Postoperative Pain Complaints Research Articles

Evaluation of Varicocelectomy Operative Therapy for Infertile Couples at the UGM Academic Hospital

Background: Infertility is a condition of the male or female reproductive system characterized by failure to achieve pregnancy after 12 months or more of having regular sexual intercourse without contraception. Since 2013, Rumah Sakit Akademik UGM (RSA UGM) has providing varicocele therapy to infertile individuals. The Ivanissevich varicocelectomy procedure is used for varicocele therapy.Objective: This study intends to examine the management of varicocele patients at RSA UGM.Methods: This research is a retrospective study by opening medical records and interviews. The study population was all patients who underwent varicocelectomy surgery between 2013 and 2021. Data is presented in the form of graphs.Results: The distribution of varicocele lateralization showed that out of 35 respondents, 23 respondents (66%) had one side varicoceles and 12 respondents (34%) both sides varicoceles. The distribution based on successful pregnancy shows that out of 35 respondents, 10 respondent couples (29%) have already gotten pregnant, 25 respondents (71%) haven't gotten pregnant. The distribution of varicocele lateralization in respondents who have children shows that 70% of respondents are one side and 30% of respondents are both sides. Complications of discomfort revealed that 88% of research participants had no complaints of postoperative pain, whereas 11% occasionally suffered pain following varicocele surgery.Conclusion: Varicocele that is one side is more common. Patients with one side varicocele who have surgery are more likely to become parents than those with both sides varicocele. At RSA UGM, the varicocelectomy success rate is comparable to the worldwide success rate.Keywords: Varicocele, success rate, one side, both sides.

NURSING CARE POST OPERATIONAL APPENDICITIS PATIENTS WITH NURSING PROBLEMS ACUTE PAIN IN BIMA ROOM RSUD JOMBANG

Background : Appendicitis is an inflammation of the appendix caused by a bacterial infection as the main cause. Method : This research design is a case study using 2 clients who experience postoperative appendicitis with acute pain nursing problems, nursing care is carried out for 3 consecutive days using non-pharmacological therapeutic interventions. Result: The results showed that acute pain with Benson relaxation and aromatherapy therapy, the problem was resolved by reducing the severe pain scale to a mild pain scale for both clients. Analysis : To carry out nursing care for clients who experience Post operational appendicitis with priority problems of Acute pain. Conclusion : Giving Benson relaxation therapy for 30 minutes will decrease pain receptors and stimulate the release of endophins so as to create a relaxed or calming state that can overcome complaints of postoperative pain after appendicitis this therapy is given for 3 days in a row.

Preoperative and Postoperative Hyperalgesia in Dental Patients on Chronic Opioid Therapy: A Pilot Study.

Opioid-induced hyperalgesia, a paradoxical increase in pain sensitivity associated with ongoing opioid use, may worsen the postoperative pain experience. This pilot study examined the effect of chronic opioid use on pain responses in patients undergoing a standardized dental surgery. Experimental and subjective pain responses were compared prior to and immediately following planned multiple tooth extractions between patients with chronic pain on opioid therapy (≥30 mg morphine equivalents/d) and opioid-naïve patients without chronic pain matched on sex, race, age, and degree of surgical trauma. Preoperatively, chronic opioid users rated experimental pain as more severe and appreciated less central modulation of that pain than did opioid-naïve participants. Postoperatively, chronic opioid-using patients rated their pain as more severe during the first 48 hours and used almost twice as many postoperative analgesic doses during the first 72 hours as the opioid-naïve controls. These data suggest that patients with chronic pain taking opioids approach surgical interventions with heightened pain sensitivity and have a more severe postoperative pain experience, providing evidence that their complaints of postoperative pain should be taken seriously and managed appropriately.

