Prevalence Of Postoperative Pain Research Articles

Acute postoperative pain prevalence and intensity in the first 72 hour in Dessie Comprehensive Specialized Hospital, Ethiopia: a prospective single center observational study.

Postoperative pain is poorly studied in developing countries. Severe pain after surgery remains a major problem, occurring in 50-70% of the patients. Differences exist across countries. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain-treatment and develop procedure-specific, optimized pain-treatment protocols, the prevalence and severity of postoperative pain must first be identified. This study aimed to determine the prevalence and intensity of acute postoperative pain and the practice of postoperative pain management. A total of 180 patients were enrolled in the study, with 160 calculated using a single population proportion formula and a 10% attrition rate added, with proportionate stratification according to the size of each ward to obtain the number of participants from each specialty ward. A multistage sampling with stratified proportionate at the initial stages and a simple random sampling technique at the final stage was used. The patients completed a numerical pain rating scale for pain immediately after surgery for the first 72h after surgery. The prevalence of mild, moderate, or severe pain was calculated. The evaluation was performed at eight time points including immediately after surgery: T2, T4, T8, T12, T24, T48, and T72. The prevalence of severe pain in patients who underwent elective surgery in the study period measured by numeric rating scale was 21.6, 43.9, 45.6, 28.9, 39.4, 10.5, and 13.4% at 2nd, 4th, 8th, 12th, 24th, 48th and 72h, respectively. The prevalence of moderate-to-severe pain within 72h postoperatively was slightly lower than that other studies conducted in Ethiopia reported. This was still high, indicating better pain management in the postoperative period. Involvement of the anesthetist in pain management is crucial for better patient management.

SCIENTIFIC UPDATE ON POST-OPERATIVE PAIN MANAGEMENT IN ORTHOPEDIC SURGERY

Postoperative pain results from the nociceptive stimulus caused by the surgical aggression, coming from direct or indirect mechanisms. Its intensity and duration depends on several factors, mainly the type of surgical approach, surgical access and anatomy. Orthopaedic surgeries are considered one of the most painful, due to the intense nociceptive stimulation of the musculoskeletal tissue.The prevalence of post-operative pain is described in 73% of patients who experience moderate to severe pain on the first day after surgery. A lower prevalence is observed in developed countries, due to pain protocols, the presence of acute pain services and advanced general anesthesia techniques. Numerous protocols have been tested, and opioids are often the drugs of choice, but the events are considered the biggest drawback. Pain control can be achieved through the use of certain medications, the use of physical means and interventions related to cognitive behavior, such as educational techniques and relaxation. Even though it is difficult to treat pain, analgesic methods are essential to reduce the incidence of persistent pain, avoiding and alleviating future chronic pain conditions that are difficult to treat.

Prevalence of postoperative pain after endodontic treatment using low and high concentrations of sodium hypochlorite: a systematic review and meta-analysis.

To determine the prevalence of postoperative pain after endodontic treatment using low (LC) and high (HC) concentrations of sodium hypochlorite (NaOCl). Six databases and the grey literature were searched to identify randomized clinical trials that evaluated postoperative pain after endodontic treatment using NaOCl. NaOCl concentrations were dichotomized into 'LC' (0.5% to 3%) and 'HC' (≥ 5%) and a proportion meta-analysis was applied to determine the postoperative pain prevalence: overall and according to pain intensity and postoperative time. The prevalence of patients using pain control medication was also determined. A significance level of 5% and a random effect model were applied for data analysis. Between-study heterogeneity was assessed by I2 index. Risk of bias (RoB) was assessed using the Cochrane Risk-of-Bias 2.0 tool. The certainty of evidence was assessed using the GRADE approach. Ten studies were included in the review and eight in the meta-analysis. The overall prevalence of postoperative pain was 45% in LC and 39% in HC. The prevalence of pain in LC and HC after 24h was 25% and 40%, respectively. After 48h, the prevalence decreased to 10% in LC and 25% in HC. 'Absent pain' was the most prevalent score. The prevalence of patients who used medication was 9% in LC and 15% in HC. Three studies were classified as 'high RoB', five as 'low RoB', and two as 'some concerns'. The certainty of evidence was very low. The overall prevalence of postoperative pain after endodontic treatment using LC and HC of NaOCl was 45% and 39%, respectively. Postoperative pain is common after endodontic treatment using NaOCl, but tends to decrease over time.

