Rating Scale Pain Research Articles

Effect Of Flippits Versus Virtual Reality On Pain, Fear, And Satisfaction During Phlebotomy Among Children.

To determine the effect of flippits versus virtual reality on pain, fear and satisfaction among children during phlebotomy. The quasi-experientialstudy was conducted at the Paediatric Medical Department of Kafrelsheikh University Hospital, Egypt, from November 2021 to April 2022, and comprised children of either gender aged 6-12 years. The subjects were randomised into flippits group A, virtual reality group B and control group C in which only traditional care was provided. Data was collected using a structured interview, Wong-Baker Faces Pain Rating Scale, Children's Fear Scale, and Blood Specimen Collection Satisfaction Evaluation Scale. Data was analysed using SPSS 20. Of the 120 children, 40(33.3%) were in each of the three groups. There were 21(52.5%) boys and 19(47.5%) girlsin group A with mean age 8.2±1.6 years, 22(55%) boys and 18(45%) girlsin group B with mean age 7.8±1.7 years, and 27(67.5%) boys and 13(32.5%) girls in group C with mean age 7.9±1.9 years (p>0.05). Mean pain and fear scores were significantly lower and mean satisfaction score was higher in groups A and B than group C (p<0.05). There was no significant difference in the mean pain scores of group A and group B (p>0.05). Flippits and virtual reality interventions had a positive effect on pain, fear and satisfaction levelsin children during phlebotomy.

Adaptation and Limitations of painDETECT Questionnaire Score Approach Before and After Posterior Cervical Decompression Surgery

The painDETECT questionnaire (PDQ) is one of the available screening tools for neuropathic pain (NeP), with a cut-off score of 13. This study aimed to investigate changes in PDQ scores in patients undergoing posterior cervical decompression surgery for degenerative cervical myelopathy (DCM). Patients with DCM undergoing cervical laminoplasty or laminectomy with posterior fusion were recruited. They were asked to complete a booklet questionnaire including PDQ and Numerical Rating Scales (NRS) for pain at baseline and oneyear after surgery. Patients with a preoperative PDQ score ≥13 were further investigated. A total of 131 patients (mean age= 70.1years; 77 male and 54 female) were analyzed. After posterior cervical decompression surgery for DCM, mean PDQ scores decreased from 8.93 to 7.28 (P=0.008) in all patients. Of the 35 patients (27%) with preoperative PDQ scores ≥13, mean PDQ changed from 18.83 to 12.09 (P<0.001). Comparing the NeP improved group (17 patients with postoperative PDQ scores ≤12) with the NeP residual group (18 patients with postoperative PDQ scores ≥13), the NeP improved group showed less preoperative neck pain (2.8 vs. 4.4, P=0.043) compared to the NeP residual group. There was no difference in the postoperative satisfaction rate between the two groups. Approximately 30% of patients exhibited preoperative PDQ scores ≥13, and about half of these patients demonstrated improvements to below to the cut-off value for NeP after posterior cervical decompression surgery. The PDQ score change was relatively associated with preoperative neck pain.

General anesthesia in spontaneous respiration with intravenous ketamine in patients undergoing pulsed-field ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Thermal ablation of atrial fibrillation (AF) by means of radiofrequency or cryo-balloon is usually performed under general anesthesia, deep sedation, or conscious sedation at operator’s discretion and based on the general condition of the patient. However, a standardized sedation protocol when performing a non-thermal ablation, such as pulsed-field ablation (PFA) through irreversible cellular electroporation, has not been well established. Purpose We report our preliminary experience of a general anesthesia in spontaneous respiration protocol with ketamine used at a high-volume center during ablation of AF with a new PFA system. Methods All consecutive patients (pts) undergoing AF ablation with PFA at our center were included. Our sedation protocol consists of intravenous administration of midazolam (1+1 mg), fentanyl (25+25+25+25 mcg/kg) at low doses before local anesthesia with lidocaine (200mg) administration. Patients underwent sedation under spontaneous respiration by administering oxygen (4-6 l/min) through a face mask with nasal cannula. Local anesthesia was performed before the percutaneous femoral venous access. Soon after the trans-septal puncture, heparin (1 mg/kg) and atropine (1 mg, to mitigate anticipated bradycardia) were injected, followed by a second bolus of midazolam (1 mg). Ketamine adjunct (1 mg/kg) was then injected about 5 minutes before the first PFA delivery which was titrated to effect based on patient’s condition, response and changes in vital signs (total ketamine adjunction of 2 mg/kg). For quantitative assessment the Numeric Rating Scale for Pain (NRS) was applied. For qualitative assessment a 3-levels satisfaction evaluation was retrieved. The ablation endpoint was PVI as assessed by entrance and exit block. Results Forty-two pts were included in this analysis (mean age of 66±9 years,72% were male, CHA2DS2VASc score=2 [IQR 1–3], median body mass index 24[20-48]kg/m2, 35% had respiratory diseases – e.g. asthma, OSAS, COPD –). At baseline, before sedation, mean systolic blood pressure was 140.5+20.1mmHg and mean oxygen saturation was 97.9+2.1%. PVI was achieved in all the patients. The number of PFA applications to reach PVI was 33.4+3 (time to PVI = 25+4min). In two cases additional PFA lesion sets were deployed outside the PVs. Lab occupancy time was 122±32min, skin-to-skin time was 78±35min and fluoroscopy time was 23±14min. All the patients achieved a NRS ≤ 3. Satisfaction level was found to be acceptable in all procedures by both the patient and the primary operator (Score equal to 0). No major procedure-related adverse events were reported. Conclusion The PFA procedure has a short execution time. The standardized anesthetic protocol with the administration of drugs with rapid onset and pharmacological offset at low doses was effective and safe with an optimal degree of patient and operator satisfaction.

