Rating Scale Pain Research Articles

Comparative evaluation of the perioperative anesthesia methods for cancer patients undergoing pancreaticoduodenectomy

BACKGROUND: Pancreatoduodenal resections are one of the most traumatic and technically complex interventions in abdominal surgery. The correct anesthetic management and pain relief allow to substantially reduce the risk of perioperative complications, which remains high even in high-volume oncology centers with extensive experience. Finding new components and methods of anesthesia combined with evaluation of their effectiveness and safety remains a pressing issue.
 AIM: To evaluate the efficacy and safety of using intravenous lidocaine infusion as a component of anesthesia and postoperative analgesia in cancer patients during pancreatoduodenal resection.
 MATERIALS AND METHODS: We analyzed the course of anesthesia, operation and postoperative period of 43 patients (mean age 63.2±7.1 years) undergoing pancreaticoduodenectomy. For the purposes of the study, patients were randomly divided into 2 groups, based on anesthesia method: for the first group (n=19) we used epidural analgesia as a component of perioperative anesthesia, for the second group (n=24) we used prolonged intravenous infusion of lidocaine at an average dose of 1 mg/(kg×h). We analyzed the severity of pain syndrome according to Numeric rating scale for pain in postoperative period, as well as opioid requirement, the time of gastrointestinal function recovery, and post-operative complications frequency. In order to prevent systemic toxicity, drug monitoring was carried out — the determination of the plasma concentration of lidocaine.
 RESULTS: Perioperative opioid requirement was comparable between groups, with no statistically significant differences observed. The degree of pain syndrome according to the Numeric rating scale for pain did not differ statistically, except for the number of points during activation on day 3: 4.00 (95% confidence interval 3.49–4.51) for epidural analgesia group, compared to 3.12 (95% confidence interval 2.64–3.61) for lidocaine infusion group, p=0.014. There was also a statistically significant increase in infusion volume for epidural analgesia group compared to lidocaine infusion group [8.83 ml/(kg×h) (Q1=7.90; Q3=10.06) and 7.33 ml/(kg×h) (Q1=6.28–Q3=8.49) respectively, p=0.034], as well as a greater need for intraoperative vasopressor support among the patients [15 (78.9%) and 10 (43.5%) respectively, p=0.029]. In the lidocaine group, the time to onset of peristalsis was significantly shorter than in the epidural analgesia group [median 48.0 h (Q1=48.00; Q3=72.00) compared to median 60.0 h (Q1=36.00; Q3=64.50) respectively, p=0.042]. The frequency of postoperative complications did not differ between the groups.
 CONCLUSION: Based on a comparative analysis of the study results, it can be concluded that prolonged intravenous infusion of lidocaine, as a component of perioperative anesthetic protection during pancreatoduodenal resections, is safe and comparable in terms of analgesic efficacy to epidural blockade.

Impact of welding occupation on serum aluminium level and its association with physical health, cognitive function, and quality of life: a cross-sectional study.

There is an occupational health concern about welders' inhalation of toxic aluminium fumes. We investigated whether serum aluminium level (SAL) and demographic variables can significantly predict physical health parameters, cognition, and quality of life (QoL) among welders. The cross-sectional study involved 100 age- and location-matched men (50 welders and 50 non-welders). SAL obtained using a graphite furnace atomic absorption spectrometer, and data collected using blood pressure and body mass index (BMI) apparatuses, biodata form, pain rating scale, General Practitioner Assessment of Cognition, WHOQoL-BREF, and Nordic musculoskeletal symptoms (MSS) questionnaire were analysed using independentsamplest test, chi-square, Pearson's correlation, and hierarchical linear regression. Welders had significantly higher SAL (mean difference [MD] = 1.77µg/L, p < 0.001), lower QoL (MD = 3.92, p = 0.039), and higher prevalence of MSS on the neck (χ2 = 10.187, p = 0.001), shoulder (χ2 = 9.007, p = 0.003), upper back (χ2 = 6.832, p = 0.009), and knee (χ2 = 12.190, p < 0.001) than non-welders. There was a significant bivariate association between SAL, systolic blood pressure (β = 0.313, p = 0.002), and BMI (β = 0.279, p = 0.005), but not pain intensity, cognition, or QoL. SAL remained a significant predictor of systolic blood pressure after adjustment for physical health and QoL parameters (β = 0.191, p = 0.044). The association between SAL and social QoL became significant after adjustment for physical health and other QoL domains (β = - 0.210, p = 0.032) and demographic variables (β = - 0.233, p = 0.046). Welders had significantly higher SAL, musculoskeletal symptoms, blood pressure, and lower QoL than non-welders. SAL was associated with adverse physical health parameters and social-related QoL, not cognition. We recommend routine aluminium bioavailability and physical health checks among welders.

