Onset Of Pain Research Articles

Prevalence, Risk Factors, and Complications of Sickle Cell Disease in Saudi Arabia: A Systematic Review.

This study examined sickle cell disease (SCD) in Saudi Arabia. A systematic search of relevant databases was conducted to identify studies investigating SCD in the Saudi population. Studies were then screened based on predefined criteria and critically appraised for methodological quality. Data was extracted and synthesized to provide an overall picture of the SCD burden in Saudi Arabia. The most commonly reported complications were vaso-occlusive crises (VOC), acute chest syndrome (ACS), acute painful crisis, splenic sequestration, osteomyelitis, aplastic crisis, hemolytic crisis, serious bacterial infections, chronic vascular occlusion (CVO), depression, sickle cell nephropathy (SCN), obstructive sleep apnea (OSA), and renal complications. Reduced blood levels of antioxidant trace elements (Cu, Zn, and Se) may encourage oxidative stress, which in turn may contribute to the pathophysiology of SCD. Infections and ACS were common among young children (<7 years) while pain attacks were common in older children (>7 years). The high rate of hospitalizations among SCD patients highlights the need for better management strategies. Future research should focus on understanding the underlying causes of SCD complications and developing new ways to control them.

Familial Mediterranean Fever Triggered by Menstruation – A Case Report from Zambia

Familial Mediterranean Fever (FMF) is an autoinflammatory autosomal-recessive disorder that is characterized by recurrent attacks of abdominal pains, fevers and serositis. It is highly prevalent among people from the Mediterranean basin including Arabs and Turks. However, due to the increase in migration worldwide, we start to recognize cases of FMF outside the Mediterranean region. We present the case of a 27-year-old Lebanese female residing in Zambia whose recurrent attacks constantly coincided with her menstruation. Due to the rarity of occurrence of FMF in regions such as Zambia, the coming up with the diagnosis was delayed and unnecessary interventions such as exploratory laparotomy were done. This case aims to highlight the importance of considering FMF and its potential triggers especially menstruation by the healthcare providers in non-Mediterranean areas to ensure timely recognition and management to avoid serious future complications such as amyloidosis.

Adnexal torsion: A comprehensive review of types, pathophysiology, diagnosis, and management strategies during pregnancy

Adnexal torsion is a gynecological surgical emergency which during pregnancy can be associated with high patient morbidity and fetal mortality if not managed promptly. Fertility preservation is an essential concern. The underlying pathophysiology involves ovarian tissue torsion on its pedicle, leading to decreased venous return, stromal edema, internal hemorrhage, and infarction. It can affect females of all age groups, and they present mainly with an acute onset of pelvic pain, followed by nausea and vomiting. Multiple risks can lead to adnexal torsion, including ovulation induction, use of in vitro fertilization, and the presence of an ovarian mass. Early diagnosis is challenging and mainly depends on clinical suspicion, ultrasound, or MRI findings; however, it is necessary to preserve the function of the ovaries and fallopian tubes and prevent the occurrence of infertility. Once adnexal torsion is suspected, surgery or detorsion is the main line of treatment. This review will summarize the most relevant studies on risk factors, radiological findings, and managing maternal adnexal torsion in pregnancy.

Unexplained colonic necrosis in a patient with end-stage kidney disease on chronic hemodialysis: case report and review of uremic colitis

BackgroundIntestinal necrosis in uremic patients has been reported but is rare.Case presentationA 56-year-old male patient who underwent long-term regular haemodialysis was admitted to the hospital due to involuntary shaking of the limbs and nonsense speech. The patient’s symptoms improved after continuous blood purification under heparin anticoagulation, rehydration, sedation, and correction of electrolyte disturbances. However, the patient experienced a sudden onset of abdominal pain and a rapid decrease in blood pressure; high-dose norepinephrine were required to maintain his blood pressure. A plain abdominal radiograph performed at bedside showed intestinal dilation. Colonoscopy revealed inflammation and oedema of the entire colon, with purulent secretions and multiple areas of patchy necrosis. The cause of intestinal ischaemia was not clear.ConclusionsAlthough rare, previous causes of uremic colitis have been reported. As the patient developed abdominal pain before the onset of shock and the necrosis was seen on colonoscopy, we suspect that this is a case of fulminant uremic colitis.

