Mean Verbal Rating Scale Research Articles

Efficacy of Preoperative Piroxicam, Diclofenac, Paracetamol With Tramadol and Placebo Tablets for Relief of Postoperative Pain After the Removal of Impacted Mandibular Third Molars: A Randomised Controlled Trial.

AimWe aimed to analyze the influence of preoperative piroxicam, diclofenac, paracetamol, tramadol, and placebo tablets as measured in the time required for rescue analgesia for postoperative pain relief after the extraction of impacted mandibular third molar.Materials & methodsForty-four patients who needed extraction of impacted mandibular third molar were arbitrarily categorized into four groups namely, piroxicam, diclofenac, paracetamol with tramadol, and placebo. The test medicine was given one hour preoperatively before the surgical removal. The pain was assessed using visual analog scale (VAS) and verbal rating scale (VRS) scores preoperatively and at the third and 24th hours. The time required for escape analgesia was measured. ResultsThe mean VAS and VRS scores showed significant differences across the groups after 24 hours. The mean score was lowest for the patients taking piroxicam (1.30+1.95) and highest for patients taking tramadol + paracetamol (4.50+2.59). As far as escape analgesia is concerned piroxicam group was by far superior.ConclusionThe pain scores and the rescue analgesic requirement suggested that piroxicam analgesic significantly reduced pain; moreover, it is a safe as well as an efficacious substitute to the conventional non-steroidal anti-inflammatory drugs (NSAIDs) for mandibular third molar impactions.

Analgesic Efficacy of Curcuma longa (Curcumin) after Surgical Periodontal Therapy.

To compare the analgesic efficacy of orally administered Curcuma longa (curcumin) and mefenamic acid (MA) after surgical periodontal therapy (SPT). Seventy-six periodontitis patients were randomly divided into two groups. In the test group, patients received curcumin capsules (200 mg), and in the control group, patients received MA (500 mg). All patients underwent post-operative antibiotic therapy using 500 mg amoxicillin and 400 mg metronidazole for 7 days. Post-operative pain and discomfort were evaluated using the numerical rating scale (NRS) and verbal rating scale (VRS), respectively. Evaluation were performed after 24 (T1), 48 (T2), and 72 h (T3). Group comparisons were done using Student's t-test and the Mann-Whitney U-test. The level of statistical significance was established at p < 0.05. All patients had stage 3/grade C periodontitis. The mean age of individuals in the test and control groups were 58.4 ± 7.3 and 57.2 ± 5.2 years, respectively. A family history of periodontal diseases was reported by 37.5% and 47.4% individuals in the test and control groups, respectively. In the test and control groups, the total mean duration of periodontal surgery was 168.2 ± 12.2 and 173.4 ± 10.7 min, respectively. There was no statistically significant difference in the mean NRS and VRS scores among patients in the test and control groups. In both groups, there was no statistically significant difference in the change in NRS scores at any time point. Compared with MA, curcumin is ineffective for pain and discomfort management after SPT. The possibility of the results being biased due to lack of operator blinding cannot be overlooked.

Intraoperative placement of a purse-string suture around the drain exit site reduces pain associated with subdural drain removal

BackgroundUse of surgical skin staples to close the subdural drain exit site after drain removal is often associated with pain. This prospective study compared the degree of pain between staple closure and a technique in which a purse-string suture is placed around the exit site the time of the operation in consecutive patients who underwent one-stage surgery for bilateral chronic subdural hematoma. MethodsIn each patient, on one side, a purse-string suture that was later manually ligated immediately after drain removal was placed around the drain exit site during the operation. On the other side, the drain exit site was closed using staples immediately after drain removal. Pain scores were compared according to method of drain exit site closure. ResultsTwenty-two patients were included for analysis. The mean Numerical Rating Scale score was significantly lower in the suture group than in the staple group (3.7 ± 2.2 vs. 7.3 ± 2.1; p < 0.001). The mean Verbal Rating Scale score was also significantly lower in the suture group (2.2 ± 0.8 vs. 3.8 ± 0.9; p < 0.001). ConclusionPain related to subdural drain removal can be reduced by use of a purse-string suture that is placed around the drain exit site during surgery and subsequently manually ligated immediately after drain removal.

