Median Visual Analog Scale Pain Research Articles

Descriptive Study of Earthquake-Related Spinal Cord Injury in Türkiye-Kahramanmaraş

Objective: We aimed to review the epidemiological data of patients who were rescued from under the rubble in the Kahramanmaraş earthquakes on February 6 and developed earthquake-related spinal vertebral fractures. Materials and Methods: Our study included 69 patients with spinal vertebral fractures and/or spinal cord injuries (SCIs) who were admitted to the Physical Medicine and Rehabilitation Clinic of Adana City Training and Research Hospital after the 6 February Kahramanmaraş Pazarcık and Elbistan earthquakes. Patients with peripheral nerve damage or loss of muscle strength due to pelvic and extremity fractures were not included in the study. Results: The mean age of the patients was 40.43±15.24 years (min=8-max=72). The median time of rescue from under the rubble was 15 (1-106) hours. The median visual analogue scale (VAS) pain score was 7 (0-10). 69.6% of the patients were female. Among the patients with a vertebral spinal injury, 72.5% had an incomplete SCI and 27.5% had a complete SCI. 84.5% of the patients underwent surgery, and posterior spinal instrumentation was performed in 56.5% of them. Conclusion: There has been a significant increase in the number of SCI cases after the Kahramanmaraş earthquakes. Rehabilitation centers should be established, patients' access to these centers should be facilitated, and complications should thus be prevented or optimized. Injured people should be helped to return to their social lives. Keywords: February 6th Kahramanmaraş, Earthquake, Spinal Cord Injury

Efficacy of Piriformis Block Using Intravenous Steroids with Bupivacaine versus Botox in Piriformis Syndrome

Background: Piriformis syndrome, a condition that affects predominantly females, leads to significant morbidity and impacts the quality of life. Despite its prevalence, it remains underdiagnosed, especially in the developed world. Treatment options include physiotherapy, painkillers, massage, heat, corticosteroids, local anesthetics, and botulinum toxin. However, comparative analysis of combination therapy versus botulinum toxin alone is limited. Objective: To compare the efficacy of intravenous steroids combined with bupivacaine versus botulinum toxin (Botox) injections in the treatment of piriformis syndrome. Methods: This quasi-experimental study was conducted at the Department of Anesthesiology, Combined Military Hospital, from January 2022 to December 2022, following ethical approval. The study included 100 patients diagnosed with piriformis syndrome, divided into two groups: Group L (n=50) received 10 ml of 0.25% bupivacaine with 40 mg of methylprednisolone, and Group B (n=50) received 100 U of botulinum toxin type A diluted in 10 ml distilled water. Standard monitoring was applied, and injections were performed under ultrasound guidance with the patients in the prone position. Pain scores were assessed using the Visual Analog Scale (VAS) at 24 hours, 72 hours, 7 days, and 28 days post-procedure. Patient satisfaction was measured using a 5-point Likert scale at 28 days. Data were analyzed using t-tests and chi-square tests, with significance set at p<0.05. Results: The mean age was 36 ± 3.35 years in Group L and 35.82 ± 3.42 years in Group B (p=0.297). The mean weight was 75.82 ± 5.23 kg in Group L and 77.64 ± 4.47 kg in Group B (p=0.066). Before the procedure, both groups had a median VAS pain score of 7.0. At 24 hours, the median pain score was 4.0 in Group L and 5.0 in Group B (p=0.292). At 72 hours, Group L had a median pain score of 3.0 compared to 4.0 in Group B (p=0.010). At 7 days, the scores were 2.0 and 3.0 respectively (p=0.013), and at 28 days, they were 2.0 and 3.0 respectively (p=0.013). The median satisfaction score at 28 days was 1.0 in Group L and 2.0 in Group B (p=0.043). Conclusion: Combination therapy with local anesthetics and steroids is superior to botulinum toxin in reducing pain and improving patient satisfaction in piriformis syndrome. This approach should be considered the first-choice treatment.

Enhancing palliative care in vulnerable patients: Robot-assisted radiofrequency ablation for multiple spinal metastases - Technical insights and preliminary outcomes.

Radiofrequency thermal ablation (RFA) coupled with vertebroplasty or kyphoplasty offers a minimally invasive, safe, and efficacious approach to palliate polymetastatic spine disease, particularly in medically fragile individuals. However, the application of robotic assistance to RFA for spinal metastases remains unexplored. This study elucidates the technical viability of robot-assisted RFA combined with vertebroplasty in patients afflicted by multiple spinal metastases and presents preliminary outcomes. An illustrative case was also presented. Ten patients aged over 65 years with multiple vertebral metastases were enrolled in this study. Preoperatively, patients exhibited a median Visual Analog Scale (VAS) pain score of 6 and a Median Oswestry Disability Index (ODI) score of 58%. From February 2021 to April 2022, all patients underwent RFA, followed by vertebroplasty for spinal metastases. Surgical procedures were executed using the ExcelsiusGPS® robotic platform. Patients experienced substantial pain relief, with a median VAS score of 2.5 at 24 h postoperatively (Δ --3.5; P < 0.001) and a median VAS score of 2 at 1 month postoperatively (Δ -4; P < 0.001). All patients were discharged on the first postoperative day and continued their oncological treatments. In addition, the median ODI score at 1 month postoperatively was 34% (Δ --24%; P = 0.006), indicating an enhanced quality of life and a satisfactory impact on daily activities. No procedural or postoperative complications were documented. This case series represents the inaugural successful application of robot-assisted RFA in conjunction with concurrent vertebroplasty/kyphoplasty. Our preliminary experience demonstrates that patients with oligo- and polymetastatic conditions can derive benefits from this minimally invasive intervention, characterized by rapid postoperative recovery and effective short- to medium-term pain management, without encountering complications.

