Reduction In Visual Analog Scale Score Research Articles

Prednisolone 20 mg vs 40 mg in complex regional pain syndrome type I: A randomized controlled trial

BackgroundHigh dose of corticosteroid has been found beneficial in complex regional pain syndrome type I (CRPS-I). We report the efficacy and safety of prednisolone 20 mg versus 40 mg in CRPS-I in an open label randomized controlled trial. MethodsThe patients with CRPS-I of the shoulder joint with a CRPS score of ≥8 were included. Their demographic details, comorbidities, and underlying etiology were noted. The severity of CRPS was assessed using a 0–14 CRPS scale, the pain using a 0–10 Visual Analogue Scale (VAS), and sleep quality using a 0–10. Daily Sleep Interference Scale (DSIS). Patients were randomized to prednisolone 40 mg/day (group I) or 20 mg/day (group II) for 14 days, then tapered to 10 mg in group I and to 5 mg in group II by 1 month. Thereafter both groups received prednisolone 5 mg/day for 2 months. The primary outcome was a >50% reduction in VAS score, and secondary outcomes were a reduction in CRPS score, DSIS score, and adverse events. ResultsFifty patients were included, and their baseline characteristics were comparable. At one month, all the patients had >50% reduction in the VAS score. The effect size was 0.38 (95% CI 0.93–0.20; p = 0.20). On the Kaplan-Mayer analysis, the improvement in the VAS score (Hazard ratio−1.43, 95 % CI-0.80–2.56, p = 0.22) and the CRPS score (HR-0.79,95 % CI-0.45–1.39; p = 0.41) was insignificant between the two groups. The DSIS score improved in group II (HR-1.85,95 % Cl-1.04–3.31,p = 0.04). Group I patients needed frequent adjustment of antidiabetic drugs (14 vs 6; p = 0.04). ConclusionThe efficacy of prednisolone 20 mg is not inferior to 40 mg in CRPS-I, and is safe in diabetic patients. LimitationsThis is an open label randomized controlled trial with small sample size without a placebo arm.

Effect of Traditional Chinese Formula Dingkun Pill on Primary Dysmenorrhea: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

Background: Primary dysmenorrhea (PD) afflicts many childbearing-age women, with a high prevalence ranging from 17% to 90%. The Dingkun pill (DKP), a traditional Chinese medicine formula, has been prescribed for managing menstrual disorders empirically in clinical practice for a long time, but there are very few high-quality studies supporting this practice. Therefore, this trial aimed to assess the efficacy and safety of DKP in patients with PD. Methods: Our study was a multicenter, prospective, randomized, double-blind, placebo-controlled study. DKP or placebo was prescribed to participants from the 5th to 14th day of each menstrual cycle for 12 weeks. Changes in pain intensity were measured by a visual analog scale (VAS) and were compared between groups using repeated measures analysis. The pain mediators and sex hormones were also assessed before and after the treatment, and their intergroup changes from the baseline were analysed by student t-test. The hemodynamic indices and safety profile of DKP were also investigated. Results: A total of 156 women were recruited and randomly allocated to receive either DKP or placebo, of whom 142 (73 in DKP and 69 in sham control) completed the study. A more distinctive reduction in VAS scores was observed in the DKP group, compared with placebo (–2.68 ± 0.21 vs. –1.29 ± 0.14, p < 0.001). Compared to placebo, DKP treatment resulted in a pronounced suppression of serum PGF2α, oxytocin and vasopressin, along with a significant increase in beta-endorphin level (p < 0.001). Moreover, uterine artery flow measured by ultrasonography indicated increased blood perfusion after DKP treatment (p < 0.01), while no change was detected in the placebo group. Additionally, except for an inhibited serum follicular stimulating hormone (FSH) (p = 0.037), no statistical difference in hormonal status and safety indicators was detected before and after the treatment. Conclusions: DKP treatment attenuated pain severity in patients with primary dysmenorrhea, and no harmful side effect was observed during 12 weeks of treatment. Clinical Trial Registration: ClinicalTrials.gov, NCT03953716. Registered 17 May 2019. https://clinicaltrials.gov/ct2/show/NCT03953716.

Sufficient mesh polyhedral intralesional injection for treatment of keloids.

