Mean Total Pain Score Research Articles

Do Spiritual Well-Being and Pain Intensity Predict Physical or Mental Components of Health-Related Quality-of-Life Scale in Patients With Multiple Myeloma?

BackgroundMultiple myeloma is a complex disease and supportive care is important for improving quality of life. Management of disease treatment symptoms, bone disease, renal dysfunction, infection, anemia, pain, and coagulation disorder are specific issues. Spirituality, or spiritual well-being, is one of the most fundamental and essential concepts for coping with the difficulties and stress caused by cancer. AimsThis study explores whether spiritual well-being, pain, and other demographic factors predict the physical and mental components of quality of life in MM subjects. MethodsThis cross-sectional descriptive study was conducted with 92 multiple myeloma patients registered with the Cancer Warriors Association in Turkey. The data were collected using the Personal Information Form, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12, the Numeric Rating Scale for Pain, and the Short Form-12 Health-Related Quality of Life Scale. ResultsThe mean age of the patients was 54.4 ± 10.7 years. It was found that the mean total pain score in the previous week was 3.9 ± 2.6, while the mean total The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 score was 28.1 ± 9.8. Their mean Short Form-12 total physical component score was 39.1 ± 25.4; whereas the Short Form-12 total mental component score was 45.5 ± 24.8. According to this model, 56.7% of the physical component score was explained by vertebroplasty, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 total score and subscale of peace and the pain intensity experienced in the previous week. According to multiple linear regression analysis, bone-sparing therapy and FACIT-Sp-12-Total and subscale peace significantly predicted the Mental component score (p < .05). ConclusionsCancer pain remains undertreated, and patients with myeloma are no exception. Pain and spiritual well-being scores were significant predictors of physical and mental component scores of quality of life in this group of patients. According to this result, pain-reducing practices should be implemented to improve the quality of life in MM patients and the spiritual needs of the patients should be met.

Comparison of the Analagesic Efficacy of Transdermally Applied Buprenorphine and Ketoprofen for Postoperative Abdominal Pain in Dogs

Transdermal drug delivery (TDD) is defined as the non-invasive delivery of medications through the skin surface. The present study was planned to evaluate the efficacy of transdermal drug delivery system to alleviate the post-operative pain after abdominal surgery. Twelve clinical cases of dogs presented to the Department of Veterinary Surgery and Radiology, VCC, College of Veterinary Science and A.H., Mhow were selected for the study and divided into two groups. In group I (n=6) ketoprofen transdermal patch and in group II (n=6) buprenorphine transdermal patch was applied to the skin. The Glasgow Composite Measure Pain Scale was used to assess the pain pre-operatively (1 hour before surgery), complete post recovery, 24, 48 and 72 h post operatively. The mean total pain score was maximum in ketoprofen group than the buprenorphine group. Serum glucose and serum cortisol values increased significantly (P&lt;0.05) in the animals of both the groups however, this increase was minimum in buprenorphine group at complete post recovery. Based on above study, it is concluded that buprenorphine transdermal patch was considered more effective for controlling the visceral pain in comparison to ketoprofen transdermal patch in dogs.

COMPARISON OF POSTOPERATIVE MEAN OPIOID CONSUMPTION IN PATIENTS GIVEN (TAP) VERSUS PLACEBO UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

Early postoperative pain from laparoscopic cholecystectomy is moderate. A transverses abdominis plane block (TAP) may be an attractive analgesic strategy for reducing postoperative opioid consumption and side effects. The study aimed to assess postoperative mean opioid utilization in patients administered (TAP) block versus placebo undergoing laparoscopic cholecystectomy.This randomized controlled trial was conducted at the Department ofAnesthesiology, Aziz Bhatti Shaheed Teaching Hospital Gujrat,from June 1, 2022, toSeptember 30, 2022. A total of80 patients undergoingLaparoscopic cholecystectomy fulfilling inclusion criteria were recruited and further divided into two equal groups. TAP block procedure was performed in both groups. In group A, 40 patients received 20 mL of isotonic saline 0.9% bilaterallyas a placebo, and in group B, 40 patients had 20 mL of 0.5% bupivacaine. The two groups werecompared for the mean consumption dose of opioid analgesia in 24 hours postoperatively. A T-test was appliedfor statistical differences. (p-Value &lt; 0.05 was taken as significant. Data was collected on specially designed proforma.The total tramadol consumption decreased by 35% in the TAP block group (280.19 ± 56.67mg) compared to the control group (428.79 ± 58.69mg), and the difference was statistically significant (p &lt; 0.001).The mean total pain scores were significantly lower in the TAP block group (46.47 ± 6.17) compared to the control group (60.52 ± 5.67). Thus, it can be concluded from the study that theTAP block is an effective analgesia regimen for reducing postoperative mean opioid requirement and painafter Laparoscopic cholecystectomy.

