Reduction Of Postoperative Pain Research Articles

Pulsed electromagnetic fields (PEMF) as a valid tool in orthognathic surgery to reduce post-operative pain and swelling: a prospective study.

PEMF (pulsed electromagnetic fields) founds application in several medical fields to accelerate bone wounds healing and to reduce inflammation. The aim of our study was to evaluate the effectiveness of PEMF in reducing postoperative swelling and pain in patients undergoing orthognathic surgery. A prospective observational monocentric study was conducted on a sample of 30 patients undergone to orthognathic surgery in Maxillofacial Surgery Unit of University of Naples Federico II. The patients who followed these inclusion criteria were enrolled in the study: age ≥ 18 years, Class III malocclusion, Surgical procedure of Le Fort I osteotomy + Bilateral Sagittal Split Osteotomy (BSSO), Written informed consent. Patients were divided into two groups: Group SD) postoperative standard treatment with medical therapy and cryotherapy, Group SD + PEMF) postoperative standard therapy + PEMF. Each patient underwent a 3D facial scan, at one (1d) and four (4d) days after surgery to compare the swelling reduction. The pain score was assessed through VAS score and analgesics administration amount. In SD + PEMF group, the facial volume reduction between 1d and 4d scan was on average 56.2ml (6.23%), while in SD group, it was 23.6ml (2.63%). The difference between the two groups was 3.6% (p = 0.0168). VAS pain values were significantly higher in SD group compared to SD + PEMF group in the second day after surgery (P = 0.021) and in the total 4 days (P = 0.008). Our data suggest that PEMF is valid tool to promote faster postoperative swelling and pain reduction in patients undergoing orthognathic surgery.

Evaluating the Efficacy of Methocarbamol and Nefopam in Orthopedic Surgical Pain.

Introduction Pain after orthopedic surgeries represents a special concern in patients with fractures. The use of multimodal analgesia significantly reduced the opioid need and reduced the risk of their side effects. Objectives This study compared the effectivenessand safety of methocarbamol and nefopam in the reduction of post-operative pain for patients undergoing orthopedic surgeries. Method This prospective, double-blind, randomized controlled trial took place at Al-Sader Teaching Hospital in Basrah, Iraq, from the first of February 2022 to the end of October 2023. The study aimed to assess the post-operative pain relief efficacy and safety of intramuscular nefopam (20 mg) and intravenous methocarbamol (1 g) in 110 adults (aged 18-65) undergoing elective orthopedic surgeries. Exclusions were made for allergies to the drugs, substance abuse history, and severe hepatic or renal impairment. Participants were randomized into two groups, with pain intensity measured at one hour, six hours, and 12 hours post-operation using the visual analog scale (VAS). Side effects were also evaluated. Statistical analysis was done using SPSS 27, with a significance level set at p<0.05 and a 95% confidence interval (CI). Results In this study, we conducted a rigorous comparison between two groups, methocarbamol and nefopam, to evaluate their efficacy and safety in post-operative pain management. We started by ensuring that the groups were well-matched in terms of age, gender distribution, and body mass index (BMI). The results showed remarkable similarities in mean age, gender distribution, and BMI, supported by robust p-values, affirming the effective matching of the two groups. Moving to pain management, we observed a significant advantage in favor of methocarbamol. At all-time intervals (one hour, six hours, and 12 hours post-operation), methocarbamol consistently demonstrated lower mean VASscores compared to nefopam. These differences were highly statistically significant, underscoring the superior pain relief efficacy of methocarbamol. Exploring side effects, we found no statistically significant disparities in the occurrence of nausea and vomiting between the two groups. However, there was a noticeable trend towardhigher tachycardia incidence in the nefopam group, though it did not reach statistical significance. Conclusion The present study showed a higher efficacy of methocarbamol in post-operative pain reduction in comparison to nefopam. No serious side effects were observed with both drugs.

