Preoperative Pain Scores Research Articles

Predictors of Persistent Pain after Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is an orthopedic procedure performed on patients with severe knee pain and advanced knee conditions, such as osteoarthritis and rheumatoid arthritis, in order to restore joint function. Despite the procedure’s high success rates, persistent postoperative pain (PPP) remains a significant complication, affecting a substantial proportion of patients. Identifying predictors of PPP is crucial for improving patient outcomes and satisfaction. Methods: A retrospective analytic study was conducted, reviewing the medical records of patients who underwent unilateral or bilateral TKA at King Abdulaziz Medical City. The data collection focused on demographics, comorbidities, clinical presentations, surgical details, and postoperative outcomes. Data were analyzed using JMP software. A p-value of less than 0.05 was considered statistically significant. Results: This study included 838 patients, predominantly female (71.5%), with an average age of 65.4 years. Osteoarthritis was the primary reason for surgery (98.3%). The mean preoperative pain score was 3.4, and the average pain duration prior to surgery was 6.2 years. We identified dyslipidemia as a significant predictor of PPP (OR 1.40, p = 0.042), while we found younger age to be a significant predictor (OR 0.979, 95% CI 0.967–0.991, p = 0.001). Other factors such as gender, diabetes, hypertension, cardiovascular disease, anxiety disorder, mood disorder, tobacco use, chronic kidney disease, chronic lung disease, and BMI were not significant predictors of PPP. Conclusion: This study identifies younger age and dyslipidemia as significant predictors of persistent postoperative pain and improved outcomes following total knee arthroplasty Further research is needed to validate these results in diverse populations and settings, with the objective should be to refine preoperative counseling and postoperative pain management protocols.

The efficacy of loco-regional ropivacaine analgesia via intercostal catheters after lung resection: a randomized, double-blind, placebo-controlled, superiority study.

Postoperative pain remains a burden for patients after minimally invasive anatomic lung resection. Current guidelines recommend the intraoperative placement of intercostal catheters to promote faster recovery. This trial aimed to determine the analgesic efficacy of continuous loco-regional ropivacaine application via intercostal catheter and establish this method as a possible standard of care. Between December 2021 and October 2023, patients were randomly assigned to receive ropivacaine 0.2% or a placebo through an intercostal catheter with a flow rate of 6-8 ml/h for 72 h after surgery. Patients were undergoing anatomic VATS lung resection under general anaesthesia for confirmed or suspected stage I lung cancer (UICC, 8th edition). The sample size was calculated to assess a difference in numerical rating scale associated with pain reduction of 1.5 points. Fourteen patients were included in the ropivacaine group, whereas the placebo group comprised 18 participants. Patient characteristics and preoperative pain scores were similar in both groups. There was no statistically significant difference in postoperative pain scores and morphine consumption between the 2 groups. The mean numerical rating scale when coughing during the first 24 h postoperatively was 4.9 (SD: 2.2) in the ropivacaine group and 4.3 (SD: 2.4); P = 0.47 in the placebo group. We were unable to determine any effect of administered ropivacaine on the postoperative pulmonary function (FEV1, PEF). Our preliminary results suggest that continuous loco-regional ropivacaine administration via surgically placed intercostal catheter has no positive effect on postoperative pain scores or morphine requirements. NCT04939545.

Early Postoperative Pain is Similar after Arthroscopic Rotator Cuff Repair versus Short-Stay Shoulder Arthroplasty: A Prospective Study.

IntroductionOne of the barriers to counseling patients for shoulder arthroplasty (SA) is the anticipated pain after surgery. This can be contrasted with the common perception of arthroscopic rotator cuff repair (RCR) surgery being less painful due to the less invasive nature of the procedure. We conducted a prospective study comparing postoperative pain levels and narcotic consumption after SA compared to those after RCR. MethodsThis prospective study enrolled 102 patients undergoing short-stay SA and RCR at a single hospital. 50 patients underwent RCR and 52 underwent SA. All participants received a multimodal pain regimen consisting of an interscalene block with liposomal bupivacaine and one of two oral pain medication regimens. Patients were provided a daily pain diary to be completed for 14 postoperative days that tracked pain levels, narcotic consumption, and pain location. Patients were excluded for age <40, revision surgery, SA for fracture, history of chronic opioid use, or an inability to adhere to study protocol. Demographics, visual analogue scale (VAS) scores, and pain sensitivity questionnaires (PSQ) were collected preoperatively. Primary study outcomes were daily VAS pain scores and narcotic consumption during the 14 days after surgery. ResultsRCR patients were younger (60.6 vs. 68.9 years; p<0.01) but other demographics, preoperative pain, and PSQ scores were similar between groups. Peak mean VAS pain levels for RCR and SA each occurred on postoperative (POD) 2 and were 4.4 ± 3.1 and 5.1 ± 2.7 respectively (p=0.214). There was no significant difference in VAS pain during the 14-day postoperative period between RCR and SA patients (p>0.05) or between anatomic SA and reverse SA (p>0.05). Narcotic usage was greater for RCR patients at POD 7 (0.5 vs. 0.2 tablets; p=0.039) and 8 (0.5 vs. 0.2 tablets; p=0.015) compared to SA patients. ConclusionsOur study demonstrated that postoperative pain levels do not significantly differ between RCR and short-stay SA, with greater narcotic usage observed for RCR at one week after surgery. These findings support the notion that despite the increased invasiveness of SA, early postoperative pain is comparable with early pain after RCR.

