Mean VAS Research Articles

Freiberg`s disease of lesser metatarsals treated with bone grafting and autologous matrix induced chondrogenesis (AMIC) membrane – A series of 10 cases

BackgroundFreiberg’s infraction is osteonecrosis of lesser metatarsal heads most commonly affecting adolescent females. They usually present with pain and swelling of the forefoot. MRI is useful investigation in the early diagnosis. It is a self-limiting disease and the main stay of treatment is non operative. Surgery is indicated in failed conservative management which include open debridement, cheilectomy, micro fracture, osteotomies and excision arthroplasty with varying success. MethodsA retrospective analysis of ten patients with Freiberg`s disease of the lesser metatarsals treated with open debridement, microfracture, bone grafting and application of AMIC (Autologous Matrix induced Chondroplasty) membrane was carried out. The patients were followed up to five years and the outcome measures were scored using Manchester-Oxford Foot Questionnaire (MOxFQ) and EQVAS best health scores. ResultsThe mean age was 42.7 years and follow-up time was 36.4 months. The most common site was second metatarsal, eight (80%) followed by third metatarsal, two (20%). The mean base line MOxFQ was 72.5 (95% CI- 45 ± 100) which improved to 42.5 (95%CI- 2.5 ± 82.5) at one year. The mean baseline VAS improved from 26.4(10.2 ± 42.6) to 30.3 (95%CI- 2.1 ± 58.5) at one year. The mean MOxFQ and VAS at the end of 36 months was 31.4(95%CI-6.6 ± 57.2) and47.3(4.3 ± 80.3) respectively. ConclusionsOpen debridement of the Freiberg`s disease combined with microfracture of the defect, bone grafting and application of AMIC membrane shows reliable functional and radiological outcomes at short term follow up.

Low Back Pain, Disability, and Quality of Life One Year following Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate.

Degenerative disc disease is a common cause of chronic low back pain. Surgical intervention is an invasive treatment associated with high costs. There is growing interest in regenerative medicine as a less invasive but direct disc treatment for chronic discogenic low back pain. To evaluate clinical improvement of primary discogenic low back pain with intradiscal injection of autologous bone marrow aspirate concentrate (BMAC). Study Design. Prospective cohort study. Setting. Single, multiphysician center. Patients. 32 adult patients undergoing intradiscal injection of autologous BMAC for the treatment of primary discogenic low back pain. Interventions. Intradiscal injection of autologous BMAC. Main Outcome Measures. Primary outcome measure is visual analog back pain scale (VAS back pain). Secondary outcome measures include ODI, VAS leg pain, and EQ-5D-5L scores. Outcomes were compared from baseline to 1 year. Thirty-two patients (56.3% male) with a mean age of 45.9 years were enrolled, giving 92 treated levels. Mean VAS back and leg pain scores improved from 5.4 to 3.0 (p < 0.001) and 2.8 to 1.3 (p = 0.005), respectively. Mean ODI scores decreased from 33.5 to 21.1 (p < 0.001), and EQ-5D-5L scores improved from 0.69 to 0.78 (p = 0.001). Using established MCID values, 59.4% had clinically significant improvement in VAS back pain, 43.8% in VAS leg pain, and 56.3% in ODI scores. Intradiscal injection of autologous BMAC significantly improved low back pain, disability, and quality of life at one year. This study suggests that intradiscal BMAC has the potential to be an effective nonsurgical treatment for chronic discogenic low back pain.

Education level has an effect on the recovery of total knee arthroplasty: a retrospective study