ChatGPT in the development of medical questionnaires. The example of the low back pain.

In the last year, Chat Generative Pre-Trained Transformer (ChatGPT), a web software based on artificial intelligence has been showing high potential in every field of knowledge. In the medical area, its possible application is an object of many studies with promising results. We performed the current study to investigate the possible usefulness of ChatGPT in assessing low back pain. We asked ChatGPT to generate a questionnaire about this clinical condition and we compared the obtained questions and results with the ones obtained by other validated questionnaires: Oswestry Disability Index, Quebec Back Pain Disability Scale, Roland-Morris Disability Questionnaire, and Numeric Rating Scale for pain. We enrolled 20 subjects with low back pain and we found important consistencies among the validated questionnaires. The ChatGPT questionnaire showed an acceptable significant correlation only with Oswestry Disability Index and Quebec Back Pain Disability Scale. ChatGPT showed some peculiarities, especially in the assessment of quality of life and medical consultation and treatments. Our study shows that ChatGPT can help evaluate patients, including multilevel perspectives. However, its power is limited, and further research and validation are required.

Development and Initial Validation of the Pain Progress Measure

Introduction. Current numerical rating scales for pain mostly measure symptom intensity. There is a need to develop outcome measures reflecting the multifaceted nature of pain. The purpose of this study is to describe the development and validation of the Pain Progress Measure (PPM), which is an outcome measure intended to capture the holistic nature of pain. Methods. The author developed 15 pain assessment items related to the biopsychosocial theory of pain. For content validity, 14 expert panelists were purposely selected to assess items as either essential, or useful but not essential, and not essential. The number of essential items was then taken to get the content validity ratio (CVR). Internal consistency reliability was established through Cronbach's alpha. Results. The mean content validity ratio (CVR= 0.69) was above the critical value of 0.57 and therefore showed that the PPM has good content validity. There were 10 items shown with good CVR, but 5 items did not reach the critical values. Cronbach's alpha shows a coefficient of 0.883, demonstrating good reliability. Pearson-R correlation of 0.94 demonstrates excellent inter-rater reliability. Discussion. Pain Progress Measure (PPM) items below CVR critical value were removed to create the shortened version of the PPM. The shortened version without items below CVR critical value showed a higher mean CVR. Initial validation and reliability testing of the Pain Progress Measure has shown its capabilities to holistically quantify the pain of patients undergoing physical rehabilitation interventions. However, further research is recommended to expand on other psychometric properties such as concurrent validity, confirmatory factor analysis, and test-retest reliability.

Performance of the streamlined quality outcomes database web-based calculator: internal and external validation

