Significant Difference In Pain Research Articles

Manual handling amongst physiotherapists: Analysis of intra-shift variations in pain, fatigue and movement.

Manual handling injuries amongst physiotherapists are common and the need to improve our understanding of causal influences is imperative. The objective was to determine whether intra-shift variations in manual handling task performance occurred in our cohort, which may inform mechanisms underpinning related injuries. We used motion capture, force plate dynamics and electromyography to identify variations in task performance, loading forces and muscle activity, during the performance of one static and one dynamic standardized manual handling task, pre- and post-shift, by 40 physiotherapists. Participants also rated their pain and fatigue on a visual analogue scale (VAS). Statistical analysis utilised paired samples Student's t tests. Significant differences were seen in the EMG activity in the quadriceps during the static task only. No significant differences were seen for any of the kinematic variables. Significant differences in fatigue (p < 0.005) were seen between the pre- and post-shift sessions. Notably, there were significant differences in pain between the pre- and post-shift sessions in the static (p < 0.01) and dynamic tasks (p < 0.05). This increase in pain was at a level which impacted on function. Whilst significant variations in task performance were not observed, our findings indicate that physiotherapists frequently experience task-related pain towards the end of their shift. Contemporary research indicates that frequent transient low back pain may transition to a chronic disabling condition, as such we posit that the effects of intra-shift pain, and its causative factors, should be more widely considered in a 'whole-of-job' approach to mitigating risk in this demographic.

Treatment of type II symptomatic ulnar styloid nonunions with reinsertion of the triangular fibrocartilage complex

PurposeThe purpose of this retrospective study was to introduce an alternative technique for the treatment of type II symptomatic ulnar styloid nonunion by the reinsertion of the triangular fibrocartilage complex and the ulnar collateral ligament.MethodsBetween March 2009 and May 2017, 45 patients (34 males and 11 females) suffering from the nonunion of type II ulnar styloid fractures all underwent the subperiosteal resection of the avulsed fragments and the reinsertion of the TFCC and ulnar collateral ligament. Outcome assessments included the ranges of motion of the wrist, grip strength, pain, and Mayo wrist score. The preoperative and postoperative parameters were compared. A P-value less than 0.05 was considered to be statistically significant.ResultThe mean follow-up period was 21.66 ± 7.93 months (range, 12 to 26 months). At the final follow-up, the mean preoperative flexion and extension were 79.32 ± 4.52° and 74.40 ± 4.36° respectively. The mean preoperative pain score, grip strength, and Mayo wrist score were 32.48 ± 4.00; 23.88 ± 8.38 kg, and 77.72 ± 8.31 respectively. The mean postoperative flexion and extension of the wrist were 80.56 ± 6.32° and 75.43 ± 3.12° respectively. The mean postoperative pain score, grip strength, and Mayo wrist score were 12.41 ± 3.27, 26.31 ± 8.30 kg, and 90.71 ± 7.97 respectively. There were significant differences in pain, grip strength, and Mayo wrist score (P < 0.05), but no significant differences concerning the range of motion of the wrist.ConclusionIn the treatment of the nonunion of type II ulnar styloid fractures, the resection of the avulsed fragments followed by the reinsertion of the TFCC and the ulnar collateral ligament with an anchor was a reliable alternative technique, bringing the satisfactory function of the wrist.

Évaluation de la douleur lors des interruptions volontaires de grossesse médicamenteuses jusqu’à 14 semaines d’aménorrhées : une étude prospective comparative sur 1 an

ObjectivesPain assessment of patients requesting a medical abortion according to the term, up to 14 weeks, by a numerical rating scale (NRS). MethodsThis was a single-centre prospective observational study conducted at the University Hospitals of Strasbourg from 1st October 2019 to 31st December 2020. ResultsThere was no significant difference in pain assessed by the NRS for medical abortion performed between 7–9 weeks and those performed between 9–14 weeks (6.5±2.5 vs. 6.6±2.2, P=0.85). Regardless of the term (before 7 weeks, between 7–9 weeks and between 9–14 weeks), patients felt relieved by taking painkillers in the case of medical abortion in 88.9%, 80.3% and 87.3% of cases respectively (P=0.18). The use of analgesics allowed a decrease of 3 points of the NRS in the 3 groups (P=0.67). Patients were more painful in case of medical protocol vs. surgical (maximum pain at 6.0±2.6 vs. 1.4±2.0, P<0.01), but declared to be relieved by analgesics in 85.1 and 94.3% of cases (P=0.24). ConclusionsAs pain is similar whatever the term in the case of medical abortion, and its management by analgesics seems to be effective, this criterion should not guide the professional in the choice of method, particularly between 9 and 14 weeks. This choice must be made by the patient.

