Postoperative Visual Analog Scale Pain Research Articles

Clinical analysis of subxiphoid vs. lateral approaches for treating early anterior mediastinal thymoma.

To investigate the clinical efficacy of the subxiphoid approach for early anterior mediastinal thymoma and evaluate its advantages over the lateral intercostal approach. A total of 345 patients with early anterior mediastinal thymoma were retrospectively analyzed from January 2016 to December 2020 in the First Affiliated Hospital of Soochow University. Out of these, 99 patients underwent subxiphoid video-assisted thoracoscopic thymectomy and 246 patients underwent transthoracic video-assisted thoracoscopic thymectomy. We compared the intraoperative conditions (such as operation time and intraoperative blood loss), postoperative conditions [such as postoperative pleural drainage volume, extubation time, postoperative hospital stay, and postoperative visual analogue scale (VAS) pain score], and postoperative complications (such as death, pneumonia, delayed wound healing, cardiac arrhythmia, and phrenic nerve injury) of the two groups and analyzed the clinical advantages of the subxiphoid approach for treating early anterior mediastinal thymoma. There was no significant difference between the two groups in terms of general clinical features, operation time, and postoperative complications (P > 0.05).However, there was a significant difference in terms of intraoperative blood loss, postoperative pleural drainage volume, tube extubation time, postoperative hospital stay, postoperative VAS pain score, and postoperative analgesics (a significantly decreased flurbiprofen axetil amount) (P < 0.05). Compared with the lateral intercostal thoracic approach, the subxiphoid approach had advantages in terms of intraoperative blood loss, postoperative hospital stay, tube extubation time, postoperative pleural drainage volume, postoperative VAS pain score, and analgesics dosage. It could provide a better view of the bilateral pleural cavities and more thorough thymectomy and superior cosmesis, and it proved to be a safe and feasible minimally invasive surgical method.

Comparison of the Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion and Endoscopic Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Retrospective Matched Case-Control Study

We compared the clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF). We retrospectively analyzed the clinical data of patients who underwent single-segment Mis-TLIF or Endo-TLIF between June 2016 and June 2019 at our hospital. The patients in each treatment group were matched 1:1 for sex, age, and type of lumbar degenerative disease, and their clinical outcomes were compared at discharge and at 1 and 2years postoperatively. Our study included 64 patients, with 32 patients in each treatment group. Operative time and fluoroscopy time were significantly higher in the Endo-TLIF versus Mis-TLIF groups, whereas estimated blood loss, postoperative drainage volume, and the low back pain visual analog scale score at discharge were significantly lower. Both treatments achieved exact interbody fusion at the final-follow up. There was no significant difference in the visual analog scale score or Oswestry Disability Index between the groups at 1 and 2years postoperatively. Complication rates were higher in the Endo-TLIF group (21.9%) than in the Mis-TLIF group (6.2%), although the difference was not significant. Although there was no difference in the long-term outcomes between the treatments, Endo-TLIF had less blood loss and a lower postoperative drainage volume and low back pain visual analog scale score at discharge than Mis-TLIF. However, the longer operative time and potentially higher complication rate of Endo-TLIF suggest that surgeons may need to overcome the steeper learning curve than the procedure of Mis-TLIF.

Intermediate to Long-Term Follow-up of the Salto Talaris Fixed-Bearing Total Ankle Prosthesis.

Total ankle arthroplasty (TAA) remains a viable option for recalcitrant, end-stage ankle arthritis. Among the various Food and Drug Administration (FDA)-approved prosthetic options is the fixed-bearing Salto Talaris implant. The aim of the present study was to evaluate the intermediate to long-term clinical outcomes and radiographic complications following implantation of the Salto Talaris TAA. Nineteen Salto Talaris total ankle implants were included in the present retrospective study. Medical records were reviewed to determine pre- and postoperative visual analog scale (VAS) pain scores, and both medical records and radiographs were utilized to assess for complications. Telephone interviews were then conducted to assess for overall patient satisfaction. At a mean follow of 6.9 years (range, 3.5-12 years), there was a 21% complication rate according to the classification system described by Glazebrook et al. The reoperation rate was low at 10.5%, and there was 100% survivorship of the total ankle implant. The average pain decreased from 9.1 (range, 7-10) preoperatively to 2.6 (range, 0-10) postoperatively. Patients reported a 95% satisfaction rate, and 16% of patients reported using a brace postoperatively. The Salto Talaris arthroplasty was associated with low complication and reoperation rates, and a high survivorship at intermediate to long-term follow-up. 4.

