Post-procedure Pain Scores Research Articles

Computed Tomography-Guided Coeliac Plexus Neurolysis in Palliative in-Patients with Intra-Abdominal Malignancy: Retrospective Evaluation of Neurolytic Solution Spread as a Predictive Factor.

Computed tomography (CT)-guided coeliac plexus neurolysis (CPN) is considered effective at controlling pain in patients with intra-abdominal malignancies. The primary objective was to correlate pain outcomes with the spread of neurolytic solution in the coeliac area and to evaluate the predictive value for the spread of injectate for pain outcomes and side effects. Blinded CT scans were reviewed. The coeliac area was divided into nine quadrants. Assessors evaluated quadrants according to contrast spread, needle tip position, and the contact between the injectate and other organs and plexuses. Efficacy of CPN and complications were estimated. In 54.9% there was complete spread of the neurolytic in the coeliac area with no correlation between pain relief and spread of injectate. In 85% the neurolytic had contact with viscera with no correlation with pain relief or complications. There was no correlation between needle tip position and spread of the neurolytic and contact of the neurolytic with viscera. In 71.6% the injectate was found to have spread into "other" plexuses. In 13.3% hampered spread of the injectate was observed. There was no correlation between patterns of injectate spread and pain relief, pain relief and spread of injectate in any particular quadrants, and expected and documented post-procedural pain scores. Based on the spread of contrast medium clinicians can neither correctly anticipate the pain relief or post-procedural NRS, nor the duration of pain relief and complications. It is not essential to have the perfect sickle-shaped spread of the injectate for adequate pain control.

Retrospective analysis of cervical transforaminal versus interlaminar epidural steroid injections

BackgroundSeveral studies have compared outcomes from lumbar epidural steroid injections (ESIs) based upon technique (transforaminal (TF) vs interlaminar (IL) vs caudal). However, little on this topic has been reported in the cervical spine, and results have been conflicting. PurposeTo compare success rates of fluoroscopically-guided cervical TFESIs vs ILESIs. Study design/settingRetrospective, observational, in vivo study of consecutive patients at outpatient Physical Medicine & Rehabilitation clinics at a single academic spine center. Patient sampleConsecutive patients who received a cervical TF or IL ESI between January 2010 and October 2018. Outcome measuresNRS pain scores within 60 days of the ESI. MethodsCurrent procedural terminology (CPT) codes were used to search all consecutive patients at a single outpatient academic spine center who received a cervical TF or IL ESI between January 2010 October 2018. All patients with pre and post injection NRS pain scores within 60 days of the injection were included in the analysis. ResultsA total of 178 ​TF and 185 ILESIs were analyzed. Success was defined as ≥ 50% improvement in NRS pain score. 52% [95% CI: 47 – 57%] of all patients receiving a cervical ESI achieved a successful outcome. There was a strong trend towards better results in the ILESI group with 59% [95% CI: 52 – 66%] of patients achieving at least 50% pain relief compared to 46% [95% CI: 39 – 53%] in the TF group. A higher proportion of patients in the IL group obtained at least 80% pain relief (37% [95% CI: 30 – 44%]) compared to those in the TF group (17% [95% CI: 11 – 23%]). Post-procedure median NRS pain scores, and improvement in median NRS pain scores were better in the ILESI group compared to the TFESI group (p<0.001). ConclusionThis retrospective study demonstrated better results in the cervical ILESI group compared to the cervical TFESI group.

Intranasal fentanyl for first-trimester uterine aspiration pain: A randomized controlled trial

ObjectiveTo evaluate whether administration of intranasal fentanyl reduces reported pain during first-trimester uterine aspiration. Study DesignWe conducted a multicenter, randomized, double-blind, placebo-controlled trial of patients with pregnancies less than or equal to 14 weeks gestation seeking uterine aspiration for induced abortion, early pregnancy loss, or failed medication abortion. We randomized participants 1:1 to either intranasal fentanyl 100 mcg or intranasal placebo. All participants received ibuprofen and a standardized paracervical block. The primary outcome was pain indicated at the time of uterine aspiration on a 100 mm visual analog scale (VAS). We designed the study to detect a 15 mm difference in mean pain scores, which required 53 people in each arm for a total of 106 participants. Secondary outcomes included postprocedure pain and patient satisfaction with pain control. ResultsFrom March 2017 through June 2018, we screened 355 people for eligibility and enrolled 107 participants. Those who received intranasal fentanyl reported similar uterine aspiration pain to participants who received placebo (58.4 ± 28.0 fentanyl vs 58.6 ± 24.5 placebo, p = 0.97). Participants who received intranasal fentanyl also reported similar postprocedure pain scores compared to participants who received placebo (19.1 ± 19.4 fentanyl vs 17.2 ± 19 placebo, p = 0.63), and were equally satisfied with procedure pain control (66.8 ± 31.2 fentanyl vs 63.3 ± 29.2 placebo, p = 0.57). ConclusionIntranasal fentanyl did not decrease reported pain with first-trimester uterine aspiration, nor did it decrease postprocedure pain compared to placebo. As an adjunct to ibuprofen and paracervical block, intranasal fentanyl did not improve patient satisfaction with pain control. ImplicationsIntranasal fentanyl does not reduce reported pain with first-trimester uterine aspiration, however abortion-seeking patients are amenable to receiving intranasal medications for pain management.