Interventions for leg cramps in pregnancy.

Interventions for leg cramps in pregnancy.

Application of Lateral Wedge in Knee Osteoarthritis for Improving Pain and Quality of Life

OBJECTIVE: To determine the effectiveness of lateral wedge with and without conventionalphysiotherapy in relieving knee pain and quality of life in patients of knee Osteoarthritis.METHODOLOGY: This Randomized controlled study was conducted in Madina Clinics, Faisalabad. Byusing simple random technique 40 patients in range 40-60 years of age with clinically and radiologicallydiagnosed cases of grade II and III were studied, from February to August 2016. Subjects were divided intwo groups with 20 subjects in each group. KOOS knee survey was used for the assessment of Qualityof life.RESULTS: Mean total pain score on baseline of experimental group was 79.95±2.5 while the scoreamongst the control group was 79.95±7.69, after application of lateral wedges along with othertreatments, score after 2nd week was 84.65 ± 2.94 while in control group was 80.25±2.9.97. After 4th weekthe symptoms score in experimental group was 83.00 ± 0.00 while control group was 88.95 ± 2.96. Afterthe 6th week score was 91.5±14.5 of experimental and 81.8±9.5 of control group.These results of insoleWedges is also correlated with a lateral shift in the location of the COP in stance phase. Increase in theknee joint varus moment with insole Wedges suggests that the indication and limitations of laterallywedged insoles in general should be analysed in detail.CONCLUSION: This study concluded that the lateral wedges were significant in reduction of pain andsymptoms as well as improve the quality of life.

Outcome of Laparoscopic Transperitoneal Ureterolithotomy for Proximal Ureteric Stones - Our Two Years Experiences

To evaluate the results of laparoscopic transperitoneal uteterolithotomy for management of large proximal ureteric stones. This study was performed on 24 patients having proximal ureteric stone greater than 1.5cm at the Department of Urology, Shahid Sheik Abu Naser Specialized Hospital, Khulna, Bangladesh from January 2016 to December 2017. Patients having stone size less than 1.5cm, previous abdominal surgery and sepsis were excluded from this study. Patients characteristics, stone characteristics, perioperative and follow-up data were studied. Twenty-four patients (mean age=52.9±12 years) with large upper ureteric stones (mean stone diameter=35±12) were included. Twenty-two patients had single stone and 2 patients had two stones. Mean operative time was 107±49.5 min with mean blood loss of 60.5±19.2 cc. Mean total pain score was 38.4±5.5 (100 point scale) and mean time resuming oral intake was 7.2±1 h. Mean duration of hospital stay was 2.6±1.4 days and mean time of stenting was 7.2±2 weeks. Throughout a mean duration of follow-up of 10.8±6.6 months 100% stone clearance rate was achieved with no recurrence. Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain short hospital stays and cost effective and should be considered as a choice of treatment option for such stones.Medicine Today 2018 Vol.30(2): 71-73

Long-term Outcomes of APL Suspensionplasty with No, Partial, or Complete Trapezoid Excision

