Postoperative Visual Analog Scale Research Articles

Association between Histological Composition and Clinical Symptoms in Lumbar Disc Herniation in Different Age Groups

Study Design. Retrospective study of prospectively collected data. Objective. To investigate the influence of cartilaginous endplates (CEs) in herniated discs on clinical symptoms and postoperative outcomes in patients with lumbar disc herniation (LDH) in different age groups. Summary of Background Data. LDH involving CEs, which are hard and less resorptive, is frequently observed with increasing age and appears to affect the natural course and clinical outcomes following discectomy. Methods. Overall, 239 patients who underwent microscopic discectomy were included. Main outcomes were evaluated using motor strength, visual analog scale (VAS) for back and leg pain, and Rolland–Morris Disability Questionnaire. The effects of CEs on clinical variables and postoperative outcomes were compared between two groups (<50 y and ≥50 y). Furthermore, we investigated the characteristics of CE avulsions in each group and examined the association between CE occupancy rate and clinical symptoms. Results. CEs were predominantly observed with increasing age and were more frequently detected in patients with Modic changes in both groups (P<0.001). A higher proportion of LDH with a ≥20% occupancy rate was found in patients aged <50 years (P=0.009) and was associated with a decrease in motor strength preoperatively (P=0.007). Postoperative VAS score for low back pain (LBP) was higher in patients with CEs than in those without CEs in the ≥50-year-old group (P<0.001). In multiple regression analysis, the presence of CEs was independently associated with residual LBP at 1 year postoperatively in older patients (β=0.46, P<0.001). Conclusion. Avulsion-type herniations in patients aged <50 years had a higher CE occupancy rate, which is a potential cause of preoperative motor weakness. Clinical outcomes following discectomy improved regardless of the presence of CEs, however, cartilaginous herniation in patients aged ≥50 years may affect residual LBP at 1 year.

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.

High-Dose Compound Betamethasone Used in Local Infiltration Analgesia Does Not Increase Reinfection Rates Following Periprosthetic Joint Infection Treatment

BackgroundThe administration of cocktails that contain glucocorticoids for local infiltration analgesia (LIA) is highly advocated and has been shown to be effective in managing pain in total joint arthroplasty (TJA). However, it remains ambiguous whether this protocol maintains its safety and efficacy in the treatment of periprosthetic joint infection (PJI), a devastating complication of TJA. MethodsA comprehensive retrospective study was carried out on 299 single-stage revision cases for PJI spanning the years 2010 to 2021. Of these, 127 received LIAs containing high-dose compound betamethasone (CB) were termed the CB group, and the other 172 were termed the non-CB group. The rates of reinfection and other postoperative complications, along with postoperative visual analog scale (VAS) scores, and opioid consumption were compared. ResultsDuring minimum 2-year follow-up, there was no significant difference in the reinfection rate between the non-CB and CB groups (9.3 versus 8.7%; P = 0.85), consistent within the subsets of hip (8.4 versus 4.5%; P = 0.51) and knee (10.4 versus 13.3%; P = 0.60) PJIs individually. The administration of high-dose CB was neither an independent risk factor for reinfection (P > 0.05; 95% CI [confidence interval] including 1) nor was it associated with the occurrence of reinfection (P > 0.05). The incidence of postoperative nausea and vomiting (PONV) was significantly lower in the CB group (P < 0.05). In the initial 48-hour postoperative period, the CB group exhibited lower mean scores in both resting and movement VAS evaluations (P < 0.05). Notably, the movement VAS scores of the CB group remained lower even at 72 hours post-surgery for knee PJIs (P < 0.001). Furthermore, within the first 72 hours post-surgery, the necessity for additional opioid analgesics in the CB group was significantly reduced compared to the non-CB group (P < 0.05). ConclusionA LIA with a high-dose compound betamethasone reduces postoperative pain, opioid consumption, and the incidence of PONV following a single-stage revision without affecting reinfection and other complication rates.

Scaphocapitate Arthrodesis for Wrist Deformities: A Systematic Review.

