Postoperative VAS Research Articles

Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study

BackgroundvNOTES has been documented as a viable approach for conducting benign gynecologic surgery; however, its application in ectopic pregnancy cases remains relatively scarce. The principal objective of this investigation was to assess the practicability, effectiveness, and safety of vNOTES in surgical procedures related to ectopic pregnancy.MethodsClinical data pertaining to patients diagnosed with ectopic pregnancy at Beijing Hospital between January 2018 and August 2023 were retrospectively collected (This study retrospectively registered with the China Clinical Trial Registry with the registration number ChiCTR2100052223 in September 22, 2021.). Based on the surgical technique employed, participants were categorized into two groups: the vNOTES group (29 cases) and the conventional laparoscopy (CL) group (34 cases). The baseline data, including age, body mass index (BMI), parity, and maximum diameter of pregnancy objects, were collected and analyzed, along with intraoperative indicators such as operation time and intraoperative blood loss, and postoperative indicators including postoperative exhaust time, hospital stays after surgery, and postoperative pain score at 24 h.ResultsA total of 73 patients were included in this study, and all surgeries in both groups were performed according to the assigned procedures. There were no statistically significant differences observed in operation time, intraoperative blood loss, and hospital stays between the vNOTES group and the CL group (P > 0.05). However, the vNOTES group exhibited significantly lower postoperative exhaust time and 24-hour VAS scores compared to the CL group (P < 0.05).ConclusionsvNOTES proves to be a safe and effective approach for performing conservative tubal festration or salpingectomy in cases of tubal pregnancy. Furthermore, vNOTES offers a more minimally invasive surgical technique, resulting in reduced postoperative pain in patients.

Analgesic Protocols in Total Knee Replacement: Early Efficacy and Functional Outcomes

Abstract Objective Comparison of traditional opioid-based analgesic protocols with multimodal pain management strategies in terms of postoperative pain, opioid consumption, and knee range of motion (ROM). Materials and Methods The study included 397 patients (mean age 67.4 ± 8.6 years) undergoing unilateral TKA, divided according to the analgesic protocol: adductor canal block (ACB), periarticular local infiltration anesthesia (LIA), epidural analgesia, and traditional pharmacotherapy. Pain (VAS), opioid consumption (MME), and knee ROM were assessed over 4 postoperative days. Results Postoperative VAS scores differ significantly between cohorts at all time points (p &lt; 0.001). The ACB cohort had the lowest VAS scores on the day of surgery (3.30 ± 2.23) and on postoperative day 4 (2.10 ± 1.05), followed by the LIA cohort (2.30 ± 1.12). Epidural analgesia and traditional pharmacotherapy showed higher pain scores. Knee flexion on day 4 was highest in the ACB cohort (92.4° ± 7.2°), followed by the LIA cohort (88.5° ± 8.3°) (p &lt; 0.001). Opioid consumption was lowest in the ACB cohort (6.3 ± 5.8 MME) and highest in the traditional pharmacotherapy cohort (43.1 ± 12.8 MME) (p &lt; 0.001). BMI significantly influenced opioid consumption (p = 0.018), with higher BMI (&gt; 30 kg/m2) which was associated with higher doses. However, BMI, age, and gender had no effect on knee ROM (p &gt; 0.05). Conclusion Multimodal protocols, including ACB in particular, improve pain control, reduce opioid consumption, and support faster rehabilitation.

Effect of percutaneous vertebroplasty through UTPP approach on prognosis and quality of life in elderly patients with osteoporotic vertebral compression fractures: a retrospective study

