Significant Difference In Visual Analogue Scale Score Research Articles

Comparing the Efficacy of Intra-articular Dexmedetomidine versus Buprenorphine for Postoperative Analgesia Following Arthroscopic Knee Surgeries: A Prospective Interventional Study

Introduction: Arthroscopy for knee surgery is the most often used minimally invasive orthopaedic surgical technique. Postoperative discomfort can be caused by irritation to the nerve endings in the synovial tissue, the fat pad in the front of the knee, and the joint capsule that can take place during the excision and resection. Aim: To compare the efficacy of Intra-Articular (IA) dexmedetomidine versus buprenorphine for postoperative analgesia following arthroscopic knee surgeries. Materials and Methods: A prospective interventional study was carried out for a period of one and a half years from January 2021 to June 2022 at Department of Anaesthesiology B.L.D.E. (Deemed to be University) Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India. Around 80 patients of both genders of American Society of Anaesthesiologists (ASA) grade I and II who were scheduled for arthroscopic knee surgeries were randomly divided into two equal groups of 40 each. After the operation was finished, the patients in each group received the respective medications intra-articularly through an arthroscopy port. Group D received Inj. Dexmedetomidine 100 mcg+ Inj. Bupivacaine 0.25%, 20 mL. Injections of buprenorphine 100 mcg and bupivacaine at a concentration of 0.25% , 20 mL were given to the participants in group B. Immediately following surgery, the patient’s temperature, pulse, Mean Arterial Pressure (MAP), and Visual Analogue Scale (VAS) score for pain were all monitored and recorded at the 1st, 2nd, 4th, 8th, 12th and 24th hour. Time to first rescue analgesia, the number of patients requiring rescue analgesia within the next 24 h, the visual analog scale at rest, and on mobilisation at 1st, 2nd, 4th, 8th, 12th, and 24 hour were measured. Side-effects like sedation, pruritis, nausea, vomiting, respiratory depression, and hypotension were also monitored. Descriptive statistics were reported as mean (SD) for continuous variables, and frequencies (percentage) for categorical variables. Data were statistically evaluated with IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 26.0, IBM Corp., Chicago, IL. Results: The mean age of the study participants was 38.38±11.30 years among the buprenorphine group and 36.40±12.07 years among the Dexmedetomidine group. Among the Buprenorphine group 52.5% were females and 47.5% were males. There was a statistically significant difference in VAS score at rest and mobilisation between the groups. The mean time for first rescue analgesia was longer for the buprenorphine group 1016.22±137.54 minutes and for the dexmedetomidine group, it was 523.67±117.47 minutes. Rescue analgesia was given to 9 (22.5%) in the buprenorphine and 18 (45%) in the dexmedetomidine group. Conclusion: In comparison to IA dexmedetomidine, buprenorphine produces analgesia for a longer period of time and reduces the amount of postoperative rescue analgesic that is required.

Comparison of conservative treatment of lateral epicondylitis with wrist splint and epicondylitis band: Assessing patient compliance and clinical outcomes Short (Running) Title: Compliance with orthoses in lateral epicondylitis

Objective: Lateral epicondylitis, commonly known as "tennis elbow," is a prevalent condition affecting middle-aged individuals. The lack of a universally accepted treatment protocol has led to a variety of conservative options, including wrist splints and epicondylitis bands. However, limited research exists comparing the clinical outcomes and patient compliance associated with these two treatment modalities. Materials and Methods: A total of 120 patients diagnosed with lateral epicondylitis were enrolled in this comparative study. Cohort A (n=62) received treatment with a wrist splint, while Cohort B (n=58) received an epicondylitis band. Patient adherence to the prescribed orthosis was monitored during follow-up visits. Clinical outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and Visual Analog Scale (VAS) scores. Results: Patients in Cohort A exhibited significantly higher adherence rates (90.3%) to wrist splint usage throughout the treatment process compared to Cohort B (60.3%) with epicondylitis bands (p<0.001). At the end of the sixth week, Cohort A demonstrated superior MEPS scores (p<0.001) compared to Cohort B, but there was no statistically significant difference in VAS scores (p=0.149). Both treatment groups showed significant improvement in VAS and MEPS scores compared to baseline (p<0.001). Conclusion: Our study emphasizes the importance of patient compliance in achieving successful outcomes for lateral epicondylitis treatment with orthoses. Wrist splints demonstrated better patient adherence and superior clinical results compared to epicondylitis bands. Proper patient education and clear instructions on orthosis usage are crucial for treatment success.

Ultrasound-guided serratus anterior plane block versus paravertebral block on postoperation analgesia and safety following the video-assisted thoracic surgery: A prospective, randomized, double-blinded non-inferiority clinical trial

Both the anesthetic efficacy of ultrasound-guided serrate anterior plane block (SAPB) and the ultrasound-guided paravertebral block (PVB) in alleviating postoperative pain have been well concerned. This study primarily aims to evaluate whether the ultrasound-guided SAPB and ultrasound-guided PVB can provide comparable analgesia for video-assisted thoracic surgery. Secondarily, the safety and clinical satisfaction of the two blocks are evaluated. It was a prospective, randomized, double-blinded non-inferiority clinical trial involving 99 patients with lung nodules receiving video-assisted thoracic surgery with ultrasound-guided SAPB or PVB on T4 and T7 vertebra using 0.375% ropivacaine at 3mg/kg. The Visual Analogue Scale (VAS) scores at rest and cough at 24h/48h postoperatively and the incidence and severity of chronic pain at 3 and 6 months postoperatively were the primary outcome. Secondary outcomes included the complications and block application time of two kinds of blocks, and consumption of sufentanil as an analgesic rescue. A total of 92 eligible patients were recruited, including 46 in the SAPB group and 46 in the PVB group. No significant differences in VAS scores at rest and cough at first 48h, 3 months, and 6 months postoperatively between the SAPB group and PVB group were detected (all P>0.05). The SAPB group had fewer complications and higher patient satisfaction(P＜0.05). The ultrasound-guided SAPB was not inferior to PVB in alleviating postoperative pain following the VATS with fewer complications and higher patient satisfaction.

