Visual Numeric Scale Research Articles

Application of single-point prostate biopsy in elderly patients with highly suspected prostate cancer.

ObjectiveTo explore the feasibility of single-point prostate biopsy in elderly patients with highly suspected prostate cancer.MethodsForty-three patients with a prostate imaging reporting and data system score (PI-RADS) of 5, age ≥ 80 years and/or PSA ≥ 100 ng/ml and/or Eastern Cooperative Oncology Group score ≥ 2 were enrolled in our hospital from March 2020 to June 2022. Targeted surgery of these patients was performed using only precise local anesthesia in the biopsy area. The biopsy tissues were examined by intraoperative frozen section examination (IFSE). If the result of IFSE was negative, traditional systematic biopsy and further routine pathological examination were performed. The positive rate of biopsy, operation time, complications and pain score were recorded.ResultsThe positive rate of prostate biopsy was 94.7%. The results of IFSE in two patients were negative, and the routine pathological results of further systematic biopsy of those patients were also negative. The visual analog scale and visual numeric scale were 2 (2-4) and 3 (2-3), respectively, during the biopsy procedure. The mean time of operation was 8.5 ± 2.1 min from the beginning of anesthesia to the end of biopsy. It took 35.3 ± 18.7 minutes to obtain the pathological report of IFSE. The incidences of complication hematuria and urinary retention were 10.5% and 2.6%, respectively.ConclusionFor elderly patients with highly suspected prostate cancer, single-point prostate biopsy can be used to quickly and safely obtain pathological results.

Translated article] Benefits of analgesic blocks, PENG block (PEricapsular Nerve Group), in fast recovery after hip surgery

IntroductionHip fracture is a frequent orthopaedic emergency which associates high morbidity and mortality and intense pain. Locoregional analgo-anaesthetic techniques, both central and peripheral, occupy a preferential place in the multimodal therapeutic arsenal. Recently, a new regional blockade has emerged, the pericapsular block or PENG block (PEricapsular Nerve Group).The objective is to evaluate in patients with hip fracture, the antinociceptive efficacy of the preoperative PENG block, residual motor block and time for postoperative functional recovery. Method and materialsProspective descriptive observational study with patients going to have total hip arthroplasty. PENG block was performed before surgery. Pain was assessed with the Visual Numerical Scale (VNS) before the blockade, 30min later, in the immediate postoperative period and 24h after the intervention. Motor block according to the Bromage scale and time needed for assisted walking were also evaluated. ResultsPENG block provided effective analgesia in all patients, with a decrease in at least 3 points on the VNS at every step in which it was evaluated. The average difference between pain before and after the block was 7.5 points on the VNS. It allowed the transfer and placement of the patient without haemodynamic alteration, exacerbation of pain or other complications. ConclusionsPENG block is an effective and safe regional analgesic technique for patients with hip fracture. It allows mobilisation and placement before surgery without pain exacerbation, promoting early mobility and rehabilitation.

Digital occlusal splints for temporomandibular joint disorders: a systematic review

Objectives. This systematic review aimed at assessing the therapeutic efficacy of computer-assisted or digitally constructed occlusal splints in comparison to conventional splint treatment for temporomandibular disorders or bruxism. Material and methods. The study was prospectively registered in the Open Science Framework. Four electronic databases, PubMed, Embase, Web of Science, and Scopus, were searched comprehensively. The following keywords were employed: “3D-printed”, “additive manufacture”, “computer-aided design/computer-aided manufacturing”, “temporomandibular joint”, “temporomandibular joint dysfunction”, “bruxism”, “disc displacement”, “temporo-mandibular disorder”, “splint’, “oral splint”, “occlusal splint”, “occlusal device”, “bite splint”, “occlusal appliance”. Two risk of bias evaluation instruments were used to assess the quality of the included studies. Outcomes. Following the application of the search strategy, a total of 557 publications were identified in the electronic databases. Seven eligible articles were finally included in the analysis. Six publications (85.7%) compared digitally manufactured occlusal splints to conventionally created splints, while one examined if the use of a facebow influences the performance of digital splints. Visual assessment scores or numerical rating scales of pain, optical axiography, tooth wear, and bruxism frequency were reported as outcomes. Conclusions. Computer aided design occlusal splints provide equivalent outcomes to traditional splints. Some generated superior results, mainly probable as a result of the virtual articulator's greater precision and the splint materials' material qualities.

