NRS Pain Score Research Articles

Comparison of the efficacy of intramedullary nailing via the lateral parapatellar approach versus the infrapatellar approach in the treatment of tibial metaphyseal-diaphyseal junction fractures

BackgroundTo compare the efficacy of intramedullary nailing via the lateral parapatellar approach versus the infrapatellar approach in treating fractures at the tibial metaphyseal-diaphyseal junction.MethodsA retrospective analysis was conducted on the clinical data of 45 patients with proximal or distal tibial fractures treated with intramedullary nailing via lateral parapatellar approach (n = 23) or infrapatellar approach (n = 22) between January 2019 and March 2023. We recorded and compared the operative time, intraoperative blood loss/fluoroscopies, success rate of closed reduction, anteroposterior and lateral entry point accuracy, postoperative infection, fracture healing time, as well as NRS pain scores, Lysholm knee function scores, and knee range of motion.ResultsBoth groups completed the surgery without any complications. The lateral parapatellar approach group had significantly better results regarding shorter operative time, less intraoperative blood loss, and fewer intraoperative fluoroscopies compared to the infrapatellar approach group (P < 0.05). All cases in the lateral parapatellar approach group achieved closed reduction, while 10 cases in the infrapatellar approach group required open reduction. Fractures in both groups healed successfully, without statistically difference in healing time (P > 0.05). The accuracy of anteroposterior and lateral entry points was better with lateral parapatellar approach (P < 0.05). At 3 and 12 months postoperatively, lateral parapatellar approach showed better Lysholm and NRS scores compared to infrapatellar approach (P < 0.05). Two groups had no significant difference in range of motion (P > 0.05).ConclusionsLateral parapatellar approach combined with the blocking screw technique provides superior clinical outcomes compared to infrapatellar approach in the treatment of proximal or distal tibial fractures, making it suitable for further investigation.

Ropivacaine and magnesium sulfate in sciatic nerve block at the popliteal level: randomized double-blind study.

Following surgical procedures, over 80% of patients experience acute pain, with half of them expressing dissatisfaction with pain relief. The modern approach to surgical treatment and pain management increasingly relies on implementing multimodal analgesia, which includes the use of adjuvants in addition to long-acting local anesthetics (such as ropivacaine). This double-blind randomized study evaluated the analgesic effect of magnesium sulfate added to ropivacaine in the sciatic nerve block at the popliteal level for bunion correction surgery. In this double-blind study, fifty patients were enrolled and randomized in a 1:1 ratio to receive ropivacaine and MgSO<inf>4</inf> 200 mg or ropivacaine and physiological solution. The primary endpoint was the duration of sensory block. A statistically significant difference was observed in the onset time for sensory block (9.2 minutes vs. 21.8 minutes, P<0.001) and its duration (18.2 hours vs. 13.9 hours, P<0.001) between the two groups. Between 12 and 24 hours postoperatively, the maximum NRS pain scores in the magnesium group were lower than those in the control group (IQR [range]) 2 (2-3.8 [0-6.5]) vs. 6.7 (5.6-7.9 [2.7-9.2], P<0.001). The need for additional opioids after 12-24 hours was significantly higher in patients in the physiological solution group compared to those in the magnesium group. Our results suggest that magnesium added to the local anesthetic extends sensory block duration, reduces postoperative pain, improves the quality of analgesia, decreases the need for additional opioids. Further studies are needed to confirm these preliminary findings.

A comparison of steroid dose with or without local anesthetic in lumbar interlaminar epidural steroid injections

AbstractIntroductionEpidural steroid injections (ESIs) are commonly used as a treatment for lumbar radiculopathy. Currently, most research on comparative efficacy of various steroids in epidural steroid injections is focused on transforaminal ESIs (TFESIs). Through this study, we aimed to compare various steroid doses with or without local anesthetic in interlaminar ESIs (ILESIs).MethodsWe reviewed charts for all adult patients who received ILESIs identified by CPT code 62323 between January 2017 to April 2021. Baseline demographic data including age, sex, BMI, and smoking status were recorded. NRS pain scores before the injection and percentage of pain relief at 1‐month follow‐up were recorded. We compared percentage of patients reporting pain relief at 1 month follow‐up of low‐dose dexamethasone alone (5 mg), to low‐dose dexamethasone mixed with local anesthetic, and to high‐dose dexamethasone (10 mg) mixed with local anesthetic, specifically for ILESIs.ResultsData were available for 311 patients. There was no significant difference in pain relief between the 3 groups at 1 month follow‐up. The majority of patients had moderate to significant improvement in pain, supporting the use of ILESIs. Moreover, low‐dose steroid with local anesthetic was found to be as efficacious as high‐dose steroid alone. Although not statistically significant, the addition of local anesthetic to low‐dose or high‐dose steroid increased the percentage of patients reporting moderate to significant pain relief.ConclusionILESIs with non‐particulate steroids provide moderate to significant pain improvement in the short term, with low‐dose steroid mixed with local anesthetic being as efficacious as a high‐dose steroid.

