Postoperative Visual Analog Scale Pain Research Articles

Does severe preoperative shoulder pain affect postoperative outcomes after reverse total shoulder arthroplasty

BackgroundThe purpose of this study is to determine the improvement of pain and postoperative function after reverse total shoulder arthroplasty (rTSA) in patients who have severe preoperative pain. We hypothesized that these patients would have lower postoperative function and not experience the same scaled improvement as other patients. MethodsAfter the application of exclusion criteria, 214 patients who underwent primary rTSA in a 6-year period and had at least one year outcome data met the inclusion criteria. Age, demographics, preoperative, and 1-year postoperative pain visual analog scale (VAS) were recorded, range of motion (ROM), subjective shoulder value (SSV), and postoperative shoulder outcome scores (American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California-Los Angeles, and Constant) were collected. Additional information, such as number of patient-reported allergies, history of anxiety/depression, preoperative use of antidepressants/anxiolytics/psychotropics, and preoperative opioid usage, were also obtained. Patients were separated into two cohorts as follows: severe preoperative pain (VAS scores of 9-10, n = 114) and lower preoperative pain (VAS scores < 9, n = 110). ResultsPatients with severe preoperative pain had significantly lower preoperative SSV and ROM in each category compared to the other cohort. Postoperative differences in VAS, ROM, and outcome scores were not significant between the severe preoperative pain cohort and the lower preoperative pain cohort. When examining the changes in outcomes from preoperatively to postoperatively, patients with severe preoperative pain experienced statically significant improvements in VAS, SSV, and all ROM measurements except for active external rotation. No significant differences were seen in the number of patient-reported allergies, tobacco usage, history of anxiety/depression, usage of antidepressants/anxiolytics/psychotropics, or preoperative opioid usage between the two groups. Discussion and ConclusionThis study demonstrated that patients with severe preoperative pain had significantly lower shoulder function preoperatively. However, these patients had similar outcomes after rTSA compared to other patients undergoing the same procedure who did not report severe preoperative pain. Further, these patients experience a significant increase in shoulder function and decrease in pain after rTSA compared to preoperative assessments, in contrast to other patients who did not report severe preoperative pain.

The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study.

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients' stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.

Therapeutic effects of low-temperature plasma radiofrequency ablation and partial laryngectomy for glottis cancer: A comparative study.

To compare the therapeutic effects of low-temperature plasma radiofrequency ablation and partial laryngectomy in the treatment of early glottis carcinoma. Clinical data of 80 patients with early glottis carcinoma treated in our hospital from June 2019 to January 2021 were analyzed. Patients were retrospectively divided into two groups based on the type of intervention. Forty patients received partial laryngectomy (Control group) and 40 patients received low-temperature plasma radiofrequency ablation (Observation group). Surgical indexes, length of hospital stay, postoperative complications, and visual analog scale (VAS) score of postoperative pain of patients in the two groups were compared. Postoperative stress response indexes, clinical efficacy, and postoperative recovery in two groups were compared and analyzed. The operation time, hospital stay, intraoperative bleeding, and the incidence of postoperative complications in the observation group were significantly lower than those in the Control group (P<0.05). The postoperative pain VAS scores, Levels of malondialdehyde (MDA) and glutathione (GSH) in the observation group were significantly lower than those in the control group (P<0.05), while the level of nitro tyrosine (3-NT) and superoxide dismutase (SOD) were significantly higher than that in the control group (P<0.05). After a one-year follow-up, the excellent and good rate of pronunciation function in the observation group (95%) was significantly higher than control group (75%) (P<0.05). Low-temperature plasma radiofrequency ablation in the treatment of early glottis carcinoma is associated with less trauma, short operation time, less bleeding, short hospital stay and low postoperative stress reaction rate. Compared with partial laryngectomy, it has higher safety and better postoperative vocal cord function recovery.

＜Editors' Choice＞ Neck pain after cervical laminoplasty is associated with postoperative atrophy of the trapezius muscle.

Cervical laminoplasty is a safe and effective treatment for cervical myelopathy. However, it has a higher frequency of postoperative axial pain than other methods. A variety of causes of postoperative axial pain have been reported, but these have not been fully elucidated. This study aimed to investigate the association between postoperative axial pain and changes in the posterior neck muscles before and after surgery. The study included 93 patients with cervical myelopathy who underwent surgery at our institute between June 2010 and March 2013. The patients with greater preoperative and 1-year postoperative neck pain visual analog scale scores comprised the neck pain group. The cross-sectional area of the cervical posterior extensor muscles and the trapezius muscle were measured by magnetic resonance imaging before and 1 year after surgery at the C3/4, C4/5, and C5/6 levels to compare with neck pain. The total cross-sectional area atrophy rate (C3/C4, C4/C5, and C5/C6) of the trapezius muscle was significantly larger in patients with neck pain (12.8 ± 13.2) than in those without (6.2 ± 14.4; p<0.05). The cross-sectional area atrophy rate of the trapezius muscle at only the C5/6 level was significantly higher in patients with neck pain (16.7 ± 11.7) compared to those without (3.3 ± 14.4; p<0.001). No significant differences were found in the cross-sectional areas of the cervical posterior extensor muscles. Trapezius atrophy, especially at the lower cervical vertebrae, was associated with neck pain after cervical laminoplasty.