Scaphocapitate Arthrodesis for Wrist Deformities: A Systematic Review.

Scaphocapitate arthrodesis (SCA) is a described technique for chronic wrist pathology such as Kienbock disease and carpal instability. The technique aims to preserve motion, while maintaining carpal height, preserving the radioscaphoid articulation, and offloading the lunate. Limited case series evaluate the outcomes of this previously described technique. We aim to determine if the collective, updated literature on outcomes of SCA support its continued application by the wrist surgeon. Furthermore, we investigated if any technical variations offer an advantage in improving patient-reported outcomes after SCA. A literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles selected for critical review were examined for patient demographic data, functional outcomes, radiographic outcomes, and complications. A qualitative analysis was then performed to synthesize the available date. A total of 18 unique articles published between 1991 and 2022 were identified, representing a total of 285 individual cases of SCA. Nonunion rate ranged 0%-22%. Preoperative visual analog scale pain scores ranged from 3.2 to 10, whereas postoperative visual analog scale pain scores ranged from 0 to 4. Patient-reported outcomes are reported by validated instruments, including the Disabilities of the Arm, Shoulder, and Hand, QuickDASH, Patient-rated Wrist Evaluation, and Mayo Wrist Score. SCA is a viable treatment option for patients with Kienbock disease. SCA offers reliable improvements in patient pain, grip strength, and patient-reported outcomes.

Postoperative pain evaluation in patients undergoing endodontic treatment subsequent to working length determination with and without integrated apex locator endomotor: Randomized control trial

Abstract Introduction: Precise working length control during chemomechanical preparation is one of the primary factors for successful endodontic therapy. Aim: The study aims to evaluate the postoperative pain after determining working length with an integrated apex locator-endomotor and a separate apex locator-endomotor. Subjects and Methods: One hundred and twenty subjects with a diagnosis of symptomatic irreversible pulpitis and preoperative pain score Visual Analog Scale (VAS) &gt;50 were allocated into Group I with nonintegrated apex locator and endomotor and Group II with integrated apex locator endomotor, further treated by single endodontist. Postoperative pain was assessed with a VAS chart on days 1, 3, and 7. The necessity of analgesic intake if required was considered as the highest VAS score. Statistical Analysis Used: Pre- and post-operative VAS scores between the groups were compared using the Mann–Whitney and one-way ANCOVA tests. Results: On days 1 and 3, Group II showed significantly lower values of postoperative pain and lesser frequency of rescue medication when compared with Group I (P &lt; 0.05). On day 7, none of the patients reported postoperative pain. Conclusion: Simultaneous working length determination during instrumentation leads to significantly lesser postoperative pain.

Endovenous thermal ablation mid-term outcomes for the treatment of large diameter incompetent great saphenous veins.