The Association of Pre-Procedural Psychological Evaluations on Post-Procedural Pain Control in VA Patients Who Received Spinal Cord Stimulator Therapy

Introduction: Spinal cord stimulators (SCSs) are intended to treat chronic pain and are marketed as an opioid alternative. Patients require psychological screening prior to device placement to ensure the patient has an ideal profile that would lead to the device’s being effective. There is variation in the quality of pre-procedure psychological evaluations (PPPE), which may be associated with post-procedure pain (PPP) control. This fact is significant given that psychological evaluations are not currently regulated. Varying implementation of PPPE subsequently leads to variation in clinical practice and outcomes where patients may not achieve the desired outcome. Aim: This research is a retrospective, longitudinal, cohort study using secondary data collected from the electronic medical record (EMR) in an ambulatory pain clinic of patients who received SCS implants. The purpose of this study is to examine the association between the quality scores of PPPE and PPP control. We hypothesize that patients who had a poor-quality score of PPPE also had less PPP control, possibly due to being misclassified as an appropriate candidate for the device. The following aims are proposed to achieve the purpose: 1. Examine the association between the quality score of PPPE and PPP (average pain score 2 to 6 weeks post SCS placement). 2. Determine the association between the quality score of PPPE and PPP improvement (comparing pre SCS and post SCS pain scores). Methods and analysis design: For aim 1, a bivariate correlation will be utilized to determine if PPPE quality scores and PPP scores are related. For aim 2, a logistic regression will be utilized to analyze the quality scores of PPPE and PPP improvement, since the outcome variable will be dichotomous (improved or not improved). If necessary, an adjusted model, or interaction model, will be considered to look for interaction among covariates, such as age. This study would need a sample size of 123 to be powered at 80% with a .05 significance level. Ethics and dissemination: The novel information gathered through this research intends to assist clinicians in identifying optimal candidates for SCS devices and may reveal common factors in patients who are successful in achieving improved pain control after spinal cord stimulator placement.

Effectiveness of music therapy as an adjuvant to conscious sedation in women undergoing transvaginal oocyte retrieval: A randomized controlled trial.

Assisted reproductive technique (ART) has emerged as the highest form of treatment for infertile couples. Transvaginal oocyte retrieval is currently performed under conscious sedation in most centers. Since it is a relatively painful procedure, a number of adjuvant therapies have been tried to improve pain relief during the procedure. Music therapy is a nonpharmacological technique that has been successfully used for pain relief in perioperative and chronic pain of malignancy. However, studies evaluating its usefulness in ART-related procedures are limited. We evaluated the effectiveness of music therapy as an adjuvant for pain relief during oocyte retrieval. This was a randomized controlled trial conducted at a tertiary level teaching hospital in South India from September 2020 to March 2021. All women undergoing transvaginal oocyte retrieval were randomized to receive either music therapy along with conscious sedation (Group A) or conscious sedation alone (Group B). The primary outcome was postprocedure pain score assessed by the visual analog scale. Secondary outcomes included anxiety score. A total of 109 women were randomized into Group A (54 women) and Group B (55 women). The postprocedure pain score was comparable between the two study groups (6.0, interquartile range [IQR] 4 to 6 vs. 6.0, IQR 4 to 6; p=0.69). However, anxiety levels were found to be significantly lower in women who were offered music therapy (3.0, IQR 1 to 5 vs. 4.0, IQR 3 to 6; p=0.004). The use of music therapy as an adjuvant to conscious sedation was found to have no significant benefit in pain relief during oocyte retrieval.