The Impact of The Labial Flange and Artificial Teeth on Lip Support in Elderly Patients with Maxillary Complete Dentures

Both maxillary complete denture’s labial flange and anterior artificial teeth play important roles in re-establish major support for the upper lip of elderly patients. However, whether the labial flange can be removed and still perceived as aesthetic remain unclear. Objective: To determine the perception of young adults toward the effect of a labial flange and anterior teeth on lip support of an elderly with maxillary complete dentures. Methods: A total of 64 young adults were recruited to evaluate the lip support for facial aesthetics of 30 full-face photographs in 3 different states: with an original complete denture (CD), with a flangeless duplicated denture and without the complete denture. They were rated using a Visual Numerical Scale (VNS) of 10, with 1 being the least attractive and 10 being the most attractive and repeated twice in random order. Soft-tissue profile analysis was performed to determine which facial anatomical landmarks were most important for lip support and aesthetics. Results: The overall VNS rating with CD (6.33 ± 0.58) was significantly higher (p < 0.001) than images with flangeless (5.58 ± 1.01) or without CD (5.23 ± 1.30). The landmarks that showed the most significant changes were in the subnasale area and NLA with original CD (p=0.060, p=0.072) and in frontal lip thickness with flangeless (p=0.082). There are strong correlations between subnasale and NLA and the mean total aesthetic VNS rating of images with CD, but not statistically significant (r=0.708; p=0.118, r=-0.835; p=0.078). Conclusion: The labial flange of a maxillary complete denture plays an important role in lip support and results in the aesthetic perception of the dentures wearer. The anterior teeth alone provide fullness to the lips, but not enough for labial support.

The effect of listening to the music of the patient's own or others' choice during cesarean sections on pain, and its contribution to anesthesia technicians

To investigate the effect of listening to the music of the patient's own or others' choice during the cesarean section on the intraoperative pain of the expectant mother and its contribution to the anesthesia technicians' practice. This study is a single-centre, controlled and randomized trial involving 92 patients. During cesarean section, pregnant women in the intervention group listened to music of their own or our choice with headphones. We placed headphones on the patients in the control group but played no music. We performed cesarean sections under regional anesthesia. We collected a variety of subjective (visual analog and numerical scale for pain) and objective parameters (heart rate, blood pressure and amount of medication leftover from postoperative PCA) during the incision and suturing of the skin. We found no differences between the groups in terms of systolic-diastolic blood pressure and heart rate. However, we observed that the VAS scores in the group listening to music in the Acemashiran maqam (a melody type in Turkish classical music) were lower than the control group (p=0.02). On the other hand, there was no difference between the VAS scores of patients listening to the music of their own choice and that of the group listening to music in the Acemashiran maqam or from the control group (p>0.05). At the end of the study, 87.5% of the patients liked the music preferences, while 93.8% desired to listen to music during the next cesarean section. Listening to music reduces patients' pain during cesarean section. Comparisons with the control group showed that the effect of music in the Acemashiran maqam on pain was even more pronounced than that of the patient's own choice.

The Effectiveness of Intraosseous Basivertebral Nerve Radiofrequency Ablation for the Treatment of Vertebrogenic Low Back Pain: An Updated Systematic Review with Single-Arm Meta-analysis.

