Postoperative Visual Analog Scale Research Articles

Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis.

Peritoneal drainage (PD) following laparoscopic appendectomy(LA) has long been considered beneficial for appendicitis patients, especially those with complicated appendicitis. However, recent research has raised doubts about the advantages of PD, as it not only fails to reduce postoperative complications but also prolongs the operative duration and hospital stay and incurs higher medical expenses. Given this controversy, we conducted a meta-analysis to determine whether drainage is necessary after LA for complicated appendicitis. This meta-analysis had registered in PROSPERO(ID: CRD42023472382). This study assessed current evidence regarding the efficacy, safety, and potential benefits of drainage versus no drainage following LA for complicated appendicitis. We conducted a comprehensive search of PubMed, Springer, and the Cochrane Library using the search terms "appendicitis", "laparoscopic appendectomy", and "drain" or "drainage" for studies published between January 1, 2000, and December 31, 2022. We employed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria for study inclusion and exclusion. Primary outcomes included postoperative intra-abdominal abscess, postoperative intestinal obstruction, postoperative stump leakage, wound infection and postoperative visual analog scale(VAS) score, while secondary outcomes consisted of operative time, postoperative recovery time and total hospitalization duration. Studies with at least two outcomes were considered for meta-synthesis. Depending on I2 values, fixed- or random effects models were used for data synthesis. Pooled odds ratios (OR) and weighted mean differences (WMD) were calculated for outcome comparisons between PD and no peritoneal drainage (NPD). Sensitivity analysis and meta-regression were performed to assess and investigate inter-study heterogeneity. After conducting our literature search and screening, twelve studies were analyzed, comprising 3374 cases. During the comparison of primary outcomes between PD and NPD, the incidence of wound infection and postoperative VAS score were significantly higher in the PD group(P < 0.05). While during the comparison of secondary outcomes, the operative duration, postoperative recovery time and hospitalization duration were significantly longer in the PD group than in the NPD group(P < 0.05). PD following LA for complicated appendicitis not only increases the incidence wound infection and aggravate patients' postoperative pain, but also prolongs the operative duration, postoperative recovery time and hospitalization duration. Therefore, routine PD after LA for acute complicated appendicitis is not recommended.

Effect of Patient Resilience on Functional Outcomes After Anterior Cruciate Ligament Reconstruction.

Previous studies have examined the relationship between patient resilience and functional outcome scores after anterior cruciate ligament reconstruction (ACLR). However, past studies have failed to explore the longitudinal relationship between preoperative resilience and functional outcomes 2 years after ACLR. To evaluate the relationship between preoperative patient resilience and functional outcomes 2 years after ACLR. Cohort study; Level of evidence, 3. Patients were identified who underwent ACLR for anterior cruciate ligament tears between January and June 2020 at a single institution. Those who completed the Brief Resilience Scale preoperatively as part of routine patient questionnaires were considered for inclusion. Patients were contacted a minimum of 2 years after ACLR to complete the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR), Single Assessment Numeric Evaluation (SANE), International Knee Documentation Committee (IKDC) Subjective Knee Form, and visual analog scale (VAS). Outcomes were compared among patients with low resilience (LR), normal resilience (NR), and high resilience (HR), as defined in a previous study.23. A total of 81 patients were included in the final analysis, with 14 patients in the low preoperative resilience group, 54 in normal, and 13 in high. The mean age of the cohort was 32.0 years, and there were no significant differences in age, sex, race, graft type, or psychiatric comorbidities among the resilience groups. Significantly increased postoperative KOOS-JR scores were observed in patients in the HR group as compared with those in the NR and LR groups (94.8, 86.7, and 79.6, respectively; P = .031). There were also significantly increased postoperative SANE scores in patients in the HR group versus those in the NR and LR groups (92.3, 83.5, and 69.2; P = .012). Patients with high preoperative resilience achieved the IKDC Patient Acceptable Symptom State at significantly higher rates (P = .003). No significant differences were observed in postoperative VAS (P = .364), IKDC (P = .072), or change in IKDC (P = .448) over time among resilience groups. Postoperatively, 30 patients (37.0%) changed resilience groups, with 13 moving down and 17 moving up in category (low, n = 12; normal, n = 55; high, n = 14). Preoperative resilience correlated with KOOS-JR and SANE scores 2 years after ACLR but did not correlate with VAS, IKDC, or change in IKDC over the same period. Resilience was not static, with changes in resilience observed from initial to final evaluations. Resilience is not a strong predictor of postoperative patient-reported outcomes after ACLR.

