Verbal Numeric Scale Research Articles

Evaluation of Oral Pregabalin as a Preemptive Adjuvant for Postoperative Pain in Patients Undergoing Coronary Artery Bypass Grafting With General Anesthesia and High Thoracic Epidural: A Randomized Controlled Study.

Aim This study aimed to evaluate the effectiveness of oral pregabalin as a preventive supplement in managing postoperative pain in patients undergoing coronary artery bypass grafting (CABG) with a combination of general anesthesia and high thoracic epidural anesthesia. Material and methods This 18-month randomized controlled study at a tertiary hospital's anesthesiology department included 62 American Society of Anesthesiologists (ASA) II or III patients aged 35-75 with left ventricular ejection fraction >35%. Placebo (Group B, n = 31) or pregabalin (Group A, n = 31) was randomly allocated. Group A got 150 mg of pregabalin the night before surgery and 75 mg on postoperative days 0 and 1, whereas Group B received a placebo. Postoperative pain was evaluated using the Verbal Numerical Scale and Visual Analogue Scale, while sedation was assessed with the Ramsay Sedation Scale. Statistical analysis was performed using SPSS for Windows, Version 16.0 (Released 2007; SPSS Inc., Chicago). Results In this study, pregabalin significantly reduced postoperative pain on Day 0 and Day 1 (p < 0.001) compared to the placebo. The pregabalin group exhibited higher sedation scores on Day 0 (p < 0.001), but there were no significant differences on Day 1. Inotrope requirements were similar between both groups. Conclusions CABG patients' postoperative pain was greatly reduced by pregabalin without impacting sedation or inotrope needs. These data imply that pregabalin was a useful supplementary analgesic for CABG patients' multimodal pain treatment.

Розробка та впровадження удосконалених методів управління бізнес-процесами підприємств торгівлі та апк

The study aims to identify methods of improving the management of business processes in trade and agricultural enterprises. Integration and transformational processes in the Ukrainian economy, high competition, pressure of crisis factors, and high unpredictability of changes in the external environment require Ukrainian trade and agricultural enterprises to search for new, more effective management methods constantly. New management methods should be aimed at strengthening the competitive advantages of trade and agricultural enterprises in the market and the stable operation of the enterprise from a strategic perspective. Therefore, one of the most problematic areas is reorienting trade and agricultural enterprises to a high-tech model of improvement and development of business processes. However, the potential benefits of improving the methods of managing business processes of trade and agricultural enterprises within the framework of implementing the development strategy are promising. It allows them to optimize their activity (economic efficiency) while considering future management specifics. The conducted analysis, which was thorough and comprehensive, made it possible to develop and systematize the criteria for evaluating the effectiveness of managing business processes of trade and agricultural enterprises based on the proposed algorithm in accordance with the goals of business processes and consumer requirements. The work has developed a methodology for evaluating and improving the effectiveness of business process management of trade and agro-industrial complex enterprises, which allows the evaluate the business processes of the enterprise of the correspondingly achieved level (effectiveness of business processes) and increases the efficiency of business processes of trade and agro-industrial complex enterprises relative to the industry and global levels (benchmarking of business processes). During the research, the technology of conducting benchmarking was improved, which allows for an increase in the effectiveness of business processes of trade and agricultural enterprises due to the inclusion of a stage for evaluating the effectiveness of the developed measures in the benchmarking process. Thanks to this, a toolkit is proposed to determine the effectiveness of business process management and its ranking based on Harrington’s verbal-numerical scale. The Harrington scale allows you to determine the effectiveness of business processes, considering the results that are obtained that fall into numerical intervals. The paper proposes using the method of analyzing hierarchies to obtain the most reliable value of the performance indicator of the business process management system of trade and agricultural enterprises. Keywords: business process management, assessment criteria, business process performance, business process benchmarking.

Pulsed Radiofrequency in the Management of Postsurgical Abdominal Wall Chronic Pain: A Report From a Single Oncological Center.