The recurrence of keloids after intralesional injections is significant, and a review of the literature shows an inconsistent range of success rates. In this study, the modified medical proportion and intralesional injection method were intended to enhance the treatment effect. Twenty patients completed the study. Regional block anesthesia (lidocaine, ropivacaine) was performed. Triamcinolone acetonide (40 mg/mL), 5-fluorouracil (25 mg/mL), and ropivacaine (7.5 mg/mL) were configured in a ratio of 2:1:4 and applied on the lesion by reticular injection (horizontal fan-shaped stratified and vertical shaking pressurized injection). The minimum volume of injection per square centimeter was approximately 3.5 mL. The outcome indicators were the Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS), treatment frequency. The patients had an 82% ± 7% average reduction in VSS scores and 89% ± 13% and 93% ± 10% reductions in VAS scores of pain and pruritus, respectively, after an average of 2.5 ± 0.7 injections administered within 1 year. The sufficient mesh polyhedral intralesional injection can achieve excellent results for the treatment of keloid scars.

Comparison of postoperative outcomes between bikini-incision via direct anterior approach and posterolateral approach in simultaneous bilateral total hip arthroplasty: a randomized controlled trial

The purpose of this study was to compare an oblique bikini-incision via direct anterior approach (BI-DAA) to a conventional posterolateral approach (PLA) during simultaneous bilateral total hip arthroplasty (simBTHA) in terms of early patient outcomes, postoperative functional recovery, and complications. From January 2017 to January 2020, 106 patients receiving simBTHA were enrolled and randomly allocated to the BI-DAA or PLA group. Primary outcomes were measured using hemoglobin (HGB) drop, transfusion rate, the length of stay (LOS), the visual analog scale (VAS) for pain, the Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index, and the scar cosmesis assessment and rating scale. Secondary outcomes were the operative time, radiographic measurements, including femoral offset, femoral anteversion, stem varus/valgus angle, and leg length discrepancy (LLD). The occurrence of postoperative complications was also recorded. There were no differences in demographic or clinical characteristics before surgery. Compared to the PLA, the patients in the BI-DAA group had lower HGB drop (24.7 ± 13.3 g/L vs. 34.7 ± 16.7, P < .01) and transfusion rates (9/50 vs. 18/50, P = .04) and a shorter LOS (5.12 ± 1.5 vs. 6.40 ± 2.0 days, P < .01) without increasing the operative time (169.7 ± 17.3 vs. 167.5 ± 21.8 min, P = .58). The BI-DAA group yielded a smaller LLD (2.1 ± 2.3 vs. 3.8 ± 3.0 mm, P < .01) and less variability in component orientation than the PLA group (100% vs. 93%, P = .01). As for the scar, the BI-DAA group produced a shorter incision length (9.7 ± 1.6 vs. 10.8 ± 2.0 mm, P < .01) and higher postoperative recovery satisfaction than the PLA group. Furthermore, the BI-DAA group had a reduced VAS score one week after surgery and had better functional recovery in three months postoperatively. The BI-DAA group had a higher incidence of LFCN dysesthesia (12/100 vs. 0/100 thighs, P < .01), while other complications did not differ significantly between the two groups. For simBTHA, the bikini incision offers early recovery, less variance in components orientation, better postoperative outcomes, and scar healing than the PLA. Therefore, the bikini incision could be a safe and feasible option for simBTHA recipients.