There is no financial information to disclose. Partial or complete trapezoid excision, combined with trapeziectomy and abductor pollicis longus (APL) suspensionplasty, impacts long term radiographic and clinical results. Sixty-nine patients (79 hands) underwent surgery for basal joint arthritis. Eighty-seven percent were female with a mean age 64. The dominant hand was involved in 57%. Advanced scaphotrapezial-trapezoid arthritis was noted intraoperatively in 55%, and treated with resection of the proximal 50% of the trapezoid (PT) in 21 hands (27%), and complete trapezoid (CT) resection in 22 (28%). No trapezoid excision was required (NT) in 36 hands. Fisher’s exact tests compared categorical outcomes and linear regression investigated whether predictors of interest (PT, CT or NT) had any effect on continuous variables such as Patient Rated Wrist Evaluation (PRWE), or DASH. Mean follow up was 95 months. There was no significant difference in satisfaction or the desire to have the procedure again. Mean total pain score was significantly lower with CT (4.89) and PT (4.94) when compared to NT (11.37). CT had significantly lower (better) mean total functional and usual activity scores on the PRWE, and four sub-scores on the quickDASH when compared to NT, but not to PT. Significant decreases in mean carpal height ratio (CHR) were seen in NT and CT. There was no significant difference between PT and CT; NT and PT had significantly more proximal collapse of the thumb metacarpal relative to the scaphoid compared to CT. Only NT had a significant change in the scapholunate angle. Both PT and CT had significant proximal migration of the index metacarpal. Complication rates trended higher in CT (27.3%) when compared to PT (23.8%)and NT (16.7%) but was insignificant. Secondary procedures were highest in CT (18%) and involved arthrodesis of the index and long finger carpometacarpal joints. •Complete trapezoidectomy had the greatest decrease in CHR and radiographic collapse of the index metacarpal, but without significant change in the scapholunate angle. It had the lowest (best) total pain and functional scores on the PRWE.•While CT also led to the greatest improvement in total functional scores (PRWE), the authors now only do PT for two reasons: (1) No significant differences in radiographic or clinical outcomes between PT and CT. (2) Higher complication rate with CT, notably an 18% incidence of symptomatic index CMCJ collapse and arthritis requiring arthrodesis.•NT patients had the highest total pain score and this may be due to impingement between the thumb metacarpal and trapezoid.

Efficacy and safety of oral robenacoxib (tablet) for the treatment of pain associated with soft tissue surgery in client-owned dogs

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) have been proven to be effective in controlling peri-operative pain in dogs. Robenacoxib is an NSAID with high selectivity for the cyclooxygenase (COX)-2 isoform. The objective of this study was to assess the efficacy and safety of an oral tablet formulation of robenacoxib in client-owned dogs undergoing soft tissue surgery. The study was a prospective, multi-center, randomized, masked, placebo-controlled, parallel-group clinical trial. A total of 239 dogs were included and randomly allocated in a 1:1 ratio to receive either robenacoxib or placebo. Each dog received an oral tablet administration of either robenacoxib, at a target dose of 2 mg/kg, or placebo once prior to surgery and for two additional days post-operatively. All dogs also received a pre-anesthetic dose of 0.2 mg/kg butorphanol (intravenous or intramuscular). Pain assessments were performed using the short form of the Glasgow Composite Measure Pain Scale. Robenacoxib was compared to the placebo group on a success/failure basis. Treatment failure was defined as the need for rescue therapy to control post-operative pain.ResultsSignificantly (P = 0.019) more dogs administered robenacoxib were considered treatment successes (89 of 116, 76.72%) compared to dogs given placebo (74 of 115, 64.35%). The percentage of treatment failure was therefore 23.28% in the robenacoxib and 35.65% in the placebo group. The least squares mean total pain scores were significantly different between groups and in favor of robenacoxib at 3 and 5 hours (P < 0.05) and 8 hours post-extubation (P < 0.01). Pain at the surgery sites (response to touch) was also significantly improved at 3, 5 and 8 hours post-extubation in dogs receiving robenacoxib versus placebo (P < 0.01). In addition, a significant overall improvement in posture/activity was revealed with robenacoxib having lower scores versus placebo (P < 0.01). No significant differences between the robenacoxib and placebo groups in the frequency of reported adverse events were observed.ConclusionsRobenacoxib by oral (tablet) administration was effective and well tolerated in the control of peri-operative pain and inflammation associated with soft tissue surgery in dogs.

Interventions for leg cramps in pregnancy.

Interventions for leg cramps in pregnancy.