The effect of intravenous lidocaine infusion on subarachnoid anesthesia in patients undergoing total knee replacement: a randomised controlled trial.

Intravenous lidocaine is a non-opioid analgesic adjunct for perioperative pain relief. The aim of our study was to explore whether concurrent administration of intravenous lidocaine prolongs the duration of sensory block during total knee replacement (TKR) under spinal anaesthesia. This prospective randomized double blind controlled trial was conducted on 28 patients (14 in lidocaine group and 14 in the control group) undergoing unilateral TKR under spinal anesthesia. In the lidocaine group, intravenous lidocaine 1.5mg·kg-1 followed by an infusion of 1.5mg·kg-1·h-1 was administered intraoperatively after spinal anesthesia. The primary outcome was the duration of sensory block of spinal anesthesia. Secondary outcomes included onset time of sensory and motor block, duration of motor block, time to first postoperative analgesic, postoperative visual analog scale (VAS) scores and postoperative analgesia requirement in 24h after surgery. The duration of sensory and motor block was longer in the lidocaine group (Mean ± SD; 112.50 ± 5.80min versus 78.21 ± 9.12min;p < 0.001 and 237.14 ± 9.14min versus 215.00 ± 10.12min;p < 0.001, respectively). Time to requirement of first rescue analgesia was 184.29 ± 9.38min in the lidocaine group and 127.14 ± 23.35min in the control group (p < 0.001). VAS scores were lower in the lidocaine group at 4, 8, 12 and 24h after surgery (p < 0.00001, p < 0.00001, p < 0.00006, p = 0.032, respectively). Requirement of additional analgesia in the first 24h was higher in the control group. There were no clinical signs to suggest lidocaine toxicity in any patient. During unilateral TKR under spinal anaesthesia, concurrent use of intravenous lidocaine prolonged sensory block and reduced postoperative analgesic requirements.

Topical Therapies for Management of Olfactory Dysfunction in Chronic Rhinosinusitis with Nasal Polyps: Steroid-Eluting Stents.

Steroid-eluting stent implantation after endoscopic sinus surgery (ESS) effectively alleviates postoperative symptoms and polyp recurrence in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, the efficacy of steroid-eluting stents for the treatment of olfactory dysfunction in CRSwNP and the influencing factors therein have not been studied. Fifty-nine patients with CRSwNP with olfactory dysfunction from Peking University Third Hospital who were hospitalized for ESS were recruited and randomly divided into a stent group (n = 30) and a control group (n = 29), and were assessed for symptom scores, olfactory function, endoscopic findings, and type 2 inflammatory mediators (IL-4, IL-5, IL-13, IL-33, eotaxin-3, periostin) expression. Postoperative olfactory Visual Analogue Scale (VAS) scores, T&T olfactometer scores, SNOT-22 scores, and Lund-Kennedy (LK) scores were reduced in patients with CRSwNP (P < .01). Postoperative olfactory VAS scores, T&T olfactometer scores, SNOT-22 scores, and LK scores, IL-5, IL-13, and periostin were significantly lower in the stent group than in the control group (P < .05). Correlation analysis was performed and found that the postoperative olfactory VAS scores were strongly correlated with IL-5 and IL-13 (r = .496, P < .001 and r = .289, P = .026), and the postoperative T&T olfactometer scores were strongly correlated with IL-5 and IL-13 (r = .553, P < .001 and r = .398, P = .002). Steroid-eluting stent implantation after ESS is an effective treatment for olfactory deficits in patients with CRSwNP and may be related to the stent's more effective reduction of local type 2 inflammatory mediators in the nasal cavity.

Two types of vidian neurectomy show efficacy in treating allergic rhinitis and vasomotor rhinitis

This study aimed to evaluate the efficacies of endoscopic vidian neurectomy (VN) and highly selective vidian neurectomy (HSVN) for the treatment of allergic rhinitis (AR) and vasomotor rhinitis (VMR). All AR and VMR patients were divided into two groups, Group VN and Group HSVN. The efficacy evaluation methods were visual analog scale (VAS), rhinoconjunctivitis quality of life questionnaire (RQLQ), and medication score. The efficacy evaluations were used to assess patient rhinitis symptoms, quality of life and drug usage. The time points of follow-up period were preoperative, 3 months, 6 months, 1 year, 2 years, and 3 years post operation. By analyzing pre- and postoperative VAS, medication score and RQLQ score, the results showed that rhinitis symptoms and quality of life in both VN and HSVN groups were significantly improved at 3 years, and the rate of improvement decreased gradually with time. Post operation, there were no significant differences in VAS and medication scores between the VN and HSVN groups. With respect to RQLQ, postoperative 2 years and 3 years improvements in sleep disorders, non-nasal symptoms and eye symptoms were significantly greater in the HSVN group than in the VN group. Improvements in rhinitis symptoms and quality of life in AR and VMR were sustained by VN and HSVN until 3 years post operation, with greater quality of life improvements in the HSVN group.