Radiological features of degenerative cervical kyphosis and relationship between sagittal parameters

To investigate the radiological features of degenerative cervical kyphosis (DCK) and the relationship between cervical sagittal parameters. The quality of life scores and imaging data of 89 patients with DCK treated between February 2019 and February 2022 were retrospectively analysed. There were 47 males and 42 females, with an average age of 48.4 years (range, 25-81 years). Quality of life scores included visual analogue scale (VAS) score and neck disability index (NDI). The imaging data included C 0-C 2 angle, C 2-C 7 angle, C 3-C 7 inclination of zygapophyseal joints, C 7 slope (C 7S), cervical sagittal vertical axis (cSVA), kyphosis range, and kyphosis focal. The patients were grouped by gender, and the differences of the above parameters between the two groups were compared. Pearson correlation was used to analyze the relationship between age, quality of life scores, and cervical sagittal parameters, and the relationship between cervical sagittal parameters. The preoperative VAS score was 0-9 (mean, 4.3); NDI was 16%-44% (mean, 30.0%). There was no significant difference in VAS score and NDI between male and female groups ( P>0.05). The kyphosis range of cervical spines was C 3-5 in 3 cases, C 3-6 in 41 cases, C 3-7 in 30 cases, C 4-6 in 4 cases, C 4-7 in 10 cases, C 5-7 in 1 case, and the kyphosis focal was mostly located between C 4-C 5 (78/89, 87.64%). The C 3-C 7 inclination of zygapophyseal joints were (60.25±5.56)°, (55.42±5.77)°, (53.03±6.33)°, (58.39±7.27)°, and (64.70±6.40)°, respectively. The C 0-C 2 angle, C 2-C 7 angle, C 7S, and cSVA were (-23.81±6.74)°, (10.15±2.94)°, (15.31±4.59)°, and (2.37±1.19) mm, respectively. The C 7S and cSVA of males were significantly larger than females ( P<0.05), with no significant difference in other parameters between male and female groups ( P>0.05). VAS score and NDI were negatively correlated with C 0-C 2 angle ( P<0.05), and positively correlated with C 2-C 7 angle and cSVA ( P<0.05); VAS score was negatively correlated with C 7S ( P<0.05). Except VAS, NDI and all cervical sagittal parameters were affected by age. Age was positively correlated with NDI, C 7S, and cSVA ( P<0.05), and negatively correlated with C 0-C 2 angle and C 2-C 7 angle ( P<0.05). The correlation analysis of cervical sagittal parameters showed that C 0-C 2 angle was negatively correlated with C 2-C 7 angle and cSVA ( P<0.05); C 7S was negatively correlated with C 2-C 7 angle ( P<0.05) and positively correlated with cSVA ( P<0.05). There was no correlation among other parameters ( P>0.05). The inclination of zygapophyseal joints of cervical spines of DCK patients is U-shaped in the kyphosis range, and the inclination at the kyphosis focal is the smallest. When cervical degenerative kyphosis occurs, in addition to the interaction of sagittal parameters, age, gender, neck pain, and dysfunction will also affect the cervical sagittal balance. Furthermore, cervical curvature and morphological changes are not purely local problems.

A prospective study of vertebroplasty with reverse designed unilateral targeted puncture for osteoporotic thoracolumbar compression fractures

To explore the feasibility and effectiveness of vertebroplasty with reverse designed unilateral targeted puncture in treatment of osteoporotic vertebral compression fracture (OVCF) by comparing with curved unilateral puncture. A total of 52 patients with OVCF met selection criteria and were admitted between January 2019 and June 2021 were selected as the research objects. According to the random number table method, they were divided into two groups ( n=26). In trial group, the reverse designed unilateral targeted puncture was used in the percutaneous vertebroplasty (PVP); while the control group used the curved unilateral puncture. There was no significant difference in gender, age, bone mineral density (T value), cause of injury, time from injury to operation, the level of responsible vertebral body, pedicle diameter of the planned puncture vertebral body, and preoperative visual analogue scale (VAS) score, anterior vertebral height, and Cobb angle between the two groups ( P>0.05). The operation time, bone cement injection volume and leakage, intraoperative radiation exposure times, and hospitalization costs in the two groups were recorded. VAS score was used to evaluate the relief degree of low back pain after operation. X-ray film was used to review the diffusion degree of bone cement in the responsible vertebral body, and Cobb angle and anterior vertebral height were measured. The operation was successfully completed in the two groups. Patients in the two groups were followed up 12-18 months, with an average of 13.6 months. The operation time, volume of injected bone cement, intraoperative radiation exposure times, and hospitalization costs in the trial group were significantly lower than those in the control group ( P<0.05). With the prolongation of time, the low back pain of the two groups gradually relieved, and the VAS score significantly decreased ( P<0.05). And there was no significant difference in VAS score between the two groups at each time point ( P>0.05). There were 2 cases (7.6%) of bone cement leakage in the trial group and 3 cases (11.5%) in the control group, and no significant difference was found in the incidence of bone cement leakage and the diffusion degree of bone cement between the two groups ( P>0.05). Imaging examination showed that compared with pre-operation, the anterior vertebral height of the two groups significantly increased and Cobb angle significantly decreased at 2 days and 1 year after operation ( P<0.05); while compared with 2 days before operation, the anterior vertebral height of the two groups significantly decreased and Cobb angle significantly increased at 1 year after operation ( P<0.05). There was no significant difference in the above indexes between the two groups at different time points after operation ( P>0.05). Compared with curved unilateral puncture, the use of reverse designed unilateral targeted puncture during PVP in the treatment of OVCF can not only achieve similar effectiveness, but also has the advantages of less radiation exposure, shorter operation time, and less hospitalization costs.