BackgroundTo explore the clinical characteristics of percutaneous vertebroplasty (PVP) via unilateral transverse process-pedicular (UTPP) approach in the treatment of osteoporotic vertebral compression fracture (OVCF) in the elderly.MethodsA total of 120 elderly patients with lumbar OVCF who underwent PVP via unilateral pedicular (UTP) and UTPP approaches in our hospital from January 2022 to January 2024 were retrospectively analyzed. The postoperative VAS score (visual analog scale), ODI score (Oswestry disability index), surgical indicators, and imaging indicators were recorded in the two groups.ResultsThe VAS scores and ODI scores of the two groups of patients were lower than those before surgery 1 day, 6 months, and 12 months after surgery (P < 0.05). The amount of bone cement (BC) injected in the UTPP group was greater than that in the UTP group, the excellent BC distribution rate was higher than that in the UTP group, and the BC leakage rate was lower than that in the UTP group (all P < 0.05). The vertebral anterior edge height and Cobb angle of the UTPP group were significantly different from those of the UTP group 1 day after surgery (P < 0.05).ConclusionsAfter UTPP-PVP, BC is fully diffused, the BC leakage rate is low, and the analgesic effect is good, which can enable patients to get out of bed early and improve their quality of life.

Effects of combined transversus abdominis plane block under direct vision and acupoint injection on promoting rapid recovery after laparoscopic cholecystectomy

ObjectiveTo study the effect of transversus abdominis plane (TAP) block under direct vision with acupoint injection on the rapid recovery of patients after laparoscopic cholecystectomy.MethodsNinety-three patients undergoing laparoscopic cholecystectomy at Hangzhou Hospital of Traditional Chinese Medicine from January 2023 to December 2023 were selected and divided into control, TAP block under direct vision (TAP-DV), and TAP-DV with acupoint injection (TAP-DVA) groups using a random number table method. Postoperative VAS, Ramsay score, IL-6, CRP, and postoperative rehabilitation indices were compared among the three groups.ResultsThe VAS pain score at 6 h after surgery was significantly lower in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05). The VAS pain score at 24 h after surgery was significantly lower in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05) and was significantly lower in the TAP-DVA group than in the TAP-DV group (P < 0.05). The VAS pain score 48 h after surgery was significantly lower in the TAP-DVA group than in the control and TAP-DV groups (P < 0.05). The mean IL-6 level was significantly lower in the TAP-DVA and TAP-DV groups than in the control group (P < 0.05). The postoperative nausea and vomiting rate was significantly lower in the TAP-DVA group than in the control group (P < 0.05). The postoperative exhaust time was earlier in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05) and was earlier in the TAP-DVA group than in the TAP group (P < 0.05). The postoperative hospitalization days and total cost were significantly lower in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05).ConclusionTAP-DVA has a stable and good analgesic effect and can promote rapid recovery after laparoscopic cholecystectomy.

Comparing different timings of tourniquet application in total knee arthroplasty: effects on postoperative pain and bone cement interface

ObjectiveThis study aims to elucidate the impact of varying tourniquet application timings on postoperative pain and the bone cement interface following TKA.MethodPatients who underwent TKA in our department between March 2021 and July 2023 were included in this study. They were randomly assigned to three groups: Group 1 used tourniquets throughout the operation, Group 2 applied tourniquets before the osteotomy, and Group 3 applied tourniquets after completing the osteotomy. The general epidemiological data, tourniquet pressure and duration, postoperative VAS scores, osteotomy surface preparation, blood loss, transfusion rate, KSS scores, knee flexion deformity, knee and thigh circumference differences, and perioperative complications were analyzed and compared among the three groups.ResultThere was no significant difference in the general epidemiological data among the three groups. At different times after the operation, VAS scores for the surgical site and tourniquet site were significantly different among the three groups. The three groups had similar osteotomy surface preparation before prosthesis installation. At two weeks, they differed significantly in knee flexion deformity. While the differences in knee circumference were not significant, Group 1 had a significantly larger thigh circumference difference than the other two groups at 24 h. The incidence of skin complications and DVT in Group 1 was significantly higher than that in Group 3.ConclusionThe use of tourniquets after osteotomy can lead to a good bone cement interface and reduce postoperative leg pain, swelling, and complication rates.