Chronic postsurgical pain (CPSP) is defined as pain that develops or increases in intensity after a surgical procedure or tissue injury and persists beyond the healing process, lasting at least three months after the precipitating event. Often neuropathic in nature, CPSP can be challenging to manage. CPSP is a common complication, with data suggesting an incidence ranging from 5% to 85%, depending on the type of procedure. Meralgia paresthetica (MP) and ilioinguinal/iliohypogastric neuralgias (IH/IL N) are two possible clinical scenarios of CPSP following lower abdominal procedures. Pulsed radiofrequency (PRF) is a minimally invasive technique of peripheral neuromodulation effective in various pain etiologies; however, evidence is scarce regarding its use in MP and IH/IL N. This case series aims to assess the potential role of PRF in the management of CPSP following abdominal wall procedures. This case series was set in a single oncological center between January 2017 and February 2022 and included adult patients (>18 years old) referred to our unit with a high suspicion of postsurgical MP or IH/IL N refractory to conservative treatment. PRF was performed after a positive diagnostic block in patients whose pain could not be controlled despite optimal medical treatment. The efficacy of PRF was assessed regarding pain intensity using the verbal numeric scale (VNS) and the duration of pain relief in weeks. The follow-up period was from the initial PRF procedure to the end of data collection. Parametric data were presented as mean and standard deviation (SD), and non-parametric data as median (minimum-maximum). Seventeen patients were included: 82.35% (n=14) were female, and the mean age was 58.0 ± 11.35 years. MP was present in 47.1% (n=8) and IH/IL N in 52.9% (n=9). Transverse rectus abdominis muscle flap reconstruction (TRAM) was the most common procedure (n=5, 29.41%). Diagnostic blocks were performed in 88.24% (n=15) of the patients. Initial VNS scores were 7.59 ± 2.62; 2.82 ± 2.62 at 24 hours; and 2.47 ± 1.58 at 15 days. During follow-up, 70.59% (n=12) of patients had no recurrence of initial symptoms. A second PRF was performed in 29.41% (n=5) cases based on the recurrence of symptoms, following a mean period of pain relief of 112 (8-238) weeks. No major or minor complications were identified during early or late follow-up. PRF can be a useful tool to improve the multimodal management of postsurgical abdominal wall chronic pain.

Pain Predictors in Patients in the Postanesthesia Care Unit

To analyze the effects of pain-predicting factors on patients in the postanesthesia care unit (PACU). This is an observational and prospective study. This study was conducted at a University Hospital in the state of Minas Gerais (Brazil). To collect data on demographic, clinical, and surgical factors, a collection instrument was devised. The verbal numerical scale was employed to measure pain levels before and after surgery in the PACU. A path analysis was used to assess a predictive model. A total of 226 patients were included in this study. The incidence of pain in the PACU was 31.9%. A model with demographic, clinical, and surgical variables was tested. The final model, after including modification indices, obtained results that indicated an acceptable data fit (comparative fit index=0.996; root mean square error of approximation=0.08). Age (being young), sex (being a woman), oncological diagnosis as an indication for the surgical procedure, type of surgery (surgery of the digestive system), duration of surgery (longer surgeries), and high intraoperative doses of opioids were predictive variables for pain in the PACU. This study's findings provide support for pain management in the PACU. Furthermore, the results of this research can be used to anticipate the occurrence of acute postoperative pain and personalized perioperative analgesia needs.

The role of nutraceuticals in the management of temporomandibular disorders.

