Mean Postoperative Pain Score Research Articles

INTRAOPERATIVE LOCAL BUPIVACAINE WOUND INFILTRATION VERSUS TRADITIONAL SYSTEMATIC ANALGESIA: A COMPARISON IN TERM OF POST-OPERATIVE PAIN

Effective management of post-operative pain is essential for patient recovery and satisfaction, especially in procedures like appendectomies where pain management can influence overall outcomes. Traditional systemic analgesia, while effective, often comes with side effects and limitations. Local infiltration of anesthetics like bupivacaine may provide a targeted approach to pain control with fewer systemic effects. Objective: To compare the effectiveness of intraoperative local bupivacaine wound infiltration versus traditional systemic analgesia in managing post-operative pain in patients undergoing appendectomies. Methods: This randomized controlled trial was conducted at Lady Reading Hospital, Peshawar, following approval from the hospital's Ethical Committee. A total of 60 patients, who consented and met eligibility criteria, were enrolled. All patients underwent appendectomy under general anesthesia, followed by random allocation into two groups. Group A received 0.5% bupivacaine for local wound infiltration, while Group B did not. Both groups were administered intravenous tramadol on demand, with a maximum dose of 400 mg per 24 hours. Post-operative pain was assessed using a Visual Analog Scale (VAS) at 4, 12, and 24 hours post-surgery. Stratified analysis by age and gender was also performed. Results: The study population (mean age: 41.13 ± 7.96 years) included 34 males (56.7%) and 26 females (43.3%). Group A (bupivacaine group) had a significantly lower mean post-operative pain score (3.33 ± 0.66) compared to Group B (systemic analgesia group) with a score of 5.30 ± 0.95 (p=0.00). Age-based stratification revealed significant differences: among 22-30-year-olds, Group A scored 3.00 versus 6.00 in Group B (p=0.00); for 31-50-year-olds, Group A scored 3.36 compared to 5.33 in Group B (p=0.00); and for those over 50, scores were 3.33 in Group A and 4.50 in Group B (p=0.04). Both male and female patients in Group A experienced significantly lower pain scores compared to Group B (p=0.00 for both). Conclusion: Intraoperative bupivacaine wound infiltration significantly reduces post-operative pain in appendectomy patients compared to traditional systemic analgesia. These findings support its use as an effective pain control method. Further research is recommended to optimize dosing and assess the combined use with other analgesics to enhance pain management across various surgical procedures.

Lidocaine Patches After Cesarean Sections: A Randomized Control Trial

ObjectivesLidocaine patches are a common topical analgesic therapy but have not been thoroughly investigated in the surgical or obstetric literature. We sought to investigate the impact of adding topical lidocaine patches to routine post-cesarean pain management on patients’ post-cesarean pain scores and opioid use. Study DesignThis is a prospective randomized subject blinded controlled trial of patients undergoing cesarean delivery at a single institution. Individuals were excluded if they had three or more cesarean sections, abdominoplasty, history of abdominal hernia repair with mesh, active polysubstance use, or history of opiate use disorder with current medication-assisted treatment. Patients were randomized via a 1:1 randomization scheme to a placebo patch or lidocaine patch. Baseline maternal characteristics were collected. The primary outcome was mean visual analog pain scores (0-10). Our secondary outcome was total morphine equivalents used over the post-operative hospital stay. Pre- and post-study surveys were performed to evaluate subject's prior analgesia use (including opioids) and patient experience in the study. ResultsA total of 100 patients were randomized and 93 had complete data for analysis (46 placebo group, 47 treatment group). Groups had similar baseline characteristics (age, BMI, ethnicity, surgical time, and estimated blood loss). Mean maximum post-operative pain score by visual analog scale did not differ between placebo or lidocaine patch groups on post-operative day 1 (p=0.3), day 2 (p=0.9), day 3 (p=0.07), or day 4 (p=0.09). Mean post-operative pain score by visual analog scale did not differ between placebo or lidocaine patch groups on post-operative day 1 (p=0.7), day 2 (p=0.6), day 3 (p=0.2), or day 4 (p=0.5). In the post-study survey, 0% of the respondents in the lidocaine patch group reported disruption of their care and 63% reported desired use of lidocaine patch in the future. ConclusionsThe addition of lidocaine patches did not significantly decrease the maximum or average post-operative pain scores via visual analog scale after cesarean sections. More research is needed into non-opioid pain management strategies in the post-operative period in obstetric care.

