference was statistically significant.ConclusionTAPB can enhance the analgesic effect of patients after laparoscopic radical resection of cervical cancer, stabilize their physical signs, has little effect on the patient's immune function, with a high safety profile.

Effects of Different Nonsteroidal Anti-Inflammatory Drugs Combined with Platelet-Rich Plasma on Inflammatory Factor Levels in Patients with Osteoarthritis.

Objective To investigate the effects of different nonsteroidal anti-inflammatory drugs combined with platelet-rich plasma on inflammatory factor levels in patients with osteoarthritis. Methods The clinic data of 120 patients with osteoarthritis who were treated in our hospital (June 2019-June 2021) were retrospectively reviewed. All the patients were given platelet-rich plasma. According to the different nonsteroidal anti-inflammatory drugs the patients received, they were equalized into diclofenac sodium group, celecoxib group, and iguratimod group, with 40 cases in each group. After treatment, the patients' clinical efficacy was compared and analyzed. Results After treatment, the pain degrees of the patients in the three groups were gradually reduced. After 4 weeks and 8 weeks of treatment, the statistical differences in the scores of Visual Analogue Scale (VAS) were found among the three groups. Specifically, compared with the other two groups, the iguratimod group had remarkably lower VAS scores (P < 0.05) and the celecoxib group had signally lower VAS scores compared with the diclofenac sodium group (P < 0.05). After treatment, the inflammatory factor levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) in the diclofenac sodium group were observably higher compared with the celecoxib group (P < 0.05), and the inflammatory factor levels in the celecoxib group were remarkably higher compared with the iguratimod group (P < 0.05). Before treatment, no notable difference in the Lysholm scores was found among the three groups, and the patients' knee joint function was gradually improved after treatment. To be specific, after 4 and 8 weeks of treatment, the iguratimod group had observably higher Lysholm scores compared with the other two groups (P < 0.05), and the celecoxib group had signally higher Lysholm scores compared with the diclofenac sodium group (P < 0.05). The iguratimod group got markedly lower Western Ontario and McMaster Universities (WOMAC) score compared with the celecoxib group (P < 0.05); Compared with the diclofenac sodium group, the celecoxib group got remarkably lower WOMAC score (P < 0.05). During treatment, few patients suffered from mild gastrointestinal discomfort and hepatic dysfunction in the three groups, and no other severe adverse reactions were found. No statistical difference in the total incidence of adverse reactions among the three groups was observed (P > 0.05). Conclusion The combination of nonsteroidal anti-inflammatory drugs with platelet-rich plasma can further reduce the inflammatory reactions of the patients with osteoarthritis and improve their knee joint function. Significantly, the iguratimod, with high safety, has observably better effects on inhibiting inflammatory factors and improving knee joint function compared with diclofenac sodium and celecoxib.

Comparison of Therapeutic Effects of PVP and PKP Combined With Triple Medication on Mild and Moderate Osteoporotic Vertebral Compression Fracture in the Elderly.

ObjectiveTo compare and analyze the therapeutic effect of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) combined with triple therapy on elderly patients with mild to moderate osteoporotic vertebral compression fractures (OVCF).MethodsA total of 114 cases of elderly patients with mild to moderate osteoporotic vertebral compression fractures were identified as research subjects in our hospital from January 2017 to January 2018, and a total of 136 vertebrae were included. The patients who underwent PVP operation were included as the control group with 67 injured vertebrae, and the patients who underwent PKP operation were included as the experimental group with 69 injured vertebrae.ResultsThe operation time and bone cement injection volume of the experimental group were significantly higher than the control group. The visual analog scale (VAS) scores of the two groups at 3 months and 6 months after operation were lower than those before operation, with lower VAS scores observed in the experimental group at 3 months and 6 months after operation. The anterior height of the vertebral body in the experimental group was higher than that of the control group. The experimental group outperformed the control group in the incidence of postoperative complications. The postoperative Oswestry dysfunction index (ODI) scores of the two groups were lower before the operation, in which the experimental group had lower scores than the control group (P < 0.05).ConclusionPVP and PKP combined with postoperative triple therapy can achieve a promising analgesic effect. PKP has a higher volume of bone cement injection volume, and a lower incidence of complications, which gives rise to a better vertebral body recovery height than that of PVP, with rapid postoperative body function recovery and good quality of life.