Comparative analysis of unilateral biportal endoscopic discectomy, percutaneous endoscopic lumbar discectomy, and fenestration discectomy in treatment of lumbar disc herniation

To investigate the effectiveness of unilateral biportal endoscopic discectomy (UBED), percutaneous endoscopic lumbar discectomy (PELD), and traditional fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). The clinical data of 347 LDH patients who met the selection criteria and underwent discectomy between January 2017 and December 2021 were retrospectively analyzed. They were divided into FD group (160 cases), PELD group (86 cases), and UBED group (101 cases) according to operation methods. There was no significant difference in gender, age, surgical level distribution, disease duration, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between groups ( P>0.05). The operation time, hospitalization stay, treatment cost, and incidence of surgery-related complications were recorded and compared between groups. The patients' pain and functional recovery were evaluated by VAS score and ODI before and after operation. The operation time of FD group was significantly shorter than that of PELD group and UBED group, and the hospitalization stay was significantly longer than that of PELD group and UBED group ( P<0.05); there was no significant difference between PELD group and UBED group ( P>0.05). The treatment cost in UBED group was significantly higher than that in PELD group, and in PELD group than in FD group ( P<0.05). All the patients were followed up 6-24 months, with an average of 14.6 months. VAS score of lower extremity and ODI in 3 groups significantly improved after operation when compared with that before operation ( P<0.05). At 1 day after operation, VAS score of lower extremity of UBED group was significantly better than that in PELD group and FD group ( P<0.05), but there was no significant difference between PELD group and FD group ( P>0.05). There was no significant difference in VAS scores of lower extremity between the 3 groups at 1 and 3 months after operation ( P>0.05). The difference of ODI before and after operation in FD group and UBED group was slightly better than that in PELD group ( P<0.05), and there was no significant difference between FD group and UBED group ( P>0.05). Incidence of surgery-related complications in FD group (20.0%) was significantly higher than that in PELD group (12.8%) and UBED group (6.9%), and PELD group was significantly higher than UBED group ( P<0.05). All the incision infection occurred in FD group (12 cases), symptomatic disc cyst and myeloid hypertension-like occurred in 1 case each in PELD group. UBED, PELD, and FD have similar effectiveness on lower extremity pain in early LDH. Compared with FD, UBED and PELD have the advantage of shorter hospitalization stay and fewer complications.

Comparison of effectiveness of unilateral biportal endoscopy technique and the interlaminar uniportal endoscop technique for treatment of L 5, S 1 lumbar disc herniation

To compare the effectiveness of unilateral biportal endoscopy (UBE) technique with the interlaminar uniportal endoscopy (IUE) technique for the treatment of L 5, S 1 lumbar disc herniation. The clinical data of 69 patients with L 5, S 1 lumbar disc herniation who met the selection criteria between January 2020 and December 2020 were retrospectively analysed. The patients were divided into UBE group (30 cases) and IUE group (39 cases) according to endoscopic surgical technique. The general data, such as gender, age, body mass index, disease duration, and preoperative visual analogue scale (VAS) scores of low back/leg pain and Oswestry disability index (ODI), was not significantly different between the two groups ( P>0.05). Perioperative outcomes [estimated blood loss (EBL), total operation time, extracanal operation time, intracanal decompression time, intraoperative radiation exposure dose, incision length, operative related complications, and postoperative hospitalization stay] and clinical outcomes (VAS score of low back/leg pain before operation and at 3 days, 3 months, 6 months, and 12 months after operation as well as the ODI before operation and at 3 months, 6 months, and 12 months after operation) were recorded and compared between the two groups. All patients completed the surgery successfully. The incision length, EBL, and extracanal operation time in UBE group were significantly longer than those in IUE group ( P<0.05), and the intracanal decompression time in UBE group was significantly shorter than that in IUE group ( P<0.05). There was no significant difference in the total operation time, intraoperative radiation exposure dose, and postoperative hospitalization stay between the two groups ( P>0.05). Patients in both groups were followed up 12-15 months (mean, 13.3 months). Dural tear ocurred in 1 patient of the UBE group, and recurrence ocurred in 1 patient of the IUE group, the others of both groups had no surgery-related complications and recovered well after operation. The VAS scores of low back/leg pain and ODI in both groups at each time point after operation significantly improved when compared with those before operation ( P<0.05); there was no significant difference in VAS scores and ODI at each time point after operation between two groups ( P>0.05). The effectiveness of UBE technique in the treatment of L 5, S 1 lumbar disc herniation is similar to that of IUE technique, and the efficiency of intraspinal operation is better than that of IUE technique. Although UBE technique is inferior to IUE technique in terms of surgical trauma, there is no significant difference in postoperative recovery between the two techniques.

Blood flow restriction training promotes functional recovery of knee joint in patients after arthroscopic partial meniscectomy: A randomized clinical trial.