BACKGROUND CONTEXTWith an increasing number of web-based calculators designed to provide the probabilities of an individual achieving improvement after lumbar spine surgery, there is a need to determine the accuracy of these models. PURPOSETo perform an internal and external validation study of the reduced Quality Outcomes Database web-based Calculator (QOD-Calc). STUDY DESIGNObservational longitudinal cohort. PATIENT SAMPLEPatients enrolled study-wide in Quality Outcomes Database (QOD) and patients enrolled in DaneSpine at a single institution who had elective lumbar spine surgery with baseline data to complete QOD-Calc and 12-month postoperative data. OUTCOME MEASURESOswestry Disability Index (ODI), Numeric Rating Scales (NRS) for back and leg pain, EuroQOL-5D (EQ-5D). METHODSBaseline data elements were entered into QOD-Calc to determine the probability for each patient having Any Improvement and 30% Improvement in NRS leg pain, back pain, EQ-5D and ODI. These probabilities were compared with the actual 12-month postop data for each of the QOD and DaneSpine cases. Receiver-operating characteristics analyses were performed and calibration plots created to assess model performance. RESULTS24,755 QOD cases and 8,105 DaneSpine lumbar cases were included in the analysis. QOD-Calc had acceptable to outstanding ability (AUC: 0.694–0.874) to predict Any Improvement in the QOD cohort and moderate to acceptable ability (AUC: 0.658–0.747) to predict 30% Improvement. QOD-Calc had acceptable to exceptional ability (AUC: 0.669–0.734) to predict Any improvement and moderate to exceptional ability (AUC: 0.619–0.862) to predict 30% Improvement in the DaneSpine cohort. AUCs for the DaneSpine cohort was consistently lower that the AUCs for the QOD validation cohort. CONCLUSIONQOD-Calc performs well in predicting outcomes in a patient population that is similar to the patients that was used to develop it. Although still acceptable, model performance was slightly worse in a distinct population, despite the fact that the sample was more homogenous. Model performance may also be attributed to the low discrimination threshold, with close to 90% of cases reporting Any Improvement in outcome. Prediction models may need to be developed that are highly specific to the characteristics of the population.

Correlation between psychosocial stresses, stress coping ability, pain intensity and degree of disability in patients with non-specific neck pain

This study was conducted to find out which factor among stress inducing factors and stress coping factors that can affect patients with non-specific neck pain has more correlation with the intensity of neck pain and the degree of disability. This study is a cross-sectional correlational study. 100 patients diagnosed with non-specific neck pain participated in this study. The characteristics of the participants in this study are as follows. There were 56 men and 44 women, with an average age of 34.11 years, height of 169.91, and weight of 66.97 kg. The participant`s pain intensity was 5.18 and disability index was 21.44. In order to evaluate the pain intensity and disability level of patients with non-specific neck pain, Numeric Pain Rating SCALE (NPRS), and Neck Disability Index (NDI) were investigated, respectively. Depression, Anxiety, Stress Scale-21 (DASS-21), and Tampa Scale of Kinesiophobia (TSK) were used to evaluate stress inducing factors. Brief Resolution Scale (BRS), Latack Coping Scale (LCS), and Pain Self-Efficacy Questionnaire (PSEQ) were used to evaluate stress coping factors. Spearman correlation coefficients were used to determine the correlation between NPRS, NDI, and DASS-21, TSK, BRS, LCS, and PSEQ in patients with non-specific neck pain. As a results of this study, the NPRS was correlated with NDI and TSK. The NPRS and NDI were found to have a moderate correlation, but they were correlated with TSK, but showed a weak correlation. The NDI was found to be correlated with TSK, DASS, BRS, and PSEQ. In addition, NDI showed a weak correlation with TSK, BRS, and PSEQ, but the DASS showed a moderate correlation, showing the strongest correlation among the factors. These outcomes suggest that psychosocial factors, particularly stress-related factors such as depression, anxiety, and fear of movement, exert a more pronounced influence on pain intensity and disability in individuals with non-specific neck pain.

Efficacy of transauricular vagus nerve stimulation for the treatment of chemotherapy-induced painful peripheral neuropathy: a randomized controlled exploratory study.

Chemotherapy-induced painful peripheral neuropathy (CIPN) is a common adverse event in cancer patients, and there is still a lack of effective treatment. Transauricular vagal nerve stimulation (taVNS) is a minimally invasive treatment, but there are few reports regarding its efficacy for CIPN. To investigate the efficacy and possible mechanism of taVNS in patients with CIPN. Twenty-seven patients with CIPN were randomly divided into a taVNS group (n = 14) and a sham stimulation (SS) group (n = 13). A numerical rating scale (NRS) for pain, NCICTCAE 4.0 (neurotoxicity classification), quantitative sensory test (QST), Short-Form-Health Survey-12 (SF-12), and Athens Insomnia Scale (AIS) were administered before the intervention (D-10) and on the day after the intervention (D0), and the inflammatory cytokines in plasma were also measured. The NRS, NCI-CTCAE 4.0, SF-12, and AIS were administered again at D30 and D90. Compared with the SS group, the NRS and AIS in the taVNS group were significantly lower at D0. The impact lasted until D30. There were no statistically significant differences in the NRS and AIS between the 2 groups at D90. On D30, the mental component score of the SF-12 was significantly higher in the taVNS group than in the SS group. No adverse events were found. There was no significant difference in QST and plasma inflammatory cytokines between the 2 groups. taVNS can relieve chemotherapy-induced neuropathic pain in the short term, can improve sleep status and quality of life, and is expected to become a novel clinical treatment method for CIPN.

