Pain Scale Research Articles

Worth the Pain? Comparing Pain Scores in Primary Furlow Palatoplasty With and Without Buccal Flap Augmentation.

Pain following primary palatoplasty can adversely affect nutritional and quality of life following primary palatoplasty. The incorporation of buccal flaps during primary cleft palate (CP) repair provides additional tissue to reduce the risk of velopharyngeal insufficiency, though the additional donor site may alter pain levels in the postoperative period. This study sought to compare postoperative pain levels in patients undergoing primary CP repair with or without buccal flaps. A single-institution, retrospective cohort study. An academic children's hospital with an affiliated comprehensive cleft care team. Patients age 18 months or less with cleft palate undergoing primary palatoplasty from 2016 to 2021 were included. Patients were stratified by the number of buccal flaps utilized during repair. Primary outcome was 24-h postoperative pain score, measured using the FLACC pain scale. Secondary outcome was 24-h postoperative narcotic use, measured in morphine milligram equivalents (MME). A total of 106 patients (53 without buccal flaps, 53 with 1 + buccal flaps) were included. There was no significant difference in postoperative pain scores between the groups (p > 0.9). Both groups had similar postoperative narcotic utilization (p = 0.8). This study demonstrates no significant difference in postoperative pain levels or narcotic utilization between patients undergoing primary Furlow palatoplasty with or without buccal flaps. This information can help address parental concerns regarding pain in the context of a larger donor site for patients undergoing primary palatoplasty with buccal flaps. Larger, multi-institutional randomized trials are needed to confirm these findings.

An open label, single-centric, post market clinical study to evaluate the safety and efficacy of a new antimicrobial wound dressing (VELVERT) as an adjuvant therapy in the treatment of venous leg ulcer.

An open label, single-centric, post market clinical study was undertaken to evaluate the safety and efficacy of a new antimicrobial wound dressing (VELVERT) as an adjuvant therapy in the treatment of venous leg ulcer (VLU). Patients with VLU of grade C-5 according to CEAP classification and above were evaluated using doppler ultra sound. The efficacy of new antimicrobial wound dressing (VELVERT) was assessed in terms of wound area reduction within a time frame of 60 days and surgeon questioners. Patients were evaluated for VELVERT safety and pain level on a scale of 0-10 Numeric Pain Chart. Presence of micro-organism load was monitored at regular time interval. VELVERT treatment was effective as 71.43% reduction in the ulcer area was observed. After 60 days, a total of 9 (45%) patients had complete ulcer closure. A remarkable decrease in the severity of pain was observed with 11 (55%) patients expressing no pain at the EOT. Swab test showed negative result for micro-organism growth. No serious adverse events were observed during the trial. The data indicates that VELVERT is an effective treatment for VLUs and showed the potential in the wound care of VLUs.

The collagen-augmented chondrogenesis technique demonstrates superior cartilage repair compared to microfracture for cartilage defects of the knee joint, regardless of age.

This study investigated whether age affects clinical outcomes and cartilage repair quality in patients who underwent collagen-augmented chondrogenesis. The study included patients who underwent either the collagen-augmented chondrogenesis technique or microfracture for cartilage defects of the knee joint of International Cartilage Repair Society grade 3 or 4. Patients were categorised according to an age threshold of 50 years and the treatment method, whether collagen-augmented chondrogenesis technique or microfracture. Group 1 comprised 31 patients aged 50 years or older who received the collagen-augmented chondrogenesis technique, Group 2 consisted of 32 patients under the age of 50 years who received the collagen-augmented chondrogenesis technique and Group 3 included 243 patients aged 50 years or older who received microfracture. Clinical outcomes were assessed using the walking visual analogue scale (VAS) for pain and the Western Ontario McMaster University Osteoarthritis Index scale score (WOMAC) two years after surgery. For patients with magnetic resonance imaging results 1 year postoperatively (Group 1: 30 patients; Group 2: 31 patients; and Group 3: 31 patients), Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) assessment was used to evaluate repaired cartilage lesions. There were no significant differences in the VAS and WOMAC scores between the three groups 2 years after surgery (all n.s.). The MOCART score in patients who underwent MRI at 1 year postoperatively showed significant differences in the degree of defect repair, integration with the border zone, surface of the repaired tissue, adhesion and total score among the three groups (all p < 0.05). Post hoc analysis revealed no difference in the total MOCART scores between Groups 1 and 2. However, Groups 1 and 2 had significantly higher MOCART scores than Group 3 1 year after surgery (all p < 0.05). The collagen-augmented chondrogenesis technique group showed improved quality of cartilage repair compared to the microfracture group, regardless of patient age. Compared with simple microfracture treatment, there were no differences in clinical outcomes between the patient groups, related to age. Level Ⅲ.