TRANSVERSUS ABDOMINIS PLANE(TAP) BLOCK AS A PART OF MULTIMODAL ANALGESIA AFTER CAESAREAN SECTION DELIVERY

Background: Patients after Caesarean Section go through post operative pain. Most of this pain is experienced after the abdominal wall incision. Transversus abdominis plan (TAP) block as part of multimodal analgesia is a novel approach for patients delivered by caesarean section (CS). This technique (TAP block) lends itself particularly well to resource-poor settings as it does not require a nerve stimulator. The aim of this study was to evaluate the efcacy of transversus abdominis plane (TAP) block when it is used as part of multimodal analgesia on obstetric patients after Caesarean Section. Methods: Institution based prospective cohort study design was conducted on patients, who have Caesarean Section from January to March, 2023. All patients operated under spinal anaesthesia for caesarean delivery were included. Patients divided into TAP block (n=20) and controls (n=20). The TAP block group was given bilateral 20 ml of 0.25% bupivacaine at the end of surgery. Postoperative pain was assessed within the rst 24 hours i.e. at 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours using 100 mm long visual analogue scale (VAS), total analgesic consumption and time for the rst analgesic request. Result: There was reduction of VAS scores within the rst 24 hours after caesarean section in TAP block group compared with the control group. VAS scores as median(IQR) at 2 hours 0.00(0.00-11.50) vs 39.00(7.75-60.50), p=0.001, at 4 hours 0.00(0.00–12.75) vs 17.50(13.25-24.00), p=0.000, at 6 hours 9.00(1.50-12.00) vs 22.00(14.75-45.00), p=0.000, at 12hours 13.00(11.00-16.00) vs 42.00(10.00-52.00), p=0.003, at 24 hours 10.00(8.0012.00) vs 15.50(11.25-26.00), p=0.013 respectively. The total analgesic Tramadol consumption within 24 hours was reduced in TAP block group, and time for the rst analgesic request was signicantly prolonged (286.00 vs 76.25, p=0.000) minutes. Conclusion: Bilateral TAP block provides lower postoperative severity of pain, reduced total postoperative Tramadol analgesics consumption and prolonged time for the rst analgesic request after caesarean section under spinal anaesthesia when it is used as multimodal analgesia. We recommend TAP block should be included as part of multimodal analgesia in the postoperative period for women after Caesarean Section delivery

Efficacy of Magnesium Sulfate as an Adjuvant to Bupivacaine in Transversus Abdominis Plane Block for Abdominal Hysterectomy Surgeries.

Background Major abdominal surgeries are often accompanied by excruciating pain, which, if not adequately managed, can reduce patient comfort and satisfaction, delay mobilization, compromise respiratory and cardiac functioning, and increase healthcare costs. The transversus abdominis plane (TAP) block is an efficient and safe complement to multimodal postoperative analgesia for abdominal surgery. This study evaluates the efficacy of combining magnesium sulfate (MgSO4) with bupivacaine for TAP block in patientsposted for total abdominal hysterectomy (TAH). Methodology Seventy female patients between the ages of 35 and 60 who were scheduled to have a TAH under spinal anesthesia were divided randomly into two groups of 35 each: group Bupivacaine (B) and group Bupivacaine-Magnesium sulfate (BM). Group B received 18 milliliters (mL) of bupivacaine 0.25 percentage (%) 45 milligrams (mg) with 2 mL normal saline (NS) whereas group BM received 18 mL of bupivacaine 0.25% (45 mg) with 1.5 mL of 10% weight/volume (w/v) MgSO4 (150 mg) and 0.5 mL NS in the ultrasonography-guided (USG) bilateral TAP block performed after the end of surgery. Groups were compared for the postoperative visual analog scale (VAS) scores, the time required for first rescue analgesia, the number of analgesic rescues at various time intervals, patient satisfaction score, and any side effects. Results Postoperative VAS scores at 4, 6, 12 and 24th hour (hr) (p < 0.05) in group BM were lower compared to group B.Time required for rescue analgesia was significantlyprolonged in group BM (882.94 ± 70.22 minutes) compared to group B (459 ± 100.53 minutes) with minimal usage of rescue analgesia (p < 0.05)up to 12 hr.In group BM, the patient satisfaction score was higher (p = 0.001). Conclusion In addition to a considerable reduction in post operative VAS scores and overall use of rescue analgesia, the addition of magnesium to bupivacaine significantly prolongs the TAP block and increases the initial postoperative period of bearable pain.

Clinical effect of acupuncture along fascia, meridians, and nerves combined with ultrasound-guided paravertebral nerve block in the treatment of postherpetic neuralgia: a randomized parallel-controlled study.

To observe the clinical efficacy of acupuncture along fascia, meridians, and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia. A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital, China Academy of Chinese Medical Sciences from May 2019 to June 2021. They were randomly divided into two groups. Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block (PVB) alone, one patient declined to continue during treatment ( 30), and thirty patients in the observation group received the acupuncture along the fascia, meridians, and nerves combined with ultrasound-guided PVB treatment ( 30). Both control and observation group received treatment weekly for 4 weeks. The medical history data such as age, sex, presence or absence of comorbidities and disease course were analyzed. The visual analog scale (VAS) score was used to assess the pain degree of two groups at T0 (before treatment), T1 (1-time treatment ended), T2 (2 times treatment ended), T3 (3 times treatment ended), and T4 (4 times treatment ended). The sleep state was examined by Pittsburgh Sleep Quality Index (PSQI) before and after the study. There was no significant difference in general conditions between the control group and the observation group (> 0.05). The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment. There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment ( > 0.05). After 3 and 4 weeks of treatment, the VAS score was significantly decreased in the observation group compared with that in the control group ( < 0.001). In addition, the reduction in VAS score (after treatment-before treatment) between the two groups was statistically significant [D value: -1.53, 95% (-2.32, 0.74), < 0.001]. Furthermore, the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group ( < 0.05). These results suggest that a combination of acupuncture along fascia, meridians, and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone. Chinese Clinical Trial Registry ChiCTR2200057955.