Association of Psychological Distress with Primary Dysmenorrhea among Adolescents Living in West Bengal, India

Background: Primary dysmenorrhea, a painful uterine cramp without any pelvic pathology that occur before or during menstruation among reproductive women.&#x0D; Objective: The objective of this study was to compare the psychological distress between adolescent female students with dysmenorrhea and without dysmenorrhea and also to examine relationship between psychological distress and dysmenorrhea.&#x0D; Methods: This is a cross sectional questionnaire based study conducted among 1646 adolescent female having age limit 14-19 years. Only unmarried adolescent females were included in the study however, females with gynecological, psychological or other medical problems were excluded from the study. It used validated and reliable questionnaire such as VAS for pain rating scale and DASS-21 for assessment of depression, anxiety, stress. Then, the descriptive data analysis and chi-square test were used to explore the relationship between psychological distress and dysmenorrhea. t-test was used to compare psychological distress between dysmenorrhea and non-dysmenorrhea. P&lt;0.05 was considered as significant.&#x0D; Results: Mean age of the adolescent female was 15.91+ 1.27 years. Prevalence of dysmenorrhea was 88.94%. Among dysmenorrhea 22.40% was severe, 28.89% was under moderate and 48.71% was under mild dysmenorrhea. There was significant difference of psychological distress indices scores between dysmenorrhea and non-dysmenorrhea (p&lt;0.001). Majority of dysmenorrheic females had severe to extreme severe levels of anxiety, depression and stress in contrast to non-dysmenorrheic females who have mild to moderate level. Significant association was noted between depression, anxiety, mental irritability and mood swing with primary dysmenorrhea (p&lt;0.001).&#x0D; Conclusion: The present study suggested that dysmenorrhea is associated with psychological distress including anxiety, depression, mental irritation and mood swing. Psychological interventions and counselling are important for young women with primary dysmenorrhea to lessen the severity of menstrual pain.

ASSOCIATION OF CHRONIC LOW BACK PAIN AND DEPRESSION AT A TERTIARY CARE SETTING OF PAKISTAN

Objective: To assess the association of Depression with Chronic Low back pain. Methodology: In this cross-sectional investigation, 169 participants with a mean age of 54.1 years were studied at the PN Shifa medical outpatient department in Karachi, Pakistan. The research was conducted over a three-month period, from June to August 2020, using a non-probability convenience sampling approach. The severity of low back pain (LBP) was measured using the Numeric Rating Scale (NRS) and the Wong Baker Faces Pain Rating Scale. To evaluate levels of depression, the Patient Health Questionnaire (PHQ-9) scale was employed. The Chi-square test and one-way ANOVA test were used to establish statistical significance. Results: Patients with moderate to severe chronic low back pain (CLBP) demonstrated higher pain levels on both the Wong Baker Faces Pain Rating Scale and NRS, with a p-value of 0.000. Based on the PHQ-9 scores, severe depression correlated with more intense pain, with a p-value of 0.000, and greater pain severity in the current and previous week (as assessed by the NRS and Wong Baker Faces Pain Rating Scale). A higher percentage of males (34%) experienced mild CLBP compared to females (22%). However, 26% of females were found to suffer from severe CLBP, as opposed to 12% of males, with a p-value of 0.014. Conclusion: Patients with chronic low back pain often experience depression and report high levels of pain.