Efficacy and safety of multidrug cocktail injections in postoperative pain management for lumbar microendoscopic decompression surgery: a prospective randomized controlled trial.

This study aimed to evaluate the analgesic effects and safety of multidrug cocktail injections for postoperative pain management in patients undergoing lumbar microendoscopic decompression surgery. A prospective randomized controlled trial was conducted with 70 patients who underwent lumbar microendoscopic decompression surgery between December 2023 and May 2024. Patients were randomly assigned to receive either a multidrug cocktail injection (cocktail group, n = 35) or no cocktail injection (non-cocktail group, n = 35). Primary outcomes included scores of the numerical rating scale (NRS) for pain from postoperative days 1 to 7 and the number of analgesics used within the first 3 postoperative days. Secondary outcomes included sex, age, body mass index, preoperative diagnosis, surgical levels, duration of surgery, blood loss, C-reactive protein (CRP) levels on postoperative day 1, and drain output. The cocktail group experienced significantly lower pain levels from postoperative days 1 to 7 (p < 0.05) and used fewer analgesics within the first 3days (p = 0.01) compared with the non-cocktail group. Additionally, the cocktail group had significantly lower CRP levels (p < 0.001) and a shorter hospital stay (p = 0.01). No significant differences were observed in the duration of surgery, blood loss, or drain output between the groups. Multidrug cocktail injections are effective and safe for postoperative pain management in lumbar microendoscopic decompression surgery, significantly reducing pain, analgesic use, CRP levels, and hospital stay. These findings suggest that incorporating multidrug cocktail injections into postoperative care protocols can enhance patient recovery and outcomes.

The Effect of Maternal Oxytocin Induction during Birth on Early Neonatal Pain and Stress: A Quasi-Experimental Study.

Oxytocin induction is a commonly used intervention during childbirth worldwide. This study aimed to compare the pain and stress levels of newborns born to mothers who administered synthetic oxytocin at birth with those who did not. This quasi-experimental study included 164 participants and their newborns who were delivered vaginally in a public hospital. The data were collected using an Information Form, a Neonatal Follow-Up Form, and the Assessment of Neonatal Pain and Stress Scale (ALPS-Neo). In the study, there were no differences between the two groups in terms of the participants' and newborns' demographic characteristics (p > .05). During and after drying, before, during, and after the first injection, and before, during, and after blood glucose measurement, the mean ALPS-Neo scores were higher in the oxytocin induction group, with the difference being statistically significant (p < .001). Although the data presented here are observational, the findings indicate that infants born to participants who underwent oxytocin induction exhibit more intense pain and stress responses. The pain-stress scores of newborns born to participants who underwent oxytocin induction were higher than those of newborns whose mothers did not receive oxytocin induction.

Clinical effect analysis of vertebroplasty with high viscosity and standard bone cement for Kummell disease.

