Verbal Rating Scale Pain Research Articles

Is arthroplaSty bEtter than interNal fixation for undiSplaced femoral nEck fracture? A national pragmatic RCT: the SENSE trial

IntroductionUndisplaced femoral neck fractures (FNFs) are usually treated by internal fixation (IF) but two randomised controlled trials (RCTs) have demonstrated advantages of treatment with arthroplasty. The complication rate was lowered...

Comparing erector spinae plane block with serratus anterior plane block for minimally invasive thoracic surgery: a randomised clinical trial

BackgroundMinimally invasive thoracic surgery causes significant postoperative pain. Erector spinae plane (ESP) block and serratus anterior plane (SAP) block promise effective thoracic analgesia compared with systemically administered opioids, but have never been compared in terms of terms of quality of recovery and overall morbidity after minimally invasive thoracic surgery. MethodsSixty adult patients undergoing minimally invasive thoracic surgery were randomly assigned to receive either single-shot ESP or SAP block before surgery using levobupivacaine 0.25%, 30 ml. The primary outcome was quality of patient recovery at 24 h, using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes included area under the curve (AUC) of pain verbal rating scale (VRS) over time, time to first opioid analgesia, postoperative 24 h opioid consumption, in-hospital comprehensive complication index (CCI) score and hospital stay. ResultsThe QoR-15 score was higher among ESP patients compared with those in the SAP group, mean (standard deviation): 114 (16) vs 102 (22) (P=0.02). Time (min) to first i.v. opioid analgesia in recovery was 32.6 (20.6) in ESP vs 12.7 (9.5) in SAP (P=0.003). AUC at rest was 92 (31) mm h−1vs 112 (35) in ESP and SAP (P=0.03), respectively, whereas AUC on deep inspiration was 107 mm h−1 (32) vs 129 (32) in ESP and SAP (P=0.01), respectively. VRS pain on movement in ESP and SAP at 24 h was, median (25–75% range): 4 (2–4) vs 5 (3–6) (P=0.04), respectively. Opioid consumption at 24 h postoperatively was 29 (31) vs 39 (34) (P=0.37). Median (25–75%) CCI in ESP and SAP was 1 (0–2) vs 4 (0–26) (P=0.03), whereas hospital stay was 3 (2–6) vs 6 (3–9) days (P=0.17), respectively. ConclusionCompared with SAP, ESP provides superior quality of recovery at 24 h, lower morbidity, and better analgesia after minimally invasive thoracic surgery. Clinical trial registrationNCT 03862612.

Utilization of a Novel Opioid-Sparing Protocol in Primary Total Hip Arthroplasty Results in Reduced Opiate Consumption and Improved Functional Status

BackgroundTotal hip arthroplasty (THA) candidates have historically received high doses of opioids within the perioperative period; however, the amounts are being continually reduced as awareness of opioid abuse spreads. Here we seek to evaluate the effectiveness of a novel opiate-sparing protocol (OSP) for primary THAs in reducing opiate administrations, while maintaining similar levels of pain control and postoperative function. MethodsAll patients undergoing primary THA between January 1, 2019 and June 30, 2019 were placed under a novel OSP. Data were prospectively collected as part of standard of care. To assess the primary outcome of opiate consumption, nursing documented opiate administration events were converted into morphine milligram equivalences (MMEs) per patient encounter per 24-hour interval. Postoperative pain and functional status were assessed as secondary outcomes using the Verbal Rating Scale for pain and the Activity Measure for Post-Acute Care scores, respectively. ResultsOne thousand fifty primary THAs had received our institution’s OSP, and 953 patients were utilized as our historical control. OSP patients demonstrated significantly lower 0-24, 24-48, and 48-72 hours with less opiate administration variance (total MME: Control 75.55 ± 121.07 MME vs OSP 57.10 ± 87.48 MME; 24.42% decrease, P < .001). Although pain scores reached statistical significance between 0 and 12 (Control 2.09 vs OSP 2.36, P < .001), their differences were not clinically significant. Finally, OSP patients demonstrated a trend toward higher Activity Measure for Post-Acute Care scores across all 6 domains (total scores: Control 20.53 ± 3.67 vs OSP 20.76 ± 3.64, P = .18). ConclusionImplementation of an OSP can significantly decrease the utilization of opioids in the immediate postoperative period. Inpatient opioid administration can be significantly reduced while maintaining a comparable and non-inferior level of pain and function.