ObjectiveThis study aimed to observe the relationship between education level and outcomes after total knee arthroplasty (TKA).MethodsOne thousand two hundred sixty four patients after TKA in our hospital from April 2016 to April 2020 were reviewed. These patients were divided into 4 groups (A who were illiterate, B who had elementary school degree, C who had junior high school degree, D who had senior high school degree or higher) by the educational level, which was blinded to the observers. The postoperative outcomes of KSS score, pain, joint extension and flexion function were observed 1 year after discharged from hospital.ResultsAmong 1253 patients met the inclusion criteria, the average age was 68.63 years, the average body mass was 57.73 kg. There are no distinctions among 4 groups one day after the surgery. However, the outcomes of the follow up were that, the KSS score was: 77.84 ± 10.635; 80.70 ± 8.956; 87.92 ± 8.123;91.27 ± 8.262, with significant differences (P < 0.05). The mean VAS scores were: 1.97 ± 1.60; 2.07 ± 1.66; 1.197 ± 1.5265, 1.044 ± 1.4662. Patients in Group C and D had significantly less pain than that in Group A and B (P < 0.05). The knee flexion range of motion (ROM) was: 91.21 ± 11.69°; 91.77 ± 11.95°; 102.12 ± 11.38°; 109.96 ± 10.64°, Group D performed best, with significant differences (P < 0.05). The knee extension ROM were: – 2.41 ± 4.49°; – 0.91 ± 2.82°; – 0.83 ± 2.87°; – 0.35 ± 1.60°, with significant difference between Group D and the others (P < 0.05).ConclusionEducation level affects the outcomes such as VAS score, KSS score, the extension and flexion ROM of the knee after TKA. The patients with higher education level have better outcomes.

Short course palliative radiotherapy in advanced solid tumors: a pooled analysis (the SHARON project)

Previous trials showed the tolerability and efficacy of a palliative radiotherapy (RT) regimen (SHARON) based on the 4 fractions delivered in 2 days in different oncological settings. In order to identify possible predictors of symptomatic response, the purpose of this study is to perform a pooled analysis of previous trials. We analyzed the impact on symptomatic response of the following parameters: tumor site, histological type, performance status (ECOG), dominant symptom, and RT dose using the Chi-square test and Fisher’s exact test. One-hundred-eighty patients were analyzed. Median RT dose was 20 Gy (range: 14–20 Gy). The overall response rate was 88.8% (95% CI 83.3–92.7%) while pre- and post-treatment mean VAS was 5.3 (± 7.7) and 2.2 (± 2.2), respectively (p < 0.001). The overall response rate of pain, dyspnea, bleeding, dysphagia, and other symptoms was 86.2%, 90.9%, 100%, 87.5%, and 100%, respectively. Comparing the symptomatic effect based on the analyzed parameters no significant differences were recorded. However, patients with locally advanced disease showed a higher rate of symptomatic responses than metastatic ones (97.3% vs 83.0%; p = 0.021). Finally, the complete pain response rate was more than double in patients with mild to moderate (VAS: 4–7) compared to those with severe (VAS > 7) pain (36.0% vs 14.3%; p = 0.028). This pooled analysis showed high efficacy of the SHARON regimen in the relief of several cancer-related symptoms. The markedly and significantly higher complete pain response rate, in patients with mild-moderate pain, suggests early referral to palliative RT for patients with cancer-related pain.

Effect of Perineural Dextrose Injection on Myofascial Pain Syndrome

Background: Myofascial pain syndrome (MFPS) is defined as the motor, sensory, and autonomic signs resulting from trigger points (TrPs). Objectives: To assess the effectiveness of the perineural injection in patients with MFPS. Materials and methods: The study was conducted at AL Ramadi Teaching Hospital, Department of Rheumatology, Ramadi City, Iraq. The study period was from June 2019 to January 2021. A retrospective review of 100 patients with prospectively collected clinical and radiologic data was performed to evaluate the effectiveness of perineural injection on MFPS. A 3 ml of 5% dextrose solution was managed sub-cutaneous straight at the labeled chronic constrictive injury and tender spots rounding the knee. The VAS and WOMAC were calculated for each participant at the time of the presentation and 1, 3, and 6 months following treatment. Results: The mean age of the patients was 60.93 ± 6.17 years (25-70 years). Three-quarters (75/100) of the cases were female. Seventy subjects were from the age group ≥ 40 years, while the remaining 30 cases were from the age group < 40 years. Fifty-five cases were with right-sided involvement. Successful results were achieved in 90% of the participants. There were no statistically significant differences between the effective and not effective groups regarding the age, gender, and the involved side (P-value > 0.05). There was a reduction in the mean VAS (8.47 ± 0.77) of pain and WOMAC (78.99 ± 5.69) score at the time of presentation to 1.87 ± 1.32 for the VAS and 17.84 ± 4.66 WOMAC at 6-months post-injection period. No complications were reported in all patients apart from mild pain at the injection site. Conclusion: Perineural dextrose injection was successful in 90% of the patients with MFPS. This modality results in a sharp reduction of both VAS and WOMAC scores from the time of the presentation to 6-months post-treatment. We recommend using this modality because it is easy, effective, and safe.