A nomogram for postoperative pain relief in patients with osteoporotic vertebral compression fracture treated with polymethylmethacrylate bone cement

Osteoporotic vertebral compression fractures (OVCFs) can be painful. Percutaneous kyphoplasty (PKP) aims at strengthening the vertebra and reducing pain, but efficacy can vary among patients. The purpose of this study was to establish a risk prediction model for pain relief following PKP in patients with OVCF. This retrospective study included 208 (training set) and 54 (validation set) OVCF patients who underwent bone cement treatment between January 2018 and October 2023. Based on postoperative VAS scores, patients were divided into two groups (0–2 and 3–6). Univariable and multivariable logistic regression identified significant factors affecting VAS scores, leading to the creation of a nomogram model. Internal validation was performed using the bootstrap method. The model’s performance and clinical value were evaluated using the area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA), and calibration curves. Four predictors were identified: number of segments, PMMA dose, comorbidities, and central nervous system (CNS) medications. The AUC, DCA, and calibration curves demonstrated good model discrimination and accuracy. The clinical impact plot highlighted the model’s practical value. We developed and validated an intuitive nomogram model for predicting a postoperative VAS score ≤ 2, reflecting therapeutic efficacy in OVCF patients treated with PMMA. The model could be used for a more careful selection of patients suitable for PKP and who would benefit the most from PKP. The other patients should at least be advised of the risk of suboptimal pain control or directed toward other treatments.

3D-printed drill guide versus fluoroscopic-guided free-hand technique for pedicle screw insertion in the upper cervical spine: a systematic review and meta-analysis.

3D-printed (3DP) drill guides have demonstrated significant potential to accurately guide pedicle screw insertion in spinal surgery. However, their role in the upper cervical spine is not well established. This review aimed to compare the efficacy and safety of 3DP drill guides to the conventional fluoroscopic-guided free-hand technique for pedicle screw insertion in the upper cervical spine. A comprehensive literature search was conducted across five databases (Medline, Scopus, CENTRAL, Web of Science, and Embase). The meta-analysis compared the accuracy of pedicle screw placement, screw placement time, operative time, blood loss, fluoroscopy usage, and post-operative JOA and VAS scores between the two approaches. Seven studies were included in the review, encompassing 386 patients and 1,512 screws. The meta-analysis demonstrated that 3DP drill guides increased the rate of perfect screw insertion (OR: 4.34, P < 0.00001) and lowered the incidence of moderate (OR: 0.26, P < 0.00001) and poor (OR: 0.09, P < 0.00001) screw insertion compared to the free-hand technique. Additionally, operative time (MD: -36.07, P < 0.00001), blood loss (MD: -83.82, P < 0.00001), and fluoroscopy usage (MD: -3.47, P < 0.0001) was significantly reduced in the 3DP cohort. No significant difference was detected in screw placement time (MD: -2.65, P = 0.07), or post-operative JOA (MD: 0.17, P = 0.47), and VAS (MD: -0.09, P = 0.19) scores between the two cohorts. The review demonstrated that 3DP drill guides are a safe and effective tool to assist pedicle screw fixation in the upper cervical spine.

Evaluation of Carbohydrate-Containing Fluid Preloading in Pregnant Women Using the Obstetric Quality of Recovery Scale after Caesarean Section.

To test the short and long-term effects of consuming carbohydrate-rich beverages on patient-centred outcomes after caesarean delivery under spinal anaesthesia. A prospective randomised controlled study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Karaman Training and Research Hospital, Karaman, Turkiye, between May 2023 and February 2024. A total of one hundred parturients were randomly assigned to two groups. Fifty parturients were in the control group (Group C) and 50 in the oral carbohydrate preloading group (Group OCH). Group OCH were given carbohydrate-rich fluids, while those in Group C received distilled water before undergoing elective caesarean surgery. The primary outcome of this study was to evaluate the Obstetric Quality of Recovery-10 scores (ObsQoR-10) at the postoperative 24th hour. Secondary outcomes were ObsQoR-10 scores on the postoperative 3rd and 7th day, postoperative pain scores, VAS scores, opioid consumption, and sensation of breast fullness. Welch's t-test and mixed-effect models were employed to analyse the outcomes. The total recovery scores of both groups at the 24th hour, 3rd day, and 7th day were similar (Group C: 80.08 ± 15.58, Group OCH: 80.18 ± 14.6; Group C: 93.98 ± 7.45, Group OCH: 94.12 ± 8.86; Group C: 97.2 ± 5.16, and Group OCH: 98.16 ± 3.18, respectively). The sensation of breast fullness was significantly higher in the Group OCH (p <0.05). No difference was recorded between the groups regarding postoperative tramadol consumption, VAS scores, and the presence of postdural puncture headache (p >0.05). Although carbohydrate-rich beverages did not affect the ObsQoR-10 score, they may have a notable influence on the increase of breast fullness and tenderness, which promotes breastfeeding among postoperative mothers. Carbohydrate-containing fluid, Caesarean section, ObsQoR-10 scale, Postpartum recovery, Spinal anaesthesia.