Purpose: To explore the effect of blood flow restriction training (BFRT) on the recovery of knee function in patients after arthroscopic partial meniscectomy (APM). Methods: Forty patients undergoing APM surgery were included in this parallel group, two-arm, single-assessor blinded, randomized clinical trial. The subjects were randomly divided into two groups: routine rehabilitation group (RR Group, n = 20) and routine rehabilitation + blood flow restriction training group (RR + BFRT Group, n = 20). One subject in each group dropped out during the experiment. All patients received 8 weeks of routine rehabilitation starting from the second day after APM. In addition, patients in the RR + BFRT group required additional BFRT twice a week. Visual analogue scale (VAS) score, range of motion (ROM), one-leg standing test (OLST) score, Lysholm knee score, quadriceps muscle strength, quadriceps thickness, and thigh circumference were evaluated at preoperative, postoperative, 4 and 8 weeks after surgery. SPSS 25.0 software was used for statistical analysis of the data. Repeated measures ANOVA was used if the data were normally distributed and had homogeneity of variance. Generalized estimating equations were chosen if the data were not normally distributed or had homogeneity of variance. Results: There were no significant differences in VAS score, ROM, OLST score, Lysholm knee score, quadriceps muscle strength, quadriceps thickness, and thigh circumference between the two groups before surgery (p > 0.05). Compared with postoperative, VAS score, ROM, OLST score, Lysholm knee score, and thigh circumference were significantly improved in the RR group (p < 0.05), while quadriceps muscle strength and quadriceps thickness were not significantly enhanced at 8 weeks postoperatively (p > 0.05). However, VAS score, ROM, OLST score, Lysholm knee score, quadriceps muscle strength, quadriceps thickness, and thigh circumference were all significantly improved in the RR + BFRT group at 8 weeks postoperatively (p < 0.05). Furthermore, compared with the RR group, VAS score (50% vs. 86%), ROM (7.9% vs. 16.0%), OLST score (57.3% vs. 130.1%), Lysholm knee score (38.4% vs. 55.7%), relative peak torque (11.0% vs. 84.7%), mean power (20.6% vs. 88.1%), rectus femoris thickness (0.40% vs. 13.0%), vastus medialis (0.29% vs. 5.32%), vastus lateralis (0% vs. 6.2%), vastus internus (0% vs. 5.8%), and thigh circumference (2.7% vs. 5.8%) in the RR + BFRT group were significantly improved at 4 and 8 weeks postoperatively (p < 0.05). Conclusion: BFRT combined with routine rehabilitation training can better promote the recovery of knee joint function in patients after APM, especially the improvement of quadriceps muscle strength and thickness.

Comparative study of gap balancing and measured resection technique in patients receiving staged bilateral total knee arthroplasty

Objective: To compare the clinical outcomes of staged total knee arthroplasty (TKA) performed on both knees in the same patient using gap balancing (GB) and measured resection (MR) techniques, respectively. Methods: The clinical data of 57 patients undergoing bilateral staged TKA at the Xi'an Jiaotong University Affiliated Honghui Hospital from July 2018 to January 2020 were analyzed. Using the random number table, MR or GB technique was selected when patients underwent primary TKA, and contralateral procedure was done with another technique. The procedures were performed by one chief surgeon, and the same prosthesis was chosen for all the procedures. The two osteotomy techniques for TKA were compared in terms of surgical status, radiographic data, functional recovery and satisfaction rate. Results: Total of 57 patients, including 16 males and 41 females, were included in the study with a mean age of (68.5±4.6) years (59-79 years) at primary TKA. All patients were followed up for (29.6±4.5) months (22-39 months). The interval between the two procedures was (4.7±3.0) months (0.5-12.0 months). Postoperative drainage was less in the GB side when compared with that in the MR side [(93.6±22.2) ml vs (109.9±36.9) ml, P=0.003]. At the 1-month postoperative follow-up, the visual analogue scale (VAS) of pain was lower on the GB side (3.0±0.8) than on the MR side (3.5±1.2), the range of motion (ROM) was higher on the GB side (105.7°±8.2° vs 100.2°±7.5°), the Knee Society Score (KSS) was higher on the GB side (78.5±5.4 vs 74.2±6.3), and the Western Ontario and McMaster University (WOMAC) score was lower on the GB side (35.4±5.5 vs 38.0±6.3), there were significant differences in the up-mentioned indexes between the two groups (all P<0.05). However, the repeated-measures analysis of variance indicated that there was no significant difference in VAS score, ROM, KSS score and WOMAC score between the two techniques (all P>0.05). The satisfactory rate of GB technique was 84.2%(48/57), ant it was 86.0%(49/57) with MR technique (P=0.446). There was also no significant difference between the two techniques in terms of complications (P=0.754). Conclusion: Both the GB and MR technique result in good knee function with similar clinical outcomes in patients receiving TKA in both knees for osteoarthritis without significant deformity.