The level of agreement between the numerical rating scale and visual analogue scale for assessing pain intensity in adults with chronic pain.

The numerical rating scale and visual analogue scale are used to quantify pain intensity. However, it has not yet been explored whether these scores are interchangeable in adults with chronic pain. Data from the prospective multicentre cross-sectional INTERVAL study were used to evaluate the one-dimensionality and agreement between numerical rating scale scores and visual analogue scale scores in adults with chronic pain. Pain intensity scores using the numerical rating scale and visual analogue scale were provided by 366 patients with chronic pain for current, average, minimal and maximal pain. To evaluate whether pain intensity scales are completed in accordance with each other, the proportion of patients who satisfied the following condition was calculated: minimal pain intensity ≤ maximal pain intensity. A factor analysis confirmed the one-dimensionality of the pain measures. A significant difference was found between numerical rating scale and visual analogue scale scores for average, current, minimum and maximum pain. Intra-class correlation coefficient estimates ranged from 0.739 to 0.858 and all measures failed to show sufficient and acceptable agreement at the 95% level. The strength of agreement between pain severity categories was classified as 'moderate' for average and minimal pain and 'substantial' for current and maximal pain. The proportion of patients who scored minimal pain ≤ maximal pain was 97.5% for the numerical rating scale and 89.5% for the visual analogue scale. This study failed to show an acceptable agreement between the numerical rating scale and visual analogue scale when pain intensity was rated by adults with chronic pain, despite showing both scales measure the same information.

Effect of aloe vera gel compresses on breast engorgement among postpartum mother

Navigating the challenges of new motherhood, a staggering 50 to 70 percent of women find themselves grappling with clogged milk ducts.. Aloe vera gel compresses can be used on breasts to reduce edema. Aloe vera is known for its effective anti-inflammatory properties. This study aimed to investigate the effect of aloe vera gel compresses on breast engorgement in postpartum mothers. The study included postpartum mothers as the target population. The research design employed a pretest-posttest methodology comprising a control group and non-probability sampling using consecutive sampling. Statistical analyses involved the Paired T-Test and Independent T-Test, with a significance level of p &lt; 0.05. The sample consisted of thirty respondents, with 15 in the control group and 15 in the experimental group. Over a period of three days, aloe vera gel compresses were applied to the breasts twice a day. The Bourbonnais pain scale evaluation checklist was used to assess the degree of breast pain. The findings of this study demonstrate that the intervention involving aloe vera gel compresses significantly reduced breast engorgement (p = 0.000; mean SD 2 ± 1.25) and associated pain (p = 0.000; mean SD 2.2 ± 1.37). The results of this study suggest that the use of aloe vera gel compresses can effectively alleviate breast pain and swelling in postpartum mothers. Given the substantial benefits observed, healthcare professionals may consider incorporating aloe vera gel compresses as a non-invasive and natural intervention for postpartum mothers experiencing breast engorgement and discomfort.

Effectiveness of photobiomodulation therapy on pain intensity in postpartum women with nipple or perineal trauma: protocol for a multicentre, double-blinded, parallel-group, randomised controlled trial

IntroductionPhotobiomodulation (PBM) using low-level laser can affect tissue repair mechanisms and seems promising in reducing pain intensity. However, few studies support the effectiveness of PBM on postpartum period complications, such...

Dual-portal robotic-assisted thoracic surgery (DRATS) as a reduced port RATS: early experiences in three institutions in Japan.