Comparison of perioperative analgesic effectiveness of ultrasound-guided erector spinae plane block and transversus abdominis plane block in patients undergoing laparoscopic nephrectomy.

In this study, we aimed to compare the efficacy of two regional anesthesia methods, transversus abdominis plane (TAP) block and erector spinae plane (ESP) block, for intraoperative and postoperative pain relief in patients undergoing laparoscopic nephrectomy. Fifty patients aged 18-80 years with American Society of Anesthesiologists (ASA) classification I-II scheduled for elective laparoscopic nephrectomy were included after ethical approval and informed consent. Patients were randomly assigned to either Group TAP (receiving TAP block) or Group ESP (receiving ESP block). Postoperatively, all patients received patient-controlled analgesia (PCA) with morphine. We evaluated intraoperative hemodynamics, additional opioid use, resting and coughing pain scores (Visual Analog Scales - VAS), time to first PCA dose, postoperative opioid consumption, rescue analgesic needs, opioid side effects, and patient and surgeon satisfaction. In Group ESP, postoperative VAS scores at 8 hours and during the first mobilization were significantly lower (p=0.019, p=0.004, respectively) compared to Group TAP. Patient satisfaction was notably higher in Group ESP (p=0.014). However, other postoperative parameters were similar between the groups (p>0.05). These findings held true when considering only radical nephrectomies, with no differences in the assessed parameters between simple and partial nephrectomies. In conclusion, both TAP and ESP blocks demonstrated comparable effectiveness in postoperative pain management for laparoscopic nephrectomies. Nevertheless, due to lower VAS scores during mobilization and higher patient satisfaction, the ESP block appears to be more effective for multimodal analgesia. Further research is required to comprehensively assess their efficacy in laparoscopic radical nephrectomies.

Comparison of WALANT and General Anesthesia for Trapeziectomy and Abductor Pollicis Longus Hammock Ligamentoplasty

Trapeziectomy and abductor pollicis longus hammock ligamentoplasty may be performed in the surgical management of trapeziometacarpal joint osteoarthritis (TMC OA). Several anaesthesia techniques are available for TMC joint surgery, including wide-awake local anaesthesia no tourniquet (WALANT), regional anaesthesia, and general anaesthesia (GA). The aim of this study was to compare the clinical outcomes of trapeziectomy and abductor pollicis longus hammock ligamentoplasty performed under WALANT versus GA. This retrospective study included 22 patients who underwent surgery for TMC OA between 2017 and 2019. Patients' pre- and post-operative pain intensity, grip and pinch strength, and functional scores were compared. Pain intensity was assessed 1h after surgery, while overall outcome measures were evaluated one year post-operatively. The results showed that patients who underwent WALANT had significantly lower pain intensity 1h postoperatively compared to those who received GA. Both groups experienced a reduction in pain, improvement in grip strength, and functional scores after at one year, with no significant differences between them. No significant differences were found between the GA and WALANT groups in terms of postoperative VAS scores, grip strength, and functional scores. We recommend WALANT for trapeziectomy and APL hammock ligamentoplasty due to its effectiveness in reducing early post-operative pain and achieving functional outcomes comparable to those of GA.