Effect of Pre-procedure Anxiety Levels on Post-procedure Pain Scores in Women Undergoing Hysterosalpingography in South-south Nigeria

&#x0D; Background: Infertility is the inability of a couple to conceive after one year of regular, unprotected sexual intercourse. Hysterosalpingography plays a very crucial role the evaluation of the women with infertility.&#x0D; Objective: To determine the relationship between pre-procedure anxiety and procedure-associated pain among infertile women undergoing hysterosalpingography.&#x0D; Materials and Methods: This prospective survey was conducted at the Obstetrics and Gynaecology, and Radiology Departments of the two tertiary health institutions in Bayelsa State, Nigeria, from January to August, 2021. Hysterosalpingography was done for 380 infertile women, after obtaining written informed consent. Beck's Anxiety Inventory (BAI) and Numerical Rating Scale (NRS) were used to grade levels of anxiety and pain, respectively. Data were entered into a pre-designed proforma, and analysed using Statistical Product and Service Solutions (SPSS) version 25.0. Results were presented in frequencies and percentages for categorical variables; mean and standard deviation for continuous variables.&#x0D; Results: The pre-procedure anxiety scores showed significant, positive, and strong relationship with post-procedure pain scores, reflected in a correlation coefficient of 0.50 (p – 0.001). For every unit change in anxiety score, there was an estimated 25.4% change in the pain perception documented by the participants. For participants who had an anxiety score of 0, there was an average pain score of 3.45.&#x0D; Conclusion: This study established a positive correlation between pre-hysterosalpingography anxiety scores and post-hysterosalpingography pain scores.&#x0D;

Oral phenazopyridine versus intravesical lidocaine for office onabotulinumtoxina analgesia: a randomized controlled trial

To compare pain scores in women undergoing intradetrusor onabotulinumtoxinA for idiopathic overactive bladder (OAB) between women randomized to pre-procedure oral phenazopyridine versus intravesical lidocaine. Non-pregnant adult females scheduled for office injection of 100 units intradetrusor onabotulinumtoxinA were randomized to either 200mg of oral phenazopyridine taken 1-2 hours preprocedure versus a 20 minute preprocedure intravesical instillation of 50mL 2% lidocaine. We excluded patients with neurogenic bladder, and those who had received intradetrusor onabotulinumtoxinA injections in the previous 12 months. The primary outcome was pain measured by a 100mm visual analog scale (VAS). Demographic characteristics and overall satisfaction with the procedure were also collected. Providers answered questions about cystoscopic visualization, ease of procedure, and perception of patient comfort. In order to detect a difference of 14 (SD 25) or greater on the VAS with 80% power and a significance level of .05, we planned to obtain complete data for 100 patients, 50 in each treatment arm. We performed an intention to treat analysis and compared variables by T-test or Fisher’s exact test. 111 patients were enrolled; complete data was obtained for 100 participants. 47 patients were randomized to phenazopyridine and 53 to lidocaine. Baseline characteristics did not differ between groups. 19.6% and 20.8% in the phenazopyridine and lidocaine groups, respectively, had previously undergone intradetrusor onabotulinumtoxinA injections. Pre-procedure pain scores did not differ between groups. The mean post-procedure pain score was not significantly different between groups, with a mean of 24 (28) in the phenazopyridine group compared to 28 (31) in the lidocaine group (p=0.52). A post-hoc power analysis with 47 and 53 patients per treatment arm showed similar power. Greater than 90% of patients in both groups stated the pain was tolerable. Slightly more patients reported being “very satisfied” in the lidocaine group, although this was not statistically different (50.0% vs 40.4%, p = 0.34). Providers reported clear visualization in 89.4% of patients in the phenazopyridine group versus 100% in the lidocaine group (p=0.02). Provider perception of patient comfort and overall ease of procedure was not different between groups. Length of time in the exam room was significantly shorter in the phenazopyridine versus the lidocaine group (44.4 vs 57.5 minutes, p=0.0003). In women receiving intradetrusor onabotulinumtoxinA injections for idiopathic OAB, there was no difference in pain scores when comparing oral phenazopyridine versus intravesical lidocaine. Phenazopyridine is well-tolerated by patients, allows for the procedure to be performed with similar ease, and is associated with shorter appointment times.

Evaluation of the Safety and Efficacy of Resection of Endometrial Polyps and Submucosal Fibroids in an Outpatient Setting in a Large District General Hospital in the UK.