Pain relief after more than 24 hours of preoperative skin traction in patients with intertrochanteric fractures: A retrospective comparative cohort study

AimThe primary aim of the study was to investigate pain relief after more than 24 h of preoperative skin traction (because of delay in surgery due to comorbidities and system issues) in patients with intertrochanteric fractures. MethodWe performed a retrospective comparative cohort study of 56 patients who underwent intramedullary nailing for the treatment of intertrochanteric fractures and who had waited for surgery for more than 48 h after admission due to comorbidities or system issues. Preoperative therapy was randomly selected with a ratio of one to two and patients classified as skin traction (n = 18) or no traction (n = 38). The Verbal Rating Scale (VRS) was used to assess pain at 12–60 h post-admission. ResultsThere was no significant difference in VRS at 12 h after admission (1.1 ± 1.0 vs. 0.8 ± 0.9, p = 0.73), but patients who received skin traction had a lower VRS pain score at 24–60 h after admission compared to those with no traction (24 h, 0.4 ± 0.8 vs. 1.1 ± 1.0, p < 0.05; 36 h, 0.2 ± 0.5 vs. 0.9 ± 0.9, p < 0.05; 48 h, 0.2 ± 0.4 vs. 0.8 ± 0.9, p < 0.05; 60 h, 0.2 ± 0.4 vs. 0.9 ± 0.9, p < 0.05). ConclusionSkin traction for patients with intertrochanteric fractures for more than 24 h preoperatively resulted in a lower VRS pain score. Therefore, more than 24 h of preoperative skin traction for patients with intertrochanteric fractures may give effective pain relief in situations where surgery is delayed.

Non-Steroid Anti-Inflammatory Drug Salsalate Provides Safe and Effective Pain Control during Stem Cell Transplantation

<h3>Intro</h3> NSAIDs are drugs of choice for the treatment musculo-skeletal pain and other inflammatory conditions. Salsalate is a platelet sparing NSAID with less gastric toxicity compared to aspirin. Using NSAIDs during HSCT is challenging as periods of profound pancytopenia and toxicity raise concerns about the safety of these agents. To date, the use of salsalate during HSCT has not been previously reported. <h3>Methods</h3> All HSCT recipients treated with salsalate for at least 7 days during the period of profound neutropenia and thrombocytopenia were included. Patients were monitored for kidney, liver (25% for > 2 days), hearing, emergence of GI/GU or other bleeding disorders, time to engraftment, drug toxicity or discontinuation. The Verbal Rating Scale for Pain (Severe: 7-10, Moderate: 4-6, Mild: 1-3) was used to grade pain before and after treatment. <h3>Results</h3> 44 (28 autologous and 16 allogeneic) stem cell recipients were identified. Female (24/44; 55%), Age -61(32-74); Dx: Myeloma (n=24), NHL (n=8), AML (n=5), Other(n=7). 8 patients were receiving NSAIDS prior to admission. 6 patients were admitted with baseline grade 3 CKD . Median WBC and platelet nadir while receiving salsalate was <0.1 and 8 cells/ml respectively. Median salsalate start date was Day+4(-6-32), median daily dose was 1.5g/day (1-3gm), and number of treatment days was 9(7-41). More than 80% patients experienced mucositis in addition to their treatment-directed pain. Table 1 show pain was improved or eradicated in 27/44 (64%) of patients, and stable in 15/44 (36%)- 9 of which were receiving NSAID PTA. All patients who experienced generalized body pain improved with salsalate. Change in kidney and liver function was infrequent (<10%) and there were no major bleeding episodes or hearing loss. Discontinuation occurred in 4 patients, 2 in patient for possible toxicity, and 2 for lack of effect. Time to engraftment was within normal limits and there was no hospital related mortality. Moderate doses of NSAID salsalate are well tolerated throughout the entire transplantation period in autologous and allogeneic recipients and may benefit patients with a variety of different types of pain, including growth factor, engraftment and cytokine release pain syndromes. Additional studies are needed to confirm these results.