Scaphocapitate arthrodesis (SCA) is a described technique for chronic wrist pathology such as Kienbock disease and carpal instability. The technique aims to preserve motion, while maintaining carpal height, preserving the radioscaphoid articulation, and offloading the lunate. Limited case series evaluate the outcomes of this previously described technique. We aim to determine if the collective, updated literature on outcomes of SCA support its continued application by the wrist surgeon. Furthermore, we investigated if any technical variations offer an advantage in improving patient-reported outcomes after SCA. A literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles selected for critical review were examined for patient demographic data, functional outcomes, radiographic outcomes, and complications. A qualitative analysis was then performed to synthesize the available date. A total of 18 unique articles published between 1991 and 2022 were identified, representing a total of 285 individual cases of SCA. Nonunion rate ranged 0%-22%. Preoperative visual analog scale pain scores ranged from 3.2 to 10, whereas postoperative visual analog scale pain scores ranged from 0 to 4. Patient-reported outcomes are reported by validated instruments, including the Disabilities of the Arm, Shoulder, and Hand, QuickDASH, Patient-rated Wrist Evaluation, and Mayo Wrist Score. SCA is a viable treatment option for patients with Kienbock disease. SCA offers reliable improvements in patient pain, grip strength, and patient-reported outcomes.

Postoperative pain evaluation in patients undergoing endodontic treatment subsequent to working length determination with and without integrated apex locator endomotor: Randomized control trial

Abstract Introduction: Precise working length control during chemomechanical preparation is one of the primary factors for successful endodontic therapy. Aim: The study aims to evaluate the postoperative pain after determining working length with an integrated apex locator-endomotor and a separate apex locator-endomotor. Subjects and Methods: One hundred and twenty subjects with a diagnosis of symptomatic irreversible pulpitis and preoperative pain score Visual Analog Scale (VAS) &gt;50 were allocated into Group I with nonintegrated apex locator and endomotor and Group II with integrated apex locator endomotor, further treated by single endodontist. Postoperative pain was assessed with a VAS chart on days 1, 3, and 7. The necessity of analgesic intake if required was considered as the highest VAS score. Statistical Analysis Used: Pre- and post-operative VAS scores between the groups were compared using the Mann–Whitney and one-way ANCOVA tests. Results: On days 1 and 3, Group II showed significantly lower values of postoperative pain and lesser frequency of rescue medication when compared with Group I (P &lt; 0.05). On day 7, none of the patients reported postoperative pain. Conclusion: Simultaneous working length determination during instrumentation leads to significantly lesser postoperative pain.

Is microfracture sufficient for high-tibial osteotomy, or should intra-articular hyaluronic acid and oral glucosamine-chondroitin be used as additional treatments?

BackgroundThis study aimed to compare the effects of microfracture (MF) versus intra-articular hyaluronic acid (HA) + oral glucosamine and chondroitin sulfate (GC) in addition to MF in patients with osteoarthritic knees who underwent medial open wedge high tibial osteotomy (MOWHTO) after an average follow-up of five years.MethodsThe study was designed retrospectively and included patients who underwent MOWHTO due to gonarthrosis, the MF method performed on these patients, and HA + GC treatments applied in addition to MF. Three groups consisting of 79 patients were formed: only HTO (Group 1), HTO + MF (Group 2), and HTO + MF + HA + GC (Group 3). The groups were compared using knee injury and osteoarthritis outcome score (KOOS), visual analog scale (VAS) for pain, and range of motion (ROM). The associations between the degree of correction and function and pain were evaluated. Additionally, the KOOS subparameters were compared between the groups.ResultsThere were significant improvements in the postoperative KOOS and VAS scores in all three groups (p < 0.05). However, the ROM did not improve in Group 1. There was no significant difference in the postoperative KOOS, VAS, or ROM values ​​between Groups 2 and 3, but these values ​​were significantly better in Groups 2 and 3 than in Group 1 (p < 0.05). When the degree of correction increased, there were no significant positive changes in the postoperative KOOS or VAS score in Group 1, unlike in the other two groups (p < 0.05). In corrections of ≥ 10°, while there was no significant difference in the postoperative KOOS or VAS score ​​between Groups 2 and 3, these parameters significantly improved in these two groups compared to Group 1 (p < 0.05). Among the KOOS subparameters, pain and activities of daily living scores ​​were greater in Groups 2 and 3 than in Group 1 (p < 0.05).ConclusionsIn MOWHTO, MF is a sufficient treatment method that improves the patient’s clinical condition without requiring additional treatments such as HA and GC.Level of evidenceIII, retrospective cohort study.

A retrospective comparative study of robot-assisted unilateral biportal endoscopic lumbar decompression and fusion surgery versus percutaneous endoscopic lumbar decompression and fusion surgery.