Innovative Physiotherapy Approaches in Managing Patellar Tendinopathy (Jumper’s Knee): An Updated Literature Review

Introduction: Patellar tendinopathy (jumper's knee) is an overuse injury that usually has a gradual onset of pain. This condition is common in jumping athletes, characterized by local pain at the attachment of the proximal tendon to the bone and dysfunction of the patellar tendon during jumping and landing. Patellar tendinopathy clinically results from high loads on the tendon, such as jumping and changing direction. Patellar tendinopathy can affect health and quality of life by limiting participation in sports and activities for athletes. Objective: This study aims to summarize secondary data related to physiotherapy management of patellar tendinopathy. Methods: The research method used is a literature study using secondary data in the form of journals related to the topic of patellar tendinopathy (jumper's knee) obtained through Google Scholar, Science Direct, and PubMed. Results: From five recent journal articles obtained with various physiotherapy intervention protocols, the results were able to reduce symptoms in patients with patellar tendinopathy. Conclusion: Physiotherapeutic interventions such as progressive tendon-loading exercises (PTLE), Eccentric exercise programmes, Kinesio-tape® and isometric exercises are effective in reducing symptoms in patients with patellar tendinopathy. Keyword: patellar tendinopathy, jumper's knee, physiotherapy

Postoperative pain management is basic support of comfortable treatment in alveolar surgery

As a new clinical concept, comfortable treatment is gaining increasingly acceptance. Pain is the fifth vital sign in humans and the primary concern for patients. It is also a clinical issue that must be faced in alveolar surgery. This article summarizes pain cognition, the impact of postoperative pain and clinical pain grading. It also discusses the significance of postoperative pain management. It also categorizes commonly used analgesic medications in clinical practice; and introduces the concepts and techniques of comfortable treatment and comfortable therapy. The author suggests that in order to achieve comfortable treatment in alveolar surgery, the first step is to relieve postoperative pain. Postoperative pain management should not only be treated as temporary analgesia but should be managed around the perioperative period as the key stage. Using preemptive analgesia before the onset of pain, combined with non-pharmacological methods, provides basic support and guarantee for patients to achieve the goal of comfortable treatment. The purpose of this article is to emphasize comprehensive control of postoperative pain in alveolar surgery, guiding and promoting the popularization and promotion of corresponding technologies with the concept of comfortable treatment. This aims to reduce the adverse impact of surgery on both physical and mental well-being, facilitating physiological recovery and enhancing patient compliance. To ensure that patients undergo diagnosis, treatment, and rehabilitation processes with ease, comfort, and satisfaction.

Current Challenges and Emerging Therapies in the Treatment of Gout.

Gout is a common form of inflammatory arthritis characterized by the deposition of MSU in the joints and surrounding tissues, which results in inflammation and recurrent painful attacks. Currently, xanthine oxidase inhibitors, i.e., Allopurinol and Febuxostat, are used in the therapy. Recently, nanoparticles (NPs) containing metal oxides and non-metal oxides have also been developed to better manage gout. This comprehensive review summarizes the pathophysiology of gout, currently used drugs in the treatment, followed by emerging therapies for gout.

Psychiatric morbidity across the life course and provoked vulvodynia: is it dependent upon the presence of non-stress-related immune dysfunction?