Thoracic spine manipulation did not improve maximal mouth opening in participants with temporomandibular dysfunction.

Temporomandibular joint disorders (TMD) have a prevalence of more than 5% in the general population. A positive correlation exists between temporomandibular joint mobility and cervical spine mobility. Similarly, a relationship exists between thoracic and cervical spine mobility. However, it is unknown if interventions to improve the mobility of the thoracic spine positively impact temporomandibular joint motion and pain. This study tested the hypothesis that a single thoracic thrust joint manipulation (TJM) would improve maximum mouth opening (MMO) compared with participants without TMD as well as decrease TMD symptoms. Forty-eight people with TMD (30.9 years old ±11.3) and 55 people without TMD (28.5 years old ±9.2) participated. Both groups received a seated upper thoracic TJM and were measured for MMO before and immediately following the TJM. The duration of TMD symptoms and pre-thrust current pain, using the 11-point Verbal Pain Rating Scale (VPRS), was recorded in the TMD group. Participants in the TMD group were contacted 2-3 days after TJM to report current VPRS and improvement utilizing the Global Rating of Change (GROC) scale. No difference in MMO treatment response over time was observed between groups (p = .56). The MMO in the TMD group improved from 40 to 41.3 mm, and the non-TMD similarly improved from 44.5 to 45.4 mm. The VPRS decreased from 2.4 (±1.8) to 1.3 (±1.5) following thoracic TJM (p < .001), and the average GROC score was 1.8 (±2.25), which was statistically different than zero (no change; p < .001). The duration of TMD symptoms prior to TJM was not associated with GROC scores (r = .018, p = .90) or VPRS change scores (r = -.07, p = .64). The observed treatment effects did not exceed previously reported standards for clinical relevance (5 mm and 2 points, respectively).

Fasciotomy for chronic exertional compartment syndrome of the leg: clinical outcome in a large retrospective cohort.

Chronic exertional compartment syndrome (CECS) is an overuse disorder typically affecting an athletic population. CECS is a diagnosis based on history and intracompartmental pressure (ICP) testing. CECS patients can be treated surgically by fasciotomy; however, research on the relationship between ICP and patient symptoms and also between ICP and patient-reported outcome post-fasciotomy is limited. This study aims to (1) assess functional outcome and patient satisfaction post-fasciotomy and (2) identify any potential correlation between ICP and reported levels of pain. 138 CECS patients who had ICP measurements and subsequently underwent fasciotomy were identified from our regional service for exercise-induced lower limb extremity pain between January 2000 and March 2017. Clinical outcomes were recorded at the time of ICP testing and in the post-operative follow-up clinic. Pain was reported using a verbal rating scale (VRS) ('low', 'moderate' or 'high') or as a visual analogue score (VAS) 0-10 (0 = least painful, 10 = most painful). Spearman's ranked correlation test was used to calculate correlation between ICP and reported pain. A total of 138 patients were eligible for inclusion in this study (mean age 29.7 ± 9.7years, 110 M, 28 F) of which 109 patients (VRS n = 61, VAS n = 48) reported pain level at pre- and post-operative stages. Mean pre-operative VAS score was 8.52 ± 0.71, and decreased to 0.77 ± 0.69 post-operatively. An insignificant positive correlation (r = 0.046, two-tailed p = 0.76) was found between VAS pain and ICP. A significant moderate positive correlation (r = 0.497, two-tailed p = 0.01) was found between VRS pain and ICP. Fasciotomy significantly reduces pain and increases activity levels in CECS patients. ICP was found to positively correlate with patient-reported pain.