Topical anesthesia for cataract surgery: the patients' perspective.

Purpose. To evaluate the analgesic efficacy of 0.5% propacaine hydrochloride as topical anesthesia during phacoemulsification surgery. Methods. Intraoperative pain intensity was assessed using a 5-category verbal rating scale during each of three surgical stages. Pain scores from each surgical stage and total pain scores were compared for the factors of patient age, gender, cataract laterality, and type. Results. In comparison of cataract type subgroups, the mean total pain scores and mean stage 2 pain scores in both white mature cataract (WMC) and corticonuclear plus posterior subcapsular cataract (CN + PSC) groups were significantly higher than in the PSC-only (PSC) group (P < 0.05). Conclusion. Phacoemulsification with topical anesthesia is not a completely painless procedure. Pain intensity varies with cataract type and stage of surgery.

Efficacy of transversus abdominis plane block in patients undergoing emergency laparotomies.

Background:Pain experienced following laparotomy is largely due to abdominal wall incision. Effective mitigation of this pain is vital to improve patient satisfaction and for early ambulation. We evaluated the efficacy of transversus abdominis plane (TAP) block for postoperative analgesia, as a component of multimodal analgesia.Materials and Methods:Sixty adult ASA physical status I to III patients undergoing emergency laparotomy under general anesthesia were recruited for this double-blind, randomized, controlled trial. The TAP block was performed before skin incision, using the double pop technique in the midaxillary line, at the level of the umbilicus with a 22 gauge blunt needle. The patients were randomly assigned to receive either 25 ml of 0.25% bupivacaine or normal saline (NS), bilaterally. Tramadol was used for postoperative analgesia via a patient-controlled analgesia pump (PCA) along with an intramuscular (IM) injection of diclofenac sodium, 12-hourly. Each patient was assessed in the Post Anesthesia Care Unit (PACU) immediately after shifting and every two hours thereafter, for 24 hours, for pain, nausea, sedation scores, and pruritus. The two-hourly and total tramadol consumption, over 24 hours, was assessed.Results:The mean total pain scores were significantly less in the TAP block group (48.07 ± 6.76) when compared to the control group (62.63 ± 6.66). The total tramadol consumption was decreased by 36% in the TAP block group (281.33 ± 69.66 mg) compared to the control group (439 ± 68.59 mg). Tramadol consumption measured every two hours was also less up to 18 hours postoperatively, after which, there was an increase in pain scores and tramadol consumption in the TAP block group. There was no statistically significant difference between the two groups in terms of nausea, vomiting, sedation or pruritis.Conclusion:TAP block is an effective component of the multimodal analgesia regimen for reducing postoperative pain and opioid requirement after emergency laparotomy.

The Mannerfelt wrist arthrodesis – A study of patient-reported outcomes in a rheumatoid population

BackgroundWrist arthrodesis has been established as a mainstay form of surgical intervention in the rheumatoid wrist. Despite this however, there is a distinct lack of patient-reported outcome measure (PROM) studies justifying the efficacy of this procedure in rheumatoid disease. The aim of this study was to report any change in function or pain following the tunnel Mannerfelt wrist arthrodesis in a single surgeon series of rheumatoid patients over a 6 year period. Methods14 consecutive patients (15 wrists) who had undergone the Mannerfelt wrist arthrodesis were followed prospectively with a mean follow up period of 45 months. No patients were lost to follow up. The primary outcome measures included the validated Patient Rated Wrist Evaluation (PRWE) questionnaire and a satisfaction questionnaire. ResultsThe mean total pain score improved from 41 points preoperatively to 14.2 points postoperatively correlating with a 65.4% improvement in overall pain outcomes. The mean total functional score improved from 83.7 points preoperatively to 45.5 points postoperatively demonstrating a 45.6% improvement in overall function at the time of follow up. ConclusionsAll patients reported an overall improvement in pain and functional capacity. The satisfaction results were excellent. All patients reported that they would elect to have the procedure again with the vast majority being ‘very pleased’ with the outcome of their surgery (93.7% very pleased and 6.3% fairly pleased). The procedure enjoyed favourable mid-term results and we recommend the tunnel Mannerfelt wrist arthrodesis for improving both pain and level of function in this group of patients.