Robotic-assisted thoracic surgery (RATS) has gained increasing interest in recent years, with most procedures performed using the conventional multiportal approach. Uniportal RATS (URATS) approaches have recently been reported in the pursuit of minimally invasive procedures. However, URATS requires specific skills. Herein, we introduce dual-portal RATS (DRATS) performed with two incisions. Data of DRATS procedures performed from December 2022 to May 2023 were retrospectively reviewed. Twenty patients with lung cancer underwent anatomical lung resections via DRATS performed by our group at three institutes. Among 20 cases of planned DRATS for anatomical pulmonary resections, there were no conversions to thoracotomy and no need for extra ports. The mean surgery time was 121±60 minutes and mean console time was 91±47 minutes. The mean intraoperative blood loss volume was 9.6±12.1 g. The mean duration of chest tube drainage and hospital stay were 2±1 and 5±2 days, respectively. The mean numerical rating scale for pain was 2±1 on the first postoperative day, 1±1 on the third day, and 1±1 at discharge. There were no postoperative complications or mortalities. Our primary experience shows that DRATS is safe and feasible for anatomical lung resection. We consider DRATS to be a very good preliminary step in the future transition to URATS.

Efficacy and safety of pregabalin and gabapentin in spinal stenosis: a systematic review and meta-analysis

Background and Objective: Multimodal management of spinal stenosis is on the rise, and central sensitisation inhibitors are playing an essential role in the treatment of central sensitisation processes. Pregabalin and gabapentin are antiepileptic drugs that decrease presynaptic excitability. The aim of this study was to investigate whether the use of pregabalin and gabapentin is effective in the symptomatic management of spinal stenosis, compared to other drugs, by using pain and disability rating scales. We also assessed the safety profile associated with these drugs.Methods: We conducted a bibliographic search in the Pubmed, Web of Science, and Cochrane Collaboration Library databases. The inclusion criteria were studies that compared pregabalin or gabapentin to a control group in patients with lumbar spinal stenosis. We included randomized clinical trialsand a comparative retrospective cohort study. The primary clinical endpoints were VAS/NRS and ODI, measured at two, four, 8 weeks, and 3 months, while adverse events and walking distance were also collected. We combined the data using Review Manager 5.4 software.Results: Our meta-analysis included six studies with a total of 392 patients, with a mean age of 60.3 years. We observed no significant differences in VAS scores at two, four, and 8 weeks: MD: 0.23, 95% CI: 0.63 to 1.09; MD: −0.04, 95% CI: −0.64 to −0.57; and MD: −0.6, 95% CI: −1.22 to 0.02, respectively. However, at 3 months, we found significant differences in favor of pregabalin with respect to VAS: MD: −2.97, 95% CI: −3.43 to −2.51. We did not observe significant differences respect to the ODI: MD: −3.47, 95% CI: −7.15 to −0.21. Adverse events were significantly higher in the pregabalin/gabapentin group (OR 5.88, 95% CI: 1.28–27.05).Conclusion: Our meta-analysis suggests that abapentinoids may have a significant effect on VAS score at 3 months, but no significant differences were observed in ODI scores, and adverse events were higher in the gabapentinoids group.

The effect of vibrating cold application and puppet use on pain and fear during phlebotomy in children: A randomized controlled study

BackgroundNon-pharmacological methods are often used as a creative strategy to reduce pain and fear in children during a painful procedure such as phlebotomy. ObjectivesThis study was conducted to evaluate the effects of Bee Buzzy and puppet use on pain and fear during phlebotomy in children. MethodsThis randomized controlled study was conducted in the pediatric phlebotomy unit of a university hospital. The CONSORT checklist was used in this study. The sample of 3–6 years children (n = 105) was divided into groups by block randomization. Children's pain and fear scores were evaluated with the Wong-Baker Faces Pain Rating Scale and Children's Fear Scale by the parents and the nurse who attempted phlebotomy during phlebotomy. ResultsA statistically significant difference was found between the Bee Buzzy and puppet and Bee Buzzy and control groups in pain scores (p < .05). Pain scores were lower in the Bee Buzzy group than in the puppet and control groups. A statistical difference was found between Bee Buzzy and the control group or puppet and control group according to all fear scores (p < .05). Fear scores were lower in the Bee Buzzy and puppet group (p < .05). ConclusionsThe results show that the use of Bee Buzzy during phlebotomy has a pain-relieving effect, and the use of Bee Buzzy and puppet has an anti-fear effect in 3–6-year-old children. Implications for practicesThe use of Bee-Buzzy and puppets is effective in reducing pain and fear in children as they increase effective communication and distract attention.Clinical Trial Registration: National Institutes of Health (NIH), ClinicalTrials.gov, NCT05827783.