Improvement in Clinical and Radiographic Outcomes After Isolated Realignment Surgery in Patients With Large Cystic Osteochondral Lesion of the Talar Shoulder and Concurrent Malalignment.

Malalignment has been suggested as a predisposing factor for the development of osteochondral lesions of the talus (OLTs). To evaluate the clinical and radiographic outcomes of realignment surgery in patients with a large cystic OLT of the talar shoulder and concurrent malalignment of the foot and ankle. Case series; Level of evidence, 4. The authors reviewed consecutive patients with large cystic OLTs (diameter, >10 mm) of the talar shoulder and concurrent malalignment of the foot and ankle who underwent realignment surgery between September 2013 and April 2021. The type of realignment procedure was determined based on patient symptoms and findings on plain radiographs and weightbearing computed tomography. Clinical improvement was assessed using pre- and postoperative Foot Function Index (FFI) scores and the visual analog scale (VAS) for pain. The OLT location was categorized according to Raikin zone, and the OLT area and volume were measured and compared pre- and postoperatively. The comparative analysis was performed using the Wilcoxon signed-rank test. In total, 27 ankles in 27 patients (mean age, 34.4 ± 11.9 years) were included in the analysis. There were 25 patients with a medial lesion (zone 4 [n = 19], zone 7 [n = 5], and zone 1 [n = 1]), and 2 patients with a lateral lesion (zone 6). Despite OLT location, patients' symptoms varied; 15 (55.6%) patients reported both medial- and lateral-sided pain, 10 (37%) reported lateral-sided pain, and 2 (7%) reported medial-sided pain. Supramalleolar osteotomy was performed in 18 patients, while foot and hindfoot correction without supramalleolar osteotomy was performed in 9 patients. Postoperatively, both the median FFI (from 44.4 [interquartile range (IQR), 35.7-52.2] to 9.1 [IQR, 5.2-13.9]) and median VAS pain score (from 6 [IQR, 5-6] to 1 [IQR, 1-2]) improved significantly (P < .0001 for both), and the median lesion size (from 25.8 mm2 [IQR, 19.3-45.2 mm2] to 13.8 mm2 [IQR, 6.8-26.5 mm2]) and median volume (from 2226.8 mm3 [IQR, 1311-3104 mm3] to 1326.5 mm3 [IQR, 714-2100 mm3]) decreased significantly (P < .0001 for both). During the mean follow-up of 4.1 ± 2.1 years, no subsequent surgery for OLT was necessary. The results suggest that realignment procedures can improve the symptoms and radiographic profile of OLTs in patients with large cystic OLTs of the talar shoulder and malalignment of the foot and ankle.

Percutaneous CT-Guided Microwave Ablation for the Treatment of Osteoid Osteomas: A Single Center Experience

Rationale and ObjectivesThe aim of the current study was to evaluate the feasibility and effectiveness of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OO). Materials and methodsData from 59 consecutive patients who underwent percutaneous CT-MWA for OO treatment were examined in the current retrospective study. The period of this study spanned from January 2021 to May 2023 at a single institution. The study involved an evaluation of clinical and radiological characteristics, procedural data, Visual Analog Scale (VAS) pain scores, complication incidences, as well as clinical and technical success rates. Statistical analyses were performed by using the Wilcoxon test with Bonferroni correction, Friedman, Spearman, Mann-Whitney U test. Results59 patients with an average age of 17.31±8.53 years underwent CT-guided MWA for the treatment of OO. The procedure demonstrated a high success rate, with 96.6% of cases achieving both technical and clinical success. However, recurrence was observed in two patients (3.4%) at the three-month follow-up. These cases were successfully managed with a second MWA procedure. The median VAS pain scores reported by the patients was significantly improved post-procedure: from 8.64 ± 1.14 before treatment to 0.63 ± 0.98 in the first month, 0.41 ± 1.02 in the third month, and 0.15 ± 0.45 in the sixth month. Only one patient (1.7%) experienced a minor complication; no major complications were recorded in this study. ConclusionCT-guided percutaneous MWA is a minimally invasive and a highly effective and safe approach for the treatment of OO.

Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical Outcomes.