Clinical manifestation of pediatric acute pancreatitis - a prospective multicenter nationwide cohort

The purpose of this investigation was to compare child behavior before surgery with experience of pain and anxiety in relation to two techniques of tonsil surgery, to relate previous experiences of surgery/tonsillitis with anxiety and pain, and to compare the children's, parent's and nurse's rating of pain.Ninety-two children (5–15 years) with sleep-disordered breathing (SDB) and with or without recurrent tonsillitis were randomized to partial tonsil resection/tonsillotomy (TT) or full tonsillectomy (TE). Measures: Parents: Child Behavior Checklist (CBCL). Children: State-Trait-Anxiety Inventory for Children (STAIC) and seven-point Faces Pain Scale (FPS). Parents/staff: seven-point Verbal Pain Rating Scale (VPRS). Pain relievers were opoids, paracetamol and diclophenac.These children with SDB scored significantly higher on CBCL than did normative groups, but no connection was observed between CBCL rating and experience of pain. There was no relation between pre-operative anxiety and pain. The post-operative anxiety level (STAIC) correlated with pain. The TE-group scored higher on STAIC after surgery. Previous experience of surgery or tonsillitis did not influence post-operative pain. The TE-group rated higher experience of pain despite more medication. The nurses scored pain lower than the parents/children and under-medicated.SDB may influence children's behavior, but with no relation to post-operative pain. The surgical method predicts pain better than does the child's behavior rating. The nurses underestimated the pain experienced by the child.

Acceptability of Endometrial Polyp Resection under Local Anaesthesia

<strong><em>Introduction</em></strong>: New evidence is emerging to suggest that outpatient endometrial polyp removal under hysteroscopic guidance by morcellation with local anaesthesia is non-inferior to in patient polypectomy under general anaesthesia. However, evidence on its acceptability warrants further evaluation. <strong><em>Objective: </em></strong>To assess the patient’s acceptability of endometrial polyp resection under local anesthesia in an outpatient setting. <strong><em>Methodology </em></strong>: A prospective cohort study was carried out for three months on all patients who underwent this procedure under local anaesthesia in a secondary care unit in the United Kingdom. Intra-operative and post-operative acceptability was assessed by a standard questionnaire filled immediately after the procedure and before discharge on the first post-operative day. <strong><em>Results </em></strong>: Fifty patients underwent this procedure. The mean age was 56.48(range36-83). Complete resection of the polyps was achieved in 94% of the patients, while 6% had partial resection without total failure. Average, intra operative, immediate post operative and day 1 post operative pain scores were 2.38, 1.44 and 1.38 respectively and were in the mild category of the Discrete Quantitative Pain Verbal Rating Scale. Seventy eight percent of the patients were totally satisfied with the procedure while 14% and 8% were generally and fairly satisfied. None expressed that the procedure was unacceptable. Ninety four percent opted to recommend the procedure to a friend while 96% of patients expressed their willingness to undergo the procedure under local anesthesia, if they were to have another resection of the polyp. <strong><em>Conclusion</em></strong>: Outpatient hysteroscopic polyp resection by morcellation under local anesthesia is well tolerated and accepted by patients in an outpatient setting.

A comparison of three self-report pain scales in Sri Lankan children

Background: Many self-report pain scales are available to assess the intensity of pain reported by children. There is hardly any research to compare their validity in Sri Lankan children. Objective: To compare 3 self-report pain scales viz. FACES Pain Scale (FPS), Numeric Pain Rating Scale (NRS) and Verbal Pain Rating Scale (VRS). Method: The study population comprised children 4-12 years old who presented to the paediatric ward and clinic of Ampara General Hospital with a complaint of pain from July 2012 to June 2013. Each child graded the pain intensity on the three pain scales introduced in random order by a trained investigator and rated the most easily understood scale. The investigator was asked to rate the most easily explainable scale in the individual case. The scales were ranked according to internal consistency, child preference and investigator preference. Results: There were 152 children aged between 4-12 years who presented to the paediatric ward and clinic of Ampara General Hospital with a complaint of pain during the study period. The correlations between FPS/NRS, FPS/VRS and NRS/VRS were 0.82, 0.73 and 0.73 respectively, all with p Conclusions: The reliability of all three pain scales in terms of correlation and internal consistency is moderate to high in Sri Lankan children. The FPS is recommended since it is easily understood by children and because of its easy administration and favourable internal consistency. Sri Lanka Journal of Child Health , 2017; 46 (1): 23-28