EFFECT OF VARICOCELECTOMY ON SEMEN ANALYSIS AND CLINICAL PARAMETERS

To determine changes in semen and clinical parameters following varicocelectomy. Prospective comparative study conducted on 30 Methods: patients at Santosh Medical college and hospital, Ghaziabad., undergoing varicocelectomy. Study aimed at comparing the semen analysis and various clinical parameters (pain VAS score and size of the swelling) postoperatively, at 3 month and 6 monthly follow up. Semen pH Results: value and total semen volume did not show any statistically signicant improvement postoperatively. Post operatively statistically signicant improvement was seen in total sperm count, motility as well as sperm morphology. The improvement was more when preoperative parameters were in lower range compared to normal range parameters. 7 patients who were oligospermic preoperatively showed marked improvement in their sperm count at 3 and 6 months respectively(p value 0.001); which is more signicant improvement than preoperatively normospermic patients (p value 0.003). Postsurgery sperm motility showed signicant improvement, better results were seen when preoperative motility was &lt; 28% versus when motility was &gt;28%. Signicant improvement in sperm morphology postoperatively(p value 0.001)was seen, with better results in patients with preoperative sperm morphology &lt;3% versus &gt;3%. Mean VAS score showed statistically signicant decrease at 3 months and at 6 months postoperatively (p value 0.001).83.3% patients were relieved of pain at 6months follow up post surgery. Of the 12 patients who presented with swelling, 11 patients showed signicant decrease in swelling size at 6 months follow up postoperatively. We advice varicocelectomy Conclusions: in all patients of varicocele who are either clinically symptomatic with scrotal pain and swelling, and also in asymptomatic patients with subnormal semen parameters.

A COMPARATIVE STUDY OF INTRAARTICULAR PRPAND HYALURONIC ACID FOR OSTEOARTHRITIS KNEE JOINT

Intrarticular injections with PRP and HAcan be quite benecial to treat OAknee patients that cannot be managed by analgesics and physiotherapy alone. However, there is no consensus regarding the better efciency of PRP vs HA till now. Hence, this study compares the efciency of these procedures in terms of clinical outcomes as measured by functional and pain assessment. This hospital based prospective randomised trial was conducted among 100 patients (50 study group and 50 in control group), selected using simple randomisation sampling. The functional assessment after both procedures was evaluated at 6 weeks, 3 months, 6 months and 1 year using the WOMAC scale and VAS scale. The p-value using unpaired t-test in comparison between the two groups not statistically signicant through all the follow up periods showing that PRPwas not superior to HA even though both the groups showed signicant improvement in the WOMAC scores at all follow up points (p=0.215 ;6 weeks, p=0.961; 3 months,p=0.738;6 months) .Group I VAS shows a reduction in mean of 7.3 to 3.1 which denotes improvement in the patient's pain There was a signicant reduction of VAS mean from 7.04 to 3.04 in Group II, showing signicant improvement in pain.The p value was not statistically signicant when comparing the 2 groups (p=0.807) Our studies conclude that both modalities were efcient in improving the functional status of the knee and reduce symptoms of OA, PRP did not provide superior clinical improvement compared with HA in symptomatic or functional improvement at different follow-up stages.

Tranversus Abdominis Plane Block in Laparoscopic Surgery

Good postoperative pain relief has been observed following various inguinal and abdominal procedures using transversus abdominis plane (TAP) block. Objective: To determine the outcome of laparoscopically assisted transverses abdominis plane block in laparoscopic cholecystectomy in comparison to periportal local anaesthesia in terms of mean pain. Methods: The study was conducted at the Department of General Surgery, Pakistan Atomic Energy Commission Hospital, Islamabad from January 2020 to June, 2020. In this randomized controlled trial, 92 patients underwent elective laparoscopic cholecystectomy were enrolled. Pain score was calculated by visual analogue score at 24 hours post-operatively. Data were entered in SPSS version 25.0. Comparison of both groups was done for pain score using t-test. Data were stratified. The t-test was performed. Results: Total 92 patients underwent elective laparoscopic cholecystectomy were selected foe the study. The subjects were divided into two categories such as Group1 or A (TAP block) and Group 2 or B (Periportal local anaesthesia). In the group A the 34(73.9%) subjects were males while the other 12(26.1%) were females, while in the group B the males were 31(67.4%) and 15(32.6%) were females. Mean VAS was 3.69±1.21 in group-A (TAP block) and 4.26±1.29 in group-B (periportal local anaesthesia) with p-value of 0.033. It is statistically significant. Conclusion: The one of the safest and effective modalities that provide postoperative analgesia with essentially decreased/ less postoperative pain when compared to periportal local anaesthesia is named as laparoscopic assisted TAP block.