Comparative study of mesh fixation versus without mesh fixation in laparoscopic inguinal hernia repair by TAPP approach

Background: An inguinal hernia is a protrusion of abdominal contents through the inguinal canal. Laparoscopic TAPP inguinal hernia repair without mesh fixation is comparitively easy and safer than TAPP with mesh fixation with no increase in recurrence rate. Hence the current study was conducted to analyse complications after laparoscopic inguinal hernia repair (TAPP) with mesh fixation vs without mesh fixation in patients with inguinal hernia. Patients has provided informed consent for publication. Methods: It was an observational cohort study, comparing the outcome in 60 patients undergoing laparoscopic TAPP for inguinal hernia, where patients were randomly allotted into two groups as 30 with mesh fixation and 30 without mesh fixation over a period of two years October 2020 to September 2022. Results: In the current study, we observed that recurrence was reported among 3.33% study subjects without mesh fixation. While Recurrence reported among 6.67% study subjects with mesh fixation. However, the difference in the observations was statistically not found to be significant and there is significant reduction in postoperative pain, operation duration and hospital stay duration in laparoscopic TAPP without mesh fixation group. Conclusions: It was observed that laparoscopic TAPP repair without mesh fixation does not increase recurrence rate but reduces operative duration, hospital stay duration and decreases the incidence of postoperative pain compared to laparoscopic TAPP with mesh fixation.

Holistic approaches to living well with endometriosis

Endometriosis is a common chronic condition for which there is currently no cure. Those suffering from endometriosis-related pelvic pain (ERPP) may struggle with side effects and/or risks presented by conventional medical and surgical treatment strategies, or not get pain relief. Increasing numbers of endometriosis patients wish to explore holistic management with fewer side effects, however it is important that medical professionals maintain an evidence-based practice for recommended treatments. We present up-to-date evidence of holistic strategies used for managing ERPP including nutritional strategies, body and mind therapies, acupuncture, traditional Chinese medicine (TCM) and the use of adjunct devices such as phallus length reducers and transcutaneous electrical nerve stimulation (TENS). Recent findings Nutrition: Gluten-free, low-nickel and high intake of omega-3 polyunsaturated fatty acids diets improve ERPP. Low FODMAP (fermentable oligo-, di-, monosaccharides and polyols) is helpful in those with concurrent irritable bowel syndrome. Body and mind: Cognitive behaviour therapy (CBT) is particularly beneficial in postoperative pain reduction, whilst mindfulness has been shown to reduce pain scores and dyschezia. Progressive muscle relaxation therapy and regular yoga sessions improve ERPP and Quality of life. Acupuncture: 15 randomised control trials assessing acupuncture and moxibustion show improved pain scores when compared to those receiving conventional therapies alone. Adjunct devices: TENS improves deep dyspareunia and lessens the number of days pain is experienced. Conclusions Holistic management strategies for ERPP should be incorporated into routine counselling when discussing conservative, medical and or surgical treatments for endometriosis. The growing evidence presented for the use of holistic management strategies gives hope to those patients who cannot have, or don’t respond to conventional approaches and as an adjunct alongside standard treatments.

Impact of Single-Session Intraoral and Extraoral Photobiomodulation on Pain Control after Extraction of Impacted Mandibular Third Molar: A Pilot Study

This study aims to evaluate the impact of a single session of intraoral and extraoral photobiomodulation (PBM) on controlling pain and improving a patient’s daily activities following surgical extraction of the impacted mandibular third molar, using combined three wavelengths: “445 nm, 660 nm, and 970 nm”. A pilot study was conducted on 22 patients undergoing extraction of an impacted mandibular third molar. The patients were randomly divided into two groups: (1) The Test Group consisted of patients subjected to immediate postoperative PBM. The extraoral PBM parameters were power = 550 mW and spot area = 5 cm2, while the intraoral parameters were power = 200 mW and spot area = 2 cm2. (2) The Control Group consisted of the patients not subjected to PBM. For all the patients, the pain was evaluated via a Numeric Rating Scale (NRS) on day 0, day 1, day 3, and day 7 after surgical intervention. The patient’s daily activities were evaluated on day 7 via a custom-made questionnaire. A statistically significant difference was observed between groups in the pain NRS scores on day 0 (p = 0.022), day 1 (p = 0.047), and day 7 (p = 0.028). No significant difference was found on day 3 (p = 0.153). A marginal statistical significance was observed with the number of painkillers taken (p = 0.054). No significant difference was observed with the questionnaire score (p = 0.206). This pilot study showed a significant reduction in postoperative pain on days 0, 1, and 7 with a single session of intraoral and extraoral PBM. However, the number of painkillers taken and the scores of the daily activities questionnaire did not show statistical significance despite the observed better results in patients subjected to PBM.