Effects of Low and Standard Intra-Abdominal Pressure on Postoperative Pain in Laparoscopic Cholecystectomy

Objective: To analyze the effects of low and standard intra-abdominal pressure on post-operative pain in laparoscopic cholecystectomy.
 Study Design: Comparative prospective study.
 Place and Duration of the Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Nov 2019 to Feb 2020.
 Methodology: The study comprised 53 patients who underwent Laparoscopic Cholecystectomy and were selected for the study. They were randomly divided into two groups by third-party randomization. The first group was operated on under low pneumatic pressure, i.e. 8-12 mmHg and the second group was operated on under high pneumatic pressure, i.e. (≥15 mmHg). The complaint of post-operative pain was evaluated using a visual analogue scale (VAS) in the next 12 hours.
 Results: The group that was operated under high pneumatic pressure showed a higher occurrence of post-operative pain (50.9%) than the group that operated under low pneumatic pressure. On the Visual Analogue Scale, 80.0% of patients with high pneumatic pressure showed a pain of score four or more which is very high compared to the other group (p <0.05).
 Conclusion: The patients operated for laparoscopic cholecystectomy under low-pressure pneumoperitoneum would suffer from less post-operative abdominal pain, which needs less analgesia and leads to early hospital discharge.

Thoracic Epidural Versus General Anaesthesia For Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide. Aim of our study was to compare the effectiveness of thoracic epidural anaesthesia with general anaesthesia for Laparoscopic cholecystectomy in terms of changes in blood pressure during surgery, postoperative pain, respiratory complications and average length of hospital stay. It was a randomized controlled trial conducted from 1stOctober 2018 to 31st October 2019. Eightytwo patients planned to undergo elective laparoscopic cholecystectomy were randomly divided into two groups, T and G. In Group T all patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia with 12 ml of 0.25% bupivacaine and 1% lignocaine plain whereas in group G all patients underwent surgery under general anaesthesia. Intra-operative mean arterial pressure (MAP) and postoperative opioid consumption in first 24hrs were recorded as primary outcomes whereas presence or absence of respiratory complication and duration of hospital stay as secondary outcome.. Out of 82 patients, 41 patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia and 41 patients had surgery under general anaesthesia. Mean arterial pressure was lower in Group T and the difference was statistically significant. The average time of first complaint of postoperative pain in Group T was 5.4±1.26 hours as compared to less than 0.79±0.25 hours in Group G. Patients in group T required lower doses of opioid analgesia in first twenty-four hours as compared to patients in group G. Mean hospital stay in group T was 1 day as compared to 3 days in group G. Thoracic epidural anaesthesia provides a better alternative to general anaesthesia for Laparoscopic cholecystectomy with lower intraoperative mean arterial blood pressure, 24 hours postoperative consumption of opioids, respiratory complications and length of hospital stay.

Feasibility of Local Anaesthesia in Various Upper Abdominal Surgical Procedures; A Tertiary Care Hospital Study

Background: This study was conducted to evaluate the feasibility of local anesthesia (LA) instead of general anesthesia (GA) in upper gastrointestinal abdominal procedures including open gastrostomy, gastrojejunostomy, gastroduodenal disjunction, jejunostomy and traction esophageal stenting. Materials and Methods: This study was conducted at Thoracic surgery department, Nishtar Hospital Multan, Pakistan from September,1st-December,31st,2020. Out of 147 patients 80 and 67 patients were operated under LA and GA respectively. Age, BMI, gender, procedure performed, etiology, mean time, stay in recovery, PONV, postoperative pain at 4, 8, 12 hours, postoperative sedation and discomfort, within 3-and 7-days postoperative mortality were documented and compared between the two groups. Results: Mean age of the patients in group LA was significantly higher as compared to group GA(p<0.001). Procedure time was 30.06±12.01minutes and 34.42±11.76minutes (p=0.029), mean duration of stay in recovery was 2.31±5.68minutes and 18.80±6.40minutes(p<0.001) in group LA and GA, respectively(p=0.029). Postoperative discomfort was also higher in group GA as compared to group LA(p=0.001). The incidence of PONV was 12.5% and 35.8% in group LA and GA, respectively(p=0.001). Complaint of postoperative pain was 16.2% and 37.3% at 4 hours(p=0.004); 18.8% and 35.8% at 8 hours(p=0.020); and 21.2% and 26.9% at 12 hours(p=0.426) in group LA and GA, respectively. Conclusion: For performing various upper abdominal procedures, LA is safe for the patients who are medically unfit for GA. Moreover, LA is associated with lesser adverse effects as compared to GA. Patient is more comfortable and there is better pain relief in early postoperative period.