Effect Of Giving A Vibrator With A Cooler On Pain Level In Childhood With Venipuncture In Tidore Kepulauan Hospital

BACKGROUND : Atraumatic care is therapeutic care that is carried out as part of an intervention to remove or suppress psychological or physical stress suffered by a child. The act of minimizing pain, stress and trauma to children when given at the time of blood collection is part of the principle of atraumatic care. One of the atraumatic actions that can be performed on children is the use of a vibrator with a cooler to minimize pain when stabbing a vein AIMS : to determine the effectiveness of giving a vibrator accompanied by a cold compress against pain in children when taking venous blood. METHODS : The design of this research is true experimental with a post-test only control group design. Researchers divided into 2 groups, namely the intervention and control groups were taken randomly. Then the researcher made a vibrator with a cooler that had been previously tested on 30 adults, then after being declared to have passed the ethical study it would be applied to children when taking venous blood, assessing children's pain using the FLACC instrument (face, legs, activity, cry and controllability). The study was conducted at the Tidore Islands Hospital. Data processing was carried out previously by testing the homogeneity and normality test, if normally distributed it will use the independent t-test to assess the difference in the average of the two groups, while if it is not normally distributed it will be tested with Mann-Whitney. RESULT : The results of this study indicate that the characteristics of respondents according to age are mostly 4 years old. In the control group the average age of children is 3.87 while in the intervention group the average age of children is 3.93. Most of the experience of having blood drawn in both groups had blood drawn before. Based on gender characteristics, most of the control and intervention groups were women. There are differences in pain scores in the control and intervention groups. The mean pain score in the intervention group was 3.13 and the mean pain score in the control group was 7.87. The results of statistical tests using Mann Whitney showed that there was a significant difference in pain during venipuncture in the intervention group and the control group (p=0.013). CONCLUSION : The results of the statistical test show that there was a significant difference in pain in the intervention group and the control group (p=0.013). The use of a cooling vibrator can be an alternative to reduce pain in children during venipuncture.

Differences of Pain among Children During Infusion in Buleleng Regency

Pain in children with treatment or management in the hospital is very common. Especially when seen when rehydrating children with infusions, almost all children are anxious, scared and crying. The purpose of this study was to see the difference in pain during infusion between those who were given the distraction of watching cartoons and those who were given conventional methods. Quantitative research method with quasi-experimental design. The sample used in the treatment and control groups was 34 respondents. The instrument uses a FLACC (Face, Legs, Activity, Cry and Consolability) pain scale sheet. Analysis using the Independent T-Test. The result is that there is a significant difference in pain from the treatment group to the control with a p value &lt;0.005.

Acupressure versus NSAID for relief of orthodontic pain : A randomized controlled clinical trial.

To compare ibuprofen and acupressure for pain relief after insertion of elastomeric orthodontic separators. Arandomized control clinical trial was conducted in an orthodontic clinic. Atotal of 75orthodontic patients aged 12-16years participating in the study were randomly allocated to receive either 400 mg of oral ibuprofen, applying acupressure therapy, or no pain-relief approach. Pain scores were recorded on visual analog scales (10 cm) over aweek at different times (4,10, 18, 24 h, and 1week). The margin of equivalence was defined as 10 mm. For all timepoints, the control group recorded the highest pain. For the ibuprofen and acupressure group, after 4 h, 18 h, and 1week, no significant difference was noted. However, after 10 h, no significant difference in pain between the control and acupressure groups was noted and the ibuprofen group showed significantly lower pain. In the acupressure group, the highest pain was noted at 10 h. After this timepoint, pain progressively decreased with time and the lowest pain was noted after 1week. In the control and ibuprofen groups, the highest pain was after 4 h, and then progressively decreased with time and the lowest pain was noted after 1week. There was no significant difference in pain perception between participants using ibuprofen or acupressure and both groups recorded significantly lower pain than the control group at most of the observed timepoints. Results support the analgesic effect of the acupressure approach.

Assessment of Oral Health-Related Quality of Life in Patients Receiving Corticobasal Dental Implants.