217. Improved outcomes with concurrent instrumentation and fusion of the sacroiliac joint in patients with long lumbosacral constructs

217. Improved outcomes with concurrent instrumentation and fusion of the sacroiliac joint in patients with long lumbosacral constructs

Cheilectomy With Decompression Osteotomy for Treatment of Hallux Limitus and Rigidus: A Retrospective Study With 5-Year Outcomes

We examined outcomes following metatarsophalangeal joint cheilectomy with decompression osteotomy to evaluate the efficacy of this technique for treatment of hallux limitus/rigidus. At a minimum follow-up of 5 years, we identified 94 patients who fit the inclusion criteria. Chart review was performed to obtain range of motion (ROM) of the first metatarsophalangeal joint (MTPJ) preoperatively and at 6 weeks, 6 months, and 5 years postoperatively. Additionally, time to traditional shoe gear return, need for revision arthrodesis, radiographic findings, and postoperative visual analog scale (VAS) pain scores were reviewed. Statistical analysis was conducted by 1-way analysis of variance with post-hoc analysis and independent sample t-test. At an average follow-up of 6.3 ± 0.9 years, 42.3% (33/78) of females and 25.0% (4/16) of males reported limited ROM of the first MTPJ with 5 patients requiring first MTPJ arthrodesis. MTPJ ROM improved on average from 11.0° to 36.3° by 5-year minimum follow-up after surgery (p < .001). Analysis of variance revealed a significant difference of the preoperative ROM when compared to all postoperative time points (F[3,368] = 69.4, p < .001). Mean postoperative VAS pain scores after decompression osteotomy of the 5 patients who required MTPJ fusion were higher when compared to the rest of the patient cohort at final follow-up (7.4 ± 0.6 vs 1.5 ± 1.3; p < .001). Cheilectomy with decompression osteotomy for treatment of hallux limitus/rigidus leads to satisfactory long-term outcomes.

Outcomes after anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty in patients with long-term disability claims

BackgroundStudies have shown that patients with workers' compensation claims have worse clinical outcomes after various orthopedic procedures. This study aimed to determine the influence of disability status on 2-year clinical outcomes after reverse total shoulder arthroplasty (RTSA) and anatomic total shoulder arthroplasty (ATSA). MethodsReview of an institutional database identified patients on disability with a minimum of 2-year follow-up and compared them to a comorbidity-matched cohort of patients without disability claims. Assessments between patients included preoperative and postoperative Visual Analog Scale (VAS) pain scores, American Shoulder and Elbow Surgeons (ASES) scores, strength, range of motion (ROM), and postoperative complications. ResultsForty-eight shoulders (45 patients) were in the ATSA cohort (24 with disability, 24 without disability) and 46 shoulders (45 patients) in the RTSA cohort (23 with disability, 23 without disability). Patients in the ATSA cohort with disability claims had higher 3-month and 2-year VAS scores (4 vs. 1, P = .003; 4 vs. 1, P = .02, respectively), lower 2-year ASES scores (58 vs. 87, P = .015), and decreased forward elevation ROM and internal rotation ROM (150 vs. 170, P = .017; 60 vs. 62.5, P = .024, respectively) compared to the cohort without disability. Significant differences in baseline values also were noted between cohorts (lower preoperative ASES: 31.7 vs. 40.5, P = .033; higher VAS: 7 vs. 6, P = .03; decreased forward elevation ROM: 90 vs. 110, P = .02). Patients in the RTSA cohort with disability claims had higher 3-month and 2-year VAS (5 vs. 1, P = .02; 3 vs. 0.5, P = .04, respectively) scores than those without claims. The baseline values for the disability cohort with RTSA demonstrated lower ASES (22.1 vs. 43.6, P = .005) and higher VAS (8 vs. 4, P = .004) scores. No significant differences were noted in improvement for the ATSA or RTSA cohorts in any parameter. The ATSA with disability cohort had a higher complication rate (45% vs. 16.6%, P = .0299). No differences were noted in complication rates in the RTSA group. ConclusionPatients who have reported disability status demonstrated worse outcomes after ATSA and RTSA compared to patients without disability claims. However, there was no significant difference in the amount of change in outcomes between groups, indicating that patients on disability can still realize significant improvements after shoulder arthroplasty.

Mini-Percutaneous Nephrolithotomy With an Endoscopic Surgical Monitoring System for the Management of Renal Stones: A Retrospective Evaluation.