Clinical significance of methyl-CpG binding protein 2 in postherpetic neuralgia: an observational study

The present study was aimed to investigate the clinical significance of methyl-CpG binding protein 2 (MECP2) in patients with postherpetic neuralgia (PHN). This prospective case control study enrolled 319 cases of PHN patients from April 2017~December 2019. The patients’ sleep quality and quality of life were evaluated using the Pittsburgh sleep quality score and the SF-36 scale, respectively. The serum levels of MECP2, CRP, IL-6 and TNF-α were tested using enzyme linked immunosorbent assay (ELISA). The pain condition of the patients was evaluated using the visual analogue scale (VAS). The levels of MECP2 were significantly increased in PHN patients compared with the patients without PHN. Serum MECP2 levels were the highest in patients with severe pain, and were the lowest in patients with mild pain. Similarly, the frequency of severe pain in patients with low expression of MECP2 was significantly lower than the patients with higher MECP2 expression. Besides, serum levels of inflammatory factors CRP, IL-6 and TNF-α were markedly increased in PHN patients, which were also increased with the increase of the severity of pain. CRP, IL-6 and TNF-α were positively correlated with serum levels of MECP2 in PHN patients. Before the study, patients with lower MECP2 levels showed a significantly higher SF-36 score and lower Pittsburgh and VAS scores than patients with higher levels of MECP2. However, after one month, no significant difference was found between the patients. ROC curve showed MECP2 had the potential as a diagnostic biomarker for PHN. In conclusion, higher serum MECP2 levels are associated with a more severe pain condition and increased release of inflammatory factors.

Efficacy comparison of unilateral biportal endoscopic decompression and extended interlaminar fenestration for lumbar lateral recess stenosis

Objective: To analyze and compare the clinical efficacy of unilateral biportal endoscopic(UBE) decompression and extended interlaminar fenestration for lumbar lateral recess stenosis. Methods: A retrospective analysis of 103 patients treated with UBE decompression or extended interlaminar fenestration for lumbar lateral recess stenosis from July 2017 to June 2020 in the Second Hospital of Anhui Medical University was performed. Eighty patients aged 40 to 86 (63.2±9.8) years were included in this study, including 42 males and 38 females. Forty patients received UBE decompression (UBE group) and 40 patients received extended interlaminar fenestration (fenestration group). Operative time, length of incision, hospital stay and complications were recorded. The visual analogue scale (VAS) scores of low back pain and leg pain and Oswestry dysfunction index (ODI) scores were recorded preoperatively and at 1, 3 and 6 months after the operation and at the final follow-up, and the modified Macnab scale was used to evaluate the clinical efficacy at the final follow-up. Results: Patients in both groups successfully received lumbar lateral recess decompression and were followed up for (12.9±5.4) months in the UBE group and (14.9±3.5) months in the fenestration group, respectively. The operation time in the UBE group was (63.9±11.6) min, it was higher than that in the fenestration group ((54.1±9.2) min, P<0.001). The average incision length in the UBE group was (18.2±1.7) mm, it was lower than that in the fenestration group ((73.5±11.6) mm, P<0.001). Postoperative hospital stay in the UBE group was (4.1±2.2) d, it was lower than that in the fenestration group ((7.6±3.1) d, P<0.001). VAS scores of low back pain were improved after operation in both groups. Low back pain VAS scores of UBE group were lower than those in fenestration group at 1 and 3 months post operation (both P<0.05). The VAS scores of lower limb pain were improved after operation in both groups and there was no statistically significant difference between the two groups at postoperative 1, 3, 6 months after the operation and at the last follow-up (all P>0.05). ODI scores were improved after operation in both groups. ODI scores of UBE group were lower than those in fenestration group at postoperative 1 month and 3 months(both P<0.05). Intraoperative dural tear occurred in 2 cases(5.0%) in the UBE group and 1 case(2.5%) in the fenestration group, with no statistically significant difference between the two groups (P=0.556). According to the modified Macnab scale at the last follow-up, 35 cases were excellent, 3 cases were good, and 2 cases were fair in the UBE group, and 37 cases were excellent, 2 cases were good, and 1 case was fair in the open group. The difference was not statistically significant between the two groups (P=0.745). Conclusion: Compared with the extended interlaminar fenestration, UBE technique can not only reduce the early postoperative low back pain, shorten hospital stay, but also achieve the same long-term clinical efficacy with less trauma.