The aim of this study was to assess the efficacy and safety of endovenous thermal ablation (EVTA) in treating large diameter, ≥12mm, incompetent great saphenous vein (GSV) in comparison to smaller ones. A retrospective comparative study was undertaken including 196 patients (205 limbs) undergoing EVTA. According to maximum GSV diameter patients were divided into two groups (group A <12mm, group B ≥12mm). Primary outcome was anatomic success defined as absence of reflux of GSV. Secondary outcomes were complications, postoperative pain using the 10-cm Visual Analog Scale (VAS) and improvement of Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) scores assessed at 7- days, 1month, 12months and 24months postoperatively. 118 patients with GSV diameter <12mm (group A) and 87 with GSV diameter ≥12mm (group B) were included. Patients' demographics, CEAP classification and length of ablated vein did not differ between the groups. Preoperative VCSS and VAS pain score were significant greater in group B (6.03 vs 6.94, p = .04 and 5.21 vs 5.77, p = .032, respectively). No differences in adverse events were observed post-operatively among groups. GSV occlusion rate at 1month was 98.3% (SE 1.3%) in group A and 96.5 % (2.2%) in group B (p = .3), at 12months 95.7% (SE 2%) and 94.2% (SE 2.8%) (p = .5), and at 24months 94% (SE 2.4%) and 93.1% (SE 3%) (p = .4) respectively. Both groups experienced significant and similar improvement in their VCSSs and CIVIQ scores postoperatively. In a subgroup analysis among different EVTA and GSV >12mm, 1470nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) showed comparable results in terms of occlusion rates, complications, VCSS and CIVIQ scores. Endovenous thermal ablation techniques are efective and safe in the treatment of GSV incompetence regardless the diameter of the GSV. Both 1470nm EVLA and RFA techniques performed similar outcomes.

DYSPLASTIC HIPS THAT ARE TOO LATE FOR PERIACETABULAR OSTEOTOMY ARE NOT TOO EARLY FOR TOTAL HIP ARTHROPLASTY

Total hip arthroplasty (THA) is often performed in symptomatic patients with developmental dysplasia of the hip (DDH) who do not qualify for periacetabular osteotomy (PAO). The impact of osteoarthritis (OA) severity on postoperative outcomes in DDH patients who undergo THA is not well described. We hypothesized that DDH patients who undergo THA with mild OA have slower initial recovery postoperatively, but similar one-year patient reported outcome measures (PROMs) when compared to DDH patients with severe OA.We performed a retrospective review at a single academic institution over a six-year period of patients with DDH who underwent primary THA and compared them to patients without DDH who underwent THA. Within the DDH cohort, we compared PROMs stratified by DDH severity and OA severity. Diagnosis of DDH was verified using radiographic lateral center edge angle (LCEA). Minimum one-year follow-up was required. PROMs were collected through one-year postoperatively. Logistic and linear regression models were used adjusting for age, sex, body mass index, and Charlson Comorbidity Index.263 patients with DDH were compared to 1,225 THA patients without DDH. No significant differences were found in postoperative PROMs or revision rates (p=0.49). When stratified by DDH severity, patients with LCEA&lt;10° had worse preoperative pain (p=0.01), mental health (p&lt;0.01) and physical function (p=0.03) scores but no significant difference in postoperative PROMs. Within the DDH group, when stratified by OA severity, patients with Grade 3 Tonnis score had worse preoperative pain (p=0.04) but no significant difference in postoperative PROMs. Recovery curves in DDH patients based upon severity of DDH and OA were not significantly different at 2-weeks, 6-weeks and 1-year.DDH patients who have mild OA have similar recovery curves compared to those with severe OA. THA is reasonable in symptomatic DDH patients who have mild arthritis and do not qualify for PAO.

A retrospective cohort study of pain post groin hernia surgery repair in females-a neglected problem

BackgroundFemale groin hernias are understudied. This study aims to see whether females are more likely to experience post-operative pain than males following groin hernia repair. MethodParticipants with groin hernia repaired aged 18+ were recruited from a private clinic's surgical database of two different surgeons. Data collected included pre and post operative pain questionnaires, demographics, and operative details. Data collected included age at operation, preoperative pain score, types of groin hernia (femoral, inguinal), recurrence of hernia, bilateral vs unilateral, conversion vs laparoscopic vs open hernia repair, and mesh used. Results144 females and 1850 males completed post-operative questionnaires. Females had an OR of 1.79 (95% CI 1.04-3.07, p = 0.04) for experiencing pain at follow up. Protective factors were age (OR 0.98, 95% CI 0.97-0.98, p < 0.001), and laparoscopic (OR 0.68, 95% CI 0.51-0.91, p = 0.01) while risk factors were recurrent (OR 1.60, 95% CI 1.04-2.47, p = 0.03), bilateral (OR 1.35, 95% CI 1.04-1.74, p = 0.02), and having a complication at less than 30 days (OR 1.67, 95% CI 1.28-2.19, p < 0.001). Of the 378 who had enough data to calculated whether pain had improved or not, there was an insignificant trend towards females having less chance of improvement (OR 0.80, 95% CI 0.37-1.74, p = 0.57) at follow up after accounting for post-operative complications at less than 30 days post operatively (OR 0.55, 95% CI 0.30-1.01, p = 0.06). ConclusionFemales experience significantly more pain post hernia repair surgery in comparison to males.

