Need For Analgesic Medication Research Articles

Management of symptomatic irreversible pulpitis using irrigation agitation techniques in anterior teeth.

Endodontic pain, a common complication after root canal treatment, affects 2.5% to 60% of patients. Therefore, it is of interest to compare apical negative pressure irrigation (EndoVac) with conventional needle irrigation to assess their impact on postoperative pain in permanent anterior teeth with symptomatic irreversible pulpitis. Fifty patients were randomly assigned to either the EndoVac or needle irrigation group. Pre and post-operative pain levels were assessed using a Visual Analog Scale and the amount of Ibuprofen taken was recorded. At 12-, 24-, and 48-hour intervals, the EndoVac group reported significantly less pain than the needle irrigation group. The needle irrigation group also required more Ibuprofen. The apical negative pressure irrigation system (EndoVac) resulted in significantly less postoperative pain and reduced the need for analgesic medication than the conventional needle irrigation protocol.

Postoperative effects of bilateral sphenopalatine ganglion blockade in septorhinoplasty operations; double-blind randomized clinical trial

ObjectiveWe aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. MethodsIn this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. ResultsThere was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p > 0.05) All VAS values were statistically lower in Group S than in Group C (p < 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0–2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p < 0.05). ConclusionBilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. Level of evidence2, degree of recommendation B.

Endoscopic Ultrasound-Guided Celiac Plexus Block Can Be a Useful Procedure for Pain Relief in Chronic Pancreatitis When Used Selectively

Abstract Background and Objectives: Endoscopic ultrasound (EUS)-guided celiac plexus block (CPB) for pain relief in chronic pancreatitis (CP) has wide variation in results as reported in the literature. The objective was to find out the efficacy of EUS-CPB in painful CP from our region where phenotype of CP is different from West and to find out factors favoring response to EUS-CPB. Methods and Results: Patients with known CP who underwent EUS-CPB were assessed for response to CPB. Response to EUS-CPB was recorded as more than 50% reduction in visual analogue scale (VAS) score for pain severity at 1 week, 4 weeks, 12 weeks and 24 weeks after procedure. Factors between responders and nonresponders were analyzed. Among 29 patients who underwent EUS-CPB during the study period, response was seen in 72.4% patients after the procedure. The mean time to response to EUS-CPB was 1.22 (± 0.43) days. Mean duration of response was 8 months (± 4.73). Short duration of painful CP (≤2 years) was seen in 15 patients (51.72%) and long duration (&gt;2 years) was seen in 14 (48.27%). Among responders (21/29), those patients who had short duration of disease had significantly lower median VAS score at 12 weeks, (1 versus 3, p-value= 0.026) and at 24 weeks, (1.5 versus 2.5, p-value= 0.049), as compared to those with longer duration of disease. Overall, 83.3% males responded as compared to 54.54% females (p = 0.04). Significant proportion of subjects who responded either stopped or used analgesics occasionally (p &lt; 0.0001). There was no statistically significant difference in response to EUS-CPB with respect to age, prior history of endoscopic retrograde cholangiopancreatography (ERCP), etiology of CP, prior history of surgery, or whether only EUS-CBP was done (p &gt; 0.05 for all). Conclusion: EUS-CPB can be effective when used in select group of painful CP patient who are not immediate candidates for surgery especially in early course of disease. It can be offered to patients with persistent pain despite optimum medical therapy. When effective, it can reduce need for analgesic medication at least in short to medium term.

Efficacy of Lidocaine Infusion for Treatment of Chronic Neuropathic Pain: A Case Control Study