PurposeTo compare the outcomes and postoperative quality of life of patients with renal calculi who underwent standard percutaneous nephrolithotomy (sPNL), mini-invasive percutaneous nephrolithotomy (mPNL) or mPNL with an endoscopic surgical monitoring system (ESMS) using a retrospective clinical trial.MethodsEighty-six adult patients with renal stones who were treated with sPNL were retrospectively compared to ninety-two patients who were treated with mPNL between July 2014 and December 2017. Next, further studies were retrospectively conducted using a matched paired method. The ninety-two patients treated with mPNL were divided into two groups based on whether the endoscopic surgical monitoring system (ESMS) was used (ESMS-mPNL vs. non-ESMS-mPNL). The ESMS used strain gauge transducers to measure the inflow and outflow of irrigation solution. Bleeding and fluid absorption during endoscopic surgery could be accurately calculated by computer program in ESMS.ResultsThe fluoroscopy time, complication rate, stone-free status and clinically insignificant residual fragment (CIRF) rate were not significantly different between the two groups (sPNL vs. mPNL). The mPNL group had a significantly longer operation time than the sPNL group, and the mPNL group exhibited a markedly reduced 12-h postoperative visual analogue pain scale (VAS) score, mean hospitalization time, and return to work time, had slightly reduced haemoglobin loss, and underwent more tubeless operations. Moreover, among the 92 patients who underwent mPNL, the operation time (P = 0.090), complication rate (P = 0.996), stone-free status (P = 0.731), CIRF rates (P = 0.125) and number of tubeless operations (P = 0.760) were not significantly different between the two subgroups (non-ESMS-mPNL vs. ESMS-mPNL); however, the patients in the ESMS-mPNL group had significantly longer irrigation times than those in the non-ESMS-mPNL subgroup, along with marked reductions in irrigation fluid, blood loss, haemoglobin loss, 12 h postoperative VAS score, mean hospitalization time, and return to work time.ConclusionsmPNL is less painful than sPNL in patients undergoing treatment for 20–40 mm renal stones. Similar stone-free rates were achieved by the two procedures, but mPNL was superior to sPNL in terms of blood loss, discomfort, hospitalization time and return to work time. We think that ESMS-mPNL is less painful for patients and more efficacious than non-ESMS-mPNL, and ESMS-mPNL achieves a stone-free rate that is similar to non-ESMS-mPNL in patients receiving treatment for 20–40 mm kidney stones.

Remodeling of Epidural Fluid Hematoma after Uniportal Lumbar Endoscopic Unilateral Laminotomy with Bilateral Decompression: Comparative Clinical and Radiological Outcomes with a Minimum Follow-up of 2 Years.

Retrospective cohort study. To evaluate the clinical and radiological effects of epidural fluid hematoma in the medium term after lumbar endoscopic decompression. There is limited literature comparing the effect of postoperative epidural fluid hematoma after uniportal endoscopic decompression. Magnetic resonance imaging (MRI) and clinical evaluation were performed for patients with single-level uniportal endoscopic lumbar decompression with a minimum follow-up of 2 years. A total of 126 patients were recruited with a minimum follow-up of 26 months. The incidence of epidural fluid hematoma was 27%. Postoperative MRI revealed a significant improvement in the postoperative dura sac area at postoperative day 1 and at the upper endplate at 6 months in the hematoma cohort (39.69±15.72 and 26.89±16.58 mm2) as compared with the nonhematoma cohort (48.92±21.36 and 35.1±20.44 mm2), respectively (p <0.05); and at the lower endplate on postoperative 1 day in the hematoma cohort (51.18±24.69 mm2) compared to the nonhematoma cohort (63.91±27.92 mm2) (p <0.05). No significant difference was observed in the dura sac area at postoperative 1 year in both cohorts. The hematoma cohort had statistically significant higher postoperative 1-week Visual Analog Scale (VAS; 3.32±0.68) pain and Oswestry Disability Index (ODI; 32.65±5.56) scores than the nonhematoma cohort (2.99±0.50 and 30.02±4.84, respectively; p <0.05). No significant difference was found at the final follow-up VAS, ODI, and MRI dura sac area. Epidural fluid hematoma is a common early postoperative MRI finding in lumbar endoscopic unilateral laminotomy with bilateral decompression. Conservative management is the preferred treatment option for patients who do not have a neurological deficit. Symptoms last only a few days and are self-limiting. A common endpoint is a remodeled fluid hematoma and the subsequent expansion of the dura sac area.