Among various treatment modalities for tooth replacement, dental implants are considered the best one. This study assessed the effects of smoking, periodontitis, and diabetes on oral health-related quality of life (OHRQoL) in patients receiving corticobasal dental implants. One hundred twenty patients of either gender who received corticobasal dental implants were enrolled. All were subjected to Oral Health Impact Profile-20 (OHIP-20) for dental implant patients (OHRQoL questionnaire). The patient satisfaction level was measured on a scale with points ranging from 0 to 5. The value 0 indicates no satisfaction, whereas the value 5 shows highly satisfied. Of 120 patients, males were 70 and females were 50. The overall satisfaction level was 4.92, articulation speech was 4.12, implants were 4.80, and construction was 4.88. The overall satisfaction, articulation speech, implants, and construction values in patients with and without diabetes were 4.90 vs 4.93, 4.56 vs 4.86, 4.76 vs 4.92, and 4.94 vs 4.83, respectively. The overall satisfaction, articulation speech, implants, and construction values in patients with and without smoking were 4.83 vs 4.91, 4.52 vs 4.88, 4.70 vs 4.82, and 4.12 vs 4.84, respectively. The overall satisfaction, articulation speech, implants, and construction values in patients with and without periodontitis were 4.72 vs 4.96, 4.52 vs 4.88, 4.73 vs 4.98, and 4.81 vs 4.95, respectively. The overall satisfaction, articulation speech, implants, and construction values in patients with one to three risk factors and control were 4.85 vs 4.96, 4.82 vs 4.94, 4.88 vs 4.97, and 4.76 vs 4.86, respectively. There was a significant difference in pain, infections and/or swelling, sleeping problems, problems with self-confidence, taste, chewing discomfort and/or difficulties, and influence on food choice before and after in patients treated with corticobasal dental implants (P < 0.05). The satisfaction level is higher after obtaining corticobasal dental implants in patients with diabetes, smoking, and periodontitis as compared to control. Thus, corticobasal dental implants may be considered alternate treatment options for these patients.

Immediate effect of craniocervical flexion exercise and Mulligan mobilisation in patients with mechanical neck pain- A randomised clinical trial.

Mechanical neck pain (MNP) is one of the most prevalent musculoskeletal pathologies in the present time. Physiotherapy management strategies comprising manual therapy and exercise therapy are routinely administered in patients with MNP. To compare the immediate effect of craniocervical flexion (CCF) exercise and Mulligan mobilisation on pain, active cervical range of motion (CROM) and CCF test performance in patients with MNP. This prospective, randomised, single-blinded study involved 26 patients with MNP (16 females; mean age; years) randomised to a single session of active CCF exercise (3 sets of 10 repetitions) or Mulligan mobilisation (3 sets of 6-10 repetitions). Pain intensity was measured on a numerical pain rating scale (NPRS), active CROM was measured using CROM device, and CCF test performance with surface electromyography (EMG) from bilateral sternocleidomastoid (SCM) and anterior scalene (AS) muscles recorded pre- and immediately post-intervention by an assessor blinded to the treatment groups. Mann-Whitney U test was used to analyse between groups and Wilcoxon signed rank test was used to analyse within-group significance for pain and CROM, Cochran-Mantel-Haenszel correlation test was used to analyse the CCF test performance on EMG from the bilateral SCM and AS muscles. Comparison between pre- and post-intervention readings revealed statistically significant within-group () and no between-group significant difference for pain, ROM, and CCF test performance, indicating both interventions were equally effective. Patients with MNP who received active CCF exercise or Mulligan mobilisation exhibited similar reduction in pain intensity and increased CROM and CCF test performance post-intervention. Surprisingly, AS surface EMG amplitudes were increased post-intervention in both groups warranting further exploration of its role in neck pain.