Prevalence and Characteristics of Persistent Postoperative Pain After Thoracic Surgery: A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis was conducted to investigate the prevalence and characteristics of persistent (≥3 months) postoperative pain (PPP) after thoracic surgery. For this purpose, Medline, Embase, and CINAHL databases were searched for the prevalence and characteristics of PPP after thoracic surgery from their inception to May 1, 2022. Random-effect meta-analysis was used to estimate pooled prevalence and characteristics. We included 90 studies with 19,001 patients. At a median follow-up of 12 months, the pooled overall prevalence of PPP after thoracic surgery was 38.1% (95% confidence interval [CI], 34.1-42.3). Among patients with PPP, 40.6% (95% CI, 34.4-47.2) and 10.1% (95% CI, 6.8-14.8) experienced moderate-to-severe (rating scale ≥4/10) and severe (rating scale ≥7/10) PPP, respectively. Overall, 56.5% (95% CI, 44.3-67.9) of patients with PPP required opioid analgesic use, and 33.0% (95% CI, 22.5-44.3) showed a neuropathic component. One in 3 thoracic surgery patients developed PPP. There is a need for adequate pain treatment and follow-up in patients undergoing thoracic surgery.

Prevalence of postoperative pain after hospital discharge: systematic review and meta-analysis.

Assessment and management of postoperative pain after hospital discharge is very challenging. We conducted a systematic review to synthesize available evidence on the prevalence of moderate-to-severe postoperative pain within the first 1 to 14 days after hospital discharge. The previously published protocol for this review was registered in PROSPERO. MEDLINE and EMBASE databases were searched until November 2020. We included observational postsurgical pain studies in the posthospital discharge setting. The primary outcome for the review was the proportion of study participants with moderate-to-severe postoperative pain (eg, pain score of 4 or more on a 10-point Numerical Rating Scale) within the first 1 to 14 days after hospital discharge. This review included 27 eligible studies involving a total of 22,108 participants having undergone a wide variety of surgical procedures. The 27 studies included ambulatory surgeries (n = 19), inpatient surgeries (n = 1), both ambulatory and inpatient surgeries (n = 4), or was not specified (n = 3). Meta-analyses of combinable studies provided estimates of pooled prevalence rates of moderate-to-severe postoperative pain ranging from 31% 1 day after discharge to 58% 1 to 2 weeks after discharge. These findings suggest that moderate-to-severe postoperative pain is a common occurrence after hospital discharge and highlight the importance of future efforts to more effectively evaluate, prevent, and treat postsurgical pain in patients discharged from the hospital.

Postoperative Pain After Using Passive Ultrasonic Irrigation and EasyClean Device, Irrigation Activation Techniques: A Randomized Clinical Trial

IntroductionThis randomized clinical trial aimed to compare postoperative pain after the use of 2different irrigation activation techniques: passive ultrasonic irrigation and the EasyClean device. MethodsSixty-six single-rooted teeth diagnosed with asymptomatic pulp necrosis and apical periodontitis were randomly assigned to 2experimental groups (n = 33), which differed in the irrigation activation technique. Postoperative pain levels were assessed after 24, 48, and 72 hours using a verbal rating scale; the ibuprofen intake amount was recorded at the same time intervals. Data were analyzed using Student's t-test, Mann–Whitney U and Fisher's exact tests, with a significance level of 5%. ResultsPostoperative pain levels and analgesic intake frequency were not significantly different across the 2irrigation activation techniques (P > .05). The frequencies obtained in relation to the prevalence of postoperative pain were 3.1-25.8% for all participants of the 2studied groups. ConclusionThe irrigation activation techniques of passive ultrasonic irrigation and the EasyClean device were found to be equivalent in terms of postoperative pain and analgesic intake.