Safety and efficacy of intra-articular injection of platelet-rich plasma for the treatment of ankle osteoarthritis: a systematic review and meta-analysis.

To evaluate the safety and efficacy of platelet-rich plasma (PRP) intra-articular injective treatments for ankle osteoarthritis (OA). A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Scopus, Embase, Google Scholar, and the Cochrane library until May 2022. Both randomized and non-randomized studies were included with the assessment of the risk of bias. We recorded the participant's age, gender, type of PRP, injection volume, the kit used, and activating agent. We subsequently assessed the short-term and long-term efficacy of PRP using the functional scores and visual analog scale (VAS). We included four studies with a total of 127 patients, with a mean age of 56.1years. 47.2% were male (60/127), according to eligibility criteria. There were three cohort studies and one randomized controlled trial (RCT) study, and no study reported severe adverse events. All included studies used the Leukocyte-poor PRP. Short-term follow-up results suggested significant improvement of the American Orthopaedic Foot and Ankle Society (AOFAS) score in the PRP injection group compared to the control group (n = 87 patients; MD: 6.94 [95% CI: 3.59, 10.29]; P < 0.01). Consistently, there was a statistical difference in AOFAS score between PRP injection and control groups in the final follow-up (≥ 6months) (n = 87 patients; MD: 9.63 [95% CI: 6.31, 12.94]; P < 0.01). Furthermore, we found a significant reduction in VAS scores in the PRP groups at both the short-term follow-up (n = 59 patients; MD, - 1.90 [95% CI, - 2.54, - 1.26]; P < 0.01) and the ≥ sixmonths follow-up (n = 79 patients; MD, - 3.07 [95% CI, - 5.08, - 1.05]; P < 0.01). The improvement of AOFAS and VAS scores at ≥ sixmonths follow-up reached the minimal clinically important difference (MCID). Nevertheless, the treatment effect of AOFAS and VAS scores offered by PRP at short-term follow-up did not exceed the MCID. Substantial heterogeneity was reported at the ≥ sixmonths follow-up in VAS scores (I2: 93%, P < 0.01). This meta-analysis supports the safety of PRP intra-articular injection for ankle OA. The improvements of AOFAS and VAS scores in the PRP group at short-term follow-up do not exceed the MCID to be clinically significant. PRP injection provides significant improvement of AOFAS score and reduced pain at ≥ sixmonths follow-up. The efficacy of PRP should be interpreted with caution regarding the high heterogeneity and the scarcity of available literature, which urges large-scale RCTs with longer follow-up to confirm the potential efficacy of PRP injection for ankle OA.

A clinical study of C arm-guided selective spinal nerve block combined with low-temperature plasma radiofrequency ablation of dorsal root ganglion in the treatment of zoster-related neuralgia.

This study evaluated the analgesic efficacy and psychological response of low-temperature plasma ablation of dorsal root ganglion (DRG) combined with selective spinal nerve block in patients with acute or subacute zoster-related neuralgia (ZRN). Totally 90 ZRN patients were randomly and evenly divided into three groups. Treatment was given to Group A using C arm-guided selective spinal nerve block (C-SSVB), Group B using C-SSVB and pulsed radiofrequency (PRF), and Group C using C-SSVB and low-temperature plasma ablation of the DRG. The outcomes were examined using the Visual Analog Scale (VAS). Anxiety and depression of patients were evaluated using the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). Quality of life was assessed using the Pittsburgh Sleep Quality Index (PSQI) and postoperative Satisfaction scale. In addition, data on adverse events and medication usage rates were collected. The 90 patients were eligible for this study. The three treatments reduced VAS scores with no significant difference between groups A and B at the same time points; however, group B tended to have numerically lower VAS scores. Comparatively, group C had significantly reduced VAS scores on day 1 and 1 month after treatment compared with the other two groups. In terms of the decreasing SAS, SDS and PSQI scores, all the three treatments improved the anxiety, depression and sleep quality of the patients. In addition, significant alleviation in anxiety was found in group C compared with group A at all- time points. However, there was no statistically significant difference among the three groups in treatment-related adverse events that mainly focused on puncture pain at the surgical-site, skin numbness and medication usage rates. C-SSVB and LTPRA of DRG will be considered as a promising treatment option for ZRN patients if those results can be confirmed after further validation.