Background: Neuropathic pain is a type of chronic pain that is related to nerve damage and is defined by the International Association of Study of Pain (IASP) as “pain caused by a disease or lesion of the somatosensory nervous system”. It remains a challenging clinical problem as pain often can be quite severe and debilitating. The rationale of this study is to find out the efficacy of intravenous lidocaine infusion for neuropathic pain management in our population as there has been no study conducted in Pakistan for this purpose. As our country has a rather low-income population and cheaper options for treatment need to be explored. Objective: To determine the efficacy of lidocaine infusions of 3 mg/kg in managing the chronic neuropathic pain given at 0,1, 2 and 3 weeks in comparison to the placebo infusion. Study Design: Case control study. Settings: The study was conducted in the Sheikh Zayad Hospital Lahore Pakistan. Duration: July 2022 to December 2022. Methods: 100 outdoor patients fulfilling the inclusion and exclusion criteria were enrolled after taking informed written consent and were randomly allocated to Lidocaine group (A) 3 mg/kg, diluted in 50 ml normal saline and placebo group (B) 50 ml intravenously over 30 minutes. The Lidocaine group was injected with lidocaine, intravenously over 30 minutes once a week for 4 weeks. Patients with established diagnosis of neuropathic pain, adults of both genders, age above 18 years were enrolled in this study. Their pain severity was recorded using Numerical rating scale (NRS). The data of both groups was recorded in predesigned proforma and efficacy was also noted as labelled as Yes/No for two points; 1: Decrease in pain score by at least 2 out of 10 and 2: Decrease in oral analgesics intake. Results: There were 50 patients in group A and B with the mean age of 53.82 years and 54.4 years respectively. Patients in group A who received an intravenous infusion of lidocaine reported less severe pain and fewer instances of breakthrough pain. No statistically significant difference (P&gt;0.05) was discovered between NRS ratings before and after infusions in the control group despite the fact that several patients reported lower pain intensity after the infusion. The quantity of opioid used was determined for the Lidocaine and Placebo groups. Opioid in the placebo group was 0.472–0.572 g per patient, but in the Lido group it was only 0.1–0.2 g per patient which is significantly different from placebo group (p=0.0021). Conclusion: Lidocaine intravenous infusion (3 mg/kg daily for 4 weeks) improved short-term results of therapy, decreased the need for analgesic medication, and shortened pain score without causing major adverse effects.

Assessment of Analgesic Effect of Ketamine Vs Ketamine Magnesium Infusion and Their Effect on Postoperative Morphine Consumption after Surgical Nephrectomy

ABSTRACT Two non-opioid analgesics such as ketamine and magnesium have been investigated for their potential use as adjuvants for opioid analgesics. They were shown to have anaesthetic and analgesic qualities, and it has been proposed that they may have a role in reducing the need for analgesic medication through the post-operative time. Aim and Objectives Primarily, we compare intra and postoperative analgesic effect of ketamine versus ketamine magnesium infusion and their influence on postoperative morphine consumption after nephrectomy and secondarily to assess hemodynamic changes and intensity of pain Methods This study was conducted in Six October University Hospital, 100 patients presented for elective nephrectomy under general anesthesia in the Department of Anesthesiology were randomly assigned in this prospective double blinded study into one of the two groups using computer generated table. All participants got oral midazolam 0.1 mg/kg in the evening before surgery, ketamine participants (Group I): intravenously injected by ketamine bolus dose (0.3 mg/kg), followed by continued ketamine infusion (0.15 mg/kg/h), Ketamine Magnesium participants (Group II): injected by a bolus dose of magnesium (50 mg/kg) + ketamine (0.3 mg/kg) intravenously, then by continuous infusion of (0.15 mg/kg/h) of ketamine + (10 mg/kg/h) of magnesium sulphate. Following the procedure, VAS score, Ramsay sedation scale, total rescue analgesic doses of morphine taken postoperatively, and unfavorable complications like nausea and vomiting were all documented. Results There were statistically significant differences between the two groups in post-operative VAS score, Ramsay Sedation Scale, and hemodynamic changes it was better in group II. Postoperative morphine consumption was remarkably decreased in collection II, with fewer side-effects. Conclusion Magnesium sulphate and ketamine together are more effective in curing the postoperative pain and maintaining patient hemodynamics while reducing narcotic side effects.

Analgesic effects of low-dose radiotherapy in greater trochanteric pain syndrome: results in a clinical series of 155 patients with recurrent or refractory symptoms.

This prospective study assessed the effects of low-dose radiotherapy in patients diagnosed with greater trochanteric pain syndrome (GTPS) with recurrent symptoms or refractory to previous conservative measures. We evaluated a total of 155 patients (90.3% women, mean age 69 years). Most patients (n = 136) received 10 Gy (1 Gy/day/3 fractions per week on alternate days), but after recommendations of DEGRO guidelines published in 2015, the remaining 19 patients (12.2%) received 6 Gy (1 Gy/day/3 fractions per week on alternate days). At the pre-treatment visit, the mean (standard deviation, SD) visual analog scale (VAS) score was 8), which decreased to 5 (SD 2.2) after 1 month of the end of treatment and to 4 (SD 2.3) after 4 months. An objective symptom response with increased mobility, better sleep quality, and reduction of analgesic medication was found in 56% of patients at 1 month. In 129 patients (83.2%), there was a decrease of at least 1 point in the VAS score, and in 49 patients (29.0%), the VAS score was lower than 3. The mean length of follow-up was 45 months. The probability of maintaining the analgesic response estimated by the Kaplan-Meier method was 53% at 5 years. Low dose radiotherapy effectively improved pain in the trochanteric area in most patients with recurrent or refractory GTPS, allowing a reduction in the need for analgesic medications and, more, importantly, better functioning and mobility. Further randomized studies in selected populations of GTPS are needed to define the treatment position of low-dose radiotherapy in this clinical setting.