Transoral Atlantoaxial Reduction Plate (TARP) Technique for the Treatment of Irreducible Atlantoaxial Dislocation (IAAD) Caused by Old Odontoid Fracture.

Retrospective case series study. This study aimed to evaluate the clinical efficacy of TARP technique for treating IAAD caused by old odontoid fracture and assess the outcomes of patients who underwent TARP technique over 2years of follow-up. Between January 2005 and September 2017, 56 patients with IAAD caused by old odontoid fractures were treated with TARP technique. Patients' clinical, radiological, and surgical data were retrospectively analyzed. Radiological parameters included the atlantodental interval (ADI) and the space available for the spinal cord (SAC) were measured. Occipitocervical pain levels and neurologic status were evaluated with Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) score respectively. Degree of cervical dysfunction was assessed by Neck Disability Index (NDI). Fusion status was evaluated by images during the follow-ups. Surgeries for 56 cases were performed successfully with no injury to the spinal cord, nerve, or blood vessels. All patients achieved satisfactory reduction and fixation. Clinical symptomatic relief was obtained in all cases (100%). Patients were followed up for an average of 33.9 ± 9.6 months (ranged 24-60 months). Improvements in the postoperative ADI, SAC, VAS, JOA score and NDI were significant (P < .05). Besides, Bone fusion was observed in all patients. No hardware failure or re-dislocation occurred during the follow-up period. TARP technique is an effective procedure for the treatment of IAAD caused by old odontoid fracture, which can achieve complete release, satisfactory decompression, reduction and fixation, and reliable bone fusion through a single transoral approach.

Efficacy of endoscopic interlaminar decompression in lumbar spinal stenosis: a retrospective study.

This retrospective study evaluated the clinical effectiveness of endoscopic interlaminar decompression for lumbar spinal stenosis in 40 patients treated from February 2020 to January 2022. The procedure was successful in all cases, with only one dural sac injury reported and no other complications. Postoperative Visual Analogue Scale (VAS) and Japanese Orthopaedic Association (JOA) scores improved significantly (P<0.05), and the modified Macnab criteria showed an 87.5% rate of excellent and good outcomes at follow-up. No patients required revision surgery. Overall, the endoscopic interlaminar approach proved to be effective, safe, and supported early recovery.

Comparison of low-pressure and standard-pressure pneumoperitoneum laparoscopic cholecystectomy in patients with cardiopulmonary comorbidities: a double blinded randomized clinical trial

BackgroundThe benefits of low-pressure laparoscopic cholecystectomy (LPLC) in patients with cardiopulmonary comorbidities remain unclear. This study aimed to explore the feasibility and pulmonary effects of LPLC in patients with cardiopulmonary comorbidities.MethodsThis was a multicenter, parallel, double-blind, randomized controlled trial. Eligible patients included patients with cardiac or pulmonary comorbidities, who were randomly assigned (1:1) to undergo LPLC (10 mmHg) or standard-pressure laparoscopic cholecystectomy (SPLC) (14 mmHg). The primary outcome was postoperative partial pressure of carbon dioxide (CO2). Surgical safety variables, patient recovery, pulmonary function parameters, and surgeon comfort were also compared between groups.ResultsThis study enrolled 144 participants, with 124 participants extracted for the final analysis (62 in LPLC and 62 in SPLC group, respectively). The median postoperative PaCO2 was similar in the LPLC (43.3 mmHg) and SPLC (43.0 mmHg) groups (p = 0.988). Pulmonary parameters including postoperative pH, PaCO2, HCO3, and lactate levels were similar between the two groups. Postoperative base excess was significantly higher in the LPLC group (− 0.6 mmol/L [− 6.9 ~ 7.5] vs. −1.9 mmol/L [− 6.6 ~ 5.4]; p = 0.031). There was no between-group difference regarding intraabdominal operative time, rate of intraoperative bile spillage, blood loss, surgeon comfort during surgery, and conversion rate. Moreover, postoperative major complication rates, the median time to the first flatus, postoperative hospital stay, or mean postoperative visual analog scale score for pain were similar in both groups.ConclusionsThis study found no reduction of partial pressure of CO2 with LPLC compared with SPLC for patients with cardiopulmonary comorbidities. LPLC with a pneumoperitoneum pressure of 10 mmHg may be safe and feasible for these patients when performed by experienced surgeons, although it does not improve pulmonary parameters.RegistrationThe trial is retrospectively registered at ClinicalTrials.gov (NCT04670952) on December 17, 2020.