Vaginal Packing After Pelvic Floor Reconstructive Surgery: Does the Soaking Agent Used for Packing (Bupivacaine, Estrogen or Saline) Impact Postoperative Pain Scores?

Study ObjectiveVaginal packing is traditionally placed after pelvic floor reconstructive surgery (PFRS) to prevent hematoma formation. We seek to determine if there is a difference in post-operative pain scores after PFRS if vaginal packing is soaked with estrogen cream, bupivacaine, or saline. The primary outcome was pain as measured by a visual analog scale (VAS) at 2 hours, 6 hours, and 1 day post-operatively. Secondary outcomes include change in hemoglobin, urinary retention and length of stay (LOS) in hospital. DesignProspective cohort study SettingTertiary care academic teaching hospital. All PFRS performed by fellowship-trained urogynecologists. ParticipantsConsenting patients undergoing PFRS. InterventionsAt the completion of surgery, gauze packing soaked with either estrogen cream 0.25% bupivacaine with 1% epinephrine, or normal saline was placed inside the vagina and removed on post-operative day 1. ResultsWe included 210 patients (74 estrogen, 66 bupivacaine, 70 saline). There was no significant difference in mean post-operative pain scores between the groups (estrogen, bupivacaine, saline-soaked vaginal packs respectively) at 2 hours (2.66±2.25, 2.30±2.17, 2.24±2.07; p=.4656), 6 hours (2.99±2.38, 2.52±2.30, 2.36±2.01; p=.2181) or on post operative day 1 (1.89±2.01 vs. 2.08±2.15 vs. 2.44±2.19; p=.2832) as measured by VAS scores (0-10). There was no difference in the secondary outcomes of change in pre-/post-operative hemoglobin (21.8±10.73g/L, 20.09±11.55g/L, 21.7±9.62g/L, p=.68), urinary retention (37%, 45% and 48%, p=.45), LOS (1.05±0.46 days, 1.02±0.12, 1.03±0.24, p=.97) or in-hospital opioid usage during admission (represented in morphine milligram equivalents (median (IQR1, IQR3), Kruskal-Wallis test): 11.25mg (0,33), 7.5mg (0, 22.5) and 15mg (0, 33.88) p =0.41. ConclusionThere was no difference found between soaking vaginal packing with estrogen cream, bupivacaine, or saline after PFRS with respect to post-operative pain scores, LOS, in-hospital opioid usage, or urinary retention. Saline-soaked packing is an equivalent alternative to estrogen or bupivacaine vaginal packing. Clinical Trial RegistrationNCT03266926. Registered February 1, 2017. https://clinicaltrials.gov/study/NCT03266926

Efficacy of subcutaneous sumatriptan in postcraniotomy pain and opioid consumption.

Traditional pain management pathways following craniotomy are predicated on opioids. However, narcotics can confound critical neurological examination, contribute to respiratory depression, lower the seizure threshold, and lead to medication habituation, dependence, and/or abuse. Alternative medications to better address postoperative pain while mitigating opioid-related adverse effects remain insufficiently studied. Preliminary studies suggest sumatriptan, a 5-HT (1B/1D) receptor agonist known to regulate dural vasoactivity and inflammation, may moderate pain following trigeminal microvascular decompression and chronic postcraniotomy headache. In this study, the authors evaluated the efficacy of sumatriptan to modulate pain and opioid requirements following craniotomy surgery. This was a single academic center, retrospective cohort study of 300 consecutive adult patients who underwent elective craniotomy surgery between 2015 and 2022. Patients were equally divided between a control and a sumatriptan cohort contingent upon administration of 6 mg of subcutaneous sumatriptan within 1 hour of surgery completion and prior to opioid administration. Postoperative opioid consumption at 6, 12, and 24 hours, as well as admission total, inpatient length of stay, and 30-day global reevaluation, were assessed. Three hundred patients were included for analysis. Significant differences were seen in baseline hypertension (p < 0.01), hyperlipemia (p < 0.01), anxiety (p = 0.04), and operative time (p = 0.02). A significant reduction of mean postoperative pain scores at 12 (p = 0.03) and 24 (p < 0.01) hours and total opioid consumption (p = 0.04) was observed in the sumatriptan cohort. Subgroup analysis revealed significantly lower postoperative pain scores at 6 (p = 0.05), 12 (p < 0.01), and 24 (p < 0.01) hours in patients who underwent burr hole placement in the sumatriptan cohort as compared with controls; however, no significant difference in opioid consumption was noted. No adverse events related to sumatriptan administration were noted throughout the study. Postoperative single-dose subcutaneous sumatriptan following elective craniotomy may reduce pain scores and opioid requirements. Additional studies are needed to better understand nuanced differences in opioid modulation and optimal patient selection.