Kinematic status of Bryan and Mobi-C artificial cervical discs post cervical hybrid surgery: a retrospective study

ObjectiveTo examine the mid-term efficacy and imaging results of using the Mobi-C and Bryan implants after cervical hybrid surgery for 2-level cervical spondylolisthesis, and to observe their postoperative changes and differences in the flexion-extension center of rotation (FE-COR) for the anterior cervical disc replacement (ACDR) segment.MethodsPatients who underwent cervical hybrid surgery between June 2014 and June 2019 were included in this study. The mJOA, NDI, and VAS scores were used to assess clinical outcomes, and the FE-COR of the ACDR segment was measured. Pre-operative and 36-month radiographs were collected to compare the range of motion (ROM) in the total cervical spine, ACDR segmental ROM, and operated adjacent segmental ROM. Translation distances for the Mobi-C and Bryan devices were measured. The degree of disc degeneration in the adjacent segment and bony fusion of the ACDF segment were observed.ResultsEighty-one patients were included (40 in the Mobi-C group and 41 in the Bryan group). All patients showed improvements in their postoperative mJOA, NDI, and VAS scores (P < 0.05). The C2-C7 ROM decreased in both groups (P < 0.05). There was no significant decrease in ACDR segmental ROM and upper or lower adjacent segmental ROM compared with preoperatively (P > 0.05). No significant differences were found between the two groups in the above ROM measurements (P > 0.05). For the Mobi-C group, the follow-up compared with pre-surgery showed statistical significance in both FE-COR-X (44.86 ± 7.70% vs. 57.13 ± 8.45%, P < 0.05) and FE-COR-Y (52.29 ± 12.71% vs. 34.47 ± 10.32%, P < 0.05). For the Bryan group, there were no significant differences at follow-up in FE-COR-X and FE-COR-Y compared with pre-surgery (P > 0.05). No significant difference in translation distance between the two groups was observed (P > 0.05). All ACDF segments were in a stable condition. Twenty-two out of 162 adjacent segments showed imaging ASD (9 cases in the Mobi-C group and 13 cases in the Bryan group). In the Mobi-C group, there were mild cases in 6 instances and moderate cases in 3 instances. In the Bryan group, there were mild cases in 8 instances and moderate cases in 5 instances.ConclusionsCervical hybrid surgery using either the Mobi-C or Bryan artificial cervical discs can achieve satisfactory results. The FE-COR of the Mobi-C segment shifts forward and downward, while the FE-COR of the Bryan segment is relatively closer to the pre-operative condition. Changes in the FE-COR after hybrid surgery in both the Mobi-C and Bryan segments might not affect clinical outcomes.

The radiohumeral synovial plica: anatomy, histology, and implications in chronic lateral epicondylitis.

Our study aimed to elucidate synovial plica (SP) of the elbow histological characteristics and the anatomical relationship with adjacent structures. Subsequently, we sought to assess the relationship between SP and clinical symptoms as well as magnetic resonance imaging (MRI) features in patients with chronic lateral epicondylitis. MRI was performed on eight cadaveric elbows specimens. The MRI findings were compared with those in anatomic sections and histologic preparations. In addition, ninety-nine patients with chronic lateral epicondylitis who underwent preoperative elbow MRI and arthroscopic surgery were included. The patients were divided into SP and without SP groups. The differences in clinical symptoms and MRI features between the two groups were compared. SP is located proximal to the annular ligament that extends into the joint cavity, then moves to the lateral collateral ligament (LCL) complex, and finally attaches to the lateral epicondyle of the elbow along with the common extensor tendon (CET). The SP, ligament, and tendon blend imperceptibly without distinct boundaries. Furthermore, in a study of patients with chronic lateral epicondylitis, we found that compared to the without SP group, patients in the SP group had higher preoperative and 3-week postoperative VAS scores and more severe abnormalities in LCL complex and CET. The SP is distinct from the annular ligament and closely correlates with the LCL complex and CET enthesis at the lateral epicondyle. Chronic lateral epicondylitis patients with SP have more severe abnormalities of the LCL complex and CET, more severe pain, and longer postoperative recovery times. Question Synovial plica (SP) cause lateral elbow pain, but few studies regarding histological and imaging features of SP and its relationship to chronic lateral epicondylitis exist. Findings The presence of SP leads to more severe common extensor tendon abnormalities and higher visual analog scale scores in patients with chronic lateral epicondylitis. Clinical relevance The combination of magnetic resonance imaging and clinical symptoms to further understand the effect of SP on the clinical symptoms and postoperative recovery in chronic lateral epicondylitis can help refine treatment strategies and improve the prognosis of patients.