Comparison of the effect of oral pregabalin with intravenous ketamine on reducing acute pain after abdominal hysterectomy: A randomized double-blind clinical trial.

Background:The aim of this study was to compare the analgesic effects of pregabalin and ketamine on reducing pain after abdominal hysterectomy.Methods:In this double-blind clinical trial, one hundred forty ASA I and II patients of age range 30-60 years scheduled for abdominal hysterectomy undergoing general anesthesia in 2018, were randomly divided into 4 equal groups. Pregabalin group received 300 mg oral pregabalin, ketamine group received 0.3 mg/kg of intravenous ketamine, and pregabalin- ketamine group received the combination of the two-above medication, and placebo group received the placebo and saline. Patients were evaluated for pain intensity according to the visual analogue scale (VAS) at 2, 4, 6, 12, 18, and 24 hours after surgery. Also, the need for analgesic drugs and the frequency of repetitions were also recorded. Statistical analysis was performed using STATA, Version 14. A p- value less than 0.05 was considered statistically significant.Results:In the pregabalin and pregabalin-ketamine groups, pain in the first 6 hours after the end of operation was significantly less than the other two groups (p<0.05), but there was no significant difference between the 4 groups at 18 and 24 hours after surgery. The need for analgesic medications in the pregabalin group was lower than in other groups (p<0.05).Conclusion:The results of this study show that the administration of oral pregabalin with and without intravenous ketamine before abdominal hysterectomy can decrease postoperative pain and reduce the need for analgesia.

Efficiency of Image Guided Percutaneous Celiac Plexus Neurolysis in Abdominal Malignancy: A Prospective Interventional Study

Introduction: Celiac Plexus Neurolysis (CPN) is an underutilised tool in oncology and interventional radiology set-up. Upper abdominal malignancy specifically carcinoma pancreas, carcinoma stomach which causes intolerable pain, for which patients require a high dose of pain killers. CPN being a day care procedure alleviates the pain in a short duration and its effectiveness may last for months. Aim: To assess the efficiency of image guided CPN in alleviating intractable pain in upper abdominal malignancy. Materials and Methods: A prospective interventional study was conducted on 25 patients with inoperable upper abdominal malignancy with intractable pain referred from the Palliative Care Department. These patients were subjected to Computed Tomography (CT)-guided or Ultrasonography (USG)-guided CPN using 97% absolute alcohol either via posterior or anterior approach under CT guidance or anterior approach in USG guidance. Pain intensity score was assessed before and after the procedure (one, three, and seven days after the procedure) using Visual Analogue Scale (VAS). Results: There was decrease of the pain intensity significantly in all the patients postprocedure. The VAS score at baseline was 6.48±1.56. One day after CPN, pain severity decreased to 4.16±2.17; three days later, it was 1.68±1.78; Seven days after CPN, pain severity still decreased significantly to 0.58±1.10. Percentage decrease in VAS from preprocedure to one, three, and seven days after procedure was found to be 39.07%, 76.29% and 90.06%, respectively and VAS score reduction was statistically significant at p-value &lt;0.001. Conclusion: CPN is an underutilised palliative procedure for upper abdominal malignancy which effectively controls pain, thus, reducing the need for analgesic medication. Both CT guidance and USG guidance can be used in performing the procedure.