Comparison of ultrasound-guided fascia iliaca compartment block versus the combined obturator nerve and adductor canal block application in postoperative analgesia for patients undergoing arthroscopic knee surgery

Background: Arthroscopic knee surgery is a surgical intervention that is frequently performed by orthopedic clinics and new studies are constantly carried out by anesthetists to ensure effective pain control. This study aimed to compare the efficacy of ultrasound-guided suprainguinal fascia iliaca compartment block (FICB) versus the combined adductor canal and obturator nerve block application in terms of postoperative analgesia in patients undergoing arthroscopic knee surgery under spinal anesthesia.Materials and Method: Sixty patients, who underwent arthroscopic knee surgery under elective conditions were included in the study. They were randomly divided into two groups, Group 1 (n=30) and Group 2 (n=30), using a lottery method. Patients operated under spinal anesthesia received ultrasound-guided suprainguinal fascia iliaca compartment block (FICB) for Group 1. The combined adductor canal and obturator nerve block for Group 2 at the end of the surgery. Intravenous patient-controlled analgesia (PCA) device containing tramadol was connected to all patients in both groups, and they were evaluated for Visual Analog Scale (VAS) scores at 0, 2, 4, 12, and 24 hours of ward follow-up. The amount of PCA used at 24 hours, additional analgesic use, development of side effects, mobilization capabilities, and satisfaction levels were assessed at the end of 24 hours.Results: There were no significant differences between the groups in terms of demographic characteristics and the type of surgery performed (p&gt;0.05). In Group 1, where fascia iliaca block was applied the block administration time was observed to be significantly shorter compared to Group 2 (p&lt;0.05). No significant differences were observed between the two groups in terms of postoperative VAS scores, PCA usage amounts, incidence of side effects, postoperative mobilization abilities, and satisfaction measures (p&gt;0.05).Conclusions: Ultrasound-guided fascia iliaca compartment block alone can be effectively applied for postoperative analgesia in patients undergoing arthroscopic knee surgery, instead of combined adductor canal and obturator nerve block.

Efficacy comparison of the S8 navigation-assisted correction versus manual correction in adolescent congenital scoliosis

Objective: Comparison of the efficacy of S8 navigation system-assisted correction versus manual correction in the treatment of adolescent congenital scoliosis (ACS). Methods: A cohort study. A retrospective analysis was conducted on the clinical and imaging data of 48 patients with congenital scoliosis who were treated at the Honghui Hospital Affiliated with Xi'an Jiaotong University between May 2021 and January 2023. Based on the auxiliary systems, the patients were divided into two groups: the S8 navigation system-assisted correction group (navigation group, n=20) and the C-arm-assisted manual correction group (manual group, n=28). The primary outcome measures were coronal balance (CB), sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch (PI-LL), and the Scoliosis Research Society-22 (SRS-22) questionnaire. The secondary outcome measures included surgery-related conditions and postoperative complications. Results: Of the 48 patients, there were 21 males and 27 females, with a mean age of (13.3±3.0) years. There was no statistically significant differences in preoperative distance of C7 plumb line to center sacral vertical line (C7PL-CSVL), SVA, LL, PI, PT, PI-LL mismatch, or SRS-22 scores between the two groups (all P>0.05). Postoperatively, the C7PL-CSVL and SVA in the navigation group were both better than in the manual group [(12.51±11.86) mm vs (19.64±1.33) mm, (15.72±3.64) mm vs (25.42±2.53) mm, both P<0.05]. There was no statistically significant differences in postoperative LL, PI, PT, PI-LL mismatch, or SRS-22 scores between the two groups (all P>0.05). The accuracy rates for Grade 0 and Grade 0+1 screw placements were 91.17% (93/102) and 95.09% (97/102) in the navigation group, respectively, which were higher than those in the manual group [84.45% (125/148) and 91.89% (136/148), respectively] (both P<0.05). The rates of adjacent facet joint violation in Grades A, B, and C were 88.23% (90/102), 11.76% (12/102), and 0 (0/102) in the navigation group, respectively, which were all better than those in the manual group [83.44% (121/145), 8.96% (13/145), and 7.58% (11/145)] (P=0.015). The navigation group had shorter operative time, single screw placement time, and total screw placement time, and the distance between the screws and the cortex was closer compared to the manual group (all P<0.05). Intraoperative blood loss in the manual group was higher than that in the navigation group (P<0.05). The average curve correction rate in the navigation group (74.68%±10.70%) was better than that in the manual group (59.60%±6.90%) (P<0.001). The intraoperative fluoroscopy dose in the navigation group was higher than that in the manual group [(416±70) mGy vs (360±81) mGy, P=0.015]. The incision length in the navigation group was longer than that in the manual group (P<0.05). There was no statistically significant difference in preoperative VAS pain score between the two groups (P>0.05). The postoperative visual analogue scale scores of pain on day 3 was better in the navigation group [(2.60±0.22) vs (3.10±0.32), P<0.001], while there was no statistically significant differences at other time points between the two groups (all P>0.05). No complications occurred in either group. Conclusion: The S8 navigation system demonstrates good corrective outcomes, high screw placement accuracy, low facet joint violation, and favorable clinical results in the treatment of adolescent congenital scoliosis, making it an ideal auxiliary tool.