Efficacy of Anterior Quadratus Lumborum Block and Pain After Total Hip Arthroplasty: A Randomized Controlled Trial

BackgroundAnterior quadratus lumborum block (AQLB) is one of the compartment blocks and has recently attracted attention as a new method of analgesia for postoperative hip surgery analgesia. This study aimed to compare the analgesic efficacy of AQLB in patients undergoing primary total hip arthroplasty (THA). MethodsThere were 120 patients undergoing primary THA under general anesthesia randomly allocated to receive a femoral nerve block (FNB) or an AQLB. The primary outcome was total morphine consumption over the initial 24-hour postoperative period. Secondary outcomes included the pain score evaluation while at rest and during active and passive motion over the 2 days following surgery and the manual muscle testing of the quadriceps femoris. The numerical rating scale (NRS) score was used for evaluating the postoperative pain score. ResultsThere were no significant differences between the 2 groups concerning morphine consumption within 24 hours after surgery (P = .72). The NRS score at rest and passive motion were similar at all-time points (P > .05). However, there was a statistically significant difference in pain reported during the active motion for the FNB group compared to the AQLB (P = .04). No significant differences were found between the 2 groups concerning muscle weakness incidence. ConclusionBoth AQLB and FNB demonstrated adequate efficacy for postoperative analgesia at rest in THA. However, based on our study, whether AQLB is inferior or noninferior to FNB as an analgesic method for THA was inconclusive.

The Effect of Vapocoolant Spray and Baby Shark Vibrator on Children’s Pain during Invasif Procedure

Invasif procedure is a procedure that is often performed on children. This procedure is related to needles that causes pain in children. Children who experienced pain during invasif procedure need treatment to avoid trauma. It is necessary to apply atraumatic care through the use of interventions that eliminate or minimize the psychological and physical distress suffered by children, one of which is the use of vibrators with music and cold compresses to minimize pain. This study aims to determine the effectiveness of giving a baby shark vibrator compare with vapoocoolant spray against pain in children undergoing invasif procedure such as injection and venipuncture. The researcher divided the respondents into 2 groups, the intervention group (baby shark vibrator) and the control group (vapocoolant spray) which are taken randomly with a total of 60 children participating in this study. The assessment of children's pain using the FLACC instrument (face, legs, activity, cry and consolability). The results of statistical tests showed that there was a no significant difference in pain in the intervention group and the control group (p=0.077). The use of a baby shark vibrator can be an alternative to reduce pain in children during invasif procedure because for some children, it is more convenient and distracting.

Elimination of a Postoperative Brace Does Not Increase Complications Following Hip Arthroscopy.

Background The practice of routine postoperative bracing to limit abduction and internal rotation, along with weight-bearing restrictions after hip arthroscopy (HA), varies significantly among surgeons. It is unclear whether the use of a postoperative brace improves short-term outcomes in patients undergoing HA. The purpose of this study was to determine the differences in patient outcomes before and after eliminating routine usage of a postoperative brace. Methods A retrospective review was conducted of 176 adult patients undergoing HA by a single, high-volume surgeon. The no-brace protocol was implemented in October 2020. The patients were divided into two groups: pre-implementation (January-October 2020) and post-implementation (October 2020-April 2021). Twenty-three patients that used a brace during the post-implementation period were excluded. All patients had weight-bearing restrictions with crutches for three weeks postoperatively. The primary endpoint was any complication in the first sixweeks postoperatively. Results There were no significant differences in demographics between groups, although the body mass index in the brace group was higher (28.1 vs. 26.4 kg/m2, p = 0.066) and the rate of additional procedures performed was higher in the brace group (55.2% vs. 40.1%, p = 0.056). There was no significant difference in postoperative outcomes between groups when looking at 90-day emergency department visits (1.7% vs. 0%, p = 0.548), complications at two (1.7% vs. 1.7%, p = 1.000) and six weeks (0% vs. 1.7%, p = 0.341) postoperatively, all complications in the first six weeks (1.7% vs. 1.7%, p = 1.000), and continued pain at six weeks (10.3% vs. 16.7%, p = 0.238). Conclusion The brace and no-brace groups were similar demographically. Patients undergoing HA with no brace and crutches experienced no significant differences in pain or complications in comparison to those receiving a traditional bracing protocol. Routine use of a postoperative brace may not be necessary in this population.

Hypnotherapy for chronic pelvic pain: A scoping systematic review and meta-analysis

BackgroundChronic pelvic pain (CPP) is typically managed with anti-inflammatory analgesics and opioids; however, these do not adequately manage the pain or address the associated negative impact on quality of life. Hypnotherapy has been found to reduce pain associated with a range of disorders, including some with symptoms of chronic pain. AimThe aim of this review is to systematically scope research investigating the use of hypnosis on chronic pelvic pain, quality of life, anxiety, depression and fatigue. MethodThe scoping review was guided by the method described by Arksey and O'Mallee [1]. A systematic search was conducted in six databases. The Covidence Risk of Bias tool and the National Institutes of Health (NIH) quality assessment tool were used. ResultsNine studies (four RCT's and five case series) were suitable for inclusion. Meta-analysis of the RCT's found no significant difference in pain or quality of life for the intervention group compared to controls. Only one study reported a reduction in pain after hypnotherapy and did not outperform controls. These results are limited due to lack of a standardised intervention and heterogeneity of the included studies. ConclusionThere is a need for further research using well designed randomized controlled trials with validated measures of pain, quality of life, anxiety, depression and fatigue. Hypnotherapy interventions utilised in further research should be grounded in evidence-based best practice for dealing with pain.