How Adductor Hallucis Reattachment Affects Outcomes Following Scarf Osteotomy in Hallux Valgus Correction: A 4- to 8-Year Follow-Up Retrospective Comparative Study

This study observed the differences between 2 adductor hallucis release techniques (nonreattachment vs reattachment) in 4- to 8-year follow-up outcomes of scarf osteotomy combined with distal soft tissue release (DSTR) in moderate to severe hallux valgus correction. A retrospective review of moderate to severe hallux valgus patients treated with scarf osteotomy with DSTR was conducted. The patients were divided into 2 groups based on adductor hallucis release techniques (without and with reattachment to the metatarsophalangeal joint capsule). The demographic-matching process divided the samples into 27 patients per group. A comparison of last follow-up of clinical foot ankle ability measure (FAAM) for activity of daily living (ADL) and numerical rating scale for pain during 2 hours of ADL and radiographic outcomes (hallux valgus angle (HVA) and intermetatarsal angle (IMA) was analyzed. A p < .05 was considered a statistically significant difference. The final follow-up of FAAM for ADL was statistically better in the reattachment group as the median was 79.0 (IQR=4.00) versus 76.0 (IQR=4.00), p=.047. However, this difference did not achieve minimal clinical importance difference (MCID). The last follow-up of IMA was also statistically better in the reattachment group as the mean was 7.67 (SD=3.10) versus 10.5 (SD=3.59), p=.003. DSTR with adductor hallucis reattachment has statistically better IMA correction and maintenance than nonreattachment for moderate to severe hallux valgus correction using scarf osteotomy at 4- to 8-years follow-up. However, the better clinical outcomes did not achieve MCID.

Validity of the Modified Defense and Veterans Pain Rating Scale Supplemented With Items Germane to Total Joint Replacement: Secondary Analysis From a Randomized Trial.

Valid measures of pain are helpful to adjust treatment plans in real time after total joint replacement (TJR). We enhanced the existing Defense and Veterans Pain Rating Scale (DVPRS) with items related to pain at rest and movement, in specific reference to operative and nonoperative joints, creating the TJR-DVPRS. This manuscript is presented to validate the modified survey instrument. The aims of this psychometric study were to evaluate (1) the latent structure of the TJR-DVPRS, (2) the relationships among the pain dimensions represented on the TJR-DVPRS and the reference-standard Short-Form McGill Pain Questionnaire (version 2, SF-MPQ-2), and (3) the responsiveness of these two measures before and after TJR. This report involves a secondary analysis of pain surveys from 135 veterans undergoing TJR at one center who participated in a randomized trial. The study was approved by the institutional review boards from participating institutions. The TJR-DVPRS and SF-MPQ-2 were completed preoperatively, during postoperative day 1, and 6 weeks post-surgery. Standard psychometric evaluations included correlations, principal component analysis, and internal consistency of survey items and subscales, using preoperative baseline data as a frame of reference. Responsiveness analysis included assessing both effect size and thresholds of clinically important change for survey subscales using data from all three time points. Two reliable subscales were identified for the TJR-DVPRS, one including items about pain intensity and interference related to the operative joint (Cronbach's α = .809) and the other including two pain items on the nonoperative joint. Combining the subscales indicated a two-factor solution: The first valid factor entailed the four subscales of the SF-MPQ-2 and the TJR-DVPRS operative joint subscales, indicating that these subscales validly represent the same pain dimension. The second valid factor entailed the TJR-DVPRS subscale addressing the nonoperative joint. Responsiveness analysis following accepted psychometric methods demonstrated significant decreases in pain from the preoperative period to 6 weeks postoperatively for all subscales. The TJR-DVPRS and SF-MPQ-2 subscales were similarly responsive, except for the SF-MPQ-2 neuropathic and TJR-DVPRS nonoperative joint subscales, which were minimally responsive during the preoperative to 6-week period. The TJR-DVPRS is valid for use among veterans undergoing TJR and poses significantly less respondent burden than does the SF-MPQ-2. The brevity and ease of use of the TJR-DVPRS make it a practical tool for use during surgical recovery to monitor pain intensity at rest and with movement in the operative joint, and to assess pain interference with activity, sleep, and mood. The TJR-DVPRS is at least as responsive as the SF-MPQ-2, but the SF-MPQ-2 neuropathic and TJR-DVPRS nonoperative joint subscales were minimally responsive. Limitations of this study include the small sample size, under-representation of women (which would be expected in the veteran population), and using only veterans. Future validations studies should include civilians and active military TJR patients.

Multidisciplinary Approaches: Cingulotomy in an Adult With Refractory Neuropathic Cancer-Related Pain.

Background: Oral medications, intravenous medications, and invasive interventions are effective means of neuropathic pain control. In patients with pain refractory to more conventional approaches, cingulum bundle ablation is an alternative treatment modality not routinely considered by providers. Case Description: A 42-year-old woman with history of cervical cancer in remission presented with intractable left lower extremity pain. Workup revealed radiation-induced left iliopsoas osteosarcoma complicated by deep venous occlusion and thrombosis. Her pain remained intractable to pharmacologic therapies and more invasive pain control interventions. A multidisciplinary decision was made to pursue bilateral subcortical cingulum bundle radiofrequency ablation. After a technically successful surgery, the patient exhibited improved pain control as evidenced by a decline in her numerical rating scale of pain and analgesic medication requirements. Conclusion: Cancer-related neuropathic pain often requires treatment with multiple modalities involving multidisciplinary teams. In select refractory cases, cingulum bundle ablation may be an effective alternative treatment modality.