Vulvodynia impacts up to 8% of women by age 40, and these women may have a more compromised immune system than women with no vulvar pain history. Given that psychiatric morbidity is associated with vulvodynia and is known to activate immune inflammatory pathways in the brain and systemically, we sought to determine whether the association between psychiatric morbidity and vulvar pain was independent of or dependent upon the presence of immune-related conditions. Women born in Sweden between 1973 and 1996 with localized provoked vulvodynia (N76.3) and/or vaginismus (N94.2 or F52.5) diagnosed between 2001 and 2018 were matched to two women from the same birth year with no vulvar pain. International Statistical Classification of Diseases and Related Health Problems (ICD-9 or -10 codes) were used to identify women with a history of depression, anxiety, attempted suicide, neurotic disorders, stress-related disorders, behavioral syndromes, personality disorders, psychotic disorders, or chemical dependencies, as well as a spectrum of immune-related conditions. The Swedish National Prescribed Drug Register was used to identify women with filled prescriptions of antidepressants or anxiolytics. Vulvodynia, vaginismus, or both were outcomes assessed in relation to psychiatric morbidity. Women with vulvodynia, vaginismus, or both, relative to those without vulvar pain, had adjusted odds ratios between 1.4 and 2.3, with CIs highly compatible with harmful effects. When we assessed women with and those without a lifetime history of immune-related conditions separately, we also observed elevated odds ratios in both groups for mood, anxiety, and neurotic and stress disorders. Documenting psychiatric impairment as a cause or consequence of vulvodynia is critical in clinical practice because psychiatric conditions may impact treatment efficacy. Strengths of this study include a data source that represents the entire population of women in Sweden that is known to be highly accurate because Sweden provides universal healthcare. Limitations include difficulty in making an accurate assessment of temporality between psychiatric morbidity and the first onset of vulvar pain. In addition, because Swedish registry data have limited information on lifestyle, behavioral, and anthropomorphic factors such as smoking, diet, physical activity, and obesity, these conditions could not be assessed as confounders of psychiatric morbidity and vulvar pain. Immune pathways by which women with psychiatric conditions increase their risk of vulvar pain could be independent from other immune pathways.

Clostridial Myonecrosis: A Comprehensive Review of Toxin Pathophysiology and Management Strategies.

Clostridial myonecrosis, commonly known as gas gangrene (GG), is a rapidly progressing and potentially fatal bacterial infection that primarily affects muscle and soft tissue. In the United States, the incidence of GG is roughly 1000 cases per year, while, in developing countries, the incidence is higher. This condition is most often caused by Clostridium perfringens, a Gram-positive, spore-forming anaerobic bacterium widely distributed in the environment, although other Clostridium species have also been reported to cause GG. The CP genome contains over 200 transport-related genes, including ABC transporters, which facilitate the uptake of sugars, amino acids, nucleotides, and ions from the host environment. There are two main subtypes of GG: traumatic GG, resulting from injuries that introduce Clostridium spores into deep tissue, where anaerobic conditions allow for bacterial growth and toxin production, and spontaneous GG, which is rarer and often occurs in immunocompromised patients. Clostridium species produce various toxins (e.g., alpha, theta, beta) that induce specific downstream signaling changes in cellular pathways, causing apoptosis or severe, fatal immunological conditions. For example, the Clostridium perfringens alpha toxin (CPA) targets the host cell's plasma membrane, hydrolyzing sphingomyelin and phosphatidylcholine, which triggers necrosis and apoptosis. The clinical manifestations of clostridial myonecrosis vary. Some patients experience the sudden onset of severe pain, swelling, and muscle tenderness, with the infection progressing rapidly to widespread tissue necrosis, systemic toxicity, and, if untreated, death. Other patients present with discharge, pain, and features of cellulitis. The diagnosis of GG primarily involves clinical evaluation, imaging studies such as X-rays, computer tomography (CT) scans, and culture. The treatment of GG involves surgical exploration, broad-spectrum antibiotics, antitoxin, and hyperbaric oxygen therapy, which is considered an adjunctive treatment to inhibit anaerobic bacterial growth and enhance the antibiotic efficacy. Early recognition and prompt, comprehensive treatment are critical to improving the outcomes for patients affected by this severe and life-threatening condition.