Association Between Single-Injection Regional Analgesia and Postoperative Pain in Cardiac Surgery Patients: A Single-Center Retrospective Cohort Study

Effective pain control after cardiac surgery may facilitate recovery. This study aimed to assess the use and association of ultrasound-guided single-injection chest wall blocks with liposomal bupivacaine on postoperative pain scores and short-term opioid requirements after cardiothoracic surgery at a single institution. Retrospective cohort study. Midwestern academic hospital. Adult patients who underwent cardiothoracic surgery between July 1, 2020, and June 30, 2022. Ultrasound-guided single-injection chest wall block with liposomal bupivacaine. Of the 1,038 patients included in this study, 301 (29%) received a perioperative nerve block for postoperative sternotomy pain, and 737 (71%) did not. Most of the single-shot blocks were bilateral parasternal intercostal plane blocks (n = 294 [98%]) performed after induction and before surgical incision (n = 280 [93%]). After adjusting for age, gender, American Society of Anesthesiologists status, select comorbidities, and surgical procedure type, mean postoperative pain scores were not significantly different between groups in the immediate postoperative period at all time points assessed (12 ± 2 hours, 24 ± 4 hours, 48 ± 8 hours, and 72 ± 12 hours). Similarly, there was no difference in mean opioid requirements (milligram morphine equivalents) at 72 hours between groups (68.6 [95% confidence interval, 56.3-83.4] vs 62.9 [95% confidence interval, 52.8-74.9], p = 0.195). In this retrospective study, the implementation of single-shot chest wall nerve blocks with liposomal bupivacaine was not associated with decreased postoperative pain scores or opioid consumption at 72 hours in select cardiac surgical patients at one institution.

Erector Spinae Plane Block Versus Thoracolumbar Interfascial Plane Block in Lumbar Spine Surgery: A Meta-Analysis of Randomized Controlled Trials.

Meta-analysis. To compare the effectiveness of postoperative pain control between erector spinae plane block (ESPB) and thoracolumbar interfascial plane (TLIP) block in lumbar spine surgery. PubMed, Embase, and MEDLINE electronic databases were searched for articles containing randomized controlled trials (RCTs) published between January 1900 and January 2024. We extracted the postoperative mean pain score, the first 24-h postoperative morphine consumption, and their standard deviation from the included studies. Meta-analysis was performed using the functions available in the metafor package in R software. We pooled continuous variables using an inverse variance method with a random-effects model and summarized them as standardized mean differences. Five RCTs that directly compared the ESPB and TLIP block in lumbar spine surgery were included, enrolling 432 participants randomly into the two groups with 216 participants in each group. The pooled analyses showed that there was no significant difference between the ESPB and TLIP groups in terms of lower pain scores during the early (1h) (standardized mean difference [SMD] -1.49, 95% confidence interval [CI], -3.10; 0.11), middle (12h) (SMD -3.12, 95% CI, -6.86; 0.61), and late (24h) (SMD -1.38, 95% CI, -3.01; 0.24) postoperative periods. There was also no significant difference in the first 24-h postoperative morphine equivalent consumption between the ESPB and TLIP groups (SMD -0.46mg, 95% CI -1.23; 0.31). No significant difference was observed between the ESPB and TLIP block in terms of postoperative pain control and 24-h morphine equivalent consumption for lumbar spine surgery.

Safety of an anchor-based device for sacrospinous ligament fixation: A pilot case-control study

Introduction and hypothesisSacrospinous ligament fixation (SSLF) is a popular surgical technique for treating apical prolapse. The use of suture-capturing devices (SCD), or the more recently introduced anchor-based device (ABD), is useful for a posterior approach but essential for an anterior one. The aim of our study was to assess the safety of the ABD, which was recently introduced to our unit, compared to the traditionally used SCD. MethodsThis was a pilot case-control study of 40 patients who had a SSLF, 20 of these represented all the patients who had the procedure with the aid of the ABD and 20 patients who had the procedure using the SCD over approximately the same duration. The main safety endpoints of this pilot study were patient reported postoperative pain scores and perioperative complications rate. ResultsThe population characteristics were similar. The mean postoperative pain scores differed significantly only on postoperative day 1 in favor of the suture capturing device (3.40 [2.60] vs 1.60 [1.64], p = 0.013). The mean highest pain score was similar in both groups. Peri-operative complications rates were low and comparable between both groups. According to POPQ at 6 weeks follow-up the median Ba point was higher in the ABD group and this difference was significant (−3.00 [-3.00; −2.25] vs. −2.00 [-3.00; −1.50]; p = 0.03). ConclusionThe anchor-based device for sacrospinal ligament fixation seems to have comparable safety profile to the traditionally used suture capturing devices.

