Numeric Rating Scale Pain Scores Research Articles

Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail

BackgroundPostpartum depression (PPD) is a common mental disease in postpartum women, which has received more and more attention in society. Ketamine has been confirmed for its rapid antidepressant effect in women with PPD. We speculate that esketamine, an enantiomer of ketamine, pretreatment during cesarean can also reduce the incidence of PPD.MethodsAll the parturients enrolled in the study were randomly assigned to two groups: the esktamine group (0.2 mg/kg esketamine) and the control group (a same volume of saline). All the drugs were pumped for 40 min started from the beginning of the surgery. The Amsterdam Anxiety and Information Scale (APAIS) scores before the surgery, the Edinburgh postnatal depression scale (EPDS) scores at 4 d and 42 d after surgery, the Pain Numerical Rating Scale (NRS) scores at 6 h, 12 h, 24 h and 48 h post-operation were evaluated, as well as the adverse reactions were recorded.ResultsA total of 319 parturients were analyzed in the study. The incidence of PPD (EPDS score > 9) in the esketamine group was lower than the control group at 4 days after surgery (13.8% vs 23.1%, P = 0.0430) but not 42 days after surgery (P = 0.0987). Esketamine 0.2 mg/kg could reduce the NRS score at 6 h,12 h and 24 h after surgery, as well as the use of vasoactive drugs during surgery (P < 0.05). The incidences of maternal dizziness (17.0%), blurred vision (5%), illusion (3.8%) and drowsiness (3.8%) in the esketamine group were higher than those of control group (P < 0.05).ConclusionsIntraoperative injection of esketamine (0.2 mg/kg) prevented the occurrence of depression (EPDS score > 9) at 4 days after delivery but not 42 days. Esketamine reduced the NRS scores at 6 h, 12 h and 24 h after surgery, but the occurrence of maternal side effects such as dizziness, blurred vision, drowsiness and hallucination were increased.Trial registrationRegistered in the Chinese Clinical Trial Registry (ChiCTR2100053422) on 20/11/2021.

The Reverse Dual Plane: A Novel Technique for Endoscopic Transaxillary Breast Augmentation.

Quite a few Asian patients prefer axillary incision for breast augmentation. However, this surgery needs improvement. To introduce a reverse dual-plane technique through a transaxillary approach and compare it with a transaxillary dual-plane approach. Eighty-two patients were divided into Group A (n = 40) and Group B (n = 42). Axillary incision and endoscope were utilized in the 2 groups. Tebbetts' dual plane was performed in Group A patients. Patients in Group B underwent our reverse dual-plane technique, in which the upper 70% was subfascial and the lower 30% was subpectoral, with the fascia of the external oblique and anterior serratus being elevated together with the pectoral muscle. The Numeric Pain Rating Scale (NPRS) scores were recorded daily for 7 days. Breast shape and softness, in both sitting and supine positions, were assessed by the patients, and complications were compared. The NPRS scores of Group B patients were significantly lower than those of Group A patients (P < .01). The satisfaction rate of shape and softness in the seated position was not significantly different (P > .05). However, in the supine position, only 20 patients (50.0%) in Group A and 32 patients (76.2%) in Group B were satisfied with their breast softness (P < .01), and the breasts of the others became stiffer. Breast animation deformity (BAD) occurred in 2 patients in Group A and in no patient in Group B (P < .01). Other complications were not significantly different. Compared with Tebbetts' dual plane, this procedure significantly reduced pain, improved breast softness, and eliminated BAD, without increasing complications.

The efficacy of ultrasound-guided erector spinae plane block (ESPB) versus freehand ESPB in postoperative pain management after lumbar spinal fusion surgery: a randomized, non-inferiority trial.