Standard Versus Tubeless Percutaneous Nephrolithotomy in Children: A Comparative Study at Tertiary Care Centre

Background: Percutaneous nephrolithotomy is a urological technique advocated to extract kidney and proximal ureter calculi. Various strategies evolved throughout time as a result of experiences and new instruments. Tubeless PCNL is chosen over traditional PCNL due to fewer post-operative problems, a shorter patient hospital stay, and shorter procedure duration. This is the first of its kind study, to our knowledge in paediatric population in our setup. Objective: To compare the outcomes of standard versus tubeless percutaneous nephrolithotomy in children. Material and Methods: This prospective descriptive comparative study conducted at Department of Paediatric Urology, Institute of Kidney Disease, Peshawar; from October 2021 to September 2022 consisting of 100 patients. Patients in the age range of 4 to 14 years with renal or ureteric stones were arbitrarily assigned to two groups. Group A underwent through standard PCNL and group B underwent through tubeless PCNL. Outcomes of both groups were compared in terms of operative time, post-op pain and post-op complications. All the data was analyzed through SPSS version 24. Results: Mean age of the patients in group A and B was 9.12±2.07 years and 8.68±1.82 years respectively. The mean operation time, hospital stay in group A (standard PCNL) and B (tubeless PCNL) were 86.06 ±7.20 minutes, 6.46±.97 days and 83.68 ±3.81 minutes and 3.42±.81days respectively. The mean VAS pain scores in group A and group B were 6.24 ± .71 and 3.70 ± .81 respectively. Post operative complications were less seen in the tubeless PCNL. Conclusions: Tubeless PCNL is a safe technique having shorter operative time while post-operatively associated with shorter hospital stay and fewer complications as compared to standard PCNL. Keywords: Renal Stones, Standard PCNL, Tubeless PCNL, Outcomes Abbreviations: PCNL=Percutaneous Nephrolithotomy, VAS=Visual Analogue Scale

Open Versus Laparoscopic Appendicectomy in Pediatric Patients; A Comparative Study in A Single Center

Appendicitis is the commonest surgical emergency in paeadtric patients. Appendicectomy is still being performed by both open and laparoscopic methods. The first laparoscopic appendicectomy was performed in 1983. Objective: To compare the outcome of open appendectomies with laparoscopic appendectomies in pediatric patients was the objective of this study. Methods: Two hundred pediatric patients of both genders with acute appendicitis were enrolled from emergency department of Pediatric Surgery, Qazi Hussain Ahmad medical complex, Nowshehra, from March 2020- December 2020. In this convenient study patients were dividing into two groups. Group A patients received open appendectomy and Group B received laparoscopic appendectomy. Outcome of both procedures were noted and compared between groups by chi square test. Results: Mean ages of patients were 10.11±2.67 and 10.01±2.31 years (p=0.796) in group A and B, respectively. There were 63.0% and 69.0% males 1) in group A and B, respectively. Mean operative time, mean hospital stay and mean VAS were26.19±8.14 vs. 36.79±11.41 min.,2.01±0.61 vs. 1.03±0.01 days and 3.67±1.41 and 6.07±2.01 (p=0.000) in group A and B, respectively. Complications were hemorrhage (0.0% vs. 0.0%; p=1.0), Iatrogenic injury (0.0% vs. 0.0%; p=1.0) and Pelvic collection (3.0% vs. 0.05; p=1.0), SSI (6.0% vs. 0.0%; p=0.00) in group A and B, respectively. None of the pediatric patients after laparoscopic appendectomy required another exploration to deal with complications however, 3.0% patients needed exploration in open appendectomy. No mortality (0.0%) was observed in any group. Conclusions: laparoscopic appendectomies in pediatric patients is safe and feasible as compared to open appendectomy