Introduction: Radical prostatectomy is increasingly performed laparoscopically with robot assistance (RALRP). RALRP, as with all laparoscopic procedures, requires a pneumoperitoneum, which might result in peritoneal inflammatory response reactions and postoperative pain. The aim of this retrospective single-centre study was to analyse the effects of a pneumoperitoneum during RARLP on clinical outcomes. Methods: All patients who underwent robot-guided prostatectomy in our clinic were included, with the exception of patients who were converted to open prostatectomy. C-reactive protein was used as a marker for the primary outcome, namely the postoperative inflammatory response. Intra-abdominal pressure (IAP) was evaluated as a potential factor influencing inflammation. In addition, the waist-hip ratio was used to estimate the amount of visceral adipose tissue, and the administration of dexamethasone was considered as a factor influencing inflammation. The Visual Analogue Scale (VAS) was used to determine postoperative pain. Patients were consecutively recruited between 1 September 2020 and 31 March 2022. Results: A total of 135 consecutive patients were included. The median waist-hip ratio was 0.55. The median duration of the pneumoperitoneum was 143 min. The median values of the average and maximum IAP values were 10 mmHg and 15 mmHg, respectively. The mean CRP of the first postoperative day was 6.2 mg/dL. The median VAS pain level decreased from 2 to 1 from the first to the third postoperative day. On the first postoperative day, 16 patients complained of shoulder pain. In addition, 134 patients were given some form of opioid pain treatment following surgery. Conclusion: We could not identify any relevant associations between the duration and IAP of the pneumoperitoneum and the indirect markers of inflammation or indicators of pain, or between the latter and the amount of visceral adipose tissue. In addition, we found no significant effect of the administration of dexamethasone on postoperative inflammation. The results point to a noninferior tolerability of moderate pressure during the procedure compared to the commonly utilised higher pressure, yet this must be confirmed in randomised controlled trials.

Needle-Free Jet Injector-Assisted Triamcinolone Treatment of Keloids and Hypertrophic Scars is Effective and Well Tolerated in Children.

Keloids and hypertrophic scars can cause severe pain, pruritus, and psychological distress. Conventional intralesional corticosteroid treatment with needle injections remains challenging, especially in children with needle phobia. We aimed to evaluate the effectiveness, tolerability, and patient satisfaction of intralesional treatment with triamcinolone acetonide using a needle-free electronic pneumatic jet injector in children with keloids and hypertrophic scars. A retrospective study was performed in children with keloids and hypertrophic scars who received intralesional triamcinolone acetonide treatments using an electronic pneumatic jet injector. Effectiveness was evaluated using the Patient and Observer Scar Assessment Scale and Global Aesthetic Improvement Score at follow-up versus baseline. Tolerability was assessed with reported adverse effects and injection-related pain using a visual analog scale. Satisfaction questionnaires were used to evaluate treatment-related patient satisfaction. Six female patients and five male patients aged 5-17 years, with a total of >118 keloids or hypertrophic scars were included. Electronic pneumatic jet injector treatment led to a significant reduction in the total Patient and Observer Scar Assessment Scale observer and patient scores compared with baseline, with a median reduction of 28.9% and 23.8%, respectively (p = 0.005; p = 0.009). Median visual analog scale pain scores for electronic pneumatic jet injector treatment were significantly lower compared with needle injections, 3.0 versus 7.0, respectively (p = 0.027). No severe adverse effects were reported. Overall, 6 patients were 'satisfied' and five patients were 'very satisfied' with the treatment. Electronic pneumatic jet injector-assisted intralesional triamcinolone acetonide is an effective and well-tolerated treatment for keloids and hypertrophic scars in children. It should be considered as an alternative non-traumatic delivery method, especially in children with needle phobia or severe pain during previous needle injections.

Cannabidiol as an Alternative Analgesic for Acute Dental Pain

Odontogenic pain can be debilitating, and nonopioid analgesic options are limited. This randomized placebo-controlled clinical trial aimed to assess the effectiveness and safety of cannabidiol (CBD) as an analgesic for patients with emergency acute dental pain. Sixty-one patients with moderate to severe toothache were randomized into 3 groups: CBD10 (CBD 10 mg/kg), CBD20 (CBD 20 mg/kg), and placebo. We administered a single dose of respective oral solution and monitored the subjects for 3 h. The primary outcome measure was the numerical pain differences using a visual analog scale (VAS) from baseline within and among the groups. Secondary outcome measures included ordinal pain intensity differences, the onset of significant pain relief, maximum pain relief, changes in bite force within and among the groups, psychoactive effects, mood changes, and other adverse events. Both CBD groups resulted in significant VAS pain reduction compared to their baseline and the placebo group, with a maximum median VAS pain reduction of 73–77% from baseline pain at the 180-min time point (P < 0.05). CBD20 experienced a faster onset of significant pain relief than CBD10 (15 versus 30 min after drug administration), and both groups reached maximum pain relief at 180-min. Number needed to treat was 3.1 for CBD10 and 2.4 for CBD20. Intragroup comparisons showed a significant increase in bite forces in both CBD groups (P < 0.05) but not in the placebo group (P > 0.05). CBD20 resulted in a significant difference in mean percent bite force change in the 90- and 180-min time points compared to the placebo group (P < 0.05). Compared to placebo, sedation, diarrhea, and abdominal pain were significantly associated with the CBD groups (P < 0.05). There were no other significant psychoactive or mood change effects. This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain.

Self-expanding metallic stent for refractory pancreatic duct stricture in chronic pancreatitis: A prospective follow-up study.