Ultrasound-versus visual-guided transversus abdominis plane block prior to transabdominal preperitoneal ingunial hernia repair. A retrospective cohort study

BackgroundThe transversus abdominis plane block is a regional anesthesia technique. Recently, its impact on early chronic pain and the cumulative need of analgesic medication following inguinal hernia repair is being monitored. In terms of effectiveness and patient safety, it remains unclear whether the approach should be conducted preoperatively through ultrasound guidance, or through intraoperative visual guidance.The study at hand aims to provide more evidence on this topic. MethodsA monocentric retrospective matched pair analysis was performed. The intraoperative visual guided and ultrasound guided -transversus abdominis plane block prior to inguinal hernia repair in transabdominal preperitoneal technique were consecutively compared in regard to analgesic effectiveness and complication rate. The data of individuals who were operated on from June 2007 to February 2019 were analyzed. The matching criteria were ASA-Score, Gender, Age ( ±6 years), and hernia size (<1,5 cm, 1,5-3 cm, >1,5 cm). ResultsA total of 116 patients were enrolled. Both groups were homogenous in terms of age, gender contribution, body mass index, ASA-Score, hernia type, and size. The pain score at the postoperative anesthesia care unit was lower in the ultrasound-guided-transversus abdominis plane group without being statistically significant (VAS-Score: 0.67 vs.0.84). Patients of the ultrasound-guided-transversus abdominis plane group received significantly less metamizole on the day of operation (1.29 g (0.96) vs. 1.68 g (0.70), p = 0.015). ConclusionDue to our findings, we assume that the ultrasound-guided-transversus abdominis plane -Block may reduce postoperative pain and analgesic consumption more effectively than the visual-guided-transversus abdominis plane lock. Further prospective clinical trials are mandatory.

The transversus abdominis plane block reduces the cumulative need of analgesic medication following inguinal hernia repair in TAPP technique: a retrospective single center analysis among 838 patients.

Laparoscopic inguinal hernia repair (IHR) may lead to early postoperative pain. Therefore, opioid and non-opioid analgesic agents are often administered in the post-anesthesia care unit (PACU). To reduce the postoperative cumulative need of analgesic medication, as well as to accelerate the physical recovery time, the transversus abdominis plane (TAP) block has recently been studied. The TAP block is a regional anesthesia technique. Even though there is evidence about the efficacy of the block used in procedure such as an open inguinal hernia repair, the evidence regarding its use for the TAPP (transabdominal preperitoneal) technique remains low. We aim to provide more sufficient evidence regarding this topic. A monocentric retrospective observational study investigating the effect of the TAP block prior to primary IHR in TAPP technique was conducted. The data of 838 patients who were operated on using this technique from June 2007 to February 2019 were observed. 72 patients were excluded because of insufficient information regarding their analgesic medication protocol. The patients' data were taken from their files. The patients in the TAP block group (n = 364) did not differ statistically significantly compared to the control group (n = 402) in terms of gender, BMI and age. Individuals of the TAP block group experienced less postoperative pain in the PACU (p < 0.001) and received less analgesic medication (morphine, oxycodone, piritramide, acetaminophen; p < 0.001). We assume that the TAP block is a sufficient approach to reduce postoperative pain and analgesic medication administration for IHR in TAPP technique.

Postoperative pain after root canal filling with different endodontic sealers: a randomized clinical trial.

The aim of this randomized clinical trial was to compare the occurrence and intensity of postoperative pain and analgesic intake after root canal treatment, using different root canal sealers. Sixty single-rooted teeth diagnosed with asymptomatic necrosis and apical periodontitis were randomly assigned to 3 experimental groups (n=20), according to the root canal sealer: AH Plus, Endofill or MTA Fillapex. Endodontic treatment was performed in two sessions, and calcium hydroxide was used as the intracanal dressing. Patients were instructed to record pain intensity as none, slight, moderate and severe. Scores from 1 to 4 were attributed to each level of pain after 24 h, 48 h and 7 days. The need for analgesic intake was also recorded. Differences in the incidence of postoperative pain and the need for an analgesic were analyzed using the chi-square test. Differences in pain intensity after treatment were analyzed using the ordinal (linear) chi-square test. No significant differences were detected among the groups in terms of either incidence or intensity of postoperative pain, or need for analgesic intake, at any timepoint (p>0.05). No pain was reported after 7 days. AH Plus, Endofill and MTA Fillapex used for filling root canals resulted in the same rate of postoperative pain and need for analgesic medication.