Background:Conventionally, endometrial pathologies of varying complexity have been surgically treated as inpatients under a general or regional anesthetic.Aim:In this paper, we evaluate the safety and efficacy of hysteroscopic morcellation of endometrial pathology in the form of endometrial polyps (EPs) and submucosal fibroids in an outpatient setting for both simple and complex lesions using the Myosure™ device.Methods:Two hundred and forty-nine hysteroscopic resections were performed in an outpatient setting at the < BLINDED FOR REVIEW > from May 2014 to March 2021. The median age of the patients was 54 years. More than half of the patients presented with postmenopausal bleeding; 64% were diagnosed with EPs and 24% with submucous fibroids (SMFs). The size, topography, extension, penetration, and wall classification system scoring system were used to grade them as simple (≤4) or complex (≥5) pathologies.Results:90% of pathologies were simple (≤4), of which complete resection was carried out in 95% of patients; 10% of the pathologies were complex (≥5), of which 63% had complete resection. Two patients with complex pathologies returned for completion surgery as a two-step procedure. No procedure was abandoned due to the patient intolerance. The median intraprocedure pain score visual analog scale was 5/10 and immediate postprocedure pain score was 1/10. Notably, there was no intra- or post-procedure complications.Conclusion:Outpatient resection of endometrial pathology, both simple and complex, can be safely and effectively performed using hysteroscopic morcellator (Myosure™) and is accepted and well tolerated by patients.

The Effect of Using Virtual Reality During Breast Biopsy on Pain and Anxiety: A Randomized Controlled Trial

PurposeVirtual reality (VR) is a nonpharmacological method used in healthcare settings. This study aimed to determine the effectiveness of distraction through VR on pain and anxiety during fine needle aspiration (FNA) breast biopsy. DesignThis was a randomized controlled trial. MethodsA total of 60 Turkish females undergoing FNA breast biopsies were randomly divided into two groups. The patients in the experimental group (n = 30) viewed a specific scenario using VR from one minute before the procedure to the end of the procedure. The patients in the control group (n = 30) were subject to a standard protocol in which no anesthetic was given during the procedure. Immediately after the implementation of the FNA breast biopsy, the pain scores of all patients in groups were measured with the Visual Analogue Scale (VAS), and their anxiety levels were assessed with the State-Trait Anxiety Inventory. FindingsA statistically significant difference was determined between the post-procedure mean pain scores and average state anxiety scores of the patients in the experimental and control groups (P < .001). ConclusionsThe use of VR during FNA breast biopsy is effective in reducing pain and anxiety in adult female patients.

Effect of a Musical Intervention During the Implantation of a Central Venous Catheter or a Dialysis Catheter in the Intensive Care Unit: A Prospective Randomized Pilot Study.

Listening to music may reduce anxiety during medical procedures. However, the magnitude of any effect may differ with respect to patient and procedure. We evaluated the effect of a musical intervention on patient anxiety during a central venous catheter or dialysis catheter implantation in an intensive care unit. A prospective single-center controlled open-label 2-arm randomized trial was conducted in a medical intensive care unit (ICU) from February 2018 to February 2019. Patients undergoing central venous catheterization were randomized to listening to music or not during the procedure. Patients randomized to music listened to the Music Care application via headphones. The primary outcome was the change in anxiety assessed on a 100-mm Visual Analogue Scale between the beginning and end of the catheterization procedure. Secondary outcomes included postprocedural pain. We included 37 patients in the musical intervention group and 35 in the standard care group. The primary reasons for intensive care unit admission were the need for a central catheter for chemotherapy for hematologic malignancy and sepsis and/or septic shock in both groups. Postprocedural anxiety and pain assessments were missing in 1 (2.7%) and 4 (11.4%) patients in the intervention and standard care groups. We found no between-group difference in change in anxiety score: median -1 (interquartile range, -3 to 0) vs 0 (-3 to 0) in the musical intervention and standard care groups (median difference, -1 [-2 to 0]) (P = .24). Postprocedural pain score did not differ between the groups: median 0 (0-2) and 0 (0-3.75) in the musical intervention and standard care groups (median difference, -0 [0-0]) (P = .40). To account for missing outcome assessments, sensitivity analyses were performed using 2 extreme scenarios, one favoring the standard care group (scenario 1) and the other favoring the intervention group (scenario 2). In either scenario, change in anxiety score did not differ between the intervention and standard care groups: -1 (-3 to 0) vs 0 (-4 to 0) (P = .88) in scenario 1 and -1 (-3 to 0) vs 0 (-2.75 to 1) (P = .07) in scenario 2. In this first randomized pilot study of musical intervention for central venous catheterization in awake patients in the intensive care unit, the musical intervention did not reduce patients' anxiety as compared with usual care.

Placebo Effect of Sham Spine Procedures in Chronic Low Back Pain: A Systematic Review.