Successful treatment of a Himalayan cat with feline orofacial pain syndrome

AbstractFeline orofacial pain syndrome is a neuropathic pain disorder in cats, characterised by oral discomfort and tongue self‐mutilation. The pathogenesis of feline orofacial pain syndrome remains unclear, but trigger factors such as dental disease and environmental stress have been described. Feline orofacial pain syndrome is a diagnosis of exclusion, and suggested treatment includes administration of non‐steroidal anti‐inflammatory agents, opioids and adjuvant drugs for analgesia. This case report describes a 4‐year‐old female Himalayan cat with anorexia, ranula and unilateral lesions of the tongue. Clinical signs ranged from pawing at the mouth to tongue self‐mutilation during severe pain attacks. Although no dental disease was present, a dominant and suppressive partner cat may have had a stressful influence. First‐line treatment with non‐steroidal anti‐inflammatory drugs and opioids could not prevent further pain attacks. Successful treatment was achieved with administration of pregabalin and minimisation of potential stress factors. No clinical signs of pain were observed in a follow‐up period of 2 years.

Polyarthritis in Sjögren's Syndrome: Difficulties in Distinguishing Extraglandular Manifestation and Associated Rheumatoid Arthritis.

Aim of the study was to investigate the demographic data and disease course characteristics of patients with Sjögren's syndrome (SS) and inflammatory joint pain of various origins and to search for factors that might help with the distinction of polyarthritis as an extraglandular manifestation and rheumatoid arthritis as an associated systemic autoimmune disorder. A total of 355 patients were retrospectively analyzed, 128 of whom served as controls (SS-C), while 159 had polyarthritis as an extraglandular symptom of Sjögren's syndrome (SS-pa) and 68 were diagnosed as having associated rheumatoid arthritis (SS-RA). The patients without any inflammatory joint manifestations were significantly older than the SS-pa patients, while, for the SS-RA group, the difference was not significant. The onset of joint pain appeared significantly earlier in the SS-RA patients. Regarding either extraglandular manifestations or associated autoimmune disorders, there were significant differences between the controls and both SS-pa and SS-RA groups, while no significant difference was found between the SS-pa and SS-RA groups. Thus, laboratory and imaging methods should be used to differentiate between the two conditions, but laboratory biomarkers are even more important for early diagnosis. A ROC curve analysis showed an acceptable diagnostic accuracy in differentiating between SS-pa and SS-RA patients using a binary logistic regression model, where highly positive rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) values, kidney involvement, and anti-Ro/SS-A positivity were shown to significantly raise the odds of having RA, whereas anti-La/SS-B positivity seemed to have a protective role, since it significantly decreased the odds of having it. Further biomarkers are needed to better classify SS patient cohorts with inflammatory joint pain of different origins and, consequently, different management requirements.

Cerebral hemodynamics as biomarkers for neuropathic pain in rats: a longitudinal study using a spinal nerve ligation model.

Neuropathic pain is one of the most challenging types of pain to diagnose and treat, a problem exacerbated by the lack of a quantitative biomarker. Recently, several clinical and preclinical studies have shown that neuropathic pain induces cerebral hemodynamic changes as a result of neuroplasticity in the brain. Our hypothesis in this study is that neuropathic pain leads to cerebral hemodynamic changes over postoperative time in a spinal nerve ligation (SNL) rat model, which has not been longitudinally explored previously. Furthermore, by identifying multiple regional hemodynamic features that are the most distinct between SNL and sham groups, where the sham group underwent only an incision without SNL, it may be possible to classify the SNL group regardless of when the onset of pain occurs. We investigate cerebral hemodynamic changes using dynamic susceptibility contrast magnetic resonance imaging in a rat model up to 28 days after ligating L5/L6 spinal nerves. We trained a linear support vector machine with relative cerebral blood volume data from different brain regions and found that the prediction model trained on the nucleus accumbens, motor cortex, pretectal area, and thalamus classified the SNL group and sham group at a 79.27% balanced accuracy, regardless of when the onset of pain occurred (SNL/sham: 60/45 data points). From the use of the SNL model without prior knowledge of the onset time of pain, the current findings highlight the potential of relative cerebral blood volume in the 4 highlighted brain regions as a biomarker for neuropathic pain.