Transcutaneous Pulsed Radiofrequency Treatment in Patients with Osteoarthritis of the Upper Extremity

Background: Non-invasive treatment options are preferred for managing upper extremity pain due to osteoarthritis (OA). Transcutaneous pulsed radiofrequency (TcPRF) is a promising technique and appears effective in managing knee and shoulder pain. Objectives: To investigate whether TcPRF treatment is effective in reducing pain and safe to use among patients with OA of the upper extremity. Methods: In this retrospective study, patients with painful OA of the upper extremity who underwent TcPRF treatment from February 2021 to February 2022 were included. The primary outcome measure was the change in NRS pain scores between baseline and 1, 2, and 6 weeks of follow-up. Secondary outcome measures included adverse events. Data were extracted from electronic medical records and via telephone consultation after the 6-week follow-up. Results: A total of 41 initial TcPRF treatments were performed among 37 patients. The NRS score at rest showed a statistically significant improvement at 6 weeks [median = 5 [interquartile range (IQR) 2 - 8)] compared with baseline [median = 6 (IQR 4 - 8)], P = 0.023, with a moderate effect size, r = -0.44. For NRS scores during activity, all follow-up moments had lower NRS scores [median = 7 (IQR 5 - 8)] than before TcPRF [median = 8 (IQR 7 - 9)], P = 0.002 - 0.006, with moderate to large effect sizes, r = -0.45 to r = -0.51. No adverse events were reported. Conclusions: Transcutaneous pulsed radiofrequency treatment is effective in reducing pain and is safe to use among patients with upper extremity pain due to OA.

Needle-free jet injector treatment with bleomycin is efficacious in patients with severe keloids: a randomized, double-blind, placebo-controlled trial.

Severe keloids are difficult to treat. Corticosteroid injections with needles are painful and associated with frequent recurrences. Therefore, more effective, safe and patient friendly alternative treatments are urgently needed. To assess the efficacy, tolerability, and patient satisfaction of intralesional bleomycin treatment using a needle-free electronic pneumatic jet injector (EPI) in severe keloids. Patients with severe keloids were included in this double-blind, randomized placebo-controlled trial with split-lesion design. Three EPI treatments with bleomycin or saline, were administered every four weeks in respectively the intervention and control side. Outcome measures were change in scar volume assessed by 3D-imaging, Patient and Observer Scar Assessment Scale (POSAS), skin perfusion with laser speckle contrast imaging (LSCI), spilled volume, procedure related pain, adverse events, and patient satisfaction. Fourteen patients (9 female, 5 men) were included. The estimated mean keloid volume was significantly reduced with 20% after EPI-assisted bleomycin, compared to a slight increase of 3% in the control side (p<0.01). The estimated mean POSAS patient and observer scores decreased with respectively 26% and 28% (p = 0.02; p = 0.03). LSCI showed no significant change in perfusion. EPI treatment was preferred over previous needle injections in 85% of patients. The estimated mean spilled volume after EPI was around 50%, and NRS pain scores were moderate. Adverse events included bruising, hyperpigmentation, and transient superficial necrosis. Three EPI-assisted bleomycin treatments are efficacious and well-tolerated in severe keloids. Moreover, EPI treatment was preferred by most patients and may serve as a patient-friendly alternative treatment.

Association between Mid-Term Functionality and Clinical Severity in Patients Hospitalized for Pulmonary Embolism.