PREVALENCE AND INTENSITY OF ACUTE POST-OPERATIVE PAIN AND MANAGEMENT ASPECTS IN ADULT PATIENTS: A CROSS-SECTIONAL TERTIARY HOSPITAL-BASED STUDY

The prevalence of acute postoperative pain varies widely, but quite often inadequate relief of acute postoperative pain is found, which, in turn, is associated with the development of chronic postoperative pain and other health consequences. The aim of the study was to determine the prevalence of acute postoperative pain and the degree of satisfaction of patients with anesthesia after surgery in four specialized hospitals in the capital of the country. The results showed that the post-operative pain prevalence is high 88.5% (95.0% CI = 81.2-95.8). Mean pain relief - 76.3, SD -14.8, median - 80%. Patients’ satisfaction with pain relief measured by NRS at the scores 9 and 10 composed 36.5% and 25.0% accordingly. Adequate perioperative pain management should be integral to patient care with active engagement of patients in pain management and taking decision in pain therapy.

OC-006 LAPAROSCOPIC TOTALLY EXTRA-PERITONEAL REPAIR OF BILATERAL INGUINAL HERNIAS WITH A LARGE SINGLE MESH: A SINGLE CENTER STUDY WITH MINIMUM 5 YEARS FOLLOW UP

Abstract Background Laparoscopic totally extraperitoneal (TEP) surgery with a single large mesh is currently the technique of choice for repair of bilateral inguinal hernias in our institution. Most surgeons use two meshes for the TEP repair. We present our experience with a single mesh repair. Material & Methods Records of all patients who had bilateral inguinal hernia and underwent bilateral laparoscopic TEP repair at our institution, 2010–2016, were retrospectively reviewed. We excluded patients who had a conversion to transabdominal intraperitoneal or open approach. Results A total of 470 patients were identified. The median age of patients was 56 (IQR 1–3; 41–66) years and median BMI was 25.9 (IQR 1–3; 23.1–28.1). 18.7% of the cohort (88 patients) had previous abdominal surgery and 39 patients (8.41%) had a recurrent inguinal hernia. Median length of operation was 63 (IQR1–3; 48–89) minutes. Operative complication were bleeding (0.4%) and bladder injury (0.2%). Post operative complications occurred in 32 patients; among the complications were seroma (2.6%), hematoma (2.1%), surgical site infection (0.4%) urinary retention (1.5%) and intestinal obstruction (0.2%). Median length of hospitalization was 1 day (IQR1–3; 1–2). After a median follow up of 102 months, 36 patients had a recurrence. 20 patients (4.3%) had a re-operation for recurrent inguinal hernia. Post-operative groin pain was present in 48 patients. Conclusion The use of a large single mesh is an effective and safe technique for TEP repair of bilateral inguinal hernias. The recurrence rate and prevalence of post-operative pain is consistent with the results reported by others.

Comparison of Milligan Morgan Versus Stapled Hemorrhoidectomy in Patients Attending Tertiary Care Hospital

Background and Aim: Hemorrhoids are common anorectal problems that cause fear by bleeding, pruritus burden, and thrombosis pain. Prolapse and hemorrhoids are managed by stapled hemorrhoidectomy (SH). Initially, Stapled hemorrhoidectomy seemed to be a good alternative for Milligan Morgan (MM) hemorrhoidectomy verified by various studies. However, recent studies found that long-term assessment of stapled hemorrhoidectomy gives poor outcomes in terms of postoperative complications and patient’s satisfaction. Therefore, the present study aimed to compare the Milligan Morgan versus stapled Hemorrhoidectomy in patients attending Tertiary Care Hospital. Methodology: This prospective study was carried out on 120 patients at the Department of Surgery Unit-I Sheikh Zayed Medical College Rahim Yar Khan from 1st May 2021 to 31th April 2022. All the patients of either gender with an age range from 18 years to 60 years after 2nd degree hemorrhoids failure of multiple rubber band ligations and 3rd and 4th degree hemorrhoids were enrolled. Concomitant anal disease patients such as ano-rectal cancer, fissure, fistula, and abscess were excluded. Patients were divided into two categories: Group-I Stapled Hemorrhoidectomy and Group-II Milligan Morgan. Post-operative complications such as stenosis and urinary retention during hospitalization were recorded. All the data were entered and analyzed using SPSS version 25. Results: The overall mean age of Group-I and Group-II was 46.78±12.66 years and 48.91±14.82 years respectively. Each group comprised 60 patients. Out of the SH group, 35 (58.3%) were males and 25 (41.7%) were females. Of the MM Group-II, male and females were 44 (73.3%) and 16 (26.7%) respectively. About 53 (88.3%) patients in Group-I and 32 (53.3%) patients in Group-II had relief from bleeding and other symptoms. The surgical duration in Group-I and Group-II was 22.9 ± 12.9 minutes and 34.8 ± 9 minutes with statistical significance (p=0.000) respectively. The vessel spurting ligation and postoperative hemorrhage was developed in 5 (8.3%) in SH group patients. Post-operative bleeding and intervention was found in 26 (43.3%) patients in Group-II. The prevalence of postoperative pain requiring analgesia was found in 20 (33.3%) in Group-I and34 (56.7%) in Group-II respectively. After treatment, fecal incontinence was developed in none of the patients in both groups. The postoperative complications such as anal tag, tenderness, bleeding, urinary retention, and wound discharge were higher in Group-II as compared to Group-I with statistical insignificance (p< 0.05). Conclusion: The present study found that hemorrhoids could be effectively treated by Stapled hemorrhoidectomy compared to Milligan-Morgan procedure in terms of postoperative pain, hospital stay, and usage of analgesics, reduced postoperative complications, patient’s satisfaction, and time taken for operation. Beside lesser complications, fecal incontinent, severe pain, and other complications could result from stapling technique. Post-operative pain and complete pain relief was significantly lower in MM group. Hospitalization in the SH group was shorter than the MM group. Hemorrhoid recurrence was null in both SH and MM group. Keywords: Hemorrhoid Surgery, Stapled Hemorrhoidectomy, Milligan-Morgan