The Comparison Of The Low-Level Laser Therapy And High Intensity Laser Therapy On Pain And Functional Ability In Knee Osteoarthritis

Introduction: Osteoarthritis (OA) of the knee causes disability due to pain and will affect the functional ability to walk. Low-Level Laser Therapy (LLLT) has been shown to reduce pain in knee OA, while High Intensity Laser Therapy (HILT) is able to reach deeper joint areas.&#x0D; Method: This study aimed to compare the effect differences between LLLT and HILT on pain and functional capacity in knee OA. Methods: This is a double-blind randomized controlled trial with 61 subjects randomized into LLLT (n=31) and HILT (n=30) groups. All the subjects were knee OA patient with Visual Analog Scale (VAS) ≥ 4. The laser therapy and exercise were given 3 times per week for 6 sessions. The pain scale evaluated using VAS and functional ability evaluated using 50-feet walk test.&#x0D; Result: After 6 sessions, both LLLT and HILT group showed reduced VAS score [∆VAS Score LLLT = 3 (2 – 4), HILT = 3 (2 – 5)] and increased walking speed (∆ walking speed for LLLT = 0.23 (0.02 – 1.24) m/s, HILT = 0.22 (0.08 – 0.7) m/s) which were statistically (p &lt; 0.001) and clinically significant. HILT group had faster walking speed and greater VAS reduction compared to LLLT group (p &lt; 0.001), but there was no significant difference in walking speed between two groups (p=0.655).&#x0D; Conclusion: HILT and LLLT combined with exercise were effective in reducing pain and increasing functional ability in knee OA after 6 sessions of intervention. Pain and functional ability improvement was faster and greater in HILT group than LLLT group.&#x0D;

Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial

To evaluate the efficacy and safety of acupuncture in the treatment of endometriosis-associated pain. A multicenter, randomized, single-blind, placebo-controlled trial. Four tertiary hospitals in Jiangxi and Hainan Provinces. Women with endometriosis-associated pain aged between 20 and 40 years. Subjects were assigned randomly to receive either acupuncture or sham acupuncture treatment for 12 weeks, starting one week before each expected menstruation and administered as a 30-minute session once per day, 3 times a week. During the menstruation period, acupuncture was administered daily when pelvic pain associated with endometriosis occurred. After acupuncture or sham acupuncture treatment, the subjects were followed for another 12 weeks. Changes in maximum pain as assessed with the visual analog scale (VAS) for various pelvic pain, duration of dysmenorrhea, and scores on the Multidimensional Pain Inventory, Beck Depression Inventory, Profile of Mood States, and Endometriosis Health Profile from baseline to week 12 and week24. A total of 106 women were assigned randomly to the acupuncture and sham groups. In the acupuncture group, the reduction in the dysmenorrhea VAS score was significantly greater after treatment, but not at the end of the trial, compared to the sham group. The duration of pain was significantly shorter in the acupuncture group. All test scores were improved to a significantly greater extent in the acupuncture group than in the sham group at week 12 but not at week 24. Changes in nonmenstrual pelvic pain and dyspareunia VAS scores were not different between the groups. No severe adverse events or differences in adverse events were recorded. Acupuncture is an effective and safe method of relieving dysmenorrhea, shortening the pain duration, and improving wellbeing and quality of life in women with endometriosis-associated pain, although its efficacy fades after treatment is discontinued. NCT03125304.

Clinical efficacy of transforaminal endoscopic discectomy in the treatment of recurrent lumbar disc herniation: a single-center retrospective analysis

PurposeTo investigate the clinical efficacy of transforaminal endoscopic discectomy (TED) in treating recurrent lumbar disc herniation.MethodsClinical datal of 31 patients who were hospitalized in the Department of Pain Management, First Affiliated Hospital of Nanchang University, between 2015 and 2018 due to recurrent lumbar disc herniation were collected and analyzed retrospectively. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were used to assess alterations of patients’ leg pain intensity and nerve function, respectively. The Modified MacNab criteria were used to evaluate patients’ excellent and good rates.ResultsCompared to clinical data before surgery, there was a significant reduction in VAS scores (P < 0.01) along with a significant improvement in JOA scores (P < 0.01) at 2 years after revision surgery. The patients’ excellent and good rates were 83.9% at the 2 years after surgery.ConclusionThe TED is safe and effective in the long term and is applicable to the treatment of recurrent lumbar disc herniation.