ObjectiveTo provide an estimate of the effectiveness of basivertebral nerve (BVN) radiofrequency ablation (RFA) to treat vertebrogenic low back pain (LBP).DesignSystematic review with single-arm meta-analysis.PopulationPersons ≥18 years of age with chronic LBP associated with type 1 or 2 Modic changes.InterventionIntraosseous BVN RFA.ComparisonSham, placebo procedure, active standard care treatment, or none.OutcomesThe proportion of patients treated with BVN RFA who reported ≥50% pain score improvement on a visual analog scale or numeric rating scale. The main secondary outcome was ≥15-point improvement in Oswestry Disability Index score.MethodsThree reviewers independently assessed articles published before December 6, 2021, in MEDLINE and Embase. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to evaluate the overall quality of evidence.ResultsOf the 856 unique records screened, 12 publications met the inclusion criteria, representing six unique study populations, with 414 participants allocated to receive BVN RFA. Single-arm meta-analysis showed a success rate of 65% (95% confidence interval [CI] 51–78%) and 64% (95% CI 43–82%) for ≥50% pain relief at 6 and 12 months, respectively. Rates of ≥15-point Oswestry Disability Index score improvement were 75% (95% CI 63–86%) and 75% (95% CI 63–85%) at 6 and 12 months, respectively.ConclusionAccording to GRADE, there is moderate-quality evidence that BVN RFA effectively reduces pain and disability in most patients with vertebrogenic LBP. Further high-quality studies will likely improve our understanding of the effectiveness of this procedure.

The influence of cold versus room temperature charcoal on reducing nausea of poisoned patients: A randomized clinical trial

Objective: Intoxication is among the most common causes of emergency department (ED) visits. Activated charcoal is one of the useful treatments preventing poison absorption. However, nausea caused by using charcoal has made this substance less acceptable among patients. This study aims at investigating the influence of using cold charcoal on reducing the nausea among poisoned patients. Methods: This clinical experimental trial study approved by the Medical Ethics Committee of Regional School of Medicine of Mashhad University of Medical Sciences with the code 930106. Randomization was provided by Sealed Envelope. Accordingly, the experimental group received cold charcoal (4ᵒC), while the control group received room temperature charcoal (23ᵒC). We used the coding method in order to double blind the study. After half and one hour, nausea was checked in patients by visual numeric scale (VNS). Data were described by using descriptive and analytic test indices including frequency, mean ± standard deviation and suitable charts and tables. Results: The average age of participants was 25.83±7.05. The severity of nausea half an hour after consuming charcoal in cold charcoal group and experimental group was 1.3 and 2.73, respectively (P<0.001). One hour after consuming charcoal, the severity of nausea in cold charcoal group and experimental group was 0.39 and 1.38 (P<0.001). As indicated by the results of the study and after investigating the changing trend of nausea severity, nausea severity decreased in both groups by passing time from half to one hour (P<0.001). Conclusion: Cold charcoal can reduce the rate of nausea and make it more acceptable among patients.

Beneficios de los bloqueos analgésicos, PENG (PEricapsular Nerve Group), en la recuperación precoz tras la cirugía de cadera

IntroductionHip fracture is a frequent orthopedic emergency which associates high morbidity and mortality and intense pain. Locoregional analgo-anesthetic techniques, both central and peripheral, occupy a preferential place in the multimodal therapeutic arsenal. Recently, a new regional blockade has emerged, the pericapsular block or PENG block (PEricapsular Nerve Group).The objective is to evaluate in patients with hip fracture, the antinociceptive efficacy of the preoperative PENG block, residual motor block and time for postoperative functional recovery. Method and materialsProspective descriptive observational study with patients going to have total hip arthroplasty. PENG block was performed before surgery. Pain was assessed with the Visual Numerical Scale (VNS) before the blockade, 30min later, in the immediate postoperative period and 24h after the intervention. Motor block according to the Bromage scale and time needed for assisted walking were also evaluated. ResultsPENG block provided effective analgesia in all patients, with a decrease in at least 3 points on the VNS at every step in which it was evaluated. The average difference between pain before and after the block was 7.5 points on the VNS. It allowed the transfer and placement of the patient without hemodynamic alteration, exacerbation of pain or other complications. ConclusionsPENG block is an effective and safe regional analgesic technique for patients with hip fracture. It allows mobilization and placement before surgery without pain exacerbation, promoting early mobility and rehabilitation.