Spine surgeries have experienced exponential growth over the past 2 decades. These surgeries are often accompanied by long and severe perioperative pain, presenting a significant management challenge. This study aims to assess and compare the efficacy of two techniques for postoperative pain (POP) management in lumbar spine surgeries: ultrasound-guided erector spinae plane block (ESPB) and intraoperative freehand ESPB. In this prospective randomized non-inferiority trial (Registration Number: IRCT20221107056427N1), adult patients who were candidates for lumbar spinal fusion surgery were randomly divided into two groups: ultrasound-guided ESPB (n = 29) and freehand ESPB (n = 29). The primary outcomes were the total amount of morphine consumed during the first 24h following the surgery and the numerical rating scale (NRS) pain score at various time points within the first 24h following the surgery. The secondary outcome was the fentanyl used during surgery. Participants in the intraoperative freehand approach had considerably higher total morphine consumption in the first postoperative 24h. The trend of NRS changes in both the ultrasound-guided ESPB group and the freehand ESPB group during the first 24h after surgery showed a significant decrease. Still, there was no significant difference between the two groups. However, the first analgesic demand time was significantly shorter in the intraoperative freehand ESPB group compared to the ultrasound-guided approach. According to our results, the ultrasound-guided approach of ESPB is more effective in POP management and opioid sparing in lumbar spinal fusion surgeries compared to the freehand approach. However, the data from this study are not sufficient to draw robust conclusions, and further randomized controlled trials with larger sample sizes are required to validate our results.

Comparison of ultrasound- and computed tomography-guided pulsed radiofrequency in treating ophthalmic branch postherpetic neuralgia: a retrospective study.

The objective of this study was to compare the efficacy and safety between ultrasound- and computed tomography-guided pulsed radiofrequency in treating ophthalmic branch postherpetic neuralgia. A retrospective study was conducted on data of 84 patients with ophthalmic branch postherpetic neuralgia. According to the puncture guiding method, the patients were divided into the ultrasound- and computed tomography-guided groups, which received the ultrasound- and computed tomography-guided supraorbital nerve pulsed radiofrequency treatment, respectively. The puncture time, numeric rating scale pain score before pulsed radiofrequency and after pulsed radiofrequency, effective rate of treatment, and intraoperative and postoperative adverse events were observed. The puncture time in the ultrasound-guided group was significantly shorter than that in the computed tomography-guided group (p<0.05). At 1, 4, and 12 weeks after pulsed radiofrequency, in two groups, the numeric rating scale pain score was significantly lower than that before pulsed radiofrequency, respectively (p<0.05). At each time, the numeric rating scale pain score showed no significant difference between the two groups (p>0.05). At 12 weeks after pulsed radiofrequency, there was no significant difference in the effective rate of treatment between the two groups (p>0.05). During the intraoperative and postoperative periods, the incidences of adverse event hematoma and oculocardiac reflex in the ultrasound-guided group were significantly lower than those in the computed tomography-guided group, respectively (p<0.05). Both ultrasound- and computed tomography-guided supraorbital nerve pulsed radiofrequencys have good efficacy in treating the ophthalmic branch postherpetic neuralgia. Compared with the computed tomography-guided pulsed radiofrequency, the ultrasound-guided pulsed radiofrequency has faster puncture operation and is safer. It is more worthy of clinical applications.

Effectiveness and Safety of Vertebral Body Stenting for Acute Spinal Compression Fractures due to Primary Osteoporosis: A Multicenter Prospective Clinical Study.

Segmental spinal deformity results from vertebral compression fracture (VCF) and progressive collapse of the fractured vertebral body (VB). The VB stenting (VBS) systemⓇ comprises a balloon-assisted, expandable, intrasomatic, metal stent that helps maintain the restored VB during balloon removal and cement injection, which minimizes cement leakage. We performed a prospective, multicenter, clinical trial of the VBS system in Japanese patients with acute VCF owing to primary osteoporosis. Herein, 88 patients, 25 men and 63 women aged 77.4±8.3 years, with low back pain, numerical rating scale (NRS) score of ≥4, and mean VB compression percentage (VBCP) of <60% were enrolled. The primary endpoints were the VBCP restoration rate and reduction in low back pain 1 month and 7 days after VBS surgery, respectively. Secondary endpoints included changes in VBCP, NRS pain score, Beck index, kyphosis angle, and quality of life according to the short form 36 (v2) score. Safety was assessed as adverse events, device malfunctions, and new vertebral fractures. Overall, 70 patients completed the study. VBS surgery increased the restoration rates of anterior and midline VBCP by 31.7%±26.5% (lower 95% confidence intervals (CI): 26.8) and 31.8%±24.6% (lower 95% CI: 27.2), respectively, and the reduction in NRS pain score was -4.5±2.4 (upper 95% CI: -4.0). As these changes were greater than the predetermined primary endpoint values (20% for VBCP and -2 for NRS score), they were judged clinically significant; these changes were maintained throughout the 12-month follow-up (p<0.001). Likewise, significant improvement was observed in the Beck index, kyphosis angle, and quality of life score, which were maintained throughout the follow-up. There were three serious adverse events. New fractures occurred in 12 patients-all in the adjacent VB. VBS surgery effectively restored the collapsed VB, relieved low back pain, and was tolerable in patients with acute osteoporotic VB fracture.