High Preoperative Pain Score is a Predictor of Cheilectomy Failure in Hallux Rigidus

Hallux rigidus (HR) is a prevalent arthritic condition in the foot. Cheilectomy is a common joint-preserving procedure for HR, involving the removal of prominent osteophytes to relieve impingement of the 1st MTPJ. This study aims to identify factors associated with the failure of cheilectomy in the treatment of HR. A retrospective review of a prospectively collected database from 2007 to 2021 identified all cheilectomy cases. The minimum follow-up was 2 years. Preoperative demographic data, patient-reported outcome measures (PROMs) and foot radiographs were collected. PROMs were reassessed in post-operative reviews, and cases were categorized as successes or failures. Failure was defined by meeting at least one of the following criteria at the latest review: 1) Visual analog pain score (VAS) more than or equal to 4, 2) undergoing subsequent revision procedures, or 3) reporting poor or terrible satisfaction with the surgery. The analysis involved 66 patients, with 19 failure and 47 success cases. Both groups showed similar age, BMI, and gender profiles. Preoperative radiographic parameters were comparable between groups. However, preoperative VAS was significantly higher in the failure group: 7.16 vs. 5.23 (P = 0.0029). Logistic regression confirmed preoperative VAS as a predictor of non-response (P = 0.023). Receiver Operating Characteristic analysis established an optimal cut-off VAS score of 7.0. Patients with a preoperative VAS score of more than 7 had an odds ratio of 5.11 (P = 0.0055) for failure. A higher preoperative VAS score is significantly associated with cheilectomy failure in HR treatment, suggesting a cutoff score of 7.0.

Outcomes of cooled radiofrequency ablation of cervical nerves for the treatment of chronic pain.

Chronic pain, defined as pain persisting for more than 3-6 months, has a mean one-year prevalence in the United States of 25.8% and is one of the most frequent reasons adults seek medical care. Treatment options include physical therapy, analgesics, anticonvulsants, exercise, and muscle relaxants. Even with conventional treatment modalities, in a subset of patients, pain may persist. Cooled radiofrequency ablation (c-RFA), a minimally invasive therapy, employs thermal energy generated by electrical currents to disrupt the transmission of pain stimuli along nociceptive pathways. This leads to an attenuation of pain impulses, primarily through nerve tissue necrosis. The potential of c-RFA to alleviate chronic pain for patients who struggle to find relief elsewhere accentuates the importance of rigorously investigating its outcomes. This study investigates whether patients receiving c-RFA for relief of chronic neck pain caused by cervical facet joint arthropathy experience a reduction in pain scores, the length of this reduction in pain scores, and the magnitude of this reduction in pain. This study was a retrospective analysis of data extracted from UW-Health Electronic Medical Health records (EMR), encompassing cervical c-RFA procedures performed from 2015 through 2022. Patient data were obtained, including diagnosis, pre-operative pain score, post-operative pain score, duration of relief, patient age, sex, and BMI. A two-tailed paired t-test was used to statistically analyze the pre-operative and post-operative pain scores, in which a p-value ≤0.05 was considered significant. A total of 450 cervical c-RFA procedures were reviewed, 152 were excluded due to absent pre- or post-op pain scores. 298 were included in the analysis, comprising 203 unique patients: 129 females and 74 males with an average age of 56.03 ± 12.76 and a BMI of 28.76 ± 6.05. Improvement of pain symptoms was reported in 85.23% (n = 263), 6% (n = 19) reported complete pain remission, 8.72% (n = 26) reported no change, and 3.02% (n = 9) reported worsening symptoms. Patients reported an average pre-operative pain score of 6.15 (M = 6.15, SD = 1.55) and an average post-operative pain score of 3.64 (M = 3.64, SD = 2.09) this achieved significance (p < 0.0001). Of the 85.23% (n = 263) charts that noted improvement, there is an average of 48.04% ± 26.53 reduction from their pre-operative pain scores. The average duration of relief lasted 6.67 ± 4.84 months. This study supports the potential efficacy of c-RFA as a minimally invasive treatment for chronic neck pain secondary to cervical facet joint arthropathy refractory to conventional treatment measures, demonstrating significant relief for a substantial length of time. Due to chronic pain's detrimental effect on one's quality of life, finding effective treatment options is essential, especially for those refractory to conventional treatments.