The psychometric strength and patient centeredness of the Defense and Veterans Pain Rating Scale.

The psychometric strength and patient centeredness of the Defense and Veterans Pain Rating Scale.

Patients' perspective, quality of life and treatment goals in Hailey-Hailey disease: Lessons learned from the German National Registry.

Hailey-Hailey disease (HHD) remains a difficult-to-treat dermatosis and little is known about the patient's perception of the disease activity, the treatment success and its impact on quality-of-life (QoL). To obtain better understanding of HHD patients' needs regarding their medical condition, financial burden, QoL, subjective well-being and treatment thereof as well as satisfaction to evaluate common treatments' 'real-life' relevance. With initiation of the national registry for Darier's disease (DD; Morbus Darier, MD) and Hailey-Hailey disease (HH) MDHHgermany, patients with HHD diagnosis were included starting June 2020. To assess subjective symptoms, patients filled out questionnaires such as the DLQI (dermatological life quality index), numeric rating scale (NRS) for itch, pain and burning sensation, as well as the SWLS (satisfaction with life scale) questionnaire to quantify overall satisfaction in life. Additionally, data on therapies were collected along with the patients' satisfaction of those and their medical care. Furthermore, patients assessed financial aspects and work ability. One hundred and two patients were recruited from dermatology clinics, office-based dermatologists and self-help platforms across Germany between June 2020 and February 2023, 90 were eligible and analysed (mean: 49.91 years, 73.33% females, 26.67% males). 39.77% stated according to the DLQI their life is severely/very severely affected. Satisfaction with life was mediocre. Burning sensation was most pronounced among subjective symptoms (NRS 5.85 ± 2.80). Systemic treatments were rated as ineffective according to 56.92%, 25.56% had never received one. Most prescribed systemic treatments were corticosteroids (73.8%), followed by low-dose naltrexone (LDN) (26.2%), retinoids (15.4%) and antibiotics (13.8%). Satisfaction with medical care was generally low. Our 'real-life' data state a major disease burden and impact on the QoL for affected individuals, as well as limited disease control due to inadequate therapies. MDHHgermany can provide insights into improvement of healthcare support with this debilitating disease and improve QoL. In the long term, it aims to provide basis for further clinical trials, epidemiological studies and immunological investigations.

Athrodesis of the lateral atlanto-axial joint for the relief of neck pain and cervicogenic headache.

Osteoarthrosis of the lateral atlanto-axial joint (LAAJ) may be a cause of upper neck pain and headache. Intra-articular injection of steroids may provide only short-lasting relief. For intractable pain, arthrodesis of the joint might be considered. To determine the success rates of arthrodesis of the lateral atlanto-axial joint for relieving neck pain and disability. Practice audit. Private practice of senior author. Prospective series of 23 consecutive patients. Outcomes were measured using a numerical rating scale for neck pain, and the Neck Disability Index for disability. Success rates were calculated for various degrees of improvement of neck pain at long-term follow-up (8-40 months), and for achieving various combinations of improvement of both neck pain and disability. Complete relief of pain was achieved in 40% of patients, with a further 40% achieving at least 50% relief. At long-term follow-up, 30% of patients had no neck pain and no disability, and a further 25% had only minimal pain, minimal disability, or both. The present study did not corroborate earlier studies that claimed outstanding outcomes for arthrodesis of the LAAJ, but its outcomes are consonant with more recent studies that provided transparent outcome data. These studies provide Pain Physicians with empirical data on success rates and outcomes, upon which they can base their consideration of referral for arthrodesis.