This study aims to observe and compare the effects of high-viscosity bone cement versus standard bone cement on the postoperative outcomes of percutaneous vertebroplasty (PVP) in patients with Kummell disease. A retrospective analysis was conducted on 135 patients with Kummell disease who underwent PVP between January 2019 and May 2023. Patients were divided into 2 groups: the high-viscosity group (group H, 63 cases) received high-viscosity bone cement during surgery, while the standard group (group S, 72 cases) received standard bone cement. Surgery duration, bone cement volume, bone cement leakage rate, as well as preoperative and postoperative evaluations using the Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), anterior vertebral height, and kyphotic Cobb angle were recorded and compared between the 2 groups. In the group H, significant improvements were observed in VAS scores, ODI, anterior vertebral height, and Cobb angle at 24 hours, 3 months, and 1 year postoperatively compared to preoperative values (P < .01). In the group S, VAS scores and ODI showed significant improvement at 24 hours, 3 months, and 1 year postoperatively (P < .01), but there were no significant differences in anterior vertebral height or Cobb angle compared to preoperative values (P > .05). Comparatively, the group H demonstrated superior outcomes in terms of bone cement volume, leakage rate, recovery of anterior vertebral height, and Cobb angle correction at 24 hours, 3 months, and 1 year postoperatively (P < .05). However, there were no significant differences between the 2 groups in terms of surgery duration, VAS scores, and ODI at the same time points (P > .05). PVP is an effective treatment for Kummell disease, providing significant pain relief and improved spinal function. The use of high-viscosity bone cement allows for greater volume infusion, better restoration of vertebral height, and correction of deformities, while also reducing the risk of cement leakage.

Mid-Term Outcomes Following Trapeziectomy With Suture Suspensionplasty for Thumb Carpometacarpal Joint Osteoarthritis

In the treatment of symptomatic thumb carpometacarpal joint arthritis, numerous techniques have been used to maintain the trapezial space following trapeziectomy. The purpose of this study was to report the clinical and radiographic outcomes of the suture suspensionplasty technique. The hypothesis was that suture suspensionplasty would have similar clinical and radiographic outcomes compared with other techniques aimed at maintaining the trapezial space following trapeziectomy. Data were collected on 42 patients following trapeziectomy with suture suspensionplasty for symptomatic Eaton stage II-IV carpometacarpal osteoarthritis at an average follow-up of 2.1 years. Outcomes included the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, visual analog scale for pain, radiographic analysis of subsidence, and physical examination of lateral pinch strength and thumb opposition. Radiographs demonstrated that 42% of the trapezial space was maintained at 2.1 years following trapeziectomy with suture suspensionplasty. Median postoperative QuickDASH scores were 3.4 (first quartile, 0; third quartile, 15.9), which is consistent with or better than normative values in the population. Median postoperative visual analog scale scores were 0 (first quartile, 0; third quartile, 0) with good postoperative thumb opposition and pinch strength. Patients who underwent trapeziectomy with suture suspensionplasty had similar functional and radiographic outcomes at an average of 2.1 years after surgery compared with other techniques used for treatment of symptomatic thumb carpometacarpal joint arthritis. Therapeutic IV.

Comparison of Total Intravenous Anesthesia with Inhaler Anesthesia in Children Intubated with Remifentanil without Muscle Relaxant

Objective: The effects of remifentanil and muscle relaxant-free intubation as well as total intravenous anesthesia and inhaled anesthesia for tonsillectomy and/or adenoidectomy in children were compared. Materials and Methods: The study was conducted on 80 patients who were to undergo tonsillectomy and/or adenoidectomy between December 2014 and June 2015. Patients were randomized and divided into two groups. In the total intravenous anaesthesia group, 2.5 mg/kg propofol and 2 mcg/kg remifentanil were administered as induction within 90 seconds. In this group, 3 mg/kg/h propofol and 0.5 mcg/kg/min remifentanil were used for maintenance of anesthesia. In the sevoflurane group, 8% sevoflurane and 2 mcg/kg remifentanil were administered as induction within 90 seconds. In this group, 2.5% sevoflurane, 50% nitrogen protoxide and 50% oxygen were used at 6 l/min for maintenance of anesthesia. Results: Peak heart rate and systolic arterial pressure were significantly higher in Group I. Diastolic arterial pressure was significantly higher in Group T at 1 and 2 minutes after intubation and in Group 2 at 10 minutes postoperatively. Mean arterial pressure was higher in Group T at 2 minutes after intubation. In addition, Wong-Baker pain scale and agitation score were significantly higher in Group I. Spontaneous respiration and extubation time were significantly shorter in Group I. There was no difference between the groups in terms of side effects. Conclusion: Group total intravenous anaesthesia was thought to be a better choice in children because it had less impact on postoperative pain, agitation and recovery.