Communicating pain: emerging axonal signaling in peripheral neuropathic pain.

Peripheral nerve damage often leads to the onset of neuropathic pain (NeuP). This condition afflicts millions of people, significantly burdening healthcare systems and putting strain on families' financial well-being. Here, we will focus on the role of peripheral sensory neurons, specifically the Dorsal Root Ganglia neurons (DRG neurons) in the development of NeuP. After axotomy, DRG neurons activate regenerative signals of axons-soma communication to promote a gene program that activates an axonal branching and elongation processes. The results of a neuronal morphological cytoskeleton change are not always associated with functional recovery. Moreover, any axonal miss-targeting may contribute to NeuP development. In this review, we will explore the epidemiology of NeuP and its molecular causes at the level of the peripheral nervous system and the target organs, with major focus on the neuronal cross-talk between intrinsic and extrinsic factors. Specifically, we will describe how failures in the neuronal regenerative program can exacerbate NeuP.

Assessment of three criteria to establish borrelial infection in suspected lyme neuroborreliosis.

Diagnosis of (European) Lyme neuroborreliosis has been based on clinical presentation, cerebrospinal fluid (CSF) pleocytosis and demonstration of intrathecal borrelial antibody synthesis (ITBAS) to document Borrelia burgdorferi s. l. It is not known if other criteria to document Borrelia infection may contribute to the diagnosis. We compared the sensitivity of three individual criteria (ITBAS, CSF Borrelia culture, and the presence of erythema migrans [EM]) to confirm the diagnosis of early Lyme neuroborreliosis in 280 patients ≥ 15 years of age evaluated at a Lyme borreliosis outpatient clinic in Slovenia. The patients had either radicular pain of new onset or involvement of a cranial nerve but without radicular pain, each in conjunction with CSF pleocytosis. Evaluation was of patients who had each of the three confirmatory criteria assessed, and for whom at least one criterion was positive. Analysis of 280 patients, 120 women and 160 men, median age 57 (range 15-84) years, revealed that ITBAS was the most frequently observed positive criterion (85.4%), followed by EM (52.9%), and by a positive CSF Borrelia culture (9.6%). Of the 280 patients, 154 (55%) met only one criterion (43.2% ITBAS only, 10.7% EM only, and 1.1% positive CSF culture only), whereas 42.1% met two criteria. Only 2.9% of patients were positive by all three criteria. Although ITBAS was the most frequent criterion for confirmation for Borrelia infection, the presence of EM alone confirmed an additional 10.7% of patients and a positive CSF Borrelia culture alone added another 1.1%.

CARPAL TUNNEL SYNDROME AND MIGRAINE LATERALIZATION

Abstract Background/Aims: Within the scope of this research, we aimed to elucidate the relationship between carpal tunnel syndrome and migraine to explore both the pain intensity and the localization of carpal tunnel syndrome (CTS) in concomitant migraine. The primary outcome variable was elaborated as the pain lateralization, and the secondary outcome variable was the pain intensity. Methods: This was a cross-sectional, observational prospective study of 500 patients with a preliminary carpal tunnel syndrome diagnosis in our institution. After patients with missing data were excluded from the study, 413 remained, 365 (88.4%) women and 48 (11.6%) men. After recording the demographic characteristics, the patient's migraine pain year of onset of pain, pain characteristics, localization, frequency, duration, severity, triggering factors, symptoms, and findings accompanying the pain were recorded. Results: The lateralization of migraine was on the right side (only on the right or mostly on the right) in 25.9% and on the left side (only on the left or mostly on the left) in 26.4% of the patients. Almost half of the patients (47.7%) experienced bilateral migraine headaches. Carpal tunnel syndrome was in the right hand in 13.3%, in the left hand in 11.6%, and bilateral in 75.1%. Of 197 patients with bilateral pain, 68 (34.5%) had mild, 116 (58.9%) had moderate, and 13 (6.6%) had severe CTS. The VAS level of migraine pain was higher only in patients with CTS in the left hand and in those with moderate CTS. Conclusion: It has been determined that those with carpal tunnel syndrome on the right side have migraines mostly on the right, those with carpal tunnel syndrome on the left have migraines on the left, and those with carpal tunnel syndrome in both directions have migraines predominantly in both directions.