Invasive surgical procedures for the management of internal derangement of the temporomandibular joint: a systematic review and meta-analysis regarding the effects on pain and jaw mobility.

This systematic review compared minimally and invasive surgical procedures to manage arthrogenous temporomandibular joint (TMJ). The review included clinical trials assessing surgical procedures of arthrogenous temporomandibular disorder (TMD) management by carrying out comparisons within the same surgical procedure (pre- and post-treatment) as well as between different surgical procedures. Meta-analyses were conducted only for similar comparison reporting the same outcome measures, visual analog scale (VAS) values to evaluate pain and maximum incisal opening (MIO) values. Of the 1,015 studies identified by the search strategy, 26 were selected for full-text reading, and 19 were included in the review. Of these, 16 studies were included in the meta-analysis and 3 in the qualitative analysis. The VAS scores showed significantly lower values after discectomies (p < 0.001) and discoplasties (p < 0.001) in the within-group comparison. Moreover, significantly lower VAS scores and higher MIO values were observed after discectomy compared to arthroscopy, eminectomy, and discoplasty (p < 0.05). The findings of this systematic review suggest that although significantly lower VAS scores and higher MIO values were observed after discectomy, the currently available scientific evidence is unclear, and the use of invasive surgical procedures should not be implemented as an efficient first-line treatment option for arthrogenous TMD management. VAS and MIO outcomes could be insufficient to describe the success or failure of open surgical procedures like discectomy and discoplasty.

Quality of life of children with neurodevelopmental disorders and their parents during the COVID-19 pandemic: a 1-year follow-up study

This study aimed to reveal changes in the quality of life (QOL) of children with neurodevelopmental disorders and their parents, and the interaction between their QOL and parental mental state during the coronavirus 2019 (COVID-19) pandemic. Eighty-nine school-aged children and parents participated in surveys in May 2020 (T1) and May 2021 (T2). The parents completed questionnaires that assessed their QOL, depression, parenting stress, and living conditions. Children’s temporary mood status was evaluated using the self-reported visual analog scale (VAS). Children’s QOL and VAS at T2 were higher than their QOL at T1. Parents’ QOL at T2 was lower than their QOL at T1. Severe parental depression at T1 had a synergistic effect on severe parenting stress and severe depressive state at T2. Additionally, children’s high QOL at T1 had a synergistic effect on low parenting stress and children’s high QOL at T2. Furthermore, children’s low VAS scores and parents’ low QOL at T2 were associated with deterioration of family economic status. Children and parents’ QOL changed during the prolonged COVID-19 pandemic. Improvement in children’s QOL was influenced by reduced maternal depressive symptoms. Public support for parental mental health is important to avoid decreasing QOL.

Reduced Concentrations of NSE, S100β, Aβ, and Proinflammatory Cytokines in Elderly Patients Receiving Ultrasound-Guided Combined Lumbar Plexus-Sciatic Nerve Block during Hip Replacement.