In chronic pancreatitis, fully covered self-expanding metal stents (FCSEMS) are used to treat refractory pancreatic duct strictures. However, the FCSEMS design, effectiveness, safety, optimal stent indwelling time and patient selection remain unclear. This study aimed at evaluating technical success, clinical success and adverse events with FCSEMS in patients with symptomatic pancreatic duct stricture. The prospective study was conducted between May 2017 and May 2021 at a tertiary care center for chronic pancreatitis with refractory pancreatic duct stricture using controlled radial expansion (CRE) endoscopic retrograde cholangiopancreatography (ERCP) with FCSEMS (Niti-S, Bumpy stent, Taewoong Medical, Gimpo-Si, South Korea). During the study period, a total of 11 patients underwent ERCP with FCSEMS for refractory pancreatic duct stricture. The mean age (± standard deviation, [SD]) was 32.36 ± 10.98years and nine patients (81%) were male. Technical and clinical success rates were 100% and 90.9%, respectively. All patients had a history of prior pancreatic endotherapy. The median (inter quartile range, [IQR]) stent indwell time was seven (6-10) months. The median visual analogue scale (VAS) pain score pre and post-FCSEMS was 8 (5-8) and 1 (0-2), respectively (p-value 0.003). Median (IQR) follow-up after stent removal was 48 (40-60) months. One patient (9%) developed de novo main pancreatic duct (MPD) stricture, which was asymptomatic. None of the patients had cholangitis, pancreatitis, perforation, proximal migration or stent fracture. The FCSEMS treatment appears to be safe, feasible and possibly an effective option for patients who have not responded to endoscopic plastic stenting.

A single-center prospective study on pain alleviation during peroral upper endoscopy with an ultrathin endoscope

BackgroundThe efficacy of transnasal endoscopy using an ultrathin endoscope has been reported in several studies. However, few studies regarding peroral endoscopy with ultrathin endoscopes with high resolution have been reported. This study investigates the pain alleviation of peroral endoscopy with an ultrathin endoscope.MethodsPatients with a history of peroral endoscopy using a conventional, normal-diameter scope with no sedation who underwent peroral esophagogastroduodenoscopy (EGD) using a thin scope between April-July 2022 were included in this study. After the procedure, the patients completed a questionnaire evaluating pain during the examination and willingness to repeat the procedure. The physicians were surveyed regarding their level of satisfaction. The primary endpoint was patient satisfaction, which corresponded to the rate of patients who rated the thin endoscope as more comfortable or somewhat more comfortable than the previously-used, conventional endoscope.ResultsOne hundred and forty-five patients were included in the analyses. Patient satisfaction was achieved in 86.2% (125/145) of patients. The median visual analog scale pain score was 3 (0–7) points in this study, which is significantly lower than the pain score after the previous endoscopy (5 (0–10) points; p < 0.001). In addition, 96% (24/25) of patients who underwent EGD by an expert and 95.8% (115/120) who underwent EGD by a non-expert were willing to repeat endoscopy using the thin scope (p = 0.69).ConclusionPeroral endoscopy using a thin scope reduces patient pain regardless of the endoscopist’s experience.

Effectiveness of Benzydamine Hydrochloride + Cetylpyridinium Chloride (Difflam®) Lozenges in Alleviating Sore Throat among COVID-19 Patients: A Real-World Evidence Study in the Clinical Practice

Objective: Since the start of the pandemic, the SARS-CoV-2 which causes COVID-19 infection, has aggressively taken a toll on millions of lives worldwide. Recent studies have shown that newer variants consistently present with a greater frequency of sore throat. This study explored the real-world effectiveness of benzydamine hydrochloride + cetylpyridinium chloride (Difflam®) lozenge in alleviating sore throat of Filipino patients, under condition of routine medical practice. Study Design: Observational, uncontrolled study design Setting: Ambulatory / out-patient health facilities Method: This study included patients with mild to moderate COVID-19 infection in a real-world setting confirmed either with rapid antigen test (RAT) or positive real-time polymerase chain reaction (RT-PCR), who manifested with symptoms and signs of dysphagia / odynophagia. They were prescribed with Difflam® lozenge as an adjunct to standard care, in accordance with the respective local prescribing information and routine clinical practice. Results: A decreasing trend was observed in the median visual analogue scale (VAS) pain scores from baseline up to the seventh day. The difference from the baseline VAS score was significant in all observation period from day 1 to day 7 (p&lt;0.001). The greatest difference was seen on day 4 and 5 (median VAS scores of 1 and 0, respectively). The mean duration of symptoms before total resolution of sore throat (VAS score = 0) was 4.4 SD ± 1.9 days with majority of participants (87 %) reporting resolution at the end of seven days observation. The mean length of time before negativity of COVID-19 RAT was 3.9 SD ± 1.6 days. Majority did not experience adverse events, and if so, were generally mild. Conclusion: The benzydamine hydrochloride + cetylpyridinium chloride (Difflam®) lozenge reduced the duration of COVID-19 (RAT negative) and completely alleviated symptoms of dysphagia and odynophagia among patients with mild to moderate COVID-19 infection within four to five days of initiation of therapy