New approaches to proven technology: Force control posterior thoracolumbar fusion with an innovative pedicle screw system

ObjectiveDespite continuous advancements, posterior thoracolumbar fusion with pedicle screw systems (PSS) has failed to reduce the rate of reoperation over recent decades. Implant failure, including screw pullout or loosening, implant breakage, and disassembly, is the leading cause for hardware-related reoperations. Since mechanical failure is due to overloading, efforts must be made to eliminate avoidable stresses. The study aim is to compare the results of a novel force-controlled PSS with literature. MethodsThis retrospective, consecutive cohort includes 150 patients who received the Neo Pedicle Screw System™ for single- or multilevel thoracolumbar fusion. Fusion rate, VAS back pain, reoperations, screw loosening, and surgical site infections (SSI) were evaluated. A structured literature search was performed specifically on screw loosening. Statistical significance was assumed at p < 0.05. ResultsIndications were mainly trauma (62,7%) and degeneration (34,0%), and mean age was 66 years. Overall fusion or fracture healing rate was 93,8% (CI 89,3%-98,3%), mean VAS back pain improvement 6,2 (p < 0,001), overall reoperation rate 16,7%, (CI 10,7%–22,7%), including 8,7% (CI 4,2%-13,2%) re-interventions involving the implant system, patient-based screw loosening rate 8,9% (CI 3,9%-13,9%) and screw-based loosening rate 2,3% (CI 1,3%-3,3%), SSI rate 2,7% (CI 0,1%-5,3%). No implant breakages occurred. The literature search revealed screw loosening rates of 15,1% (CI 14,2%-16,0%) patient-based and 3.8 % (CI 3,5%-4,1%) screw-based, which were statistically significantly higher than in the study. ConclusionBy controlling the forces applied intraoperatively, the surgeon can avoid unintended spinal stresses and better consider the patient's individual anatomical and biomechanical balance. The results suggest that the principle of force-control can be effective.

Échogénicité des pleurésies : facteur prédictif d’amélioration de la dyspnée ? Étude pilote concernant les pleurésies métastatiques

Metastatic pleural effusion is a cause of dyspnea. The American thoracic society has strongly suggested that studies evaluating thoracic ultrasonography as potentially predictive of improvment of dyspnea are needed. We conducted a prospective monocentric observational study to assess chest ultrasound predictors of response to thoracentesis. Fifteen patients with metastatic pleural effusion were included. The initial mean VAS score was5±2,9cm. The majority of patients had pleural effusions equal to or greater than 5 intercostal spaces (EIC) in height, while 7 patients had an abnormal curvature of the hemidiaphragm (flattened or inverted). The volume removed was greater in the group with anechoic pleurisy compared to the group with sonographic septation, notwithstanding complex pleural effusion (non-septated, relatively hyperechoic, with some spots in the effusion). The patients with complex pleural effusions had an higher score of dyspnea. The 7 patients with abnormal diaphragmatic curvature presented significant dyspnea with a pain score of approximately 7 and profuse pleurisy occupying 8 intercostal spaces in height. The effusions of those who could not normalize their curvature had a complex aspect and the volume removed was lower. The ultrasound characteristics of pleural effusions seem to be predictors of improvment of dyspnea after thoracentesis. The septated and complex aspects are probably predictors of non improvment of dyspnea.

EQ-5D-3L Norms for the European Older Population: Country-Specific Norms for 15 European Countires Based on the Survey of Health, Ageing, and Retirement in Europe

ObjectivesThis study presents a country-specific 3-level version of EQ-5D population norms for the European older population. MethodsNorm data were obtained from the fourth wave of the Survey of Health, Ageing and Retirement in Europe, and determined, for each EQ-5D dimension, the EQ–visual analog scale (EQ-VAS) and EQ-5D index values by 7 age groups and sex for 15 European countries. The EQ-5D index values were calculated using the European VAS value set for all countries. ResultsData resulting from 50 013 older respondents (mean age 65.9 years, range 50-111 years, 55.6% women) revealed an increasing number of self-reported health problems on EQ-5D dimensions and decreasing EQ-VAS scores with increasing age and for women compared with men. There are notable differences between countries in terms of the age gradient, the proportion of respondents in full health, and sex. Across all age groups, problems with pain & discomfort are the most frequent (36%-73% any problems), whereas problems with self-care are the least frequent (3%-31% any problems). The mean EQ-VAS score is 71.2 and the mean European VAS score is 0.79. ConclusionsGiven the growing number of older adults and elderly people in Europe, these population norms provide a valuable source of reference data that can be used to compare older adults or patient subgroups to the average of the general elderly population in a similar age or sex group in 15 European countries. The index value results may be further used to assess the burden of disease across older European populations and to identify the unmet needs of targeted older patient populations.