Impact of Low Social Support Systems on Post-Operative Outcomes of Ankle, Hindfoot and Midfoot Surgery

Category: Other; Hindfoot; Midfoot/Forefoot; Trauma Introduction/Purpose: Degenerative conditions of the ankle, hindfoot and midfoot can markedly limit mobility, and functional disability due to bone and joint pathology has been demonstrated to predict mortality, and in some cases, decrease life expectancy by up to 10 years. Optimizing outcomes in surgical treatment of these conditions is therefore essential and requires analysis of both medical interventions and psychosocial factors. Physicians have only recently begun to identify social support to be a key factor in post-operative functional ability, though our understanding of their impact on surgical outcomes is limited. The purpose of this study was to elucidate the link between low social support and postoperative surgical foot and ankle outcomes. Methods: A single-center, prospective study was conducted on patients who underwent elective or non-elective ankle, hindfoot, or midfoot surgery between 2015 and 2019. Patients who were pre-operatively and post-operatively assessed at 6 month or 1 year follow up using the Short Form Health Survey (SF-36), Life-Space Assessment survey (LSA), and/or visual analog scale (VAS) for pain were administered a social support survey scoring the individuals social support system. Patient reported outcomes were compared between low social support patients (score &lt;= 13) and high social support patients (score &gt; 13). Results: Preoperative baseline and 6 month LSA scores in the low social support group were significantly lower compared to the normal social support group (P = 0.044, P = 0.038), a trend not observed at the 1 year post-operative mark. Low social support pre-operative SF-36 MCS scores (P = 0.015) were significantly lower than the high social support group with no difference detected in pre-operative SF-36 PCS scoring. At 6-month follow-up, the low social support group had significantly lower SF-36 PCS scores (P = 0.031) and SF-36 MCS scores (P = 0.006) compared to the high social support group. At 1 year follow up, these differences in PCS (P = 0.04) and MCS (P= 0.007) persisted. No significant differences in VAS scores were observed. Conclusion: Among adults undergoing foot and ankle surgery, low perceived social support was associated with lower degrees of perceived mental well-being and physical wellbeing up to 1 year postoperatively.

A Comparison of Percutaneous Kyphoplasty with High-Viscosity and Low-Viscosity Bone Cement for Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Study

BackgroundOsteoporotic vertebral compression fracture (OVCF) has become a health issue of worldwide concern. Percutaneous kyphoplasty (PKP) is one of the main surgical methods for OVCFs. This study aimed to evaluate and compare the clinical efficacy and safety of PKP with high- and low-viscosity bone cement for OVCFs.MethodsTotally 62 patients with single-level OVCF were enrolled in this study from December 2018 to April 2021. Among them, 32 cases underwent PKP with high-viscosity bone cement, while 30 cases underwent PKP with low-viscosity bone cement. Visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were used in the pre- and post-operative period to assess patients’ rehabilitation. Compression rates of anterior vertebra height (AVH) and posterior vertebra height (PVH) were analyzed to evaluate the restoration of vertebra height. Leakage rates and locations were recorded to show clinical safety.ResultsVAS and ODI scores both significantly improved in 2 groups at 1 day, 1 month, and 3 months after surgery. Compression rates of AVH and PVH at 1 day and 3 months after PKP were lower than those before surgery. However, there was no significant difference in VAS scores, ODI scores, and compression rates between both groups. However, PKP with high-viscosity bone cement achieved a lower bone cement leakage rate significantly, which showed the safety of high-viscosity bone cement in PKP.ConclusionsPKP with high- and low-viscosity bone cement both improved the recovery of patients and restored vertebra heights. Notably, PKP with high-viscosity bone cement can achieve favorable clinical outcomes as well as lower bone cement leakage rate.

Effects of Different Concentrations of Ropivacaine Lumbar Plexus-Sciatic Nerve Block on Recovery from Anesthesia, Postoperative Pain and Cognitive Function in Elderly Patients with Femoral Neck Fracture.

To investigate the effects of lumbar plexus-sciatic nerve block with different concentrations of ropivacaine on recovery from anesthesia, postoperative pain, and cognitive function in elderly patients with femoral neck fracture. A total of 110 elderly patients with femoral neck fractures who were treated in our hospital from January 2020 to January 2022 were selected as the research objects. According to the concentration of ropivacaine, they were divided into low-, medium-, and high-concentration groups (concentrations of ropivacaine were 0.15%, 0.25%, and 0.40%, respectively), with 36, 37, and 37 cases, respectively. Extubation time, anesthesia recovery time, and hospitalization time were recorded. Cognitive symptoms were assessed by the spatial cognitive ability, working memory ability, simple computing ability, and picture recognition ability test. The pain degree of patients was assessed by visual analogue scale (VAS). The occurrence of adverse reactions in patients was recorded. There was no significant difference in extubation time, anesthesia recovery time, and hospitalization time among the three groups (P > 0.05). The PCA time of the patients in the high-concentration group was significantly longer than that in the low- and medium-concentration groups. The dosage of sufentanil within 24 hours and total sufentanil in the high-concentration group were significantly lower than those in the low- and medium-concentration groups, and the dosage of sufentanil within 24 hours and total sufentanil in the medium-concentration group was significantly less than that in the low-concentration group (P < 0.05). The cognitive function score for each entry of the three groups 1 d after surgery was lower than that before surgery (P < 0.05); On the 1 day after operation, the cognitive function score for each entry of the patients in the low-concentration group was significantly higher than that in the middle- and high-concentration groups, and the cognitive function score for each entry in the middle-concentration group was significantly higher than that in the high-concentration group (P < 0.05). There was no significant difference in VAS scores between the three groups at 2 h and 8 h after surgery (P > 0.05); 16 h and 24 h after operation, the VAS score of patients in the high-concentration group was significantly lower than that in the low- and medium-concentration groups, and the VAS score in the medium-concentration group was significantly lower than that in the low-concentration ropivacaine group (P < 0.05). The incidence of adverse reactions in the high-concentration ropivacaine group was significantly higher than that in the low- and medium-concentration groups (P < 0.05). The middle concentration of ropivacaine has good analgesic and nerve block effects and has less influence on cognitive function and less adverse reactions in elderly patients.