The aim of this study is to evaluate the relationship between clinical severity and functionality, occupational performance, and health-related quality of life in patients hospitalized with pulmonary embolism. Pulmonary embolism patients were grouped by clinical severity using the Pulmonary Embolism Severity Index. Those scoring ≥160 were in the high-severity group (HSG); those scoring < 160 in the low-moderate group (LMSG). The main variables were functionality assessed by the World Health Organization Disability Assessment Schedule (WHODAS), self-perception of occupational performance assessed by the Canadian Occupational Performance Measure (COPM), pain and fatigue assessed by a Visual Analogue Scale (VAS), and health-related quality of life assessed by the EuroQol-5Dimensions (EQ-5D). Patients were evaluated at hospital admission and at 1-month and 3-month follow-up. At admission, there were significant differences between groups in the WHODAS and health-related quality of life in favor of the LMSG. At 1-month and at 3-month follow-up, there were significant differences between the LMSG and HSG in WHODAS, COMP, NRS pain, fatigue and EQ-5D scores in favor of the LMSG. An association exists between clinical severity and mid-term functionality, self-perception of occupational performance, pain, fatigue, and health-related quality of life in PE patients.

Neuropathic pain after major limb amputation: a cross-sectional study

Background &amp; Objective: Residual limb pain (RLP) and phantom pain can arise following amputation and may require additional treatment or surgery. This study aimed to determine the prevalence of neuropathic RLP following limb amputation and identify prognostic factors for the development of neuropathic RLP. Methods: A cross-sectional study was performed of patients who underwent upper or lower extremity amputation between 1990 and 2021 with a minimum of twelve months follow-up. The primary outcome was the prevalence of neuropathic RLP, defined as a 0-10 NRS pain score in the residual limb of ≥4, in combination with a score ≥4 on the short form DN4 questionnaire (s-DN4), validated for discriminating between nociceptive and neuropathic pain. The secondary outcome was quality of life for amputees with and without (neuropathic) RLP. A multivariable linear regression model was used to identify prognostic factors for neuropathic RLP development. Results: A total of 121 patients were included: 87 with lower extremity amputations, 29 with upper extremity amputations, and 5 with both. Neuropathic RLP was experienced by 21.5%, while 10.7% reported non-neuropathic RLP. Smoking status and Complex Regional Pain Syndrome as indication for limb amputation were associated with more severe neuropathic pain symptoms. Patients experiencing neuropathic RLP reported a significantly lower quality of life compared to patients without neuropathic RLP. Conclusions: This study demonstrates that neuropathic RLP is common after limb amputation and impacts daily functioning. The absence of numerous manageable prognostic factors associated with neuropathic pain development emphasizes the importance of the consideration of prophylactic interventions at the time of amputation.

A comparison of fascia iliaca compartment block with intravenous analgesia to improve pain control in patients with femoral fracture.

The most common approach to managing severe pain following femoral fracture is with intravenous systemic analgesics, such as opioid analgesics and non-steroidal anti-inflammatory drugs associated with side effects such as respiratory depression, nausea, and vomiting. These side effects might be intolerable in trauma patients and may result in under treatment of pain. Improving the quality of analgesia may reduce these intolerable side effects. Our study compared the efficacy of fascia iliaca compartment block (FICB) with intravenous analgesics for preoperative pain management of femoral fractures. The study was a quality improvement prospective randomised study, where 50 patients aged between 18 and 65 years, and American society of anesthesiologists I and II were recruited into two groups. Group A received FICB with a combination of 0.4 mL/kg of 0.5% plain bupivacaine and adrenaline 1:200,000 made up to 30 mL, while group B received placebo FICB using 30 mL normal saline. Also, group B received a combination of intravenous paracetamol 15 mg/kg not exceeding 900 mg and tramadol 1 mg/kg not exceeding 100 mg, while group A received an equal volume as normal saline intravenously. The study revealed no significant difference in age, gender, associated injuries, X-ray description of fractures, and mechanism of injuries; however, there was a significant difference in the NRS-pain score at 30 min, summed pain intensity difference for 4 h and patient satisfaction in the FICB group compared to the standard group. The study revealed that FICB results in better pain control compared to a combination of intravenous tramadol and paracetamol in patients with femoral fractures.