Physiotherapy versus alternative medicine for pain and quality of life in patients with lumbar spinal stenosis: a systematic review with meta-analysis

IntroductionLumbar spinal stenosis (LSS) is a prevailing condition widely affecting mobility. However, many non-invasive treatments have been proposed for LSS. Physiotherapy is reported as more commonly used with very little evidence reporting the efficacy of alternative medicine. For clinicians, there was a need to find a better mode of treatment. The purpose of this paper is to compare the effectiveness of physiotherapy interventions and alternative medicine for leg pain, back pain, and walking distance in patients with LSS.MethodsData sources: PubMed, Web of Science, and Scopus databases were searched for papers published in the previous 5 years (2016–2020). The systematic review and meta-analysis were conducted from September 2021 to December 2021 at the Musculoskeletal Research Lab of Maharishi Markandeshwaer Institute of Physiotherapy &amp; Rehabilitation. Study selection and outcomes: randomised controlled trials (RCT), randomised clinical trials, randomised cross-over trials, quasi-RCTs, and non-RCTs were included if they evaluated the effects of physiotherapy or alternative medicine on pain and walking distance in patients with LSS. The Numeric Rating Scale (NRS), Visual Analogue Scale (VAS), Self-paced walk test (SPWT), and treadmill walking were used as outcome measures. All the authors independently screened and extracted data from the 8 studies retrieved through the search using a pilot-tested performa. The quality of studies was assessed using the PEDro scale and the Cochrane risk of bias criteria.ResultsMeta-analysis was performed using a fixed-effects model that showed (1) Physiotherapy was more effective than the control in improving leg pain. The Standardised mean difference (SMD) (95% CI) in the NRS score for leg pain was found to be 1.12 (0.83, 1.40); (2) Physiotherapy was more effective than the control in improving back pain. The SMD (95% CI) in the NRS score for back pain was 0.29 (−0.18, 0.76); (3) Physiotherapy was more effective than the control in improving walking distance. The SMD (95% CI) for walking distance was found to be 144.59 m (133.16 m, 159.02 m).ConclusionsThe results of the present study indicate that physiotherapy has higher significant results than alternative medicine in patients with lumbar spinal stenosis.

Targeted vibratory therapy as a treatment for proprioceptive dysfunction: Clinical trial in older patients with chronic low back pain.

Proprioceptive function declines with age, leading to falls, pain, and difficulties in performing activities of daily living among older adults. Although individuals with low back pain (LBP) exhibit decreased lumbosacral proprioception in various postures, the mechanism by which reduced proprioceptive function causes LBP remains uncertain. Vibratory stimulation may enhance proprioceptive function; however, its efficacy in treating LBP has not been investigated. Thus, we investigated the feasibility of improving proprioceptive function and its effect on alleviating chronic LBP in older patients through targeted vibratory therapy (TVT) administration. This single arm designed trial included older patients aged >65 years with non-specific chronic LBP. TVT involved applying vibratory stimulation, matching the frequency of dysfunctional receptors, for 1 min daily over 14 days to activate proprioceptors; patients performed TVT three times daily at home. In cases of reduced proprioceptive function at multiple sites, TVT was aimed at the lowest frequency band value. LBP and proprioceptive function were evaluated at 2 weeks after TVT and at 2 weeks after the end of TVT in patients with declined proprioception in the trunk or lower extremities. Overall, 56 patients with chronic LBP were enrolled; 32 patients were recruited for treatment based on a proprioceptive dysfunction diagnosis and 24 patients were recruited with a normal diagnosis with no significant differences observed between the two sets of patients in sarcopenia-related factors and clinical proprioception-related characteristics. No patient had any adverse events. Two weeks after TVT, the numerical pain rating scale score improved to <3 points in 78.1% of patients, with 73.1% of patients achieving a score of ≤ 3 points. Proprioceptive function improved in 81.3% of cases, and engagement in activities of daily living improved significantly. TVT demonstrated efficacy in improving proprioception and alleviating LBP in older patients with impaired proprioceptive function without affecting non-targeted proprioceptors.