The Relationship Between Cognitive Intrusion of Pain, Fear of Surgery, and Comfort

The aim of this study was to examine the relationship between cognitive intrusion of pain, fear of surgery, and comfort in the perioperative period. This was a descriptive study conducted with 180 patients hospitalized for surgery in a training and research hospital. A sociodemographic questionnaire, Surgical Fear Questionnaire, General Comfort Questionnaire, and Experience of Cognitive Intrusion of Pain Scale were administered to the participants prior to surgery, while General Comfort Questionnaire and Experience of Cognitive Intrusion of Pain Scale were administered after surgery. Of the participants with a mean age of 49.94 ± 17.26 years, 62.2% were male and 31.1% had at least one chronic disease. The mean preoperative and postoperative pain scores were 2.65 and 3.47, respectively. There was a statistically significant negative correlation between perioperative experience of cognitive intrusion of pain and perioperative comfort and a positive correlation between perioperative experience of cognitive intrusion of pain and preoperative fear of surgery (p < .05). Cognitive intrusion of pain does not change in the perioperative period. As the cognitive intrusion of pain increases, patient comfort decreases and surgical fear increases. Our study contributes to the literature since it is the first study evaluating the cognitive intrusion of pain in the perioperative period.

Intraperitoneal Onlay Mesh (IPOM Plus) Repair Versus Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) Repair in Primary Ventral Hernias: Experience With 50 Cases in a Tertiary Care Hospital.

Background Primary ventral hernias are abnormal protrusions of abdominal viscera through the areas of weakness in the fascia of the abdominal wall. The aim of this study was to compare the benefits and complications, and the overall outcome in the Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) repair versus Intraperitoneal Onlay Mesh (IPOM Plus) repair in the management of primaryventral hernias. Methods After obtaining institutional ethical committee clearance, this prospective comparative study between IPOM Plus and eTEP-RS was conducted in a tertiary care hospital from December 2020 to January 2022. A total of 50 patients presenting with primary ventral hernias were included in the study, of whom 25 underwent IPOM Plusand 25 underwent eTEP-RS repairs. Group selection was doneby simple randomization using the lottery method. Patients more than 18 years of age with primary ventral hernias presenting with a hernial defect width less than 6 cm, consenting to the study, were included in the study. Patients who did not fulfill the inclusion criteria, strangulated/obstructed hernias, recurrent/incisional hernias, connective tissue disorders, skin infections, enterocutaneous fistulas, pregnancy, morbid obesity, and parastomal hernias were exclusion factors. Results The mean intraoperative duration in the eTEP-RS group (192.3 ± 16.20 min) was significantly higher than in theIPOM Plus group (102.6 ± 16.78min, p=0.001). The mean duration of hospital stay in the IPOM Plus group (5.9 ± 2.19 days) was longer than in the eTEP-RS group (4.6 ± 3.17 days, p=0.02). The mean postoperative pain scores, from the Visual Analogue Scale(VAS), on days 1, 7, and 90 were 3.2 ± 1.11, 2.64 ± 1.11, and 1.68 ± 1.46in the IPOM Plus group and 1.84 ± 0.688, 0.76 ± 0.66 and 0.08 ± 0.40 in the eTEP-RS group, respectively(p=0.001). Conclusion Despite being a technically easy procedure requiring less intraoperative time, IPOM Plus had several disadvantages, such as increased postoperative pain, longer duration of hospital stays, higher chances of wound site seromas, and higher rates of postoperative paralytic ileus.On the other hand, eTEP-RS was a more challenging procedure requiring more intraoperative time; however, it had several advantages: less postoperative pain, less duration of hospital stay, early recovery, and fewer chances of seromasand paralytic ileus.However, more robust data is required to compare and validate the differences between both procedures' short- and long-term outcomes.