Temporomandibular disorders (TMDs) are usually treated with occlusal appliances and supportive treatments such as physical therapy and drugs. Supplements can be included among potential supportive therapies, with the aim of reducing the use of drugs. To evaluate the efficacy of nutraceuticals' short-term treatment in subjects with temporomandibular disorders. The study started in January 2021 and ended in January 2022. Subjects with temporomandibular disorders and a verbal numeric scale >40 were recruited and randomly assigned to one of the following groups. If waiting to start a therapy, to the nutraceutical group or to the no treatment group, while if already undergoing splint therapy, to nutraceautical+splint group or to splint therapy group. Nutraceutical used was composed by Boswellia Serrata Casperome, Magnesium, Tryptophan and vitamins B2 and D with a posology of one tablet/day before sleep for 40days. Presence of temporomandibular pain, headache, neck pain and sleep/emotional disorders were assessed at T0 and at T1, after 40days. ANOVA was performed to compare treatments with nutraceuticals and theirrespective controls, as for the variables related to painful symptomatology. Chi- Squared was conducted to assess differences in sleep/emotional disorders between groups. The statistical significance was p<0.05. The groups using nutraceuticals showed statistically significant improvements over controls for most of the variables analyzed. The use of nutraceutical seems to be a valuable support for TMD therapy in the short term either alone or combined with occlusal splint therapy.

Combined Ultrasound and Fluoroscopy versus Ultrasound versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain: A Retrospective Comparative Study.

Background and Objectives: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. Materials and Methods: A total of 154 patients who underwent CESI between 2018 and 2022 were included. Patients were categorized into three groups based on the guidance method: combined US and FL (n = 51), US-guided (n = 51), and FL-guided (n = 52). The study design was retrospective case-controlled, utilizing patient charts and standardized forms to assess clinical outcomes, adverse events, complications during the procedures. Results: In all groups, Oswestry Disability Index and Verbal Numeric Scale scores improved at 1, 3, and 6 months after the last injection, with no significant differences between groups (p < 0.05). The treatment success rate at all time points was also similar among the groups. Logistic regression analysis showed that injection method, cause, sex, age, number of injections, and pain duration did not independently predict treatment success. Blood was aspirated before injection in 2% (n = 1), 13.5% (n = 7), and 4% (n = 2) of patients in the combined US and FL groups, FL-guided groups, and US-guided groups, respectively. Intravascular contrast spread was detected in one patient in the combined method groups and seven in the FL-guided groups. Conclusions: When comparing pain reduction and functional improvement, there was no significant difference between the three methods. The combined method took less time compared to using FL alone. The combined approach also showed a lower occurrence of intravascular injection compared to using FL alone. Moreover, blood vessels at the injection site can be identified with an ultrasound using the combined method. Given these advantages, it might be advisable to prioritize the combined US- and FL-guided therapy when administering CESI for patients with unilateral lumbar radicular pain.

Comparison of Dexmedetomidine and Ketamine in Serratus Anterior Plane Block for Postoperative Pain Control in Thoracotomy Patients: A Randomized Clinical Trial.

Postoperative pain control after thoracotomy is very important, and if not controlled, it can cause severe complications. This study aimed to compare dexmedetomidine and ketamine in serratus anterior plane block (SAPB) in pain control after thoracotomy. This randomized clinical trial was conducted on 74 patients aged 18 to 60 years old with American Society of Anesthesiologists (ASA) class I or II who were referred to Imam Khomeini hospital in Ahvaz, Iran, for thoracotomy and randomly divided into two groups. After surgery, the SAPB with ultrasound-guided was performed. In the ropivacaine-ketamine (RK) group, ketamine 0.5 mg/kg and 0.4 cc/kg ropivacaine solution 0.25% and in the ropivacaine-dexmedetomidine (RD) group, in addition to 0.4 cc/kg ropivacaine 0.25%, dexmedetomidine 0.5 µg/kg was added. Verbal Numeric Scale (VNS), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), heart rate (HR), and mean arterial blood pressure (MAP) were recorded. There was no significant difference in both groups in terms of demographic information (P < 0.05). The average VNS was lower in the ketamine group than in the dexmedetomidine group; however, there was a significant difference only at 1, 12, and 24 hours after surgery (P < 0.05). There was no statistically significant difference between the two groups in terms of SBP and DBP, HR, and MAP. There was a significant difference in the RR in the two groups at 12 and 24 hours after the operation (P < 0.05). Dexmedetomidine and ketamine, which were used as supplements to ropivacaine for SAPB in patients undergoing elective thoracotomy, reduced the pain intensity after thoracotomy; nevertheless, the intensity of pain reduction was more and more effective in the group receiving ketamine.