Development of a Blended Physiotherapeutic Module for Young Adults with Non-Specific Chronic Low Back Pain: A Feasibility Study

Introduction: Non-Specific Chronic Low Back Pain (NSCLBP) is a prevalent non-communicable disease in India, burdening individuals psychologically and socially. Due to economic constraints, people prefer self-management rather than seeking professional advice. Therefore, their go-to search strategy for self-management is social media platforms. Many researchers have identified a lack of evidence in these social media videos. Aim: To develop and evaluate the feasibility of a blended physiotherapeutic module for young adults with NSCLBP. Materials and Methods: This feasibility study was conducted at Nitte Institute of Physiotherapy, NITTE (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India from July 2023 to December 2023. This study involved three phases: identifying modifiable risk factors for exercise adherence in individuals with NSCLBP, developing a module, and evaluating its feasibility. Twenty-four young individuals with low back pain were given the blended physiotherapeutic module for four weeks, consisting of three sessions per week. The first two sessions were conducted online, and the following session was face-to-face. The data were analysed using SPSS software (SPSS Inc.; Chicago, IL) version 29.0.10. The collected data were summarised using Descriptive Statistics: frequency, percentage; mean, and Standard Deviation (SD). To compare the Quebec Back Pain Disability Scale (QBPDS) and Numerical Pain Rating Scale (NPRS) scores, repeated measures ANOVA was employed. The Bonferroni test was utilised for pairwise comparisons of QBPDS and NPRS scores. A p-value &lt;0.05 was considered significant. Results: In this study, the average percentage of individuals who performed exercises for four weeks was 22 (91.7%), indicating high adherence. There was a significant difference (p-value &lt; 0.05) in the QBPDS as well as the NPRS from baseline to weeks -2, 3, and 4. Conclusion: The developed blended physiotherapeutic module for NSCLBP individuals was found to be feasible. Positive results were identified in reducing pain and disability after two weeks. This study aids individuals struggling with physiotherapy exercises in a digitalised society, suggesting that future research could incorporate real-time movement analysis and regional language databases and software that should be validated.

Local injection of a freshly manufactured 35 kDa hyaluronan fragment reduces neuropathic and inflammatory pain: A clinical study

To investigate the ability of the 35 kDa low-molecular-weight hyaluronan fragment (HA35) to relieve neuropathic and inflammatory pain, including postherpetic neuralgia and shoulder, neck, back and temporomandibular pain. Ten patients with postherpetic neuralgia and 26 patients with shoulder, neck, back or temporomandibular pain were studied and assessed. The 35 kDa hyaluronan fragment (HA35) was prepared by mixing hyaluronidase and 100 mg of high-molecular-weight HA at room temperature for 20 mins. This mixture was locally injected once at the pain point or where the nerve trunk innervated the pain point. Patients scored their pain and comfort on the numerical pain rating scale (NPRS) and the General Comfort Questionnaire (GCQ). After treatment, the NPRS scores and GCQ scores improved. Patients with postherpetic neuralgia and shoulder, neck, back or temporomandibular pain had significantly lower NPRS scores at 30 min to 180 min after injection, especially at 180 min ( p &lt; .001). The GCQ scores after treatment for 24 h was significantly greater than that before treatment ( p &lt; .01). No adverse reactions occurred. The 35 kDa hyaluronan fragment (HA35) effectively relieved postherpetic neuralgia-induced neuropathic pain and shoulder, neck, back and temporomandibular inflammatory pain. Clinical Trial Registration: NCT05809700 at https://www.clinicaltrials.gov .