Percutaneous foraminal endoscopy for the treatment of lumbar lateral recess stenosis in elderly

To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly. The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy. All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred. The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.

Percutaneous transforaminal endoscopic surgery combined with mini-incision OLIF and anterolateral screws rod fixation vs. MIS-TLIF for surgical treatment of single-level lumbar spondylolisthesis.

Oblique lumbar interbody fusion (OLIF) has been used to treat lumbar spine spondylolisthesis. However, it usually needs posterior pedicle screws fixation for biomechanical stability and possible posterior direct decompression for relieving neurologic symptoms. We use percutaneous transforaminal endoscopic surgery (PTES) combined with mini-incision OLIF and anterolateral screws rod fixation for surgical treatment of lumbar spondylolisthesis. The purpose of study is to evaluate the feasibility, efficacy, and safety of this method compared with minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF). From July 2016 to May 2018, 65 patients of lumbar spondylolisthesis (L2-4) with neurologic symptoms were treated using PTES combined with mini-incision OLIF and anterolateral screws rod fixation (31 cases, group A) or MIS-TLIF (34 cases, group B) in this study. Operative duration, blood loss, incision length, fluoroscopy frequency, and hospital stay are compared. Preoperative and postoperative visual analog scale (VAS) pain scores of back and legs, Oswestry disability index (ODI), intervertebral space height, lumbar lordotic angle, operative segmental lordotic angle, and complications are recorded. The fusion status is assessed according to Bridwell's fusion grades. The VAS score of back and leg pain and ODI significantly dropped after surgery in both groups (p < 0.001). There was no statistical difference of back and leg VAS score and ODI between two groups except that back VAS scores in group A were significantly lower than that of group B immediately after surgery (p = 0.000). Group A had significantly more intervertebral space height and operative segmental lordotic angle than group B postoperatively (p = 0.022, p = 0.002). Twenty-three segments (74.2%) were grade I and 8 segments (25.8%) were grade II in group A; 20 segments (58.8%) were grade I and 14 segments (41.2%) were grade II in group B at a 2-year follow-up (p = 0.194). No difference was observed in the complication rate between the two groups (6.5% vs. 5.9%, p = 0.924). The long-term clinical efficacy and complication rates of both groups are comparable. PTES combined with mini-incision OLIF and anterolateral screws rod fixation is a good choice of minimally invasive surgery for lumbar spondylolisthesis, which hardly destroys the paraspinal muscles and bone structures.

Drainage Followed by Primary Closure with Suction Drain Versus Drainage Only in the Treatment of Breast Abscess

Background: Breast abscess is a common inflammatory condition among young lactating women. Although initial stages of breast abscess can be managed with antibiotics, surgery may be required in advanced stages in the form of incision and drainage with or without placement of a surgical drain. There are various methods for the treatment of breast abscesses. Objectives: To compare the outcome of drainage followed by primary closure with suction drain and drainage only in the treatment of breast asbscess. Methods: A total of 74 diagnosed cases of lactational breast abscess who underwent surgery were included in this prospective observational study. The patients were divided into two groups, 37 patients who underwent primary closure with suction drain were considered as group- A and the rest 37 patients who underwent drainage only were considered as group-B. Diagnosed cases of lactational breast abscess who underwent drainage of the abscess by either of the two above-mentioned methods were enrolled in this study. Statistical analyses of the results were obtained by using windows-based computer software Statistical Packages for Social Sciences (SPSS-22). Results: The mean age was 24.16±4.02 years in group-A and 23.27±3.63 years in group-B. More than half (54.1%) patients were primipara in group-A and 24(64.9 %) in group-B. More than half (56.8%) patients had S. aureus in pus culture in group-A and 28(75.7%) in group-B. The differences were statistically not significant (p&gt;0.05) between the twogroups. The mean healing time was 8.95±1.51days in group-A and 25.76±4.23 days in group-B. The mean duration of hospital stay was 5.14±1.03 days in group-A and 26.05±4.03 days in group-B. The mean time required to resume of breastfeeding was 4.57±1.04 days in group-A and 25.73±4.2 days in group-B. The mean score of postoperative pain (visual analog scale) was 1.35±0.48 in group-A and 3.76±0.6 in group-B. The mean requirement of analgesia was 5.24±1.28 days in group-A and 13.95±2.75 days in group-B. More than half (51.4%) patients had better scar quality in group-A and 26(70.3%) had good scar quality in group-B. The differences were statistically significant (p&lt;0.05) between the two groups. Conclusion: Primary closure with suction drain results better outcome than conventional incision &amp; drainage in the treatment of breast abscess.