Objective The increase of hip fractures is related to the aging of the population, which has caused a huge medical burden in many countries. Hip replacement has been approved as a highly successful surgical intervention for the patients with hip fractures. Different anesthesia choices in the surgical intervention are associated with the prognosis of patients. This study focused on investigating the application of ultrasound-guided combined lumbar plexus-sciatic nerve block in elderly patients with hip fractures. Methods In this retrospective study, 62 elderly patients received combined spinal-epidural anesthesia and 58 elderly patients underwent ultrasound-guided combined lumbar plexus-sciatic nerve block during the surgery. Hemodynamic monitoring including pulse oxygen saturation (SpO2), heart rate and blood pressure, the assessment of pain intensity using Visual Analogue Scale (VAS), cognitive function assessment through Montreal Cognitive Assessment (MoCA) and biomarkers consisting of serum levels of neuron specific-enolase (NSE), S100 beta protein (S100-β), and amyloid beta protein (Aβ), as well as immune function by interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and high sensitivity C-reactive protein (hs-CRP) were detected in this study. Furthermore, length of hospital stay (LOS) and adverse reactions including hematoma, hypotension, nausea, and vomit were analyzed. Results The findings indicated that comparing with the patients receiving combined spinal-epidural anesthesia, those undergoing ultrasound-guided combined lumbar plexus-sciatic nerve block showed significantly lower level of heart rate, higher level of SpO2, and lower level of diastolic pressure and systolic pressure at 5 minutes and 30 minutes after anesthesia and after surgery (P < 0.05), indicated obviously lower VAS score at 12, 24, and 48 hours after surgery (P < 0.05), and revealed higher MoCA score at 12 days after surgery (P < 0.05). A significantly higher level of NSE, S100β, Aβ, IL-6, IL-1β, TNF-α, and hs-CRP was revealed in the two groups receiving different anesthesia methods at 10 days after surgery compared with that before surgery (P < 0.05). However, the patients receiving ultrasound-guided combined lumbar plexus-sciatic nerve block had obviously lower expression of NSE, S100β, Aβ, IL-6, IL-1β, TNF-α, and hs-CRP compared with the group accepting combined spinal-epidural anesthesia (P < 0.05). The two groups indicated no significant difference in incidence of hypotension and vomit, etc. (P < 0.05), but showed remarkable difference referring to total incidence of adverse reactions and LOS (P < 0.05). Conclusion The application of ultrasound-guided combined lumbar plexus-sciatic nerve block in hip replacement contributes to the stability of hemodynamics and alleviation of postoperative pain intensity. It can reduce cognitive and immune impairment of the elderly patients with hip fractures.

The effect of leucocyte concentration of platelet-rich plasma on outcomes in patients with lateral epicondylitis: a systematic review and meta-analysis.

The concentration of leukocytes influences the quality of platelet-rich plasma (PRP). However, there is no consensus on which type of PRP based on the concentration of leukocytes is the best for lateral epicondylitis (LE). We systematically searched the MEDLINE, Embase, and Cochrane Library databases until March 1, 2020. Studies involving randomized controlled trials, patients with LE, and treatment with PRP injections were included. PRP was classified into leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP. LR-PRP was defined as PRP with a white blood cell concentration exceeding that of whole blood (4.0-10.0 per μL3), whereas LP-PRP was defined as PRP with a lower white blood cell concentration than that of whole blood. The efficacy of PRP was assessed using the visual analog scale (VAS) and success rates. Eleven randomized controlled trials (six involving LP-PRP and five involving LR-PRP) were eligible for inclusion in this review. Eight studies were included in the meta-analysis to evaluate the VAS score. Regarding short-term follow-up, there was no difference in the VAS scores between the LP-PRP and control groups (standard mean difference [SMD], 0.01; 95% confidence interval [CI], -0.29 to 0.30; P=0.97), with no heterogeneity (I2=0%). There was also no difference in the VAS scores between the LR-PRP and control groups (SMD, -0.19; 95% CI, -0.57 to 0.20; P=0.34), with substantial heterogeneity (I2=56.7%). Regarding long-term follow-up, there was no difference in the VAS scores between the LP-PRP and control groups (SMD, -0.73; 95% CI, -1.69 to 0.23; P=0.134) with substantial heterogeneity (I2=88.4%). The LR-PRP group had lower VAS scores than the control group (SMD, -1.06; 95% CI, -2.02 to -0.09; P=0.032) with substantial heterogeneity (I2=92%). In the LP-PRP group, there was no significant difference in the success rate (odds ratio, 1.08; 95% CI, 0.07-16.47; P=0.956) with substantial heterogeneity (I2=87.7%). In the LR-PRP group, however, the patients who received PRP had a higher success rate than those in the control group (odds ratio, 2.85; 95% CI, 1.67-4.85; P<0.01) with substantial heterogeneity (I2=82.9%). LR-PRP may provide pain relief and successful outcomes for patients with LE compared with alternative local injections. Better results were observed with the use of LR-PRP than with the use of LP-PRP.