Risk factors for postpartum readmission: a prediction model in Iranian pregnant women

BackgroundPostpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran.MethodsThis retrospective cohort study was conducted on the mothers who were readmitted after delivery within 30 days, at Imam Ali Hospital (2019–2023). The demographic and obstetrics characteristics were identified through the registry system. Univariate and multivariate logistic regressions with odds ratios (ORs) and 95% CIs were carried out. To identify the most important variables by machine learning methods, a random forest model was used. The data were analyzed using SPSS 22 software and R (4.1.3) at a significant level of 0.05.ResultsAmong 13,983 deliveries 164 (1.2%) had readmission after delivery. The most prevalent cause of readmission after delivery was infection (59.7%). The chance of readmission for women who underwent elective cesarean section and women who experienced labor pain onset by induction of labor was twice and 1.5 times greater than that among women who experienced spontaneous labor pain, respectively. Women with pregnancy complications had more than 2 times the chance of readmission. Cesarean section increased the chance of readmission by 2.69 times compared to normal vaginal delivery.ConclusionThe method of labor pain onset, mode of delivery, and complications during pregnancy were the most important factors related to readmission after childbirth.

Case report of a child with nephronophthisis from South Africa

BackgroundNephronophthisis (NPHP) is an autosomal recessive disorder with a subset of patients presenting with extrarenal manifestations such as retinal degeneration, cerebella ataxia, liver fibrosis, skeletal abnormalities, cardiac malformations, and lung bronchiectasis. However, the involvement of other organ systems has also been documented. Extrarenal manifestations occur in approximately 10–20% of patients. In developed countries, it has been reported as one of the most common causes of monogenic chronic kidney failure (CKF) during the first three decades of life, with more than 25 genes associated with this condition. The current treatment options for managing NPHP include supportive care, management of complications, and kidney replacement therapy when necessary.The index patient is a 10-year-old Caucasian female who presented with recurrent attacks of abdominal pain. Her elder sister, TN, who was 17 years old, was diagnosed with CKF and noted to have persistently elevated liver enzymes (gamma-glutamyl transferase, alanine, and aspartate transaminases). Following genetic testing, her elder sister was shown to have Nephronophthisis Type 3, and a liver biopsy showed early fibrotic changes. Subsequent genetic testing confirmed the index patient as having NPHP Type 3. A kidney biopsy showed focal sclerosed glomeruli with patchy areas of tubular atrophy and related tubulointerstitial changes in keeping with NPHP. We present the first confirmatory case of NPHP from South Africa based on histopathology and genetic testing in a 10-year-old Caucasian female who presented with recurrent attacks of abdominal pain, whose elder sister also presented with CKF and early liver fibrosis, confirmed on biopsy and genetic testing.ConclusionIn low-middle-income countries, genetic testing should be undertaken whenever possible to confirm the diagnosis of NPHP, especially in those with a suggestive biopsy or if there is CKF of unknown aetiology with or without extra-renal manifestations.