THE EFFECT OF SELF-ACUPRESSURE ON REDUCING BLOOD PRESSURE, HEADACHE AND SLEEP QUALITY DISORDERS IN HYPERTENSIVE PATIENTS

Hypertension is still a major health problem in Indonesia. Various efforts to overcome the problem of hypertension have been made, both pharmacological and non-pharmacological treatments. A therapy based on the patient's habits or culture will certainly be easier to implement and obey by. Therefore, this study aims to analyze the effect of self-acupressure on blood pressure, headache, and sleep quality of hypertensive patients. The research method used is a quasi-experiment, single-group pre-post-test design. The sample in this study were hypertensive patients who fit the inclusion and exclusion criteria at Wonokerto Health Centre, Pekalongan Regency. The data analysis used was univariate and bivariate analysis. Bivariate analysis used paired group t-test technique. The results showed that there was an effect of self-acupressure in reducing systolic blood pressure (p-value: 0.004), headache pain scale (p-value: 0.001), and decreased sleep quality disorder score (p value: 0.000). Massaging at acupressure points has the effect of improving blood flow, stimulating endorphin hormones and providing a relaxing effect so that it can reduce blood pressure, headache pain scale and sleep quality disturbance scores. Recommendations for future research are to add a control group and/or compare it with other independent complementary therapy techniques.

Use of butorphanol as a local anaesthetic for pain management in calves undergoing umbilical hernia repair.

The aim of the study was to compare the analgesic efficacy of butorphanol and lidocaine, alone or in combination, in calves undergoing surgical repair of umbilical hernia. The study was conducted in 60 calves of different breeds. Xylazine 0.3 mg/kg was administered intramuscularly to all animals in the study. The animals were then divided into three groups (n = 20) that received different treatments with lidocaine at 4.5 mg/kg and butorphanol at 0.02 mg/kg. The L group received lidocaine both by infiltration of the surgical planes and intraperitoneally, the B group received butorphanol both by infiltration of the surgical planes and intraperitoneally, and finally the LB group received lidocaine by infiltration of the surgical planes and butorphanol intraperitoneally. Heart and respiratory rates, haemoglobin oxygen saturation, non-invasive blood pressure and temperature were recorded during surgery. Response to the surgical stimulus was scored on a cumulative numerical scale that included percentage changes in HR, RR and SAP. Postoperative pain was assessed by three independent observers, blinded to treatment, using the UNESP-Botucatu Unidimensional Composite Pain Scale (UNESP-Botucatu UCPS-IV) for the assessment of postoperative pain in cattle. The course of physiological variables was appropriate for patients under anaesthesia. No subject required rescue intraoperative analgesia. In group L, 4 subjects at 40 m and 5 subjects at 50 m required postoperative rescue analgesia. Both butorphanol alone and the combination of butorphanol and lidocaine showed excellent intraoperative and postoperative scores. Furthermore, this combination did not cause any cardiopulmonary or other adverse effects. Based on the results of this study, both butorphanol alone and the co-administration of butorphanol and lidocaine administered locally proved to be safe and effective in providing adequate and long-lasting analgesia in calves, helping to reduce postoperative discomfort and maintaining adequate animal welfare.