Single incision laparoscopic surgery (SILS) versus conventional laparoscopic technique for ileostomy: a retrospective cohort study.

Minimal-invasive surgery has gained wide acceptance in colorectal surgery. Single incision laparoscopic surgery (SILS) was designed to minimize surgical trauma and improve postoperative outcome. However, the role of SILS in ileostomy formation is unclear. In this retrospective cohort study 26 patients were included. Six patients were operated with SILS and 20 with conventional laparoscopic technique for ileostomy. We retrospectively evaluated patient charts for baseline characteristics including prior abdominal surgeries and combination of surgeries. Our primary efficacy objectives were operation time and postoperative hospitalization days. Our safety objectives included the prevalence of postoperative pain, parastomal hernia, incisional hernia, perforation, wound infection, ileus, and infections in general. Baseline characteristics including previous abdominal surgery and concomitant surgeries were comparable in both groups. Total operation time using SILS (37.5 ± 6.2 min [mean ± SD]), compared to laparoscopic surgery (82.2 ± 54.8 min [mean ± SD]) was significantly shorter (p = 0.0002). In a sensitivity analysis excluding patients with combined surgery, ileostomy formation by SILS was shorter (36.5 ± 6.2 min [mean ± SD]), compared to laparoscopy (59.7 ± 28.7 min [mean ± SD]; p = 0.024). Length of postoperative stay was not statistically different between the groups (SILS: 5.5 ± 2.4 days [mean ± SD]; laparoscopic: 13.8 ± 17.3 days [mean ± SD], p = 0.193). Postoperative complication rates were low and comparable in both groups. Placement of a loop ileostomy using SILS technique not only reduces surgical trauma but also operation time without affecting postoperative hospital stay or postoperative complication rates. Single-incision laparoscopic surgery for ileostomy is an appealing approach for ileostomy in selected patients.

The effect of timing and dosing of 5% and 10% dextrose versus saline on postoperative nausea and vomiting in high-risk women following ambulatory surgeries: a randomized double-blind controlled trial

A common complication after outpatient surgeries is postoperative nausea and vomiting (PONV) which is concomitant with high levels of patient distress and dissatisfaction. Perioperative dextrose-containing fluid administration has been used as a non-pharmacologic preventive measure against postoperative nausea and vomiting (PONV). However, its efficacy remains unclear. This study aimed to compare different concentrations of dextrose solution on PONV for 24 hours after surgery. This is a randomized double-blind controlled study where 120 women were divided into three equal groups. Group C was infused with IV 0.9% saline 100 mL/h for two hours (200 mL) starting one hour before anesthesia and ending during surgery. Group D5%, was infused with dextrose 5%. Group D10%, was infused with D10%. PONV within 24 hours was compared between groups by PONV score. Other outcomes were the antiemetic drugs needed, VAS Score, total fentanyl consumption, hemodynamic data, unplanned admission, and complications. The incidence of nausea and vomiting was significantly reduced in dextrose 10% and 5% patients in comparison to the control group (five patients [12.5%], 18 [42.5%], and 39 [87.5%] respectively). The request for antiemetic drugs decreased significantly in groups D10% and 5% than in group C (36 [90%], 29 [72.5%] and 19 [47.5%] patients did not receive any antiemetics, P=0.002). Postoperative pain prevalence in patients with PONV was significantly different only at 24 h, P=0.03. There was a potential role for preoperative IV infusion of dextrose 10% solution that significantly reduces the incidence and severity of PONV and pain in patients at high risk for PONV.