Efficacy analysis of splint combined with platelet-rich plasma in the treatment of temporomandibular joint osteoarthritis.

Objective: To evaluate the efficacy of splints combined with PRP for the treatment of temporomandibular joint osteoarthritis. Methods: Thirty-one patients with temporomandibular joint osteoarthritis who were treated with splints combined with platelet-rich plasma (PRP) from January 2021 to June 2021 at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China) were retrospectively reviewed. The VAS scores of all the patients were recorded before and 6 months after treatment, and the maximum comfortable mouth opening was recorded. All data were analyzed by the paired t-test using SPSS software, and a p-value < 0.05 indicated statistically significant differences. Results: Splint + PRP treatment was successful in 31 patients. The mean pretreatment VAS score was 6.1, and the mean VAS score 6 months posttreatment was 4.1. The posttreatment VAS score was significantly lower than the preoperative VAS score (p < 0.05). The mean pretreatment maximum comfortable mouth opening (MCMO) was 27.6mm, and the mean MCMO 6months posttreatment was 34.8mm. The MCMO was significantly increased (p < 0.05). Conclusion: Splint + PRP is an effective treatment for temporomandibular joint osteoarthritis.

Efficacy of Transdermal Buprenorphine Patch in Postoperative Pain Management in Oral and Maxillofacial Surgery.

To evaluate the therapeutic efficacy of transdermal Buprenorphine patch in postoperative pain management in Major Oral and Maxillofacial surgeries done under general anesthesia. A total number of 100 subjects, both males and females in the age group of 18-60years were included in the study. At the screening visit, a brief medical history was recorded for each prospective subject. The subject was selected according to the inclusion and exclusion criteria and consent was taken before placing the patch. For a period of 7days, 10mg Buprenorphine patch was placed on the skin of the patient for 3h before the surgery. Analgesic efficacy was recorded for the next 7days by using visual analogue scale (hereinafter refered to as "VAS"). If the VAS score was above 5, the rescue analgesia inj. Dynapar I.V was administered to the patient. The mean VAS score in females 4.4, was high when compared to males 3.9, which would suggest that the patch was more effective in males compared to females. Trauma patients showed mean VAS score of 3.9 and pathology patients showed a mean VAS score of 4.1. 36% of the patients required additional analgesics as the VAS score was more than 5. 20% of patients between age group of 20-30years required additional analgesics, 66.7% in 31-40yrs, 0% of 41-50yrs and 13.3% in 51-60yrs required additional analgesics. 24% of the females patients required 37 additional analgesics compared to the 12% in male patients. 21.6% of patients treated for pathology required additional analgesics compared to the 8.2% in trauma patients. Thus, the sensitivity of this study was 94.1% and specificity was 33.3%. Buprenorphine has high analgesic potential, good safety profile, ease of opioids switches and reversibility by μ- antagonist. Transdermal route is cost effective and has increased patient compliance and ease of handling with less adverse effects. Thus, the efficacy of transdermal buprenorphine in postoperative pain management was good.

Combination of thoracic epidural analgesia with patient-controlled intravenous analgesia versus traditional thoracic epidural analgesia for postoperative analgesia and early recovery of laparotomy: a prospective single-centre, randomized controlled trial