Peripheral nerve block compared to peri-articular injection for postoperative pain control in total ankle arthroplasty: A randomized, controlled, non-inferiority trial

Background Peripheral nerve blocks (PNB) are widely used for postoperative pain management, including total ankle arthroplasty (TAA), but introduce potential neuropathic complications. This study evaluates the effectiveness and tolerability of peri-articular injections (PAI) compared to PNB in TAA, measured by narcotic consumption and pain scores. Methods A prospective, non-inferiority trial randomized 51 adults undergoing primary, unilateral TAA, to either PAI (n=26) or a popliteal fossa with distal femoral nerve block (n=25). Outcomes included mean difference (MD) in postoperative morphine milligram equivalents (MME) consumption and Visual Analogue Pain Scale (VAS, 0-100mm) at 24 hours and two weeks, and complications through three months. Non-inferiority margins were MD in narcotic consumption less than 30 MME (24 hour) and 75 MME (two weeks), and MD less than 15mm on VAS using the upper limit of one-sided 95% confidence intervals (UCI). Results Complete data were available for 23 participants with PAI and 18 with PNB. Mean 24 hour MME was 53.6 (sd = 47.5) in PAI versus 57.2 (sd = 44.0) in PNB (p=.711) with 3.6 MME MD (UCI 32.6). Mean VAS at 24 hours was 25.1 (sd = 24.7) in PAI compared to 25.2 (sd = 29.4) in PNB (p=.991) with MD -0.09 (UCI 17.0). At two-weeks, MD in MME was 80.8 (UCI 363.3). Non-inferiority was not supported for these outcomes. Mean two week VAS was 14.6 (sd = 24.7) in PAI versus 16.4 (sd = 21.0) for PNB (p=.828) with MD of -1.9 (UCI 10.4), supporting non-inferiority. Conclusion PAI offers a simple approach to pain control in TAA that should be considered. There were no significant differences in 24 hour or two week postoperative pain, or complications for patients randomized to PAI compared to PNB. Further research will likely demonstrate PAI is no worse than PNB for postoperative pain control and avoids potential neuropathic complications.

Are the best anatomic total shoulder arthroplasties better than the best reverse total shoulder arthroplasties?

BackgroundSurgeons often state anecdotally that their best anatomic shoulder arthroplasties (TSAs) do better than their best reverse shoulder arthroplasties (RSAs). Limited data exist comparing patients at the upper limits of outcomes between RSA and TSA. MethodsA retrospective study was performed in patients undergoing TSA and RSA with minimum 2-year follow-up. Baseline patient demographic information as well as preoperative and postoperative active range of motion, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation, and Visual Analog Scale score for pain were collected. Patients in the top 20% of postoperative ASES scores were identified as those with the best outcomes. Descriptive statistics, univariate, and multivariate analyses were performed to evaluate differences between patients in the top 20% of ASES scores undergoing TSA and RSA. ResultsA total of 40 TSAs and 88 RSAs were included in the top 20% of each group, from a total of 205 TSAs and 447 RSAs, with a mean postoperative follow-up of 33 ± 14 months. Baseline patient-reported outcome measures and range of motion did not differ between groups (P > .05). There were no significant differences in the change of preoperative to postoperative Visual Analog Scale-pain (P = .539), Single Assessment Numeric Evaluation (P = .388), ASES (P = .912), and forward elevation (P = .439). The median (interquartile range) change in external rotation (40° [30°, 50°] vs. 30° [20°, 50°]; P = .017) and internal rotation (4.0 [2.0, 6.0] vs. 2.0 [1.0, 4.0]; P = .005) was statistically different between the TSA and RSA groups, respectively. A minimal clinically important difference for ASES was achieved by 100% of patients in both groups. A substantial clinical benefit was achieved by 100% of patients in the TSA group and 98% (n = 86) of patients in the RSA group. ConclusionWhile there is a common notion that patients treated with TSA have a greater potential for excellent outcomes, our findings show that clinical outcomes of the best TSAs are comparable to those of the best RSAs. Longer follow-up is needed to identify long-term differences in outcomes including revision and implant durability.

Use of the Straight Retrograde Intramedullary Nail for Tibiotalocalcaneal Arthrodesis: A Single-Institution, Single-Surgeon, Single-Implant Retrospective Series.

Background:The hindfoot fusion nail has become a popular implant for tibiotalocalcaneal (TTC) arthrodeses given its rigidity, ease of insertion, and potential for less invasive surgical approaches. The purpose of this study was to evaluate fusion and complication rates following the use of a straight, retrograde intramedullary nail for TTC arthrodeses, and the influence of diabetes and smoking on these results.Methods:A review of patient cases performed by a single surgeon at a single institution was performed. Variables included age, comorbidities, smoking history, BMI, hemoglobin A1c, preoperative and postoperative visual analog scale pain scores, assessment of healing, and complications. Relative and absolute risk were assessed for smoking, diabetes, fusion, and surgical complications through risk ratios. Cox proportional hazards survival analyses were performed to assess the effects of smoking and diabetes on fusion rates and complications. Linear regressions were performed to investigate the effects of smoking and diabetes on patient-reported pain levels.Results:Of 103 patients, there were 37 cigarette smokers and 30 diabetic patients. Eighty-three patients achieved union of all involved joints and 19 patients achieved union of 1 or 2 joints. Smokers demonstrated a 1.46 (risk ratio) (95% CI 1.03-2.07) times greater risk of nonunion but were not at an increased risk of experiencing surgical complications (0.86, 95% CI 0.56-1.33). Diabetic patients did not demonstrate an increased risk of nonunion (0.86, 95% CI 0.56-1.33) or complications (1.18, 95% CI 0.76-1.83).Conclusion:Because of increased nonunion risk, patients undergoing elective tibiotalocalcaneal arthrodesis should be counseled increased nonunion risks associated with smoking. In this series, we did not find a relationship between diabetes and complications or nonunion.Level of Evidence:Level III, retrospective cohort study.