Efficacy for epidural fenatnyl in single level fenestration lumbar discetomies: An randomised controlled trial

: Lumbar disc prolapse is among the most frequent causes of Back pain resulting in surgery accounting for 5% of all lumbar surgeries. In this study, post operative effecgtiveness of fentanyl in lumbar disc prolapse patients is being assessed. Pateints who undergo fenestration discectomies have moderate to severe pain at surgical site, which lasts for 48 to 72 hours post surgery.: This study would evaluate the efficacy of intra-operative epidural fentanyl infiltration on post surgical analgesia following single-level fenestration discectomy and the adverse events that occurred among the groups. 60 patients were into two groups (Group A: Control &amp; Group B: Drug). Between November 2018 and February 2021, 30 patients in the drug group—injected with intraoperative epidural fentanyl (1 mcg/kg weight) and 30 patients in the control group with placebo. All patients were followed up for the next 3 days. VAS scoring was used to assess post-operative pain and data on time to mobilization, the requirement for rescue analgesia (50 mg IV tramadol). Group A and Group B's post-operative VAS scores at the first post-operative hour were statistically significant (value of p = 0.02). The respective times for mobilization were 19.6 and 18.4 hours. A single-level discectomy patient's (p=0.02) early postoperative pain (VAS) was statistically significantly reduced after intraoperative fentanyl infiltration and there were no appreciable side effects. Although not statistically significant(p&amp;#62;0.05), there was a earlier time to mobilization in the test group.

Comparison of robot versus fluoroscopy-assisted pedicle screw instrumentation in adolescent idiopathic scoliosis surgery: a Meta-analysis

AimTo investigate the safety and accuracy of robot-assisted pedicle screw placement in adolescent idiopathic scoliosis (AIS) surgery.MethodsPubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for studies utilizing the clinical data of adolescent idiopathic scoliosis patients (robot-assisted and fluoroscopy-assisted group) who underwent posterior pedicle screw fixation to collect preoperative, postoperative and follow-up indexes and imaging parameters, including screw implantation accuracy, the number of intraoperative fluoroscopy times, amount of bleeding, operation time, postoperative VAS score and postoperative Cobb angle.ResultsSix studies were included in this meta-analysis, including 154 patients in the intervention group and 171 patients in the control group. Our results showed that screw implantation accuracy (WMD 1.07, 95% CI (1.01,1.14), P = 0.03) was higher than that in the control group. The number of intraoperative fluoroscopy times (WMD -6.11, 95% CI (-9.60, -2.62), P = 0.0006) and operation time (WMD 31.52, 95% CI (5.70,57.35), P = 0.02) in the robot group were less, and the differences were statistically significant. Intraoperative blood (WMD -59.05, 95% CI (-212.81,94.70), P = 0.45), postoperative VAS score (WMD -0.07, 95% CI (-0.24,0.11), P = 0.46), preoperative Cobb angle (WMD 0.79, 95% CI (-1.12,2.69), P = 0.42) (Fig. 7), postoperative Cobb angle (WMD -0.25, 95% CI (-1.12,0.62), P = 0.57) (Fig. 8) had no statistical significance in the robot group compared with control group.ConclusionThe robot navigation system can improve screw implantation accuracy and reduce the operation time and radiation exposure during the operation.

Prospective randomized study comparing mesh displacement in enhanced-view totally extraperitoneal versus totally extraperitoneal laparoscopic inguinal hernia repair without mesh fixation.