Efficacy of different endodontic procedure with post-operative pain and Quality of Life (QoL) using (OHIP-14).

To assess efficacy of different Endodontic Procedure with Post-operative Pain and Quality of Life (QoL) using (OHIP-14). Study Design: Longitudinal study. Setting: Dow International Dental College and Dr Ishrat Ul-Ibad Khan Institute Karachi, Pakistan. Period: March 2019 till September 2019. Material & Methods: A convenient sampling was used. Conventional and hand protaper root canal technique were used. Both techniques were separately performed by house officers and Post graduate trainees. Study instrument was a structured questionnaire. There were 3 visits. Patients were recalled after 3 days to ask about the post-operative pain and treatments impact on oral health related quality of life. Data analysis was done using SPSS*20 software. Result: There is a significant association existing between the type of treatment provided to the patient and post-operative pain. Patients who underwent manual protaper RCT felt less pain as compared to those treated with conventional RCT. (p=0.00). Patients who were treated by house officer had experienced more pain (p=0.000) also patients who were treated by house officers take more medication. (p=0.001). Their oral health (OHIP-14) was improved after the endodontic treatment. (P=0.000). Conclusion: Effect of root canal therapy on QoL is apparent in both the groups. Experience level impacts improvement as the postoperative pain complaints were less when treated by postgraduate trainee.

Healing of Open Upper Lip Vermillion Wounds Irradiated with CO2 Laser Immediately After Injury.

Objective: To evaluate the healing of open upper lip vermillion wounds irradiated with CO2 laser immediately after injury.Background: There are reports of using CO2 laser therapy on healed wounds for scar tissue reduction. However, limited data exist regarding its use immediately after an injury. Thus, the role of CO2 laser in wound healing remains unclear.Methods: Two patients with open upper lip vermillion wounds were treated using CO2 laser irradiation to the area postsuturing.Results: Good functional and aesthetic results were obtained from the therapy, with no postoperative pain complaints or infection.Conclusions: CO2 laser irradiation, performed immediately after an injury, could be an effective treatment option for open vermillion wounds.

A randomised‐controlled, prospective study on the effect of dorsal penile nerve block after TURP on catheter‐related bladder discomfort and pain

In the present study, the impact of penile nerve block (PNB) on postoperative pain and Catheter-Related Bladder Discomfort (CRBD) in the transurethral resection of prostate(TURP) patients were evaluated. Participants of the present study were selected from patients who performed TURP under spinal anaesthesia for benign prostatic hyperplasia (BPH) between January 2018 and July 2020. The present study was planned as a single-centre, randomised-controlled prospective study in which the patients were divided into two groups. Group 1 was administered Control (n:40), and Group 2 ultrasonography(USG) guided PNB (n:40). The patients were included in the Groups, respectively. Visual analogue scale (VAS) scores were questioned and recorded in order to evaluate the postoperative pain complaints of the patients after the operation. In addition, in order to evaluate the CRBD, VAS scores were questioned and recorded as 0th, 0-1th hour, 1st-2nd hour, 2nd-4th hour, 4th-8th hour, 8th-12th hour, and 12th-24th hour. In addition, postoperative pain and need for analgesic drug were recorded. Tramadol was given to patients with moderate to severe CRBD. The findings were compared between the Groups. There was no statistical difference demographic and per-operative data between Group 1 and Group 2. The CRBD and pain-related VAS scores were significantly higher in Group 1 between the 0 and 8th hours. There was no difference between VAS scores in the postoperative 8-24th hours. In total 24hours, Group 2's need for tramadol was significantly less than Group 1. On examining the factors affecting CRBD in the multivariate analysis, age, body mass index(BMI), prostate volume, operation time do not affect CRBD statistically, and only PNB reduces CRBD (P: .029). While less drug-related complications were observed in Group 2, no serious complications related to PNB were observed. Penile nerve block is an effective method for the decrease pain and CRBD after urological surgery. It will also reduce the need for analgesics, and provide painless patients in the postoperative period.