V11-10 ANATOMIC TRANSPERINEAL PUDENDAL NERVE BLOCK BEFORE PENILE PROSTHESIS PLACEMENT TO REDUCE IMMEDIATE POSTOPERATIVE PAIN - DESCRIPTION AND OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023V11-10 ANATOMIC TRANSPERINEAL PUDENDAL NERVE BLOCK BEFORE PENILE PROSTHESIS PLACEMENT TO REDUCE IMMEDIATE POSTOPERATIVE PAIN - DESCRIPTION AND OUTCOMES Kieran Lewis, Raevti Bole, Jacquelyn Booher, Lydia Deangelo, Gwendolyn Fuller, Ly Hoang Roberts, Petar Bajic, and Scott Lundy Kieran LewisKieran Lewis More articles by this author , Raevti BoleRaevti Bole More articles by this author , Jacquelyn BooherJacquelyn Booher More articles by this author , Lydia DeangeloLydia Deangelo More articles by this author , Gwendolyn FullerGwendolyn Fuller More articles by this author , Ly Hoang RobertsLy Hoang Roberts More articles by this author , Petar BajicPetar Bajic More articles by this author , and Scott LundyScott Lundy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Inflatable penile prosthesis (IPP) is the gold standard surgery for refractory erectile dysfunction, though patients can experience significant pain in the postoperative period. Historically, this pain has been managed with opioid medication, which presents additional risk to patients. Pudendal nerve block (PNB) has long been used for intraoperative pain management in IPP, though knowledge of its impact in the postoperative period is limited. Recently, a multimodal analgesic regimen that included a PNB was shown to reduce pain and opioid use following IPP when compared to opioid medication alone. In this video abstract, we describe a simple and safe pudendal nerve block to reduce postoperative pain in patients undergoing IPP. METHODS: We retrospectively reviewed 10 patients who underwent a transperineal PNB prior to IPP at our institution. To explore its safety, we documented intraoperative complications and 90-day postop complications. We also documented immediate postop pain using the visual analog scale (VAS), immediate postop opioid administration, and patient-reported pain at the first follow-up visit. Our PNB is a single component of an ERAS protocol, which utilizes pre and postoperative gabapentin, meloxicam, and acetaminophen, in addition to intracavernosal lidocaine. RESULTS: Of the 10 patients we reviewed, 0/10 experienced intraoperative complications and in the 90-day period following surgery 0/10 experienced postop complications. The median VAS pain score in the immediate postop period was 2 (IQR=0 – 3), with 5/10 patients receiving fentanyl for pain control in the PACU. Patients that received fentanyl were on average given two 50mcg doses and had a median VAS pain score of 5 prior to the first dose. 9/10 patients reported no pain at first follow-up, with just a single patient reporting mild pain along the scrotum. CONCLUSIONS: In this video abstract, we demonstrate a safe and effective transperineal pudendal nerve block to minimize pain and reduce opioid use in patients following IPP implantation. Our PNB adds minimal pre-op time, does not require ultrasound, and has a low risk of possible complications. For quality control, we reviewed 10 patients who received a PNB before IPP. None of these patients experienced intraoperative or postop complications, demonstrating the safety of the procedure. Additionally, patients reported minimal pain in the immediate postop period and at first follow-up, once again demonstrating the safety and potential efficacy of the nerve block. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1001 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kieran Lewis More articles by this author Raevti Bole More articles by this author Jacquelyn Booher More articles by this author Lydia Deangelo More articles by this author Gwendolyn Fuller More articles by this author Ly Hoang Roberts More articles by this author Petar Bajic More articles by this author Scott Lundy More articles by this author Expand All Advertisement PDF downloadLoading ...

The use of intrathecal morphine for acute postoperative pain in lower limb arthroplasty surgery: a survey of practice at an academic hospital

Background and purpose of the studyIntrathecal morphine (ITM) provides optimal postoperative analgesia in patients who are scheduled for total knee and hip operation with spinal anaesthesia. However, the ideal dose at which maximal analgesic effect occurs with minimal side effects is not known. This study aimed to describe the use of two doses of ITM and side effect profile in patients undergoing elective hip and knee arthroplasty.MethodsThis was a prospective, descriptive, and contextual study conducted on patients who had total hip and knee replacement at Chris Hani Baragwanath Academic Hospital from 1 September to 30 November 2020. The sample size consisted of 66 patients who were 18 years and older, American Society of Anaesthesiology (ASA) classification 1–3, patients who had received either 100 mcg or 150 mcg ITM dose under spinal anaesthesia and sent to the ward postoperatively. Visual Analogue Scale (VAS) score was used to assess pain in the first 24 h, consumption of rescue analgesia and reported side effects were documented.ResultsThere was no relationship between age, weight, ASA classification or type of surgery and VAS score classification groups. Patients who received 100 mcg ITM had a higher median VAS pain score 2 (1–5) compared to those who received 150 mcg ITM 1 (0–2), p = 0.01. The need for rescue analgesia between the two groups was marginally less in the 150 mcg ITM group (p = 0.098). There was no difference in the rate of side effects between the 100 mcg ITM group [12 (41%)] and the 150 mcg ITM group [17 (59%)], p = 0.92. Rescue analgesia was marginally different between groups, p = 0.09. There were no real differences in the VAS pain scores between the total knee and total hip surgeries. None of the patients experienced clinically significant respiratory depression.ConclusionThe 150 mcg ITM dose provided good analgesic effects with longer duration of action and comparable side effect profile to the 100 mcg ITM dose. This dose was not associated with development of respiratory depression and can therefore be administered safely to patients who are discharged to the ward postoperatively in a resource constraint environment.