Clinical evaluation of feasibility and effectiveness using a virtual reality device during local anesthesia and extractions in pediatric patients.

Pediatric dentistry requires more than routine dental knowledge and skills in executing quality dental care. The quality of dental treatment is indirectly proportional to a child's anxiety and fear. The recent distraction technique, the use of virtual reality (VR) devices has intrigued many researcher's minds. Therefore, this study was conducted to assess the clinical feasibility and effectiveness of the VR device in reducing pain and anxiety in pediatric patients during mandibular primary molar extraction. This research trial had 30 healthy children between the ages of 6 and 12 who required mandibular primary molar extraction. The subjects were divided into two groups using a simple randomization method. In the study group (n = 15), extraction was carried out using a VR device, whereas, in the control group (n = 15), extraction was carried out without the use of a VR device. Pre- and post-extraction anxiety levels were measured by Venham's picture test (VPT) and the heart rate. After the procedure, pain and behavior were evaluated by the Wong-Bakers Faces pain rating scale (WBS) and FLACC Scale respectively. The pre-extraction values of the VPT and heart rate showed no statistically significant difference. This indicates that participants of both groups had a similar level of anxiety at baseline. There was a statistically significant increase (p = 0.028) between pre- and post-heart rates in the control group, with no significant change in the study group. The use of a virtual reality device in children can reduce anxiety during primary molar extractions as evaluated by heart rate. Virtual reality devices might be an adjunct to high-quality dental care and to other behavior managementmethods. Definitive outcomes can be attained by encouraging studies overcoming the present limitations, and considering salivary biochemical indicators for the assessment of these devices.

Neuropathic Pain Was Associated with Central Sensitivity Syndrome in Patients with Preoperative Lumbar Spinal Stenosis Using the painDETECT and Central Sensitization Inventory Questionnaires: A Cross-Sectional Study.

Lumbar spinal stenosis (LSS) patients have been reported to have neuropathic pain and central sensitivity syndrome (CSS). These associations have been reported in other diseases but are unknown in preoperative LSS patients. We aimed to investigate the association between neuropathic pain and CSS in preoperative LSS patients using the painDETECT and the Central Sensitization Inventory (CSI) questionnaires. This cross-sectional study was conducted from November 2021 to March 2022. The data were collected regarding demographics and pain, including neuropathic pain, numbness, LSS severity, physical function, quality of life, and CSS. Patients were divided into two groups, patients with acute and chronic pain, and further classified into three categories based on the clinical phenotype of patients in each group. Independent variables included age, gender, type of LSS (bilateral or unilateral symptoms), Numerical Rating Scale of leg pain, CSI, and the Zurich Claudication Questionnaire (ZCQ) for symptom severity and physical function. The dependent variable was painDETECT. Multiple regression analysis using the forced entry method examined the association between painDETECT and CSI. Of the 119 patients with preoperative LSS, 106 were included. The mean age of the participants was 69.9 years, and 45.3% were female. Neuropathic pain was present in 19.8%, and CSS was present in 10.4%. The CSI (β = 0.468, p < 0.001) and ZCQ for symptom severity (β = 0.304, p < 0.01) were significantly associated with the painDETECT, explaining 47.8% of the variance in the painDETECT score. There is an association between neuropathic pain and CSS in patients with preoperative LSS using the painDETECT and CSI questionnaires.

Effects of ultrasound-guided erector spinae plane block on postoperative acute pain and chronic post-surgical pain in patients underwent video-assisted thoracoscopic lobectomy: a prospective randomized, controlled trial