A comparative study of scalpel versus surgical diathermy skin incisions in clean and clean-contaminated effective abdominal surgeries in AVBRH, Wardha, Maharashtra, India

Aim: To study the safety and efficacy of diathermy as a modality to give skin incisions. Study Design: Observational study conducted in department of surgery at AVBRH, over 2 years from 2013 to 2015. Material and Methods: 100 cases were studied. In 50 cases incision was given by scalpel and in 50 incisions was given by diathermy. Primary outcome variable was the incisional blood loss, calculated by measuring the weight of swabs used exclusively during incision until complete hemostasis was achieved. Secondary outcome variables were incision time, operative time, pain verbal rating scale (VRS), wound healing, and wound complications. Incision time was defined as the time from the beginning of skin incision until subcutaneous fat arrived, with complete haemostasis; it was expressed in s/cm2. Severity of pain was defined using VRS. Results: we reported shorter time for skin incision, lesser blood loss during surgery and lesser wound complication in cases of diathermy incision, and has more significant pain reduction as compared to scalpel group. Conclusion: The findings of the present study shows that diathermy seems to provide some benefit with respect to postoperative wound pain and has obvious safety advantages to the surgical team compared with scalpel.

Effect of High-Intensity Laser Treatments on Chronic Pain Related to Osteoarthritis in Former Professional Athletes: A Case Series

Background: We evaluated the use of a new higher intensity 42 Watt cold laser for treating chronic pain related to osteoarthritis (OA) in former NFL football players. Methods: 39 consenting former NFL football players with OA underwent 1-3 treatment sessions lasting 10-20 min with a 42 Watt FDA-approved high-intensity cold laser (Phoenix thera-lase, Dallas, TX) at a wavelength of 1275 nm. We recorded their pain verbal rating scale (VRS) score at rest and with activity before and after each treatment using an 11-point VRS with 0=no pain to 10=worst pain imaginable. In addition, we assessed the duration of the painrelieving effect produced by each laser treatment, as well as its effects on other OA-related symptoms. Results: The chronic pain scores were significantly reduced both at rest and with activity after each treatment. Baseline VRS pain scores were 3.5 ± 2.9 at rest and 6.0 ± 2.6 with activity. After the initial treatment, the pain scores were reduced to 1.2 ± 1.8 (p<0.01) at rest and to 2.0 ± 2.0 (p<0.01) with activity. The overall beneficial effect was 7.2 ± 1.8 on a scale from 0=no relief to 10=complete relief, and the duration of the beneficial effect lasted 1-3 weeks in 64% of the players treated. Finally, 90% of the players would recommend the laser treatment to their colleagues. Conclusion: High-intensity cold laser treatments reduced chronic OA-related pain in former NFL football players by ~67% at rest and with activity and the beneficial effect typically persisted for 1 week or longer after 1-3 treatments in the majority of these chronic pain patients.