BackgroundThe literature lacks information about the characteristics of the placebo effect following sham spine procedures for chronic low back pain. We aim to evaluate the effect using pain score data from the sham arms of published trials.MethodsRelevant trials were selected and reviewed. Baseline and post-procedure pain scores were collected. Each follow up pain score was considered an episode and compared to its baseline for significance. Patients and episodes were pooled and analyzed using three parameters: patient reported outcome measures (PROMs) (Oswestry Disability Index [ODI], Visual Analog Scale [VAS], Numerical Rating Scale [NRS] and Short Form-36 [SF]), anatomical targets (disc, facet, sacroiliac joint [SIJ], ramus communicans nerve [RCN], basivertebral nerve [BVN], and caudal) and follow up periods (early: 0–2, intermediate: >2–4 and late: >4–6) in months. The percentage of pooled patients in the episodes that had significant reduction in pain scores was termed placebo effect. The outcome was defining the magnitude of the placebo effect and determining if it was influenced by the three parameters.ResultsSeventeen studies that reported 535 patients and 55 pain scoring episodes were considered eligible. Significant reduction in pain scores was reported in 21 episodes. The overall placebo effect among the patients during the studied period was 53.2%. The rate ranged according to PROMs from 42.4% to 72.1%, anatomical targets from 11.1% to 100% and follow up periods from 47.9% to 59%. The placebo effect differed significantly between the various domains in the three parameters.ConclusionPlacebo effect was observed in nearly half of the patients during the first 6 months following a sham spine procedure. The effect was influenced by utilized PROMs, anatomical target and follow up period. The findings should be considered in the design of new sham spine procedure trials. Further research is required to delineate the effect of bias on the findings.

Inframalleolar access in endovenous treatment of venous ulcers and C5 disease with nonthermal nontumescent techniques

PurposeTo evaluate the use of inframalleolar access for endovenous ablation when treating advanced venous disease with nonthermal nontumescent (NTNT) techniques. MethodsThis single-center retrospective study included 109 patients with advanced venous disease, treated using inframalleolar access between May 2018 and March 2020. NTNT techniques included ClariVein (Merit Medical Systems, South Jordan, Utah) and ScleroSafe (VVT Medical, Kefar Sava, Israel). Outcomes measured were postprocedure pain, leg edema, ulcer healing and recurrence rates, and venous insufficiency recurrence. ResultsSeventy-seven patients (70%) were treated with ClariVein and 32 (30%) with ScleroSafe. Postprocedure pain score (range, 0-10) after 1 week decreased from a preprocedure median of 5 (interquartile range, 3-6) to 1 ((interqartiel range, 0-2) (P = .0001). Complete wound healing was achieved in 38 patients (43.7%) after 30 days and in 71 patients (81.6%) after 90 days. One patient developed an ulcer recurrence and six developed venous insufficiency recurrence. There was no reported nerve or skin injuries. ConclusionsNTNT ablation techniques using inframalleolar access are effective and safe without risk of nerve damage. Their use facilitates ulcer healing and limits pain in patients with advanced disease.

Lidocaine and dexmedetomidine combined infusion as an alternative to propofol for sedation in colonoscopy

BackgroundColonoscopy is one of the commonly performed procedures for the diagnosis of colonic disorders. Several sedation regimens are administered during colonoscopy. To date, the propofol-based sedation regimen is commonly used, although it may have some risks. I studied the efficacy of dexmedetomidine–lidocaine combination as a substitution for propofol for sedation in colonoscopy procedures.It is a prospective randomized controlled study; 62 patients were recruited and divided into two equal groups: group P is the propofol group which included patients who received sedation with IV propofol using a loading dose of 50–100 mg of propofol and were continued on propofol IV infusion 25–75 μg/kg/min and group D-L is the dexmedetomidine–lidocaine group where patients received a loading dose of dexmedetomidine 1 μg/kg infused over 10 min followed by infusion of dexmedetomidine 0.2–0.7 μg/kg/h and lidocaine 1 mg/kg IV followed by an infusion of 1.5 mg/kg/h. The primary outcome was the median patients’ satisfaction scores after recovery assessed by the Likert 5-item scoring system. Other outcomes included postprocedure pain score, mean arterial blood pressure, saturation, heart rate during the procedure, amount of fentanyl and midazolam used during the procedure, and the number of apneic attacks.ResultsPatients in both groups were satisfied by the procedure, and the median and 1st–3rd IQ satisfaction scores were 5 (4.0–5.0) in group P and 4 (4.0–5.0) in group D-L; however, this difference was statistically significant (P value = 0.014), reflecting more satisfaction in patients who received propofol. Patients in group D-L required significantly more doses of midazolam and fentanyl to achieve an adequate sedation score, had a more significant drop in heart rate, and had significantly more postoperative pain scores than those in group P. Patients in group P had significantly more apneic attacks and lower intraprocedural oxygen saturation levels than those in group D-L.ConclusionDexmedetomidine–lidocaine combined IV infusion was found to be effective and safe for sedation in colonoscopy with less side effects in terms of apneic attacks and desaturation, although patient satisfaction was significantly higher in the propofol group, yet as per the sedation scores this was considered to be clinically non-significant.Trial registrationThe study was registered by the Australian New Zealand Clinical Trials Registry (trial ID: 12620000249954).