Comparison of postoperative pain following single-visit and two-visit root canal therapy in controlled diabetic patients with irreversible pulpitis: A randomized control trial.

Aim:The aim of this study was to evaluate and compare the prevalence of postoperative pain after single- and two-visit endodontic therapy in controlled Type 2 diabetic and nondiabetic individuals in multirooted teeth with irreversible pulpitis.Materials and Methods:Ninety patients with irreversible pulpitis (30 controlled diabetics and 60 nondiabetics), between 18 and 60 years were included in the study. After obtaining initial pain scores, patients were randomly allocated to single-visit or two-visit root canal treatment (RCT) groups to receive standardized treatment. After the first visit, patients were given visual analog scale form to mark pain intensity at 1 h, 6 h, 12 h, 24 h, 48 h, 72 h, and 1 week. The compiled data collected were statistically analyzed using 20 SPSS software.Results:In both groups, for patients undergoing single-visit and multi-visit RCT, pain intensity was highest on 1st day of treatment and dropped afterward. A comparison of pain between single-visit and two-visit patients revealed no significant difference in pain scores for the respective time intervals. Intergroup comparison between controlled diabetics and nondiabetics showed no significant difference in pain reported between both groups.Conclusion:According to the results of this study, being diabetic or nondiabetic, no difference in pain perception was seen between single- and multiple-visit endodontics suggesting that single-visit as well as two-visit endodontic treatment can be done in controlled diabetic patients.

The Influence of Single and Multiple NiTi Rotary File Systems on Prevalence of Postoperative Pain Following Root Canal Instrumentation Using Mechanical or Manual Glide Path Techniques

Purpose: The current investigation was carried out to estimate the influence of single and multiple NiTi rotary file systems on prevalence of postoperative pain following root canal instrumentation using mechanical or manual glide path techniques. Materials and methods: Forty participants with a sympotomatic irreversible pulpitis of mandibular molars were contributed in this randomized, controlled, clinical double blinded study. The participants were assigned into two main groups according to the gliding path system used then further subdivided into two subgroups according to the shaping system used. After access cavity preparation and working length determination, the glide path was prepared using either the PathFiles or the K-Files then the canal shaping was carried out using either the WaveOne Gold or ProTaper Next systems then the root canals were obturated. The postoperative pain was assessed by means of the modified visual analogue scale following 6, 12, 24, 48, 72 hours and 7 days then the data were collected and analyzed. Results: Postoperative pain was significantly higher after using the WaveOne Gold and the K-Files. Conclusions: Although all systems caused postoperative pain, the mechanical glide path along with the multi-file continuous rotational systems could be considered as a promising and reliable approach in preparing the root canals with less postoperative pain.

Incidence of postoperative pain after single-visit and multiple-visit root canal therapy: A randomized controlled trial.

Background:Short-term complications after root canal therapy (RCT) include mild pain or flare-up. Patients regard these complications as a benchmark for the assessment of clinician's abilities. In this context, the evidence for recommending either one- or two-visit RCT is not consistent.Aims:This study aims to compare the prevalence of postoperative pain and tenderness to percussion after single-visit (SV) versus two-visit RCT on the mandibular first molar.Materials and Methods:The study was registered with www.ctri.nic.in (CTRI/2019/05/019067). Seventy individuals requiring RCT on a mandibular first molar were selected and randomly ascribed to either single- (Group 1, n = 35) or two-visit RCT (Group 2, n = 35). Postoperative pain levels were assessed using heft parker visual analog scale. The treated teeth were appraised for tenderness to percussion after 1 week of obturation.Statistical Analysis:Thirty-four patients were evaluated in each group: One patient, each, dropped out from both the groups. The data analysis was done using Student's t-test and Chi-square test.Results and Conclusion:Pain score in multiple-visit (MV) was significantly higher than SV after 12- (P = 0.039) and 48 h (P = 0.043). Short-term postoperative pain was higher in MV than SV RCT of mandibular first molar teeth.