The impact of ketamine on delayed neurocognitive recovery in elderly patients undergoing spinal anaesthesia for orthopaedic procedures, a pilot study.

Delayed neurocognitive recovery is an objectively measurable decline in the cognitive status at varying intervals after surgery under both general and spinal anaesthesia. In this study, we used the Short Portable Mental Status Questionnaire to evaluate the protective effect of ketamine infusion on cognitive function of elderly patients undergoing spinal anaesthesia for orthopaedic procedures. A randomised, double-blinded placebo-controlled trial. Forty-two geriatric patients listed for elective orthopaedic surgery under spinal anaesthesia were randomly assigned to receive an intravenous infusion of either ketamine (0.3mg/kg) or isotonic saline (control group) after receiving spinal anaesthesia, which continued throughout the procedure. Cognitive performance was evaluated, as a primary outcome, with Short Portable Mental Status Questionnaire. Baseline cognitive performance was comparable in both groups. Patients in the ketamine group showed statistically significant fewer errors in the postoperative Short Portable Mental Status Questionnaire compared with the baseline evaluations (p = 0.038). Patients in the ketamine group showed significantly lower verbal numerical scale scores than the control group (p = 0.04) at six hours after surgery. Elderly patients undergoing spinal anaesthesia showed a better cognitive status after receiving an intravenous infusion of 0.3mg/kg ketamine. However, further research with a larger sample size and different assessment tools might be required to verify our results.

Benefits of using a support bra in women undergoing coronary artery bypass graft surgery: A randomized trial

BackgroundApproximately 30 % of cardiac surgeries are conducted on women by median sternotomy, which often causes discomfort such as pain, affects quality of life, and delayed recovery compared with men. Breast size is related to operative wound complications, such as incisional pain, sternum dehiscence, and infection, which may affect hospital costs due to prolonged hospital stays. ObjectiveTo evaluate breast size and operative wound complications and the effect of breast support on the incidence of pain, infection, and quality of life in women after coronary artery bypass grafting. MethodWomen were randomly assigned to one of three groups: group A (surgical breast support), group B (ordinary breast support), and group C (no-support). Observations were taken daily between the second and seventh postoperative days and at 30, 60, and 180 days. Pain was assessed using the Short-Form 36 Health Survey (SF36) for quality of life and a verbal numerical scale. The authors used the nonparametric Kruskal–Wallis and Friedman tests to examine variance. The authors used the Pearson correlation coefficient or the Spearman correlation for correlations between variables. A multivariate study was conducted to evaluate the occurrence of infection, and the logistic regression model with “stepwise” variable selection was used. A linear regression model with the “stepwise” variable selection was also used for hospitalization. The authors used SPSS 17.0 software for Windows, with a significance level of p < 0.05. ResultsThere was no difference in pain evaluation between the groups in 190 women (p > 0.05). When comparing quality of life, there was a statistically significant difference in the functional capacity domain at 30 and 60 days, with group A having the best functional capacity (p < 0.05). The larger the breast size, the longer the hospital stay (p < 0.001) and the higher the probability of infection (p = 0.032). Patients with a history of stroke had a 3.8 higher incidence of infection (p = 0.040). ConclusionThe use of surgical support did not affect acute pain or sternal infection rate in the 6-month follow-up. However, it was effective in the functional capacity domain 30 days after surgery and maintained at 60 days.