Comparative study between effect of preoperative multimodal analgesia and pregabalin as unimodal analgesia in reduction of postoperative opioids consumption and postoperative pain in laparoscopic cholecystectomy

BackgroundLaparoscopic cholecystectomy is a popular abdominal surgery and the most common problem for patients undergoing laparoscopic cholecystectomy is the postoperative pain, and associated side effects due to opioids use for pain management and multimodal analgesia is suggested to reduce postoperative pain and need for postoperative opioids. This controlled clinical trial compares the effects of multimodal analgesia and pregabalin as unimodal analgesia on postoperative pain management, postoperative opioids consumption, and reduction of opioids accompanied adverse effects in patients undergoing laparoscopic cholecystectomy where large multicenter studies evaluating specific analgesic combinations are lacking.MethodThis comparison randomized controlled trial between multimodal analgesia approach and pregabalin as unimodal analgesia included 95 laparoscopic cholecystectomy patients that were randomly allocated to three groups using a simple randomization method where multimodal and pregabalin groups included 30 patients in each and the drugs was administered orally one hour before the incision and control group included 35 patients that did not receive any preoperative analgesia. Multimodal analgesic therapy included acetaminophen 1 g, pregabalin 150 mg and celecoxib 400 mg while pregabalin group received pregabalin 150 mg only.ResultsMultimodal group showed a significantly lower need for total opioid analgesics mean ± SD (1.33 ± 1.918) as compared to the control group mean ± SD (3.31 ± 2.784) with p-value 0.014. Pregabalin and multimodal groups showed significantly lower postoperative visual analogue scale used for pain assessment mean ± SD (3.50 ± 2.543) and mean ± SD (3.70 ± 2.231), respectively, compared to the control group mean ± SD (5.89 ± 2.857) with p-value 0.001.ConclusionMultimodal analgesia reduced postoperative opioids consumption more than pregabalin alone when used preoperatively in laparoscopic cholecystectomy and consequently reduced opioids associated adverse effects, but they have the same efficacy in reducing postoperative pain, so pregabalin can be used alone preoperatively in patients with contraindications for using some analgesics included in multimodal analgesia protocol. The study was registered retrospectively in clinical trials; Trial registration ID: NCT05547659.

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

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

Inferior Clinical Outcomes Following Endoscopic Proximal Hamstring Repair in Patients with Chronic Degenerative Tears Despite the use of Dermal Allograft Augmentation

PurposeTo compare clinical outcomes in patients undergoing endoscopic proximal hamstring repair with and without dermal allograft augmentation. MethodsA retrospective review of prospectively collected data was performed on patients undergoing endoscopic proximal hamstring repair (PHR) and proximal hamstring repair with dermal allograft augmentation (PHR-A) by a single surgeon between 2016 and 2023. Augmentation was utilized for cases of chronic degenerative tears (> 6 weeks from the time of initial injury) where hamstring tissue quality was deemed poor intraoperatively. A survey of patient-reported outcome measures (PROMs) was completed at a minimum of 1 year postoperatively. PROMs included a Visual Analogue Scale (VAS) for pain; University of California, Los Angeles (UCLA) Activity Scale; modified Harris Hip Score (mHHS); Hip Outcome Score-Sports-Specific Subscale (HOS-SSS); and a Single Assessment Numeric Evaluation (SANE). The proportion of patients achieving the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) for PROMs were compared between groups. ResultsSixty-four patients were included (42 PHR, 22 PHR-A). No differences were seen between the PHR and PHR-A groups in terms of age at surgery (49 ± 12 vs. 54 ± 9, p=0.08), sex, or body-mass index (BMI). There was a significantly longer time to follow-up (41.5±23.4 vs. 20.1±10.2 months, p<0.001) in the PHR group. There were significantly greater postoperative mHHS (82.7±15.1 vs. 72.0±18.0, p=0.02) and SANE (89.6±9.9 vs. 73.6±22.5, p=0.002) scores in the PHR group. There were no significant differences in postoperative VAS, UCLA, or HOS-SSS between groups. A greater proportion of patients in the PHR group achieved a SCB for mHHS (71% vs. 36%, p=0.008). ConclusionsOur study demonstrates inferior clinical outcomes in patients undergoing endoscopic proximal hamstring repair with dermal allograft augmentation compared to patients undergoing endoscopic proximal hamstring repair without augmentation. Level of EvidenceIII, retrospective comparative case series