The objective of this study is to illustrate the advantages of robot-assisted unilateral biportal endoscopy in lumbar decompression fusion and internal fixation surgery. According to the different surgical methods, we divided the 26 patients into 2 groups, robot-assisted unilateral biportal endoscopy for lumbar interbody fusion (R-ULIF) group and percutaneous endoscopic lumbar decompression and interbody fusion (Endo-LIF) group, with a 1:1 ratio. Gender, disease course, lesion site, fluoroscopy times, operative time, blood loss, postoperative hospital stay, screw placement success rate, fusion rate, complications rate, postoperative pain visual analog scale (VAS) (The VAS score is used only to evaluate pain in the lower back and legs.) Oswestry Disability Index (ODI) (The ODI score can serve as a reference indicator for evaluating the effectiveness of treatment for patients with low back pain, and has good responsiveness in assessing patients with chronic low back pain), and MacNab (The MacNab standard is divided into 4 levels: excellent, good, fair, and poor, which can be used to evaluate the therapeutic efficacy of certain spinal surgeries) standard efficacy evaluation were analyzed and compared between the 2 groups. All patients successfully completed the surgery. Compared with the Endo-LIF group, the R-ULIF group had fewer fluoroscopy procedures, less intraoperative blood loss, and shorter postoperative hospital stay (P < .05). The VAS scores and ODI scores of both groups significantly decreased at all-time points (P < .05). The ODI scores of the R-ULIF group were better than the Endo-LIF group at 1 month and 3 months after surgery (P = .017/P = .047), but there was no statistically significant difference between the groups before surgery and 1 week after surgery (P > .05). The efficacy was evaluated using the MacNab criteria at 6 months after surgery. The R-ULIF group has an excellent and good rate of 84.6%, while the Endo-LIF group has an excellent and good rate of 76.9% (P = 1.000). Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has shown short-term clinical efficacy in the treatment of lumbar disc herniation combined with lumbar instability, surpassing endoscopic lumbar interbody fusion surgery. Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has demonstrated high success rate in screw placement, minimal radiation exposure, less intraoperative blood loss, shorter hospital stay, and thus deserves further clinical promotion.

Short-to-Mid-Term Outcomes of Ipsilateral Femoral Head Autograft Combined with Uncemented Total Hip Replacement for Partial Periacetabular Defects Following Tumor Resection.

Periacetabular tumors, especially in young to middle-aged patients with invasive benign tumors or low-grade malignant tumors involving type II or II + III, present significant challenges due to their rarity and the complexity of the anatomical and biomechanical structures involved. The primary difficulty lies in balancing the need to avoid unfavorable oncological outcomes while maintaining postoperative hip joint function during surgical resection. This study aimed to evaluate the effectiveness and reliability of a surgical method involving partial weight-bearing acetabular preservation combined with the use of an uncontaminated femoral head autograft to reconstruct the segmental bone defect after intra-articular resection of the tumorous joint, providing a solution that ensures both oncological safety and functional preservation of the hip joint in these patients. We conducted a retrospective study with a follow-up period of at least 36 months. From January 2010 to October 2020, we reviewed 20 cases of patients under 60 year of age with periacetabular invasive benign tumors or primary low-grade malignant tumors. All patients underwent reconstruction of the tumorous joint using autologous femoral head grafts. Data collected included patient age, gender, tumor type, preoperative and postoperative visual analog scale (VAS) scores, Musculoskeletal Tumor Society (MSTS) scores, Harris Hip Scores (HHS), patient survival rates, postoperative tumor recurrence, and surgical complications. To analyze the data, we utilized various statistical methods, including descriptive statistics to summarize patient demographics and clinical characteristics, and paired sample t-tests to compare preoperative and postoperative scores. The study included 20 patients, and a total median follow-up was 83 months. Their pathologic diagnoses comprised 13 giant cell tumors (GCTs), 5 chondrosarcomas, one chondroblastoma, and 1 leiomyosarcoma. Postoperatively, the median differences in vertical and horizontal center of rotation (COR) were 3.8 and 4.0 mm. Median limb length discrepancy (LLD) postoperatively was 5.7 mm (range, 2.3-17.8 mm). Two patients (10%) experienced delayed wound healing, resolved with antibiotics and early surgical debridement. One patient experienced dislocation 3 months postoperatively, which was promptly addressed under general anesthesia without further dislocation. Through multiplanar osteotomy with limited margins, femoral head autograft, and uncemented total hip replacement for pelvic segmental bone defects in selected patients in type II or II + III appears to be an encouraging limb-sparing surgery worthy of consideration for carefully selected patients.