Methodology for selecting objects for reverse engineering at oil and gas industry enterprises

The basic methods of reengineering and the possibility of their application at the enterprises of both oil and gas industry and enterprises of defense-industrial complex under the conditions of ensuring technological independence are presented. The methodology of justification of selection of objects for reverse engineering at the presented enterprises has been developed, including the following criteria: participation of the reverse engineering object in the production of special products, reduction of unit production costs when implementing the reverse engineering object, the share of revenue from products containing the object in the total revenue of the enterprise, the level of import-independence provided by the reverse engineering object. For each criterion, verbal-numerical scales are developed, a complex coefficient is proposed, the values of which are used in making managerial decisions justifying the choice of objects for reverse engineering.

Foco do olhar do pediatra na avaliação da dor neonatal durante uma punção de calcanhar

ABSTRACT Objective: To evaluate the focus of pediatricians’ gaze during the heel prick of neonates. Methods: Prospective study in which pediatricians wearing eye tracker glasses evaluated neonatal pain before/after a heel prtick. Pediatricians scored the pain they perceived in the neonate in a verbal analogue numerical scale (0=no pain; 10=maximum pain). The outcomes measured were number and time of visual fixations in upper face, lower face, and hands, in two 10-second periods, before (pre) and after the puncture (post). These outcomes were compared between the periods, and according to pediatricians’ pain perception: absent/mild (score: 0–5) and moderate/intense (score: 6–10). Results: 24 pediatricians (31 years old, 92% female) evaluated 24 neonates. The median score attributed to neonatal pain during the heel prick was 7.0 (Interquartile range: 5–8). Compared to pre-, in the post-periods, more pediatricians fixed their gaze on the lower face (63 vs. 92%; p=0.036) and the number of visual fixations was greater on the lower face (2.0 vs. 5.0; p=0.018). There was no difference in the number and time of visual fixations according to the intensity of pain. Conclusions: At bedside, pediatricians change their focus of attention on the neonatal face after a painful procedure, focusing mainly on the lower part of the face.

Comparison of Two Different Positions for Ultrasound-Guided Intervertebral Distance Evaluation.

During neuraxial anaesthesia, correct patient positioning is key for increased block success and (patient) comfort. The aim of this prospective study was to compare the lateral fetal decubitus (LFD) position with the sitting fetal lotus (SFL) regarding interspinous distance, transverse diameters of paravertebral muscles measured with ultrasonography, and patient comfort. Fifty adult participants who could sit cross-legged and had no lumbar anomalies were included in our prospective study. In both SFL and LFD positions, measurements were performed with ultrasonography; in the axial plane, interspinous distance at the level of L4-L5, in the sagittal plan, with the probe slightly tilted, subcutaneous tissue-spinous process depth, and transverse diameters of paravertebral muscles were measured. Stretcher, waist position, and abdominal comfort were scored on a scale of 1 (very bad) to 7 (perfect) with a verbal numeric satisfaction scale. Interspinous distance was significantly larger in the SFL position than in the LFD position (P < 0.05). There was no significant difference between the two positions (P > 0.05) regarding patient comfort. Paravertebral muscle diameters were significantly broader in the SFL position than in the LFD position. The diameter of the left paravertebral muscle in the SFL position (45.8±8.8 mm) was larger than that in the LFD position (43±7.8 mm; P < 0.001). The diameter of the right paravertebral muscle in the SFL position was (47±9 mm) larger than that in the LFD position (43.4±7.6 mm; P < 0.001). Although there was no difference regarding the comfort between the two positions, the interspinous distance was larger in the SFL position than in the LFD position.

Transcutaneous electrical nerve stimulation (TENS) versus sham TENS in adult ED patients with abdominal pain: A clinical trial