Local Infiltration Analgesia Versus Interscalene Block for Pain Management Following Shoulder Arthroplasty: A Prospective Randomized Clinical Trial.

While providing effective analgesia following shoulder arthroplasty, an interscalene block has known complications. Local infiltration analgesia (LIA) using ropivacaine has been successfully employed in other joint arthroplasties, but its efficacy in shoulder arthroplasty has not been studied extensively. The purpose of this study was to compare pain and opioid consumption between LIA and an interscalene block following shoulder arthroplasty. Patients undergoing primary shoulder arthroplasty were prospectively randomized into 2 groups: the block group received an interscalene block using liposomal bupivacaine, and the injection group received an LIA injection intraoperatively. The LIA injection included ropivacaine, epinephrine, ketorolac, and normal saline solution. Postoperative visual analog scale pain scores, opioid consumption in morphine milligram equivalents, and complications were compared between the groups. The mean pain scores during the first 24 hours postoperatively were used to test noninferiority of LIA compared with an interscalene block. The study included 74 patients (52 men and 22 women with a mean age of 69 years; 37 were in the injection group and 37 in the block group). There was no significant difference between the groups with respect to pain scores at any postoperative time points (p > 0.05), except for the 8-hour time point, when the injection group had a significantly higher pain score than the block group (p = 0.01). There was no significant difference in opioid consumption between the groups at any time points postoperatively (p > 0.05). The amount of intraoperative opioid consumption was significantly higher in the injection group (p < 0.001). In noninferiority testing for the mean pain scores during the first 24 hours, the injection group was found to be noninferior to the block group. One patient in the block group developed transient phrenic nerve palsy. One patient in the injection group developed dislocation after reverse arthroplasty related to noncompliance. The mean procedure hospital charge was $1,718 for an interscalene block and $157 for LIA. LIA and an interscalene block provided similar analgesia during the first 24 hours after primary shoulder arthroplasty. LIA was associated with worse pain at 8 hours postoperatively and more intraoperative opioid consumption but was also substantially less costly. Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Poster 139: Outcomes After Arthroscopic Assisted Lower Trapezius Transfer: A Retrospective Study

Objectives:Massive irreparable rotator cuff tears lead to significant pain and disability. Tendon transfers have been described as one option to improve pain and function for patients, but clinical data are limited. The purpose of this study was to evaluate outcomes in patients after arthroscopically assisted lower trapezius tendon transfer (AALTT) for massive irreparable rotator cuff tears.Methods:Twenty-one patients with massive irreparable rotator cuff tears who underwent AALTT with a single surgeon from January 2017 to July 2021 were analyzed. Patient demographics such as age, sex, followup, worker’s compensation claims, and prior surgical history were recorded. Preoperative and one-year postoperative range of motion, external rotation strength, and pain visual analogue scale (VAS) were extracted from medical records. Patient reported outcomes measurements used for comparison included American Shoulder and Elbow Score (ASES), as well as Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function and Mental Function. Six-month postoperative MRIs were reviewed when available. Descriptive and univariate statistical analyses were performed.Results:The average patient age was 56.1 (range, 29-72) years and 19 patients (90.5%) were male. The average follow up was 13.2 (range, 4-45) months. Seven patients (33.3%) were involved in worker’s compensation claims and 17 patients (81%) had undergone prior rotator cuff repair. Out of 21 patients who were working at the time of surgery, eleven patients (52.4%) were able to return to their same occupation and 19 patients (86.4%) demonstrated complete tendon healing on postoperative MRI scans (Table 1). There was significant improvement in postoperative pain VAS (5.8±2 vs. 1.7±2) and ASES scores (44.3±18 vs. 71.6±23). No significant changes in PROMIS Physical (47.1±7 vs. 51.4±11) and PROMIS Mental (53.1±8 vs. 53.8±10) were observed. There were significant improvements in external rotation motion (11.0±17 degrees vs. 42.1±13 degrees) and strength (2.9/5 ±1 vs. 4.6/5 ±1) at final followup (Table 2).Conclusions:AALTT is a successful treatment option for the massive irreparable rotator cuff tear. Patients demonstrated significant improvements in pain, range of motion, and strength at one year, with complete tendon healing visualized on postoperative MRI scans.Table 1.AALTT Patient DemographicsTable 2.Ranee of Motion and Patient Reported Outcomes after AALTT