Assessment of Patient Characteristics Influencing the Analgesic Effects of Ibuprofen Gargle After Mandibular Third Molar Extractions.

Introduction In our previous work, we investigated the analgesic effects of ibuprofen gargle after mandibular third molar extractions. However, a subsequent detailed review of individual patient data revealed variations in postoperative pain reduction among patients. Consequently, the present study was designed to conduct post-hoc subanalyses that identified factors contributing to variation in the analgesic response to ibuprofen gargle after third molar extractions. Materials and methods This study involved thirty-five Japanese patients from a prior randomized, double-blind, placebo-controlled, crossover study, which focused on the analgesic effects of ibuprofen gargle after mandibular third molar extractions. Participants were categorized as responders (n = 13) and non-responders (n = 22) based on the within-subject difference (ibuprofen-placebo, IP) of visual analog scale (VAS) changes. Baseline characteristics were compared, along with variables, such as age, sex, the reason for extraction, extraction site, Pell Gregory (space and depth) classification, Winter's classification, surgeon's experience, and surgery time. Baseline characteristics predicting responder status were examined using multivariate logistic regression. Results In the univariate analysis, variables such as age, sex, and baseline VAS scores with p-values <0.2 were evaluated using a stepwise approach. This analysis identified age (per -10 years) with an odds ratio of 4.163 (95% confidence interval (CI): 1.170-31.952, p = 0.0233) and sex (female) with an odds ratio of 9.977 (95% CI: 1.336-208.256, p = 0.0213) as significant predictors of responder status. Conclusions In young and female patients, ibuprofen gargle decreased postoperative pain after mandibular third molar extractions.

A systematic review and meta-analysis on the effects of phototherapy on postoperative pain in conventional endodontic reintervention.

This systematic review and meta-analysis (SRM) aimed to evaluate the efficacy of laser phototherapy (LPT) on the reduction in postoperative pain (PP) of endodontic origin after conventional/non-surgical reintervention of root canals. This SRM was registered with PROSPERO (CRD42021243500) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Meta-analysis was conducted using R software with the "META" package, the mean difference (MD) measure of effect was calculated, and the fixed effect model was applied with a 95% confidence interval (CI). The Cochrane collaboration scale was used to assess the risk of bias and the GRADE tool to assess the quality of evidence. Initially, 1028 articles were found, and five articles were included. Most studies were classified as "low" risk of bias. Of the five clinical studies, four showed a significant decrease in PP after endodontic reintervention in the LPT groups compared to the control group, especially in the first four days after the intervention. In symptomatic teeth with multiple roots, LPT led to less PP at 24h (MD -0.52 [-1.03; -0.02] p = .04). However, no significant difference between the groups was found at 48 and 72h (p > .05). The certainty of the evidence was classified as low. Despite the limitations of this SRM, LPT was shown to be a promising alternative for reducing and controlling PP in conventional endodontic reintervention. The use of LPT in endodontic reintervention may be a safe and promising alternative to clinically efficacious agent for use in the management of PP in this procedure.

Quadratus lumborum block in laparoscopic inguinal hernia repair: A single center study.

Objective: To evaluate the efficacy of QL block in patients undergoing laparoscopic TEP inguinal hernia repair. Study Design: Randomized Clinical Trial. Setting: Kalsoom International Hospital, Islamabad. Period: Dec 2022 to June 2023. Methods: In this, all patients between the ages of 18 and 70 who were scheduled for laparoscopic TEP inguinal hernia repair to repair a one-sided inguinal hernia and did not have any complications related to the hernia. In one group, the patients received general anesthesia and in the other group, the patients were given sedation along with a technique called QL block. Age, gender, pain score on VAS at 1 hours, 6 hour and 12 hours after procedure was noted. Comparison of pain according to the VAS by type of anesthesia was done between the two groups and independent sample t-test was applied to see the statistical significant. Results: The patients' mean age was 43 + 9.09 years. Around 70% of the patients were males, while 30% were females, indicating a male predominance. The study's outcome was the mean pain score after 1 hour, 6 hours, and 12 hours. The two techniques of anesthesia utilized in the two groups were compared in terms of pain. The mean VAS at 1 hour after the initiation of anesthesia was not significantly different between the two groups, but it was statistically significant at 6 and 12 hours (p value of 0.001). Conclusion: QL block is a safe and effective alternative for patients undergoing TEP inguinal repair because to the observed reduction in early postoperative pain, shorter hospitalization, and cheaper anesthetic and hospital costs. Although our research showed that pain was significantly reduced for up to 12 hours after the operation, more information is needed before we can confidently endorse it for widespread use.