ObjectiveThere is a growing consensus that the risks of current pharmacologic analgesics warrant consideration of alternative modalities for acute and chronic pain control. The objective of this study was to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in adult emergency department (ED) patients presenting with abdominal pain. MethodsWe conducted a patient and observer blinded randomized controlled trial comparing TENS to sham TENS. The study was conducted at a large suburban academic ED. Patients with abdominal pain and a verbal numeric pain scale (VNS) of 5 or greater were randomized to TENS or sham TENS applied via 4 skin pads, one in each abdominal quadrant for 30 min. The primary outcome was change in pain scores 30 min after the intervention. Our study had 80% power to detect a between group difference of 1.5 points on the VNS. Results81 patients were randomized to TENS (n = 41) or sham TENS (n = 40). Groups were similar in baseline characteristics. The mean (SD) reductions in pain scores were 1.9 (2.1) and 1.7 (2.6) in patients treated with TENS and sham TENS respectively (P = 0.81). Use of rescue medications in patients with treated with TENS and sham TENS was similar (49 vs 55% respectively, P = 0.66). ConclusionsApplication of TENS to the abdominal wall did not result in more effective pain relief than sham TENS in adult ED patients with abdominal pain.

Pain in older adults with dementia: Brazilian validation of Pain Intensity Measure for Persons with Dementia (PIMD).

Although there are several ways to assess pain in dementia, there is still a need for tools with better items to assess the presence of pain intensity in these individuals. To validate to Brazilian version of the "Pain Intensity Measure for Persons with Dementia - PIMD-p. Older adults, all demented with impaired verbal communication and exposed to potentially painful situations, were selected from an outpatient clinic and long-term care facility (LTCF). The PIMD-p was applied independently by 2 researchers (E1 and E2) on the same day. Within 14 days, the instrument was reapplied by one of the 2 researchers (E3). The pain intensity reported by participants' caregivers and LTCF nurses were recorded on a verbal numeric pain scale. For the statistical analysis, Cronbach's Alpha, Spearman's Coefficient and intraclass correlation Index were calculated. A total of 50 older individuals were selected (mean age 86 years), majority with musculoskeletal pain. The PIMD-p demonstrated good internal consistency according to Cronbach's α (0.838), excellent intra and interobserver reproducibility (0.927 and 0.970, respectively; p < 0.001), and convergent validity (strong significant correlations between reported pain intensities and pain indicators on the PIMD-p (except for expressive eyes; corr = 0.106 and p = 0.462). A ROC curve was plotted to determine the best cut-off for the PIMD-P, and a score of 7.5 predicted moderate-to-severe pain, with 77.8% sensitivity and 95.7% specificity (p < 0.001). The PIMD-p showed satisfactory psychometric properties for measuring intensity of pain in demented older adults with impaired verbal communication.

Аssessment of pain intensity: tools and their clinical using

Pain is an accompanied problem for many pathologic conditions and diseases. Such sensations disappear gradually when related to acute pathology or trauma. However, pain can became chronic and acquire traits of self-sustained disease. In practice, many characteristics can be useful for estimation of pain sensation, and the goal of this paper is to analyze of modern methods for intensity pain assessment in adults and children, of interpretation of pain estimation, and of possible algorithm for next steps. In majority cases, pain intensity is changing parameter. Therefore, pain assessment is performed in some standard points of time. For a quantitative assessment of pain, a scale is proposed to help the patient, relative to the extreme points of which a pointer can be placed indicating the relative severity of his sensations. For such purpose visual analog scale, numeric rating scale, and verbal numeric scale can be used. The Wong-Baker Faces Pain Rating Scale, the FLACC scale, the CRIES pain scale can be exploited in small children. In this population the CHEOPS scale, the OPS scale, and the COMFORT scale were recommended to apply after surgery. The final step of interpretation implies that quantitative data converts to ratings. The last ones form to basis of WHO analgesic ladder that is exploited for drugs selection to treat pain, in particular in patients with cancer pain or postoperative pain. From this approach, moderate and severe pain recommends to administer full opioid agonists. However, today there is a good alternative in the form of selective mu1-receptots agonist, which has lower risk of side opioid effects. Thus, in this time, there is some progress in pain management. This progress, in our opinion, is due to improved analysis of the condition of patients suffering from moderate and severe pain, and the emergence of new opioid agonists with high selectivity for the mu1 subclass of opioid receptors.