Safety and Efficacy of Embolization with Microspheres in Chronic Refractory Inflammatory Shoulder Pain: A Pilot Monocentric Study on 15 Patients.

Purpose: Musculoskeletal (MSK) embolization is emerging in tendinopathy treatment. The objective of this study was to assess the efficacy and safety of MSK embolization with microspheres in the treatment of chronic shoulder pain. Patients and methods: This retrospective monocentric study included patients with chronic shoulder pain resistant to 6 months or more of conventional therapies who were treated with MSK embolization between 2017 and 2021. Embolization was performed using calibrated 100–250 µm microspheres. Clinical success was defined as pain reduction, i.e., a decrease in the visual analogue scale (VAS) pain score of ≥50% at 3 months after MSK embolization as compared to baseline. Adverse events were collected. Results: Fifteen patients (11 women, 4 men) were included, with a median age of 50.3 years (IQR: 46.7–54.5). The median duration of symptoms was 26.6 months (20.6–39.8). The median VAS pain scores were 7.0 (7.0–8.0) at baseline, 6.0 (3.5–7.0) at 1 month, 5.0 (4.5–6.5) and 5.0 (3.0–7.4) at 3 months and 6 months (p = 0.002). Three patients (20%) reported clinical success at 3 months. Three patients experienced minor complications after embolization (paresthesia, n = 2; transient osteo-medullary edema, n = 1) and two patients had moderate complications (transient skin ischemia). Conclusion: MSK embolization with microspheres for treatment of refractory chronic shoulder pain showed moderate results in terms of clinical success and safety.

The L-shaped tunnel technique showed favourable outcomes similar to those of the Y-graft technique in anatomic lateral ankle ligament reconstruction.

To compare the mid- to long-term clinical and radiological outcomes of the confluent L-shaped tunnel technique with the Y-graft technique for anatomic lateral ankle ligament reconstruction. This retrospective study involved 41 patients who underwent lateral ankle ligament reconstruction between 2013 and 2018. Based on the tunnel direction and tendon fixation method at the fibula side, patients were divided into two groups, with 17 patients in the L-shaped tunnel group and 24 patients in the Y-graft group. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner score, and Karlsson score were evaluated and compared preoperatively and at follow-up. Anterior talar translation and talar tilt at stress radiographs, postoperative sprain recurrence, range of motion (ROM) restriction, sensory disturbance, etc., were also collected and compared. The mean follow-up times were 72 and 42months for the L-shaped group and Y-graft group, respectively. The median VAS pain score, Tegner score, AOFAS score, Karlsson score significantly improved from a preoperative level in both groups (all with p < 0.01). No significant difference was found between the two groups regarding the changes from preoperatively to postoperatively except for the VAS pain score reduction (1.58 ± 1.58 in the L-shaped group vs. 2.53 ± 1.29 in the Y-graft group, p = 0.035). The incidence of flexion-extension ROM restriction (≥ 5°) was significantly higher in the Y-graft group (41.2%) than in the L-shaped group (12.5%) (p = 0.035). Both the confluent L-shaped tunnel technique and the Y-graft technique significantly improved symptoms, ankle function, and radiographic outcomes in patients with chronic lateral ankle instability (CLAI) at mid- to long-term follow-up. The confluent L-shaped tunnel technique resulted in lower rates of flexion-extension ROM restriction, while the Y-graft technique showed better VAS pain reduction. This result could provide further evidence for the surgical treatment of CLAI. III.

Impact of Liposomal Bupivacaine on Post-Operative Pain and Opioid Usage in Thyroidectomy.

Opioid analgesia has been integral in post-operative pain control for decades. The over-prescription of opioids, commonly in the surgical patient, has contributed to the current opioid epidemic. Liposomal bupivacaine (LB), a long-acting analgesia formulation, has demonstrated decreased post-operative pain and opioid requirements in patients treated across multiple surgical subspecialties. The aims of this retrospective study are to assess post-operative pain and opioid use in patients who received LB at the time of thyroidectomy. A cohort-matched retrospective review of patients who underwent thyroidectomy by 2 surgeons between January 2010 and December 2019 was performed. Patients were divided into those that received LB intraoperatively and those that did not. Statistical analyses were performed using the Chi-square or Fisher's exact test, and 2-sample T-test or Wilcoxon rank sum test. Of the 201 patients included in this study, 113 patients received LB and 88 did not. Patients who received LB had a lower median visual analog scale (VAS) pain score (2 vs 3, P = .2252), lower maximum VAS pain score (6 vs 7, P = .0898), were less likely to require opioid medications (73.5% vs 85.2%, P = .0434), and had a lower percentage of daily morphine milligram equivalent value ≥45 (89.8% vs 95.3%, P = .1581) during the post-operative period when compared to those that did not. This study suggests a role for incisional infiltration with LB for post-operative pain management in patients undergoing transcervical thyroidectomy. We report reduced post-operative pain scores and opioid analgesia requirements in patients who received LB.