Effect of Propolis nanoparticles versus sodium hypochlorite as root canal irrigant on postoperative pain and bacterial reduction in mandibular premolars with necrotic pulps: a randomized clinical trial

Effect of Propolis nanoparticles versus sodium hypochlorite as root canal irrigant on postoperative pain and bacterial reduction in mandibular premolars with necrotic pulps: a randomized clinical trial

The Effect of Cannula Drain in Reducing Edema and Ecchymosis after Rhinoplasty.

Rhinoplasty is one of the most common plastic surgeries and is commonly associated with postoperative edema, ecchymosis, and pain which play a role in patients' dissatisfaction. In this randomized comparative study, we discuss the effect of cannula drainage in the reduction of postoperative periorbital edema, ecchymosis, pain, and nasal obstruction after open structural septorhinoplasty. The study was conducted at a tertiary referral center from April to November 2022. We performed internal lateral osteotomy on all patients using the lateral saw and aided by lateral osteotome. At the end of the procedure, a cannula drain is prepared and inserted in the subperiosteal tunnel on the left side only. Patients were examined on the 1st, 3rd, 7th, 14th, and 21st days for periorbital edema, ecchymosis, pain, and nasal obstruction, and each side is scored separately. A total of 40 patients (80 sides in total) were recruited, 22 females (55%) and 18 males (45%), all of whom were adults (18-44 years old; mean age 29 years). The most frequent age group is those younger than 20 years representing 35% of the sample and the males forming 33.3%. The reduction in edema and pain was statistically significant in the drained sides (p = 0.000) during all the postoperative days. On the other hand, ecchymosis was lower on the drained side but statistically insignificant (p = > 0.29). Nasal obstruction was reduced significantly only on the seventh postoperative day (p = 0.000). The postoperative morbidities associated with rhinoplasty could have important functional and psychological effects on patients. This study demonstrates that inserting a cannula in the subperiosteal tunnel for drainage in rhinoplasty yields a significant clinical and statistical decrease in postoperative periorbital edema and pain with little effect on ecchymosis and nasal obstruction.

Transanal Hemorrhoidal Dearterialization (THD): A Single Center Experience on 100 Consecutive Cases

Introduction. Surgeons, using all available means for the treatment of the hemorrhoidal disease, must make compromises between the radicality of the potential surgical treatment (to prevent recurrence) and the maintenance of the postoperative functionality of the anorectum (avoiding stricture, anal fissures, incontinence, reduction of postoperative pain etc.). Materials and methods. All patients treated with the THD method using a system manufactured by THD S.p.A., Correggio, Italy, consisting of a proctoscope equipped with a Doppler probe and a light source was used to perform the operation. Results. Out of 100 operated patients, 64 (64%) were men and 36 (36%) were women. 54 patients had third degree hemorrhoidal disease, 32 had fourth degree, 7 patients had fourth degree hemorrhoidal disease with active bleeding and 7 patients had second degree hemorrhoidal disease with active bleeding. In the follow-up period, anal fissure formation in two patients and prolapse of a hemorrhoidal node in a treated patient with fourth-degree hemorrhoidal disease were noted. Discussion. It is estimated that more than 50% of the general population will experience at least one episode of symptomatic hemorrhoids during their lifetime. Morphological and hemodynamic changes that occur in patients with hemorrhoidal disease is the finding of an increased diameter of the terminal branches of the superior rectal artery that supplies the hemorrhoidal nodes. These branches are 10–11 in number, of which ligation of up to six is allowed for effective treatment with the THD method. Conclusion. If the THD technique is used according to the established standards, postoperative complications in patients in the form of fecal incontinence and chronic pain have not been described, which is also confirmed in our series. The absence of serious complications while addressing a hemorrhoidal disease at the level of the cause of its occurrence, makes the THD+mucopexy technique applicable in most cases. Correct manipulation of the instruments, precision in dearterization, mucopexy of the rectal mucosa and submucosa are imperative for achieving excellent results.