Assessing the impact of adding bupivacaine on immediate and delayed post-procedure pain scores in interlaminar epidural steroid injections.

A local anesthetic is frequently administered as part of a lumbar epidural steroid injection (LESI); however, there is a rare potential for this to result in transient paralysis if administered incorrectly. The purpose of this retrospective study is to determine if the addition of bupivacaine significantly improves patient-reported pain scores. This retrospective review includes patients undergoing LESI over an approximately 1year time span. Pre-procedure, immediate post-procedure, and 1-week integer scaled pain scores were recorded. Ordinal regression was used to compare the distributions of the aggregated ordinal pain score categories between bupivacaine- and non-bupivacaine-injected patients. Two hundred fifty-eight patients met the inclusion criteria (126F:132M, mean age 64.7years) with 164 receiving bupivacaine and steroids and 94 receiving steroids alone. The relative frequency distributions for pre-injection pain did not differ between the bupivacaine patients and the non-bupivacaine patients (p = 0.114). Similarly, the relative frequency distributions for immediate and 1-week post-procedure pain did not differ between the bupivacaine patients and the non-bupivacaine patients (p = 0.293 at immediate time point and p = 0.306 at 1-week time point). Odds ratios comparing pain severity change between the bupivacaine and non-bupivacaine patients also were not significantly different at either the immediate post-procedure (p = 0.769) or 1-week (p = 0.203) time points. The lack of a significant downward shift in the bupivacaine patients' post-procedure pain scores compared to the non-bupivacaine patients' post-procedure pain scores raises doubts about bupivacaine's utility as a standard component of a lumbar epidural injection.

Safety and efficacy of image-guided retrocalcaneal bursa corticosteroid injection for the treatment of retrocalcaneal bursitis.

To determine the safety and efficacy of image-guided retrocalcaneal bursa corticosteroid injection for retrocalcaneal bursitis. After IRB approval, all fluoroscopically guided and ultrasound-guided retrocalcaneal bursa injections (2013-2019) were retrospectively evaluated. Pre-procedure US and radiographs were scored by 2 blinded radiologists in consensus for Achilles tendinosis and retrocalcaneal bursitis (0-3 scale), Achilles enthesopathy (present/absent), and Haglund deformity (present/absent). Pre- and post-procedure pain scores (0-10 scale) evaluated short-term response at 1-4weeks: excellent (7-10 point decline), good (4-6 point decline), fair (1-3 point decline), or no response. Paired t-test determined significance of short-term improvement. Kaplan-Meier method analyzed time to progression to surgery or complication at 6-month minimum follow-up. Logistic regression analysis evaluated for association between demographic and imaging variables and negative outcome. Two hundred eighteen injections (181 female; mean 54.5years) performed under ultrasonographic (157, 72%) or fluoroscopic (61, 28%) guidance were evaluated for complication and long-term outcomes. Injections with short-term follow-up (n = 62) yielded excellent or good response in 62.9% (p < 0.00001). Thirty patients (14%) had subsequent elective Achilles surgery. Bursal Doppler flow was associated with progression to surgery (p = 0.00042). No differences were identified in outcomes between US and fluoroscopic-guidance cohorts. Four Achilles ruptures (1.8%) were identified 15-59days post-injection, each with immediately preceding acute injury. Image-guided retrocalcaneal bursa corticosteroid injection yields significant short-term decrease in pain score in majority (63%) of patients. Subsequent Achilles tendon rupture rate was 1.8%. Bursa Doppler flow was significantly correlated with progression to surgery and may represent a negative prognostic indicator.