Treatment of hyoid bone syndrome with surgical excision: our monocentric experience in the past five years

PurposeIn 1968, Steinmann described the hyoid bone syndrome as a degenerative and inflammatory insertion tendinosis. It causes unilateral pain in the neck, increased by swallowing and palpation. The treatment is conservative, but when this fails, surgery is an option. Our aim is to assess the post-operative outcome of patients for whom a surgical hyoid bone resection procedure was performed in the University Hospital of Antwerp (UZA). MethodsA retrospective study was performed. Patients were seen at the laryngology clinic in the UZA from 2018 until 2023. They were diagnosed with the hyoid bone syndrome based on anamnesis and clinical examination. Pre-operative imaging was performed to evaluate for anatomical changes and fiberoptic laryngoscopy performed to exclude other causes. Pre- and postoperative VAS pain scores were questioned. ResultsSeventeen patients were operated, two of them bilaterally. All patients had pain located to the affected side, and almost half of patients (n = 7) had dysphagia. On imaging, 10 patients had an elongated styloid process and 7 had calcification of the stylohyoid ligament. All patients underwent resection of the greater horn of the hyoid bone, 13 patients underwent resection of the stylohyoid ligament and in 9 patients the superior horn of the thyroid cartilage was removed. Mean pre-operative VAS pain score was 9 (/10) and mean postoperative score was 1.3 (/10). ConclusionOur preliminary results show a good clinical effect of the surgical excision procedure and offer insight in the hyoid bone syndrome. Follow-up is necessary to assess the long-term results and potential recurrence of symptoms.

Initial experience of minimally invasive mesh explantation for inguinodynia.

Chronic pain after minimally invasive inguinal hernia repair with mesh can have debilitating effects on quality of life (QOL), limiting daily activities and ability to work. Many medical and surgical options for treatment have been proposed, however there is no consensus on the role of mesh explantation in the management of these patients. We performed a retrospective review of all patients who underwent groin mesh removal by robotic or laparoscopic approach from July 2012 to July 2023 at our institution. Patients were interviewed post-operatively to determine their overall pain scores and QOL was assessed using the Carolinas Comfort Scale (CCS) Questionnaire. Patient characteristics, operative times, pre-operative imaging techniques and analgesia use was also recorded. Twenty-two patients underwent groin mesh removal for chronic pain, including 12 robotic and 10 laparoscopic operations. The mean pre-operative pain score in all patients was 7.6/10 compared to 4.0/10 post-operatively. The mean post-operative CCS score was 24, indicating moderate discomfort. Four patients demonstrated CCS scores <11 indicating no discomfort and no patients demonstrated CCS scores >90, indicating severe debilitating discomfort. The majority of patients had a reduction or total cessation of analgesia intake post-operatively. Both laparoscopic and robotic mesh explantation for treatment of chronic pain post-inguinal hernia repair is safe and effective in achieving a reduction in pain and reducing the need for long-term analgesia.

EVALUATION OF INTRAOPERATIVE PAIN OCCURRENCE AND NEED FOR SUPPLEMENTAL ANESTHESIA DURING EMERGENCY DENTAL CARE

Aims: This study aimed to evaluate the intraoperative pain (IOP) occurrence in situations of symptomatic irreversible pulpitis (SIP) and symptomatic apical periodontitis (SAP).Materials and Methods: Patients who sought emergency care presenting a diagnosis of SIP or SAP were included. IOP was measured with a Visual Analogue Scale (VAS) after five minutes of local anesthesia, during access to the pulp chamber, root canal exploration and at the end of procedures. In cases where pain was reported during treatment, supplementary anesthesia was performed. Pain scores were recorded and analyzed using a generalized estimating equation model with posthoc comparisons. Results: 56 patients were included. 35 had a diagnosis of SIP; and 21 a diagnosis of SAP. Mean preoperative pain scores for SAP and SIP were 6.69 (±1.54) and 6.39 (±1.48), respectively (p&gt;0.05). In patients with SIP, significant differences were observed between: preoperative scores and other time points; scores after five minutes of local anesthesia and other time points; scores during pulp chamber access and at the end of procedures; and scores during root canal exploration and at the end of procedures (p&lt;0.05). In patients with SAP, significant differences were observed between preoperative pain scores with all other time points (p&lt;0.05). Chi-square test indicated an association between diagnosis and the need for supplementary anesthesia (p&lt;0.05). Conclusions: In conclusion, there is a strong relationship between reduction of moderate/severe pain after application of local anesthesia. The need for supplemental anesthesia is significantly associated to the diagnosis of symptomatic irreversible pulpitis.