Unilateral biportal endoscopic discectomy (UBE) versus percutaneous endoscopic lumbar discectomy (PELD) in the treatment of lumbar disc herniation linked with posterior ring apophysis separation: a retrospective study

ObjectivesPosterior ring apophysis separation (PRAS) associated with lumbar disc herniation (LDH) is a relatively rare form of disc herniation. This study aims to evaluate the clinical effectiveness of unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of PRAS with LDH. MethodsWe enrolled 41 patients who met the inclusion criteria to undergo either unilateral biportal endoscopic discectomy (UBE) (15 cases) or percutaneous endoscopic lumbar discectomy (PELD) (26 cases) between October 2022 and October 2023. Perioperative evaluation parameters included mean operative time, hemoglobin (Hb) loss, length of stay (LOS), and postoperative complications. Outcomes were assessed at admission, as well as at 1, 3, and 6 months post-surgery using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Additionally, we evaluated the results according to the modified MacNab criteria. ResultsBoth groups demonstrated improvements in postoperative VAS and ODI scores. However, there were no significant differences between the two groups in VAS and ODI scores before surgery, or at 1, 3, and 6 months post-surgery. Additionally, no notable differences were observed in the modified MacNab criteria. The UBE group experienced greater hemoglobin (Hb) loss, longer mean operative time, and increased length of stay (LOS) compared to the PELD group. Furthermore, two patients in the PELD group reported recurrence, while one patient in the UBE group experienced a dural tear. ConclusionsUBE and PELD possess strong clinical effectiveness for treating PRAS with LDH. Although the UBE group had a longer mean operative time and LOS, with more Hb loss, the UBE group had a lower recurrence rate. Therefore, UBE remains safe and innovative for the treatment of PRAS with LDH.

An Underrated Performer in Repair of Rotator Cuff Tears: Single-row Suture Anchor Technique

Abstract Background: Single-row suture anchor technique is a well-established, economical, and relatively easier method of arthroscopic rotator cuff repair that has been recently tripped over by double-row technique which is proven to be biomechanically superior. However, this advantage is not reflected in the functional outcome scores which are reported to be identical with both single- and double-row techniques. Materials and Methods: A prospective cohort study was performed on 67 patients with degenerative rotator cuff tear, diagnosis was confirmed on radiological magnetic resonance imaging, treated surgically by single-row suture anchor method, and evaluated for functional outcome at minimum 1-year follow-up. Pre- and postoperative Visual Analog Scale (VAS) and American Shoulder and Elbow Surgeons (ASES) scores were calculated at initial evaluation and the end of 1-year follow-up. Results: Eighty-six percentage of the patients showed a clinically significant improvement in VAS and ASES scores. Conclusion: Consistent acceptable success rates in terms of outcome functional scores, including patient reported outcomes, depict single-row suture anchor technique as a reliable option for the management of degenerative rotator cuff tears 3 cm or less.

Clinical efficacy of unilateral laminotomy for bilateral decompression in the treatment of adjacent segment disease after lumbar fusion.

To assess the clinical impact of unilateral laminotomy for bilateral decompression (ULBD) in managing patients with adjacent vertebrae following lumbar fusion. A retrospective analysis was conducted on 21 patients, with a mean age of 67.4 years, who underwent ULBD for adjacent vertebra disease at our department from January 2021 to November 2023. We reviewed demographic data, surgical techniques, imaging studies, and patient-reported outcomes. The study compared Visual Analog Scale (VAS) scores, Numeric Rating Scale (NRS) scores, Japanese Orthopaedic Association (JOA) scores, Short Form-36 (SF-36) scores, and imaging outcomes before surgery, immediately post-surgery, and at 1 month, 6 months, and 12 months post-surgery. Evaluation of 21 patients with adjacent segment disease (ASD) (13 males, 8 females; mean age 67.42 years) was performed with follow-ups at various intervals post-surgery. Postoperative VAS, NRS, JOA, and SF-36 scores showed significant improvements compared to preoperative scores. Immediately after surgery, there were significant improvements in NRS score (2.76 ± 0.70 vs. 3.71 ± 0.85, P < 0.05) and JOA score (15.38 ± 1.02 vs. 9.29 ± 1.01, P < 0.05) compared to preoperative scores. Similarly, at 12 months post-surgery, significant improvements were observed in NRS score (1.52 ± 0.51 vs. 3.71 ± 0.85, P < 0.05) and JOA score (25.0 ± 1.10 vs. 9.29 ± 1.01, P < 0.05) compared to preoperative scores. The clinical satisfaction rate was 95.0% among all patients, with postoperative imaging examinations revealing a significant decompression effect. No complications were reported among the surgical patients. This study suggests that endoscopic ULBD can be a safe and effective technique for managing symptomatic ASD, providing satisfactory clinical outcomes for patients with ASD. Endoscopic ULBD may serve as an alternative treatment option for ASD with lumbar stenosis.