The effect of two different methods on reducing the pain and fear during phlebotomy to children: A randomized controlled trial

IntroductionReducing pain and fear during painful medical procedures in children is important since mismanagement of pain causes the child and parent to feel anxious, which can have negative long-term consequences. This study aimed to evaluate the effects of two different distraction methods in reducing pain and fear during the phlebotomy procedure in children. MethodThe study, which has a randomized controlled experimental design was conducted between July and October 2020 with 111 children aged 6–12 years who underwent phlebotomy in the emergency department of a public hospital and their parents. The children were randomly assigned to soap bubble blowing (n:37), ball squeezing (n:37) and control (n:37) groups. During the phlebotomy, soap bubble blowing, and ball squeezing methods were used as active distraction methods. Data were collected using the Wong Baker Faces Pain Rating Scale, and the Children’s Fear Scale. ResultsThe pain scores of the soap bubble blowing group and the ball squeezing group during the phlebotomy procedure were found to be lower than the control group (p < 0.001). In addition, the soap bubble blowing group had lower fear scores than the ball squeezing and control groups (p < 0.001). ConclusionThe active distraction methods used in the study reduced pain and fear during the phlebotomy procedure. In addition, the method of soap bubble blowing was found to be a more effective method in reducing fear. Distraction methods should be used as a nursing intervention to reduce pain and fear during the phlebotomy procedure in children.

MANAGEMENT AND OUTCOMES OF PATIENTS WITH DEGENERATIVE MENISCAL TEARS IN AN ESP PHYSIOTHERAPIST-LED ORTHOPAEDIC CLINIC: AN OBSERVATIONAL COHORT

AbstractObjectiveMeta-analysis of clinical trials highlights that non-operative management of degenerative knee meniscal tears is as effective as surgical management. Surgical guidelines though support arthroscopic partial meniscectomy which remains common in NHS practice. Physiotherapists are playing an increasing role in triage of such patients though it is unclear how this influences clinical management and patient outcomes.MethodsA 1-year cohort (July 2019–June 2020) of patients presenting with MRI confirmed degenerative meniscal tears to a regional orthopaedic referral centre (3× ESP physiotherapists) was identified. Initial clinical management was obtained from medical records alongside subsequent secondary care management and routinely collected outcome scores in the following 2-years. Management options included referral for surgery, conservative (steroid injection and rehabilitation), and no active treatment. Outcome scores collected at 1- and 2-years included the Forgotten Joint Score-12 (FJS-12) questionnaire and 0–10 numerical rating scales for worst and average pain. Treatment allocation is presented as absolute and proportional figures. Change in outcomes across the cohort was evaluated with repeated measures ANOVA, with Bonferroni correction for multiple testing, and post-hoc Tukey pair-wise comparisons. As treatment decision is discrete, no direct contrast is made between outcomes of differing interventions but additional explorative outcome change over time evaluated by group. Significance was accepted at p=0.05 and effect size as per Cohen's values.Results81 patients, 50 (61.7%) male, mean age 46.5 years (SD13.13) presented in the study timeframe. 32 (40.3%) received conservative management and 49 (59.7%) were listed for surgery. Six (18.8%) of the 32 underwent subsequent surgery and nine of the 49 (18.4%) patients switched from planned surgery to receiving non-operative care. Two post-operative complications were noted, one cerebrovascular accident and one deep vein thrombosis. The cohort improved over the course of 2-years in all outcome measures with improved mean FJS-12 (34.36 points), mean worst pain (3.74 points) average pain (2.42 points) scores. Overall change (all patients) was statistically significant for all outcomes (p&lt;0.001), with sequential year-on-year change also significant (p&lt;0.001). Effect size of these changes were large with all Cohen-d values over 1. Controlling for age and BMI, males reported superior change in FJS-12 (p=0.04) but worse pain outcomes (p&lt;0.03). Further explorative analysis highlighted positive outcomes across all surgical, conservative and no active treatment groups (p&lt;0.05). The 15 (18%) patients that switched between surgical and non-surgical management also reported positive outcome scores (p&lt;0.05).Conclusion(s)In a regional specialist physiotherapy-led soft tissue knee clinic around 60% of degenerative meniscal tears assessed were referred for surgery. Over 2-years, surgical, non-operative and no treatment management approaches in this cohort all resulted in clinical improvement suggesting that no single strategy is effective in directly treating the meniscal pathology, and that perhaps none do. Clinical intervention rather is directed at individual symptom management based on clinical preferences.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Intravenous low-dose ketamine in addition to systemic analgesia versus systemic analgesia alone for post-operative pain management in laparotomies:Adouble-blind randomised controlled study