Evaluation of Pharmacotherapy of Cancer Pain in Patients with Head and Neck Cancer at a Tertiary Care Teaching Hospital

Background Head and Neck Cancers (HNC) account for 5% of all malignant tumours, but 80% of patients experience pain. As per the WHO analgesic ladder, analgesics are a cornerstone for the management of pain in HNC patients. Purpose Our study aims to analyse the prescribing pattern of analgesic drugs in patients with HNC pain. Materials and Methods A prospective, continuous, observational study was conducted among patients with HNC pain. Demographics, detailed history of pain (type, duration, location and Numerical Rating Scale [NRS] score), details of drugs prescribed and any adverse drug reactions (ADRs) were recorded at baseline visit and at first, second and sixth month follow-up. Descriptive statistics were used to analyse the above parameters. The mean reduction in NRS was analysed by the Z test. Results Out of 145 patients, 118 (81.37%) were male and 27 (18.62%) were female. The mean age of patients was 51.89 + 7.07 years. Tramadol (81.37%) followed by morphine (62.75%) were the commonly prescribed analgesics. Amitriptyline (20%) followed by pregabalin (19.31%) were commonly prescribed adjuvant analgesics. A statistically significant reduction in mean NRS was found at each follow-up visit ( p &lt; .05). A total of 50 ADRs were observed. Constipation (38%) and drowsiness (24%) were the most frequently reported ADRs, with morphine and tramadol being the most common suspected causal drugs. Conclusion Tramadol and morphine were frequently prescribed analgesics in patients with HNC pain in accordance with the WHO analgesic ladder. The majority of patients with HNC pain achieved a significant reduction in NRS pain scores at the end of six months.

The sex-dependent impact of adipose tissue and inflammation on chronic pain – A cross-sectional study from the all of us research program

Emerging evidence suggests an association between chronic pain and elevated body fat. We sought to determine if individuals with higher body fat, measured by hip circumference (HC) and waist circumference (WC), are at risk for chronic pain when they demonstrate higher expression of inflammatory markers. We investigated the incidence and severity of pain in patients with varying WC/HC and inflammatory markers (C-Reactive Protein, IL-6, leptin) using the NIH-sponsored All of Us Database. For each inflammatory marker and sex, participants were divided into four groups based on combinations of normal/high marker levels and small/large WC/HC. We used statistical analysis to compare WC/HC and pain severity (mean NRS pain score) between groups of the same sex. In females, but not males, combinations of elevated CRP with large WC/HC exerted additive effects on the incidence of chronic pain (p < 0.01) and severe pain (p < 0.001), as well as on the severity of pain evaluated by the mean NRS pain score (p < 0.01). This relationship held true for females with high IL-6 or leptin and large WC or HC (p < 0.001 for chronic pain and severe pain incidence, and p < 0.05 for pain severity). Neither IL-6 nor leptin showed any significant impact on pain in males. Obesity status and CRP exert additive prognostic effects for chronic pain in females, but not in males. The concomitant evaluation of other inflammatory factors, such as IL-6 or leptin in females, may further augment the prediction of chronic pain. PerspectiveThis article investigates the relationship between chronic pain, obesity, and inflammatory markers. It could help elucidating sex difference in pain mechanisms, as well as the risk factors for chronic pain, potentially improving patient diagnosis, follow-up and treatment.

Effect of epidural dexmedetomidine in single-dose combined with ropivacaine for cesarean section.

Dexmedetomidine has arousal sedation and analgesic effects. We hypothesize that epidural dexmedetomidine in single-dose combined with ropivacaine improves the experience of parturient undergoing cesarean section under epidural anesthesia. This study is to investigate the effect of 0.5µg/kg epidural dexmedetomidine combined with epidural anesthesia (EA) in parturients undergoing cesarean section. A total of 92 parturients were randomly divided into Group R (receiveing epidural ropivacaine alone) Group RD (receiveing epidural ropivacaine with 0.5µg/kg dexmedetomidine). The primary outcome and second outcome will be intraoperative NRS pain scores and Ramsay Sedation Scale. All 92 parturients were included in the analysis. The NRS were significantly lower in Group RD compared to Group R at all observation timepoint (P > 0.05). Higher Ramsay Sedation Scale was found in Group RD compared to Group R (P < 0.001). No parturient has experienced sedation score of 4 and above. No significant difference regarding the incidence of hypotension, bradycardia and nausea or vomiting, Apgar scores and the overall satisfaction with anesthesia was found between Group R and Group RD (P > 0.05). Epidural dexmedetomidine of 0.5µg/kg added slightly extra analgesic effect to ropivacaine in EA for cesarean section. The sedation of 0.5µg/kg epidural dexmedetomidine did not cause mother-baby bonding deficit. Satisfaction with anesthesia wasn't significantly improved by epidural dexmedetomidine of 0.5µg/kg. No additional side effect allows larger dose of epidural dexmedetomidine attempt. This study was registered at www.chictr.org.cn (ChiCTR2000038853).