Association of First Metatarsal Phalangeal Joint Fusion for Hallux Rigidus With Patient-Reported Pain and Mental Health Outcomes in Patients Taking Psychotropic Medications.

Limited literature examines the relationship between surgical outcomes in chronic foot and ankle conditions and concurrent psychiatric care. The present study aimed to investigate patient-reported and surgical outcomes of patients treated for a psychiatric disorder undergoing first metatarsophalangeal (MTP) fusion for hallux rigidus. We hypothesized that patients on psychotropic medications would have greater subjective pain preoperatively and less improvement in physical and mental functionality postoperatively when compared with nonmedicated patients. A single-center, retrospective review of prospectively collected data was conducted on 92 patients undergoing first MTP fusion with a preoperative diagnosis of hallux rigidus from 2015 to 2019. At their preoperative, 6-month postoperative, and 1-year postoperative visits, patients were administered visual analog pain scale (VAS) and 36-Item Short Form Health Survey (SF-36) functionality surveys. Patients were subsequently identified by chronic use of psychotropic medication preoperatively and grouped for analysis (MED, n = 42; NO MED, n = 50). Postoperative mean VAS pain scores were lower for all studied patients at 6 months (VAS = 1.6 ± 2.3) and 1 year postoperatively (VAS = 1.1± 1.8) relative to the preoperative visit (VAS = 4.7 ± 2.8) (P ≤ .0001 and P ≤ .0001, respectively). No differences in mean VAS pain scores nor SF-36 physical component summary scores were detected at preoperative, 6-month, or 1-year visits between NO MED and MED groups. Mean SF-36 mental component summary scores for those in the MED group were lower at preoperative (NO MED = 83.8, MED = 71.8, P = .006) and 6-month postoperative (NO MED = 86.1, MED = 72.7, P = .037) visits than those in the NO MED group, a trend not observed at the 1-year postoperative mark (NO MED = 84.1, MED = 76.8, P = .228). There were no observed differences in operative time (P = .219), tourniquet time (P = .359), nor time to full weightbearing (P = .512) between MED and NO MED groups. Additionally, no differences in postoperative complication rates were observed between groups. In patients treated with psychotropically active medications with hallux rigidus, MTP Fusion appears to be a reasonable treatment choice with similar outcomes for patients requiring psychotropically active medications to the outcomes of those patients not requiring psychotropically active medications. Level III, retrospective comparative study.

Surgical Transversus Abdominis Plane Block for Postoperative Analgesia in Lower Abdominal Surgeries: A Prospective Interventional Study

Introduction: Pain from lower abdominal surgeries originates from the abdominal wall incision. The Transversus Abdominis Plane (TAP) is a fascial plane between the internal oblique and the transversus abdominis muscle, which contains the nerve bundles. TAP block involves infiltrating this plane with anaesthetic drugs that block the somatic component of postoperative pain. Traditionally, the TAP block is given by anaesthesiologists as a blind procedure or under Ultrasound (US) guidance. In 2010, an innovative surgical TAP block method was developed, where the surgeon gives TAP block under direct vision before closing the abdomen during abdominal surgery. Many studies have recommended surgical TAP block as an intervention for achieving postoperative pain relief. Aim: To evaluate the efficacy of the surgical TAP block technique for postoperative analgesia following lower abdominal surgeries using Visual Analogue Scale (VAS) scores and by comparing the need for rescue analgesia and the total amount of analgesic drugs utilised within the first 24 hours of surgery. Materials and Methods: This hospital-based prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at The Oxford Medical College Hospital and Research Centre, Bengaluru, Karnataka, India, from January 2022 to December 2022. The study participants included 108 women undergoing lower abdominal surgeries under spinal or epidural or combined regional anaesthesia and belonging to the American Society of Anaesthesiologists (ASA) physical status classification system ASA I or ASA II or ASA IIE. The study group included 54 women who received surgical TAP block with 20 mL 0.25% bupivacaine and 4 mg of dexamethasone, intraoperatively on either side before closure of the abdomen. Postoperative pain was assessed using VAS at regular intervals within 24 hours of surgery. VAS was also recorded whenever the participants demanded rescue analgesia. The control group included 54 women who received intravenous tramadol 50 mg eight hourly for postoperative pain relief, while the study group received rescue analgesia on demand or if the VAS score was recorded as three or more. The time for the first request for rescue analgesia and the total dose of rescue analgesic required in the first 24 hours after surgery were also recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 25.0. For inferential statistics, numerical data were analysed by Chi-square test, and for continuous data, the Student’s t-test was used. A p-value &lt;0.05 was considered statistically significant. Results: The study group had significantly lower postoperative pain VAS scores when compared to the control group at four hours and beyond time intervals. The mean VAS scores at six hours were 1.85 in the study group and 2.35 in the control group (p-value=0.01), at 24 hours it was 2.04 in the study group and 2.24 in the control group (p-value=0.04). The mean time for the first rescue analgesia in the study group and control group was 11 hours 25 minutes and 2 hours 43 minutes, respectively, and the total tramadol consumption was 77.78±46.24 mg and 117.59±36.55 mg, respectively. Both results were statistically significant (p-value&lt;0.001). Conclusion: Surgical TAP block significantly delays the need for rescue analgesia and decreases the total analgesia required in the first 24 hours after surgery. It is an effective, safe, and simple technique for achieving postoperative pain relief.