Comparison of anxiety level in patients under uterine fibroid treatment by myomectomy and uterine artery embolization (UAE) and its relationship with pain and duration of postoperative hospitalization in Ahvaz educational hospitals in 2018

Introduction:Uterine fibroids are the most common benign tumors in women. Preoperative anxiety is due to concerns about the consequences of surgery and prevents recovery and high prevalence of postoperative pain and increases the length of stay in the hospital. In this study, we tried to investigate the level of anxiety in patients who are candidates for uterine artery embolization (UAE) and myomectomy surgery and its relationship with the length of hospitalization and postoperative pain.Methods:The present descriptive-analytical study was performed on candidates for uterine fibrinoid treatment referred to Ahvaz educational hospitals in 2018. A total of 41 candidates for uterine fibroid treatment were segmented into two groups of 24 candidates for myomectomy surgery and 17 for UAE treatment considering the inclusion and exclusion criteria after informed consent. Data were analyzed by SPSS VER 20 software using Mann–Whitney test, multiple regression, and Chi-square.Results:Myomectomy surgery group recorded more overt and covert anxiety, followed by a longer hospital stay and more postoperative pain (P < 0.05). The demographic criterion of age was significantly associated with overt and covert anxiety (P < 0.05). The level of education was significantly associated with overt anxiety (P < 0.05) and marital status and BMI were not significantly associated with overt and covert anxiety levels (P > 0.05).Conclusion:According to the results of the study, overt and covert preoperative anxiety in women undergoing myomectomy surgery for symptomatic uterine fibroids is longer than in UAE treatment. And have more pain after surgery.

Prevalence of Postoperative Pain Following Hospital Discharge: Protocol for a Systematic Review.

BackgroundPain is one of the most common, feared, and unpleasant symptoms associated with surgery. However, there is a clear gap in patient care after surgical patients are discharged from hospital, resulting in poorly controlled postoperative pain. Inadequate pain management after discharge can have detrimental effects on quality of life and lead to the development of chronic postsurgical pain. The severity of postoperative pain before discharge is well described, but less emphasis has been placed on assessing pain at home after hospital discharge.ObjectiveThe objective of this review is to summarize the prevalence of moderate-to-severe postoperative pain within the first 1 to 14 days after hospital discharge.MethodsA detailed search of epidemiological studies investigating postoperative pain will be conducted on MEDLINE and EMBASE from their inception until the date the searches are run. The primary outcome will be the proportion of patients reporting moderate-to-severe postoperative pain at rest and with movement within the first 1 to 14 days after hospital discharge. The secondary outcomes will include a comparison of postoperative pain after discharge between patients who underwent ambulatory and inpatient surgery, and adverse outcomes attributable to poor pain control after hospital discharge (eg, readmission to hospital, emergency room or other unplanned medical visits, or a decrease in quality of life).ResultsThe protocol has been registered in PROSPERO (registration number CRD42020194346). The search strategies for MEDLINE and EMBASE have been completed. The final results are expected to be published in May 2021.ConclusionsThis systematic review is expected to synthesize evidence describing the prevalence of postoperative pain after hospital discharge. Available epidemiological evidence may help inform the magnitude of the problem of postoperative pain at home after hospital discharge.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020194346; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=194346International Registered Report Identifier (IRRID)PRR1-10.2196/22437

Prevalence and Risk Factors for Acute Postoperative Pain After Elective Orthopedic and General Surgery at a Tertiary Referral Hospital in Tanzania.