Comparing the therapeutic effects of pregabalin and gabapentin after transforaminal epidural nerve block in lumbar radiculopathy.

Lumbar radiculopathy can be presented as low back pain and radiating pain. Transforaminal epidural steroid injection (TFESI) has been used to treat radicular pain, and after the injection, additional medications such as gabapentinoids including pregabalin (PGB) and gabapentin (GBP) can be administered to relieve remnant pain. However, little is known about the effectiveness of gabapentinoids in relieving pain after transforaminal epidural steroid injection.This study was conducted to compare the effect of pregabalin and gabapentin in lumbar radiculopathy patients who underwent transforaminal epidural steroid injection.One hundred seven patients who received TFESI and had taken PGB or GBP after the intervention at Daegu Catholic University Medical Center from January 2013 to August 2021 were included in this study. Visual Analogue Scale (VAS) was evaluated in all patients.Among 107 patients, 57 (53.3%) patients took PGB and 50 (46.7%) patients took GBP after TFESI. The PGB and GBP groups showed reduced VAS scores according to visit (P < .001). However, no statistically significant differences in VAS scores according to the types of medication (P = .811) and change aspects according to visit were observed between the PGB and GBP groups (P = .947).The study findings suggest that both pregabalin and gabapentin can be equally used to reduce pain in lumbar radiculopathy patients who underwent TFESI. Further studies with larger sample size are needed to generalize the findings of this study.

Buccally Absorbed Cannabidiol Shows Significantly Superior Pain Control and Improved Satisfaction Immediately After Arthroscopic Rotator Cuff Repair: A Placebo-Controlled, Double-Blinded, Randomized Trial

Background: Despite the widespread use and sales of cannabidiol (CBD) products in the United States, there is a paucity of literature to evaluate its effectiveness, safety, or ideal route of administration for postoperative pain. Purpose: To evaluate the potential analgesic effects of buccally absorbed CBD in patients who have undergone arthroscopic rotator cuff repair (ARCR). Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a US Food and Drug Administration–sanctioned, multicenter, placebo-controlled, randomized, double-blinded trial conducted in patients undergoing ARCR. Patients aged from 18 to 75 years undergoing ARCR were prospectively enrolled and randomized to the control and experimental groups. The experimental group received an oral, buccally absorbed tablet containing 25 mg of CBD 3 times a day if <80 kg, or 50 mg of CBD 3 times a day if >80 kg, for 14 days postoperatively, while the control group received an identical placebo. Patients were followed up on days 1, 2, 7, and 14, and visual analog scale (VAS) for pain scores, opioid consumption, and satisfaction with pain control were recorded. Additionally, liver function tests were conducted on days 7 and 14 to assess safety, and nausea was monitored. P < .05 was considered to be statistically significant. Results: Overall, 100 patients were recruited, with 1 patient being excluded, for a total of 99 patients. There were no significant differences in patient demographics between the 2 groups. On day 1, the VAS pain score was significantly lower in the CBD group than in the control group (4.4 ± 3.1 vs 5.7 ± 3.2, respectively; P = .04), although this difference was no longer present on day 2 (4.7 ± 2.8 vs 5.3 ± 2.6, respectively; P = .32). On both days 1 and 2, patient satisfaction with pain control was significantly higher in the CBD group than in the control group (day 1: 7.0 ± 3.0 vs 5.6 ± 3.7, respectively [P = .04]; day 2: 7.3 ± 2.5 vs 6.0 ± 3.3, respectively [P = .03]). The quantity of opioids consumed was low in both groups, and there were no statistically significant differences in opioid consumption (P > .05). On days 7 and 14, there were no statistically significant differences in VAS scores, opioid consumption, or patient satisfaction with pain control between the CBD and control groups (P > .05 for all). There were no significant differences in liver function test results postoperatively (P > .05). Conclusion: Buccally absorbed CBD demonstrated an acceptable safety profile and showed significant promise in the reduction of pain in the immediate perioperative period after ARCR compared with the control. Further studies are currently ongoing to confirm dosing and effectiveness in other orthopaedic conditions. Registration: NCT04672252 (ClinicalTrials.gov identifier).

Poster 236: There is No Difference in Early Functional Outcomes for Patients Undergoing Tele-Rehabilitation versus Standard in Office Rehab after Arthroscopic Meniscectomy: A Randomized Controlled Trial

Objectives:While a growing body of evidence has demonstrated that tele-rehabilitation is effective, the functional outcomes of patients undergoing tele-rehabilitation as compared to in-person rehabilitation after arthroscopic meniscectomy remains unclear. This is especially salient against the backdrop of COVID-19 and the Delta variant and the subsequent increased demand for remote care of these patients.Methods:A randomized-controlled trial was conducted including patients scheduled to undergo arthroscopic meniscectomy for meniscal injury by one of five fellowship trained sports medicine surgeons between August 2020 and May 2021. Patients were randomized to receive tele-rehabilitation, defined as exercises and stretches provided by trained physical therapists over a synchronous face-to-face video visit, or in-person rehabilitation for their post-operative course. International Knee Documentation Committee Subjective Knee Form (IKDC) score and Visual Analogue Scale (VAS) score were collected at timepoints of baseline, 3 months, 6 months, and 12 months post-operatively. Statistical analysis was conducted using Student T-test to assess for differences across the two groups.Results:An interim analysis was conducted on 60 patients with 6 month follow-up outcomes. There were no significant differences in VAS scores between groups at baseline (p =0.716) and 3 months postoperatively (p = 0.700). and 6 months postoperatively (p = 0.688). In addition, no significant differences in IKDC scores were seen between the groups at baseline (p = 0.146) and 3 months (p = 0.746). At 6 months, 24 patients were available with no significant differences observed across groups at this time point (IKDC; p = 0.633) (VAS; p = 0.688).Conclusions:Tele-rehabilitation is demonstrated to be as efficacious as traditional in-person rehabilitation following arthroscopic meniscectomy at up to 6 months post-op. This serves as a convenient and safe alternative for conventional patients during their post-operative course.