The effect of cognitive behavioral techniques using virtual reality on birth pain: a randomized controlled trial

ObjectiveThis study was conducted to investigate the effects of cognitive behavioral techniques using virtual reality on birth pain. DesingThis study was planned as a double blind randomized controlled experimental study. Setting and ParticipantsIt was conducted with 273 pregnant women who were randomized between July 2016 and June 2019 at maternity hospital located in eastern Anatolia, Turkey. MethodsThe study included 5 groups. (A: videos of newborn photographs with classical music, B: the video of the newborn photograph album, C: an introductory film of Turkey, D: only classical music, E: routine hospital care). The data were collected by using the "Personal Information Form", "Visual Analogue Scale", "Verbal Rating Scale" and "Virtual Reality". FindingsGroups show homogeneity in terms of demographic and obstetric variables. It was found that mean Visual Analogue Scale posttest mean score of the group A was 4.98 ± 1.69; group B 4.96 ± 1.72; group C 5.96 ± 2.05; group D 5.60 ± 1.63 and group E 6.38 ± 1.86. Mean Verbal Rating Scale posttest score was found that group A was 2.64 ± 0.73, group B 2.70 ± 0.87, group C 3.18 ± 1.14, group D was 2.80 ± 0.86 and group E was 3.96 ± 1.01. It was obtained that the groups' mean Visual Analogue Scale and Verbal Rating Scale posttest mean scores was statistically significant (p<0.05). ConclusionIn this study, all cognitive techniques applied with virtual reality reduced labor pain during the active phase of labor. Especially the video of newborn photographs with classical music and newborn photograph album have been found more effective than other interventions evaluated in reducing labor pain. Implications for practiceMidwives can use these techniques to reduce birth pain.

The Adequateness of Methadone for Japanese Terminal Cancer Patients Can Be Determined Earlier than 7 Days: A Preliminary Retrospective Study.

Introduction: The Japanese packaging instructions for methadone prohibit dose escalation within 7 days of administration initiation as this may result in overdose and subsequent adverse events. However, for terminal cancer patients, evaluation of the effects of methadone may be desirable within 7 days because they have limited prognoses. We aimed to determine the possibility of estimating the adequateness of methadone earlier than the 7th day by investigating the onset timing of analgesic effects and adverse events of methadone in Japanese terminal cancer patients. Methods: Japanese terminal cancer patients who started taking methadone in Ashiya Municipal Hospital were enrolled from January 1, 2013 to February 28, 2019. Verbal rating scale (VRS) scores on pain and adverse events before and after methadone administration (on days 3, 5, and 7) were retrospectively investigated from medical records. Results: We enrolled 25 patients, of which 20 (80.0%) received methadone until day 7. The VRS score (mean ± standard deviation) on pain was significantly reduced to 0.90 ± 0.55 on day 3, compared with 1.65 ± 0.67 before the administration of methadone (p < 0.05). The mean VRS scores did not differ significantly on days 3, 5, and 7. Additionally, of the 23 patients who received methadone until day 3, 20 (87.0%) showed an analgesic effect on day 3 and 17 (85.0%) received methadone without experiencing serious adverse events until day 7. Conclusions: The adequateness of methadone in Japanese terminal cancer patients could be determined before day 7, considering the high analgesia incidence and few adverse events 3 days after the methadone administration under careful observation by a physician experienced in methadone administration. However, as this is a preliminary study, the relationship between pharmacokinetic parameters and analgesic effects was not evaluated. Further studies involving pharmacokinetics and multicenter prospective studies are required to support these findings.

Comparison of efficacy and safety of ketoprofen patch versus diclofenac patch as post-operative analgesic in hysterectomy patients