A Comparison of Clinical and Radiographic Outcomes Between Isolated Total Talus Replacement and Combined Total Talus Replacement with Total Ankle Arthroplasty or Hindfoot Arthrodesis

Total talus replacement (TTR) is a viable surgical option in the setting of talar avascular necrosis and collapse, as well as a revision option for failed total ankle arthroplasty with talar implant subsidence. The purpose of the present study was to compare the clinical and radiographic outcomes following isolated TTR and TTR combined with total ankle arthroplasty or hindfoot arthrodesis.Patients who underwent TTR were retrospectively reviewed, as a multicenter consecutive case series. Basic demographic data, comorbidities and surgical date were collected. Medical records were reviewed to obtain postoperative and preoperative visual analog scale (VAS) scores, American Orthopedic Foot and Ankle society (AOFAS) outcome scores, postoperative complications and radiographic measurements. Statistical analysis was conducted to compare radiographic and patient-reported outcomes pre- and postoperatively. Thirty-six patients underwent TTR with mean follow-up of 25.39 months.VAS pain scores improved postoperatively from 8.43 to 2.67 (P <0.001). AOFAS improved postoperatively from 36.33 to 81.78 (P < 0.001). There was an overall improvement in talar arc length (P = 0.035), talar width (P = 0.0037), talar height (P < 0.001), Bohler's (P < 0.001) and Gissane's angle (P = 0.004). The overall complication and subsequent surgery rate were each 16.7%. The TTR implant survivorship rate was found to be 94.5%. When comparing outcome scores between Isolated TTR and Combined TTR, no significant differences were detected in the degree of improvement.Both isolated and combined TTR provide a suitable and safe option for the treatment of advanced talar AVN or associated tibiotalar and hindfoot arthritis.

Risk Factors for Early Subsidence of 3D-Printed Artificial Vertebral After Anterior Cervical Corpectomy and Fusion

ObjectiveThe subsidence of vertebral body replacement may occur after anterior cervical corpectomy and fusion (ACCF) , which may lead to cervical kyphosis, spinal cord compression and neurological dysfunction. The authors aim to investigate the risk factors for early subsidence of 3D printed artificial vertebral (3D-PAVB) after ACCF surgery and to provide guidance for clinical practice. MethodsA retrospective analysis was conducted on the data of consecutive patients with cervical spondylosis who underwent ACCF surgery at Bethune Hospital of Shanxi from 2017 to 2020. The statistical data included age, gender, disease type, body mass index (BMI), surgical segment, vertebral height, Cobb Angle, and Hounsfeld Units (HU) values of the vertebral body and endplate. The clinical efficacy of the surgery was evaluated using Visual Analog Scale (VAS), Japanese Orthopedic Association (JOA), and Neck Disability Index (NDI). Follow-up data, such as VAS, JOA, NDI, and Cobb Angle, were obtained using a repeated-measures ANOVA analysis. Univariate analysis was conducted to identify the factors contributing to the early subsidence of the3D-PAVB, and independent risk factors were determined using logistic regression. The HU value was analyzed using the Receiver Operating Characteristic (ROC) curve and the area under the Area Under Curve (AUC) to predict the subsidence of the 3D-PAVB. ResultsA total of 66 patients were included in the study, out of which 19 patients experienced subsidence of 3D-PAVB,resulting in an incidence rate of 28.8%. The postoperative JOA, VAS, and NDI scores showed significant improvement in both the subsidence and non-subsidence groups. Upon conducting univariate analysis, significant differences were observed between the two groups in terms of age, diabetes, smoking, and lower vertebral Computed Tomography (CT) values. The average HU value of the subsidence group (251.39±52.615, n=19) was significantly lower than that of the non-subsidence group (317.06±73.587, n=47, p＜0.01). Multivariate analysis revealed that smoking and HU of the lower vertebra were independent risk factors for 3D-PAVB subsidence, with an AUC of 0.772 and an optimal threshold of 272 for HU (sensitivity 78.9%, specificity 74.5%). ConclusionThe occurrence of early subsidence of 3D-PAVB post ACCF surgery is influenced by two independent risk factors - smoking and low HU. To predict the likelihood of this outcome, it is advisable to consider smoking history and measure CT HU value prior to surgery. A lower CT HU value is indicative of a greater risk of subsidence.