Modified minimally invasive surgery in reconstructing the temporomandibular joint disk by transplantation of the temporalis myofascial flap

ObjectiveThe transplantation of temporalis myofascial flap (TMF) is an indispensable method to treat severe temporomandibular joint disorders with disk failure. How to select the indication and the ways of transplantation is still a challenging topic for achieving the ideal effect. We reported the new methods and follow-up results of the patients treated with pedicled TMF transplantation.MethodsRetrospective case series was performed at Temporomandibular Joint Specialist Clinic, the First Affiliated Hospital of Xinjiang Medical University, from December 2014 to August 2022. 39 patients (50 sides) included anterior disk displacement without reduction and disk perforation who underwent discectomy and immediate reconstruction with pedicled TMF. The initial and postoperative maximum mouth opening (MMO), and pain visual analogue scale (VAS) were compared via paired t-test and Wilcoxon signed-rank sum test, respectively.ResultsThe average of follow-up time was 30.07 months. The reconstructed temporomandibular joints basically achieved stable occlusion, good function, and satisfactory effect. The patients displayed a remarkable reduction of VAS score of pain, and improvement of the MMO compared with that before operation (P < 0.001). MR scanning revealed the grafts in joint space showed band-shaped soft tissue density of medium signal and had the clear edges, without interruption and fragment.ConclusionReconstruction of the temporomandibular joint disk by transplantation of the TMF applying modified minimally invasive surgery was a feasible method, which could improve the function of joints and prevent adhesion, without obvious complications in donor region.

Functional Anterior Knee Pain and Return to Sport Following Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction

Background: Bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction is a frequently used technique but has been associated with a high incidence of postoperative anterior knee pain. However, previous studies have not evaluated if this anterior knee pain is functionally limiting for patients. This study introduces the concept of functional anterior knee pain, or kneecap pain that limits patients' ability to return to their prior level of activity or sport. Methods: We reviewed BPTB ACL reconstructions from April 2013 to May 2017. Patients included in the analysis had a minimum of 1 year of clinical follow-up and 3 years of survey follow-up. Statistical analyses were performed using paired t tests and binomial test. Results: Sixty-seven patients met the inclusion criteria. Compared to the mean preoperative visual analog scale (VAS) pain score of 6.1, patients reported statistically significant reductions in VAS scores at 1 year and 3 years postoperatively to 0.9 and 1.8, respectively (P<0.01). The incidence (28.4%) of anterior knee pain was highest at the 3-month time point. This incidence decreased to 6.0% at 1 year and 7.5% at 3 years postoperatively. At 3 years postoperatively, 94% (63/67) of the patients in this study were not limited by functional anterior knee pain and returned to preoperative levels of activity and sport. Conclusion: To our knowledge, this investigation is the first to define and quantify the relationship between postoperative anterior knee pain and resultant functional limitations. This study shows that ACL reconstruction with BPTB autograft was not significantly associated with functional anterior knee pain in our population and that the incidence of postoperative anterior knee pain following BPTB ACL reconstruction may be less than previously reported.

Erector spinae plane block for postoperative analgesia following percutaneous nephrolithotomy under spinal anaesthesia- A randomised controlled study.

Postoperative pain is a multitude of various irksome sensory, emotional and mental experiences aggravated by surgical trauma and associated with autonomic, endocrine, metabolic, physiological and behavioural responses. The aim of this study was to evaluate the effect of erector spinae plane block (ESPB) in postoperative analgesia following percutaneous nephrolithotomy (PCNL) under spinal anaesthesia. This prospective randomised study was conducted on sixty American Society of Anesthesiologists physical status I and II patients scheduled for PCNL under spinal anaesthesia. They were randomised into two equal groups of thirty patients. ESPB was given in group A with 20 ml of injection bupivacaine 0.25% and dexamethasone 8 mg and group B received injection tramadol 1.5 mg/kg intravenously immediately after PCNL. The primary outcome was comparison of visual analogue scale (VAS) score in the first 24 h postoperatively, whereas secondary objectives included hemodynamic variables and requirement of rescue analgesia. VAS score in group A (ESPB) with mean of 3.15 ± 0.68 was comparatively low when compared to group B with mean of 6.61 ± 0.50 at 6 hours. After 4 h postoperatively, VAS scores continued to be higher and significant number of patients required rescue analgesia in group B. ESPB reduced VAS score, provided adequate postoperative analgesia, with similar haemodynamic changes and adverse effects in comparison to the conventional analgesia with tramadol in PCNL.