Ultrasound Guided Maxillary Nerve Block for Perioperative Pain Management for Patients Undergoing Endoscopic Sinus Surgery: Randomized Control Trial

Background: Proper perioperative pain management remains a cornerstone of well-conducted functional endoscopic sinus surgery (FESS). In such a context, proper pain management entails the adequate provision of prolonged postoperative analgesia, the avoidance of overusing opioids, and consequently limiting their unwanted side effects. Objectives: We aimed to evaluate the effect of bilateral ultrasound-guided suprazygomatic maxillary nerve block (MNB) on postoperative pain in patients undergoing FESS. Methods: Patients eligible for FESS were randomized into two groups: The MNB group (n = 30), who underwent bilateral ultrasound-guided suprazygomatic maxillary nerve block after induction of anesthesia, and a control group (n = 30), who received multimodal analgesia, including opioids. Postoperatively, patients were observed for 48 hours. Pain scores were evaluated upon arrival to the sPACU and at 2, 6, 12, 24, 36, and 48 hours postoperatively, particularly at the time of removal of the hemostatic agent after 36 hours postoperatively. Total rescue analgesia, postoperative complications (including nausea and vomiting [PONV], hypotension, bradycardia, headache), and patient satisfaction were also diligently recorded. Results: Sixty patients who were candidates and underwent FESS surgery were enrolled randomly in both groups. The NRS pain score in the MNB group was significantly lower than that of the control group (P &lt; 0.001), especially the NRS during the removal of the hemostatic agent at T10 was significantly lower in the MNB group (P &lt; 0.001). However, at the 24 - hour point post-surgery, there were no significant differences between both groups (P = 0.568). Total rescue analgesia required was significantly lower in the MNB group compared with the control group (P &lt; 0.001) throughout the first 48 hours postoperatively. The percentage of patients with no postoperative complications (nausea, vomiting, and headache) was higher in the MNB group (76.7 %) compared with the control group (40 %). Patient satisfaction was statistically significantly higher in the MNB group (P &lt; 0.001). Conclusions: Bilateral ultrasound-guided suprazygomatic MNB appeared to be safe and advantageous, as its use was associated with a decrease in total analgesic consumption, a reduction in postoperative morbidities such as pain, nausea, and vomiting, and greater patient satisfaction.

Measurements of pupillary unrest using infrared pupillometry fail to detect changes in pain intensity in patients after surgery: a prospective observational study

PurposeThe pupil displays chaotic oscillations, also referred to as pupillary unrest in ambient light (PUAL). As pain has previously been shown to increase pupillary unrest, the quantitative assessment of PUAL has been considered a possible tool to identify and quantify pain. Nevertheless, PUAL is affected by various states, such as vigilance, cognitive load, or emotional arousal, independent of pain. Furthermore, systematically applied opioids are known to reduce PUAL, thus potentially limiting its usefulness to detect pain or changes in pain intensity. To test the hypothesis that PUAL can reliably identify changes in pain intensity in a clinical setting, we measured PUAL in patients experiencing substantial pain relief when regional anesthesia interventions were applied after surgery.MethodsWe conducted an observational study at an academic surgery centre following institutional review board approval. Eighteen patients with unsatisfactory pain control following surgery underwent regional anesthesia procedures to improve pain control. We used infrared pupillometry to assess pupillary unrest before and after the regional block. We then compared the changes in pupillary unrest with the changes in pain scores (numeric rating scale [NRS], range 0–10).ResultsEighteen patients received epidural anesthesia (n = 14) or peripheral nerve blocks (n = 4), resulting in improvement of mean (standard deviation [SD]) NRS pain scores from 7.2 (1.7) to 1.9 (1.8) (difference in means, −2.2; 95% confidence interval [CI], −6.3 to −4.1; P < 0.001). Nevertheless, pupillary unrest did not change as pain decreased; the mean (SD) PUAL was 0.113 (0.062) before analgesia and 0.112 (0.068) after analgesia (difference in means, −0.001; 95% CI, −0.018 to 0.015; P = 0.88).ConclusionIn this prospective observational study, pupillometric measurements of pupillary unrest did not identify changes in pain intensity in a postoperative, predominantly opioid-exposed patient population. While the sample size was small, the use of measurements of pupillary unrest to detect and quantify pain has to be questioned.