SPIN-05 A CASE PRESENTATION ON ASTROCYTOMA

Abstract Patient initially presented to our facility with a 3 year history of limb weakness. The limb weakness started mainly with the right upper limb associated with pains that were radiating to the neck region. They had visited several local hospitals for treatment but had no improvement. One year later he developed low limb weakness, was on physiotherapy for a long time with no improvement, until 1/12 ago when he developed complete paralysis of both low limbs making him bound to use of wheelchair. He had an accompanied history of cervical and thoracic spine pains that were radiating to the chest. No history of trauma. MRI showed an expansile intramedullary cystic lesion seen throughout the length of the spinal cord with inhomogeneous post contrast enhancement, highly suggestive of astrocytoma. Ddx: Hemangioblastoma. On examination, he was not pale, no jaundice no edema, wheelchair bound, with Scoliosis. Vitals were within normal limit, with muscle atrophy and muscle power- RUL ⅗. LUL ⅘, RLL ⅗. LLB ⅖, with bilateral knee hyperreflexia with significant disuse atrophy. Pain scale 6/10. He was a secondary school student. His parents do menial jobs to support their family and would delay clinic reviews due to lack of finances.

Redefining Surgical Boundaries for Obese Patients? Full Endoscopic Lumbar Discectomy Proves Equally Effective With Shorter Hospital Stay in Obese Patients.

This cohort study aims to evaluate the impact of obesity on the outcomes of full endoscopic lumbar discectomy (FELD) in patients with lumbar disc herniation. We conducted a retrospective analysis of 156 adult patients who underwent FELD for lumbar disc herniation from January 2015 to February 2023. Patients were divided into 3 groups: obese endoscopic (n = 71), obese open surgery (n = 31), and nonobese endoscopic (n = 54). Clinical outcomes were assessed using the visual analog scale for leg and back pain, the Oswestry Disability Index, and patient satisfaction rates. Operative time, hospital stay duration, and complication rates were also analyzed. No significant differences were observed in patient-reported outcome measures, operative time, or complication rates between obese and nonobese patients undergoing FELD. The mean operative time was longer in the endoscopic group compared with the open surgery group (70.2 vs 59.8 minutes), but the hospital stay was significantly shorter for endoscopic patients (1.7 vs 2.4 nights, P = 0.0006). Both obese and nonobese groups showed significant improvements in visual analog scale and Oswestry Disability Index scores at the final follow-up, with satisfaction rates of 85.7% in the endoscopic group reporting good to excellent outcomes. FELD is a viable and effective alternative to traditional open surgery for obese patients, offering comparable clinical outcomes and the added benefit of a shorter hospital stay. These findings suggest that obesity does not inherently affect surgical outcomes, underscoring the need for further research with larger sample sizes and longer follow-up periods. FELD offers a viable and effective surgical option for obese patients, with outcomes comparable to traditional surgery but with the added benefit of shorter hospital stays.

Comparison of spinal anesthesia and local anesthesia in percutaneous interlaminar endoscopic lumbar discectomy for L5/S1 disc herniation: a retrospective cohort study

BackgroundInterlaminar endoscopic lumbar discectomy (IELD) is a prevalent method for managing lumbar disc herniation. Local anesthesia (LA) is frequently employed during IELD, albeit with its merits and drawbacks. The spinal anesthesia (SA) represents a feasible anesthetic strategy for IELD; however, the availability of clinical research data is currently limited.MethodsThe propensity score matching was conducted to ensure the comparability of the SA and LA groups. The outcome measures were operation time, intraoperative visual analogue scale (VAS) for pain, need for adjuvant analgesia, intraoperative vital signs, blood loss, adverse surgical events, anesthesia-related complications, postoperative bed rest duration, VAS for pain at 2 h postoperatively, Oswestry Disability Index score (ODI), satisfaction with surgical efficacy, and willingness to undergo reoperation at 6 months postoperatively.ResultsFifty-six patients were assigned to each group. Significant differences were found between the groups regarding intraoperative VAS for pain, use of adjuvant analgesics, willingness to undergo reoperation, maximum intraoperative systolic blood pressure, and variability (P < 0.05). Compared to the LA group, the SA group had lower VAS for pain at 2 h postoperatively, a longer operation time, a longer duration of postoperative bedrest, and more anesthesia-related complications (P < 0.05). No significant intergroup differences were detected in intraoperative heart rate variability, blood loss, ODI, satisfaction with surgical efficacy, and surgery-related complications (P > 0.05).ConclusionSA as an alternative anesthesia for IELD surgery holds great promise, exhibiting superior efficacy compared to LA. However, it is crucial to meticulously evaluate the indications due to potential risks associated with this form of anesthesia.