The Influence of Resilience on Outcomes After Total Ankle Arthroplasty.

Resiliency is the ability to recover from stressful events and has been shown to correlate with patient outcomes following certain orthopaedic procedures. The purpose of this study was to determine the relationship between resiliency and outcomes following TAA. A retrospective analysis of patients undergoing primary TAA between April 2015 and September 2022 was performed (N = 83). Data included demographics, comorbidities, complications, preoperative and postoperative visual analog scale (VAS) pain and Foot and Ankle Ability Measure (FAAM) functional scores, Brief Resilience Scale (BRS) scores, and surgical satisfaction. Patients were defined as having low resilience (LR), normal resilience (NR), or high resilience (HR) based on a BRS score of <3, 3-4.30, and >4.3, respectively. High resilience patients had significantly higher postoperative FAAM ADL, Sports, and Overall scores as well as a significantly greater increase from preoperative scores compared with LR and NR patients. Low resilience patients had significantly lower FAAM Sports and Overall scores compared with normal and high resilience patients. BRS scores positively correlated with postoperative FAAM scores. We found no difference in satisfaction or VAS between the 3 cohorts. Multivariate regression analysis identified BRS scores to be an independent predictor for greater changes in FAAM scores following TAA. Although functional improvements following TAA are expected, patients with higher resilience at baseline are more likely to experience greater improvements in functional outcomes following surgery. Level III.

Comparison of anterior vs. posterior surgery for cervical myelopathy due to OPLL: a systematic review and meta-analysis

Study Design: Systematic review and meta-analysis. Objective: To compare the effectiveness and safety between the anterior and posterior approach, and identify the more effective surgical approach for treating ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. Method: This meta-analysis searched three electronic databases (PubMed, Embase, Cochrane library), including 17 randomized and non-randomized controlled studies published since 2000 to 2023 that compared the effectiveness and safety of anterior and posterior surgical approaches for the treatment of ossification of the posterior longitudinal ligament. Japanese Orthopaedic Association (JOA) scores, functional recovery rates, excellent and good outcomes of the surgical approaches, Visual Analogue Scale(VAS), C2-C7 angle cobb and complication were analyzed. RevMan 5.3 was utilized for data analysis. Results: This study suggested that there were no statistically differences between the anterior group and posterior group in terms of preoperative JOA score (WMD=0.23, 95%CI, [−0.22, 0.67], P=0.32), preoperative VAS (WMD=0.03, 95%CI,[−0.24, 0.30]) ,postoperative VAS(WMD=−0.16 ,95%CI,[−0.47, 0.15] P=0.97) function recovery rate of patients with canal narrowing ratio&lt;50-60% (WMD=−1.54, 95%CI, [−4.46, 1.38], P=0.30). The anterior group showed higher postoperative JOA score(WMD=0.99 ,95%CI, [036,1.63] P&lt;0.05) , post C2-C7 angle cobb(WMD=2.62, 95%CI,[0.36, 4.87], P=0.02) as well as function recovery rate(regardless of canal narrowing ratio) (WMD=16.05, 95%CI,[14.08, 18.03], P&lt;0.05) , especially a significant higher function recovery rate of patients with canal narrowing ratio&gt;50-60%(WMD=19.32, 95%CI,[17.25, 21.40], P&lt;0.05). There was a significant difference between anterior group and posterior group in complication. (OR=0.12, 95%CI, [0.01, 0.24], P&lt;0.05). Conclusion: Based on the study’s finding, The study suggested that when the conservative treatment for OPLL is unsatisfied, surgical approach of entering through the anterior approach is a better choose. Nevertheless, it is still necessary to consider the specific situation of the patient. One of the next research direction is how to reduce the complications of anterior surgery.