Abstract No. 132 Same-day discharge versus overnight stay after uterine artery embolization for symptomatic fibroids: an assessment of patient safety and satisfaction

Purpose: To compare the safety of and patient satisfaction with same-day discharge versus overnight stay after uterine artery embolization (UAE) for patients with symptomatic uterine fibroids Materials and Methods: A prospective observational study of patients who underwent UAE for symptomatic fibroids from January 2018 to June 2020 was performed. Chart review was performed for outcomes of interest including complication rates, readmission rates, emergency department visits, and inpatient narcotic usage. During post-procedure follow-up, patients completed an optional survey to measure self-reported post-procedural pain scores and satisfaction with pain regimen, length of hospital stay, and overall satisfaction. Results: Of 49 UAEs performed during the study period, 29% (n = 14) of patients were discharged home the same day and 71% (n = 35) were admitted for an overnight stay. When comparing the same-day discharge to overnight stay groups, no significant difference was found in complication rates (7% vs 26%, P = 0.24), emergency department visits (0% vs 14%, P = 0.30), re-hospitalization (0% vs 6%, P = 1), or opioid use (mean of 17 vs 26 morphine equivalents, P = 0.85). The survey received 18 responses, of which 33% (n = 6) were discharged home the same day and 67% (n = 12) were admitted overnight. When comparing the same-day discharge to overnight stay groups, no significant difference was found between self-reported pain the night of the procedure (on a scale from 0 to 10, mean 7 vs 5.5, P = 0.31), self-reported pain the week after the procedure (mean 4.9 vs 3.2, P = 0.23), satisfaction with the pain regimen (P = 0.7), satisfaction with the outpatient pain regimen (P = 0.28), satisfaction with length of hospital stay (P = 0.17), and overall satisfaction (P = 0.89). Conclusions: Same-day discharge after UAE when compared to overnight stay was found to have no significant difference in rates of readmission, emergency room visits, narcotic usage, patient-reported post-procedural pain, satisfaction with inpatient and outpatient pain regimen, satisfaction with length of hospital stay, and overall patient satisfaction. Same-day discharge is a safe and feasible option for patients undergoing UAE which may provide improved cost-effectiveness and resource utilization benefits for both the patient and the healthcare system. In light of the ongoing COVID-19 pandemic, prioritization of resource allocation without compromise of patient safety will be of utmost importance.

623 Procedural Pain Management in Burn Patients – A Quality Improvement Project

Abstract Introduction Achieving adequate burn pain control in patients is paramount as inadequate control can lead to PTSD, suicidal ideation, and depression. The pain accompanying hydrotherapy can be extreme and challenging to manage. The purpose of this quality improvement project was to assess our burn center’s current nurse-driven procedural pain control protocol during hydrotherapy. Methods Burn patients admitted from June to August 2020 who underwent hydrotherapy were observed during the procedure. Demographics, comorbidities, injury related data, and pain and sedation medication data were collected. Pain scores (1–10), patient and nurse satisfaction scores (1–10) were collected before, during, and after hydrotherapy. A single patient could be surveyed for up to three times. Paired t-tests and one-way ANOVA were performed to assess significant differences between pre- and post-procedure patient pain scores and satisfaction ratings across encounters, respectively. P &amp;lt; 0.05 was considered significant. Results Twenty-eight patients and 48 hydrotherapy events were surveyed. Patients were predominately male (23, 82.1%), middle aged (44.8 ± 19.6), and had a TBSA of 11.9 ± 10.5%. Analyzing only the first hydrotherapy sessions, time from initial opioid dose to hydrotherapy varied greatly as did the opioid morphine equivalent dose (OME) provided prior to hydrotherapy (Table 1). Only 13 (46.4%) subjects received versed during hydrotherapy. Pain scores post-procedure significantly increased compared to pre-procedure scores (5.39 vs. 6.32; p = 0.035). There was no significant difference in patients’ or nurse’s satisfaction scores regarding pain control nor with nurse’s rating of ease of procedure when comparing scores across the three encounters (Table 1). No adverse events (SaO2 &amp;lt; 92% or deep sedation RAS &amp;lt; 2) were observed across all encounters. Conclusions Our results suggest that procedural pain control during hydrotherapy, while safe, has opportunities for improvement. Pre-procedural medication timing remains imprecise and widely divergent. Satisfaction scores, while high, also have room for improvement. Finally, pre-procedural pain control is unacceptable (mean 5.39) and requires attention.