Developing and Validating a Multimodal Dataset for Neonatal Pain Assessment to Improve AI Algorithms With Clinical Data.

Using Artificial Intelligence (AI) for neonatal pain assessment has great potential, but its effectiveness depends on accurate data labeling. Therefore, precise and reliable neonatal pain datasets are essential for managing neonatal pain. To develop and validate a comprehensive multimodal dataset with accurately labeled clinical data, enhancing AI algorithms for neonatal pain assessment. An assessment team randomly selected healthy neonates for assessment using the Neonatal Pain, Agitation, and Sedation Scale. During painful procedures, 2 cameras recorded neonates' pain reactions on site. After 2weeks, assessors labeled the processed pain data on the EasyDL platform in a single-anonymized setting. The pain scores from the 4 single-modal data types were compared to the total pain scores derived from multimodal data. The On-Site Neonatal Pain Assessment completed using paper quality scales is referred to as OS-NPA, while the modality-data neonatal pain labeling performed using labeling software is MD-NPL. The intraclass correlation coefficient among the 4 single-modal groups ranged from 0.938 to 0.969. The overall pain intraclass correlation coefficient score was 0.99, with a Kappa statistic for pain grade agreement of 0.899. The goodness-of-fit for the linear regression models comparing the OS-NPA and MD-NPL for each assessor was greater than 0.96. MD-NPL represents a productive alternative to OS-NPA for neonatal pain assessment, and the validity of the data labels within the Multimodality Dataset for Neonatal Acute Pain has been validating. These findings offer reliable validation for algorithms designed to assess neonatal pain.

Impact of the mother's voice on sedation need and stress during cardiologic examination of children (SMUSS study): a prospective, interventional, randomised, controlled, monocentric study.

Cardiac catheterisation is crucial for diagnosing and treating paediatric heart diseases, but it is poorly tolerated by small children, infants, and newborns without sedation. This study investigated whether maternal voice during sedation could lower stress and pain in children undergoing cardiac catheterisation and also assessed mothers' stress levels before and after the procedure. This was a prospective, monocentric, randomised, controlled interventional study at the University Hospital Bonn. Children aged 4 years or younger scheduled for elective cardiac catheterisation under procedural sedation and American Society of Anaesthesiologists class between 1 and 3 were eligible. At the end of cardiac catheterisation, the intervention group showed a higher Newborn Infant Parasympathetic Evaluation index with an adjusted mean difference of 9.5 (± 4.2) (p = 0.026) and a lower median Children's and Infants Postoperative Pain Scale score of 2.0 (IQR: 0.0-5.0) versus 4.5 (IQR: 3.0-6.0) than the control group (p = 0.027). No difference in the children's cortisol level was found (p = 0.424). The mothers in the intervention group had a lower cortisol level than those in the control group before cardiac catheterisation (adjusted mean difference: -4.5 nmol/l (± 1.8 nmol/l), p = 0.011). Listening to the maternal voice during cardiac catheterisation could lead to less postoperative pain and significantly lower stress and discomfort level in children. Less pain could reduce the incidence of postoperative delirium.Additionally, mothers perceived involvement as positive. A reduced stress level of mothers can positively influence children and possibly reduce pain and anxiety.

Description and Outcomes of an Ultrasound-Guided Technique for Catheter Placement in the Canine Quadratus Lumborum Plane: A Cadaveric Tomographic Study and Clinical Case Series.