Breastfeeding and pain relief in full-term neonates during immunization injections: a clinical randomized trial

BackgroundThe aim of this study was to examine the effect of breastfeeding on pain relief in full-term neonates during injection of hepatitis B vaccine.MethodsThis was a randomized clinical trial. A sample of full-term neonates was randomly allocated into two groups: the experimental group and the control group. Neonates in the experimental group were breastfed two minutes before, during, and after the hepatitis B immunization and the control group were held in mothers’ arms but not fed. Pain was assessed using the Douleur Aiguë du Nouveau-né (DAN) scale measuring facial expressions, limb movements and vocal expressions. The assessments were carried out after hepatitis B immunization.ResultsOne hundred thirty healthy full-term neonates were studied (65 in the experimental group and 65 in the control group). Gestational age, birth weight, Apgar score and gender did not differ between the two groups. The mean total pain score as measured by the DAN scale was 3.52 (SD = 1.37) for the experimental group and it was 6.78 (SD = 1.69) for the controls indicating a significant lower pain score for the experimental group (P<0.001). Also, there were significant differences for the three measures of DAN scale that are facial expressions, limb movements and vocal expression, between the two study groups (P<0.001).ConclusionThe findings confirm that breastfeeding reduces pain and is effective way for pain relief during hepatitis B vaccine injection.Trial registrationIRCT201104166206N1

Effect of Magnesium Administration on Passive Avoidance Memory and Formalin-Induced Nociception in Diabetic Rats

Purpose: To investigate the effect of oral consumption of magnesium on the memory and pain sensation of diabetic rats.Methods: A total of 48 rats were divided into four groups - untreated control, untreated diabetic, magnesium-treated control and magnesium-treated diabetic. Plasma magnesium and glucose concentrations were measured after induction of diabetes with streptozotocin (STZ; 60 mg/kg). Four weeks after the administration of oral magnesium (10 g/L, MgSO4), the animals were subjected to passive avoidance test whereby latency time (LT) was assessed. This was followed by formalin test which entailed the determination of licking and flinching scoresResults: Increased level of glucose and decreased concentration of magnesium in untreated diabetic group compared to untreated control group (p &lt; 0.001) were observed. There was also a significant reduction in mean LT of untreated diabetic group (p &lt; 0.001) as indicated by the increased number of animals that entered the dark compartment. Plasma glucose and magnesium levels in magnesium treated diabetic rats returned to normal 4 weeks after oral magnesium consumption. There was no significant change in mean total pain score despite elevated licking in diabetic animals after oral magnesium consumption. Significant elevation of flinching scores of untreated diabetic rats was observed in the last 20 min of the 2nd chronic phase, compared with the untreated control group.Conclusion: It seems that magnesium treatment either restores rat memory performance that is impaired by diabetes or that it affects the aversive responses evoked by electrical shock.Keywords: Diabetes, Magnesium, Glucose, Passive avoidance memory, Formalin test.

Pain assessment in premature infants treated with intravitreal antiangiogenic therapy for retinopathy of prematurity under topical anesthesia

To evaluate the physiological and behavioral pain response in premature infants receiving intravitreal bevacizumab injection (IVB) for retinopathy of prematurity (ROP) under topical anesthesia. A prospective interventional non-comparative case series. Premature infants with high-risk prethreshold or threshold ROP received IVB using topical anesthesia with tetracaine eye drops. A Premature Infant Pain Profile was used to assess the pain response during the procedure. Nine premature infants requiring bilateral IVB therapy were included in the study. Mean gestational age was 28.7 ± 1.3 weeks, and birth weight was 1,200 ± 194 grams. The mean total pain score was found to be 8.7 ± 2.4 (range 5-14), indicating generally mild pain during the procedure. Eye squeeze was the most prominent indicator of pain. Most changes occurred at the beginning, with the insertion of the lid speculum and were hardly noted during the rest of the procedure including the injection itself. Topical anesthesia with tetracaine is an effective method for the relief of pain associated with intravitreal injections in premature infants with ROP.