Predictors for Failure to Respond to Erector Spinae Plane Block Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Retrospective review of prospectively collected data. To identify the risk factors associated with failure to respond to erector spinae plane (ESP) block following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). ESP block is an emerging opioid-sparing regional anesthetic that has been shown to reduce immediate postoperative pain and opioid demand following MI-TLIF-however, not all patients who receive ESP blocks perioperatively experience a reduction in immediate postoperative pain. This was a retrospective review of consecutive patients undergoing 1-level MI-TLIF who received ESP blocks by a single anesthesiologist perioperatively at a single institution. ESP blocks were administered in the OR following induction. Failure to respond to ESP block was defined as patients with a first numerical rating scale (NRS) score post-surgery of >5.7 (mean immediate postoperative NRS score of control cohort undergoing MI TLIF without ESP block). Multivariable logistic regressions were performed to identify predictors for failure to respond to ESP block. A total of 134 patients were included (mean age 60.6 years, 43.3% females). The median and interquartile range (IQR) first pain score post-surgery was 2.5 (0.0-7.5). Forty-nine (36.6%) of patients failed to respond to ESP block. In the multivariable regression analysis, several independent predictors for failure to respond to ESP block following MI TLIF were identified: female sex (OR 2.33, 95% CI 1.04-5.98, P=0.040), preoperative opioid use (OR 2.75, 95% CI 1.03- 7.30, P=0.043), anxiety requiring medication (OR 3.83, 95% CI 1.27-11.49, P=0.017), and hyperlipidemia (OR 3.15, 95% CI 1.31-7.55, P=0.010). Our study identified several predictors for failure to respond to ESP block following MI TLIF including female sex, preoperative opioid pain medication use, anxiety, and hyperlipidemia. These findings may help inform the approach to counseling patients on perioperative outcomes and pain expectations following MI-TLIF with ESP block. III.

Comparison of the popliteal artery and the capsule of the posterior knee (IPACK) block and the genicular nerve block in primary total knee arthroplasty: A prospective randomized trial.

To compare the efficacy of genicular block and interspace between the popliteal artery and the posterior capsule (IPACK) block in the reduction of postoperative pain, the need for rescue analgesics, and the effects on a range of motion (ROM) in patients with TKA. This prospective randomized controlled study was carried out between February and May 2023. Based on the block method, 60 participants were divided into three equal groups. These groups included the IPACK block group (n=20), the genicular block group (n=20), and control group (n=20). Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Society score (KSS) and Oxford Knee score (OKS) were used for clinical evaluation in the postoperative period. The KSS and OKS scores of the IPACK and GNB were significantly lower than the control group (p<0.001, p<0.001). The timed up and go (TUG) values of the IPACK and GNB groups at 12th and 24th hour were significantly lower than the control group (p<0.001, p<0.001). The Tramadol rescue values of the IPACK block and control groups were significantly higher than the GNB group (p=0.028, p=0.001, respectively). The ROM values of the IPACK and GNB groups were significantly higher than the control group (p<0.001, p<0.001). Both GNB and IPACK blocks had a significant positive impact on postoperative pain scores within the initial 24 hours following total knee arthroplasty (TKA). In comparison with IPACK, GNB had lower opioid consumption in the early postoperative period while also promoting better mobilization.

Cyanoacrylate tissue adhesive versus silk sutures for mandibular third molar surgery: a systematic review and meta-analysis.

Cyanoacrylate tissue adhesive has been presented as an alternative to sutures and several studies have compared them. The objective of this meta-analysis was to evaluate the effect of cyanoacrylate tissue adhesive on postoperative pain and swelling, following mandibular third molar surgery. Database search was conducted in MEDLINE/PubMed and Scopus, along with extensive search in the grey literature, including randomized and non-randomized clinical trials that applied cyanoacrylate adhesive for closing mandibular third molar surgical sites and compared it with silk sutures, assessing postoperative pain and swelling. The search ended on September 22, 2023. Of 886 identified articles, six were included and meta-analyzed. Applying cyanoacrylate demonstrated a reduction in the overall postoperative pain (SMD = -0.57, 95% CI -1.00 to -0.15, p = 0.009). A similar outcome was noted when pain was evaluated on the first and last postoperative days, based on controlled clinical trials (SMD = -0.47, 95% CI -0.92 to -0.03, p = 0.04), and randomized trials (SMD = -0.97, 95% CI -1.31 to -0.62, p < 0.00001). Patients/sides received cyanoacrylate showed a decrease in postoperative swelling (SMD = -0.26, 95% CI -0.51 to -0.01, p = 0.04). Following the GRADE rating system, the quality of evidence on pain and swelling was judged as moderate and low, respectively. The use of cyanoacrylate adhesive may offer benefit in reducing postoperative pain and swelling following mandibular third molar surgery. Nevertheless, this should be further investigated, considering the low number of included reports. The current results could help clinicians who perform this procedure to manage postoperative pain and swelling more effectively.