Effect of preoperative tropisetron treatment on postoperative cognitive function: A retrospective cohort study

To investigate the effect of preoperative tropisetron treatment on postoperative cognitive function on the basis of patients' Mini-Cog scale scores. In this retrospective cohort study, data were retrieved from the medical record database. This research did not involve concerns with patient safety and violation of their interests, and therefore, no ethical review was required. Depending on tropisetron exposure status, patients were assigned to the exposure group (86 patients) and the non-exposure group (74 patients). Patients in the exposure and non-exposure groups were administered tropisetron (10 mg; intravenously 15 minutes before operation) and other antiemetics, respectively. Data on the patients' demographic characteristics, American society of Anesthesiologists (ASA) classification, comorbid underlying diseases, sleep quality, education level, anesthesia method, duration of fasting, intraoperative blood loss and fluid replacement, intraoperative minimum and maximum systolic blood pressures (SBPs), intraoperative minimum and maximum diastolic blood pressures (DBPs), postoperative Mini-Cog scale (a simple intelligence status assessment scale) score, and postoperative visual analogue scale (VAS) pain score were collected in both the groups. The postoperative Mini-Cog score (as an indicator of cognitive function) and the rate of postoperative cognitive impairment were compared between the exposure and non-exposure groups. A multifactorial logistic regression equation was constructed to analyze the factors associated with impaired cognitive function in the postoperative period. The postoperative cognitive impairment rate in the exposure group was significantly lower than that in the non-exposure group (3.5% vs 16.2%; P < .05). Multifactorial logistic regression analysis suggested that tropisetron was a protective factor for postoperative cognitive function, with a statistically significant effect (odds ratio [OR] = 5.04, 95% confidence interval [CI] = 1.31-19.4). Preoperative tropisetron exposure significantly reduces the incidence of postoperative cognitive impairment in patients, and it is a protective factor for postoperative cognitive function.

A Comparison of Postoperative Pain and Narcotic Prescriptions in Patients Undergoing Total Hip Arthroplasty Electively or for Femoral Neck Fracture

AbstractThe opioid epidemic has forced orthopaedic surgeons to reevaluate prescribing patterns and led hospitals to develop postoperative opioid-sparing protocols for patients undergoing total hip arthroplasty (THA). The purpose of this study was to investigate patient-reported pain and narcotic requirements in patients undergoing THA for fracture (F-THA) or nonfracture diagnoses (THA-E). A retrospective analysis was performed on patients who underwent primary THA at a single academic institution between January 2013 and December 2020. Patients with postoperative opioid prescription and Visual Analog Scale (VAS) pain score data were included. Patients who underwent primary THA with a diagnosis of femoral neck fracture (THA-F) were matched 1:1 with patients without primary fracture diagnoses (THA-E) using nearest-neighbor propensity-score matching. Operative time, length of stay (LOS), discharge disposition, 90-day readmission rates, 90-day opioid prescription amounts (quantified by morphine milligram equivalents [MME]), and daily postoperative VAS pain scores (averaged over 24-hour periods) were compared. A total of 8,714 patients met inclusion criteria (THA-E: 8,362; THA-F: 352). The THA-F group was older and had a higher proportion of females and a lower mean body mass index than the THA-E group. There were 331 THA-F patients successfully matched to 331 THA-E patients. Operative time (113.6 ± 41.3 vs. 914.9 ± 32.6 minutes, p &lt; 0.001) and LOS (2.90 ± 2.82 vs. 2.32 ± 1.44 days, p &lt; 0.001) were longer in fracture patients. The THA-F demonstrated equivalent pain scores at 0 to 24 and 48 to 72 hours postoperatively but had slightly higher pain scores at 24 to 48 hours postoperatively (4.04 ± 1.67 vs. 3.71 ± 1.65, p = 0.028). Ninety-day opioid prescriptions were higher in the THA-E group (median [interquartile range], 150.0 [93.3–300.0] vs. 100.0 [40.0–200.0] MME, p = 0.034). In multivariate regression, a diagnosis of fracture was not associated with changes in MME administration. Patients undergoing primary THA electively and for femoral neck fractures can expect similar postoperative pain scores, though fracture patients may require less narcotics postoperatively. All patients should continue to be counseled preoperatively on the dangers and side effects of prolonged opioid use.