COMPARISON OF ROPIVACAINE ALONE VS ROPIVACAINE WITH METHYLPREDNISOLONE INJECTION AS A TREATMENT OF TRIGGER POINTS FOR MYOFASCIAL PAIN: A SUPERIORITY RANDOMIZED CLINICAL TRIAL

Soft tissue rheumatism, known as myofascial pain syndrome (MPS), is typified by taut bands, transferred pain that is distinct, sensory alterations that occur, and a local twitch response. It is also connected with trigger points in one or more muscles. The purpose of the research is to evaluate the effects of injections of Ropivacaine alone vs. Ropivacaine with methylprednisolone in decreasing pain in people in our community who have myofascial pain caused by trigger points. The design of this study was a randomized controlled trial. This study was carried out from July 2022 to August 2023. The research comprised 50 individuals (27 females and 23 males) diagnosed with MPS who came to our clinic. Using online randomization software, the patients were randomly divided into two groups. Group B got a mixture of 0.25% Ropivacaine &amp; 10mg methylprednisolone in 3ml normal saline at each trigger point, whereas Group A received 3ml of 0.25% Ropivacaine. Dry needling of trigger sites was done in both groups. Patients were assessed at two, four, and eight weeks of intervention. The patients' pre-treatment assessment measures showed no statistically significant differences. After 4 and 8 weeks of assessment, Group B NRS pain and BDI scores showed statistically significant improvements compared to pre-treatment results (p&lt;0.05). NRS and BDI scores were reduced in group A compared to their pretreatment values, but that was not clinically significant. Results of our study showed that there was a statistically significant difference between both groups in terms of pain, stress, and anxiety after the intervention. Ropivacaine with methylprednisolone gave better results than Ropivacaine alone in reducing pain and anxiety among the study population.

Estimating meaningful change thresholds for Skin Pain-Numeric Rating Scale, Sleep-Numeric Rating Scale and Dermatology Life Quality Index in patients with prurigo nodularis.

Prurigo nodularis (PN) is characterized by intensely itchy nodules/lesions and skin pain, which can have a substantial impact on health-related quality of life (HRQoL). Treatment benefits on such symptoms and impacts are best assessed in trials using patient-reported outcome (PROs) instruments such as Skin Pain Numerical Rating Scale (NRS), Sleep-NRS and Dermatology Life Quality Index (DLQI). However, no guidance exists for interpreting meaningful changes in scores using these PROs in patients with PN. The main objective was to derive within-patient (responder definition) and between-group improvement thresholds for interpreting Skin Pain-NRS, Sleep-NRS and DLQI total scores in patients with PN. The measurement properties of the three PROs were also evaluated. Intention-to-treat (ITT), blinded and pooled data were used from the Phase 3 PRIME (NCT04183335) and PRIME2 (NCT04202679) studies evaluating the efficacy of dupilumab in adult patients with PN. Anchor- and distribution-based methods were applied to derive responder definition and between-group thresholds for Skin Pain-NRS, Sleep-NRS and DLQI. Data were additionally used to examine the instrument measurement properties, including reliability, validity and responsiveness. A total of 311 patients (mean age 49.5 years, 65.3% female) were included in the pooled ITT population. The within-patient improvement threshold for Skin Pain-NRS was estimated as 4.0 points, 2.0 points for Sleep-NRS and 9.0 points for DLQI total score. A 1.5-point improvement in Skin Pain-NRS scores, 1.0-point in Sleep-NRS and 4.0-point in DLQI indicated a between-group meaningful change. Adequate to good psychometric properties were demonstrated for all three instruments. The results of this study can aid interpretation of Skin Pain-NRS, Sleep-NRS and DLQI scores in patients with PN in both clinical trials and clinical practice to better understand and treat PN-related skin pain and the impact of PN on sleep quality and HRQoL.