Effect of Two Different Temperature Settings on Patient Comfort Level during Respiratory Therapy by High-Flow Nasal Cannula

Abstract Background Hypoxemic respiratory failure may require high flow O2 therapy (>15 L/m), which can be delivered using a high-flow nasal cannula (HFNC) device. There are three variables: FiO2, flow, and temperature that can be controlled while using HFNC. This study was planned to assess the degree of comfort level of patients at two different temperature settings. Methods A prospective interventional cross-over study was performed on 40 hypoxemic respiratory failure patients, who were on HFNC. Primary outcome was to assess patient comfort during HFNC therapy at two different temperatures (31 and 37°C), at the flow of 60 L/m for 30 minutes at each temperature setting, leaving FiO2 unchanged. After 30 minutes of each temperature setting, the comfort level was assessed using 11 score visual numerical scale (ranging from 0 to 10) together with other vital parameters. Result Patients were found to be more comfortable at temperature settings of 31°C than at 37°C (p-value < 0.05%). Also, an increase in blood pressure was observed at 37°C after completion of 30 minutes, which was statistically significant but not clinically significant. Conclusion Starting HFNC therapy at lower temperature gives better patient acceptance and reduces chances of failure due to discomfort.

Predictive Factors for the Severity of Procedure-Associated Pain in Infertile Women Undergoing Hysterosalpingography in Bayelsa State, South-South Nigeria

Background: Hysterosalpingography is the most commonly used investigative modality for the evaluation of tubal patency. It is cheap, readily available and reliable. However, its main drawback is associated pain.
 Objective: To determine the predictive factors for the severity of procedure-associated pain in infertile women undergoing hysterosalpingography.
 Materials and Methods: This prospective, descriptive, cross-sectional study was conducted at the infertility clinics and radiology departments of the Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri, both in Bayelsa State, Nigeria, between July, 2021 and February, 2022. Hysterosalpingography was done after written informed consent by the patient. The Visual Analogue Scale and Numerical Rating Scale were used to grade pain levels during and after the procedure, respectively. Data were analysed using Statistical Product and Service Solutions for Windows®, version 25. Results were presented in frequencies and percentages for categorical variables, and mean and standard deviation for continuous variables. Student’s t-test was used to compare sample means, and Chi-square, for testing associations.
 Results: The odds of experiencing pain increased with increasing age (Crude OR = 3.48 – 5.34; p = < 0.05). Women with tertiary level of education were three times more likely to report pain (Crude OR = 3.58; p = 0.029) than those with primary level of education. Parity (ꭓ2 = 19.85; p – 0.001), type of infertility (ꭓ2 = 5.93; p = 0.015) and duration of infertility (ꭓ2 = 11.08; p = 0.004) had significant relationships with the severity of pain perception. Dysmenorrhoea (Crude OR = 1.99; p = 0.001) was also significantly associated with pain perception. Pain was two times more likely to be experienced by women with abnormal hysterosalpingography findings.
 Conclusion: Our study established that the predictors of pain perception in hysterosalpingography were age, level of education, duration of marriage, duration of infertility, parity, number of children, type of infertility, dysmenorrhoea and abnormal findings on hysterosalpingography.

Topical Cannabidiol (CBD) After Total Knee Arthroplasty Does Not Decrease Pain or Opioid Use: A Prospective Randomized Double-Blinded Placebo-Controlled Trial

BackgroundMultimodal analgesia has become the standard of care for pain management following total knee arthroplasty (TKA). Cannabidiol (CBD) is increasingly utilized in the postoperative period. The purpose of this study was to analyze the analgesic benefits of topical CBD following primary TKA. MethodsIn this randomized double-blinded placebo-controlled trial, 80 patients undergoing primary unilateral TKA applied topical CBD (CBD; n = 19), essential oil (EO; n = 21), CBD and essential oil (CBD + EO; n = 21), or placebo (PLA; n = 19) thrice daily around the knee for two weeks postoperatively. This supplemented a standardized multimodal analgesic protocol. Outcomes included visual analog scale (VAS) pain and numeric rating scale (NRS) sleep scores (collected on postoperative day [POD] 0, 1, 2, 7, 14, 42), and cumulative postoperative opioid use (42 days). ResultsDemographic characteristics were similar among the four cohorts. Preoperative VAS and NRS scores were similar among groups. The CBD cohort had a higher mean VAS pain score on POD 2 compared to the EO cohort (CBD: 69.9 ± 19.3 versus. EO: 51.0 ± 18.2; P = .013). No statistically significant differences existed for VAS scores at other times, and no statistically significant differences were observed for postoperative NRS sleep scores or postoperative opioid use at any time point. ConclusionUtilization of topical CBD in supplement to multimodal analgesia did not reduce pain or opioid consumption, or improve sleep scores following TKA. These results suggest that the local effects of topical CBD are not beneficial for providing additional pain relief after TKA.