Laparoscopic transperitoneal ureterolithotomy for large ureteric stones

Objectives:To evaluate the efficacy and safety of laparoscopic transperitoneal ureterolithotomy for management of large proximal ureteric stones.Materials and Methods:Medical records of patients who underwent laparoscopic transperitoneal ureterolithotomy for proximal ureteral stones ≥2 cm were reviewed retrospectively. Patients’ characteristics, stone characteristics, perioperative and follow-up data were studied. Patients with stones <2 cm in size, previous transperitoneal surgical procedure, or follow-up duration <6 months were excluded from the study.Results:Twelve patients (mean age = 52.9 ± 12 years) with large upper ureteric stones (mean stone largest diameter = 39 ± 13 mm) were included. Nine patients had single stone, 2 patients had two stones, and 1 patient had large impacted stone with 2 small stones floating above. Mean operative time was 107 ± 49.5 min with mean blood loss of 60.5 ± 19.2 cc. Mean total pain score was 38.4 ± 5.5 (100 point scale) and mean time till resuming oral intake was 3.6 ± 0.5 h. Mean duration of hospital stay was 2.6 ± 1.4 days and mean duration of stenting was 7.3 ± 2 weeks. Throughout a mean duration of follow-up of 14.8 ± 7.6 months, 100% stone clearance rate was achieved with no recurrence. One patient developed a ureteric stricture treated by laser endoureterotomy and stenting for 6 weeks and responded without re-stricture formation.Conclusion:Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain and short hospital stay, and should be considered as a treatment option for such stones.

Assessment of Analgesic Effect of Breast Milk, Acetaminophen and No Intervention for Term Neonates Undergoing Percutaneous Venous Catheter Placement and Replacement

Background and Aims: All researchers according to AAP comments for neonatal pain treatment try to find low risk and safe therapies. So our study compares analgesic effects of breast milk and acetaminophen with each other and control group (no analgesic administration before percutaneous venous catheter placement and replacement). Methods: This interventional experimental random clinical trial study was accomplished in over one year from February 2009 to February 2010 on180term, stable admitted neonates. The Neonatal Infant Pain Scale (NIPS) and CRIES pain measurement score were accepted for determine and comparison of pain scales in our samples (Table-1). Research population divided to A (acetaminophen usage), B (breast milk feeding) and C (control) group equally with simple random method. For all groups total mean pain score calculated (table-2). Data were analyzed using SPSS statistical software and Paired t-tests and tukey test. Pvalue less than 0.05 were considered significant. Results: Mean neonatal pain score of breast feeding group population (B) was 2.18 (SD=2.7) approximately 2. 75 times lower than acetaminophen using group (A) and 3.5 times lower than control group (C). The difference of total mean pain score of each group (Fig-2), compared with tukey test. Differences were significant (p=0.001). Comparing of mean total pain score of A group [total mean pain score=7.6(SD=5.6)] and C group [total mean pain score=6(SD=5)] showed that A group had higher total mean pain score probably due to bitter taste of acetaminophen and delay analgesic effect of acetaminophen. Conclusion: Breast milk has analgesic effect before percutaneous venous catheter placement / replacement