ObjectiveTo investigate the effects of ultrasound-guided erector spinae plane block (ESPB) on acute and chronic post-surgical pain in patients underwent video-assisted thoracoscopic lobectomy.MethodsA total of 94 patients, who underwent elective unilateral video-assisted thoracoscopic lobotomy from August 2021 to December 2021 were randomly divided into general anesthesia group (group A, n = 46) and ESPB combined with general anesthesia group (group B, n = 48) by computer. Patient controlled intravenous analgesia(PCIA) was performed in both groups after operation. The numerical rating scale(NRS) of rest and cough pain at post anesthesia care unit(PACU), 2 h, 6 h, 12 h, 24 and 48 h after operation, frequency of PCIA in 24 h after operation, frequency of rescue analgesia, patient satisfaction, adverse reactions and complications were recorded in the two groups. Incidence of chronic pain at 3 months and 6 months after operation, the effect of daily life and rating of chronic pain management measures were recorded in the two groups.ResultsCompared with group A, rest and cough NRS score at 2 h, 6 h, 12 h, 24 and 48 h after surgery, frequency of PCIA use at 24 h after surgery, frequency of rescue analgesia were significantly decreased in group B (P < 0.05). There was no significant difference in NRS scores of rest and cough at PACU after operation between 2 groups after surgery at post anesthesia care unit (P > 0.05). There were no significant differences in the incidence of postoperative chronic pain between the 2 groups(P > 0.05);The effect of postoperative chronic pain on daily life and pain management measures in group B were significantly lower than those in group A(P < 0.05). Compared with group A, patients in group B had higher satisfaction degree, lower incidence of postoperative nausea and vomiting(PONV), and lower incidence of agitation during anesthesia recovery (P < 0.05). There were no pneumothorax, hematoma and toxicity of local anesthetic in the 2 groups.ConclusionUltrasound-guided erector spinae plane block can significantly reduce acute post-surgical pain, can not reduce the incidence of chronic post-surgical pain, but can significantly reduce the severity of chronic pain in patients underwent video-assisted thoracoscopic lobectomy.Trial registrationChiCTR2100050313,date of registration:26/08/2021

Evaluation of perception threshold and pain in patients with Parkinson's disease using PainVision®.

Pain is one of the most frequent non-motor symptoms occurring in patients with Parkinson's disease (PD). Traditionally, the Visual Analog Pain Scale (VAS), Numerical Rating Scale (NRS), and Wong-Baker Faces Pain Rating Scale (FRS) have been used for clinical pain assessment, but these assessments are subjective at best. In contrast, PainVision® is a perceptual/pain analyzer that can quantitatively evaluate pain as "pain intensity" based on "current perception threshold" and "pain equivalent current." We evaluated the current perception threshold in all PD patients and pain intensity in PD patients with pain using PainVision®. We recruited 48 patients with PD (PwPD) with pain and 52 PwPD without pain. For patients with pain, we measured current perception threshold, pain equivalent current, and pain intensity using PainVision®, in addition to evaluation by VAS, NRS, and FRS. For patients without pain, only current perception threshold was measured. There was no correlation with either VAS or FRS, whereas only weak correlation was identified for NRS (γ = -0.376) with pain intensity. Current perception threshold was positively correlated with duration of the disease (γ = 0.347) and the Hoehn and Yahr stage (γ = 0.259). As a quantitative evaluation of pain, pain intensity by PainVision® does not correlate with conventional subjective pain assessments. This new quantitative evaluation method of pain may be suitable as an evaluation tool for future intervention research. Current perception threshold in PwPD was related to the duration and severity of the disease and may be involved in peripheral neuropathy associated with PD.

Clinical outcomes and return to play in softball players following SLAP repair or biceps tenodesis.

Shoulder pain due to labral tears and biceps tendonitis is commonly found in softball players. Surgical options include labral repair and biceps tenodesis. Although past studies are limited by heterogeneous study groups from multiple sports, this is the first study that assesses clinical outcomes and return to play rates for fast-pitch softball players. The purpose of this study was to evaluate the clinical outcomes and return to play for fast-pitch softball players treated for a superior labrum anterior posterior (SLAP) tear and recalcitrant biceps tendonitis with a biceps tenodesis compared with a traditional SLAP repair. We hypothesized that the biceps tenodesis would have comparable outcomes with a faster return to play compared with SLAP repair. We performed a retrospective analysis on fast-pitch softball players treated surgically for SLAP tear, recalcitrant biceps tendonitis, or a combination between 2001 and 2019 at our institution. Inclusion criteria were fast-pitch softball players who underwent biceps tenodesis or a SLAP repair with greater than 2-year follow-up. Exclusion criteria involved slow-pitch softball players, patients with less than 2-year follow-up, and patients who had undergone concomitant procedures on the ipsilateral shoulder at the time of SLAP repair or biceps tenodesis. Follow-up was either self-reported through OBERD, a patient-reported outcomes (PRO)-managing software, or achieved over the phone. Follow-up data included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Andrews Carson Score, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score, Numeric Rating Scale for Pain, and our institution-specific return-to-play questionnaire. We statistically compared players who underwent biceps tenodesis or a SLAP repair, and compared pitchers with position players using Student t tests and Fisher exact test with statistical significance determined to be P<.05. From 60 eligible patients identified, follow-up outcome data were successfully captured for 47 (78%). Of the 18 SLAP repair patients, 17 (94%) returned to full competition at an average of 7.9 months. Of the 29 patients who underwent biceps tenodesis, 27 (93%) returned to full competition at an average of 7.1 months. Statistical analysis of PRO scores for each group found no significant differences between any of the measures used to evaluate patient outcomes, including no statistical difference in pitchers compared with position players. In conclusion, this study demonstrated comparable outcomes between SLAP repairs and biceps tenodesis procedures among our study group of fast-pitch softball players. There was no significant difference between RTP times between the 2 groups.