Use of Opioids and Nonopioid Analgesics to Treat Pediatric Postoperative Pain in the Emergency Department.

The incidence, demographic characteristics, and treatment approaches for pediatric patients who present to the ED with a primary complaint of postoperative pain have not been well described. The purpose of this study was to describe opioid and nonopioid prescribing patterns for pediatric patients evaluated for postoperative pain in the Emergency Department (ED). Pediatric Health Information System is an administrative database of encounter-level data from 48 children's hospitals. Emergency department visits for postoperative pain from January 2014 to September 2017 were analyzed. Visits were matched by the Pediatric Health Information System identifier to associate corresponding same site surgery encounters directly preceding ED visits. There were 7365 ED visits for acute postoperative pain, for which 4044 could be linked to corresponding surgical procedure. Eight-one percent of ED visits were within 7 days of surgery. Opioids were given at 1979 (49%) of visits, and nonopioids at 678 (17%) of visits. The most common surgeries preceding a postoperative pain ED visit were for tonsils and adenoids (48.5%). Age, sex, length of stay for both procedure and ED visits, procedure specialty, and the number of days between procedure discharge and admission to ED were associated with opioid administration during ED visits (P < 0.05). Pediatric patients treated in the ED for postoperative pain were often treated with opioid and nonopioid analgesics, with wide prescriber variability. Further research is warranted to help balance optimal pain management and safe prescribing practices.

Dermatologic Surgeons Can Positively Impact the Opioid Epidemic: A Quality Improvement Study of Pain Management in Dermatology Surgery.

The opioid epidemic is a national emergency, and it is imperative that all physicians are engaged in reducing exposure. Among dermatologists, dermatologic surgeons prescribe most opioids with the highest rates of prescription occurring in Southern states. Implement a quality improvement intervention to decrease opioids prescribed and filled to <10% of surgeries performed and have a 0% increase in the amount of patient complaints regarding postoperative pain. The number of opioids prescribed and filled in a single surgical facility in Georgia was obtained from the state's Prescription Drug Monitoring Program before, 1 month after, and 6 months after implementation of the quality improvement initiative. Telephone encounters regarding postoperative pain was also collected at the same specified periods. Proportion of opioids prescribed and filled decreased from 58% to 5% at 1-month postintervention and remained low on 6-month follow-up at 4%. There was no increase in postoperative pain complaints. Rather, a decrease in complaints was noted from 8.6% to 3.1% at 1-month postintervention and sustained on 6-month follow-up at 4.9%. Our data support the management of postoperative pain with nonopioid medications.

Gender Differences in Patients with Anxiety after Coronary Artery Bypass Surgery.

The present study was designed to evaluate the relationship between gender and coexisting anxiety in patients undergoing coronary artery surgery.Materials and Methods: A total of 137 patients (41 women and 96 men with a mean age 66.1 ± 6.0 years) patients underwent state and trait anxiety evaluation at baseline (preoperatively) and at six months after (postoperatively) coronary artery bypass graft (CABG). Anxiety symptoms were assessed at enrollment using the Spielberger State-Trait Anxiety Inventory (STAI). Psychological, social, clinical, and surgical data were assessed statistically.Results: There were statistically significant differences between female and male patient characteristics for the mean age, mean education year, and mean body mass index. The women were found to be statistically younger and less educated, and more likely to be overweight, diabetic, and hyperlipidemic. The mean hospitalization time, wound infection, and extreme postoperative pain complaints were found to be higher in the female group. 61 patients (33 female and 28 male) (44.5%) were classified as presenting clinically significant anxiety symptoms (STAI score of ≥ 40). The female patients' STAI scores were significantly higher than men in state and trait anxiety, both preoperatively and six months postoperatively. Postoperatively, there was not any significant decrease in the level of trait anxiety when comparing the level of state anxiety in female patients. Conclusion: Even after adjusting for known risk factors for compromised STAI, women do not show the same long-term quality benefits of CABG surgery that men do. The results indicate that the STAI is a valuable instrument for identifying and supporting patients with higher levels of anxiety, which can aid in determining patients that may have poor adjustment after CABG surgery.