This study aimed to describe an ultrasound-guided technique for implanting catheters for local anesthetic administration into the quadratus lumborum (QL) inter-fascial plane in canine cadavers and assessing the spread along the vertebral bodies (VBs) by computed tomography (CT). Phase 1: eight canine cadavers received one catheter per hemiabdomen, followed by injection of contrast media solution [low volume (LV) 0.3 mL kg-1 or high volume (HV) 0.6 mL kg-1]. Phase 2: postoperative pain of five dogs was managed by injecting 0.3 mL kg-1 of ropivacaine 0.5% through QL catheters every eight hours, up to 72 h after abdominal surgery. Pain was assessed using the Short Form of the Glasgow Composite Measure Pain Scale, and methadone 0.2 mg kg-1 was administered intravenously when the pain score was ≥6. The number of VBs stained by the contrast solution between the QL and psoas minor muscles was significantly higher in group HV than group LV. The catheter tip was visualized in the retroperitoneal space in 1/16 and 2/10 hemiabdomens in phases 1 and 2, respectively. Rescue analgesia was required in 3/5 dogs during the postoperative period. The QL catheter placement technique appears feasible and may be included in a multimodal analgesic approach for dogs undergoing abdominal surgeries.

Prospective, randomized, double-blind trial to validate the efficacy of an oral herbal gel on pain in the newborn during minor diagnostic-therapeutic procedures.

Term and preterm infants are frequently exposed to painful procedures and stimuli during hospitalization in the Neonatal Intensive Care Unit (NICU). Pain is widely recognized to cause short- and long-term effects in the newborn. In recent years there has been a growing medical interest and a strong demand from parents for phytotherapeutic drugs, but literature data are limited, and excellent methodological studies are necessary to evaluate the importance of phytotherapy in the neonatal period. We evaluated the use of an oral phytotherapeutic gel based on chamomile, angelica and oats in the management of full term and preterm infant pain caused by minor diagnostic or therapeutic procedures. We enrolled full term infants (>37 weeks gestational age [GA]) and preterm infants with higher GA than 28 weeks, weighing more than 1000 grams. Assessed painful procedures were minor diagnostic or therapeutic ones. Newborns were double-blind randomized into two groups (A and B) to orally receive the phytotherapeutic gel (solution A) and a gel of the same consistency and aroma (solution B) before the painful procedure. The group of newborns to whom solution A had been administered showed significantly lower scores in the Pain Scale (P<0.01) during painful procedure. This figure indicates that the herbal medicine has been effective in reducing pain experience in the population of examined newborns. To the best of our literature research, our work is the first scientific study highlighting the possibility of preventive beneficial effects of phytotherapeutic drugs on pain control.

Outcome measures and their importance for effective equine back pain rehabilitation

Effective rehabilitation for equine back pain is required due to the frequency of dysfunction effecting performance and welfare. Reliable and valid measures should be used establish a baseline in pain and dysfunction levels, and used to monitor change during rehabilitation, as well as support future research assessing the efficacy of treatment interventions. Such measures are collectively known as outcome measures and can include specific objective markers of impairments such as reduced range of motion, or pain on palpation. The aim of this narrative review is to discuss the options and tools available to use as outcome measures in relation to the treatment and rehabilitation of back pain in the horse. In this paper outcome measures critically discussed relate to conformation and standing posture, muscle dimensions, palpation, range of motion, objective gait analysis, functional analysis, owner reported outcome measures and pain scales. Recommendations are made to assist with selection of a suitable outcome measure. In conclusion, complex laboratory-based analysis systems are available to be gold-standard truly objective systems, although realism for clinical practitioners working in the field limits their use. There is a requirement for new outcome measures that are not subject to observer bias nor time or financially consuming, however it is possible to use those available currently with assist in clinical decision making for the benefit of the horse.