BackgroundThoracic epidural analgesia (TEA) has always been the first choice for postoperative pain treatment, but associated complications and contraindications may limit its use. Our study put forward a new analgesic strategy that combines TEA with patient controlled intravenous analgesia (PCIA) to optimize TEA.MethodsPatients undergoing laparotomy were enrolled in this prospective randomized study. Patients were randomized to one of two groups: TEA/PCIA group and TEA group. Patients in TEA/PCIA group received TEA in the day of surgery and the first postoperative day and PCIA continued to use until the third postoperative day. Patients in TEA group received TEA for three days postoperatively. Visual analogue scale (VSA) pain scores at rest and on movement at 6, 24,48,72 h after surgery were recorded. In addition, the incidence of inadequate analgesia, adverse events, time to first mobilization, time to pass first flatus, time of oral intake recovery, time of urinary catheter removal, postoperative length of hospital stay, cumulative opioid consumption, and the overall cost were compared between the two groups. We examined VAS pain scores using repeated measures analysis of variance; P < 0.05 was considered as statistically significant.ResultsEighty-six patients were analysed (TEA/PCIA = 44, TEA = 42). The mean VAS pain scores at rest and on movement in TEA/PCIA group were lower than TEA group, with a significant difference on movement and 48 h postoperatively (P < 0.05). The time to first mobilization and pass first flatus were shorter in TEA/PCIA group (P < 0.05). Other measurement showed no statistically significant differences.ConclusionsThe combination of TEA with PCIA for patients undergoing laparotomy, can enhance postoperative pain control and facilitate early recovery without increasing the incidence of adverse effects and overall cost of hospitalization.Trial registrationChinese Clinical Trial Registry(www.chictr.org.cn), ChiCTR 1,800,020,308, 13 December 2018.

Vestibular hyaluronic acid injection in provoked vestibulodynia patients and its effect on pain and sexual function: A preliminary report

ObjectiveProvoked vestibulodynia (PVD) is a challenging and distressing problem for women. The aim of this study was to examine the effect of hyaluronic acid (HA) in the management of this condition. MethodThis is a retrospective review of 12 women diagnosed with PVD and treated with HA (19 mg/mL) applied, point-by-point, to the vestibular region at 2 mm intervals and at a depth of 0.5 mm. Women completed a pain VAS and a Female Sexual Function Index (FSFI) before and 45 days after treatment. ResultsAn improvement was observed both in mean FSFI scores (17.8 to 23.3; p = 0.003) and mean VAS scores (7.2 to 4.1; p = 0.002) after HA application respectively. However, on a telephone interview 3 months post treatment, five women (41.7 %) complained of recurrence of their dyspareunia. ConclusionHA is a promising management option in provoked vestibulodynia. However, further larger studies with possible alternative regimens and longer follow-up are required.

A STUDY ON FUNCTIONAL OUTCOME AFTER HIGH FIBULAR OSTEOTOMY IN MEDIAL COMPARTMENT OSTEOARTHRITIS KNEE.

Background: Primary Osteoarthritis of the knee is more prevalent than that of the other joints. Treatment for knee osteoarthritis can be broken down into nonsurgical and surgical management. Initial treatment begins with nonsurgical modalities and moves to surgical treatment once the nonsurgical methods are no longer effective. Various treatment modalities available include intraarticular injections, physiotherapy, visco supplementation, arthroscopic debridement, high tibial osteotomy, and knee replacement with uni compartmental arthroplasty. All of it has its complications. Hence, there is a necessity for a modest technique, easily reproducible, provides decent functional outcomes and associated with a smaller recovery period, and develops the quality of life for the affected patients. In this scenario, this study is designed to know the functional outcomes, when an osteotomy of the bula at proximal 3rd is performed in medial compartment osteoarthritis knee. The present study was conducted at the depart Methods: ment of orthopaedics Andhra medical college/ king George hospital Visakhapatnam between 2019 and 2021.Thirtypatients who fullled inclusion criteria were taken up for study n=30. Statistical Analysis: Statistical analysis was performed using SPSS version 19.0 statistical software for the window. Continuous variables were expressed as mean, ±SD, and dichotomous variables were expressed as percentages. A two-tailed t-test was applied to analyze the postoperative weightbearing ratio of knee joint space (medial/lateral compartment) data. In addition, the nonparametric test (Wilcoxson's signed-rank test) was applied to analyze the OKS, AKSS, and VAS scores. The chi-square test will analyze the Comparison of qualitative variable, and Comparison of the quantitative variable will be analyzed by independent samples unpaired T-test. A P-value less than 0.05 was considered to be signicant. Data will be entered in Microsoft Excel, and data analysis was performed using windows MEDCALC software on a personal computer. Results: Sample size of the present study was 30 (n=30). Average age of the patients was 56 years. with males accounting to 56.66% and female's 43.33 percent. There were 17 males and 13 females among the 30 patients. The majority of the patients have grade 2 medial compartment osteo arthritis. Preoperatively, the mean medial/lateral joint space ratio was 0.26+/-0.12, which increased in the postoperative phase, reaching 0.67+/- 0.29 after six months. Proximal bular osteotomy effectively reduces the pain of m Conclusion: edial compartment osteoarthritis. It also improves the mean vas pain score earliest postoperatively. We observed modest improvement in both oxford knee scores and American knee society score.