A prospective study of laparoscopic repair of inguinal hernia by intraperitoneal onlay mesh technique using fibrin glue

Background: Inguinal hernia repair is one of the most commonly performed operations worldwide. Laparoscopic repair is rapidly becoming the procedure of choice with increasing availability of resources. The present work focuses on the advantages and benefits of the fibrin glue and IPOM procedure in hernia repair. Methods: A total of 16 cases were included operated by a single surgeon. IPOM technique was adopted for hernia repair with use of fibrin glue for mesh fixation along with tackers. Patients with reducible hernia were included, while those with irreducible, obstructed or strangulated hernia were excluded. Results: All the patients were male with right indirect inguinal hernia being the most common presentation. The post-operative complications were none on one year follow up, without any recurrence or obstructions. All patients returned to normal activity within one day. Patients showed better compliance with reduced complaint of post-operative pain, early return to activity and work and less sick day leave. Intra-operative risk of damage to vital structures was also greatly reduced with the use of fibrin glue. Conclusions: Laparoscopic IPOM hernia repair is feasible, easy to learn, has a high patient acceptance rate, reduce operating time and low complication rate. Use of fibrin glue for mesh fixation lead to reduce post-operative pain, early return to activity and less intra-operative risk.

Application of dexmedetomidine combined with ropivacaine in the cesarean section under epidural anesthesia

To explore the anesthetic effect and neonatal effects of dexmedetomidine combined with ropivacaine in the cesarean section under epidural anesthesia. Between January 2012 and March 2013 at the First Affiliated Hospital with Nanjing Medical University, sixty parturients with a single baby at full term in vertex presentation scheduled for caesarean section under epidural anesthesia, were randomly divided into 3 groups (n = 20 each) according to the random digits table: dexmedetomidine + ropivacaine (RD), fentanyl + ropivacaine (RF) and normal saline + ropivacaine (RN). After identification of the epidural space and a negative aspiration test for blood or cerebrospinal fluid, 15 ml of 0.75% ropivacaine, was administered epidurally in three the groups with addition of 1 µg/kg of dexmedetomidine in RD group, 1 µg/kg of fentanyl in RF group and 2 ml of normal saline in RN group. Recording the mean arterial pressure (MAP) and heat rate (HR) before anesthesia (T(0)), at 10 min (T(1)) and 30 min (T(2)) after the end of epidural administration, and at end of operation (T(3)). Recording the onset time, maximum sensory analgesic level, time to maximum sensory analgesic level, time to two segmental dermatomal regressions, and time to chief complaint of postoperative pain. The modified bromage degrees, sedation scores and traction reaction were also assessed. The Apgar scores at 1 and 5 min were also recorded after delivery, and the blood samples were drawn from umbilical vein for gas analysis. MAP, HR and the motor block (Bromage scale) were no statistics differences among the three groups (P > 0.05) . Compared with RN group, the onset time and the time to maximum sensory analgesic level were significantly earlier [(6.3 ± 2.4), (8.7 ± 2.3) min vs (10.9 ± 2.7) min; (11.5 ± 3.9), (16.2 ± 4.6) min vs(19.8 ± 5.2) min, P < 0.05], the time to two segmental dermatomal regressions and the time to chief complaint of postoperative pain were prolonged significantly[(22.5 ± 4.6), (18.5 ± 3.9) min vs (13.5 ± 3.8) min; (415 ± 92), (355 ± 86) min vs( 273 ± 68) min, P < 0.05], level of sedation and degree of traction reaction were better in RD group and in RF group, and the incidence of shivering was lower in RD group (5% vs 40%, P < 0.05), the incidence of dizziness was higher in RF group (20% vs 0, P < 0.05). Compared with RF group, the same results were also seen about the onset time, the time to maximum sensory analgesic level, the time to two segmental dermatomal regressions and the time to chief complaint of postoperative pain, and the level of sedation was better, the incidence of drowsiness was lower in RD group. There were no statistics differences about both the blood gas analysis of umbilical vein and the Apgar scores at 1 and 5 min after delivery. Administration of dexmedetomidine combined with ropivacaine can provide early onset, establishment of sensory anesthesia, much better sedation levels, decrease the degree of traction reaction and the incidence of shivering, and without adverse neonatal effects.