Background: The objective of the study was to compare the efficacy and safety of ketoprofen patch versus diclofenac patch as post-operative analgesic in hysterectomy patients.Methods: The study was a prospective, single blind, randomized, comparative interventional clinical study conducted in a tertiary care hospital. Sixty female patients were randomly allocated to receive either ketoprofen or diclofenac patch 1 hour prior to the hysterectomy. Pain was assessed postoperatively after an interval of every four hours for 24 hours using visual analogue scale (VAS) and verbal rating scale (VRS).Results: In ketoprofen group, mean VAS was (2.92±0.11) significantly low as compared to diclofenac group (3.25±0.14). The mean VRS score in group ketoprofen (1.62±0.22) was low as compared to group diclofenac (1.83±0.16). Safety analysis revealed no apparent serious adverse events. Inj. Paracetamol 1 gm i.v was given as rescue analgesic to the patients in whom VRS &gt;2 and VAS &gt;5 was noted. Data were analysed using unpaired student’s t-test.Conclusions: Transdermal patches are very convenient to use and causes less discomfort as compared to traditional routes of drug delivery. Ketoprofen patch was found better in providing analgesia after hysterectomy as compared to diclofenac patch with lesser side effects.

Ventral tegmental area deep brain stimulation for chronic cluster headache: Effects on cognition, mood, pain report behaviour and quality of life.

Deep brain stimulation in the ventral tegmental area (VTA-DBS) has provided remarkable therapeutic benefits in decreasing headache frequency and severity in patients with medically refractory chronic cluster headache (CH). However, to date the effects of VTA-DBS on cognition, mood and quality of life have not been examined in detail. The aim of the present study was to do so in a case series of 18 consecutive patients with cluster headache who underwent implantation of deep brain stimulation electrodes in the ventral tegmental area. The patients were evaluated preoperatively and after a mean of 14 months of VTA-DBS on tests of global cognition (Mini Mental State Examination), intelligence (Wechsler Abbreviated Scale of Intelligence), verbal memory (California Verbal Learning Test-II), executive function (Delis-Kaplan Executive Function System), and attention (Paced Auditory Serial Addition Test). Depression (Beck Depression Inventory and Hospital Anxiety and Depression Rating Scale-D), anxiety (Hospital Anxiety and Depression Rating Scale-A), apathy (Starkstein Apathy Scale), and hopelessness (Beck Hopelessness Scale) were also assessed. Subjective pain experience (McGill Pain Questionnaire), behaviour (Pain Behaviour Checklist) and quality of life (Short Form-36) were also evaluated at the same time points. VTA-DBS resulted in significant improvement of headache frequency (from a mean of five to two attacks daily, p < .001) and severity (from mean Verbal Rating Scale [VRS] of 10 to 7, p < .001) which was associated with significant reduction of anxiety (from mean HADS-A of 11.94 to 8.00, p < .001) and help-seeking behaviours (from mean PBC of 4.00 to 2.61, p < .001). VTA-DBS did not produce any significant change to any tests of cognitive function and any other outcome measures (BDI, HADS-D, SAS, BHS, McGill Pain Questionnaire, Short Form-36). We confirm the efficacy of VTA-DBS in the treatment of medically refractory chronic cluster headache. The reduction of headache frequency and severity was associated with a significant reduction of anxiety. Furthermore, the result suggests that VTA-DBS for chronic cluster headache improves pain-related help-seeking behaviours and does not produce any change in cognition.

Comparison of pre treatment with Ondansetron and Lignocaine over Pain on Etomidate Injection. A double blind prospective non randomised study

Background: Etomidate is the preferred induction agent in patient with Cardiac disease due to its cardiac vascular stability. It can cause severe pain during IV administration which can produce increased stress response. Various methods have been tried to reduce the pain of etomidate injection with variable success. Lignocaine pre-treatment which is extensively used to reduce the pain of propofol injection is also used to reduce the pain of etomidate injection. Materials And Methods: This nonrandomised double blind, study was done after getting ethical clearance from university ethical committee. After informed consent 40 patients of both sexes aged between 18 to 65 years of ASA physical status 1, 2 & 3, who were posted for various elective surgical procedure planned under general anaesthesia were enrolled for the study.. They were not given any premedication. On arriving to Operating room (OR) 20G IV cannula inserted on dorsum of both hands and both flushed with100ml of normal saline. Venous drainage was occluded with elastic band in the both hands at midarm. In one hand 2ml of 1% lignocaine followed by 1 ml (2 mg ) of Etomidate is Injected and pain is assessed by Verbal rating scale(VRS). After one minute in other hand 2 ml (8mg) ondansetron injected followed by 1 ml (2 mg ) of Etomidate and pain is assessed. Statistical analysis: Non-Parametric test-Wilcoxon Sign Ranks Test is used to compare both drugs .Analysis is perfomed using SPSS Version22. Results: A total number of 40 patients (male=57.50%, female=42.50%).The mean age of patient was 42.85, The mean VRS pain score of etomidate after pre-administration of intravenous lignocaine (Drug A) was 1.58, which was lower compared to pre-administration of ondansetron(Drug )2.43. Conclusion: This study illustrates that pre-treatment with intravenous lignocaine significantly reduces the pain on injection of etomidate compare to ondansetron. (P value<0.001).