Assessment of joint pain in teenagers with juvenile arthritis

Assessment of joint pain in teenagers with juvenile arthritisObjective. To assess mean total pain score in teenagers with juvenile arthritis (JA) and its values in groups differing on sex, variant of course, activity measures, degree of functional disturbances. To assess advisability of application of these parameters in real clinical practice. Material and methods. 73 pts with JA (mean age 14,7±1,7 years, mean disease duration7,2±4,4 years) were included. 18 from them had systemic, 42 – polyarticular and 13 – olygoarticular variant. 16 pts were examined repeatedly with interval exceeding one year. Total quantity of examinations was 94. 17 pts were examined at admission and at discharge. Pain was measured on visual analog scale (VAS) and on McGill Pain Questionnaire (83 examinations) including 3 scale: sensor (description of pain), affective (their influence on emotional state) and evaluative (verbal assessment of pain intensity). General health assessment on VAS was performed in 59 pts (in 8 from them at admission and at discharge). Summary mean measures and their values in groups differing in sex, course variant, activity measure, functional class at pts admission to and at discharge from the Institute of Rheumatology of RAMS. Statistical treatment was performed with Biomed program(descriptive statistic, χ2, Student’s pared test). Results. Mean pain score on VAS in all teenagers with JA was 31,3±17,3. It was significantlyhigher in boys with systemic variant (in comparison with polyarticular), in pts with ESR elevation above 30, in pts with functional class 3 and higher at admission to the department. Pain score was significantly lower in pts with olygoarticular variant in comparison with mean value and with value in polyarthritis. Pain above 70 mm on VAS was found in pts with polyarticular damage in systemic and polyarticular variants in active phase of the disease and in severe functional disability. Summated (on sensor and affective scales) mean pain score value was 2,4±1,4. Summated mean range of pain (4,4±3,2) was significantly higher than pain score (2,4±1,4). Conclusion. Teenagers with JA had moderate (on their assessment) pain, more intensive in active phase of the disease and in disabled pts. Pain had emotional tint. Pain measurement should be performed repeatedly (at admission to and at discharge from hospital) to assess results of treatment.

Comparison of Topical and Subconjunctival Anesthesia in Intravitreal Injection Administrations

To compare the effectiveness of topical and subconjunctival anesthesia in intravitreal injection administrations. Twenty-eight patients from a university clinic with bilateral diabetic macular edema were prospectively randomized to receive intravitreal injection of 4 mg triamcinolone under topical anesthesia for one eye and subconjunctival anesthesia for the other eye by using lidocaine 4%. Patients were asked to grade the pain they experienced during administration of both anesthesia and intravitreal injection by using a 4-point pain scale: from 0=no pain to 3=severe pain. Complications that developed during both procedures were recorded. The mean pain score experienced during subconjunctival injections was 0.78+/-0.62, whereas no anesthesia-related pain was reported in the topical group. The mean pain score experienced during intravitreal injection was 1.64+/-0.67 in the topical and 0.85+/-0.52 in the subconjunctival group (p<0.001). The mean total pain scores of both procedures were 0.82+/-0.34 in the topical and 0.82+/-0.51 in the subconjunctival group (p>0.05). Nine eyes (32%) developed subconjunctival haemorrhage after subconjunctival injection, whereas no anesthesia-related complication developed in the topical group. Subconjunctival haemorrhage was also observed in 5 eyes (18%) in the topical group and in 11 eyes (40%) in the subconjunctival group (p>0.05) after intravitreal injection. Although subconjunctival anesthesia provides better pain control during intravitreal injections, its application is more painful and leads to subconjunctival haemorrhage. Moreover, the mean total pain scores are similar in both methods. Therefore, topical anesthesia may be more suitable for daily practice.

Randomized prospective study of periprostatic local anesthesia during transrectal ultrasound-guided prostate biopsy

Objectives. To prospectively evaluate the efficacy of apical and lateral periprostatic lidocaine injection as anesthesia during transrectal ultrasound-guided prostate biopsy.Methods. A total of 152 consecutive men undergoing transrectal prostate biopsy in our department were enrolled in this study. Patients were randomized into group 1 (74 patients) who received 15 mL of 1% lidocaine in the lateral and apical periprostatic regions, 5 mL in each point, 10 minutes before the prostate biopsy, and group 2 (78 patients), controls. Pain after each biopsy (a total of 10 biopsies) was assessed using a 10-point linear visual analog pain scale.Results. In groups 1 and 2, the mean patient age was 64.8 and 65.8 years (P = 0.4), mean prostate-specific antigen was 10.9 and 11.2 ng/mL (P = 0.9), and mean prostate volume was 57 and 60 cm3 (P = 0.5), respectively. The mean total pain score (sum of each biopsy score, total of 10 for each patient) during transrectal prostate biopsy was 16 (range 0 to 62.5) and 50 (range 0 to 100) in groups 1 and 2, respectively (P = 0.0001). No adverse events were noted.Conclusions. Transrectal ultrasound-guided lateral and apical periprostatic anesthesia significantly diminishes the pain in men undergoing transrectal prostate biopsy. We recommend that this procedure be routinely offered to all patients undergoing transrectal prostate biopsy.