Postoperative pain outcomes after transvaginal mesh revision.

Although the current literature discusses mesh complications including pain, as well as suggesting different techniques for removing mesh, there is little literature regarding pain outcomes after surgical removal or revision. The purpose of this study is to determine if surgical removal or revision of vaginal mesh improves patient's subjective complaints of pelvic pain associated with original placement of mesh. After obtaining approval from the Vanderbilt University Medical Center Institutional Review Board, a retrospective review of female patients with pain secondary to previous mesh placement who underwent excision or revision of vaginal mesh from January 2000 to August 2012 was performed. Patient age, relevant medical history including menopause status, previous hysterectomy, smoking status, and presence of diabetes, fibromyalgia, interstitial cystitis, and chronic pelvic pain, was obtained. Patients' postoperative pain complaints were assessed. Of the 481 patients who underwent surgery for mesh revision, removal or urethrolysis, 233 patients met our inclusion criteria. One hundred and sixty-nine patients (73 %) reported that their pain improved, 19 (8 %) reported that their pain worsened, and 45 (19 %) reported that their pain remained unchanged after surgery. Prior history of chronic pelvic pain was associated with increased risk of failure of the procedure to relieve pain (OR 0.28, 95 % CI 0.12-0.64, p = 0.003). Excision or revision of vaginal mesh appears to be effective in improving patients' pain symptoms most of the time. Patients with a history of chronic pelvic pain are at an increased risk of no improvement or of worsening pain.

Repeated laparoscopic treatment of recurrent inguinal hernias after previous posterior repair

The reported recurrence rates after laparoscopic inguinal hernia repair are 0-4 %. It is unclear which technique could best be offered to a patient with a recurrent hernia after a previous posterior repair. The purpose of this retrospective study was to determine the safety, feasibility, and reliability of a repeated laparoscopic repair (TAPP) for a recurrent hernia after a previous posterior inguinal hernia repair. The study group contains 2,594 consecutive transabdominal inguinal hernia repairs (TAPP). Of these, 53 repairs were attempted in 51 patients for recurrent hernias after a previous posterior repair. During the follow-up period, patients were examined for recurrences and for presence of a port-site hernia. Pain was scored by the visual analogue pain scale (VAS). Fifty-one patients underwent a TAPP repair for a recurrent inguinal hernia after previous posterior hernia repair. Two patients presented a bilateral recurrent inguinal hernia. In two thirds of the patients, the recurrence was located caudally or medially from the previously placed mesh. Two attempted repairs had to be converted to an open technique due to severe adhesions. One intraoperative complication was encountered when the vas deferens was ligated during surgery due to adhesions of the previous placed mesh. Nine patients encountered an adverse event postoperatively, but none of them were serious events. No mesh infections were reported. The mean follow-up was 70 (range, 1-198) months. At follow-up, no recurrences were found at physical examination. Four patients developed a port-site hernia. Four patients had complaints of postoperative pain and were restricted in daily activities due to groin pain. The mean VAS score (scale 0-100), including the four patients with persistent pain, was 5.7 (range, 0-61). It is concluded that repeated laparoscopic hernia repair (TAPP) is a definite repair for recurrent inguinal hernias. The procedure is feasible, safe, and reliable.