Effects of Palliative Surgical Treatment for Spinal Metastases on the Patient's Quality of Life With a Focus on the Segment of the Metastasis: A Prospective Multicenter Study.

Prospective multicenter study. Palliative surgery is crucial for maintaining the quality of life (QOL) in patients with spinal metastases. This study aimed to compare the short-term outcomes of QOL after palliative surgery between patients with metastatic spinal tumors at different segments. We prospectively compared the data of 203 patients with spinal metastases at 2-3 consecutive segments who were divided into the following three groups: cervical, patients with cervical spine lesions; thoracic, patients with upper-middle thoracic spine lesions; and TL/L/S, patients with lesions at the thoracolumbar junction and lumbar and sacral regions. Preoperative and postoperative EuroQol 5-dimension (EQ5D) 5-level were compared. All groups exhibited improvement in the Frankel grade, performance status, pain, Barthel index, EQ5D health state utility value (HSUV), and EQ5D visual analog scale (VAS) postoperatively. Although preoperative EQ5D HSUVs did not significantly differ between the groups (cervical, 0.461 ± 0.291; thoracic, 0.321 ± 0.292; and TL/L/S, 0.376 ± 0.272), the thoracic group exhibited significantly lower postoperative EQ5D HSUVs than the other two groups (cervical, 0.653 ± 0.233; thoracic, 0.513 ± 0.252; and TL/L/S, 0.624 ± 0.232). However, postoperative EQ5D VAS was not significantly different between the groups (cervical, 63.4 ± 25.8; thoracic, 54.7 ± 24.5; and TL/L/S, 61.7 ± 21.9). Palliative surgery for metastatic spinal tumors provided comparable QOL improvement, irrespective of the spinal segment involved. Patients with upper and middle thoracic spinal metastases had poorer QOL outcomes than those with metastases in other segments; however, sufficient QOL improvement was achieved.

Comparative Study on the Effectiveness and Safety of Simultaneous and Staged Bilateral Saphenous Vein Radiofrequency Ablation

Chronic Venous Insufficiency (CVI) is a common condition affecting more than half of the general population, with approximately 20% of cases being bilateral. The high prevalence, diagnosis, and treatment costs, along with the negative impact on patients' quality of life, underscore its significance. This study evaluates the clinical outcomes, quality of life effects, and postoperative complications of simultaneous and staged bilateral radiofrequency ablation (RFA) in patients with bilateral CVI in the great saphenous vein (GSV) at CEAP stages 2-4. This retrospective study included 433 patients with bilateral CVI in the great saphenous vein (GSV) at CEAP stages 2-4, treated with RFA between January 2018 and December 2022. Patients were classified into two groups: Group 1 (n=257) underwent simultaneous bilateral RFA, and Group 2 (n=176) underwent staged bilateral RFA. Clinical outcomes and quality of life effects were evaluated using Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ), and Visual Analog Scale (VAS) scores. Demographic data, type of anesthesia, surgery durations and postoperative complications were analyzed. Both groups showed significant improvements in AVVQ and VCSS scores at 12 months postoperatively, with no significant differences between the groups in preoperative and postoperative scores. No significant difference was found in postoperative VAS scores. Postoperative complication rates were low and comparable. No pulmonary embolism was observed. Symptomatic DVT was detected in one patient from each group and treated successfully. Simultaneous bilateral RFA is as effective and safe as staged bilateral RFA for treating CVI, providing similar clinical outcomes and low complication rates. The simultaneous approach offers the advantage of a single treatment session, potentially improving patient satisfaction and operational efficiency. This study supports simultaneous bilateral RFA as a viable and effective option for treating bilateral CVI.