An investigation into whether changes in the posterior tibial slope affect the outcome of cruciate-retaining total knee arthroplasty by affecting tibiofemoral articular contact kinematics

AimsThe outcomes of total knee arthroplasty (TKA) are affected by many factors. This study aims to evaluate whether changes in the posterior tibial slope (PTS) affect patients’ outcomes after cruciate-retaining TKA by affecting tibiofemoral articular contact kinematics. It was hypothesized that changes in PTS affect the outcomes of PCR TKA by affecting tibiofemoral articular contact kinematics. MethodsA total of 60 knees (30 patients) that underwent posterior cruciate-retaining TKA (with the same size prosthesis) for medial osteoarthritis were assessed preoperatively and one year postoperatively. Before and after TKA, changes in the PTS, as seen on lateral radiographs, were noted. The knees were placed in groups according to these PTS changes (preoperative value − postoperative value): group 1 >3° change and group 2 ≤3° change. Knee kinematics were observed under mid-flexion weight-bearing conditions and were compared between the two groups using the two-dimensional/three-dimensional registration technique. Pain was measured using the visual analog scale, and knee function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Score (KSS). ResultsGroup 2 experienced paradoxical anterior motion of the medial femoral condyle postoperatively, but group 1 did not. A comparison of the results of the TKA between the two groups showed a significant difference in pain using the visual analog scale, and knee function of the KSS and the WOMAC (P < 0.05). The postoperative results were better in group 1 than in group 2. ConclusionsThese results suggest that achieving a greater change in the PTS improves outcomes in patients undergoing posterior cruciate-retaining TKA because it reduces the paradoxical motion of the medial femoral condyle.

Effect of Combinations of Quadriceps Exercise and Hip Abductor Exercise on Pain in Knee Osteoarthritis Patients in Orthopedic and Traumatology Outpatient Care

Background: Osteoarthritis is a disorder of the moving joints. Pain functioning are the main complaints of the disease osteoarthritis of the knee. The purpose of the study was to analyze the effect of a combination of quadricep exercise and hip abductor exercise on pain in knee among osteoarthritis patients.Subjects and Method: The study was carried out at the East Java Regional Hospital for the period of December 2022 to March 2023. The study population was knee joint osteoarthritis patients of degree 1 to degree 2. The sampling technique used in this study was purposive sampling, with inclusion and exclusion criteria. The number of samples in quantitative research was 60 respondents. The dependent variable is pain, while the independent variable is quadriceps exercise and hip abductor exercise. The instrument used is the WOMAC questionnaire. Analysis of the study was using the Wilcoxon test and the Mann Whitney test.Results: There was a significant difference in pain between the control and intervention groups after conducting a combination of quadriceps exercises and hip abductor exercises (p=0.043)Conclusion: The combination of quadriceps exercise and hip abductor exercise is effective on pain reduction in knee osteoarthritis patients.Keywords: quadriceps, hip abductor, osteoarthritis.Correspondence: Dia Metasari. Master of Nursing, Universitas Airlangga, Indonesia. Jl. Dr. Ir. H. Soekarno, Mulyorejo, Surabaya, East Java 60115. Email: dia.metasari-2021@fkp.unair.ac.id. Mobile: +628563040303.Indonesian Journal of Medicine (2023), 08(02): 186-193https://doi.org/10.26911/theijmed.2023.08.02.08

CLINICAL EFFECTIVENESS OF TENOTOMY VERSUS TENODESIS FOR LONG HEAD OF BICEPS TENDON PATHOLOGY: A SYSTEMATIC REVIEW AND META-ANALYSIS