In laparoscopic inguinal hernia repair, it is thought that the mesh can be displaced more in the enhanced-view totally extraperitoneal (eTEP) technique. The aim of this study was to compare eTEP and totally extraperitoneal (TEP) techniques without mesh fixation in terms of mesh displacement and hernia recurrence. Between December 2022 and April 2023, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups; eTEP group (n = 30) and TEP group (n = 30). There was without mesh fixation in both groups. Study was registered at http://Clinicaltrials.gov (NCT06070142). The mesh was marked with three radiopaque clips. Pelvic radiographs were performed to evaluate the displacement of the mesh. The primary outcome of this study was mesh displacement. In addition, this is the first study in the literature to compare eTEP and TEP techniques in terms of mesh displacement without fixation in laparoscopic inguinal hernia. There was no significant difference between the groups in terms of mesh displacement, recurrence, postoperative VAS scores, length of hospital stay, hematoma, and seroma formation. The operation time was higher in the eTEP group and was statistically significant. Without mesh fixation, the eTEP technique does not increase the risk of mesh displacement and recurrence. The eTEP technique can be safely applied without mesh fixation in laparoscopic inguinal hernia repairs. ClinicalTrials number: NCT06070142.

Tympanic membrane repair using improved endoscopic ear canal flap dissection method

Objective:To investigate the clinical value of tympanic membrane repairment with modified ear canal flap under endoscope. Methods:A retrospective analysis was conducted on the clinical data of 62 patients who underwent simple tympanic membrane perforation repair surgery in our hospital from August 2019 to January 2023. All patients were divided into two groups: 37 cases in the otoscopy group and 25 cases in the microscope group. The surgical duration, postoperative pain response, and postoperative tympanic membrane healing and hearing recovery were compared between the two groups. Results:Compared with the microscope group, the total surgical duration of the otoscopy group was significantly shortened[（70.4±13.2） min vs. （102.8±17.5） min, P<0.001], and there was a statistically significant difference in postoperative VAS pain score[（3.1±1.2） vs. （6.5±1.4）, P<0.001]. The two groups achieved tympanic membrane healing and no infection occurred after operation. There was no significant difference in postoperative hearing recovery between the two groups（P>0.05）. Conclusion:Modified tympanic membrane repairment through otoscope can greatly shorten the operation time and reduce the hospitalization cost, which is more suitable for the application of primary hospitals.

A comparative study of modified Bassini's repair and lichtenstein repair for indirect inguinal hernia in young age population

Background: Inguinal hernia surgery has significant world-wide diversity in management. European Hernia Society guidelines 2020, for management of groin hernias recommends the use of open non-mesh repair in specific patients or types (e.g. young males with lateral hernia)as an acceptable alternative to a Lichtenstein technique. The present study deals with the comparison of intra operative, postoperative course and clinical outcome of modified bassinis repair (non mesh) and Lichtenstein repair [mesh repair] for indirect inguinal hernia in young age population. Methods: Observational analytical prospective cohort study, conducted in General Surgery, Peoples hospital, Bhopal from November 2022 to February 2024. Patient of indirect inguinal hernia in the age (16-35 years) group and operated by either Modified Bassinis (Group A, n=34) or lichtenstein hernia repair (Group B, n=48). The above study arms group were studied and compared. Results: Mean duration of surgery among Group A patients was 62.65 minutes and 57.19 minutes in Group B. Seropurulent discharge among 2.9% patients in Group A and 4.2% in Group B and superficial SSI among 2.9% patients in Group A and 4.2% in Group B was reported. Chronic post-operative pain VAS score was assessed at end of 2nd week, end of 1 month and end of 3 months with statistically no significant among two groups. Conclusions: Our study did not demonstrate any significant difference of one repair method over the other. However, an Individualized approach for cases with a customized strategy is recommended for surgical management of hernia.

A Comparative Study of Propofol-Dexmedetomidine Versus Propofol-Ketamine for the Anesthetic Management of Patients During Endoscopic Retrograde Cholangiopancreatography.