Case Report: Wellens syndrome in acute critical coronary occlusion saved by collateral

Background It is important and challenging to distinguish between acute myocardial infarction and Wellens syndrome due to its time to intervention. Difficulties in differentiating between subtypes could mean the patients are overtreated or receive undertreatment. Case report A 57-year-old man was referred to our emergency ward with acute onset of chest pain. Electrocardiograms changes were suggestive of type A Wellens syndrome. Nitroglycerin was administrated, the patient's chest pain disappeared, and we planned an early invasive strategy. He had a previous documented electrocardiogram before he went for catheterization and based on the second electrocardiogram changes were suggestive of an ST-elevation. As the result of the invasive strategy, it was found that there was single-vessel disease, critical occlusion in the middle of the left anterior descending artery coronary artery with collateral from the right coronary artery. After two days of observation in the Intensive Cardiovascular Care Unit, the patient improved and was transferred to Low Care Unit. Conclusions The case highlights Wellens syndrome in acute critical occlusion with collateral artery.

Bilateral Erector Spinae Plane Block versus Oblique Subcostal Transversus Abdominal Plane Block for Postoperative Analgesia of Adults Patients Undergoing Laparoscopic Cholecystectomy

Abstract Background Nerve root or myofascial irritation at the abdominal wall is a common cause of pain following surgeries such as cholecystectomy, cesarean section, prostatectomy, hysterectomy and transplant surgery. Aim of the Work to test the efficacy of ultrasound guided bilateral erector spinae plane block versus ultrasound guided bilateral oblique subcostal tap block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used. Patients and Methods In the current study fifty eight patients scheduled for elective laparoscopic cholecystectomy received general anesthesia were included. Patients were divided randomly into two groups, each group consisted 29 patients. Group A: Patients in this group received bilateral US guided ESP block at the end of surgery. Group B: Patients in this group received bilateral US guided OSTAP block at the end of surgery. Results As regard the analgesic parameters recorded; in the current study, the VAS was significantly lower in group A (ESP block) when compared with that of group B (OSTAP block) and showed significant difference between both groups at 6,8 and 10hrs postoperatively. Also, time to rescue analgesia, there was clinically and statistically highly significant longer time to 1st rescue analgesic in group A (ESP block) was 15.25±1.50 hours compared to that of group B (OSTAP) was 9.86±2.01 hours These findings were in an array with a case series done by Luis-Navarro and his colleagues who reported that the first rescue analgesic was required only at 16 hours after ESP block. In the current study, total morphine consumption “mg” with the mean total consumption in each of Group was 4.45±0.42 mg in the ESP group compared with 5.44±0.37 mg in the OSTAP group there was highly statistically significant higher mean of total analgesic consumption in group B compared to Group A. Conclusion bilateral ultrasound-guided ESP block provides more potent and longer postoperative analgesia with less morphine consumption than OSTAP block after laparoscopic cholecystectomy

1225 Endoluminal Stenting for Sleeve Gastrectomy Leak: Case Report, Literature Review and Atlas of Endoscopic Management

Abstract Introduction One of the most serious complications of bariatric surgery is post-operative leak and it can result in significant risk on the patient. Early detection and management of postoperative leak is essential to reduce the morbidities and mortality of such complication. Endoluminal Stent placement is a less invasive alternative to surgical intervention for management of bariatric surgical leak. We are reporting a case of post sleeve gastrectomy leak that has been managed by inserting self-expandable metal stents (SEMS) via endoscopy. Case presentation A 55-year-old woman presented with gradual onset of epigastric pain and high temperature with reduced oral intake. She had had a Laparoscopic sleeve gastrectomy done in another country as a form of “medical tourism” 10 days ago. She had a CT scan revealed an irregular 4.5 cm paraoesophageal collection suggesting post-operative leakage. Discussion Endoscopic management of GI leaks provides a minimally invasive, safe, and efficient alternative for surgery in selected cases. Endoscopic management is then proven to be the least invasive method to control and repair post LSG leak. Conclusions The clinical presentation of post LSG leak can vary from mild abdominal pain to severe sepsis. Endoscopic management, with its different types, has been widely used because its less invasive yet very effective way of managing such feared complication.