Learning to Fake It: Limited Responses and Fabricated References Provided by ChatGPT for Medical Questions

ObjectiveTo evaluate the quality of the answers and the references provided by ChatGPT for medical questions. Patients and MethodsThree researchers asked ChatGPT 20 medical questions and prompted it to provide the corresponding references. The responses were evaluated for the quality of content by medical experts using a verbal numeric scale going from 0% to 100%. These experts were the corresponding authors of the 20 articles from where the medical questions were derived. We planned to evaluate 3 references per response for their pertinence, but this was amended on the basis of preliminary results showing that most references provided by ChatGPT were fabricated. This experimental observational study was conducted in February 2023. ResultsChatGPT provided responses varying between 53 and 244 words long and reported 2 to 7 references per answer. Seventeen of the 20 invited raters provided feedback. The raters reported limited quality of the responses, with a median score of 60% (first and third quartiles: 50% and 85%, respectively). In addition, they identified major (n=5) and minor (n=7) factual errors among the 17 evaluated responses. Of the 59 references evaluated, 41 (69%) were fabricated, although they appeared real. Most fabricated citations used names of authors with previous relevant publications, a title that seemed pertinent and a credible journal format. ConclusionWhen asked multiple medical questions, ChatGPT provided answers of limited quality for scientific publication. More importantly, ChatGPT provided deceptively real references. Users of ChatGPT should pay particular attention to the references provided before integration into medical manuscripts.

Dolor local durante la administración de paracetamol endovenoso que tiene como excipiente ácido acético

Objective: to evaluate the presence of local pain during the intravenous administration of paracetamol with acetic acid compared with the administration of paracetamol without acetic acid in patients undergoing a procedure in the surgical unit. Methods: a double-blind randomized controlled clinical trial was conducted on two groups. All patients of age who underwent a procedure in the surgical unit of the Fundació Salut Empordà (Girona, Spain) from August to November 2020 and who needed the administration of intravenous paracetamol were included in the study. Sixty (60) patients were required per group (paracetamol with acetate vs. paracetamol without acetate). Sociodemographic variables were collected, as well as those related to the venous catheter, treatment, presence and time of pain, pain assessment according to the verbal numerical scale (from 0=no pain to 10=the worst pain imaginable). Descriptive and bivariate analysis. Comparison between arms according to the assigned protocol. Results: sixty (60) patients were included in each arm. Their mean age was 56.6 years (SD =15.6), and 56.7% were male. Arms were homogeneous and comparable at baseline. The presence of pain was detected in 48.3% (n= 29) of patients in the group receiving infusion of paracetamol with acetic acid, while there were no cases of pain in the group without acetate (p< 0.001). Conclusions: statistically significant differences were observed between the group of patients undergoing procedures in the surgical unit who were administered paracetamol without acetic acid, who did not present pain, vs. the group receiving paracetamol with acetic acid, where pain was present in almost half of the patients.

Abdominal Acupuncture for Non-Responding TMD Patients: a Retrospective Observational Study in General Practice

Pain related to Temporomandibular Disorders (TMD) is severe, negatively affecting patients' quality of life, and often resistant to conventional treatments. Abdominal Acupuncture (AA) is known to be particularly effective for pain, especially chronic and musculoskeletal pain, but it is still poorly studied and never investigated in TMD patients. To analyze the efficacy of AA for the treatment of patients with subacute and chronic pain related to TMD and non-responding to previous conventional therapies (occlusal splint, medications, physical therapy). Twenty-eight patients, 24 F and four M (mean age 49.36 years), were recruited from January 2019-February 2021. All patients underwent AA treatment: two sessions per week for four weeks, for a total of eight sessions. At the beginning of therapy (T0) and at the end of the cycle (T1) the following data were evaluated: maximum mouth opening (MMO); cranio-facial pain related to TMD (verbal numeric scale, VNS); pain interference with normal activities and quality of life of patients (Brief Pain Inventory, BPI); oral functioning (Oral Behavior Checklist, OBC); impression of treatment effectiveness (Patients' Global Impression of Improvement, PGI-I Scale). Statistical comparison of data before and after the AA treatment was performed by Wilcoxon's signed-rank test (significance level p < 0.05). The MMO values were significantly improved after one cycle of AA (p = 0.0002). In addition, TMD-related pain had a statistically significant decline following AA treatment (all p < 0.001). Patients' general activity and quality of life (BPI) were described as improved following a course of AA, with statistically significant values for all aspects considered (all p < 0.05). Abdominal acupuncture resulted in effective treatment of subacute/chronic-resistant pain related to TMD, capable of improving mandibular function and facial pain, and reduced the interference of pain affecting patients' quality of life.