Analysis of the effectiveness of intrapleural analgesia after minimally invasive coronary artery bypass grafting on a beating heart

&lt;b&gt;Purpose&lt;/b&gt;: To determine the effectiveness of intrapleural analgesia (IPA) for pain relief after minimally invasive coronary artery bypass surgery on a beating heart.&lt;br /&gt; &lt;b&gt;Methods&lt;/b&gt;: We prospectively studied 35 patients who underwent coronary artery bypass grafting on a beating heart through a mini thoracotomy access on the left. Patients were divided into two groups: group I received IPA with a catheter (n=16) and group II patients were not introduced intrapleural analgesia (n=19). Postoperative pain was assessed according to the visual analogue scale (VAS), consumption of analgesics, extubation time, arterial blood gas parameters. Adequacy of respiration and lung ventilation were estimated by electrical impedance tomography.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: Extubation time after surgery did not differ in both groups. Arterial oxygen partial pressure was higher (p&amp;lt;0.05) in the first group (160.82±46.98) compared to the second group (111.42±49.26). Regarding the EIT in the quadrant mode, distribution of tidal volume was better in the first group (p&amp;lt;0.05) in the 2nd, 3rd quadrant and in the layer mode, the second layer of the first group showed better results compared to the same layer of the second group. After extubation, average pain score according to VAS was four points for the first group and six points for the second group. On the 1&lt;sup&gt;st&lt;/sup&gt; and 2&lt;sup&gt;nd&lt;/sup&gt; day pain scores were the same in both groups. Postoperative analgesia by promedol was required only for 1 patient (6.25%) from the first group, and 14 patients from the second group (73.7%). Additionally, tramadol was administered to 43.5% (7 patients) of the first group and 26.3% (5 patients) of the second group.&lt;br /&gt; &lt;b&gt;Conclusion&lt;/b&gt;: IPA can be used as one of the effective treatments for postoperative pain in minimally invasive coronary artery bypass surgeries. IPA promotes less use of opioids. An improvement in respiration was observed with reduction in postoperative pain.

Clinical, Radiologic, and Functional Outcomes following Bone Grafting for Metacarpal Non-Unions: A Systematic Review.

Objectives: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt to establish an optimal therapeutic protocol for this complication. Methods: A systematic review was conducted in adherence with PRISMA guidelines. Data collection and analysis were performed in duplicate and confirmed by a third investigator. Our primary outcomes focused on radiological time to bone fusion and rates of non-union. Additionally, functional outcomes and complications were analyzed as means of central tendency. Results: Eighteen studies were included in the systematic review, accounting for a total of 47 patients. The average follow-up time was 12.4 months. Fourteen studies analyzed radiological outcomes, with atrophic non-union representing the most common type. The time to bone fusion, assessed radiologically, following bone graft was an average of 6.9 months (n = 14), with a 100% rate of union in 42 patients. Regarding patient-reported pain improvement, 76% of patients experienced pain relief. Moreover, all patients reported a complete subjective return to baseline hand function. Adverse events, limited to hematoma and seroma, were seen in three patients, representing a complication rate of 11.8% in the examined population. Conclusions: Metacarpal non-union can be treated successfully via vascularized and non-vascularized bone grafting. Based on the available evidence, bone grafts demonstrate favorable union rates, post-operative pain reduction, hand function recovery, earlier bone fusion times, and minimal complications in the context of metacarpal non-union management.