5% NaHCO3 Is Appropriate for Skin Cleaning With Central Venous Catheters

ObjectivesThe purpose of this study was to compare the effects of skin cleaning with 5% NaHCO3 to 75% alcohol on the removal of skin grease and pain of patients with central venous catheters (CVC). Materials and MethodsThis was a randomized, controlled, single-blinded and prospective study. From January-September 2015, 143 consecutive patients who met the inclusion and exclusion criteria and who underwent elective cardiovascular surgery with placement of a CVC were selected. Patients were randomly divided into 2 groups according to the disinfection preparation procedure: experimental group (n = 60), in which 5% NaHCO3 and distilled water solution at 40-45°C were used, and the control group (n = 66), in which 75% alcohol was used. Main outcome measures were verbal rating scale pain score, satisfaction and bacterial count after 2 minutes of iodine disinfection. ResultsThe verbal rating scale pain scores were lower in the experimental group than in the control group (P < 0.001). In the control group, 4.5% of patients and 43% of nurses were satisfied with 75% alcohol cleaning before disinfection procedure, compared to 74% and 78%, respectively, in the experimental group. The bacterial count did not show any difference between these 2 groups after iodine disinfection (P = 0.455). ConclusionsCleaning of the CVC before disinfection with 5% NaHCO3 and distilled water at 40-45°C alleviated pain and improved patient and nurse satisfaction compared with using 75% alcohol.

Comparison of pre treatment with Ondansetron and Lignocaine over Pain on Etomidate Injection. A double blind prospective non randomised study

Background: Etomidate is the preferred induction agent in patient with Cardiac disease due to its cardiac vascular stability. It can cause severe pain during IV administration which can produce increased stress response. Various methods have been tried to reduce the pain of etomidate injection with variable success. Lignocaine pre-treatment which is extensively used to reduce the pain of propofol injection is also used to reduce the pain of etomidate injection. Materials And Methods: This nonrandomised double blind, study was done after getting ethical clearance from university ethical committee. After informed consent 40 patients of both sexes aged between 18 to 65 years of ASA physical status 1, 2 & 3, who were posted for various elective surgical procedure planned under general anaesthesia were enrolled for the study.. They were not given any premedication. On arriving to Operating room (OR) 20G IV cannula inserted on dorsum of both hands and both flushed with100ml of normal saline. Venous drainage was occluded with elastic band in the both hands at midarm. In one hand 2ml of 1% lignocaine followed by 1 ml (2 mg ) of Etomidate is Injected and pain is assessed by Verbal rating scale(VRS). After one minute in other hand 2 ml (8mg) ondansetron injected followed by 1 ml (2 mg ) of Etomidate and pain is assessed. Statistical analysis: Non-Parametric test-Wilcoxon Sign Ranks Test is used to compare both drugs .Analysis is perfomed using SPSS Version22. Results: A total number of 40 patients (male=57.50%, female=42.50%).The mean age of patient was 42.85, The mean VRS pain score of etomidate after pre-administration of intravenous lignocaine (Drug A) was 1.58, which was lower compared to pre-administration of ondansetron(Drug )2.43. Conclusion: This study illustrates that pre-treatment with intravenous lignocaine significantly reduces the pain on injection of etomidate compare to ondansetron. (P value<0.001).

Verbal and Non-verbal Rating Scales in the Determination of Pain Severity in Trauma Patients in the Emergency Department

Background: Using subjective tools for pain assessment is essential, but may confuse healthcare professionals in some clinical situations. It is also useful to assess pain severity objectively. Several observational pain scales have been developed, but they are mostly for intensive care units and not for the emergency department (ED). Objectives: The purpose of the present study was to compare the verbal rating scale (VRS) and Nonverbal Rating Scale (NVRS) in the determination of pain severity in patients with limb trauma, in the ED of a general hospital in Kashan, Iran, in 2014. Methods: This observational, prospective study was conducted on 450 traumatic patients admitted to the trauma ED of Shahid Beheshti Hospital in 2014. The tool used in this study consisted of three parts: demographic data, VRS, and NVRS scores at 7 time points, from arrival until 4 hours. The statistical analysis was conducted using the two-tailed Student’s t-test, Mann-Whitney U test, Pearson correlations, and repeated measures. The data analysis was conducted using SPSS software, version 16. Results: The average age of the participants was 35.2 years, and the extremities were the most common painful area (66.2%). The mean VRS and NVRS pain intensity ratings upon arrival were 6.16 (± 2.63) and 3.06 (± 2.17), respectively. The estimation of pain was lower in the NVRS when compared to the VRS, and the scores in these two tools showed a significant correlation. One-hundred and seventy-two of the patients received interventions for pain relief; 60 patients received analgesics and 112 patients (24.8%) received non-pharmacological interventions, such as stabilization of the injured extremity. Conclusions: This study indicated that the modified version of the adult NVPS in step with the VRS is a useful tool for pain intensity assessment in the ED.