The Effectiveness of Osteochondral Autograft Transfer in the Management of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis.

Osteochondral lesions of the talus (OLT) are common following ankle trauma. Operative treatment is often required, with osteochondral autografting frequently performed for large or cystic lesions, or following failed primary surgery. The aim of this systematic review was to evaluate the current evidence for osteochondral autograft transfer system (OATS) in the management of OLT. A systematic search of the PubMed, EMBASE, Scopus, and Cochrane Library databases was performed based on the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Study quality was assessed using the modified Coleman Methodology Score (CMS). Meta-analysis was carried out using RevMan, version 5.4 (The Cochrane Collaboration, 2020). A total of 23 studies were included. The mean modified CMS was 48.1±7.47. Fourteen studies reported preoperative and postoperative Visual Analog Scale (VAS) and American Orthopaedic Foot & Ankle Score (AOFAS). The aggregate mean preoperative and postoperative VAS scoreacross 14 studies was 6.47±1.35 and 1.98±1.18, respectively. Meta-analysis of seven studies on 210 patients found that OATS resulted in a significant reduction in VAS score compared to baseline (Mean Difference {MD} -4.22, 95% Confidence Interval {CI} -4.54 to -3.90, P < 0.0001). The aggregate mean preoperative and postoperative AOFAS scores across 14 studies were 56.41±8.52 and 87.14±4.8, respectively. Based on eight studies on 224 patients, OATS resulted in a significant improvement in AOFAS score compared to baseline (MD 29.70, 95% CI 25.68 to 33.73, P = < 0.0001). Donor site pain occurred in 9% of cases. Current evidence from low-quality studies suggests that OATS is a safe and effective treatment option for OLT, though it is associated with a risk of donor site morbidity.

Deep breathing alleviates propofol-induced pain: a prospective, randomized, single-blind study.

Propofol is commonly used to induce general anesthesia; however, the pain caused during propofol injection is a disadvantage. This study aimed to assess whether deep breathing attenuates propofol injection pain. This prospective, single-blind, randomized controlled study included 200 patients who were scheduled to undergo elective surgery under general anesthesia and randomly and equally divided them into group D and group C. The observers were not blinded to the pain-relieving modality, but each patient was blinded. Group D patients were requested to repeatedly take deep breaths throughout general anesthesia induction with propofol. Group C patients were requested to breathe in the usual manner. The intensity of propofol injection pain was evaluated using the visual analog scale (VAS). Furthermore, we recorded the patients' pain expressions, including grimace or hand-withdrawal, and the recalled pain measured using a VAS in the post-anesthetic care units (PACU). Compared with patients in group C, those in group D showed significantly reduced VAS scores for propofol injection pain (20 [interquartile range (IQR): 0-48] vs. 37 [IQR 9-65], P = 0.017) and recalled pain in the PACU (16 [IQR 0-32] vs. 26 [IQR 0.5-51], P = 0.031). Further, the grimace incidence was significantly lower in group D (18%) than in group C (45%) (P < 0.001). There was no significant difference in the incidence of pain at induction, recalled pain, or hand-withdrawal. Deep breathing could be an easy, safe, and inexpensive method for reducing pain during propofol injection.

Comparison of 0.12% Chlorhexidine and a New Bone Bioactive Liquid, BBL, in Mouthwash for Oral Wound Healing: A Randomized, Double Blind Clinical Human Trial.

Following surgery, healing within the oral cavity occurs in a hostile environment, and proper oral care and hygiene are required to accelerate recovery. The aim of the current study is to investigate and compare the bioreactivity characteristics of mouthwashes based on either chlorhexidine (CHX) or a novel bone bioactive liquid (BBL) in terms of oral healing within seven days application post-surgery. A randomized, double blind clinical trial was conducted in 81 patients, wherein the mouthwashes were applied twice a day for a period of 7 days. The visual analog scale (VAS) protocol was applied to determine pain index scores. Early wound healing index (EHI) score was determined for evaluating oral cavity healing progress. No adverse effects were observed using the mouthwashes, but CHX application resulted in stained teeth. Applications of both CHX and BBL were sufficient to reduce pain over a period of 7 days. However, the BBL group demonstrated a statistically significant reduction in VAS scores starting on day 4. The EHI scores were significantly higher in the BBL group compared with the CHX group, independent of tooth location. No differences in either VAS or EHI scores due to gender were observed. Compared with the commercially available CHX mouthwash, application of the BBL mouthwash reduced pain and accelerated oral cavity healing to a greater extent, suggesting it effectively improves the oral cavity microenvironment at the wound site in mediating soft tissue regeneration.