Comparison of Post-Operative Pain with Diclofenac Rectal Suppository vs Intravenous Tramadol in Patients Undergoing Inguinal Hernioplasty

Background: Pain is a highly intricate and distressing sensation that is subjective. There is uncertainty observed in the selection of optimal methods for intra and post-operative administration of analgesics for inguinal hernia repair surgery. Objective: To compare the mean postoperative pain score in diclofenac rectal suppositories with intravenous tramadol in patients undergoing inguinal hernioplasty. Study Design: Randomized control trial. Settings: Department of Surgery, Allied Hospital, Faisalabad Pakistan. Duration: From November 25, 2022 to May 25, 2023. Methods: After approval of the ethical board, patients from OPD / emergency were enrolled. All the patients undergo inguinal hernioplasty under regional anesthesia. In group A, patients received diclofenac rectal suppository 100 mg, and in group B, patients received intravenous tramadol 100 mg. The visual analog scale was explained to the patients. Pain was assessed after the 2nd, 6th, and 12th hour of hernioplasty. All the information noted on proforma. Results: Comparison of the mean post-operative pain score shows 3.67 ± 0.48 in Group A and 2.40 ± 0.50 in Group B at 2 hours, p-value 0.000, 3.64 ± 0.49 in Group A and 3.43 ± 0.50 in Group B at 6th Hour, p-value was 0.605, 3.30 ± 0.47 in Group A and 4.0 ± 0.79 in Group B at 12th hour, p-value=0.000. Conclusion: We concluded that diclofenac rectal suppository is significantly better than intravenous tramadol in patients undergoing inguinal hernioplasty in terms of mean postoperative pain score.

Effects of injectable platelet-rich fibrin (i-PRF) on pterygium surgery with conjunctival autograft.

To investigate the effects of subconjunctival injectable platelet-rich fibrin (i-PRF) injection on healing and complication rates after pterygium surgery with conjunctival autograft. This retrospective and comparative study evaluated 31 eyes that received i-PRF injections under the donor and graft conjunctiva following pterygium surgery, while 34 eyes did not receive i-PRF after the pterygium surgery. The patients' follow-up period was for 12months. Postoperative recurrence, epithelial healing time, postoperative pain score, graft edema, and sliding of the graft (need for re-suturation) data were evaluated. For the 12months after surgery, one eye (3.2%) in the i-PRF group had developed corneal recurrence, and five eyes (14.7%) in the non-i-PRF group had developed recurrence. The mean corneal epithelial healing time was 2.96 ± 0.70days in the i-PRF group and 3.58 ± 0.70days in the non-i-PRF group (p = 0.001). The mean healing time of the donor conjunctiva epithelium was 3.84 ± 0.70days in the i-PRF group, whereas it was 4.44 ± 0.74days in the non-i-PRF group (p = 0.006). The mean postoperative pain score was 4.45 ± 1.52 in the i-PRF group and 5.08 ± 1.40 in the non-i-PRF group. In the non-i-PRF group, three cases (8.8%) required re-suturation, whereas, in the i-PRF group, no one required re-suturation. Thanks to its platelets-derived growth factors, i-PRF can be a safe and effective adjuvant therapy for faster healing of conjunctival autograft and in the prevention of recurrence.

Association between anesthetic type and perioperative outcomes in pediatric patients undergoing elective surgery: An observational study

Background: Pediatric surgeries require careful anesthetic choice. The impact of general anesthesia (GA) versus regional anesthesia (RA) on post-operative outcomes remains underexplored. Aims and Objectives: The aims and objectives of the study are to assess the association between anesthetic type and perioperative outcomes, including post-operative pain, nausea incidence, and recovery room stay duration in pediatric patients undergoing elective surgery. Materials and Methods: This observational study involved 100 pediatric patients undergoing elective surgery. Participants were grouped based on the anesthetic received: GA or RA. Outcomes measured included post-operative pain (0–10 scale), post-operative nausea incidence, and recovery room stay length. Results: The mean post-operative pain score for GA patients was 4.5 (standard deviation [SD]: 1.5), with most reporting scores between 3.0 and 6.0. For RA patients, the mean pain score was 3.8 (SD: 1.2), with the majority reporting scores between 2.6 and 5.0. Patients under RA had marginally reduced post-operative pain scores than those under GA. Regarding nausea, 56% of GA patients reported post-operative nausea, while only 36% of RA patients did. The mean recovery room stay for GA patients was 120 min (SD: 30 min), with most staying between 90 and 150 min. RA patients had an average stay of 100 min (SD: 25 min), with the majority staying between 75 and 125 min. Conclusion: Pediatric patients administered RA demonstrated slightly lower post-operative pain, decreased incidence of nausea, and a shorter recovery room stay compared to those given GA. These findings suggest potential benefits of RA in pediatric elective surgeries, although further research is warranted.