Effect of diclofenac as a prophylactic analgesic during hysterosalpingography in Bayelsa State, South-South Nigeria: A randomized controlled trial

Background: Pain is the most frequent side effect of hysterosalpingography, with up to 72% – 80% of women reporting varying degrees of pain during and after the procedure. Objective: To evaluate the efficacy of diclofenac for pain relief in infertile women undergoing hysterosalpingography. Materials and Methods: This randomised controlled trial was conducted at the Radiology Departments and Infertility Clinics of the Federal Medical Centre, Yenagoa, and Niger Delta University Teaching Hospital, Okolobiri, both in Bayelsa State, Nigeria, from July 2021 – March, 2022. Three hundred and eighty infertile women undergoing hysterosalpingography were randomised into two groups. Women in Group I were administered diclofenac, while the women in Group II received placebo, prior to the procedure. Pain scores at different steps of the procedure were recorded using the Visual Analog and Numerical Rating Scales. Data were analysed using the Statistical Product and Service Solutions for Windows®, version 25. Student’s t-test was used to compare sample means, while the chi-square test was used to compare the proportion of women in the two study groups, who expressed pain at the different steps of the procedure. Results: Insertion of speculum was the step associated with the least pain during the procedure, the mean pain score at this step being 1.14 ± 1.25. Instillation of contrast media had the highest mean pain score of 4.72 ± 2.13. The pain scores at all steps of the procedure, 30 minutes and 24 hours after the procedure, were significantly lower in the diclofenac group compared to the placebo group (p=0.001).Conclusion: Diclofenac is superior to placebo for the control of hysterosalpingography-associated pain.

VAS and NRS, Same or Different? Are Visual Analog Scale Values and Numerical Rating Scale Equally Viable Tools for Assessing Patients after Microdiscectomy?

Objectives To compare the viability of the numerical rating scale (NRS) and the visual analogue scale (VAS) as a pain assessment tools among a large cohort of patients who underwent microdiscectomy. Summary of Background Data. The pain intensity (PI) reduction is a parameter of surgical treatment efficacy. The two most commonly used scales of PI are NRS and VAS. Many studies have shown strong similarities between those two scales, but the direct interchange is difficult. Methods Patients, who underwent microdiscectomy, were prospectively enrolled into the study and assessed using VAS and NRS for the back (NRS-B) and the leg (NRS-L), Short Form of McGill Pain Questionnaire (SF-MPQ) included Pain Rating Index (PRI) and Oswestry Disability Index (ODI) 1 day before and 1 month and 3 months after the procedure. Results 131 patients were included in the study. NRS-L, NRS-B, VAS, and ODI were significantly lower (p < 0.001) 1 month after microdiscectomy. NRS-L and NRS-B ratings remained at a similar level while VAS and ODI decreased after 3 months. The rate of decline of PI measured by NRS-L correlated statistically significant (rs = 0.366; p < 0.001) with ODI 1 month after surgery. Before surgery, the most significant correlation was found between ODI and NRS-L (rs = 0.494; p < 0.001), the lowest with NRS-B (rs = 0.319; p < 0.001). 3 months after surgery, there was higher correlations between ODI and VAS (rs = 0.634) than NRS-L (rs = 0.265). PRI correlated significantly (p < 0.001) and more stronger with VAS than with NRS-L and NRS-B in every points of assessment. Conclusion The results showed that PI measurements by NRS-L/NRS-B and VAS mutually correlate and impair functionality evaluated by ODI (convergent validity) but in different modes (differential validity). NRS and VAS are not parallel scales and assess different aspects of pain. The measurement of NRS-L 1 month after microdiscectomy seems to give quick insight into the effectiveness of the procedure.

Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain

PurposeThis study aimed to assess clinical outcomes following intradiscal injections of higher-concentration (> 10 ×) platelet-rich plasma (PRP) in patients with chronic lumbar discogenic pain and to compare outcomes with a historical cohort.MethodsThis retrospective study included 37 patients who received intradiscal injections of higher-concentration (> 10 ×) PRP and had post-procedure outcomes data (visual numerical scale pain score, Functional Rating Index [FRI], and NASS Patient Satisfaction Index). Outcomes were compared to a historical cohort of 29 patients who received intradiscal injections of < 5X PRP.ResultsPain and FRI scores significantly improved by 3.4 ± 2.5 and 46.4 ± 27.6, respectively, at 18.3 ± 13.3 months following intradiscal injections of > 10 × PRP (p < 0.001). These improvements were greater than those reported by the historical cohort (1.7 ± 1.6 and 33.7 ± 12.3; p = 0.004 and 0.016, respectively). Additionally, the satisfaction rate was higher in patients receiving > 10 × PRP compared to those receiving < 5 × PRP (81% vs. 55%; p = 0.032).ConclusionsFindings from this study suggest that clinical outcomes can be optimized by using PRP preparations that contain a higher concentration of platelets. Further research is needed to continue to optimize the composition of PRP used to treat patients with lumbar disc disease.

Effectiveness and safety of extracorporeal shock wave treatment for low back pain：a systematic review and meta-analysis of RCTs

This meta-analysis was designed to assess the effectiveness and safety of extracorporeal shock wave therapy (ESWT) for patients with low back pain (LBP). Pubmed, Embase, Cochrane's library, PEDro (Physiotherapy Evidence Database), China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched until December 2019 to identify studies assessing the effectiveness and safety of EPSW for LBP. The prime outcome is pain intensity measured by Visual Analog Scale (VAS) or numeric rating scale (NRS). Other outcomes included functional status, quality of life, psychological outcomes measured by Oswestry Disability Index (ODI), as well as the adverse events. Mean differences (MD) were calculated for continuous outcomes, while odd ratios (OR) were calculated for binary outcomes. Revman 5.3 software was used for statistical analysis. Five randomized controlled trials (RCTs) were finally included in this meta-analysis. The pooled mean difference in post-treatment pain scores was −2.37 (P ＜0.0001), indicating that post-treatment pain scores was significantly higher by 2.37 in control group than in ESWT group. At a mean follow-up time of 4–6 weeks, the pooled mean difference in ODI scores was −14.10 (P ＜0.00001), indicating that the pooled mean difference of post-treatment ODI scores was 14.10 higher in control group than in ESWT group. The use of ESWT is effective in alleviating pain and improving the general functional state for patients with LBP. However, more evidence was needed to verify its safety.

The Effect of Intraoperative Transversus Abdominis Plane Blocking on Postoperative Pain After Laparoscopic Transabdominal Pre-peritoneal (TAPP) Groin Hernia Repair.

BackgroundManaging postoperative pain even after laparoscopic groin hernia repair still remains an interesting challenge for clinicians especially for patients of high risk. Plenty of operative techniques and analgesic methods have been proposed in order to minimize postoperative pain after laparoscopic groin hernia repair. The aim of the present study is to compare transverse abdominis plane (TAP)-block with local analgesic infiltration at trocar entry sites in the terms of reducing postoperative pain.MethodsPatients that underwent laparoscopic trans-abdominal pre-peritoneal (TAPP) groin hernia repair in a high-volume university hospital were included. Patients were divided in two groups depending on the analgesic method used. Pain was assessed using Visual Numerical Scale (VNS) score.ResultsThirty patients were included. Intraoperative TAP-block seemed to be superior in terms of decreasing pain at the hernia area and at the trocar insertion site (p < 0.05) compared to local analgesic infiltration at the trocar insertion site at 6, 12 and 24 h after surgery (p < 0.05). In addition, pain reduction was more effective in rest rather than in motion for both analgesic methods.ConclusionIntraoperative TAP-block under direct vision seems to be an effective, fast and easy technique in order to reduce postoperative pain after laparoscopic groin hernia repair, but more studies are required to validate these results in a prospective and randomized context.