Comparison of three different exercise trainings in patients with chronic neck pain: a randomized controlled study.

Neck pain is a common problem in the general population and second only to low back pain in musculoskeletal problems. The aim of this study is to compare three different types of exercise training in patients with chronic neck pain. This study was conducted on 45 patients with neck pain. Patients were divided into 3 groups: Group 1 (conventional treatment), Group 2 (conventional treatment plus deep cervical flexor training), and Group 3 (conventional treatment plus stabilization of the neck and core region). The exercise programs were applied for four weeks, three days a week. The demographic data, pain intensity (verbal numeric pain scale), posture (Reedco's posture scale), cervical range of motion ([ROM] goniometer), and disability (Neck Disability Index [NDI]) were evaluated. In all groups, a significant improvement was found in terms of pain, posture, ROM, and NDI values in all groups (P < 0.001). Between the groups, analyses showed that the pain and posture improved more in Group 3, while the ROM and NDI improved more in Group 2. In addition to conventional treatment, applying core stabilization exercises or deep cervical flexor muscle training to patients with neck pain may be more effective in reducing pain and disability and increasing ROM than conventional treatment alone.

A Comparative Study of Epidural Butorphanol and Fentanyl as Adjuvants with 0.5% Bupivacaine for Postoperative analgesia in Lower Abdominal Surgeries

The pain is considered as sixth vital sign. Achieving adequate peri-operative and post -operative analgesia is of paramount importance to the anesthesiologist. This can be done by multiple approaches. One such technique is use of Epidural opioids. This study evaluates the analgesic efficacy of epidural fentanyl and butorphanol in lower abdominal surgeries for post -operative analgesia. Aims: To compare the degree of post-operative analgesia using butorphanol and fentanyl administered by epidural route. Settings and Design: Study setting: Tertiary care Hospital Study Design: A Prospective Double Blinded Randomised Clinical Study Methods and Material: A total of 60 Patients posted for elective lower abdominal surgeries were randomly selected for the study. The patients aged 20-60 years of ASA grade one and two posted for elective lower abdominal surgery were selected for the study. Drugs used were explained to the patients and also educated about Verbal numerical scale for assessment of pain. Patients were divided into two groups: Group A: receives Butorphanol 1mg mixed with 15 ml Bupivacaine 0.5%diluted upto 20 ml. Group B: receives Fentanyl 100 microgram mixed with 15 ml Bupivacaine 0.5% diluted upto 20 ml. Statistical analysis used: Statistical data was analysed using • Chi-square test • Student t-test (Paired and unpaired t-test) • A P value of &lt; 0.05 is significant and &gt;0.05 is not significant Results: The demographic variables were comparable in both groups. Both inj. Butorphanol 1 mg and Inj. Fentanyl 100 mcg given epidurally with Inj. Bupivacaine 0.5% as a single shot provided excellent operative conditions and satisfactory post-operative analgesia in both the groups. However, the duration of post-operative analgesia was much longer in the butorphanol group than Fentanyl group and was statistically significant. No serious side effects were noted in both groups. The method is economical, safe, convenient and acceptable and also poly pharmacy is avoided. Conclusions: Both fentanyl and butorphanol are safe and effective as epidural agents for postoperative analgesia with little side effects.