Osteoid Osteoma: Percutaneous CT-guided Cryoablation Is a Safe, Effective, and Durable Treatment Option in Adults.

Background Cryoablation is playing an increasing role in the percutaneous treatment of bone tumors. However, despite its potential advantages over heat-based ablation techniques, the clinical safety and efficacy of cryoablation have not been established for osteoid osteoma treatment. Purpose To evaluate percutaneous CT-guided cryoablation for the treatment of osteoid osteoma in young patients and adults. Materials and Methods This retrospective study reviewed data from 50 consecutive patients who underwent percutaneous CT-guided cryoablation for the treatment of osteoid osteoma between January 2013 and June 2019 in a single institution. In 30 of 50 patients (60%), the procedure was carried out with the patient under local anesthesia and conscious sedation, with the cryoprobe covering the lesion from an extraosseous position, avoiding direct penetration of the nidus. Clinical and radiologic features, procedure-related data, visual analog scale (VAS) pain scores, complications, and overall success rate were evaluated. Statistical analyses were performed by using the nonparametric Friedman test and Wilcoxon signed rank test for repeated measures. Results Fifty patients (median age, 24 years; interquartile range [IQR], 19-38 years; 31 men) underwent CT-guided cryoablation for the treatment of osteoid osteoma, with a 96% (48 of 50 patients) overall clinical success rate. Of the two patients without clinical success, one patient had incomplete pain relief and the other experienced a recurrence of osteoid osteoma at 11 months, which was successfully treated with a second cryoablation procedure. The median VAS pain score was 8 (IQR, 7-8) before the procedure and 0 (IQR, 0-1; P < .001) after the procedure at both primary (6 weeks) and secondary (18-90 months) follow-up. Three of the 50 patients had minor complications (6%); no major complications were reported. Conclusion Osteoid osteoma was safely, effectively, and durably treated with CT-guided percutaneous cryoablation. In the majority of patients, treatment could be performed without general anesthesia, with the cryosphere covering the nidus from an extraosseous position. © RSNA, 2021.

Prospective 1-Year Outcomes Are Maintained at Short-Term Final Follow-Up After Superior Capsular Reconstruction Augmentation of Complete Rotator Cuff Repair

To evaluate the outcomes of arthroscopic superior capsular reconstruction (SCR) augmentation of complete, massive rotator cuff repair (RCR). A retrospective study of dermal allograft SCR-augmented RCRs performed by a single surgeon from June 2016 through December 2017 was performed with the following inclusion criteria: massive rotator cuff tear amenable to complete repair but with poor-quality native rotator cuff tissue. Radiographic follow-up was performed at 1 year, and clinical follow-up was performed at both 1 year and a minimum 2 years after surgery. Clinical follow-up included the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, Subjective Shoulder Value score, active forward elevation, and external rotation. Radiographs and magnetic resonance imaging (MRI) scans were assessed for muscle quality using the Goutallier classification, and graft and cuff integrity was assessed according to the Sugaya classification. The inclusion criteria were met by 24 patients at 1 year and by 18 (75%) at a minimum of 2 years postoperatively. Patient-reported outcomes were improved compared with preoperative data and were maintained at minimum 2-year follow-up, with median American Shoulder and Elbow Surgeons scores of 42.5 (interquartile range [IQR], 30.8-58.7) versus 93.9 (IQR, 82.4-100) (P < .001); median Subjective Shoulder Value scores of 30 (IQR, 20-50) versus 90 (IQR, 86.2-97.2) (P < .001); and median visual analog scale pain scores of 5.5 (IQR, 1-9) versus 0 (IQR, 0-0.8) (P= .001). Evaluation of graft and tendon healing on postoperative MRI revealed poor interobserver agreement and showed 10 completely healed grafts (42%), 9 partially healed grafts (38%), and 5 completely disrupted grafts (21%), with 42% of supraspinatus tendons and 54% of infraspinatus tendons healed. SCR with dermal allograft augmentation of complete RCR with poor-quality tissue shows very good clinical outcomes at minimum 2-year follow-up. Poor interobserver agreement regarding postoperative graft and rotator cuff integrity by MRI was found. The healing rate for the SCR grafts was 79%. The rates of healing of the native supraspinatus and infraspinatus tendons were 42% and 54%, respectively. Level IV, retrospective case series.