Intra-pocket anaesthesia and pain during probing, scaling and root planing: a systematic review and meta-analysis.

A systematic review/meta-analysis was performed to evaluate pain during probing, scaling and root planing using intra-pocket anaesthesia versus placebo in adult patients. A search was performed in PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library and Grey literature. IADR abstracts, unpublished trials registries, dissertations and theses were also searched for randomized clinical trials comparing the clinical effectiveness of intra-pocket anaesthesia and placebo. Risk/intensity of pain was the primary outcome. The risk of bias tool from the Cochrane Collaboration was used for quality assessment. Meta-analysis was performed on studies considered at low risk of bias. A total of 1740 articles were identified. Eleven remained in the qualitative synthesis, and nine studies were considered at "low" risk of bias for meta-analysis. Standardized Hedge's g mean difference for pain intensity using visual analogue scale and Heft-Parker pain scales was -0.576 (95% confidence interval [CI] -0.94 to -0.22; p=0.002) and for verbal rating scale pain scale it was -1.814 (95% CI -3.38 to -0.245; p=0.023). The odds ratio for the risk of pain was 0.025 (95% CI 0.003 to 0.25; p=0.002) and the odds ratio for the need for rescue anaesthesia it was 0.358 (95% CI 0.174 to 0.736; p=0.005). The anaesthetic gel decreases the risk and intensity of pain during probing/SRP.

A randomized placebo-controlled trial to evaluate a novel noninjectable anesthetic gel with thermosetting agent during scaling and root planing in chronic periodontitis patients.

Aim:To study the efficacy of a noninjectable anesthetic gel with a thermosetting agent in the reduction of pain during scaling and root planing (SRP) in untreated chronic periodontitis patients.Materials and Methods:This study is a randomized, double-masked, split-mouth, placebo-controlled trial. Thirty patients were enrolled who underwent SRP in a split-mouth (right side/left side) manner. Before commencement of SRP, both quadrants on each side were isolated and had a randomized gel (either placebo or test gel) placed in the periodontal pockets for 30 s. The pain was measured using numerical rating scale (NRS) and verbal rating scale (VRS).Results:The median NRS pain score for the patients treated with the anesthetic test gel was 1 (range: 0-4) as opposed to 5 (range: 3-7) in the placebo treated patients. The mean rank of pain score using NRS in test gel was 16.18 as compared to 44.82 in placebo treated sites. Hence, significant reduction in pain was found in test gel as compared to placebo using NRS (P < 0.001). The VRS showed that the majority of patients reported no pain or mild pain with a median of 1 as compared to placebo treated sites with a median of 2 suggestive of moderate pain.Conclusions:The NRS and VRS pain scores showed that the side treated with anesthetic gel was statistically more effective than the placebo in reducing pain during SRP.

Contemporary Pain Management in Elderly Patients After Hip Fracture Surgery: Cross-sectional Analyses at Baseline of a Randomized Controlled Trial.