EXCISION OF A TRAUMATIC FIBROMA WITH DIODE LASER IN A PEDIATRIC PATIENT: CASE REPORT

Fibroma is currently considered the most common reactive hyperplasia of fibrous connective tissue in response to local trauma in the oral cavity. This case deals with the excision of a traumatic fibroma using diode laser (Epic X, wavelength of 940nm, continuous mode, 5W power), whose energy is absorbed by hemoglobin and melanin (chromophores) and is indicated in soft tissue surgeries, favoring coagulation. The results are consistent with the benefits demonstrated in the scientific literature: better visibility in the surgical act due to achieved hemostasis, excellent postoperative phase due to the absence of pain and inflammation, with no need for analgesic medication, no use of sutures, no scarring and no recurrence. It is a safe and fast procedure that also allows performing a histopathological study without altering the tissues to be examined. In the case presented here, the histopathological study confirmed the presumptive diagnosis of fibroma.

Is photobiomodulation therapy effective in reducing pain caused by toxicities related to head and neck cancer treatment? A systematic review.

Photobiomodulation therapy (PBMT) has been considered an effective method for preventing and managing certain cancer-related toxicities in head and neck cancer (HNC) patients treated with radiotherapy and chemotherapy. However, the potential effects of PBMT on pain control and analgesia resulting from these toxicities is still controversial. The aim of this systematic review was to compile available evidence of the effects of PMBT on pain control and reduced use of analgesics in HNC patients. We searched three indexed databases: MEDLINE/PubMed, Embase, and Scopus. The databases were reviewed up to and including December 2018. Only human clinical studies in English language were selected. Information was only available for mucositis and radiodermatitis. Fifteen out of 1112 studies met the inclusion criteria (14 for oral mucositis (OM) and 1 for radiodermatitis). From the 14 studies involving the prevention and treatment of OM, 10 had the study subjects compared to a placebo group. Of these 10 studies, all but 1 showed statistically significant difference related to pain control favoring the PBMT group. The study that compared PBMT with other treatment modality showed better results in pain control with PBMT. It appears that PBMT application frequency and potency impact on pain control. The only study involving the prevention and treatment of radiodermatitis was compared to placebo arm and showed statistically significant difference related to pain control favoring the PBMT group. Seven studies compared the need of analgesic medication between PBMT and placebo groups. Of these, five studies showed that the use of analgesic medication was significantly higher in the placebo group. The current evidence supports that PBMT is effective in pain control resulting from OM and radiodermatitis and may also reduce the need for analgesics. The evidence is not yet available of the effects of PBMT in other HNC treatment-related toxicities.

Infiltration of bupivacaine into the preperitoneal space and trocar incisions of patients undergoing laparoscopic totally extraperitoneal repair of unilateral inguinal hernia: a prospective randomized controlled observational study.

IntroductionAlthough laparoscopic repair of inguinal hernia is associated with reduced postoperative pain, it is not entirely painless. In addition to reducing the need for analgesic medication, postoperative complications, and hospitalization, postoperative pain control enables early return to normal activity.AimTo evaluate the efficacy of bupivacaine instilled into the pre-peritoneal space and trocar incisions of patients undergoing laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia.Material and methodsBupivacaine was instilled into the pre-peritoneal space and trocar incisions of the patients in group I (n = 23), whereas it was infiltrated only into the trocar incisions of the patients in group II (n = 21). No local anesthetic was administered to the patients in group III (n = 21). Postoperative pain was assessed using the Visual Analog Scale (VAS) at 4 and 24 h, and the dosage of analgesic medication was noted.ResultsNo significant difference regarding age, gender, body mass index, ASA class, history of abdominal surgery, or smoking was noted between the three groups (p > 0.05). VAS score at 4 h was significantly higher in group III than in groups I and II (p < 0.05). The dosage of analgesic medication was significantly higher in group III than in groups I and II (p < 0.05), with no significant difference between groups I and II (p > 0.05).ConclusionsInfiltration of long-acting local anesthetic into the pre-peritoneal space and trocar incisions of patients undergoing laparoscopic TEP repair of inguinal hernia reduces the need for analgesic medication by reducing early postoperative pain.