(338) Impact of Microsurgical Denervation of the Spermatic Cord Treatment of Chronic Scrotal Pain on Men's Sexual Function: A Follow-Up Study for 6 Months After Surgical

Abstract Introduction When chronic severe scrotum affects the patient's activities and life in many aspects. Hypothetical study investigating clinical, laboratory characteristics and the influence of Microsurgical Denervation of the Spermatic Cord on male sexual performance. Objective The aim of this study was to describe the impact of microsurgical denervation of the spermatic cord treatment of chronic scrotal pain on men's sexual function Methods Observation study design. All patients with severe chronic scrotal pain, after excluding other causes, were indicated for surgery at the department of andrology, Binh Dan hospital from January 1, 2022 to November 1, 2022. Results There were thirty-one patients with chronic scrotal pain who underwent surgery. Mean age 24.2 ± 4.3 years, duration of pain 2.3 ±1.6 years. Location of pain: scrotum (41.3%), testis-epididymis (47.8%), spermatic cord (24.6%), inguinal (15.1%). Causes of pain: epididymitis (45.3%) accounted for most cases. NRS pain score before surgery 6.8 ± 2.3. There are 13/31 patients with severe pain scale (NRS = 7-10). Quality of life (QOL) in patients with moderate pain (NRS pain scale 1-6) 4.6 ± 4.0 and 6.75 ± 1.1 in patients with severe pain (NRS 7-10). 6%) patients reported pain affecting daily work Patient had small testicle size 43.5%, Varicose veins on ultrasound: 3.4±1.2 mm 51.6% (16/31) patients felt scrotal pain affecting sexual activity Patients with severe scrotal pain with high pain scale (NRS 7-10 points) had an effect on erectile function compared with moderate pain group (NRS 0-6 points) (P&amp;lt;0.05) Indicators “Scrotal pain prevents sexual activity”, “IIEF”, “Decreased libido ADAM questionnaire”, “Stimulating sexual activity pain”, “painful ejaculation” all improved after surgery. Conclusions Chronic scrotal pain mostly occurs in young patients with relatively large pain scores. Chronic scrotal pain also contributes to testicular size and endocrine function affecting quality of life. Chronic scrotal pain can greatly affect sexual performance in men. Microsurgical Denervation of the Spermatic Cord improves many aspects of a patient's sexual performance. Disclosure No.

Pathology of knee osteoarthritis pain: contribution of joint structural changes and pain sensitization to movement-evoked pain in knee osteoarthritis.

Movement-evoked pain (MEP) is the primary symptom in patients with knee osteoarthritis (KOA). This study aimed to investigate the contribution of joint structural changes and pain sensitization to the mechanisms of MEP in patients with KOA. A total of 86 patients were assessed for demographic characteristics, osteoarthritis severity, Whole-Organ Magnetic Resonance Imaging Score-Hoffa synovitis and bone marrow lesions, pressure pain threshold and temporal summation of pain at the knee and forearm, Central Sensitization Inventory-9, and MEP. In measure of MEP, knee pain was scored using a numerical rating scale (NRS, 0-10) before and every minute during a 6-minute walking test (6MWT), and the MEP index was defined as the change in NRS pain score from baseline to the sixth minute of walking. On average, pain during 6MWT increased by 1.4 ± 1.5 points on the NRS relative to baseline, with 30.2% of patients showing an increase of 2 points or more. The hierarchical linear regression analysis revealed that Hoffa synovitis, pressure pain threshold at the forearm, and temporal summation of pain at the knee were associated with the MEP index. The findings of this study suggest that both synovitis and neural mechanisms, such as pain sensitization, play a role in the development of MEP in KOA.

Gender and Sex Differences in Health-related Quality of Life, Clinical Outcomes and Survival after Treatment of Metastatic Spine Disease.

Retrospective review of prospective, multicenter and international cohort study. To describe the effect of gender on HRQoL, clinical outcomes and survival for patients with spinal metastases treated with either surgery and/or radiation. Gender differences in health-related outcomes are demonstrated in numerous studies, with women experiencing worse outcomes and receiving lower standards of care than men, however, the influence that gender has on low health-related quality of life (HRQoL) and clinical outcomes after spine surgery remains unclear. Patient demographic data, overall survival, treatment details, perioperative complications, and HRQoL measures including EQ-5D, pain NRS, the short form 36 version 2 (SF-36v2) and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0) were reviewed. Patients were stratified by sex, and a separate sensitivity analysis that excluded gender-specific cancers (i.e., breast, prostate, etc.) was performed. The study cohort included 207 female and 183 male patients, with age, smoking status, and site of primary cancer being significantly different between the two cohorts (P<0.001). Both males and females experienced significantly improved SOSGOQ2.0, EQ-5D, and pain NRS scores at all study time points from baseline (P<0.001). Upon sensitivity analysis, (gender-specific cancers removed from analysis), the significant improvement in SOSGOQ physical, mental, and social subdomains and on SF-36 domains disappeared for females. Males experienced higher rates of postoperative complications. Kaplan-Meier survival analysis of both the overall and sensitivity analysis cohorts showed females lived longer than males after treatment (P=0.001 and 0.043, respectively). Both males and females experienced significantly improved HRQoL scores after treatment, but females demonstrated longer survival and a lower complication rate. This study suggests that gender may be a prognostic factor in survival and clinical outcomes for patients undergoing treatment for spine metastases and should be taken into consideration when counseling patients accordingly.