The Impact of Perioperative Multimodal Pain Management on Postoperative Outcomes in Patients (Aged 75 and Older) Undergoing Short-Segment Lumbar Fusion Surgery.

Background Due to the presence of multimorbidity and polypharmacy, patients aged 75 and older are at a higher risk for postoperative adverse events after lumbar fusion surgery. More effective enhanced recovery pathway is needed for these patients. Pain control is a crucial part of perioperative management. The objective of this study is to determine the impact of multimodal pain management on pain control, opioid consumption, and other outcomes. Methods This is a retrospective review of a prospective collected database. Consecutive patients who underwent elective posterior lumbar fusion surgery (PLF) from October 2017 to April 2021 in our hospital were reviewed. Perioperative multimodal pain management (PMPM) group (from January 2019 to April 2021) in which patients received multimodal analgesia was case-matched to the control group (from October 2017 to December 2018) in which patients were treated under the conventional patient-controlled analgesia (PCA) method. Postoperative visual analogue scale (VAS), opioid consumption, complications within 3 months, and other outcomes were collected and compared between groups. Results A total of 122 consecutive patients (aged 75 and older) were included in the PMPM group and compared with previous 122 patients. The PMPM group had a lower maximal VAS score (3.0 ± 1.7 vs. 3.7 ± 2.0, p < 0.001) and frequency of additional opioid consumption (6.6% vs. 19.7%, p=0.001) on POD3 than the control group. The rates of postoperative complications were lower in the PMPM group compared with the control group (25% vs. 49%, p=0.006) during a 3-month follow-up period. Conclusions This study demonstrates that the PMPM protocol is effective in pain control and reducing additional opioid consumption when compared with conventional analgesia, even for patients aged 75 and older. Moreover, these improvements occur with a lower incidence of postoperative complications within three months after PLF surgery.

Full endoscopic versus open discectomy for sciatica: randomised controlled non-inferiority trial

ObjectiveTo assess whether percutaneous transforaminal endoscopic discectomy (PTED) is non-inferior to conventional open microdiscectomy in reduction of leg pain caused by lumbar disc herniation.DesignMulticentre randomised controlled trial with non-inferiority design.SettingFour...

Behavioral and performance response associated with administration of intravenous flunixin meglumine or oral meloxicam immediately prior to surgical castration in bull calves.

The objective of this study was to determine the effects of flunixin meglumine or meloxicam on behavioral response and performance characteristics associated with surgical castration in crossbred bulls. Intact male Bos taurus calves (n = 252; averaging 176 kg) were randomly allocated into one of three treatment groups within pen: control (CON), flunixin meglumine (FLU; 2.2 mg/kg intravenous injection), or meloxicam (MEL; 2.0 mg/kg per os). The individual animal was the experimental unit. Calves were individually weighed on days 0 and 14 of the trial to evaluate performance outcomes. On study day 0, treatments were administered, according to their random allocation, immediately prior to surgical castration using the Henderson tool method. Visual analog scale (VAS) assessment and categorical attitude score (CAS) were collected on days −1, 0 (6 h post-castration), 1, 2, 3, and 4 in the study. The VAS was assigned using a 100 mm horizontal line with “normal” labeled at one end of the line and “moribund” at the other end of the horizontal line. The masked observer assigned a mark on the horizontal line based upon the observed severity of pain exhibited by that individual animal. The CAS was assigned by the same observer using five different categories with a score of 0 being “normal”. Average daily gain tended (P = 0.09) to be associated with the treatment group, and MEL had a greater (P = 0.04) average daily gain through day 14 compared with CON. A significant (P < 0.01) treatment by day interaction was indicated for VAS score, and MEL had lower VAS scores on days 0, 1, 2, and 3 post-castration compared with CON; FLU had lower VAS scores on days 0 and 1 compared with CON. A significant treatment by day interaction was not present (P = 0.25) for CAS. The FLU had lesser percent CAS ≥1 (17.5%; P = 0.05) compared with CON (29.4%); MEL has lesser percent CAS ≥1 observations (14.9%; P = 0.01) compared with CON. The median VAS increased as CAS was more severe. Results indicated MEL and FLU calves temporally improved behavioral responses following surgical castration with positive numerical trends for a 14 d average daily gain (ADG). The VAS system appeared to be an effective method of subjective evaluation of pain in beef calves in this study. Route of administration, duration of therapy, and low relative cost make oral meloxicam a reasonable analgesic treatment in calves when administered at the time of surgical castration.