Comparative study between intrathecal fentanyl and dorsal penile nerve block for controlling postoperative pain after inflatable penile prosthesis implanation

Objectives: To compare the efficacy of intrathecal fentanyl and dorsal penile nerve block for postoperative pain management in patients undergoing inflatable penile prosthesis (IPP). Patients and methods: A prospective single-center study included 80 patients amenable to IPP. Patients were divided equally into two groups. Group I included 40 patients who were managed with spinal anesthesia with intrathecal fentanyl before undergoing IPP. Group II comprised 40 patients who received spinal anesthesia with dorsal penile block before IPP. Study groups were compared regarding postoperative VAS (Visual Analog Scale) scores, total narcotics consumption, patient satisfaction levels, and perioperative complications. Results: The study groups were comparable regarding baseline patients’ criteria. The operative time was comparable between the study groups, with group I and group II having respective median times of 64 minutes (interquartile range: 55-78) and 67 minutes (interquartile range: 56-81) (p = 0.65). Additionally, both groups demonstrated similar distributions in IPP implant cylinder and reservoir size (p = 0.9). Postoperative pain was higher in group I, with a statistically significant difference (p &lt; 0.001). Eight patients in group I (20%) called the physician’s office asking for pain medication, compared to two patients in group II (5%) (p = 0.04). 85% of patients in group II were highly satisfied compared to 50 % in group I (p = 0.003). We reported a 5% complication rate in group I compared to 2.5% in group II (p = 0.6). Conclusions: The present study found that the dorsal penile nerve block offers superior postoperative pain control and patient satisfaction compared to intrathecal fentanyl for patients undergoing inflatable penile prosthesis insertion.

Three-dimensional-printed guide plate for direct percutaneous pedicle screw implantation in minimally invasive transforaminal lumbar interbody fusion surgery: a retrospective study of 162 patients

BackgroundThis study aimed to investigate the impact of three-dimensional (3D)-printed guide plate-assisted percutaneous pedicle screw implantation on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.MethodsOverall, 162 patients who underwent MIS-TLIF at Tai’an City Central Hospital were retrospectively reviewed. The studied variables included operative time, volume of intraoperative blood loss, fluoroscopy time, postoperative drainage volume, visual analogue scale (VAS) score, Oswestry disability Index (ODI) score (preoperatively and at 2 weeks, 3 months, 6 months, and 12 months after surgery), and intervertebral fusion rate at 6 months after surgery.ResultsThe conventional group included 99 patients who underwent a conventional procedure, while the 3D printing group included 63 patients who underwent 3D-printed guide plate-assisted percutaneous pedicle screw implantation. The conventional group required more times of positioning needle punctures than the 3D printing group (22.2 ± 5.9 vs. 16.1 ± 4.9). The operation and fluoroscopy time were also longer in the former group (183.5 ± 51.1 min vs. 148.8 ± 40.3 min and 30.2 ± 5.9 s vs. 24.1 ± 4.9 s, respectively). In 3D printing group, lower back pain VAS scores and ODI scores at 2 weeks and 3 months after surgery were observed. There were no significant differences in terms of the volumes of intraoperative blood loss; postoperative lower limb pain VAS scores; and interbody fusion rate (P > 0.05).ConclusionThe novel 3D-printed guide plate-assisted percutaneous pedicle screw implantation can achieve better amelioration of back pain and recovery of function. It also reduced the times of positioning needle puncture and fluoroscopy time during percutaneous screw placement surgery and reduced the duration of surgery.

The analgesic benefit of rectus sheath block in robotic gynecologic surgery: A retrospective study.

With the growing adoption of robotic techniques in gynecologic surgery, the advantages of minimally invasive procedures over traditional open surgery, such as reduced postoperative pain and quicker recovery, are clear. Yet, establishing an effective multimodal analgesic regimen remains a challenge. This retrospective study from a tertiary care center aimed to assess the analgesic efficacy of the rectus sheath block (RSB) on postoperative pain and opioid consumption after robotic gynecologic surgery. Between June 2022 and March 2023, 20 patients who underwent robotic gynecologic surgery were evaluated. Key parameters included postoperative visual analog scale scores, opioid consumption, and postoperative nausea/vomiting instances. Anesthesia protocols were standardized, with postsurgical pain management involving RSB and a patient-controlled analgesia device filled with morphine. Patients showed an average morphine intake of 8.2 ± 5.09 mg over the initial 24 hours postsurgery. During mobilization, average pain scores were consistently low, with no correlation identified between opioid consumption and age or body mass index. 40% of patients reported postoperative nausea on the first day, and no complications linked to the RSB were observed. The study underlines the potential of integrating RSB in a multimodal analgesic regimen after robotic gynecologic surgery. Its application may lead to reduced opioid consumption and more efficient postoperative pain management. Further randomized controlled trials are recommended to validate these findings.