Clinical Features and Response to Treatment in Elderly Subjects Affected by Hidradenitis Suppurativa: A Cohort Study.

Hidradenitis suppurativa (HS) is a chronic-relapsing inflammatory skin disease. It usually appears in the second and third decades, but a smaller proportion of patients develop late-onset HS. Geriatric HS, defined as the persistence or the development of HS after the age of 65 years, has been poorly explored. This study aimed to investigate the clinical features, treatment management and response to therapies of HS elderly subjects (≥65 years old). We designed a multicentric observational study, gathering data from seven Italian university hospitals. Demographic and clinical data of HS patients aged over 65 years were collected at baseline, week 12 and week 24. Overall, 57 elderly subjects suffering from HS were enrolled. At baseline, disease severity was predominantly moderate-to-severe, with 45.6% of patients classified as Hurley III. The gluteal phenotype was the most frequently observed; it also appeared to affect patients' quality of life more than other phenotypes. Gluteal involvement was detected in about half (49.1%) of cases and associated with severe stages of the disease. In terms of therapeutic response, Hurley III patients showed the persistency of higher values of mean IHS4, DLQI, itch- and pain-NRS scores compared to Hurley I/II. In conclusion, disease severity in this subpopulation appears high and treatment is often challenging.

A comparison of the continuous supraclavicular brachial plexus block using the proximal longitudinal oblique approach and the interscalene brachial plexus block for arthroscopic shoulder surgery: A randomised, controlled, double-blind trial.

Continuous interscalene brachial plexus block (ISB) is widely used for arthroscopic shoulder surgery, but the incidence of hemidiaphragmatic paresis (HDP) has been reported to reach 100%. Several methods, including injections distal to the C5-C6 nerve roots, have been attempted to reduce the HDP incidence. However, catheter placement distal to the C5-C6 nerve roots interferes with the surgical site. Our primary objective was to describe a new technique, the supraclavicular brachial plexus block (SCB), using the proximal longitudinal oblique approach (PLO-SCB), which can facilitate catheter placement and, when compared with ISB, to test whether this would provide noninferior analgesia and spare the phrenic nerve. Prospective, randomised, double-blind study. Operating rooms, postanaesthesia care unit, and wards. Seventy-six patients aged 20 to 80 years scheduled for arthroscopic shoulder surgery. Patients were randomly assigned to the continuous PLO-SCB ( n = 40) or the continuous ISB ( n = 40) groups. All patients received an initial low-volume single-injection (5 ml 0.75% ropivacaine) followed by a patient-controlled infusion of 0.15% ropivacaine. The primary outcomes were the incidence of HDP and pain scores. Secondary outcomes were respiratory function, postoperative analgesic consumption, sensory and motor function, and complications. The HDP incidence was significantly lower in the PLO-SCB group than in the ISB group at 30 min after block injection: 0% (0 of 38 patients) and 73.7% (28 of 38 patients), respectively ( P < 0.001). Similarly, at 24 h after surgery, the incidences were 23.7% (9 of 38 patients) and 47.4% (18 of 38 patients) in the PLO-SCB and ISB groups, respectively ( P = 0.002). Median [IQR] NRS pain scores at rest measured after surgery in the ISB and PLO-SCB groups were similar: immediately after surgery, 1 [0 to 2] vs. 1 [0 to 1], P = 0.06); at 30 min, 2 [0.25 to 2] vs. 1 [0 to 2], P = 0.065); and at 24 h 2 [0.25 to 3] vs. 1 [0 to 3], P = 0.47, respectively. For major shoulder surgery, compared with continuous ISB, continuous PLO-SCB was more sparing of diaphragmatic and respiratory function while providing noninferior analgesia. Catheter placement via the PLO approach is feasible without interfering with the surgical field. Registered by the Clinical Trial Registry of Korea (Seoul, Korea; KCT0004759, http: cris.nih.go.kr, principal investigator: Hyungtae Kim).