Pharmacological treatment in adult patients with CRPS-I: a systematic review and meta-analysis of randomized controlled trials.

Several pharmacological treatments have been proposed for the treatment of complex regional pain syndrome type-I (CRPS-I) in adults, but data regarding the efficacy of various agents for this disease is scarce. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to analyse the efficacy of the various pharmacological approaches in adults with CRPS-I. We systematically searched PubMed, Scopus, and Web of Science databases from the inception date to 30 June 2021 to identify placebo-controlled or active-controlled RCTs using bisphosphonates, ketamine, CSs, anti-epileptics, NSAIDs/COXIBs, opiates, antidepressants, scavengers/magnesium sulphate or IVIGs for the treatment of CRPS-I. The primary outcomes included changes in the visual analogue scale (VAS) or numeric rating scale (NRS) for pain before and after treatment. We included 20 placebo-controlled or active-controlled RCTs (including a total of 818 adults with CRPS-I) that used bisphosphonates (n = 7), ketamine (n = 2), CSs (n = 2), anti-epileptics (n = 1), NSAIDs/selective inhibitors of cyclooxygenase-2 (COXIBs) (n = 2), scavengers/magnesium sulphate (n = 5), or IVIGs (n = 1) to treat CRPS-I during a median follow-up of 26 weeks. Treatment with bisphosphonates showed a significant reduction in the values of the VAS/NRS pain scale compared with placebo or reference therapy (random effects weighted mean difference [WMD]: -23.8, 95% CI: -28.0 to -19.6; I2 = 36.4%). Treatment with ketamine also documented a reduction in the values of the VAS/NRS for pain (random effects WMD: -8.27, 95% CI: -12.9 to -3.70; I2 = 0%). Treatment with other agents did not reduce the values of the VAS/NRS assessments of pain. This systematic review and meta-analysis supports the recommendation of parenteral bisphosphonates as the first-line agent in the treatment of CRPS-I. Open Science Framework registries, https://osf.io/et9gu/, osf.io/et9gu.

Digital insertion of Foley catheter 16F versus 22F versus 28F in unripe cervix labor induction: A randomized trial.

To explore digital insertion in dorsal recumbent position of 16F, 22F, or 28F catheter bores on insertion failure, duration, and pain in unripe cervix labor induction. A randomized trial was performed in a University hospital in Malaysia. Term women scheduled for labor induction, Bishop score ≤ 5, singleton, cephalic presentation, intact membrane, and reassuring pre-induction fetal heart rate tracing were recruited. Women with known gross fetal anomaly, allergy to latex and inability to consent or language difficulty were excluded. Participants were randomized to 16F, 22F, or 28F Foley catheter. Primary outcome was insertion failure and main secondary outcomes were insertion duration and pain (assessed by a Visual Numerical Rating Scale [VNRS] 0-10, higher score more pain). Analysis is done by analysis of variance (ANOVA), Kruskal-Wallis, and chi square test across the three arms and by t test and Mann-Whitney U test for pair wise comparisons. One hundred twenty-seven participants' data were analyzed. The insertion failure 7/43(16%) versus 4/42(10%) versus 5/42(12%), p=0.64, insertion duration median [IQR] 2.8 [1.8-4.8] versus 2.8 [1.7-3.7] versus 2.8 [1.7-4.3] min, p=0.68 and insertion pain VNRS mean {SD} 4.2 {2.5} versus 3.4 {2.3} versus 3.6 {2.2}, p=0.26, insertion to delivery interval 26.0 {9.7} versus 25.6 {9.1} versus 22.8 {7.4} h, p=0.45, and spontaneous vaginal delivery 20/43 (45%) versus 23/42(55%) versus 25/42(60%), p=0.48 for 16F versus 22F versus 28F arms, respectively. Pairwise comparisons were not different. Foley catheter 16F versus 22F versus 28F resulted in similar digital insertion performance in the dorsal recumbent position for unripe cervix labor induction. https://doi.org/10.1186/ISRCTN21224268.