Efficacy of Ayurveda formulations, Panchamrit Lauha Guggulu and Panchguna Taila in the management of Cervical Spondylosis (Greevagraha)

BACKGROUND: Cervical spondylosis (CS) is a degenerative disease of intervertebral discs with the formation of osteophytes in the cervical vertebrae. Based on the similarity in symptoms such as intermittent neck and shoulder pain, pain and stiffness radiating to the shoulder or occipital region, restricted neck movements, numbness, and weakness in arms, hands, and fingers, CS can be correlated with Greevagraha—a disease of the neck narrated in Ayurveda. In Ayurveda, the formulations Panchamrit Lauha Guggulu (PLG) and Panchguna Taila (PGT) have been narrated in treating musculoskeletal disorders. OBJECTIVE: The objective of the study was to evaluate the clinical efficacy and safety of PLG and PGT in the management of CS. MATERIALS AND METHODS: It was a prospective, single-arm, open-label clinical study. A total of 63 patients aged 30–60 years diagnosed with CS have been treated with PLG 250 mg twice a day orally with lukewarm water after food and an external application of PGT at the neck region. The total duration of the treatment was 12 weeks, with a follow-up every 2 weeks and a post treatment follow-up after 2 weeks of the treatment. The outcome measures include change in Northwick Park Neck Pain Questionnaire (NPNPQ) score, Visual Analog Scale (VAS) score for cardinal features, SF-36 (research and development [RAND]) Health Survey Score, and incidence of adverse events (if any). RESULTS: At baseline, X-ray findings of all participants (100%) had degenerative changes at different levels of cervical vertebrae; however, posttreatment X-ray findings (on the 84th day of study) showed normal X-ray findings in eight participants (5.04%). A significant reduction in the total VAS score (P &lt; 0.001) was observed on day 84 and day 98. The mean NPNPQ score reduced significantly (P &lt; 0.0001), and a highly significant change was observed in the SF-36 Health Survey Score (P &lt; 0.0001). No adverse events were reported during the study period. CONCLUSIONS: PLG and PGT have shown promising outcomes in managing CS and were also safe. However, randomized control trials with adequate sample size, standard care as control, and a longer follow-up may be planned to establish the findings of this preliminary study.

An Observational Study of Quality of Life in Patients of Allergic Rhinitis in a Tertiary Health Care Centre of South Gujarat.

Allergic rhinitis (AR) refers to an IgE-mediated inflammation following exposure to allergen. Often deemed as a minor inconvenience rather than a disease, AR impairs the QOL. Medical treatment has a beneficial effect. To evaluate the QOL in patients of AR. Patients of AR with ≥ 18 years age, receiving treatment in our department are included. Pre and Post treatment VAS (Visual Analogue Scale) and RSDI (Rhinosinusitis Disability Index) are compared to know the effect of disease and treatment on QOL. The patients of PAR (Persistent Allergic Rhinitis) had a greater impact on QOL. In PAR, a combination of INCS (Intranasal Corticosteroids) + oral antihistaminics result in significant reduction in VAS & RSDI scores. In IAR (Intermittent Allergic Rhinitis), Oral antihistaminics monotherapy was most effective in reducing itching while Oral antihistaminics + 1 week of intranasal decongestant was most effective in reducing sneezing, running nose and nasal blockage. Oral antihistaminics + LTRA (Leukotriene Receptor Antagonist) was most effective in reducing physical RSDI score. Oral antihistaminics + 1 week of intranasal decongestantwas most effective in reducing functional and emotional RSDI score. Functional RSDI scores had improved much higher than emotional and physical scores. All these observations were statistically significant. AR does affect the QOL while pharmacotherapy helps in improving the overall QOL. Oral antihistaminic alone or in combination with local decongestant/LTRA in IAR cases while INCS + oral antihistaminic in PAR cases are significantly effective in controlling symptom scores and QOL.