There remains much debate regarding the optimal method for surgical management of patients with long head of biceps pathology. The aim of this study was to compare the outcomes of tenotomy versus tenodesis.This systematic review and meta-analysis was registered on PROSPERO (ref: CRD42020198658). Electronic databases searched included EMBASE, Medline, PsycINFO, and Cochrane Library. Randomized controlled trials (RCTs) comparing tenotomy versus tenodesis were included. Risk of bias within studies was assessed using the Cochrane risk of bias v2.0 tool and the Jadad score. The primary outcome included patient reported functional outcome measures pooled using standardized mean difference (SMD) and a random effects model. Secondary outcome measures included pain (visual analogue scale VAS), rate of Popeye deformity, and operative time.860 patients from 11 RCTs (426 tenotomy vs 434 tenodesis) were included in the meta-analysis. Pooled analysis of all PROMs data demonstrated comparable outcomes between tenotomy vs tenodesis (SMD 0.14, 95% CI −0.04 to 0.32; p=0.13). Sensitivity analysis comparing RCTs involving patients with and without an intact rotator cuff did not change the primary outcome. There was no significant difference for pain (VAS). Tenodesis resulted in a lower rate of Popeye deformity (OR 0.29, 95% CI 0.19 to 0.45, p &lt; 0.00001). Tenotomy demonstrated a shorter operative time (MD 15.21, 95% CI 1.06 to 29.36, p &lt; 0.00001).Aside from a lower rate of cosmetic deformity, tenodesis yielded no measurable significant benefit to tenotomy for addressing pathology in the long head of biceps. A large multi-centre clinical effectiveness randomised controlled trial is needed to provide clarity in this area.

Efficacy of Deep Dry Needling versus Percutaneous Electrolysis in Ultrasound-Guided Treatment of Active Myofascial Trigger Points of the Levator Scapulae in Short-Term: A Randomized Controlled Trial.

Deep dry needling (DDN) and percutaneous electrolysis (PE) provide the benefit of the mechanical effect of the needle, and PE adds the potential advantages of the galvanic current it incorporates in myofascial trigger points (MTrPs) therapy. The aim of this study was to compare the short-term efficacy between PE and DDN on active MTrPs of the levator scapulae by considering pain intensity. A simple-blind randomized controlled trial was carried out, recruiting patients suffering from non-specific neck pain lasting more than 3 months and with active MTrPs in the levator scapulae muscle (n = 52). Patients were divided into intervention (PE; n = 26) and control (DDN; n = 26) groups and received one treatment session on the active MTrPs of the levator scapulae. Patients were assessed for pain intensity, pressure pain threshold (PPT), cervical range of motion (CROM), neck disability and post-needling soreness, immediately after treatment, at 72 h and at 14 days. In addition, pain during treatment was recorded after the procedure. There were no significant differences for pain intensity, post-needling soreness and PPT. We found significant differences in CROM, immediately after treatment (p = 0.043), and at 72 h (p = 0.045), in favor of the PE group. Significant differences were found for neck disability (p < 0.047), immediately post-treatment, in favor of the DDN group. Moreover, there were significant differences for pain during the intervention (p < 0.002), in favor of the DDN group (4.54 ± 2.21) versus the PE group (6.54 ± 2.27). PE and DDN appear to have similar short-term effects. PE proved to be a more painful treatment than DDN. Clinical trial registry: NCT04157426.

Long-term Clinical Outcomes After TightRope Versus Hook Plate Fixation for Acute Acromioclavicular Joint Dislocation.

There is limited information regarding the long-term efficacy of techniques for surgical fixation after acromioclavicular (AC) joint dislocation. To evaluate the efficacy of hook plate (HP) and TightRope (TR) fixation for acute AC joint dislocations by comparing the long-term clinical and radiological patient outcomes. Cohort study, Level of evidence, 3. This study retrospectively analyzed data from 61 patients with acute AC joint dislocation between July 2011 and November 2015. The patients were grouped according to surgical procedure: HP (n = 36) and TR (n = 25). Clinical outcomes at final follow-up were evaluated using the visual analog scale (VAS) for pain; the American Shoulder and Elbow Surgery score; the Korean Shoulder Score; and the University of California, Los Angeles (UCLA) shoulder score. Side-to-side coracoclavicular (CC) distance on radiographs, postoperative complications, and the rate of subacromial erosion in the HP group were also assessed between procedures. The mean follow-up period was 7.0 ± 1.0 years, and there were no significant differences in pain or outcome scores between the HP and TR groups (all P > .05). Forward flexion was better in the TR group (172.6° ± 5.6°) versus the HP group (166.0° ± 10.8°; P = .002). The percentages of patients with a difference in the side-to-side CC distance of <5 mm were 83.3% and 72.0% in the HP and TR groups, respectively (P = .288). Complications were found in 2 patients in the HP group and 1 in the TR group (P ≥ .999). Subacromial erosion was observed in 41.7% of patients after HP fixation, with no difference in VAS pain scores at the final follow-up in patients with versus without subacromial erosion (P = .719). When comparing HP with TR fixation for the treatment of acute AC joint dislocations, there were no significant differences in functional outcome scores, final CC distance, or complications. Slightly better forward flexion was seen after TR fixation. Subacromial erosion occurred in 40% of patients after HP fixation, but this did not affect long-term VAS pain scores. Both surgical techniques are effective treatment options for AC joint dislocation.