Foley catheter and controlled release dinoprostone versus foley catheter labor induction in nulliparas: a randomized trial.

To evaluate Foley catheter and controlled release dinoprostone insert compared to foley catheter alone on induction to delivery interval and maternal satisfaction. A randomized trial was conducted in a university hospital in Malaysia from December 2018 to May 2019. Term nulliparas with unfavorable cervix (Bishop score ≤ 5) scheduled for labor induction were randomized to Foley catheter and controlled release dinoprostone insert simultaneously or Foley catheter alone. Primary outcomes were induction to delivery interval (hours) and maternal satisfaction on birth experience (assessed by 11-point Visual Numerical Rating Scale VNRS 0-10, higher score more satisfied). Induction to vaginal delivery intervals was mean ± standard deviation 22.5 ± 10.4 vs. 35.1 ± 14.9h, P = < 0.001 but maternal satisfaction on birth experience was not significantly different median[interquartile range] VNRS 8[7-9] vs. 8[7-9], P = 0.12 for Foley catheter-controlled-release dinoprostone and Foley catheter alone arms, respectively. Cesarean delivery rates were 35/102(34.3%) vs. 50/101(49.5%), P = 0.02 RR 0.7 95% CI 0.5-0.9 NNTb 6.3 95% CI 3.5-39.4, pain score at 6h after catheter insertion 5[2-8] vs. 1[1-3], P < 0.001, Bishop score at trial devices removal 9[9-10] vs. 8[7-9], P = 0.001, requirement for oxytocin induction or augmentation 39/102(38.2%) vs. 76/101(75.2%) NNTb 3 95% CI 2.0-4.1, P < 0.001 and amniotomy rates 73/99(73.7%) vs. 81/95(85.3%), P = 0.052 RR 0.9 85% CI 0.8-1.0 in Foley catheter-controlled-release dinoprostone and Foley catheter alone arms respectively. In nulliparas with unripe cervixes at term, combined Foley catheter and controlled release dinoprostone vaginal insert compared to Foley catheter alone reduces the induction to vaginal delivery interval and cesarean delivery rate but satisfaction was not significantly increased. ISRCTN2282883, 03/12/2018, "prospectively registered" ( https://doi.org/10.1186/ISRCTN12282883 ).

Directed cough manoeuvres in the early period after open abdominal surgery

IntroductionPostoperative pulmonary complications are a common cause for morbidity and mortality after open abdominal surgery (OAS). Incisional pain and restrictive lung dysfunction may impair cough effectiveness, leading to secretion retention. Ineffective cough is a most important factor in the development of postoperative pulmonary complications. The aim of this study was to determine the most effective directed cough manoeuvre early after OAS.MethodsThe study involved 41 patients (19 females, 22 males; median age: 44.0 years) who underwent OAS. Cough effectiveness was assessed by measuring peak cough flow on the 1st postoperative day with a portable flow meter in 4 different cough manoeuvres: (1) baseline cough 1: patients were asked to cough as effectively as possible; (2) supported cough; (3) supported cough after maximum inspiration; (4) baseline cough 2. Pain intensity during the measurements was evaluated with the Visual Numeric Scale (0–10).ResultsWhen the 4 cough conditions were compared, peak cough flow was significantly different (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). This difference was due to the superiority of supported cough after maximum inspiration in comparison with the other 3 manoeuvres (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Pain did not significantly differ among the 4 measurements (&lt;i&gt;p&lt;/i&gt; = 0.869).ConclusionsCoughing with abdominal support after maximum inspiration in a semi-recumbent position provides the most effective cough flow after OAS, without increasing incisional pain intensity. Patients who underwent OAS should be encouraged to practise this manoeuvre in the early postoperative period in order to help bronchial drainage and prevent postoperative pulmonary complications.