Interpectoral nerve blocks may lower postoperative narcotic use after mastectomy

BackgroundPain management following mastectomy is a significant challenge often requiring opioids. Nonopioid pain management utilizing nerve blocks has been shown in other fields to reduce postoperative opioid use and may be effective for postoperative pain in mastectomy patients. The primary purpose of this study was to compare postoperative opioid use, measured in morphine milligram equivalents (MME), between mastectomy patients who underwent interpectoral nerve block (IPNB) and a historical control group. Secondary outcomes included length of stay (LOS) and postoperative pain scores. MethodsThis is a single-center, retrospective cohort study. The charts of women who underwent mastectomy for cancer without immediate reconstruction from 10/2017–12/2019 were reviewed. Wilcoxon rank sum test was used for unadjusted analysis and multiple linear regression for adjusted analysis. ResultsThere were 105 patients included in this study, of which 37 (35%) underwent IPNB. In unadjusted analysis, median MME use was significantly lower in patients that received IPNB compared to the control group (IPNB = 5, controls = 17, p = 0.03). Patients that received IPNB had an observed reduction in LOS and postoperative pain, though these results failed to reach statistical significance. There were no IPNB-related complications. ConclusionsIPNB may be an effective strategy to decrease postoperative opioid use in mastectomy patients. Larger, prospective studies are needed to further investigate the effectiveness of IPNB.

Laparoscopic Management of Inguinal Hernia: A Systematic Review and Updated Network Meta-Analysis of Randomized Controlled Trials.

Various surgical approaches for inguinal hernia repair have been outlined in medical literature. In most cases, these lesions are repaired by general surgeons. A variety of surgical techniques for the treatment of inguinal hernias have been documented in the medical literature. In 2018, the European Hernia Society (EHS) recommended laparo-endoscopic repair as a preferred approach for adults. This method involves a combination of laparoscopic and endoscopic techniques for hernia repair. The goal of this systematic review is to conduct a thorough examination of the total extraperitoneal vs. transabdominal preperitoneal comparison in inguinal hernia repair, with an emphasis on randomized controlled trials (RCTs). It also intends to conduct a trial sequential analysis (TSA)in order to determine whether more trials and investigations are required or whether there is sufficient evidence to draw a firm conclusion. The study's systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used the PubMed and Google Scholar databases to conduct a thorough web search for articles published between January 2019 and December 2023. The meta-analysis was carried out using Resource Manager Revmanversion 5.4.1 (Revman International, Inc., New York City, New York). After a review of the studies was done, ten studies were selected to be used in conducting the systematic review and meta-analysis. The recurrence rate of TEP treatment was found to be slightly lower than transabdominal preperitoneal (TAPP). The two techniques did not differ in terms of postoperative complications; however, TEP had a marginally lower rate of postoperative pain. Further, the study revealed that there was a decreased risk of wound infections, seromas, and hematomas with total extraperitoneal (TEP) as opposed to transabdominal preperitoneal (TAPP). TEPalso reduced the amount of recovery time needed. After conducting successful hernia treatments, total extraperitoneal and transabdominal preperitoneal both had low rates of complications and recurrence. Based on the information obtained from the study analysis, this meta-analysis provides evidence for the efficacy of TAPPand TEP techniques in the management of inguinal hernias. Though there was a statistically significant difference while applying both methods in the treatment of hernia (p=0.001), TEPs have been shown to have a lower recurrence rate than TAPPs. Similarly, the TEP method has been revealed to have a slight reduction in postoperative pain compared to transabdominal preperitoneal. However, the two techniques have been shown to have no significant difference in postoperative complications. Further, laparoscopic procedures have proved to be a little bit safer and more effective than open procedures. This has been shown by reduced risk of wound infection, hematoma, seroma, and decreased sensibility while using this method. It accelerated the healing process as well. Thus, depending on the needs of the patients and the experience level of the surgeons responsible for the treatments, inguinal hernias can be repaired using either transabdominal preperitonealor total extraperitoneal techniques since both treatment techniques have generally minimal chance of complications or recurrence as both have proved to safer method.

Effectiveness of port site bupivacaine infiltration in postoperative pain reduction after laparoscopic cholecystectomy: A randomized controlled trial from a tertiary care hospital.