Poster 385: Incidence of Preoperative Depression in Knee and Shoulder Arthroscopy Using Patient Health Questionnaire-2 (PHQ-2)

Objectives: Preoperative depression has been associated with worse outcomes following orthopaedic surgery including lower patient-reported outcomes, increased pain and impairment, and a higher rate of complications. Patient Health Questionnaire-2 (PHQ-2) is a commonly administered screening tool for measuring depressive symptoms, however the relationship between PHQ-2 and preoperative characteristics of patients presenting for arthroscopic knee and shoulder surgery have not been established. The purpose of this study was to investigate the association between depression and preoperative demographics and patient recorded outcomes of patients presenting for arthroscopic knee and shoulder surgery. Methods: This retrospective chart review evaluated data from all patients who underwent elective primary arthroscopic shoulder and knee surgery at 1 health system. Current Procedural Terminology codes were used to identify patients undergoing anterior cruciate ligament reconstruction (ACLR) (29888), meniscectomy (29880/29881), meniscus repair (29882/29883), knee chondroplasty (29877), labral repair (29807), rotator cuff repair (29827), and capsulorrhaphy (29806). Patients were included if they had completed Patient-Reported Outcomes Measurement Information System - Pain Interference (PROMIS-PI) and a PHQ-2 score at least 3 months prior to their surgery. The PHQ-2 is a validated tool used to screen for depression with scores ranging from 0-6. Patients were categorized as either depressed (PHQ-2 ≥ 3) or non-depressed (PHQ-2 &lt; 3). Demographic characteristics and PROMIS scores were compared and a univariate and multivariate regression analysis was performed. Results: A total of 979 patients were included with 128 (13%) depressed patients and 851 nondepressed patients. There was no significant differences between the depressed and nondepressed group for age (49.18 ± 16.13 vs. 49.01 ± 15.71; P=0.926), sex (53.1% vs. 47.8% female; P = 0.263), median household income ($65,230 ± $24,684 vs. $66,810 ± $22,414; P=0.463), area deprivation index national percentile (62.48 ± 24.31 vs. 64.12 ± 24.58; P = 0.494), and depression diagnosis (4.7% vs. 3.1%; P = 0.333). Preoperative PROMIS-PI was significantly worse in the depressed cohort versus non-depressed (66.1 ± 5.9 vs. 63.6 ± 6.3; P &lt; 0.001). Preoperative PROMIS-Depression score (R2 = 0.34) was the highest correlated variable to preoperative PHQ2 score in the univariate analysis. In the multivariate regression analysis, higher preoperative PROMIS-PI scores were found to be a risk factor for a PHQ2 score &gt;3 (P &lt; 0.001). Patients undergoing knee chondroplasty were less likely to be in the depressed cohort (odds ratio: 0.092 (0.009-0.914); P = 0.042). No other surgeries were more or less likely to be depressed. There was no difference between groups for age, sex, smoking status, insurance type, Area Deprivation Index, Metabolic Health Index, comorbid depression, and anxiety diagnosis. Conclusions: Overall, a larger number of patients screened positive for depression amongst patients undergoing knee and shoulder arthroscopy than were formally diagnosed. Demographic and socioeconomic variables were similar indicating these patients may be hard to identify without a screening tool like PHQ-2. Preoperative pain scores were higher amongst the depressed patients, indicating higher pain scores may be associated with increased risk of depression. This study highlights the need for further research on preoperative mood screening before arthroscopic surgery.

Impact of Cryotreated and Warm Sodium Hypochlorite on Postoperative Pain in Teeth With Symptomatic Irreversible Pulpitis: A Randomized Controlled Trial

IntroductionThe purpose of this study was to evaluate effect of cryotreated and warm sodium hypochlorite (NaOCl) on postoperative pain in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis. MethodsSixty-six individuals with preoperative pain scores of ≥54 mm on the Heft Parker Visual Analogue Pain Scale (HP-VAS) diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis as per the American Association of Endodontists guidelines in mandibular molars were included. The preparation of the access and the root canals was instrumented and irrigated in accordance with a standard protocol. Based on the temperature of the final irrigant, the root canals were then randomly assigned to 3 groups and 3% NaOCl was irrigated: control (at 25°C), cold NaOCl (2°C), and warm NaOCl (60°C) (n = 22/group). Root canal treatment was completed at the same visit. Pre- and postoperative pain assessment at 6, 24, 48, and 72 hours was conducted using the HP-VAS, and analgesic consumption was noted. Suitable statistical tests were used to analyze the data. ResultsIn comparison with the other 2 groups, the cold NaOCl group had a lower HP-VAS score at all follow-up intervals. Between groups, there was a statistically significant difference in postoperative pain scores at 6 and 72 hours (P < .05). None of the subjects experienced any postoperative discomfort at 72 hours in the control and cold NaOCl groups. ConclusionPatients treated with cold NaOCl as the final irrigant experienced significantly less postoperative pain at 6 hours when compared with room temperature and warm NaOCl.

Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Compartment Block (FICB) and Outcomes in Preoperative Fast-track Geriatric Patients with Hip Fracture: A Single-center Retrospective Study

Objective: This study aimed to evaluate the analgesic efficacy of preoperative fascia iliaca compartment block (FICB) in terms of preoperative pain score reduction in geriatric hip fracture patients. Secondary objectives were to compare opioid consumption, procedure-related complications, and patient outcomes. Materials and Methods: This single-center retrospective study included patients aged 65 or older with hip fractures who experienced moderate to severe pain in a tertiary care university hospital from January 2019 to July 2021. The variables collected for analysis were patient baseline characteristics and the pain score at rest, including during movement from the beginning of service and subsequently each morning after admission until the day of surgery. Results: A total of 439 patients were included in this study, 109 patients (24.8%) receiving preoperative FICB (FICB group). When comparing the FICB and non-FICB groups, a significant reduction in pain scores was observed on postadmission day 1, both at rest (0 [IQR=0-4] vs. 0 [IQR=0-2], p&lt;0.001) and during movement (0 [IQR=0-4] vs. 0 [IQR=0-2], p=0.018). This difference in pain reduction persisted on day 2 during movement (3 [IQR=0-5.75] VS 0 [IQR=0-3], p=0.001). No significant differences in preoperative opioid consumption or postoperative morbidities were observed between these two groups, and no complications related to the procedure were observed. Conclusion: For patients experiencing moderate to severe preoperative pain at the beginning of treatment, preoperative FICB can reduce pain scores for up to 2 days.

A history of stereotactic radiosurgery may predict failure of procedure following percutaneous glycerol rhizotomy for trigeminal neuralgia.

Both stereotactic radiosurgery (SRS) and percutaneous glycerol rhizotomy are excellent options to treat TN in patients unable to proceed with microvascular decompression. However, the influence of prior SRS on pain outcomes following rhizotomy is not well understood. We retrospectively reviewed all patients undergoing percutaneous rhizotomy at our institution from 2011 to 2022. Only patients undergoing percutaneous glycerol rhizotomy following SRS (SRS-rhizotomy) or those undergoing primary glycerol rhizotomy were considered. We collected basic demographic, clinical, and pain characteristics for each patient. Additionally, we characterized pain presentation and perioperative complications. Immediate failure of procedure was defined as presence of TN pain symptoms within 1-week of surgery, and short-term failure was defined as presence of TN pain symptoms within 3-months of surgery. A multivariate logistic regression model was used to evaluate the relationship of a history SRS and failure of procedure following percutaneous glycerol rhizotomy. Of all patients reviewed, 30 had a history of SRS prior to glycerol rhizotomy whereas 371 underwent primary percutaneous glycerol rhizotomy. Patients with a history of SRS were more likely to endorse V3 pain symptoms, p = 0.01. Additionally, patients with a history of SRS demonstrated higher preoperative BNI pain scores, p = 0.01. Patients with a history of SRS were more likely to endorse preoperative numbness, p < 0.0001. A history of SRS was independently associated with immediate failure [OR = 5.44 (2.06-13.8), p < 0.001] and short-term failure of glycerol rhizotomy [OR = 2.41 (1.07-5.53), p = 0.03]. Additionally, increasing age was found to be associated with lower odds of short-term failure of glycerol rhizotomy [OR = 0.98 (0.97-1.00), p = 0.01] CONCLUSIONS: A history of SRS may increase the risk of immediate and short-term failure following percutaneous glycerol rhizotomy. These results may be of use to patients who are poor surgical candidates and require multiple noninvasive/minimally invasive options to effectively manage their pain.

Comparative effectiveness of preemptive administration of ibuprofen and ibuprofen-arginine on the anesthetic success of inferior alveolar nerve block in teeth with symptomatic irreversible pulpitis - A double-blind randomized clinical trial.