Comparison Between Lignocaine Intravenous Lignocaine Infusion and Ketorolac in Reducing Postoperative Opioid Requirement in Upper Limb Surgeries

Objective: To compare the frequency of opioid requirement, after intravenous lignocaine infusion and ketorolac tromethamine in the upper limb surgeries.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, from Oct 2017 to Apr 2018.&#x0D; Methodology: ASA I/II patients of either gender undergoing upper limb surgery were included. Patients were randomly divided into two equal groups, “L” (Lignocaine) and “K” (Ketorolac). In L-group, patients were given intravenous 1.5 mg/kg lignocaine bolus, followed by 2.0 mg/kg/hr infusion during entire procedure; while in K-group, patients were given intravenous 0.5 mg/kg (maximum 30 mg) ketorolac, at induction. The patients were monitored for 12 hours postoperatively and in case of severe postoperative pain (Visual Analogue Scale score &gt;5), rescue analgesia (intravenous Nalbuphine 0.1 mg/kg) was provided.&#x0D; Results: Total eighty patients were included in the study. There was no statistical difference between the two groups with age (p-value 0.823), gender (p-value 0.808) and ASA status (p-value 0.184). There was statistically significant difference between the two groups in terms of opioid requirement at 1-hour (p-value 0.035), 6-hours (p-value 0.032) and 12-hours (p-value 0.035), with K-group showing more requirement as compared to the L-group.&#x0D; Conclusion: Intraoperative administration of intravenous lignocaine infusion is superior to ketorolac in effective postoperative pain management in patients undergoing upper limb surgeries.

Lumbar Dynamic Stabilization With 2-Stage Surgery: Early Results.

Screw loosening, which is a major problem in dynamic systems, can be easily overcome with 2-stage surgery. In this article, the clinical and radiological results of patients undergoing dynamic stabilization with a Dynesys device in 2 stages are discussed. A total of 10 male and 13 female adult patients were included in this single-center retrospective study conducted between 2018 and 2021. The mean age of the patients was 65.6 years. All of the patients had pain complaints that affected their daily lives. Bone density T scores were determined with the dual-energy x-ray absorptiometry method before patients were admitted for surgery. In the first surgery, Dynesys system pedicle screws were inserted. After 6 months of osteointegration, Dynesys system spacers and elastic bandages were placed. Preoperative, early postoperative, and late postoperative visual analog pain scale (VAS) scores and Oswestry Disability Index (ODI) scores were determined and statistically compared. Patients were followed for an average of 30 months. Complications and recurrence were not observed. Neurological deficits were not observed after patients recovered from anesthesia. Significant improvement was observed in the ODI and VAS parameters in the preoperative (ODI: 66.2%, VAS: 7.8), early postoperative (ODI: 20.3%, VAS: 2.4), and late postoperative (ODI: 6.8% and VAS: 1.1) periods. Symptomatic improvement was seen in all patients. No screw breakage or loosening was detected by radiological evaluation in any of the patients during the 2-year follow-up period. In our experience, the insufficiency of the proximal and distal end screws is eliminated when 2 stages of dynamic system stabilizations are completed after osteointegration of the screws.

Clinical analysis of subxiphoid single-port thoracoscopic surgery for simultaneous bilateral lung lesion resection

ObjectiveTo investigate the efficacy and safety of simultaneous subxiphoid single-port thoracoscopic resection of bilateral lung lesions.MethodsThis retrospective study analyzed the clinical data of 72 patients who underwent resection of bilateral lung lesions at the Department of Thoracic Surgery in the First Affiliated Hospital of University of Science and Technology of China between August 2020 and January 2022. Surgery-related parameters were compared between patients who underwent subxiphoid single-port thoracoscopy (subxiphoid group, 36 patients) and patients who underwent intercostal single-port thoracoscopy (intercostal group, 36 patients).ResultsCompared to the intercostal group, the subxiphoid group exhibited significantly better postoperative catheterization time (P = 0.013), postoperative thoracic drainage, postoperative visual analog scale pain scores at 24 and 48 h, and incision pain and numbness at 1 and 3 months after surgery (all P < 0.05). There were no significant differences in operation time, intraoperative blood loss, or postoperative complications between the two groups (all P > 0.05). There were no cases of perioperative mortality, conversion to thoracotomy, or serious complications in either group.ConclusionSubxiphoid single-port thoracoscopic surgery for simultaneous resection of bilateral lung lesions is safe and effective, reduces postoperative acute and chronic pain, decreases trauma, allows faster recovery, and is more consistent with the concept of minimally invasive surgery than bilateral intercostal single-port thoracoscopy. Thus, this subxiphoid single-port thoracoscopic surgery approach should be considered for clinical application.

Percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures with spinal origin abdominal pain as the main symptom

To analyze the efficacy of percutaneous vertebroplasty for osteoporotic vertebral compression fractures with spinal origin abdominal pain as the main symptom. A retrospective analysis was performed on 37 patients with osteoporotic vertebral compression fractures treated from January 2015 to January 2021, all of whom had spin-derived abdominal pain as the main symptom, and were divided into surgery group(21 cases) and conservative group (16 cases) according to different treatment methods. Patients in the surgery group were treated with percutaneous vertebroplasty, including 7 males and 14 females, with an average age of (75.95±6.84) years old and an average course of disease of (5.26±3.79) days. The conservative group received non-surgical treatment, including 5 males and 11 females, with an average age of (75.50±8.07) years old and an average course of disease of (4.28±3.42) days. Two groups of patients with preoperative mainly characterized by abdominal pain, abdominal distension and constipation, have no obvious chest waist back pain symptoms, the thoracolumbar MRI diagnosed as fresh osteoporotic vertebral compression fractures, record its postoperative abdominal pain visual analogue scale (VAS), medical outcomes study short form-36 (SF-36) score, defecation interval after treatment, etc. Thirty-seven patients were followed up for (14.90±14.11) months in surgery group and( 21.42±17.53) months in conservative group. Compared with before treatment, the VAS of surgery group at each time period after treatment, VAS of conservative group at 1 month after treatment and SF-36 score between two groups at 3 months after treatment were all improved(P<0.05), while VAS of conservative group at 3 days after treatment showed no statistically significant difference(P>0.05). Compared between two groups, there were no significant differences in VAS and SF-36 scores at 1 day before treatment(P>0.05), but VAS at 3 days after treatment in surgery group, life vitality and social function score at 3 months after treatment, and defecation time after treatment in surgery group were better than those in conservative group(P<0.05). There were no significant differences in other indexes(P>0.05). The incision healing of patients in surgery group was good, and no serious complications occurred in both groups. Percutaneous vertebroplasty is an effective method for the treatment of osteoporotic vertebral compression fractures with spinal origin abdominal pain as the main symptom. Compared with conservative treatment, percutaneous vertebroplasty has more advantages in early relief of abdominal pain and constipation, recovery of vitality and social function.

Simultaneous Treatment of Osteochondral Lesion Does Not Affect the Mid- to Long-Term Outcomes of Ligament Repair for Acute Ankle Sprain: A Retrospective Comparative Study with a 3-11-Year Follow-up.

PurposeThis study aims to evaluate the mid- to long-term outcome of concurrent arthroscopic treatment of osteochondral lesion (OCL) and open anatomical repair of lateral ankle ligaments for severe acute ankle sprain patients and compare them to the outcome of those without OCL.MethodsA total of 166 patients with grade III acute lateral ankle ligament injuries underwent concurrent ankle arthroscopy and open anatomic ligament repair. Forty-three patients (group A) with OCL underwent arthroscopic treatment followed by open ligament repair. A total of 105 patients (group B) without OCL were followed up as the control. The evaluation parameters included sports recovery, postoperative visual analog scale (VAS) pain score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner score, sprain recurrence, satisfaction, and range of motion. Patients in group A were then subgroup-analyzed according to age, sex, body mass index, injury side, OCL location, and stage (Ferkel and Cheng’s staging system).ResultsThe postoperative exercise level of the two groups recovered to more than 90% of the normal level (91.2% ± 11.2% in group A and 90.9% ± 13.3% in group B, n.s.). The average time of group A and group B to return to preinjury sports activity was respectively 4.4 ± 1.0 months and 4.4 ± 1.2 months with no significant difference (p = 0.716). No significant differences were found in the preoperation VAS pain score, AOFAS score, and Tegner score between the two groups. The postoperative VAS pain score in group A was significantly higher than that in group B (0.8 ± 1.7 vs. 0.3 ± 0.8, p = 0.027), but the difference was not clinically important. The postoperative VAS pain score of patients with stage D–F lesions was significantly higher than that of patients with stage B–C lesions (1.3 ± 2.1 vs. 0.3 ± 0.9, p = 0.038).ConclusionsFor the severe acute ankle sprain combined with OCL, the simultaneous arthroscopic treatment and open lateral ankle ligament repair achieved good mid- to long-term outcomes. Except that the pain was more pronounced than in the control group, there were no differences in other outcomes. Postoperative pain was positively correlated with the grade of OCL.