Objective: To determine the effectiveness of port site bupivacaine infiltration in postoperative pain reduction among patients undergoing LC in a tertiary care hospital in Karachi, Pakistan. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Hamdard Hospital, Karachi, Pakistan. Period: April 2022 to September 2022. Material &amp; Methods: Patients of either gender aged between 18-45 years, undergoing elective laparoscopic cholecystectomy were included. Twenty ml of 0.25% bupivacaine solution were locally injected into the intervention group at the port locations. Treatment for the control group was consistent with standard of care. Post-surgery, to measure the severity of the pain, a visual analogue scale (VAS) was utilized and compared. Results: In a total of 170 patients, age, weight, systolic and diastolic blood pressure, ASA grade, SPO2, and the duration of the surgery were not substantially different between the two study groups at baseline (p&gt;0.05). Post-operatively, from third hour till ninth hour pain score, abdominal pain, incisional pain and shoulder pain were significantly lower among the group received local infiltration of bupivacaine. No significant differences were seen at 12th hour. Median time to rescue analgesia was 12 (IQR=6-12) hours and 6 (IQR=6-9) hours among the intervention and control group (p&lt;0.001). Conclusion: This study found lower pain intensity and higher time of rescue analgesia to be associated with local infiltration of bupivacaine at port as compared to control group in the early post-operative period among patients underwent laparoscopic cholecystectomy.

(041) Pre-Operative Bilateral Pudendal Nerve Blocks can Reduce Opioid Utilization for Patients Undergoing Urologic Prosthetic Procedures

Abstract Introduction Opioid related overdoses and deaths have been increasing in recent decades, and recent studies have shown that even short courses of opioids can result in dependence and misuse. Urologic prosthetic procedures can be painful, and historically pain management has been predominantly through opioid-based analgesia. Multimodal pain management plans have been shown to help reduce exposure to opioids, and these include local nerve blockade. Objective Our study aims to assess the efficacy of bilateral pudendal nerve block in post-operative pain management and reduction of opioid use. Methods We conducted a retrospective review of all patients undergoing urologic prosthetic surgeries at a single Canadian institution between September 2020 and June 2023. Prosthetic surgeries included inflatable penile prosthesis (IPP) and artificial urethral sphincter (AUS) implants and explantation/reimplantation, but patients were only included once during the study period. Patients with chronic pain or missing pain data were excluded. Patients received bilateral pudendal nerve blocks at the discretion of the surgeon as a practice change starting in 2021 and compared to a control group (no blocks). Pain was assessed by the nursing care team using an analogue rating scale (out of 10), and all opioid and non-opioid pain medications were blindly recorded by nursing as their part of their usual documentation. Opioid utilization was converted to oral morphine equivalents (OMEs). Primary outcome was OMEs utilization in the post-operative period while in hospital, with a secondary of overall pain scores. Data was analysed using two-sample t-tests, and significance set to a p-value of 0.05. Results Our study included a total of 134 patients, with 59 patients receiving preoperative bilateral pudendal nerve blocks (54 IPP, 5 AUS), and 75 patients receiving the standard protocol (31 IPP, 44 AUS). The median age of patients receiving pudendal nerve blocks was 62.51 compared to the control group median age of 67.81. (p&amp;lt;0.05). There was no difference in ages in sub-analysis of IPP and AUS cohorts. Sub-analysis of the AUS cohort demonstrated a lower median pain score immediately post-op for those receiving blocks compared to control (0.8 vs. 2.73 respectively, p&amp;lt;0.05), with no difference in pain scores otherwise. AUS patients with pudendal nerve blocks consumed significantly less OMEs on day of surgery (median 0 vs. 6.75 OMEs, p&amp;lt;0.05). The IPP cohort with pudendal nerve blocks had no difference in pain scores compared to control, but consumed significantly less OMEs on day of surgery (9.06 vs. 12.56 OMEs respectively, p&amp;lt;0.05) and on post-operative day one (2.99 vs. 7.30 OMEs respectively, p&amp;lt;0.05). Conclusions Preoperative bilateral pudendal nerve blocks appear to reduce post-operative opioid use for patients undergoing urologic prosthetic surgery. Regular use of pudendal nerve blocks for patients undergoing prosthetic and pelvic surgeries may be an efficient means to reduce patient exposure to opioids. Bilateral pudendal nerve blockade for all genital and pelvic surgeries may be an effective opioid harm reduction strategy and warrants further investigation and patient satisfaction outcomes. Disclosure No.