Verbal and Non-verbal Rating Scales in the Determination of Pain Severity in Trauma Patients in the Emergency Department

Background: Using subjective tools for pain assessment is essential, but may confuse healthcare professionals in some clinical situations. It is also useful to assess pain severity objectively. Several observational pain scales have been developed, but they are mostly for intensive care units and not for the emergency department (ED). Objectives: The purpose of the present study was to compare the verbal rating scale (VRS) and Nonverbal Rating Scale (NVRS) in the determination of pain severity in patients with limb trauma, in the ED of a general hospital in Kashan, Iran, in 2014. Methods: This observational, prospective study was conducted on 450 traumatic patients admitted to the trauma ED of Shahid Beheshti Hospital in 2014. The tool used in this study consisted of three parts: demographic data, VRS, and NVRS scores at 7 time points, from arrival until 4 hours. The statistical analysis was conducted using the two-tailed Student’s t-test, Mann-Whitney U test, Pearson correlations, and repeated measures. The data analysis was conducted using SPSS software, version 16. Results: The average age of the participants was 35.2 years, and the extremities were the most common painful area (66.2%). The mean VRS and NVRS pain intensity ratings upon arrival were 6.16 (± 2.63) and 3.06 (± 2.17), respectively. The estimation of pain was lower in the NVRS when compared to the VRS, and the scores in these two tools showed a significant correlation. One-hundred and seventy-two of the patients received interventions for pain relief; 60 patients received analgesics and 112 patients (24.8%) received non-pharmacological interventions, such as stabilization of the injured extremity. Conclusions: This study indicated that the modified version of the adult NVPS in step with the VRS is a useful tool for pain intensity assessment in the ED.

A comparative study on postoperative pain relief in laparoscopic cholecystectomy: Intraperitoneal bupivacaine versus combination of bupivacaine and buprenorphine.

Context:To assess the analgesic efficacy of the combination of bupivacaine and buprenorphine in alleviating postoperative pain following laparoscopic cholecystectomy.Aims:Laparoscopic cholecystectomy is comparatively advantageous as it offers less pain in the postoperative period and requires a shorter hospital stay. There are only a few studies performed to evaluate the analgesic efficacy of intraperitoneal instillation of buprenorphine and bupivacaine during laparoscopic cholecystectomy.Settings and Design:The present research is a randomized, double-blind controlled study conducted in the Department of Anaesthesiology, Dayanand Medical College and Hospital Ludhiana, Punjab after formal ethical approval from Hospital's Ethics Committee.Subjects and Methods:This study analyzed 90 adults admitted for elective laparoscopic cholecystectomy. After the procedure, subjects were divided into three equal groups to conduct the study. Three Groups A, B, and C had intraperitoneal instillation of the 25 ml of physiological saline (0.9% normal saline), 0.25% of bupivacaine, 0.25% bupivacaine, and 0.3 mg buprenorphine, respectively. Necessary vitals were monitored and recorded. Visual analog scale (VAS) and verbal rating scale (VRS) scores were recorded and analyzed systematically.Statistical Analysis Used:All observations were analyzed using analysis of variance and Student's t-test.Results:The mean pain scores were highest in Group A compared to Group B and Group C. Mean VAS and VRS scores were highest in Group C comparatively and lowest in Group A.Conclusion:Combination of buprenorphine and bupivacaine intraperitoneally is comparatively more effective in relieving postoperative pain in comparison to intraperitoneal instillation of bupivacaine alone for postoperative pain management after laparoscopic cholecystectomy.

Outcome of vulvar reconstruction in patients with advanced and recurrent vulvar malignancies.