P68. Racial disparities in presenting physical functionality and mental distress characteristics of patients undergoing spine surgery

<h3>BACKGROUND CONTEXT</h3> When considering severity of presentation, patient-reported outcomes (PROs) have become increasingly emphasized in orthopedic surgery as surrogates for quality of care. Additionally, PROs provide insight into the severity of an illness or injury and its impact on a patient's life and may also be predictors of treatment outcomes and patient satisfaction. The literature suggests that Black and other minority patients undergoing spine surgery are more likely to present with lower baseline PROs (bodily pain, physical functioning), worse symptom severity, and greater pain compared to white patients. <h3>PURPOSE</h3> To examine racial disparities in functional and mental health impairment, measured by PROMIS scores for mental health and physical impairment, upon indication for spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective Chart Review of patient reported scores on presentation for spinal surgery. <h3>PATIENT SAMPLE</h3> Patients between November 2018 and August 2019 who received 1-2 segment cervical decompression and fusion, 1-2 segment cervical or thoracic laminotomy, 1-2 segment lumbar laminotomy, 1-2 level lumbar interbody fusion, or arthrodesis to correct long, spinal deformity but limited to 8 segments or fewer. <h3>OUTCOME MEASURES</h3> Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score, a PROMIS Global Mental Health (GPH) score, and a Visual Analog Scale (VAS) pain score at the time of presentation. <h3>METHODS</h3> Chi Square analysis, one-way analysis of variance (ANOVA), and Kruskal-Wallis analyses were used to determine if race, socioeconomic status of a patient's community, and procedure type had an effect on the degree of physical impairment, overall pain, or mental distress of a presenting patient. Bonferroni-corrected post hoc t tests and Dunn's post hoc nonparametric test for multiple comparisons were conducted after obtaining significant ANOVA, or Kruskal-Wallis results, respectively. <h3>RESULTS</h3> The overall study sample predominantly self-identified as racially White (73.5%), and males comprised 49.8% of the total cohort. At the time of presentation for spine surgery, patients presented with an average Visual Analog Scale (VAS) pain score of 5.84 (95% C.I: 5.66-6.03), a median PROMIS mental health score of 12 (IQR: 9-15), and a median PROMIS physical health score of 11 (IQR: 8-13). Notably, there was no difference in the presenting pain score by the Visual Analog Scale among patients who underwent the five different procedures (PANOVA = 0.9749) When compared to White patients undergoing the same procedure, Black/African-American patients had median VAS pain scores that were 16.7% higher, indicating greater pain, among those undergoing cervical decompression and fusion (P= 0.047) as well as lumbar interbody fusion (P=0.0167). Black/African-American patients had median VAS pain scores that were 60% higher among those undergoing cervical/thoracic laminotomy (P=0.0005), lumbar laminotomy (P<0.0001), and arthrodesis for spinal deformity (P=0.0012) when compared to White patients undergoing the same procedure. Additionally, Black/African-American patients had lower median PROMIS mental scores among those undergoing cervical/thoracic laminotomy (P=0.0012), lumbar laminotomy (P=0.0195), and lumbar interbody fusion (P=0.0208). Black/African-American patients had lower median PROMIS physical scores among those undergoing cervical decompression and fusion (P=0.0028), cervical or thoracic laminotomy (P=0.0024), lumbar laminotomy (P<0.0001), lumbar interbody fusion (P=0.0100), and arthrodesis to correct long, spinal deformity (P=0.0261). <h3>CONCLUSIONS</h3> These findings suggest that racial disparities exist in patients' presentation for spine surgery. Likely causes include disparities in household income, characteristics of a patient's neighborhood, and a patient's access to health care. Our findings refute any notions or misconceptions held by both medical professionals and laypersons that Black/African-American patients are more immune to pain and impairment when compared to White patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Two-Year Clinical and Radiographic Evaluation of Scheker Prosthesis (Aptis) Distal Radioulnar Joint Arthroplasty

To evaluate the clinical and radiographic outcomes of patients who underwent semiconstrained distal radioulnar joint arthroplasty. A retrospective analysis was performed on a series of patients who underwent distal radioulnar joint arthroplasty with more than a 23-month follow up. The quantitative outcome variables included the visual analog scale for pain; Disability of the Arm, Shoulder, and Hand (DASH) score; Patient-Rated Wrist Evaluation (PRWE); and Mayo wrist score. The range of motion, grip strength, torque, and lifting capacity were measured at final follow up and compared with that of the nonsurgical extremity. Complications related to the prosthesis were assessed. Twenty-one patients (mean age 57 years) were assessed at an average 41-month follow up (23-73 months). Fifteen underwent prior hand, wrist, or elbow procedures. Four patients required 5 reoperations. The postoperative median visual analog scale pain score was 0.6 at rest and 2.1 with activity. The median postoperative DASH score was 26.7, PRWE 41, and Mayo wrist score was 65. Upon comparing the supination torque of the operative and intact sides, the operative side was found to average 87% of the intact side on a work simulator and 77% on the simulator's D-ring. Eight of 20 patients had lysis around the collar of the ulnar component (40%), as detected using radiography. Three of 21 (14%) radial plates were malpositioned, with 2 resulting in a fracture. The overall complication rate was 29%. Distal radioulnar joint arthroplasty using the Scheker prosthesis demonstrated good patient pain scores and the restoration of supination strength. The collar lysis resulted in weaker supination and grip strength. Still, the patients experienced mild levels of pain and moderate disability. A moderate complication rate persisted, as reported by other authors. Accurate radial component placement is important. Therapeutic IV.