This study examined the impact of premedication with ibuprofen and ibuprofen-arginine and the influence of preoperative pain and anxiety on inferior alveolar nerve block (IANB) efficacy in cases of symptomatic irreversible pulpitis. The study involved 150 SIP patients who were randomly assigned to receive ibuprofen (600mg), ibuprofen-arginine (1,155mg), or a placebo 30min before IANB. Preoperative anxiety and pain levels were assessed using the Modified Dental Anxiety Scale and the Heft-Parker visual scale. IANB efficacy was determined by the absence of or mild pain during the procedure. Statistical analysis included chi-square, z-tests, Analysis of Variance, and Student's t tests. The ibuprofen and ibuprofen-arginine groups exhibited significantly higher IANB success rates (62% and 78%, respectively) compared to the placebo group (34%). However, no significant difference was observed between the ibuprofen and ibuprofen-arginine groups. Patients with successful IANB in the ibuprofen and ibuprofen-arginine groups displayed lower median anxiety scores (8) than those with failed blocks (15) and lower mean preoperative pain scores (118.3). In cases of symptomatic irreversible pulpitis the preemptive medication with ibuprofen-arginine effectively increased the efficacy of the inferior alveolar nerve block The inferior alveolar nerve block efficacy was influenced by preoperative anxiety levels and the intensity of pain. This research underscores the potential benefits of oral premedication with ibuprofen and ibuprofen-arginine in improving anesthesia outcomes in cases of symptomatic irreversible pulpitis.

Clinical Outcomes of the Transforaminal Lumbar Interbody Fusion Technique Among Patients With Low Back Pain Showing Type 1 Modic Changes on MRI.

Introduction The unilateral transforaminal lumbar interbody fusion (TLIF) signifies a different surgical method, circumventing both the anterior method and the method via the spinal canal. Due to the shortage of literature available for clinical outcomes and consequences post-TLIF, we undertook the current study to assess the TLIF technique's clinical outcomes among patients with low back pain showing type 1 Modic changes on MRI. Material and methods A cross-sectional study was conducted between January 2019 and March 2021. All patients included in the study had Modic type 1 change and disabling lowback pain as the main complaint and/or leg pain. Data were collected on age, body mass index (BMI), gender, and other risk factors like diabetes mellitus, steroid use, and smoking. Pain intensity was evaluated using a visual analog scale (VAS) before and after surgery. A radiographic evaluation was also performed. Preand post-operative pain scores and differences in disc height were assessed using the Wilcoxon rank sum test. A p-value of less than 0.05 was considered significant. Results The mean length of stay in the hospital was 4.3±1.61. The mean pre-operative lower back pain score was 8.78±0.79. The mean post-operative score was substantially lowered to 0.83±0.7. There was a significant difference between pre- and post-operative lumbar pain (p-value < 0.001). There was a significant increase in mean disc height from pre-operative (7.14 mm) to post-operative (11.02 mm) and also at one year (10.21 mm) with a p-value of <0.001. Of the patients,82.14% did not have any complications, and 3.57% each had either delayed wound healing without any infection or transient post-operative radiculopathy that improved in six weeks. Conclusion TLIF procedure can be considered safeto provide anterior and posterior column support by adopting a unilateral posterior approach. The outcomes were favorable in terms of no prolonged length of stay, less blood loss, no mortality, reduction in the severity of pain, and improvement in disc height. However, the appropriate selection of patients for this technique is pivotal for the success of the procedure.

Influence of Diclofenac Potassium versus Prednisolone on Postendodontic Pain and Pulpal Interleukin-8 Expression in Symptomatic Irreversible Pulpitis Cases: A Randomized Placebo-controlled Trial

AimThis prospective, randomized, double-blind clinical trial investigated the impact of diclofenac potassium, prednisolone, and placebo as oral premedication on postendodontic pain and pulpal interleukin (IL)-8 expression in patients with irreversible pulpitis. MethodsThirty-six patients undergoing conventional endodontic treatment were assigned into one of 3 groups (n = 12). Pulpal blood samples were taken after access cavity preparation and stored until they were analyzed using enzyme-linked immunosorbent asssay for quantification of IL-8. Postendodontic pain was scored using the visual analogue scale. Outcome data were statistically analyzed using one-way analysis of variance, Kruskal-Wallis, Friedman's, Dunn's, Chi-square, and Fisher's exact tests and Spearman's correlation coefficient. The significance level (α) was set at 0.05. ResultsApart from preoperative pain scores, all groups had similar baseline characteristics (P > .05). Immediate postendodontic pain scores had a significant difference between all groups (P < .05) where placebo group showed the highest score. There was no significant difference between all groups at 6 and 12 hours postoperatively (P > .05). Furthermore, there was no significant difference in the incidence of postendodontic pain and in mean IL-8 levels between the 3 groups (P > .05). ConclusionsThe only impact the premedications had was on the immediate postendodontic pain intensity, and they had no influence on the later time points, incidence of postendodontic pain or pulpal IL-8 levels.