BackgroundThe use of flaps in vulvar cancer-related reconstruction has been increasing, but few studies have evaluated the outcome and quality of life of patients after this surgery. The purpose of this study was to evaluate the outcomes of vulvar reconstruction using musculocutaneous/skin flaps in patients with advanced and recurrent vulvar malignancies.MethodsPatients with vulvar malignancies who underwent vulvar reconstruction using different types of flaps were retrospectively reviewed. Patient outcomes were evaluated with a focus on quality of life and prognosis.ResultsThirty-six patients were enrolled, 58.33 % of them used anterolateral thigh flap (ALT), 16.67 % of them used pudendal thigh flap (PTF), 11.11 % of them used deep omferior epigastric perforator (DIEP) and gracilis myocutaneous flap were used in 2.78 % of the patients, the other 11.11 % patients used two types of flaps. Eleven patients (30.56 %) developed complications, including 5 patients (13.89 %) with partial necrosis, 5 (13.89 %) with minimal wound dehiscence and 1 (2.78 %) with flap cellulitis. All patients who developed partial necrosis (13.89 %) underwent reoperation. The mean verbal rating scale score was 1.44 before reconstruction and 0.17 after surgery (P < 0.0001). The mean performance status was 1.67 before surgery and improved to 0.31 after surgery (P < 0.0001). The median overall follow-up time after vulvar reconstruction was 9 months. Twenty-one patients (58.3 %) developed recurrence at a median interval of 5 months after vulvar reconstruction. After a median follow-up time of 14 months, 41.7 % of the patients were living and disease-free. The 5-year survival of the 36 patients was 53.8 %.ConclusionSoft tissue reconstruction in patients undergoing resection of advanced/recurrent vulvar malignances is associated with a low rate of postoperative complications, decreased pain, and improved functional status. Although the recurrence rate in this patient population is high, a reasonable proportion of patients who undergo resection for advanced/recurrent vulvar cancer and reconstructive surgery appear to benefit.

Contemporary Pain Management in Elderly Patients After Hip Fracture Surgery: Cross-sectional Analyses at Baseline of a Randomized Controlled Trial.

Adequate pain management following hip fracture surgery reduces length of stay, reduces incidence of delirium, promotes recovery, and improves mobility. Previous research suggests that hip fracture pain is undertreated in some patient subgroups, and that hypovitaminosis D can further aggravate pain which could hinder active rehabilitation. We provide a cross-sectional analysis of the baseline characteristics of participants in the REVITAHIP study with the aim of documenting pain intensity and its associations after hip fracture and to explore the characteristics of people who report higher levels of pain. We analyzed the baseline characteristics with a focus on pain scores in patients admitted with a hip fracture (undergoing surgery) to 3 teaching hospitals over New South Wales, Australia, between January 2011 and April 2013. Patients were evaluated using the Verbal Rating Scale (VRS). Secondary measures including 25-hydroxyvitamin D levels at baseline, hip fracture subtype, type of surgical intervention, quality of life score, and cognitive and mobility status were correlated with the VRS using the Pearson correlation, ANOVA, and regression analysis. The 218 participants had a mean age of 83.9±7.2 years and 77.1% were women of whom 16.0% had a Mini Mental State Examination score of ≤23 of 30. The mean and SD VRS pain score was 3.5±2.3. More than half (61.9%, n=113) had VRS≥3 and 18.1% (n=52) had VRS≥5. Using the EuroQOL pain subscore, 78.1% had moderate pain or discomfort and 7.9% had extreme pain or discomfort. Using a multivariate regression model, postoperative VRS was significantly higher in persons with a higher comorbidity count, those previously living independently alone, and surgical fixative modality with hemiarthroplasty. Overall, the levels of pain reported by this cohort are acceptable although approximately 10% to 15% had higher than reasonable levels of pain. This study provides an insight into pain assessment and management by identifying certain patient subtypes who are vulnerable to undertreatment of pain.

Assessment of feasibility and efficacy of Class IV laser therapy for postoperative pain relief in off-pump coronary artery bypass surgery patients: A pilot study.