Comparison of intra and postoperative analgesia efficacy of intraperitoneal levobupivacaine alone or in combination with dexmedetomidine in cats undergoing ovariohysterectomy; a randomized, prospective, blinded, clinical trial

This study aimed to compare the analgesic and cardiopulmonary effects of levobupivacaine with or without dexmedetomidine, in cats undergoing ovariohysterectomy. In this prospective, randomized, and blinded clinical trial, 24 healthy cats were recruited. Animals received either saline (S group; 2 mL NaCl), levobupivacaine alone (Lev; 0.35 mg/kg), or levobupivacaine with dexmedetomidine (LevDex group; 0.004 mg/kg), which was infiltrated intraoperatively into the subcutaneous tissue at various incision sites, including the right and left ovarian pedicles and the caudal aspect of the uterine body. Intraoperative analgesia was evaluated using a cumulative pain scale, while postoperative analgesia was assessed at various time points: before surgery (Tb), and at 0 (T0), 1 (T1h), 2 (T2h), 4 (T4h), 8 (T8h), 12 (T12h), and 24 (T24h) hours after the procedure, using the UNESP-Botucatu multidimensional composite pain scale (MCPS). Significant decreases in heart rate, respiratory rate, and mean arterial pressure were observed in LevDex group as compared to S and Lev groups (p < 0.05). The S group required significantly more rescue morphine doses than the LevDex group (p = 0.029), but the difference was not significant when compared to the Lev group (p = 0.123). At T1h and T2h, the S group had significantly higher MCPS scores than both the Lev and LevDex groups (p = 0.029). However, at T8h, no significant difference was found between the S and LevDex groups (p = 0.741). While adding dexmedetomidine to levobupivacaine may slightly prolong postoperative analgesia, this combination does not provide significant additional benefit over levobupivacaine alone in terms of response to surgical stimulation.

Quality improvement scorecards driving innovation and best practice in a large community oncology practice.

417 Background: Lean Six Sigma Visual Management dashboards, or scorecards, are visual tools designed to drive and improve quality patient care, operationalize best practices, and promote a culture of operational excellence. Practice scorecards create a disciplined problem-solving culture where root causes are identified, and systemic process-based improvements are implemented. Scorecards are created to show full practice data transparency, allowing all employees and sites to see each other’s data. Scorecards are designed so that providers can efficiently review the maximum amount of data, following a Green, Yellow, Red visual cue to signify goal adherence. Methods: Phase 1 (2018 – 2019): Clinical scorecards were created and introduced to all staff on a weekly basis focusing on a few key patient metrics (ex: pain scale, pain care plan, ACP, PHQ-9, teaching/consents, patient portal access). Phase 2 (2020 – 2022): Clinical scorecards were expanded with additional patient care initiatives. New nurse navigator scorecards created (ex: patient teaching and survivorship visits). New physician and APP scorecards created with practice-specific provider metrics. Phase 3 (2023 – 2024): Scorecards updated yearly to match practice quality initiatives. New dashboards for non-clinical employees initiated. Physician and APP compensation changed to include quality metric performance tied to financial incentive. Results: Over the course of 5 years, OHC quality scorecard metrics improved from below national averages (red) to exceeding top-tier threshold goals (green). Scorecard utilization increased across all areas of the business, expanding from one scorecard in 2018 to eight in 2024. Scorecards increased overall practice data transparency leading to increase practice quality metric performance. OHC staff utilize scorecards on a weekly, monthly, and quarterly basis to drive quality improvement adherence. Improved outcomes through full data transparency increased staff participation and ownership in quality metrics and led to achieved shared savings in managed care programs. Example of metrics and results: Patient NCCN Staging 36% (2588/7263) to 96% (10299/10749), Teaching/Consents 37% (423/1147) to 97% (3067/3160), and Oral regimen NCCN entry 69% (586/845) to 98% (1037/1055). Conclusions: Visual Management dashboards or practice scorecards are instrumental in driving and supporting practice change. Scorecards allowed OHC staff to efficiently visualize practice-wide actionable data with eye-catching colors to promote optimal clinical performance. As increased data procurement is on the rise, practices can empower their staff to drive change through data utilization. OHC’s scorecards have proven to bridge the gap to goal, facilitate transparent data sharing, and empower providers and staff toward collaboration and embracing operational excellence.