Renoprotective Effect of Intraoperative Dexmedetomidine in Renal Transplantation.

Background Renal dysfunction after kidney transplantation may be influenced by many reasons. This study was designed to evaluate whether the administration of dexmedetomidine (Dex) could ameliorate renal function and prognosis after kidney transplantation. Methods A total of 65 patients were divided into Dex group (n = 33) and Con group (Con, n = 32). Dex group intravenously received an initial loading dose of 0.6 μg/kg Dex for 15 min before anaesthesia induction, followed by a rate of 0.4 μg/kg/h until 30 min after kidney reperfusion. By contrast, Con group received saline. The concentration of urinary kidney injury molecule-1 (KIM-1), serum creatinine (Cr), blood urea, urine output, β2 microglobulin (β2-MG), Cystatin C (CysC), and estimated glomerular filtration rate (eGFR) was recorded and compared between two groups during the course of the hospitalization or follow-up. Mean arterial pressure (MAP) and heart rate (HR), vasoactive drugs, and anaesthetics were recorded during the operation. Pain degree was evaluated using a visual analogue scale (VAS) after operation. Delayed graft function (DGF), graft loss, length of hospital stay, and mortality were compared between groups. Results The concentration of KIM-1 in Dex group was lower than Con group at 2 h (P = 0.018), 24 h (P = 0.013), 48 h (P < 0.01), and 72 h (P < 0.01) after reperfusion. MAP of Dex group after tracheal intubation (P = 0.012) and incision (P = 0.018) and HR after intubation (P = 0.021) were lower than that of Con group. The dosage of sufentanil during operation in Dex group was less than Con group (P = 0.039). Patients that used atropine in Dex group were more than Con group (P = 0.027). Patients who received Dex presented with lower VAS scores at 6 h (P = 0.01) and 12 h (P = 0.002) after operation. Concentration of serum Cr and blood urea had no significant differences between groups before operation and on postoperative day 1 to 6. Urine output was recorded for 6 days after operation and had no differences between groups. Also, no differences were identified between two groups in urea, Cr, β2-MG, CysC, and eGFR in the first 3 months after operation. Incidence of DGF after operation was detected no difference between groups, while length of hospital stay in Dex group was less than Con group (P = 0.012). Conclusion Dex can decrease kidney injury marker level, attenuate perioperative stress, relieve the dosage of sufentanil and postoperative pain, and reduce length of hospital stay. However, Dex is not associated with changes in prognosis in the first 3 months after transplantation.

The Effect of Subjective Fatigue on Auditory Processing in Musicians and Nonmusicians

We assessed fatigue's effect on temporal resolution and speech perception in noise abilities in trained instrumental musicians. In a pretest-posttest quasiexperimental research design, trained instrumental musicians (n = 39) and theater artists as nonmusicians (n = 37) participated. Fatigue was measured using a visual analog scale (VAS) under eight fatigue categories. The temporal release of masking measured the temporal resolution, and auditory stream segregation assessed speech perception in noise. Entire testing was carried out at two time-points: before and after rehearsal. Each participant rehearsed for five to six hours: musicians playing musical instruments and theater artists conducted stage practice. The results revealed significantly lower VAS scores for both musicians and nonmusicians after rehearsal, indicating that both musicians and nonmusicians were fatigued after rehearsal. The musicians had higher scores for temporal release of masking and lower scores for auditory stream segregation abilities than nonmusicians in the pre-fatigue condition, indicating musicians’ edge in auditory processing abilities. However, no such differences in the scores of musicians and nonmusicians were observed in the post-fatigue testing. The results were inferred as the music training related advantage in temporal resolution, and speech perception in noise might have been reduced due to fatigue. In the end, we recommend that musicians consider fatigue a significant factor, as it might affect their performance in auditory processing tasks. Future researchers must also consider fatigue as a variable while measuring auditory processing in musicians. However, we restricted the auditory processing to temporal resolution and speech perception in noise only. Generalizing these results to other auditory processes requires further investigation.