Study on the Treatment of Postoperative Pain in Patients Operated for Incisional Hernia by Open or Laparoscopic Approach

Postoperative pain is a common symptom in the postoperative period in patients treated for incisional hernia, often refractory to treatment. The purpose of the this paper was to conduct a comparative study on the need for analgesic medication in patients operated for incisional hernia through a classical open approach and a laparoscopic approach. In this respect, we performed a retrospective observational study over a period of 4 years in which we introduced 92 patients operated for incisional hernia in the Surgery Clinic No. 1 of the Emergency County Hospital Tirgu Mures. For the reconstruction of the abdominal wall we used prosthetic materials (surgical meshes). All patients included in the study received only metamizole sodium as analgesic medication. The patients studied were divided into two groups: group A (consisting of 57 patients where open, classic surgical approach was used) and group B (consisting of 35 patients treated using a minimally invasive laparoscopic approach). It was observed that on the day of surgery and during the first two postoperative days there are no statistically significant differences in the need for analgesic medication between the studied groups. Instead, starting with the third postoperative day, the need for analgesic medication is much lower in patients where laparoscopic surgical procedure was used than in those where open, classic surgical approach was used.

Study on the Need for Postoperative Analgesic Medication in Patients where Polypropylene Mesh was Used in the Surgical Treatment of Incisional Hernias

One of the most common postoperative complications that may occur in patients treated for incisional hernias is pain. The occurrence of postoperative pain refractory to drug treatment may worsen the prognosis of these patients. We have carried out a retrospective observational study in which we have introduced 122 patients operated for incisional hernia at the Surgical Clinic No. 1 in the Tirgu Mures Emergency County Clinical Hospital. The patients included in the study were divided into two groups: group A consisting of 80 patients where the polypropylene mesh was used over the aponeurosis in the surgical treatment of the incisional hernias, and the group B consisting of 42 patients where no prosthetic materials were used in the surgical treatment of the incisional hernias. All patients were administrated 1 g of sodium metamizole monohydrate for the treatment of pain. The statistical analysis of the data revealed that, on the day of surgery, on the first, second and third postoperative day there were statistically significant differences in the need for analgesic medication between the two groups, the need for the analgesic medication being lower for group A. In contrast, on the 4th postoperative day there were no statistically significant differences in the need for analgesic medication between the two groups. In conclusion, our study showed that, when using the polypropylene mesh in the surgical treatment of incisional hernias, the need for analgesic medication is lower in the immediate postoperative period compared to cases where surgical meshes are not used in the surgical treatment of these patients.

Comparative Study on the Need for Postoperative Analgesic Medication After Surgical Treatment of Inguinal Hernia with Surgical Mesh through Laparoscopic or Classic Approach

The incidence of postoperative pain in patients operated for inguinal hernia can reach up to 40% of cases, depending on different authors, and depending on the approach used in the surgical treatment of these patients. Currently, there are two commonly accepted ways of surgical treatment of inguinal hernias, the classic approach with polypropylene mesh (Liechtenstein technique) and the laparoscopic approach. The purpose of this study was to conduct a comparative analysis on the need for analgesic medication in patients treated for inguinal hernia either by classic (group A) or by laparoscopic (group B) approach. Surgical meshes were used in all patients enrolled in our trial. The average age of the patients included in this study was 53.79 years, ranging from 20 to 88 years. Regarding the distribution of cases by gender, we observed in the studied lots that 12 cases were women (11.53%) and 92 cases were males (88.46%). In female patients, the classic inguinal hernia approach was performed in 3 cases (25% of cases), and in 9 cases the laparoscopic approach was performed in the surgical treatment of the inguinal hernia (75% of the cases). In male patients, laparoscopic approach was performed in 33 cases (35.86% of cases), and in 59 cases the surgical approach was performed in a classical manner using the Liechtenstein technique (64.13% of the cases). From the statistical analysis of the data we noticed a statistically significant difference in the need for analgesic medication administered to these patients (p = 0.0001). Although surgical correction of inguinal hernia, both classic and laparoscopic approaches, provide adequate treatment for these patients, in case of the laparoscopic technique, immediately after the operation, the need for analgesic medication is lower compared to the classical technique.

Anxiety and its predictive value for pain and regular analgesic intake after lumbar disc surgery - a prospective observational longitudinal study