The use of Ketamine, an NMDA receptor antagonist, in sub-anesthetic doses for analgesia is increasingly being administered in inpatient settings with acute pain service guidance and in outpatient settings under a variety of models. At sub-anesthetic doses, ketamine possesses centrally mediated analgesic properties with minimal effects on consciousness and cognition.In this study we have compared the efficacy of IV low-dose Ketamine as an adjunct to conventional systemic analgesia to examine preventive effect on post-operative pain and opioid consumption in patients undergoing laparotomies.The study was carried out on 50 patients, 25 patients received a pre-incisional IV bolus of 0.15 mg/kg of Ketamine,10 mins before the incision followed by IV infusion of 2mcg/kg/min continued for 24 hours postoperatively in addition to systemic analgesia (Group K)and 25 Patients received IV bolus of Normal Saline 10 min before the incision, followed by an IV infusion of normal saline (Group C) till 24 hours post-op and systemic analgesia alone. Saline bolus and infusion were given at equivalent volume/rate of the study group. The analgesic efficacy was judged by NRS (Numeric Pain Rating Scale), Time to first rescue analgesia (TFA) and Total opioid consumption (Tramadol in mg) in 24 hours. Ketamine related side effects were also recorded.Patients in the Ketamine group had significantly lower Mean total opioid consumption (88.04 ± 29.07 mg vs. 210 ± 23.93 mg)and Numerical pain Rating Scale (NRS) (3.13 +0.34 vs. 4.44+ 0.77). Time to first rescue analgesia was significantly delayed in Ketamine group as compared to Control group (20.65 ± 9.2 mins vs. 5.4 ± 5.38 mins). Ramsay Sedation scores (RSS) were significantly higher in the Ketamine group (2.4 +0.76vs. 1.52 +0.51)in the immediate post-operative period. There were no demonstrable side-effects related to Ketamine in Group K.Pre-emptive IV low-dose Ketamine is an effective adjunct to systemic analgesia in abdominal surgeries as it significantly prolongs the time to first rescue analgesia (TFA), reduces mean total analgesic requirement and lowers pain scores (NRS) in the post-operative period with negligible side effects.

Psychophysiological and Neurophysiological Correlates of Dropping Objects from Hands in Carpal Tunnel Syndrome.

Dropping objects from hands (DOH) is a common symptom of carpal tunnel syndrome (CTS). We evaluated the clinical, neurophysiological, and psychophysiological features of 120 CTS patients to elucidate the DOH pathophysiology. Forty-nine healthy controls were included. In the patients, the Boston Carpal Tunnel Questionnaire (BCTQ), the Douleur Neuropathique 4 questions (DN4), and a numeric rating scale for pain (NRS) were evaluated. In patients and controls, we evaluated bilateral median and ulnar motor and sensory nerve conduction studies, cutaneous silent period and cutaneomuscular reflexes (CMR) of the abductor pollicis brevis, cold-detection threshold (CDT) and heat-pain detection threshold (HPT) at the index, little finger, and dorsum of the hand, and vibratory detection threshold at the index and little finger by quantitative sensory testing. CTS with DOH had higher BCTQ, DN4 and NRS, lower median sensory action potential, longer CMR duration, lower CDT and higher HPT at all tested sites than controls and CTS without DOH. Predictive features for DOH were abnormal CDT and HPT at the right index and dorsum (OR: 3.88, p: 0.03) or at the little finger (OR: 3.27, p: 0.04) and a DN4 higher than 4 (OR: 2.16, p < 0.0001). Thermal hypoesthesia in median and extra-median innervated territories and neuropathic pain are predictive of DOH in CTS.