BackgroundIn Africa, postoperative pain management is still a major problem with a prevalence of postoperative pain in up to 95.2% of the patients. There are little data on the prevalence and potential risk factors for postoperative pain in Tanzania. Therefore, we aimed to investigate these at Kilimanjaro Christian Medical Centre in Northern Tanzania. Our goal is to optimize pain management.MethodsA prospective cohort study was carried out from December 2016 to April 2017. Patients ≥18 years admitted for elective general or orthopedic surgery were included in the study. Demographic data were collected during a pre-operative visit, and pain was assessed with a numerical rating scale (NRS 0–10) at 4, 24, 36 and 48 hours postoperatively. A NRS >3 was considered as moderate to severe postoperative pain. Potential risk factors for postoperative pain were identified using univariate and multivariable binary logistic regression analyses.ResultsA total of 281 patients were included in the study. The prevalence of postoperative pain was 61%, 73%, 67% and 58% at 4, 24, 36 and 48 hours after surgery, respectively. Pethidine was the most frequently prescribed analgesic for postoperative pain management (85.1%) in the first 24 hours postoperatively; only 1% received paracetamol or diclofenac, and 13% received tramadol. In the multivariable model, general anesthesia and intra-operative analgesia (OR = 3.70, 95% CI 1.70–8.04) were significant risk factors for postoperative pain.ConclusionPain is still inadequately managed at Kilimanjaro Christian Medical Centre leading to a high prevalence (73% on the first day after surgery) of reported postoperative pain in this study. It reflects the need for adequate postoperative analgesia, especially in low- and middle-income countries. Further research identifying risk factors in larger cohorts can be performed if adequate analgesia is given.

Effect of Occlusal Adjustment on Postoperative Pain after Root Canal Treatment: A Randomized Clinical Trial.

The aim of this prospective, randomized, clinical study was to analyze the influence of occlusal adjustment on the prevalence of postoperative pain after endodontic treatment. Seventy-eight patients, diagnosed with symptomatic irreversible pulpitis with indication for endodontic treatment, were selected to participate in the study. The participants were randomized and divided into two groups: in the occlusal adjustment group (OAG), endodontic treatment was performed with subsequent occlusal adjustment. In the control group (CG), endodontic treatment was performed without occlusal adjustment. Treatments were performed by the same operator. Pain occurrence and intensity were recorded on two scales: the verbal rating scale (VRS) and numerical rating scale (NRS). Pain assessment was carried out by a second examiner, blinded to the experiment, 6, 24 and 72 h after endodontic treatment. Data were analyzed using Mann-Whitney, chi-squared, and Fisher's exact tests. In the occlusal adjustment group, 71.1% reported postoperative pain and 67.5% reported pain in the control group. At the 6-hour assessment, 21 individuals reported pain in the occlusal adjustment group and 24 in the control group (p=0.672). At the 24-hour assessment, 18 and 19 individuals reported pain (p=0.991) and at the 72-hour assessment, 8 and 4 reported pain (p=0.219), respectively. Occlusal adjustment did not influence the prevalence of postoperative pain of endodontically treated teeth with symptomatic irreversible pulpitis.

Efficacy of methylprednisolone on pain, trismus and quality of life following surgical removal of mandibular third molars: a double-blind, split-mouth, randomised controlled trial.

Background The objective of the present study was to compare the efficacy of different doses of methylprednisolone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars (SRM3). Material and Methods Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateral impacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg, 30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively and compared with assessment after one day, three days, seven days and one month. Pain and trismus were estimated by visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL included Oral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made and expressed as mean values with a 95% confidence interval. Results Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo. Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00). Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00). Conclusions The present study revealed no significant improvement of methylprednisolone on postoperative sequelae and QoL following SRM3 compared with placebo. Key words:Corticosteroids, dentistry, mandible, methylprednisolone, pain, third molar, trismus.

Prevalence of Post-Operative Pain After Extraction- A Survey

Dental extraction is a very common procedure practiced in dentistry, it is defined as atraumatic removal of teeth from the socket of the alveolar bone with minimum, or no pain for the patient. Pain after extraction is a very common phenomenon. This survey is focused on understanding the knowledge about pain experienced by the patiences after extractions. A survey questionnaire of 15 questions was prepared on an online survey platform and distributed among 120 patients who had undergone extractions, to analyse prevalence of pain after extractions. IBM SPSS version 26 software was used to evaluate the results and data collection. Statistical analysis was done by chi square test. From the survey conducted we can conclude that there is a significant association found between age,medication, systemic illness, habits are the factors that influence pain after extraction. However 33% of the patients did not report back to the clinic for review. The survey helps us to understand that pain after extraction is very common in the age group 55 years and is mostly seen in females.