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) requires effective sedation for patient comfort and procedural success. This study compares propofol-dexmedetomidine (group DP) and propofol-ketamine (group KP) for anesthetic management during ERCP. Methods This randomized, double-blinded study enrolled 50 patients (aged 18-60 years) scheduled for ERCP at Dr. D.Y. Patil Medical College and Research Centre, Pune, Maharashtra, India. Patients were randomly allocated to group DP (n=25) or group KP (n=25). Hemodynamic parameters, propofol consumption, recovery time, post-procedural pain (visual analog scale [VAS]), sedation levels (Ramsay sedation score), and post-operative side effects were recorded and analyzed. Results Group DP showed significantly lower heart rates, systolic blood pressure, and mean arterial pressure throughout the procedure (p<0.001). Group KP had lower post-operative VAS scores only in the initial post-operative period (p<0.001 at 15 minutes) but similar Ramsay sedation scores as compared to group DP. Total propofol consumption was lower in group DP, though not statistically significant (378.9 vs 454.8 mg, p=0.08). Group DP required significantly less additional propofol bolus (7.8 vs 18 mg, p<0.001) and had shorter recovery times (7.24 vs 15.2 minutes, p<0.001). Group DP showed no incidence of post-operative nausea and vomiting (PONV) or post-operative cognitive dysfunction (POCD), while group KP had a 26.7% incidence of PONV and a 66.7% incidence of POCD. Conclusion The propofol-dexmedetomidine combination offers more stable hemodynamic control, lower propofol requirements, and quicker recovery times for ERCP anesthesia. It is recommended for patients requiring tight cardiovascular control and rapid post-procedure recovery.

Analysis of Surgical Complications and Functional Recovery Following Arthroscopic ACL Reconstruction with Quadriceps Tendon

Introduction: Anterior Cruciate ligament (ACL) is one of the most important intra-articular ligaments of the knee joint. It is considered the primary restraint to anterior translation of the tibia on the femur. Nowadays the use of quadriceps tendon (QT) autograft has been steadily increasing for ACL reconstruction. Therefore, this study has been designed to assess the functional recovery and analyze the surgical complications following arthroscopic ACL reconstruction with quadriceps tendon. Methods: This was a prospective interventional study conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period from March 2020 to August 2022. In our study, we included 30 patients with anterior cruciate ligament injuries who attended the orthopaedic department within the study period. Result: The mean ± SD age was 29.73 ± 7.00 years, with the majority (50%) in the 26-35 age group. This study found that 27 (90%) patients were male and 3 (10%) were female. Both Lysholm score and Tegner activity level score significantly increased after 9 months of operation. The postoperative mean VAS score was also significantly (p=0.001) decreased at 9 months after surgery. The majority (80%) of the patients had no complaints, while 16.7% had effusion and 3.3% had an infection. Conclusion: Our study found that the majority of the patients had no complications. After analyzing the results of the present study, we can say that arthroscopic isolated anterior cruciate ligament (ACL) reconstruction with quadriceps tendon showed satisfactory functional outcomes for the treatment of ACL injury.

Effect of additional free sustentaculum tali screw fixation through modified sinus tarsi approach on intra-articular calcaneal fractures

BackgroundCalcaneal fractures are the most common type of tarsal fractures. The sustentaculum tali (ST) offers anatomical stability in calcaneal fractures, and recently, ST screws have been widely used in their treatment. This study aimed to investigate the clinical efficacy and value of ST screw fixation via a modified sinus tarsi approach (MSTA) for treating displaced intraarticular calcaneal fractures (DIACFs).MethodsThis study enrolled 64 patients (64 feet): 32 patients in the calcaneal locking plate combined with the ST screw group (CLP-STS Group) and 32 patients in the simple calcaneal locking plate internal fixation group (CLP Group). The minimum follow-up duration was 18 months. Ankle function was evaluated using VAS, AOFAS, and Short Form-36 scores. Imaging evaluation included the Böhler angle, Gissane angle, length, height, and width of the calcaneus, and the Böhler angle in both groups 1 year after surgery.ResultsFunctional evaluation revealed that postoperative AOFAS and VAS scores in the CLP-STS Group were significantly better than those in the CLP Group. After surgery, the Böhler angle, Gissane angle, and length, height, and width of the calcaneus were significantly corrected compared to the preoperative values; however, the difference in these indicators between the two groups was not significant. Nevertheless, at the 1-year postoperative follow-up, the calcaneal Böhler angle loss in the CLP-STS Group was significantly better than that in the CLP Group.ConclusionCompared to simple calcaneal locking plate internal fixation, combining the plate with the additionally free ST screw can resolve the limited intraoperative exposure of MSTA, reduce postoperative foot pain in patients, and improve clinical efficacy.