Dorsal roof flap rhinoplasty: Updated results and a new classification of nasal dorsal deformity

BackgroundThe dorsal roof flap (DRF) technique was developed as a modification of the retractable roof method (1), which is a variant of dorsal preservation (DP). ObjectiveThe paper aims to present new results of the DRF technique and dorsal deformity analysis created for the technique. MethodsA total of 57 primary rhinoplasty patients treated with DRF technique between 2022-2023 years were included in the study. A dorsal deformity classification based on the anticipated amount of dorsal reduction, nasal bone shape, and hump content was used. According to the classification, the noses were categorized into 3 types. All data were obtained from patient records, computed tomography views, and pre-and postoperative photographs. Aesthetic and functional results were assessed pre-and postoperatively using a visual analog scale (VAS) (0-10, 0 points means very poor). ResultsThe mean follow-up period was 10.1±3.9 months. 23 cases were type 1, 14 were type 2, and 20 were type 3. The anticipated amount of dorsal reduction in type 1 was 2-4mm, 5-7mm in type 2, and 8-10mm in type 3 deformity. Of the total, 27 cases had a V-shaped nasal bone and 30 had an S-shaped. The hump composition was cartilaginous in 13 cases and bone and cartilage in 44 cases. Pre- and postoperative aesthetic and functional VAS scores were significantly different (p ≤0.001). No complications and therefore no revisions were observed during the follow-up period. ConclusionIt is a versatile method to reshape the nasal dorsum and minimize the revisions associated with dorsal preservation when used in appropriate cases.

Clinical efficacy of enhanced recovery surgery in Da Vinci robot-assisted pancreatoduodenectomy

Da Vinci robot-assisted pancreaticoduodenectomy offers advantages, including minimal invasiveness, precise, and safe procedures. This study aimed to investigate the clinical effectiveness of implementing enhanced recovery after surgery (ERAS) concepts in Da Vinci robot-assisted pancreaticoduodenectomy. A retrospective analysis was conducted on clinical data from 62 patients who underwent Da Vinci robot-assisted pancreaticoduodenectomy between January 2018 and December 2022. Among these patients, 30 were managed with ERAS principles, while 32 were managed using traditional perioperative management protocols. Surgical time, intraoperative blood loss, postoperative oral intake time, time to return of bowel function, time to ambulation, visual analog scale (VAS) pain scores, fluid replacement volume, length of hospital stay, total hospital expenses, complications, and patient satisfaction were recorded and compared between the two groups. Postoperative follow-up included assessment of postoperative functional scores, reoperation rates, SF-36 quality of life scores, and survival rates. The average follow-up time was 35.6 months (range: 12–56 months). There were no statistically significant differences in general characteristics, including age, surgical time, intraoperative blood loss, and preoperative medical history between the two groups (P > 0.05). Compared to the control group, the intervention group had an earlier postoperative oral intake time, faster return of bowel function, rapid ambulation, and shorter hospital stays (P < 0.05). The intervention group also had lower postoperative VAS scores, lower fluid replacement volume, lower total hospital expenses, and a lower rate of complications (P < 0.05). Patient satisfaction was higher in the intervention group (P < 0.05). There were no statistically significant differences between the two groups in two-year functional scores, reoperation rates, quality of life scores, and survival rates (P > 0.05). Implementing ERAS principles in Da Vinci robot-assisted pancreaticoduodenectomy substantially expedited postoperative recovery, lowered pain scores, and diminished complications. However, there were no notable differences in long-term outcomes between the two groups.

Percutaneous endoscopic transforaminal decompression surgery for symptomatic double-level lumbar spinal stenosis with ossification.