Background:Laser therapy, for its established analgesic properties with minimal side effects, has been used for the treatment of chronic pain. However, it has not been used for the treatment of acute postoperative pain. This pilot study was designed to assess the feasibility and efficacy of Class IV laser on postoperative pain relief following off-pump coronary artery bypass graft (OPCABG) surgery, as a component of multimodal analgesia (MMA) technique.Methods:This open observational prospective study comprised of 100 adult patients (84 male, 16 female) who underwent OPCABG through sternotomy. For postoperative analgesia, they were subjected to laser therapy subjected to laser therapy in addition to the standard institutional pain management protocol comprising of IV infusion/bolus of tramadol and paracetamol and fentanyl bolus as rescue analgesic. Pain intensity was measured by Verbal Rating Scale (VRS). The laser therapy was scheduled as once a day regime for three consecutive postoperative days (PODs) starting on POD 1, 30 min following tracheal extubation. The subsequent laser applications were also scheduled at the same time of the day as on day 1 if VRS was ≥5. 10 W Class IV laser was applied over 150 cm2 sternal wound area for 150 s. VRS was used to assess pain severity and was recorded for statistical analysis using Friedman Test.Results:The mean (standard deviation [SD]) VRS of all the 100 patients just before application of the first dose of laser was 7.31 (0.94) while on MMT; the same fell to 4.0 (1.279) and 3.40 (2.697) at 1 h and 24 h respectively following first dose of laser. The change of VRS over first 24 h among all the 100 patients was statistically significant (P = 0.000). Laser was re-applied in 40 patients whose VRS was ≥5 (mean [SD] – 6.38 [0.868]) at 24th h. After receiving the 2nd dose of laser the VRS scores fell significantly (P = 0.000) and became 0 at 54th h. No patients required 3rd dose of the laser. No patient required rescue analgesic while on laser therapy.Conclusion:Class IV laser can be an effective technique for postoperative analgesia following OPCABG surgery through sternotomy when included as a component of MMA technique.

Epidural administration of ketamine or fentanyl with bupivacaine for postoperative analgesia – A comparative study

The purpose of the study was to compare the analgesic effectiveness of epidural administration of ketamine mixed bupivacaine with fentanyl mixed bupivacaine in the management of postoperative pain. This prospective study was carried out in CMH, Bogra in one calendar year from July 2004 to June 2005. For postoperative pain management 100 patients of both sex, age ranging between 20 to 50 years, ASA physical status I and II scheduled for lower abdominal, pelvic and inguinal surgery were included in the study. All patients were divided into two groups. Epidural catheter was inserted in each patient through space between L3 to L2. Surgery was done under epidural anaesthesia in both groups. In group A (n=50) surgery was done with 0.5% bupivacaine and fentanyl (bupivacaine 1.5 ml/segment + fentanyl 2?g/ml). In group B (n=50) surgery was done with 0.5% bupivacaine and ketamine (bupivacaine 1.5ml/segment + ketamine 0.3mg/kg body weight). Epidural analgesia was continued in postoperative ward with 6 ml 0.25% bupivacaine + fentanyl 2?g/ml in group A and with 6 ml 0.25% bupivacaine + ketamine 0.3mg/kg bodyweight in group B, 4 hourly for 24 hours. The efficacy of analgesia was assessed by using Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). Mean VAS and mean VRS were less than 3 in both groups, which proved adequate postoperative analgesia. Differences of mean VAS and mean VRS between two groups were statistically not significant. Haemodynamic parameters, respiration and oxygenation were within normal range in both groups. Postoperative complications, like inadequate analgesia, post operative nausea and vomiting (PONV), headache and vertigo were less in both groups. It was observed that epidural administration of both bupivacaine mixed with ketamine and bupivacaine mixed with fentanyl found safe, effective and tolerable for postoperative pain management. DOI: http://dx.doi.org/10.3329/jbsa.v22i1.18097 Journal of BSA, 2009; 22(1): 21-25

The efficacy of time-based short-course acyclovir therapy in treatment of post-herpetic pain