Lumbar Canal Stenosis Decompression Using Bilateral Interlaminar Versus Classic Laminectomy Technique

Objective: The study compared the postoperative back pain VAS score in bilateral interlaminar and classic laminectomy techniques in patients with lumbar canal stenosis.&#x0D; Material and Methods: This randomized controlled experiment was carried out at Ayub Teaching Hospital's Neurosurgery Department. 30 patients were in the bilateral interlaminar (BIL) group (A) and 30 were in the traditional laminectomy group (B). The bilateral interlaminar decompression technique was carried out utilizing the operating microscope. Both groups employed facet joint undercutting to reduce the 61-facet joint excision. All patients had postoperative CT scans to assess how well the decompression went. Postoperative VAS score was stratified to age, gender, duration of complaints, and duration of the procedure.&#x0D; Results: In group A, the mean age of patients was 51.10 years while in group B, the mean age was 54.500 years. There was a male dominance of male patients in both groups. The baseline mean VAS score was 7.9 in group A and group B both. The duration of the procedure was 71.2 minutes in group A, and 104.7 minutes in group B. Mean postoperative VAS score was 5.4 in group A and 3.3 in group B. There existed a significant difference in mean postoperative VAS scores between groups concerning gender, the duration of complaints, and procedures.&#x0D; Conclusion: In patients with lumbar canal stenosis, bilateral interlaminar allows for safe and adequate spinal canal decompression.&#x0D; Keywords: Lumbar canal stenosis (LCS), Bilateral Interlaminar (BIL), Classic Laminectomy, Visual Analog Scale (VAS).

Transcorporeal decompression using a fully-endoscopic anterior cervical approach to treat cervical spondylotic myelopathy: surgical design and clinical application

BackgroundAnterior cervical discectomy and fusion (ACDF) is a common procedure for treating cervical spondylotic myelopathy (CSM), however, ACDF may cause pseudoarthrosis, accelerated degeneration of adjacent segments, loss of activity of fused segments and other complications. The full-endoscopic technique can treat CSM, without the aforementioned complications above. Therefore, it is of great clinical value to investigate the surgical scheme of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC).MethodsA total of 28 cases with single-segment Cervical spondylotic myelopathy (CSM) from April 2017 to July 2019 were involved in this study. The size of the disc-osteophyte complex was measured using imaging data prior to the operation. The diameter and direction of the bony passage was determined according to the size and central position of the complex, respectively. Twenty-eight patients underwent the above scheme for CSM. The clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores. The imaging assessment included MRI, CT and X-rays.ResultsThe diameter of the designed bony passage was about 6.9 mm, and directed toward the lower edge of the diseased lower vertebral body oblique to the center of the disc-osteophyte complex. All patients successfully completed the operation. The postoperative neck pain VAS and JOA were significantly improved compared to preoperative values (p < 0.01). Postoperative MRI indicated complete decompression of the spinal cord. CT scanning 1 year after the operation revealed an almost healed bony passage and X-ray imaging showed satisfactory physiological curvature of the cervical spine, without cervical instability.ConclusionBased on the diameter and direction of the bony passage, as determined by the size and position of the disc-osteophyte complex, indicated by MRI and CT scanning, anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord offers good decompression of the spinal cord and ensures excellent therapeutic outcome.