Paper 68: Cannabidiol is Effective in Improving Immediate Post-operative Pain and Patient Satisfaction Following Arthroscopic Rotator Cuff Repair: A Placebo-Controlled, Randomized, Double-Blinded Study

Objectives:The purpose of this study is to evaluate the potential analgesic effects of buccal-absorbed cannabidiol (CBD) in patients that have undergone arthroscopic rotator cuff repair (ARCR).Methods:This is an FDA sanctioned, multi-center, placebo-controlled, randomized, double-blinded trial conducted in patients undergoing ARCR. Patients from 18 to 75 years of age undergoing an ARCR were prospectively enrolled. Patients were equally randomized to the control and experimental groups. The experimental group post-operatively received 25mg of CBD (Oravexx, Orcosa Pharmaceuticals, USA) TID if < 80kg and 50mg of CBD TID if > 80kg for 14 days, with control groups receiving an identical placebo. Patients were followed-up on Day 1, 2, 7, and 14, and Visual Analog Scale (VAS) for pain, opioid consumption, and satisfaction with pain control were recorded. Additionally, liver function tests (LFT) were done on Days 7 and 14 to assess safety, and nausea was monitored. A priori power analysis was performed based on the VAS score as primary endpoint, which revealed that a minimum of 39 patients would be required in each group to detect a clinically important difference in the VAS score (1.4) with a power of 0.8. A value of p < 0.05 was considered to be statistically significant.Results:Overall, 80 patients were recruited. There were no significant differences in age, sex, or BMI between the two groups. On Day 1, VAS pain score was significantly lower in those receiving CBD (4.1 ± 3.0 vs 6.0 ± 3.1, p = 0.01), which also meets VAS MCID for shoulder arthroscopy (1.2-1.4). Patient satisfaction with pain control trended towards significance favoring the CBD group (72% vs 60%, p = 0.072). However, there were no statistically significant differences in opioid consumption (16.4mme ± 12.7 vs 20.6mme ± 14.4, p = 0.186), which was relatively small in both groups. Notably, patients receiving 50 mg of CBD reported lower VAS scores at day 1 (3.9 ± 3.3 vs 4.6 ±2.5 ± 6.0 ± 3.1, p = 0.0394) and higher satisfaction with pain control at day 1 and 2 (8.1 ± 2.3, 5.8 ± 3.3, 5.9 vs 3.6, p = 0.0175 | 7.8 ± 1.8 vs 6.3 ± 3.0 6.0 ± 3.2, p = 0.05) compared to those receiving 25 mg of CBD and control group respectively. On Day 7 and Day 14, there were no statistically significant differences in VAS score, opioid consumption, or patient satisfaction with pain control (p>0.05 for all). There were no significant differences in nausea or LFTs post-operatively (p > 0.05).Conclusions:CBD is safe and effective in reducing pain in the immediate peri-operative period following ARCR and should be considered in post-operative multimodal pain control.Table 1.Summary of Major Kinematic Effects for LMORT Lesions and Repairs

Location and Effect of Bone Cement in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures.

In this study, the effectiveness and use of bone cement are thoroughly elaborated, and the role of bone cement on percutaneous vertebroplasty (PVP) fixed joints and its distribution on PVP are also elucidated. The aim of this study was to investigate the effect of unilateral and bilateral bone cement distribution on the clinical efficacy of PVP in the treatment of osteoporotic vertebral compression fractures (OVCF) of the thoracolumbar spine. A total of 60 patients with thoracolumbar OVCF (T11-L2) hospitalized in our hospital from January 2020 to January 2021 were studied. All patients had thoracolumbar OVCF. Under the guidance of the C-arm machine, unilateral PVP was performed. According to the distribution of bone cement across the midline, the patients were divided into two groups: the unilateral group (37 cases): bone cement was distributed on one side of the midline of the vertebral body, and the bilateral group (23 cases): bone cement was distributed on both sides of the midline. Visual analogue scale (VAS), vertebral height recovery values, and preoperative and postoperative Cobb's angle were recorded at 3 days, 1 month, 3 months, and 6 months. The differences between the two groups were compared and analyzed to evaluate the clinical efficacy. There was a statistically significant difference in VAS scores between the two groups before and after surgery (P < 0.05), but there was no statistically significant difference in VAS scores between the two groups at 3 days, 1 month, 3 months, and 6 months after surgery (P > 0.05). There were statistically significant differences in vertebral height recovery value and Cobb's angle between the two groups before and after surgery (P < 0.05).