A Comparison of the Sedative Effect of Dexmedetomidine and Midazolam on Patients Undergoing Gastrointestinal Endosonography Outside the Operating Room.

Patients may experience anxiety, discomfort, and pain during endoscopy, which cannot be tolerated without sedative drugs. This study aimed to compare the sedative effects of dexmedetomidine and midazolam on patients undergoing endosonography outside the operating room. This randomized, double-blind clinical trial was conducted on 126 patients aged 18 - 65 years old with American Society of Anesthesiologists (ASA) physical status I - II undergoing elective endosonography. Patients were randomly divided into 2 groups. The dexmedetomidine group received dexmedetomidine (1 μg/kg) for 25 minutes with propofol (0.5 mg/kg) and fentanyl (1 μg/kg) at the start of the procedure. The midazolam group received midazolam (0.03 mg/kg) with propofol (0.5 mg/kg) and fentanyl (1 μg/kg). Heart rate, mean arterial pressure (MAP), and oxygen saturation (SpO2) were recorded before and 5, 10, and 15 minutes after starting the procedure. The Ramsay Sedation Scale (RSS) and the need for an additional dose of propofol were recorded during the procedure. The Numeric Pain Rating scale (Ambesh score) scores were recorded at the beginning, immediately after, and 1 hour after the procedure. Nausea and vomiting were assessed using the Visual Analogue Scale in cooperation with the patient. The dexmedetomidine group had significantly higher SpO2 and RSS scores during sedation than the midazolam group (P = 0.02). Overall, specialist satisfaction was higher in the dexmedetomidine group than in the midazolam group. There was no clinically significant difference in pain score and nausea and vomiting frequencies between the 2 groups. Dexmedetomidine is more effective than midazolam for sedation during gastrointestinal endosonography.

Effect of nursing teaching protocol on mastitis prognosis: quasi-experimental research design

Background Mastitis is a problematic issue because it may lead to many complications as early termination of breastfeeding, formation of breast abscess, deformity of breast tissue, and recurrence. Nursing management is conducted to deepen patients’ understanding of the diseases, enhancing self-care ability, and establishing healthy living habits. Aim The aim of this study is to evaluate the effect of a nursing teaching protocol on mastitis prognosis. Design A quasi-experimental research design was utilized. Setting The study was conducted in the breast unit in general surgery department at Main Assiut University Hospital. Sample A convenient sample of sixty adult female patients diagnosed with mastitis was included. Toolss Four tools used I: An interview questionnaire sheet, II: Mastitis self-care practices, III: Numeric Pain Rating Scale, and IV: Mastitis prognosis sheet. Results The mean age of both study and control groups was (37.57±9.01, 38.30±9.24 respectively). (60.0% and 50.0% respectively) of both groups had lactational mastitis. There was statistically significant improvement in study group’s level of knowledge and self-care practices at follow up. Moreover, (63.3%, 70.0% respectively) of both groups had severe pain at base line. However, at follow up (66.7%,) of study group didn’t have any pain and cured completely. while (40.0%) of control still having severe pain, (33.3%) discontinued breast feeding and (20.0%) converted into breast abscess. Conclusion Implementation of a nursing teaching protocol had a positive outcome on mastitis prognosis. Recommendation Distribution of a mastitis teaching protocol for patients with mastitis to improve prognosis.

Retrospective and Prospective Outcomes of Distal Radioulnar Joint Prosthesis Arthroplasty at a Single Center

Distal radioulnar joint (DRUJ) arthritis can cause painful and limited motion of the forearm leading to decreased function. When conservative treatment options are exhausted, surgical treatments are the next step. The purpose of this study was to retrospectively and prospectively evaluate outcomes of Scheker DRUJ total arthroplasty at a single center and add to the limited data on this procedure. In a retrospective and prospective cohort of 12 patients, 13 DRUJ prosthetics implanted from 2014 to 2021 were evaluated from a single center. The primary outcome was patient satisfaction with the procedure, including comparisons of preoperative and postoperative visual analog scale, Disabilities of the Arm, Shoulder, and Hand, and willingness to repeat the procedure. Secondary outcomes included range of motion, subjective grip strength, need for hardware revision, subsequent procedures, and postoperative complaints. Out of 12 patients that were at least 1-year after surgery from DRUJ arthroplasty, 1 was deceased at the time of final survey and 1 underwent bilateral DRUJ arthroplasty. Seven of 12 available patients were surveyed over the phone. On average, patient range of motion after surgery was 76° in each direction for pronation and supination. There was a clinically significant improvement in the Disabilities of the Arm, Shoulder, and Hand score and a statistically significant improvement in visual analog scale pain rating. Seventy-five percent of patients surveyed were satisfied with their outcomes and would undergo the surgery again. Only one patient required additional surgery, and there were no instances of hardware failure at an average follow-up of 40 months. Our study has shown positive outcomes with decrease in pain, improvement in function via Disabilities of the Arm, Shoulder, and Hand evaluation, and subjective patient satisfaction, with a 100% prosthesis survival rate. The DRUJ arthroplasty prosthesis is a viable alternative to other DRUJ salvage procedures. Therapeutic Level III.