Comparison of Aseptic Partial- and Full-Component Revision Total Knee Arthroplasty

BackgroundRevision total knee arthroplasty (rTKA) can be performed with isolated tibial, isolated femoral, and combined tibial and femoral component exchange for different indications. Replacement of only 1 fixed component in rTKA leads to shorter operative times and decreased complexity. We sought to compare functional outcomes and rates of rerevision in patients undergoing partial and full rTKA. MethodsThis retrospective study examined all aseptic rTKA patients with a minimum follow-up of 2 years in a single center between September 2011 and December 2019. Patients were divided into two groups: full rTKA (F-rTKA) if both components (femoral and tibial) were revised and partial rTKA (P-rTKA) if only 1 component was revised. A total of 293 patients (P-rTKA = 76, F-rTKA = 217) were included. ResultsP-rTKA patients had significantly shorter surgical time (109 ± 37 Versus. 141 ± 44 minutes, P < .001). At mean follow-up of 4.2 (range 2.2-6.2) years, rerevision rates did not significantly differ between groups (11.8 Versus. 16.1%, P = .358). Improvements in postoperative Visual Analogue Scale (VAS) pain and Knee Injury and Osteoarthritis Scale (KOOS), Joint Replacement scores were similar as well (P = .100 and P = .140, respectively). For patients undergoing rTKA due to aseptic loosening, freedom from rerevision due to aseptic loosening was similar between groups (100 Versus. 97.8%, P = .321). For patients undergoing rTKA due to instability, freedom from rerevision due to instability did not significantly differ as well (100 Versus. 98.1%, P = .683). In the P-rTKA cohort, freedom from all-cause and aseptic revision of preserved components was 96.1% and 98.7% at the 2-year follow-up. ConclusionCompared to F-rTKA, P-rTKA yielded similar functional outcomes and implant survivorship with shorter surgical time. When indications and component compatibility allow for such a procedure, surgeons can expect good outcomes when performing P-rTKA.

Would the width of a metal rib spreader affect postoperative pain in patients who undergo video-assisted mini-thoracotomy (VAMT)?

Hitherto, no study has evaluated postoperative pain in patients with non-small cell lung cancer (NSCLC) treated with video-assisted mini-thoracotomy (VAMT). In this study, we aimed to assess postoperative pain related to the width of the metal rib spreader in patients who underwent lobectomy using VAMT. We retrospectively analysed the data of 94 consecutive patients with NSCLC who underwent lobectomy using VAMT at our institution between March 2019 and May 2022. We divided the patients into groups according to the width ratio of the rib spreader to that of a single intercostal space. Patients with width ratios ≤ 2.5 times were assigned to group A, and those with width ratios > 2.5 times were assigned to group B. Pre-, intra-, and postoperative data were collected and reviewed. We successfully performed VAMT in 94 patients with NSCLC. Forty-five patients were in group A, and 49 were in group B. There were no intraoperative mortalities, although one patient, due to respiratory failure, experienced 30-day mortality. There were no significant differences between the two groups in terms of the blood loss volume, operative time, drainage time, postoperative complications, length of hospital stay, or number of lymph node stations explored and retrieved. The drainage volumes (Day 1-Day 3) were higher in group B than in group A (P < 0.05). The postoperative visual analogue scale (VAS) pain scores were significantly lower in Group A than in Group B at 12, 24, and 48 h (P < 0.05), although there was no significant difference in the VAS scores between the two groups at 72 h and 1 week postoperatively (P > 0.05). The smaller the width of the metal rib spreader used in surgery, the less pain experienced by the patient and the faster the recovery. Multicentre, randomised, controlled trials should be conducted in the future.

Autologous Platelet-Rich Plasma in Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: A Pilot Case Study.

Postoperative healing after clitoral reconstruction (CR) for female genital mutilation/cutting can be long and painful due to prolonged clitoral re-epithelialization time (up to 3 months). Autologous platelet-rich plasma (A-PRP) might reduce postoperative clitoral epithelialization time and pain. The authors assessed postoperative clitoral re-epithelialization time and pain after intraoperative clitoral administration of A-PRP. Five consecutive women underwent CR (Foldès technique) followed by the administration of A-PRP Regen Lab SA (Le Mont-sur-Lausanne, Switzerland) plasma and glue, injected inside and applied above the re-exposed clitoris, respectively. We recorded surgical complications, postoperative clitoral pain (visual analogue scale), painkiller intake, time to complete re-epithelialization, and the experienced subjective changes in sexual response and perception of their own body image referred by women. Sexual distress/dysfunction as well as the desire to be physically and symbolically "repaired" were the reasons behind women's requests for surgery. None of the women suffered from chronic vulvar or non-vulvar pain. All women achieved complete clitoral epithelialization by day 80, 3 women between day 54 and 70, and only 1 woman was still taking 1 g of paracetamol twice a day at 2 months postoperative. She had stopped it before the 3-month control. There were no short- or long-term complications. All women described easier access and stimulation of their clitoris as well as improved sexual arousal, lubrication, and pleasure and claimed to be satisfied with their restored body image. A-PRP could expedite postoperative clitoral epithelialization and reduce postoperative pain after CR after female genital mutilation/cutting.