This study aimed to explore the short-term effects of percutaneous endoscopic transforaminal decompression (PETD) for the treatment of symptomatic double-level lumbar spinal stenosis (LSS) with ossification. Twenty-eight patients diagnosed with double-level lumbar spinal stenosis who underwent double-level PETD surgery between January 2021 and January 2023 at our institution. General information, such as age, sex, disease duration, hospitalization time, and operation time, was recorded. Magnetic resonance imaging (MRI) dural sac cross-sectional area (DSCA) was recorded to assess the degree of spinal canal decompression. The White-Panjabi scoring system (WP) was used to assess preoperative and postoperative lumbar spine stability. Pre- and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were recorded to assess symptom improvement, and surgical efficacy was evaluated using the modified Macnab evaluation criteria at the 1-year postoperative follow-up. The types and risks of complications were also recorded. The patient's 1-year postoperative follow-up MRI showed that both L3/4 and L4/5 DSCA were significantly enlarged compared with preoperative values (P < .001). There was no significant difference in the WP scores at 3 months postoperatively compared with those preoperatively (P > .05). The VAS scores for hip and lower extremity pain at 3 days, 3 months, and 1 year postoperatively were significantly lower than those preoperatively (P < .001), and the ODI scores at 3 months and 1 year postoperatively were significantly lower than those preoperatively (P < .001). There were no significant differences in hip pain, lower extremity pain VAS scores, or ODI scores between the postoperative follow-up time points (P > .05). There was 1 case of lower limb numbness and 1 case of neuroedematous pain in the postoperative period, and all patients had no complications, such as dural sac tear, infection, or recurrence. The 1-year postoperative follow-up was assessed as excellent in 17 cases, good in 9 cases, and possible in 2 cases using the modified Macnab criteria, with an excellent rate of 92.9%. The efficacy of double-level PETD for symptomatic double-level LSS is clear, the local stability of the lumbar spine is less affected, and the risk is low, which can reduce the chances of reoperation in patients. Thus, it is a recommended surgical procedure.

Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: a prospective randomized controlled trial

BackgroundOpioid-reduced multimodal analgesia has been used clinically for many years to decrease the perioperative complications associated with opioid drugs. We aimed to assess the clinical effects of opioid-reduced anesthesia during thoracoscopic sympathectomy.MethodsSurgical patients (n = 151) with palmar hyperhidrosis were randomly divided into control (Group C, 73 patients) and test (Group T, 78 patients) groups. All patients were administered general anesthesia using a laryngeal mask. In Group C, patients received propofol, fentanyl, and cisatracurium for anesthesia induction, and maintenance was achieved with propofol and remifentanil, along with mechanical ventilation during the operation. In Group T, anesthesia was induced with propofol, dezocine, and dexmedetomidine (DEX) and maintained with propofol, DEX, and an intercostal nerve block, along with spontaneous breathing throughout the operation. Perioperative complications related to opioid use include hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness were observed. To assess the impact of these complications, we recorded and compared vital signs, blood gas indices, visual analogue scale (VAS) scores, adverse events, and patient satisfaction between the two groups.ResultsPerioperative complications related to opioid use were similar between groups. There were no significant differences in the type of perioperative sedation, analgesia index, respiratory and circulatory indicators, blood gas analysis, postoperative VAS scores, adverse reactions, propofol dosage, postoperative recovery time, and patient satisfaction.ConclusionsIn minimally invasive surgeries such as thoracoscopic sympathectomy, opioid-reduced anesthesia was found to be safe and effective; however, this method did not demonstrate clinical advantages.Trial registrationChinese Clinical Trial Register: ChiCTR2100055005, on December 30, 2021.

A Comparative Study of the Effect of Pericapsular Nerve Block (PENG) and Ultrasound-guided Fascia Iliaca Blocks on Postoperative Pain of Intertrochanteric Fractures

Background: Previous anesthesia blocks often failed to provide complete pain relief and were associated with weakness in the lower limbs, which hindered the essential mobility of patients undergoing hip surgery. Recently, the pericapsular nerve group block (PENG) has emerged as a promising alternative for managing postoperative pain following hip fracture surgery. Objectives: This study aimed to compare pain reduction between the pericapsular nerve group block (PENG) and the fascia iliaca compartment block (FICB) in patients who underwent intertrochanteric hip surgery. Methods: This randomized, double-blind clinical trial included 41 patients who were randomly assigned to either the pericapsular block group (PENG) or the ultrasound-guided (FICB). The primary outcome was pain relief, assessed using the postoperative Visual Analog Scale (VAS) score. Secondary outcomes included the dose of morphine consumed, the time of first morphine request, patient satisfaction with analgesia, and complications. Results: There was no significant difference between the PENG and FICB groups in terms of pain scores at any of the studied intervals (P-value &gt; 0.05). The dose of morphine consumed and the time to the first morphine request were similar for both methods, with no significant difference (P-value &gt; 0.05). The complication rates were 15% for the PENG group and 8.3% for the FICB group, with no significant difference observed (P-value &gt; 0.05). Conclusions: Both pericapsular and fascia iliaca blocks effectively reduced postoperative pain in patients undergoing intertrochanteric fracture surgery. Additionally, both methods were well tolerated by patients with no significant complications. However, there was no evidence to suggest that PENG is superior to FICB in terms of pain reduction.