Radiofrequency Treatment in Simple Snoring: Tolerance, Safety and Results

ObjectiveSnoring is a non-pathologic social problem. In the search for non-aggressive efficacious treatment, we introduce our experience in using temperature-controlled radiofrequency treatment for snoring. MethodsA 6-month follow-up revision of 37 patients who received a mean of 1.1 radiofrequency treatment sessions at turbinates, soft palate, tonsils and/or tongue-base. ResultsMean sample age was 39.6±9 years; mean BMI was 29.5±4. Good tolerance was presented by 78% of our patients, 78% had no postoperative pain complaints and 68.3% no postoperative symptoms a week after procedure. Minor complications (mainly mucosal breakdown) were presented by 14.6% of the patients. The snoring score went from a mean of 8.6 to 5.6 on the visual analogue scale; 86.5% of the patients improved their clinical snoring and 37.8% were cured of it. Epworth daytime somnolence test results went from mean 9.3 to 6.1. ConclusionsRadiofrequency is a procedure that is safe, well tolerated and fairly painless postoperatively, effective in improving clinical snoring in simple snorers. Radiofrequency is an effective primary treatment for snoring whose cause is accessible to radiofrequency.

Tratamiento de la roncopatía simple con radiofrecuencia: tolerancia, seguridad y resultados

Objective Snoring is a non-pathologic social problem. In the search for non-aggressive efficacious treatment, we introduce our experience in using temperature-controlled radiofrequency treatment for snoring. Methods A 6-month follow-up revision of thirty-seven patients that received a mean of 1.1 radiofrequency treatment sessions at turbinates, soft palate, tonsils and/or tongue-base. Results Mean sample age was 39.6+-9 years; mean BMI was 29.5 ± 4. Good tolerance was presented by 78% of our patients, 78% had no postoperative pain complaints and 68.3% no postoperative symptoms a week after procedure. Minor complications (mainly mucosal breakdown) were presented by 14.6% of the patients. The snoring score went from a mean of 8.6 to 5.6 on the visual analogue scale; 86.5% of the patients improved their clinical snoring and 37.8% were cured of it. Epworth daytime somnolence test results went from mean 9.3 to 6.1. Conclusions Radiofrequency is a procedure that is safe, well-tolerated and fairly painless postoperatively, effective in improving clinical snoring in simple snorers. Radiofrequency is an effective primary treatment for snoring whose cause is accessible to radiofrequency.

Catastrophizing and Depressive Symptoms as Prospective Predictors of Outcomes Following Total Knee Replacement

Several recent reports suggest that pain-related catastrophizing is a risk factor for poor acute pain outcomes following surgical interventions. However, it has been less clear whether levels of catastrophizing influence longer-term postoperative outcomes. Data were analyzed from a relatively small number (n=43) of patients who underwent total knee replacement and were followed for 12 months after their surgery. Previous research has suggested that high levels of both catastrophizing and depression are associated with elevated acute postoperative pain complaints among patients undergoing knee surgery. In this sample, catastrophizing and depression at each of the assessment points were studied as prospective predictors of pain (both global pain ratings and pain at night) at the subsequent assessment point over the course of one year. The predictive patterns differed somewhat across measures of pain reporting; depressive symptoms were unique predictors of greater global pain complaints, while catastrophizing was a specific and unique predictor of elevated nighttime pain. While surgical outcomes following total knee replacement are, on average, quite good, a significant minority of patients continue to experience long-term pain. The present findings suggest that high levels of catastrophizing and depression may promote enhanced pain levels, indicating that interventions designed to reduce catastrophizing and depressive symptoms may have the potential to further improve joint replacement outcomes.

A NEW TECHNIQUE FOR SINGLE-PERSON FASCIA LATA HARVEST

Reconstitution of a watertight dural closure at the conclusion of most neurosurgical operations is a very important step to prevent cerebrospinal fluid leak, encephalocele formation, or infection. If sufficient native dura is not available to accomplish this goal, a dural substitute is required. We have developed a system of single-person fascia lata harvest that is fast, safe, and easily mastered. Through a standard incision along the iliotibial band, the fascia lata is dissected from the underlying muscle, and with the use of a simple system of stainless steel plates, a tray, and 2 nonperforating towel clips, a large volume of fascia is harvested. We have used this technique on 23 patients in the past 12 months, with good results. We have had fewer postoperative pain complaints and less seroma formation compared with the standard technique. This technique requires only simple instrumentation and, because the harvesting is done by 1 person, it can proceed independently of the main operation, thus eliminating any added operative time and inconvenience. It reliably produces a large volume of high-quality fascia that can be used in a variety of neurosurgical procedures.