Revision Surgery after Failed Index Synthetic Cartilage Implant Resurfacing for Hallux Rigidus: Single Surgeon Five-Year Experience

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) of the first metatarsophalangeal joint (MTPJ) is a prevalent arthritic disease which causes pain and stiffness. While MTPJ arthrodesis is regarded as the gold standard treatment option for HR (Grade II and III), synthetic cartilage implant (SCI) resurfacing has gained popularity since it demonstrates similar biomechanical properties as native cartilage, eliminates pain, and preserves MTPJ motion. However, recent studies have reported variable failure rates on SCI treatment, with implant subsidence most commonly leading to a revision. The purpose of this study was to identify the SCI resurfacing failure rate by a single surgeon, while also comparing clinical outcomes of patients who underwent SCI replacement or MTPJ arthrodesis after failed index SCI resurfacing. Methods: Electronic health records were queried from 2016 to 2021 for patients who were experiencing symptomatic HR and were treated with SCI (Synthetic Cartilage Implant) by a single surgeon. Patient demographics, body mass index (BMI), medical comorbidities, American Society for Anesthesiologists (ASA) physical status, past surgical history and followup periods were recorded. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, hallux valgus (HV) angles, and x- ray imaging were compared. Subgroup analysis was performed on patients who underwent revision with either a SCI replacement or MTPJ arthrodesis. SCI replacement included the use of bone graft and/or a custom 3D-printed baseplate to prevent implant subsidence. Descriptive and univariate statistics were used to analyze data. Results: A total of 219 SCI resurfacing procedures were performed by a single surgeon, including 23 revisions. When only analyzing index procedures, a revision rate of 8.2% was determined. The revision cohort (n=23) consisted of 19 females, and presented with a mean BMI of 29.5+-5 Kg/m2, mean age of 52.8+-11 years, and mean followup of 22.3 (range, 3-54) months. Patients underwent revision surgery at an average of 12.1+-12 (range, 1-50) months after index SCI resurfacing. Specifically, 12 procedures resulted in an SCI replacement, while 11 procedures resulted in arthrodesis. There was significantly lower postoperative pain VAS (P=0.04) and a significant improvement from preoperative to postoperative pain VAS for the arthrodesis cohort (P&lt;0.001) (Table 1). Conclusion: Eight percent of index SCI resurfacing procedures performed by a single surgeon resulted in failure. When revising a failed index SCI resurfacing procedure, MTPJ arthrodesis was found to reduce pain more significantly compared to SCI replacement procedures. Future prospective studies should be performed to expand upon the limited clinical outcomes data comparing SCI revision procedures such as joint arthrodesis and SCI replacement.

Clinical Outcomes of Synthetic Cartilage Implant for Second Metatarsophalangeal Joint Arthritis

Category: Midfoot/Forefoot Introduction/Purpose: Second metatarsophalangeal joint (MTPJ) arthritis can be caused by both traumatic and non-traumatic conditions such as inflammation, osteoarthritis, and Freiberg's disease. Although many treatment options for second MTPJ arthritis are available, resurfacing with a synthetic cartilage implant (SCI) has recently gained popularity since it demonstrates similar biomechanical properties as native cartilage, eliminates pain, and preserves second MTPJ motion. With limited data available on the efficacy of SCI resurfacing for the lesser toes, the purpose of this study was to report on the clinical outcomes of SCI resurfacing in patients with second MTPJ arthritis. Methods: Electronic health records were queried from July 2017 to December 2020 for patients who were experiencing symptomatic second MTPJ pain and were treated with SCI (Cartiva Synthetic Cartilage Implant; Cartiva Inc., Alpharetta, GA) by a single surgeon. Patient demographics such as body mass index (BMI), age, sex, medical comorbidities, American Society for Anesthesiologists (ASA) physical status, past surgical history, and followup periods were recorded. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and x-ray imaging were compared. Descriptive and univariate statistics were used to analyze data. Results: A total of six patients received SCI resurfacing for second MTPJ pathologies including Freiberg's disease (50%), osteoarthritis (67%), and subluxation (50%). All six patients were female and the mean BMI and age were 28.3+-6 Kg/m2 and 56.3+-14 years, respectively. Three patients (50%) received index SCI resurfacing, while three patients (50%) received SCI resurfacing as a revision procedure. No significant differences were observed between preoperative and postoperative pain VAS, dorsiflexion, and plantarflexion measurements. The mean followup period was 16.4+-14 (range, 5-38) months and no postoperative complications were reported. When reviewing imaging, all patients demonstrated second MTPJ alignment within 10 degrees of valgus and maintenance of articular space (Table 1). Conclusion: SCI resurfacing can be utilized as a treatment option for second MTPJ arthritis. Future prospective studies should be performed to expand upon the limited clinical outcomes data presently available.