Adequate pain management following hip fracture surgery reduces length of stay, reduces incidence of delirium, promotes recovery, and improves mobility. Previous research suggests that hip fracture pain is undertreated in some patient subgroups, and that hypovitaminosis D can further aggravate pain which could hinder active rehabilitation. We provide a cross-sectional analysis of the baseline characteristics of participants in the REVITAHIP study with the aim of documenting pain intensity and its associations after hip fracture and to explore the characteristics of people who report higher levels of pain. We analyzed the baseline characteristics with a focus on pain scores in patients admitted with a hip fracture (undergoing surgery) to 3 teaching hospitals over New South Wales, Australia, between January 2011 and April 2013. Patients were evaluated using the Verbal Rating Scale (VRS). Secondary measures including 25-hydroxyvitamin D levels at baseline, hip fracture subtype, type of surgical intervention, quality of life score, and cognitive and mobility status were correlated with the VRS using the Pearson correlation, ANOVA, and regression analysis. The 218 participants had a mean age of 83.9±7.2 years and 77.1% were women of whom 16.0% had a Mini Mental State Examination score of ≤23 of 30. The mean and SD VRS pain score was 3.5±2.3. More than half (61.9%, n=113) had VRS≥3 and 18.1% (n=52) had VRS≥5. Using the EuroQOL pain subscore, 78.1% had moderate pain or discomfort and 7.9% had extreme pain or discomfort. Using a multivariate regression model, postoperative VRS was significantly higher in persons with a higher comorbidity count, those previously living independently alone, and surgical fixative modality with hemiarthroplasty. Overall, the levels of pain reported by this cohort are acceptable although approximately 10% to 15% had higher than reasonable levels of pain. This study provides an insight into pain assessment and management by identifying certain patient subtypes who are vulnerable to undertreatment of pain.

Safety and efficacy of pre-incisional peritonsillar lornoxicam in paediatric post-tonsillectomy pain: a prospective double-blind, placebo-controlled, split-body clinical study.

To evaluate the risk of peri-operative bleeding and re-intervention with peritonsillar lornoxicam infiltration in paediatric tonsillectomy. Prospective, randomised, double-blinded, placebo-controlled, split-body study. University hospital. A total of 68 patients (7-15 years), ASA I-II, scheduled for tonsillectomy divided into two groups (n = 34) to receive bilateral peritonsillar saline infiltration (placebo group) or peritonsillar saline infiltration in one tonsil (placebo side) and 8 mg lornoxicam in the other tonsil (intervention side; study group). Drugs were administered after induction of anaesthesia and before start of surgery. Intra-operative and postoperative bleeding score, platelet aggregometry before and 30 min after study drug administration, the verbal rating pain scale, time to first postoperative analgesic request, total analgesic consumption during 1st 24 h postoperative and adverse effects were evaluated. The difference in bleeding score between groups did not reach our definition of statistical significance (P < 0.05). Platelet aggregometry tests did not change significantly with time between groups. Lower postoperative pain scores, longer time to first analgesic request (372.76 ± 82.15 versus 64.89 ± 25.76 min P < 0.001) and lower paracetamol consumption (421.76 ± 125.63 versus 690.29 ± 141.47 mg, P < 0.001) were recorded in study group compared with control group. No patient required hospital re-admission or re-operation because of postoperative tonsillar bed bleeding. The lack of significant complications suggests that pre-incisional peritonsillar lornoxicam followed by intravenous paracetamol rescue analgesia may be safe for tonsillectomy in children. To avoid conflict with intra-operative bleeding, postoperative infiltration of lornoxicam is recommended.

Effect of Coronal and Sagittal Alignment on Outcome After Mobile-Bearing Total Ankle Replacement.

Comparably high revision rates are reported after total ankle replacement (TAR). Therefore, further critical analysis of the influence of implant position on clinical outcome is necessary. We analyzed the reliability and predictive value of previously published pre- and postoperative coronal and sagittal parameters in routine ankle radiographs on the clinical outcome of 84 HINTEGRA total ankle replacements (Newdeal, Lyon, France; Integra, Plainsboro, New Jersey). Mean follow-up was 4.0 years, and 15.5% of the TARs had revision surgery. Mean postoperative American Orthopaedic Foot & Ankle Society ankle-hindfoot score was 71.3; mean postoperative verbal rating scale for pain was 3.1; and mean postoperative ankle range of motion was 26.4 degrees. Most tested radiologic parameters showed moderate or high intra- and interobserver reliability. With the numbers available, no significant difference in clinical outcome for all tested radiologic parameters could be detected. Our results indicate that mild malalignment of TAR, as assessed on routine ankle radiographs, did not affect midterm clinical outcome after TAR. Further multicenter studies with longer follow-up are needed to support our findings. Level III, comparative series.