Auricular acupressure and auricular acupuncture as an adjunct for pain management during first trimester aspiration abortion: A randomized, double-blinded, three-arm trial

ObjectivesTo measure pain and anxiety during first trimester uterine aspiration when using auricular acupressure or acupuncture as an adjunct to usual care. MethodsThis randomized, double-blinded, three-arm trial enrolled patients undergoing an aspiration procedure for an induced abortion, a miscarriage, or other abnormal intrauterine pregnancy. Trial participants received auricular acupressure, auricular acupuncture, or placebo immediately prior to their procedures. The study began with 1:1:1 randomization, but later overenrolled into the acupressure group after providing retraining for greater fidelity to that intervention. All participants received ibuprofen and a paracervical block. Participants reported pain and anxiety levels via visual analog scores (0–100). Our analysis compared pain scores of those receiving acupressure versus placebo, and those receiving acupuncture versus placebo. ResultsWe randomized 177 participants over nine months and excluded data from four participants. We analyzed data from 70 participants who received acupressure, 51 who received acupuncture, and 52 who received placebo. The groups had similar baseline characteristics, including baseline pain and anxiety scores. For acupressure, acupuncture, and placebo groups, respectively, immediate post-procedure median pain scores were 50, 55, 47.5 (p = 0.88); maximum pain scores during the procedure were 77, 79, 79.5 (p = 0.96); postprocedure anxiety scores were 26, 28, and 21 (p = 0.47). The acupressure group results were similar before and after retraining. ConclusionsReceiving auricular acupressure or acupuncture did not result in lower pain or anxiety scores among women undergoing vacuum aspiration compared to a placebo group. ImplicationsThe results of this trial were null, thus differing from our previous study that had shown a benefit from auricular acupuncture. Given the conflicting results, incorporating these acupuncture techniques into abortion practice would be premature.

Short-term efficacy of epidural pain management in dogs undergoing cystoscopy.

BackgroundThe effects of epidural anesthesia in dogs undergoing cystoscopy are unknown.ObjectiveTo investigate the effect of epidural analgesia on postcystoscopy pain in dogs.AnimalsTwenty‐six dogs undergoing routine cystoscopy for lower urinary tract disease.MethodsProspective, randomized, blinded observational study. Dogs were assigned either to a treatment group that received epidural anesthesia (preservative free morphine sulfate, 0.09 mg/kg; 1% ropivacaine, 0.2 mg/kg; total volume delivered, 1 mL/4.5 kg of body weight to a maximum of 10 mL; n = 9) or to a nonepidural control group (n = 13). Vital signs were monitored for 24 hours, and sedation and pain scores, behavioral assessments, and presence or absence of complications was evaluated for 5 days postprocedure.ResultsAll dogs tolerated the epidural without complications. Four dogs were removed from the study because of status unblinding, lack of patient cooperation, or incomplete follow‐up. No significant differences were noted in postprocedural pain scores in dogs that received epidural analgesia. Significant differences in postprocedural pain scores were noted in the nonepidural control group. No significant differences were noted in vital signs, behavioral assessments, or the proportion of dogs with a 50% increase in pain scores between the epidural and nonepidural groups.Conclusions and Clinical ImportanceEpidural anesthesia was well‐tolerated. Dogs not receiving the epidural had poor postprocedural pain control. A consistent benefit for the epidural vs nonepidural group could not be identified. Additional studies are required to better assess the impact and efficacy of epidural anesthesia for cystoscopic procedures.

Age and pain score before gastrointestinal endoscopies in children are predictors for post procedure pain

BackgroundGastrointestinal endoscopy may be associated with pain and anxiety. Predictors for high pain scores after endoscopies in children are not known. The aim of our study was to identify risk factors for prolonged recovery and higher pain scores after gastrointestinal endoscopy in children.MethodsAll the children that were electively admitted for gastrointestinal endoscopies were included. We retrospectively collected demographic, clinical and endoscopic data as well as information on the recovery process. A numerical rating scale and the Faces, Legs, Activity, Cry, and Consolability Scale were used for pain scoring.ResultsDuring the study period (01/2016–10/2016), 284 children (median age 10.7 years, interquartile range 6.7–14.8) were recruited. In a univariate analysis, older age, higher pre-procedure pain scores, longer procedure durations, higher number of biopsies and longer recovery duration were associated with higher post-procedure pain scores. In a multivariate analysis higher pain scores before the procedure (OR 12.42, 95% CI 3.67–42, P < 0.001) and older age (OR 1.016, 95% CI 1.007–1.025, P < 0.001) were associated with higher pain scores after the procedure. Children with a higher pain score before the procedure also had a longer recovery period (OR 5.28, 95% CI (1.93–14.49), P = 0.001).ConclusionOlder age and higher pain score before the procedure were identified as predictors for higher pain score after pediatric gastrointestinal endoscopies. Children with these risk factors should be identified before the procedure in order to personalize their post-procedure management.