Impact of BMI on Outcomes after First Metatarsophalangeal Joint Arthrodesis

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly performed procedure for patients with various disorders of the first ray including hallux rigidus, severe hallux valgus, failed 1st MTPJ replacement, and failed hallux valgus correction. Outcomes are generally favorable and similar outcomes have been shown in the young and elderly. It is well documented that medical comorbidities have deleterious effects on outcomes in foot and ankle surgery. Obesity - in particular - has been broadly studied among the foot and ankle literature and has been associated with increased complications. Presently, there is a paucity of studies examining obesity's effect on outcomes of 1st MTPJ arthrodesis. This study's purpose was to evaluate outcomes following 1st MTPJ arthrodesis in obese vs non-obese patients. Methods: A retrospective cohort study of 94 patients undergoing first MTPJ fusion over the age of 18 with a diagnosis of hallux valgus or hallux rigidus was performed. Surgical and postoperative outcomes, Visual Analog Pain scale (VAS), and Short Form 36 (SF-36) surveys were examined and stratified into 2 patient groups: BMI &lt; 30 and 3 30, with sub-analyses conducted between Obesity class I (30-34.9) and Obesity class II (35-39.9) patients. Continueous, normally distributed data were compared with independent sample t-tests, while comparisons of categorical data were made using chi-squared tests. Alpha and beta were assumed to be 0.05 and 0.8, respectively. Results: Average overall VAS and SF-36 physical component scores improved significantly at 6 months (P&lt; 0.0001, 0.006) and 1- year postoperative visits (P &lt;0.0001, 0.007) following 1st MTP fusion in the cohort as a whole. No differences in VAS or SF-36 scores were found between the obese (BMI &gt; 30) or non-obese cohorts. Amongst BMI classified subgroups, significantly greater changes in preoperative to 6-month and 1-year postoperative VAS pain were observed in the Obesity class I patients vs. Obsesity class II or greater (P=0.043, 0.022). Conclusion: Our study showed first MTPJ fusion reliably improves pain and physical quality-of-life in arthritic obese and non- obese patients without differences in nonunion, complications, or patient-reported measures. Additionally, we observed that obese patients experienced comparable improvements in VAS pain and SF-36 physical function scores as their non-obese peers. Our findings asset that first MTPJ fusion is an effective procedure for correction of MPTJ pathology in the obese.

Outcome of Percutaneous Transforaminal Endoscopic Lumbar Decompression for Multisegment Lumbar Spinal Stenosis and the Effect on VAS Scores.

Purpose To investigate the efficacy of percutaneous transforaminal endoscopic lumbar decompression (PTED) in the treatment of multisegment lumbar spinal stenosis (LSS) and its effect on VAS scores. Methods 126 patients with multisegment LSS admitted between August 2017 and August 2021 were selected and divided into the PTED group and the traditional open surgery group (TOS group) according to the different treatment methods. There were 70 cases in the PTED group, treated with PTED, and 56 cases in the TOS group, treated with traditional open surgery. The clinical outcomes, the preoperative and postoperative pain visual analogue scale (VAS), the Oswestry disability index (ODI), the SF-36 quality of life questionnaire scores, the perioperative indicators (operative time, days in hospital, intraoperative blood loss), the postoperative complications, and imaging data were compared between the two groups. Results After the operation, the excellent and good rate in the PTED group (91.43%) was significantly higher than that in the TOS group (75.00%) (P < 0.05). At each time after the operation, the VAS and ODI scores of the two groups were lower than those before the operation, and the VAS scores of the PTED group at 1 day and 3 months after operation were lower than those of the TOS group, and the ODI scores of the PTED group at 3 months after operation were lower than those of the TOS group (P < 0.05). 3 months after the operation, the SF-36 scores in both groups were higher than those before the operation, and those in the PTED group were higher than those in the TOS group (P < 0.05). The operation time and days in hospital in the PTED group were shorter than those in the TOS group, and the intraoperative dominant blood loss and recessive blood loss were less than those in the TOS group (P < 0.05). The total incidence of complications in the PTED group (15.71%) was significantly lower than that in the TOS group (32.14%) (P < 0.05). Conclusion Both PTED and traditional open surgery are effective in treating patients with multisegmental LSS, and both show positive postoperative changes in all indicators, but the former has more promising near -term results in improving lumbar spine pain, function and quality of life than the latter, and has the advantages of less trauma, less bleeding, and fewer complications.