Comparative study of microscope assisted minimally invasive anterior fusion and mobile microendoscopic discectomy assisted fusion for lumbar degenerative diseases

To investigate the effectiveness of microscope assisted anterior lumbar discectomy and fusion (ALDF) and mobile microendoscopic discectomy assisted lumbar interbody fusion (MMED-LIF) for lumbar degenerative diseases. A clinical data of 163 patients with lumbar degenerative diseases who met the criteria between January 2018 and December 2020 was retrospectively analyzed. Fifty-three cases were treated with microscope assisted ALDF (ALDF group) and 110 cases with MMED-LIF (MMED-LIF group). There was no significant difference between the two groups in terms of gender, age, disease type, surgical segments, preoperative visual analogue scale (VAS) scores of low back pain and leg pain, Oswestry disability index (ODI), intervertebral space height, lordosis angle, and spondylolisthesis rate of the patients with lumbar spondylolisthesis ( P>0.05). The operation time, intraoperative blood loss, and hospital stay of the two groups were recorded. The effectiveness was evaluated by VAS scores of low back pain and leg pain and ODI. Postoperative lumbar X-ray films were taken to observe the position of Cage and measure the intervertebral space height, lordosis angle, and spondylolisthesis rate of the patients with lumbar spondylolisthesis. The operations were successfully completed in both groups. The operation time, intraoperative blood loss, and hospital stay in ALDF group were less than those in MMED-LIF group ( P<0.05). The patients in both groups were followed up 12-36 months, with an average of 24 months. The VAS scores of low back pain and leg pain and ODI after operation were lower than those before operation in the two groups, and showed a continuous downward trend, with significant differences between different time points ( P<0.05). There were significant differences between two groups in VAS score of low back pain and ODI ( P<0.05) and no significant difference in VAS score of leg pain ( P>0.05) at each time point. The improvement rates of VAS score of low back pain and ODI in ALDF group were significantly higher than those in MMED-LIF group ( t=7.187, P=0.000; t=2.716, P=0.007), but there was no significant difference in the improvement rate of VAS score of leg pain ( t=0.556, P=0.579). The postoperative lumbar X-ray films showed the significant recovery of the intervertebral space height, lordosis angle, and spondylolisthesis rate at 2 days after operation when compared with preoperation ( P<0.05), and the improvements were maintained until last follow-up ( P>0.05). The improvement rates of intervertebral space height and lordosis angle in ALDF group were significantly higher than those in MMED-LIF group ( P<0.05). There was no significant difference in the reduction rate of spondylolisthesis between the two groups ( t=1.396, P=0.167). During follow-up, there was no loosening or breakage of the implant and no displacement or sinking of the Cage. Under appropriate indications, microscope assisted ALDF and MMED-LIF both can achieve good results for lumbar degenerative diseases. Microscope assisted ALDF was superior to MMED-LIF in the improvement of low back pain and function and the recovery of intervertebral space height and lordosis angle.

Comparison of Temperature and Pain Changes between the Drip and Topical Methods of Administering the Transnasal Sphenopalatine Ganglion Block.

The objective of this study was to compare facial temperatures and the visual analogue scale (VAS) between the drip method and the topical method of transnasal sphenopalatine ganglion block (SPGB). The transnasal SPGB is administered to patients with facial or head and neck pain. In the transnasal approach, the drip and topical methods are frequently used. We compared facial temperatures and VAS after transnasal SPGB. Medical records of 74 patients who visited the pain clinic and underwent transnasal SPGB were retrospectively reviewed. A total of 156 transnasal SPGB were performed. The patients were divided into the drip-method and topical-method groups. Facial temperatures were measured in six areas of the right and left forehead, maxilla, and mandible before and 30 min after completion of the transnasal SPGB. Temperatures were compared before and 30 min after SPGB in each group and between the two groups. VAS scores were compared at the same times of SPGB in each group and between the two groups. In the drip-method group, there were significant increases at four areas of the face in temperature changes at 30 min after SPGB. In the topical-method group, there was no significant difference in the temperature changes at 30 min after SPGB. There were statistically significant differences in the facial temperature changes between the two groups in the right forehead (p = 0.001), left forehead (p = 0.015), and right maxillary area (p = 0.046). In herpes zoster, there were statistically significant differences in the VAS scores between before and 30 min after SPGB in both groups (p < 0.001, p = 0.008) and between two groups (p < 0.001). In migraine, there were statistically significant differences in VAS scores between before and 30 min after SPGB in both groups (p < 0.001, p = 0.004) and between two groups (p = 0.014). Transnasal SPGB using two methods showed different temperature changes and VAS scores.

A randomised prospective single-blind pilot study to compare the analgesic efficacy of thoracic epidural block and erector spinae plane block in breast cancer surgery.

Background and Aims:Thoracic epidural analgesia (TEA) is an effective analgesic technique for breast surgery, although it has many associated complications. Ultrasound (US)–guided erector spinae plane (ESP) block requires less technical expertise, is safe and may be an alternative to TEA. We aimed to compare the efficacy of TEA with US-guided continuous ESP block for post-operative analgesia in patients undergoing modified radical mastectomy (MRM) surgeries.Methods:Sixty-six female patients of age group 18–65 years, and American Society of Anesthesiologists (ASA) physical status I and II, undergoing MRM surgeries were recruited. Patients received TEA in Group Ep and US-guided ESP block in Group Er, before induction of general anaesthesia. Both the groups received 0.2% ropivacaine 15 mL, followed by 5 mL.h-1 infusion for 24 h. The primary outcome was the duration of analgesia. Secondary outcomes were total doses of rescue analgesics in 24 hours and visual analogue scale (VAS) scores at 0 h, 1 h, 2 h, 4 h, 8 h, 12 h, and 24 h.Results:The mean duration of analgesia was 21.72 ± 4.73 hours in Ep group and 20.60 ± 5.77 hours in Er group (P = 0.39). The total dose of rescue analgesics in the postoperative period was comparable between both the groups. There was no significant difference in VAS scores between the groups over 24 h.Conclusion:US-guided ESP block can be used as safe and easy to perform alternative analgesic technique over thoracic epidural analgesia for peri-operative pain management in breast cancer surgeries.