Application value of domestic single-port robot in nephron sparing surgery

Objective: To explore the application value of the domestic precision ®single-port robotic system in nephron sparing surgery. Methods: The clinical data of patients with renal masses underwent nephron sparing surgery using the domestic precision ®single-port robotic system at the PLA General Hospital, Gulou Hospital Affiliated to Nanjing University School of Medicine, Zhongnan Hospital of Wuhan University and the First Affiliated Hospital of Nanchang University from September to November 2023 were retrospectively included. Perioperative clinical data, pathological examination results, and postoperative complications were summarized. Results: A total of 12 patients were included, including 8 males and 4 females, with 26-75 (56±16) years. Body mass index (BMI) was (25.1±2.7) kg/m2. There were 6 cases on the left side and 6 case on the right side. The surgical approach was transabdominal in 9 cases and retroperitoneal in 3 case. The maximum diameter of the lesions was (2.7±0.7) cm, the warm ischemia time [M (Q1, Q3)] was 19 (15, 26) minutes, the surgical time was 180 (149, 216) minutes, and the intraoperative blood loss was 50 (28, 100) ml. Postoperative visual analogue scale (VAS) was (2.9±1.5) points. Postoperative pathology revealed malignant renal clear cell carcinoma in 9 cases, with nuclear grading of 3 cases for Grade 1, 3 cases for Grade 2, and 3 cases for Grade 3. Eight cases of pathological TNM staging were pT1aN0M0 and 1 case was pT3aN0M0, with no cancer at the resection margin. Three cases showed benign renal vascular smooth muscle lipoma. There were no postoperative blood transfusions and no complications such as fever, urine leakage and poor wound healing. Conclusion: The prliminary experience reveals that the domestic precision ®single-port laparoscopic robotic system has good clinical application value in urological nephron sparing surgery.

Propofol versus Dexmedetomidine for Sedation of Cancer Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: Randomized Single-Blinded Controlled Study

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a primary diagnostic and therapeutic option for pancreaticobiliary pathologies. Objectives: This study aimed to investigate the efficacy and safety of dexmedetomidine versus propofol during ERCP in cancer patients. Methods: This randomized controlled single-blinded trial was conducted with 202 cancer patients aged 21 to 60 years, of both sexes, with a body mass index of 18.5 to 30 kg/m2, and classified as American Society of Anesthesiologists (ASA) class II - III, who were undergoing ERCP. The patients were randomly assigned to two equal groups. The Propofol Group (n = 101) received a loading dose of propofol (1 - 2 mg/kg over 30 seconds) followed by an infusion (0.05 - 0.1 mg/kg/hour). The Dexmedetomidine Group (n = 101) received a loading dose of dexmedetomidine (1 μg/kg over 10 minutes) followed by an infusion (0.2 - 0.7 μg/kg/hour). The maintenance dose was adjusted during the procedure based on vital signs, Bispectral Index (BIS), and oxygen saturation. Results: The Dexmedetomidine group showed a significantly lower incidence of intra-procedural hypoxemic events (14.9% vs. 26.7%, P = 0.037) and a comparable incidence of hypotension (17.8% vs. 13.9%, P = 0.441). Dexmedetomidine also demonstrated significantly lower intraoperative pain scores according to the Facial Pain Score (P &lt; 0.05), significantly lower postoperative Visual Analog Scale (VAS) scores (P &lt; 0.05), and a lower frequency of postoperative nausea and vomiting (PONV) compared to the Propofol group. Additionally, there was a significantly higher frequency of endoscopist satisfaction in the Dexmedetomidine group compared to the Propofol group (P &lt; 0.05). Conclusions: Dexmedetomidine can be used as a safe and effective alternative to propofol for deep sedation of cancer patients undergoing ERCP. It is associated with a lower incidence of hypoxemic events, effective intraoperative sedation, quicker recovery, and superior analgesic effects both intraoperatively and postoperatively compared to propofol.