Retrospective Evaluation of Bipolar Peripheral Nerve Stimulation for Nociceptive and Neuropathic Pain: A Pilot Study.

This retrospective review evaluates pain and patient-defined functional goal improvement utilizing bipolar peripheral nerve stimulation (PNS) in chronic neuropathic and nociceptive pain states. Our dataset includes 24 patients who underwent implantation of a permanent peripheral nerve stimulator from January 2018 through December 2022. A total of 29 leads were implanted amongst 24 patients, with 5 patients having leads at 2 different dermatomes. Fifteen leads were placed for primarily neuropathic pain, and 14 leads were placed for nociceptive pain. Inclusion criteria were the following: pain duration greater than 6 months, documented peri-procedural Numerical Pain Rating Scale (NPRS) and greater than 60 days follow-up post implant. Data was collected and analyzed showing that 89.6% of implants at 6 months follow-up and 70% at 12 months follow-up achieved 50% or greater pain relief. A significant reduction in NPRS scores when comparingpre-procedure pain scores (Median = 7, n = 29) to 6-month follow-up data (Median = 2, n = 29), p<0.001 with a large effect size, r =0.61.Ninety-three percent of patients reported achieving their personal functional goal. Twelve of the fourteen (86%) leads implanted for primary nociceptive pain and fourteen of the fifteen (93%) leads implanted for neuropathic pain achieved ≥50% relief at 6 months. At twelve months, seven leads in each group provided ≥50% sustained pain relief. Of the 14 patients that were on opioids, 6 discontinued, while another 2 had a reduction in oral morphine milligram equivalents (MME) at the 12-month follow-up. This retrospective review demonstrates the potential clinical application of PNS in both nociceptive and neuropathic pain states. Further prospective studies are warranted to validate the effectiveness of PNS in the treatment of refractory nociceptive and neuropathic pain states.

Perioperative Transcutaneous Electrical Acupoint Stimulation Reduces Postoperative Pain in Patients Undergoing Thoracoscopic Surgery: A Randomized Controlled Trial.

This study aimed to determine the effects of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain management in patients undergoing thoracic surgery. In the prospective, randomized, controlled study, a total of 84 patients undergoing video-assisted thoracoscopic surgery (VATS) were randomly allocated to the TEAS group (Group T) or control group (Group C). Patients in the Group T received TEAS at Neiguan (PC6) and Hegu (LI4) acupoints for 30 min before anesthesia induction and 30 min after thoracoscopic surgery. Patients in the Group C received the same placement of electrodes but without electrical stimulation. The numeric rating scale (NRS) pain score, remifentanil consumption, demand for rescue analgesics and incidence of postoperative nausea and vomiting (PONV), patient satisfaction, and the levels of plasma β-endorphin (EP) and IL-6 were recorded. Patients in the Group T had significantly lower NRS pain scores at 6 h, 12 h, 24 h, and 48 h after surgery than those in the Group C. Compared with Group C, patients in Group T had lower remifentanil consumption during operation, lower demand for rescue analgesics and lower rate of PONV within 24 h after surgery. Patients in Group T also had lower IL-6 content, higher β-EP content and higher satisfaction degree than those in the Group C. Perioperative TEAS significantly decreased postoperative pain and rescued analgesia requirements and the incidence of PONV in patients undergoing thoracoscopic surgery, with a higher patient satisfaction. This trial is registered with ChiCTR2100051841.

Case Report: A Nursing Challenge - Postoperative Complications of Pacemaker Implantation in Behçet’s Disease