Evaluating the efficacy and safety of simple combination of analgesics with and without low dose opioid for perioperative analgesia, hemodynamic and recovery profile in various surgeries posted under general anaesthesia: a prospective randomised controlled study

Background: Multimodal analgesia is an emerging technique.It has been consistently demonstrated to minimise opioid consumption, related side effects and vital component of enhanced recovery after surgery pathways. The current study presents use of combination of readily available medication as a part of multimodal analgesia. Balanced anaesthesia with multimodal analgesia is harmonious use of combination of agents to produce desired effects with minimal side effects of individual agents. Methods: This study was done in a tertiary health care centre, Government General Hospital, Kakinada over a duration of two months from August 2022 to September 2022. 60 adult patients of either sex of physical status ASA grade 1and 2 undergoing elective surgery under general anaesthesia were randomly allocated into Group A and Group B of 30 patients. Group 1: received Inj. Lignocaine+Inj. Paracetamol+Inj. Magnesium sulphate+Inj. Fentanyl. Group 2:received Inj. Lignocaine+Inj. Paracetamol+Inj. Magnesium sulphate+Normal saline (control group) as premedication for perioperative analgesia. Results: All patients were hemodynamically stable for first 30 minutes period of observation in Group A compared to Group B. There is clinically and statistically significant difference in the duration of analgesia in Group A compared to Group B. There is no statistically significant difference in the Numerical Rating Scale (NRS) for pain in both the groups. Conclusions: This study concluded that simple analgesia combination of multimodal analgesia regimen comprising of Inj. Lignocaine, Inj. Paracetamol and Inj. Magnesium sulphate produces safe and effective analgesia with good recovery profiles and no adverse opioid related side effects for ASA 1 and 2 patients posted under general anaesthesia.

45. Outcomes of Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface in Oncologic Amputees: The MD Anderson Cancer Center Experience

PURPOSE: The outcomes of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) in oncologic amputees have been limited to small series. Herein, we report the MD Anderson experience with the surgical and postamputation outcomes of TMR and RPNI in the oncologic population. METHODS: We conducted a retrospective cohort study of consecutive patients who underwent oncologic amputation followed by TMR or RPNI from November 2018 to May 2022. Patient-reported Outcomes Measurement System (PROMIS) and Numerical Rating Scales for residual limb pain (RLP) and phantom limb pain (PLP) were obtained and compared with published benchmarked outcomes. RESULTS: We compared 68 patients with oncologic amputation at our institution with 727 patients with benchedmarked outcomes. Patients had mean follow-up period of 10.9±8.7 months. Oncologic amputees experienced significant reductions in pain intensity (-5.39; 95%CI,-4.28, -6.50; p<0.001), interference (-11.98; 95%CI, -8.19, -15.8; p<0.001), behavior (-32.95; 95%CI, -25.5,-40.4; p<0.001) and global health (-26.25; 95%CI, -22.09, -30.42; p<0.001) following TMR or RPNI from baseline to final follow-up. Delayed wound healing was the most common complication (14.7%) and tumor recurrence occurred in 36.8% of patients. Compared with benchedmarked outcomes, oncologic amputees who underwent TMR or RPNI demonstrated significantly lower median PLP (0.0 vs. 4.0, p<0.001), RLP (1.0 vs. 4, p<0.001), pain intensity (6.0 vs. 46.6, p<0.001), pain interference (9.5 vs. 55.9, p<0.001), and pain behavior (36.0 vs. 56.7, p<0.001) scores. CONCLUSION: Oncologic amputees who underwent TMR and RPNI demonstrated significant reductions in postamputation pain compared with their baseline and benchedmarked outcomes with relatively low postoperative complications rate.