Comparison of the Mean Post-Operative Pain Score with Ultrasound Guided Transversus Abdominis Plane (TAP) Block and Wound Infiltration with Local an Aesthetic Agent in Abdominal Surgeries

Objectives: To compare the mean post-operative pain score with ultrasound-guided transversus abdominis plane block and wound infiltration with local anaesthetic agents in abdominal surgeries. Study design: Comparative prospective study Place and Duration of Study: Department of Anaesthesia, Intensive Care and Pain Management, Combined Military Hospital, Bahawalpur Pakistan, from Oct 2018 to Apr 2019. Methodology: Sixty patients undergoing abdominal surgery aged 18-60 years were included. The patients in Group-A received transverses abdominis plane block with 20 ml of 0.25% Bupivacaine bilaterally, while those in Group-B received 20 ml of 0.25% Bupivacaine as local wound infiltration. Each patient was followed till 6 hours post-operatively. Results: Out of 60 patients, 35(58.33%) were male, and 25(41.67%) were females. In our study, the Visual analogue score was 1.63±0.85 in Group-A (ultrasound-guided TAP block) compared with 4.47±1.07 in patients with Group-B (wound infiltration with a local anaesthetic agent) with a p-value of 0.001, which was statistically significant. Conclusion: The study concluded that the mean pain score in patients with ultrasound-guided Transversus abdominis plane block is less compared to wound infiltration with local anaesthetic agents in abdominal surgeries.

Inpatient opioid use and pain control after robotic versus laparoscopic sleeve gastrectomy

BackgroundDuring the past decade, the proportion of bariatric surgery performed robotically has been rising. However, the clinical benefits of the robotic approach over laparoscopy are uncertain. One area in need of further investigation is pain control after robotic versus laparoscopic bariatric surgery. MethodsA retrospective cohort study was conducted of bariatric surgery patients undergoing laparoscopic or robotic sleeve gastrectomy at a single institution from October 2019 to August 2022. Inpatient opioid use was measured in morphine milliequivalents. Pain scores were collected by the nursing staff. ResultsA total of 368 patients were included: 286 laparoscopic and 82 robotic surgery patients. The groups shared similar demographics. For the entire cohort, the mean age was 42 years, the body mass index was 50 kg/m2, and 79% were female. Mean operative time was significantly lower for laparoscopic surgeries (87.5 ± 47.3 minutes vs 109.3 ± 30.3 minutes; P < .01). The median total inpatient morphine milligram equivalents used was similar for both groups: 52.3 (31.5–77.0) for the laparoscopic group versus 40 (24–74.5) for robotic (P = .13). Mean postoperative pain scores (scale out of 10) were not significantly different between groups: 5.2 ± 1.7 (postoperative day 0) and 4.5 ± 1.7 (day 1) for laparoscopic patients versus 5.1 ± 2.0 (day 0) and 4.4 ± 1.8 (day 1) for robotic. The proportion of patients prescribed opioids at discharge was significantly higher for the laparoscopic group (75.2% vs 62.2%; P = .02). Other clinical outcomes, including duration of stay, 30-day readmissions, and visits to the emergency department, were not significantly different. ConclusionThere is no difference in inpatient opioid use or pain scores between patients undergoing laparoscopic and robotic sleeve gastrectomy.

Do outcomes of interposition arthroplasty in young patients differ based on indication? A systematic review.