Background: Cardiovascular system involvement in Behçet’s disease is rare, especially requires surgical intervention. We report a case of a 47-year-old Chinese male with Behçet’s disease, treated with immunosuppressive agents, who developed an infection at the surgical site following the postoperative implantation of a pacemaker. Little is known about the approach to managing postoperative wounds in Behçet’s disease. This article aims to provide a reference for nursing care, improve perioperative management, and assist in achieving a good prognosis for Behçet’s disease with cardiovascular system involvement. Method: We used the following three-phase process: 1. Followed authoritative guidelines for the perioperative management of patients with cardiac implantable electronic devices (CIED), which included strict aseptic techniques, pressure bandaging, and the preventive use of antibiotics. 2. Conducted a literature search for reasons and solutions to pain and infection symptoms at the surgical site. 3. Cleaned the wound using different disinfectants and evaluated the wound’s condition; managed pain through a multimodal approach within an Acute Pain Service (APS) team management model. Determined whether to continue immunosuppressive therapy based on the Pathergy test after the patient had suspended immunosuppressive therapy for over a month. Results: Our case illustrates the wound healing process during the patient’s 50-day hospitalization, from a secondary wound with a 5x5 cm rupture and exudation to Grade A healing. The patient’s Numeric Rating Scale (NRS) pain score decreased from 6 points to 0 points upon discharge. Three months post-discharge, follow-up revealed slight scarring at the wound site, normal pacemaker function, and stable control of Behçet’s disease. Conclusion: Patients with Behçet’s disease under immunosuppressive treatment have a higher risk of infection at the surgical site following pacemaker implantation. Using hydrogen peroxide first, followed by iodine, and finally physiological saline during wound debridement is significantly effective in controlling infection. The APS team management model, composed of attending physicians and nurses, can effectively improve pain relief quality during wound recovery. The Pathergy test is an effective method to evaluate whether disease activity affects wound healing after CIED implantation and whether continued use of immunosuppressive therapies is necessary.

Management of Pain and Improvement in Quality of Life in Lumbar Disc Herniation using Class IV LASERA Placebo-controlled Study

Introduction: Intervertebral disc herniation is the most common cause of spine related disability in working-age individuals. Class IV high-intensity Light Amplification by Stimulated Emission of Radiation (LASER) therapy can help in reducing inflammation, pain and improve function with increasing microcirculation, activating angiogenesis. Aim: To find the effect of Class IV LASER on pain and Quality of Life (QoL) in patients with herniated lumbar disc. Materials and Methods: This placebo-controlled pre- and post-comparison study conducted at Jindal Physio Care, New Delhi with the sample size of 34 subjects. Participants were recruited based upon a predefined selection criteria. After signing the informed consent, all the subjects were randomly distributed among two groups. Outcome variables were Numeric Pain Rating Scale (NPRS), and QOL 36-Item Short Form Survey Instrument (SF-36) questionnaire which were assessed in the beginning and at the end of study period of 10 weeks. Control group was given placebo LASER whereas the study group was treated with high-intensity LASER. Moist heat, core strengthening exercise and use of lumbar corset was advised for both the groups. Results: There was a significant (p&lt;0.05) decrease in NPRS and SF-36 score in both the groups at the end of the study. However, study group showed significant improvement compared to control group (p&lt;0.001). Conclusion: Class IV LASER treatment has been found more effective reducing pain and improving QoL. This can be a better choice of treatment in patients with lumbar disc herniation.

Efficacy of acupuncture for whiplash injury: a systematic review and meta-analysis

ObjectivesThis study aimed to establish clinical evidence for acupuncture by analysing data from trials that demonstrated the efficacy of acupuncture for whiplash-associated disorder (WAD) with the following research question: Is...

Clinical outcomes and predictors of bleomycin polidocanol foam sclerotherapy treatment response in venous malformations.

To evaluate the safety and efficacy of bleomycin polidocanol foam (BPF) sclerotherapy for venous malformations (VMs) and analyze the associated clinical outcomes and predictors. We retrospectively assessed BPF sclerotherapy outcomes in 138 patients with VMs. We analyzed pain levels, lesion volume reduction, and subjective perception of response. Logistic regression analysis was performed to identify potential predictors of treatment outcome. Additionally, we carefully monitored and recorded complications. There was a notable average reduction in lesion volume by 78.50% ± 15.71%. The pain numerical rating scale (NRS) score decreased from 4.17 ± 2.63 prior to treatment to 1.05 ± 1.54 afterward, and 70.3% of the patients experienced effective relief after a single BPF treatment. Multivariate analysis revealed that a high baseline NRS (odds ratio [OR]: 4.026) and elevated activated partial thromboplastin time (APTT, OR: 1.200) were positive predictors of pain reduction. Additionally, a high baseline NRS score (OR: 1.992) and elevated thrombocytocrit (PCT, OR: 2.543) were positive predictors of incomplete postoperative pain relief. Minor complications occurred in 31 (22.46%) patients. BPF sclerotherapy is safe and effective for VMs, resulting in significant reduction in lesion volume, improved symptoms, and minimal complications. APTT and PCT levels are important predictors of pain outcomes following BPF treatment.