BackgroundOngoing pain after surgery is a major problem and influences recovery and the quality of life of the patient. Associations between anxiety and their impact on postoperative pain after herniated disc surgery have been reported, but the results are inconsistent. The aim of the present longitudinal study was to evaluate the predictive value of preoperative anxiety for postoperative ongoing pain and prolonged analgesic intake after herniated disc surgery.Methods106 patients with lumbar disc herniation were evaluated in the study. Anxiety was measured with the Generalized Anxiety Disorder 7-Item Scale (GAD-7) before surgery. Pain intensity was assessed on a numeric rating scale (NRS) at baseline, 6-weeks and 6-months after surgery. Regression analysis was performed to identify independent predictors of pain and regular utilization of analgesics up to 6 months after surgery while controlling for confounding variables.Results42.5% of the patients were rated as anxiety cases (sum scores GAD-7 > 5), mean scores of anxiety showed mild to moderate symptom severity, and 43% suffered from chronic pain before surgery. Six months after surgery, 55.6% of the patients indicated pain levels of 4/10 (NRS) or higher and about 40% still took pain medication on a regular basis, regardless of their preoperative classification as anxiety-case (37.7% and 41.5%). The preoperative pain level was statistically significant for ongoing postsurgical pain in all four analyses (p < 0.001). With binary logistic regression analyses, preoperative pain intensity, but neither demographic factors nor preoperative anxiety, was identified as predictor for postoperative pain and need for analgesic medication up to 6 months after lumbar disc surgery.ConclusionWe found no evidence for the presence of anxiety before disc surgery being a prognostic factor for ongoing pain and regular postoperative intake of analgesics. Only preoperative pain intensity was predictive for increased pain and continued need for analgesic medication up to 6 months after lumbar disc surgery.Trial registrationClinicaltrials.gov NCT01488617. Registered 6 December 2011.

Treatment of Chronic Lower Back Pain: Study Protocol of a Comparative Effectiveness Study on Yoga, Eurythmy Therapy, and Physiotherapeutic Exercises

Background: We aim to compare the effectiveness of 3 active interventions, i.e., yoga, eurythmy therapy, and physiotherapeutic exercise, on chronic lower back pain. Methods: In this randomized controlled trial over 16 weeks (8 weeks of intervention, 8 weeks of follow-up), data of individuals with chronic lower back pain will be analyzed. Interventions are implemented as group sessions (75 min) once per week. Participants receive a manual for home-based practice and are assessed before and at the end of the 8-week intervention period, and at the end of an 8-week follow-up period. Standardized questionnaires are: the Roland-Morris Disability Score, visual analog scales measuring intensity of pain, the Brief Multidimensional Life Satisfaction Scale, the Perceived Stress Scale, the Inner Correspondence with the Practices questionnaire, the Freiburg Mindfulness Questionnaire, the General Self-Efficacy Scale, a self-regulation questionnaire, the Internal Coherence Scale, a pain diary (registering the need of analgesic medication), and a questionnaire on the patients' expectation that the interventions will be effective in reducing pain and how strong this reduction might be (2 single items), etc. Discussion: This large multicenter study will provide evidence on the effectiveness of 3 contrasting movement-orientated treatments that share some similarities but differ in essential details: yoga, eurythmy therapy, and physiotherapeutic exercises. It will provide important data on non-pharmacological options to treat lower back pain in a large group of affected individuals.

Lumbar Facet Resurfacing: First Experience With the FENIX Implant.

This is a feasibility study to confirm the design, patient population, and the surgical technique for FENIX implants. This study evaluated the safety and the clinical and radiologic performance of bilaterally implanted FENIX facet resurfacing device. Facet joint osteoarthritis is responsible for up to 30% of chronic low back pain. Arthroplasty is a surgical treatment option that aims to relieve pain while maintaining or restoring motion. A total of 8 consecutive patients with proven single segmental bilateral lumbar facet joint osteoarthritis as unique pain generator received a bilateral implantation of the FENIX device. Correct device placement and mobility preservation were assessed on x-ray at 6 weeks and at 6, 12, and 24 months after implantation. Magnetic resonance imaging at 12 and 24 months after surgery assessed the bony ingrowth and computed tomography-single photon emision computed tomography was repeated at 6 months to assess evolution of the preoperative inflamed facet joints. The Oswestry disability index, pain visual analogue scale, and the need for analgesic medication were the parameters used for clinical assessment. At 24 months after surgery, 7 of the 8 patients were found to have all implants in place and all assessed parameters were found to be normal. Patients experienced significant pain relief and functionality improvement. Mobility was maintained and no Modic changes were noted, either at the index or at the adjacent levels. No "hot" lesions at the implanted levels were observed on computed tomography-single photon emision computed tomography. One of the 48 (2%) implants was found to be dislocated at 6 months follow-up. The FENIX facet resurfacing technique might be considered in the future as a surgical treatment of well-selected patients suffering from chronic low back pain because of facet joint osteoarthritis. A modification of the superior implant should provide an initial firm fixation preventing implant dislocation.