Combined femoral-obturator-sciatic nerve block has superior postoperative pain score and earlier ambulation as compared to spinal anaesthesia for arthroscopic anterior cruciate ligament reconstruction.

Peripheral nerve blocks can be a suitable alternative to central neuraxial blockage, as the sole anaesthetic agent for better early postoperative outcomes, decreased hospital stay and earlier mobilisation after anterior cruciate ligament reconstruction (ACLR) surgery. The purpose of this study was to compare consciousness during the procedure, pain during early postoperative period (< 7days), and perioperative outcomes following ACLR using combined sciatic, femoral, and obturator nerve blocks compared to the spinal anaesthesia. This was a prospective case-control study including patients between 18 and 55years of age, with anterior cruciate ligament (ACL) injury confirmed clinically and radiologically and undergoing ACLR. Patients were allocated in the two groups alternatively, group 1 included patients who received combined nerve blocks, and group 2 included patients who received spinal anaesthesia for the surgery. The sensory effect, motor effect, adequacy of anaesthesia, perioperative analgesic use, duration of stay, postoperative pain (visual analogue scale 0-10cm) and functional outcomes were noted. There were 60 patients in each group. A total of seven patients in group 1 (11%) and two patients in group 2 (3%) needed conversion to general anaesthesia (n.s.). In group 1, out of 53 patients who underwent surgery, 26 patients had no perception of surgery in the joint, 17 patients had perception of manipulation of the knee joint, 4 patients had sense of touch, and 6 patients had sensation of pain in the knee (VAS scale less than 3). In group 2, out of 58 patients, 42 patients had no perception of surgery, 12 had a perception of manipulation of the knee joint, 2 had sense of touch, and 2 had sensation of pain in the knee. Blockage of sensory effect was significantly better in group 2 (p = 0.0001). However, the motor effect was comparable between the two groups (n.s.). Group 1 had significantly better pain scores 6, 12, and 18h after the surgery. Moreover, patients in group 1 also had faster ambulation (mean difference of 5.5h, p = 0.0001) and reduced hospital stay (mean difference of 8.4h, p = 0.0001). Combined sciatic, femoral, and adductor canal block is an effective sole anaesthetic modality for ACLR. The sensory effect was inferior when compared to spinal anaesthesia but sufficient for the procedure without the need for supplementation with any other anaesthetic modality. Patients receiving this combined nerve block had lesser early postoperative pain scores, earlier ambulation, and shorter hospital stay as compared to the spinal anaesthesia. Level 3.

Pain score and other factors affecting the postoperative discharge time of patients who underwent lung resection: a retrospective study

Aim: Many factors affect the hospitalization period of patients after surgery. One of the most important of them is postoperative pain. Our study aims to investigate the relationship between the postoperative discharge time and the postoperative 24-hour visual analog scale (VAS) pain scores of patients who underwent thoracotomy and lung resection. Additionally, we also want to identify the parameters that affect the day of discharge, VAS scores, and chest tube removal time of these patients.&#x0D; Material and Method: Data of patients who underwent elective thoracic surgery between February 2021 and August 2021 in a tertiary chest disease and thoracic surgery center were analyzed patients aged between 18 and 75 years, in the ASA I-II-III risk group, with a body mass index (BMI) in the range of 18.5-35 kg/m2, who underwent thoracotomy and resection due to lung malignancy. Following data were extracted co-morbidities, diagnoses, performed surgery, type of surgery, duration of surgery, intraoperative complications, intraoperative blood product transfusion history, postoperative advanced complications, postoperative 24-hour VAS, length of stay, and length of chest tube stay.&#x0D; Results: A total of 104 patients who underwent elective thoracotomy and lung resection under general anesthesia between February 2021 and August 2021 were included in the study. There was a positive and highly statistically significant correlation between discharge time and chest tube removal time (p &lt; 0.001). There was no statistically significant correlation between discharge times and VAS scores (p=0.553). Additionally, there was no statistically significant correlation between VAS scores and chest tube removal time. Discharge time had a low positive and statistically significant correlation with age (p=0.027), and with the duration of the operation (p &lt; 0.001). There was a low degree of negative statistically significant correlation between discharge day and BMI (p=0.017).&#x0D; Conclusion: While the prolonged chest tube withdrawal time was directly related to the longer discharge time, the VAS scores have no significant correlation with the discharge time and the chest tube removal time. Additionally, age and operation time were also found to be associated with prolonged discharge time. Prospective comprehensive studies on this subject will be useful in clarifying the factors affecting the discharge time after thoracic surgery.