Tips and Tricks for Nerve-Sparing Modified Radical Hysterectomy for Deep Endometriosis with Firefly Technology

<h3>Study Objective</h3> To show tips and tricks for our nerve-sparing modified radical hysterectomy (NS-mRH) for deep endometriosis (DE) and provide perioperative outcomes of the procedure. <h3>Design</h3> Stepwise demonstration of this method with narrated video footage. <h3>Setting</h3> An urban general hospital. NS-mRH is known for its benefits as a definitive treatment for severe endometriosis. Furthermore, robotic surgery has become available worldwide and two meta-analyses have confirmed that robotic surgery is safe and feasible in the treatment of endometriosis, especially in advanced cases. However, reports which showed the surgical technique of robotic nerve-sparing hysterectomy for DE were limited. <h3>Patients or Participants</h3> 30 patients presented with DE and complex pelvic pathology. <h3>Interventions</h3> Our NS-mRH was performed using following 8 steps with da Vinci Xi: Step 0, observing peritoneal endometriotic lesions; Step 1, adhesiolysis and adnexal surgery; Step 2, separation of the pelvic autonomic nerve plane; Step 3, dissection of the ureter; Step 4, reopening of the pouch of Douglas; Step 5, complete removal of DE lesions while avoiding injury to the nerve plane; Step 6, hysterectomy; Step 7, checking for rectal injury using air leakage test and tissue perfusion; and Step 8, barrier agents for adhesion prevention. <h3>Measurements and Main Results</h3> 30% of patients had history of previous surgeries for endometriosis. 53% of patients presented with complete cul-de-sac obliteration and 87% of patients presented with ENZIAN B2 or B3 lesions which were predictive factors for postoperative voiding dysfunction. All procedures included NS-mRH, uterosacral ligament resection and posterior compartment peritonectomy. Mean operative time was 127 min and blood loss was 31 ml. The mean VAS score significantly decreased after surgery. No patients developed perioperative complications, including postoperative bladder, rectal, and sexual dysfunctions. <h3>Conclusion</h3> Our NS-mRH for DE using FireFly technology is safe and feasible technique with excellent outcomes. Application of ICG with NIR fluorescence appears potentially useful, not only to remove DE, but also to improve nerve-sparing.

Treatment of Trigger finger by ultrasound-guided needle release of a1 pulley: A series of 105 cases.

We aimed to evaluate the efficacy and tolerance of A1 pulley release using the needle technique, under ultrasound guidance, in patients with symptomatic trigger finger. All patients with symptomatic trigger finger underwent A1 pulley release using an intramuscular 21 gauge (G) needle. Quinnell grade (I-IV), Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score (0-100) and pain score on a visual analog scale (VAS: 0-10mm) were recorded at inclusion. The primary endpoint was complete resolution of the trigger finger at 6 months. Eighty-four patients totaling 105 treated digits were included. Mean age was 63.3±10.7 years. Prior to treatment, mean VAS pain score was 5.8±2.6mm, and mean QuickDASH score was 44.3±19.1. At 6 months, disappearance of symptoms was achieved in 85 of 91 digits with follow-up (93.4%), and in 85.7% at 12 months. The absolute reduction in VAS pain and QuickDASH scores at 6 months was respectively 4.1±3.1 (P<0.001) and 36.1±20.7 (P<0.001), and 90% of patients reported being satisfied or very satisfied at 6 months. Long duration of symptoms was significantly associated with persistent trigger finger at 6 months after intervention. Complications were rare and minor. Tenosynovitis occurred in 5.7% of cases, for which a corticosteroid injection into the tendon sheath rapidly led to favorable resolution. Treatment of trigger finger by release of the A1 pulley under ultrasound guidance using the needle technique is a mildly invasive technique that yields rapid and effective symptom resolution with good tolerance up to 12 months.