A Phase II, Randomized, Double-blind, Sham-Controlled Clinical Trial of Transcutaneous Electrical Nerve Stimulation (TENS) Therapy for the Treatment of Neuropathic Pain in Neuromyelitis Optica Spectrum Disorders (P13-5.005)

<h3>Objective:</h3> To determine whether Transcutaneous Electrical Nerve Stimulation (TENS) therapy is a safe, tolerable, and effective therapy for neuropathic pain in patients with Aquaporin-4 (AQP4) IgG positive Neuromyelitis Optica Spectrum Disorders (NMOSD). <h3>Background:</h3> NMOSD is a chronic relapsing neuroinflammatory disorder that preferentially targets the optic nerves and spinal cord. Pain due to the longitudinally extensive spinal cord lesions seen in NMOSD is a frequent, disabling, and difficult to treat component of the disease with up to 91% of patients reporting symptoms of central neuropathic pain. TENS therapy is a non-invasive pain-modifying intervention that utilizes transcutaneous electrical stimulation of ascending sensory fibers that has been investigated for the amelioration of peripheral neuropathic pain in several other conditions. <h3>Design/Methods:</h3> We conducted a 4-week, randomized, double-blind, sham-controlled, fully remote trial of the QUELL TENS in patients with NMOSD who have central neuropathic pain, followed by a 12-week open label extension period. The Numeric Rating Scale for Pain (NRS-P) was used as the primary outcome measure and was assessed at baseline and at weeks 1, 2, 3, 4, 5, 6, 7, 8, 12, and 16. <h3>Results:</h3> Forty-six patients (23 per arm) were enrolled in this trial, of which 37 completed the trial (3 in the intervention arm and 1 in the sham arm withdrew for adverse events possibly related to the device). Both the sham and intervention arms demonstrated a significant decrease in average pain, worst pain, and current pain between the baseline and 4 week periods, however there was no significant difference between the two arms on intention-to-treat primary or secondary efficacy outcomes. <h3>Conclusions:</h3> Both arms demonstrated significant decreases in reported pain between baseline and 4-week follow-up, however there was no demonstrated benefit of TENS over sham. Further trial analysis will be conducted analyzing responder groups, adverse events, and per-protocol results based on device usage data. <b>Disclosure:</b> The institution of Dr. Vishnevetsky has received research support from National MS Society. The institution of Dr. Vishnevetsky has received research support from NIH (NeuroNext). Ms. Romanow has received research support from Freeman Pain Award @ Harvard Medical School. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi Pharma. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Levy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Levy has received research support from National Institutes Health.

Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery

Epidural anesthesia is a primary choice for cesarean delivery, but supplemental analgesics are often required to relieve pain during uterine traction. To investigate the sedative and analgesic effects of intravenous esketamine administered before childbirth via cesarean delivery with the patient under epidural anesthesia. This multicenter, double-blind randomized clinical trial assessed 903 women 18 years or older who had full-term single pregnancy and were scheduled for elective cesarean delivery with epidural anesthesia in 5 medical centers in China from September 18, 2021, to September 20, 2022. Patients were randomized to receive intravenous injection of 0.25 mg/kg of esketamine or placebo before incision. The coprimary outcomes included scores on the numeric rating scale of pain (an 11-point scale, with 0 indicating no pain and 10 indicating the worst pain; a difference of ≥1.65 points was clinically meaningful) and Ramsay Sedation Scale (a 6-point scale, with 1 indicating restlessness and 6 indicating deep sleep without response; a difference of ≥2 points was clinically meaningful) immediately after fetal delivery. Secondary outcomes included neonatal Apgar score assessed at 1 and 5 minutes after birth. A total of 600 women (mean [SD] age, 30.7 [4.3] years) were enrolled and randomized; all were included in the intention-to-treat analysis. Immediately after fetal delivery, the score on the numeric rating scale of pain was lower with esketamine (median [IQR], 0 [0-1]) than with placebo (median [IQR], 0 [0-2]; median difference, 0; 95% CI, 0-0; P = .001), but the difference was not clinically important. The Ramsay Sedation Scale scores were higher (sedation deeper) with esketamine (median [IQR], 4 [3-4]) than with placebo (median [IQR], 2 [2-2]; median difference, 2; 95% CI, 2-2; P < .001). The neonatal Apgar scores did not differ between the 2 groups at 1 minute (median difference, 0; 95% CI, 0-0; P = .98) and at 5 minutes (median difference, 0; 95% CI, 0-0; P = .27). Transient neurologic or mental symptoms were more common in patients given esketamine (97.7% [293 of 300]) than in those given placebo (4.7% [14 of 300]; P < .001). For women undergoing cesarean delivery under epidural anesthesia, a subanesthetic dose of esketamine administered before incision produced transient analgesia and sedation but did not induce significant neonatal depression. Mental symptoms and nystagmus were common but transient. Indications and the optimal dose of esketamine in this patient population need further clarification, but study should be limited to those who require supplemental analgesia. ClinicalTrials.gov Identifier: NCT04548973.