A Case Report on Korean Medicine Treatment for a Patient Diagnosed with Acute Gastric Mucosal Lesion on Ultrasound Imaging

Objectives: This study reports a clinical case that showed improvement in the symptoms of a patient with acute gastric mucosal lesion (AGML) through ultrasound.Methods: A 90-year-old woman with AGML was treated with Korean medicine treatments, including Hyangsapyeongwisan Soft Ext, acupuncture, and moxibustion. The responses before and after treatment were evaluated using ultrasound imaging and the numerical rating scale (NRS).Results: After treatment, ultrasound imaging showed improvement in gastric mucosa thickness, from 1.45 cm to 0.53 cm at the anterior wall and from 1.25 cm to 0.36 cm at the posterior wall. The NRS scores for epigastric pain, nausea, and dizziness all decreased, and the symptoms of diarrhea disappeared.Conclusion: This study suggests that Korean medicine treatment can be a therapeutic option in treating the symptoms of patients with AGML.

The Efficacy of Low-Dose Esketamine and Butorphanol in Treating Depression and Pain After Cesarean Section

Objective: To explore the efficacy of combining low-dose esketamine with butorphanol in treating depression and pain following cesarean section. Methods: 100 cases of elective cesarean section were selected and randomly assigned into two groups in a 1:1 ratio. All parturients who fulfilled the inclusion criteria received spinal anesthesia, maintaining the anesthesia level at T6. In the esketamine group, the dosage regimen comprised esketamine 0.5 mg/kg and butorphanol 10 mg, diluted with 0.9% sodium chloride injection to 100 mL. The control group received butorphanol 10 mg, diluted similarly. Analgesia in both groups commenced after cutting the umbilical cord, with a loading volume of 2 mL, a background infusion dose set to 2 mL/h, and patient-controlled analgesia at 2 mL with an effective interval time of 30 minutes. The main indicators included the maternal burnout scale (MBS) and numerical rating scale (NRS) for pain to assess postpartum depression and pain after surgery. Results: No significant differences were observed in MBS scores between the two groups on postoperative days 1 to 9 (P &gt; 0.05). Postpartum depression was not detected in either group. Pain NRS scores at 24 and 48 hours after surgery, including incision and uterine contraction pain, showed no significant differences between the two groups (P &gt; 0.05). Tramadol rescue was not administered to any patients in either group. Additionally, no adverse reactions requiring drug intervention occurred in either group. Conclusion: This study concluded that the combination of low-dose esketamine with butorphanol did not further optimize the analgesic effect of butorphanol but significantly improved postpartum depression after cesarean section. Further research is needed to investigate the impact of the ketamine postoperative analgesia regimen on postpartum analgesia and depression.

Comparing the Pericapsular Nerve Group Block and the Lumbar Plexus Block for Hip Fracture Surgery: A Single-Center Randomized Double-Blinded Study.

Lumbar plexus blocks (LPBs) are routinely employed for analgesia in hip fracture surgery; however, a novel regional technique, the pericapsular nerve group (PENG) block, potentially offers comparable pain reduction while preserving motor function. Patients aged 45-90 years who underwent hip fracture surgery were allocated to receive either a PENG block or an LPB for analgesia. The primary outcome was the incidence of quadriceps motor block (defined as the paresis or paralysis of the knee extension) at 12 h postoperatively. The secondary outcomes included the performance time, the time to first analgesic requirement, postoperative intravenous (IV) fentanyl consumption, the ability to undergo physiotherapy at 24 and 48 h, complications, sensory and motor block assessments, postoperative numeric rating scale (NRS) pain scores, and patient outcome questionnaires. There was a significantly lower incidence of quadriceps motor block at 6 h (26.7% vs. 80.0%; p < 0.001) and at 12 h (20.0% vs. 56.7%; p = 0.010). The PENG block provided better preservation of the sensory block as well as better performance time (p < 0.001) and time to first analgesia requirement (p = 0.034), whereas the LPB resulted in lower postoperative IV fentanyl consumption at 24 h (p = 0.013). The PENG block demonstrated superiority over the LPB in preserving quadriceps strength and patient satisfaction without any substantial complications, despite higher opioid consumption within the first 24 h post-surgery.