Interposition arthroplasty of the elbow is often preferred in young patients compared with implant total elbow arthroplasty. However, research comparing outcomes based on diagnosis in patients with post-traumatic osteoarthritis (PTOA) and inflammatory arthritis following interposition arthroplasty is sparse. Therefore, the purpose of this study was to compare outcomes and complication rates following interposition arthroplasty in patients with PTOA and inflammatory arthritis. A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The PubMed, Embase, and Web of Science databases were queried from inception to December 31, 2021. The search generated 189 total studies, of which 122 were unique. Original studies on interposition arthroplasty of the elbow in the setting of post-traumatic or inflammatory arthritis in patients aged <65 years were included. Six studies that were suitable for inclusion were identified. The query yielded 110 elbows, of which 85 had received a diagnosis of PTOA and 25, inflammatory arthritis. The cumulative complication rate following the index procedure was 38.4%. The complication rate in patients with PTOA was 41.2% compared with 11.7% in those with inflammatory arthritis. Furthermore, the cumulative reoperation rate was 23.5%. The reoperation rates in PTOA and inflammatory arthritis patients were 25.0% and 17.6%, respectively. The average preoperative Mayo Elbow Performance Index pain score was 11.0, which improved to 26.3 postoperatively. The mean preoperative and postoperative pain scores for the PTOA patients were 4.3 and 30.0, respectively. For the inflammatory arthritis patients, the preoperative pain score was 0 and the postoperative pain score was 45. The overall mean preoperative Mayo Elbow Performance Index functional score was 41.5, improving to 74.0 after the procedure. This study found that interposition arthroplasty is associated with a 38.4% complication rate and 23.5% reoperation rate, in addition to positive improvements in pain and function. In patients aged <65 years, interposition arthroplasty may be considered in those unwilling to undergo implant arthroplasty.

The efficacy of preoperative tranexamic acid administration among patients undergoing arthroscopic rotator cuff repair: A systematic review and meta-analysis of randomized controlled trials

Aim To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that investigated the effectiveness of tranexamic acid (TXA) among patients undergoing arthroscopic rotator cuff repair (ARCR). Methods Five databases were screened until December 18, 2022. The included RCTs were assessed for risk of bias, and the endpoints were summarized as mean difference/standardized mean difference (MD/SMD) or risk ratio (RR) with the 95% confidence interval (CI) in a random-effects model. Results Seven RCTs with 510 patients (TXA = 261 and control/placebo = 249) were analyzed. The overall risk of bias was “low” and “unclear” in four and three RCTs, respectively. The mean operative time (n = 5 RCTs, MD = −9.64 min, 95% CI [−15.74, −3.54], p = 0.002) and mean postoperative pain score on postoperative day 1 (n = 5 RCTs, MD = −0.56, 95% CI [−1.06, −0.05], p = 0.03) were significantly reduced in the TXA group compared with the control group. However, there were no significant differences between both groups regarding visual clarity, amount of irrigation solution, and estimated intraoperative blood loss. Conclusion Among patients undergoing ARCR, preoperative TXA did not reduce intraoperative blood loss or improve visual clarity. However, TXA administration correlated with significant reductions (statistically) in operative time and postoperative day 1 pain score compared with the control group. Level of evidence: Level I; Systematic Review and Meta-analysis of Randomized Controlled Trials

Postoperative Morbidity of Different Tonsillectomy Techniques: A Systematic Review and Network Meta-Analysis.

To compare different tonsillectomy techniques in terms of postoperative bleeding incidence and postoperative pain. An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were postoperative bleeding incidence and mean postoperative pain score. A total of 6464 patients were included for five different interventions (cold dissection tonsillectomy; extracapsular coblation tonsillectomy; intracapsular coblation tonsillectomy [ICT]; bipolar diathermy tonsillectomy [BDT]; monopolar diathermy tonsillectomy). ICT showed the lowest absolute risk (4.44%) of postoperative bleeding incidence (73.31% chance of ranking first) and the lowest mean postoperative pain score (1.74 ± 0.68) with a 94.0% chance of ranking first, whereas BDT showed both the highest absolute risk of bleeding incidence (10.75%) and the highest mean postoperative pain score (5.67 ± 1.43). ICT seems to offer better postoperative outcomes, in terms of reduced risk of bleeding and reduced pain. Further prospective studies are advised to confirm these findings. NA Laryngoscope, 134:1696-1704, 2024.

Comparison of Mean Pain Score in Patients Undergoing Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy

Background: Laparoscopic hysterectomy becomes a preferred option all over the world because it is related with less post-operative pain, short hospital stay and earlier recovery as compared with total abdominal hysterectomy. Objective: To compare the mean pain scores between patients undergoing total laparoscopic hysterectomy and total abdominal hysterectomy. Study Design: Randomized control trial. Settings: Department of Obstetrics &amp; Gynecology, Allied Hospital, Faisalabad Pakistan. Duration: 8th March 2019 to 7th September 2019. Methods: Total 60 patients, 40-75 years of age undergoing hysterectomy were selected. Patients with history of pelvic or abdominal irradiation, endometriosis or pelvic inflammatory disease, history of cardiac or pulmonary disease or previous pelvic surgery were excluded. Patients in group A, total laparoscopic hysterectomy was performed where as in group B, total abdominal hysterectomy was performed. All patients were followed for mean post-operative pain for first 24 hours. Results: Our study showed that stratification of pain scores with respect to age in 40-60 years age group was significant where as in 61-75 years age group it was nonsignificant. Another effect modifier in the study was BMI, which showed significant p-value i.e. 0.0001 in both groups (&lt;25 and &gt;25BMI). Postoperative mean pain score in both group of patients were assessed at 2hr, 4hr, 8hr, 12hr and 24hr, which were significant. Conclusion: Standardized technique, patients counselling, relatively younger age group, lower BMI and appropriate post-operative nursing care plays vital role in maintaining pain scores in TLH.

Temporary Peripheral Nerve Stimulation as Treatment for Chronic Pain.

Chronic pain is a growing problem across the world, and in the midst of an opioid epidemic, it is imperative that alternative treatment measures are identified to help alleviate the pain experienced by these patients. Chronic pain greatly affects ones quality of life and many patients do not experience adequate relief with conventional treatment measures. The purpose of this retrospective analysis is to assess the efficacy of peripheral nerve stimulation (PNS) therapy in adult patients suffering from chronic pain refractory to conventional treatment measures who underwent therapy on various anatomical locations. This retrospective analysis consisted of data collected from electronic health records for n = 89 patients who underwent PNS therapy. Data collected relates to patient age, sex, weight, height, body mass index (BMI), diagnosis, targeted nerves, follow-up encounters, pain scores from before and after PNS therapy, and duration of improvement. Statistical analysis used SPSS software, version 26 (IBM), using a paired ttest to assess significance between pre and post PNS therapy pain scores. P values were significant if found to be ≤ 0.05. Further analysis assessed the correlation between age and BMI with visual analog scale (VAS) pain improvement and subjective percentage pain relief. The mean pre-operative (pre-op) pain score before PNS therapy was 6.36 (standard deviation (SD) = 2.18, SEM = 0.23) and the mean post-operative (post-op) pain score after PNS therapy was 4.19 (SD = 2.70, SEM = 0.29). The mean patient-reported percent improvement in pain following PNS therapy was 49.04% (SD = 34.79). The improvement in pain scores between pre-op and post-op was statistically significant (M = 2.17, SD = 2.82, SEM = 0.30, t(88) = 7.26, p < .001), 95% confidence interval (CI) [1.57, 2.76]. The mean duration of improvement for patients was 123days after therapy initiation (min = 6, max = 683, SD = 126). This study demonstrated the potential role for PNS therapy in improving patient-reported pain levels for various neuropathies, targeting various nerves. With PNS therapy's use as a chronic pain treatment and available research being limited, further study needs to be done on the efficacy of PNS therapy for pain management and complications associated with PNS device placements at various locations.

Thermal welding tonsillectomy versus cold dissection tonsillectomy: A systematic review and meta-analysis of randomised controlled trials.

To evaluate the efficacy of thermal welding (TW) versus cold dissection (CD) strategies among tonsillectomy patients. A systematic review and meta-analysis of randomised controlled trials (RCTs). Patients undergoing tonsillectomy. The outcomes were summarised as risk ratio (RR) or mean difference/standardised mean difference (MD/SMD) with 95% confidence interval (CI) in a random-effects model. Fourteen RCTs were analysed. The mean operative time (n = 14 RCTs, MD = -7.99 min, 95% CI [-12.88, -3.10], p < .001), mean intraoperative blood loss (n = 11 RCTs, MD = -57.18 mL, 95% CI [-71.58, -42.78], p < .001) and postoperative pain score on day 1 (n = 15 RCTs, SMD = -0.40, 95% CI [-0.75, -0.06], p = .02) were significantly reduced in the TW group compared with the CD group. However, there was no significant difference between both groups regarding the rate of reactionary bleeding (n = 13 RCTs, RR = 0.62, 95% CI [0.23, 1.71], p = .36) and delayed bleeding (n = 13 RCTs, RR = 1.03, 95% CI [0.46, 2.30], p = .95). Compared with CD, TW significantly reduced the operative time and intraoperative blood loss, without an impact on the rate of postoperative bleeding. The reduction in postoperative pain score provided by the TW strategy was not clinically meaningful in clinical practice. TW might appear superior to CD among tonsillectomy patients.