Various treatments have been used to manage post-herpetic neuralgia (PHN). Safe and effective therapies to prevent PHN are needed. A clinical trial involving 152 patients diagnosed with acute herpes Zoster (HZ) was conducted to determine whether short-course acyclovir therapy (800 mg five times a day for four days) can alleviate HZ-associated pain and prevent post-herpetic neuralgia (PHN). The patients were divided into two groups: Group 1 had a rash with a duration of less than 72 hours and Group 2 had a rash with a duration of more than 72 hours. To assess PHN, the patients categorized and assessed the severity of their symptoms using a four-point verbal rating scale (VRS). By the fourth week, 134 out of 152 patients (88.2%) had complete pain response (CPR). Of these, 68 patients (89.5%) were from Group 1 and 66 from Group 2 (86.8%). After four weeks, the mean VRS scores had changed significantly in both groups compared to the scores at the beginning of study (p = 0.001), but there was no difference between the two groups (0.88 ± 0.66 Vs. 0.94 ± 0.72; p = 0.66) After three months no differences were observed in the treatment results between the two groups (0.51 ± 0.13 Vs.0.54 ± 0.19; p = 0.77). Short-course acyclovir therapy is an effective treatment for zoster and its efficacy in patients with a rash duration of more than 72 hours is similar to that in patients with rash duration of less than 72 hours.

Oral acetaminophen (paracetamol) for additional analgesia in phacoemulsification cataract surgery performed using topical anesthesia: Randomized double-masked placebo-controlled trial

To evaluate the clinical analgesic efficacy of 1.0 g oral acetaminophen (paracetamol) given in addition to topical anesthesia before phacoemulsification cataract surgery. Inpatient and outpatient ophthalmology clinics, Bydgoszcz, Poland. Consecutive patients with age-related cataract having phacoemulsification under topical anesthesia (tetracaine 0.5%) were enrolled in a prospective double-blind randomized placebo-controlled study. Patients were randomly assigned to preoperative oral administration of a placebo medication or to oral administration of 1.0 g acetaminophen. The main outcome measure was intensity of pain during and after surgery. Pain intensity was measured using a 10 cm baseline visual analog scale and a discrete 5-category verbal rating scale. The study comprised 160 consecutive patients (80 in each group). Intraoperatively, the mean visual analog scale pain intensity score was 2.17 +/- 1.81 in the placebo group and 1.45 +/- 1.17 in the acetaminophen group and the mean verbal rating scale score, 1.11 +/- 0.73 and 0.67 +/- 0.66, respectively (P<.01). Postoperatively, the mean visual analog scale score for pain was 1.47 +/- 1.39 in the placebo group and 0.56 +/- 0.61 in the acetaminophen group and the mean verbal rating scale score, 0.94 +/- 0.79 and 0.28 +/- 0.41, respectively (P<.01). There was no significant difference in patient behavior during surgery and no significant adverse effects of acetaminophen use. Preoperative oral administration of acetaminophen 1.0 g was effective, convenient, safe, and cost effective in reducing intraoperative and postoperative pain in phacoemulsification performed using topical anesthesia.

Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skills

Early recovery of patients following sedation/analgesia and anesthesia is important in ambulatory practice. The aim of this study was to assess whether modafinil, used for the treatment of narcolepsy, improves recovery following sedation/analgesia. Patients scheduled for extracorporeal shock wave lithotripsy were randomly assigned to one of four groups. Two groups received a combination of fentanyl/midazolam with either modafinil or placebo. The remaining groups received remifentanil/propofol with either modafinil or placebo. Modafinil 200 mg was administered to the treatment group patients 1 h before sedation/analgesia. Groups were compared using the digital symbol substitution test (DSST), trail making test (TMT), observer scale of sedation and analgesia (OAA/S) and Aldrete score. Verbal rating scale (VRS) scores for secondary outcome variables e.g. energy, tiredness and dizziness were also recorded before and after treatment. Sixty-seven patients successfully completed the study. Groups received similar doses of sedation and analgesic drugs. No statistically significant difference was found for DSST between groups. No significant adverse effects occurred in relation to modafinil. No statistically significant difference between groups was identified for TMT, OAA/S and Aldrete scores. The mean VRS score for tiredness was lesser in the modafinil/fentanyl/midazolam group [1.3 (2.0)] compared with the placebo group [3.8 (2.5)], P=0.02. Such a difference was not found between the remifentanil/propofol groups [placebo 2.6 (2.2) vs. modafinil 3.1(2.7)], p>0.05. Dizziness was greater in the modafinil/remifentanil/propofol group 1.7 (2.0) vs. placebo 0.0 (0.5), p<0.05. Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve recovery in terms of objective measures of patient psychomotor skills.