Efficacy of continuous arterial perfusion chemotherapy combined with transarterial chemoembolization regional arterial thermal perfusion in the treatment of pancreatic cancer with liver metastases

Abstract Background The aim of the study was to investigate the efficacy of continuous transcatheter arterial infusion chemotherapy combined with transarterial chemoembolization (TACE) for the treatment of advanced pancreatic cancer with liver metastasis. Methods Sixty patients with advanced pancreatic cancer and liver metastases were enrolled in this study. In the treatment group, 31 patients underwent continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial thermal perfusion, whereas 29 patients included in the control group received intravenous chemotherapy with gemcitabine and S-1. All patients received maintenance chemotherapy with S-1 after 4 cycles of the study regimen. Treatment efficacy, quality of life, survival, and toxicity were evaluated. Results Efficacy was better in the treatment group than in the control group, as reflected by the objective remission, partial remission, and disease progression rates (all P &lt; 0.05). The Eastern Cooperative Oncology Group and Numerical Rating Scale pain scores were also higher in the treatment group (both P &lt; 0.05). In survival analysis, the 1-year overall survival rates in the treatment and control groups were 64.516% and 10.345%, respectively, whereas the median overall survival times were 16 and 6 months, respectively (both P &lt; 0.05). The 6-month progression-free survival rates in the treatment and control groups were 77.419% and 13.790%, respectively, and the median progression-free survival times were 12 and 3 months, respectively (both P &lt; 0.05). The rates of hematological and nonhematological toxicological adverse effects were also lower in the treatment group (both P &lt; 0.05). Although the rate of liver dysfunction was higher in the treatment group, this finding had no adverse effects on prognosis. Conclusions Continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial perfusion chemotherapy resulted in better efficacy and safety outcomes in patients with pancreatic cancer and liver metastasis, suggesting its utility as a reference method for the clinical treatment of advanced pancreatic cancer.

Effectiveness of Routine Physiotherapy with and without Soft Tissue Mobilization in Improving Pain and Functional Mobility in Chronic Low Back Patient

Background: Chronic low back pain (CLBP) is a prevalent condition affecting a significant portion of the global population, impacting their quality of life and functional mobility. Despite various treatment modalities, the quest for the most effective intervention remains a critical area of research. Existing literature suggests varied efficacy of different physiotherapy techniques in managing CLBP. Objective: This study aimed to evaluate the effectiveness of routine physiotherapy with and without soft tissue mobilization in improving pain and functional mobility in patients with chronic low back pain. Methods: A randomized control trial was conducted with 128 participants, divided into two groups: Group A (routine physiotherapy with soft tissue mobilization) and Group B (routine physiotherapy without soft tissue mobilization). Baseline and post-treatment measurements included the Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI). Participants were assessed at baseline and after a 3-month treatment period. Statistical analysis was performed using independent samples t-tests. Results: At baseline, NPRS and ODI scores showed no significant differences between the groups (NPRS: 7.4 ± 1.2 for Group A and 7.5 ± 1.3 for Group B, p=0.760; ODI: 50.3 ± 5.0 for Group A and 50.8 ± 4.8 for Group B, p=0.690). Post-treatment, Group A demonstrated significantly greater improvement (NPRS: 2.8 ± 1.1 for Group A and 4.6 ± 1.2 for Group B, p&lt;0.001; ODI: 19.7 ± 3.5 for Group A and 29.4 ± 4.0 for Group B, p&lt;0.001). Conclusion: The study concluded that routine physiotherapy combined with soft tissue mobilization was more effective in reducing pain and improving functional mobility in CLBP patients compared to routine physiotherapy alone. This suggests that incorporating soft tissue mobilization into standard physiotherapy regimens could be beneficial for CLBP management.