The Effect of Placing 0.5% Bupivacaine-Soaked Gelfoam in the Gallbladder Bed on Pain after Laparoscopic Cholecystectomy

Background and objective: Patients undergoing laparoscopic cholecystectomy (LC) experiences post operative abdominal pain. This study aimed to determine the character of pain after LC and its relief with 0.5% bupivacaine-soaked gelfoam placed in the gallbladder bed. Methods: A prospective randomized, double blinded placebo-controlled study was conducted on 200 patients with chronic cholecystitis, patients were divided into four groups of 50 patients :group A (2 mg/kg 0.5% bupivacaine-soaked gelfoam kept in gallbladder bed), group B (2 mg/kg 0.5% bupivacaine infiltrated at trocar sites), group C ( 1/2 of the required dose of 2 mg/kg 0.5% bupivacaine infiltrated into the gallbladder bed and at trocar sites, and group D (normal saline in the gallbladder bed and at trocar sites). Postoperatively, the character of pain was noted, and its relief was assessed with verbal rating scale (VRS) scoring. Results: 77.50% of the patients had visceral, 60.50% had parietal, and 23.50% had shoulder pain postoperatively. The visceral pain was significantly less in group A patients than in the control patients (p &lt; 0.01),the mean VRS score at 4, 8, 12 and 24 h in the group A patients also was less than in control group D. Trocar-site infiltration alone was not effective in relieving the parietal pain. Conclusion: Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked gelfoam in the gallbladder bed alone.

Percutaneous Vertebroplasty in Octogenarians: Results and Follow‐Up

To determine pain relief, performance status, morbidity, and mortality associated with percutaneous vertebroplasty for spinal pain in patients aged 80 years and older. Prospective, descriptive, third-party independent interview, clinical audit. University Hospital, Geneva, Switzerland. Patients aged 80 years and older who underwent vertebroplasty between August 1997 and August 2004 because of vertebral fractures from osteoporotic or malignant etiologies. Primary outcome measures were verbal rating scale (VRS) (0--no pain, 5--intolerable) and Eastern Cooperative Oncology Group (ECOG) performance status scale (0--normal activity, 4--unable to get out of bed) before and after procedure. Patients were interviewed 8 to 35 months post treatment (mean 25), independently assessed for pain relief, analgesic consumption, and overall satisfaction by using the American Society of Anesthesiologists (ASA) Outcome Measures questionnaire. Mean VRS scores significantly decreased from 4.86 +/- 0.64 to 2.39 +/- 1.14 (P < 0.05), and mean ECOG performance scores improved from 1.87 +/- 0.97 to 1.29 +/- 1.06 (P < 0.05) after treatment. When patients were analyzed by etiology (group 1--cancer; group 2--osteoporosis), both groups significantly reduced their VRS (P < 0.05); however, only group I significantly improved their performance (P < 0.05; P = 0.334, respectively). Nine patients answered the ASA questionnaire (18 deceased, 1 demented, 1 lost to follow-up) and reported an improvement in their ability to perform daily tasks. No early or late complications were observed; none of the deaths were procedure-related. Percutaneous vertebroplasty is a safe, minimally invasive, well-tolerated analgesic procedure among octogenarians suffering from spinal pain, permitting increased activities of daily living. Pain reduction is significant regardless of the etiology; performance scores are significantly improved in cancer pain.

頚椎椎弓形成術後の早期運動療法の検討

We investigated the effects of early kinesitherapy for patients undergoing cervical laminoplasty. The subjects consisted of twenty-one males and eight females. The average age was 66.4 years. Twelve early stage patients used cervical collar for four weeks from operation. Seventeen late stage patients underwent early muscle training and ROM exercise of neck, and were able to remove their cervical collar after about ten days from operation.We investigated the loss of the lordotic angle of the cervical spine and verbal rating scale (VRS) as a nuchal pain scale in the post operative period for all patients. No significant differences were seen in the loss of the lordotic angle between the early and late stages. The mean VRS was 2.4 points in the early stage, and 3.9 points in the late stage. Nuchal pain was significantly relieved in the late stage compared to early stage.Early kinesitherapy after cervical laminoplasty is considered effective for the relief of nuchal pain.