The safest power to be applied in relation to diameter of the vein to give maximal benefit with least complications in endovenous laser ablation of varicose veins

Background Over the years, there have been significant advancements in the treatment of varicose veins. In most surgical settings, the open procedure is still the primary approach. Yet, the popularity of less invasive procedures like EVLA and RFA has produced fantastic outcomes. Objective to assess the safest power of laser which gives maximal effect and least complications in ablation of varicose veins. Methodology A prospective observational study inducing EVLA of different laser power settings (7W &amp; 10W) with preoperative assessment then follow up by CEAP &amp; VCSS and duplex ultrasound measuring great saphenous vein (GSV) diameter and also post-operative complications and time to return to work. Results This study included 50 patients (52 limbs). The Patients were distributed as regard laser power used into two groups (7W, 10W) of 26 limbs for each one. As regard GSV measures changes, there was highly statistically significant decrease in GSV diameter after 1 m and after 3 m compared to preoperative, with P value P&lt;0.001, among patients group. Also, there is higher number of cases with GSV&gt;10 mm in power of laser ‘10w’ group compared to ‘7w; group, with P value (P&lt;0.001); while there is no statistically significant difference between power of laser 7w versus 10w, because all patients ≤10 mm after 1 month and after 3 months, with P value &gt;0.05.Statistically there was no significant difference between 7W &amp; 10W groups as regards time to return to work, CEAP scores and postoperative complications except the significant difference in Pain over the treated vein being less in 7W laser power group. Conclusion For endovenous laser ablation of varicose veins, both 7W and 10W laser power are indicated. They are risk-free and provide the greatest impact with the fewest difficulties for the chosen vein diameter. In our investigation, we came to the conclusion that patients with small GSV diameter required low laser power (7W), while those with large GSV diameter required high laser power (10W).

Comparison of Outcomes After Septoplasty With Non-Absorbable or Biodegradable Synthetic Polyurethane Foam Nasal Packing With a Focus on Pain and Cardiac Factors

Background and Objectives: We compared pain levels, cardiovascular parameters, and complications according to whether patients underwent nasal packing with non-absorbable or biodegradable materials.Methods: Patients who underwent septoplasty from May 2015 to April 2020 were retrospectively reviewed. Numeric rating scale (NRS) scores for pain, blood pressure, and heart rate were measured three times (immediately after surgery, 6 hours later, and on postoperative day [POD] 1). We collected data on complications, including postoperative bleeding, septal hematoma, adhesions, septal perforation, and the recurrence of septal deviation.Results: In total, 200 patients underwent septoplasty, of whom 100 underwent nasal packing with Merocel and 100 underwent packing with Nasopore. The summed NRS scores over the three time points did not differ significantly between the groups. The NRS scores at 6 hours after surgery were highest in both groups. The systolic and diastolic blood pressure and the heart rate immediately after surgery were significantly higher than before surgery in both groups. The blood pressure and heart rate at 6 hours after surgery and on POD 1 did not differ significantly from those before surgery in either group. The incidence of sleep disturbance, postoperative bleeding, septal hematoma, adhesions, septal perforation, and recurrence of septal deviation did not differ significantly between the two groups.Conclusion: Although the level of postoperative pain and the cardiovascular parameters changed over time, we found no significant differences in pain, blood pressure, heart rate, or the complication rate according to whether patients underwent nasal packing with Nasopore or Merocel.

Transhepatic versus transperitoneal approach in percutaneous cholecystostomy: a meta-analysis

To determine whether the transhepatic or transperitoneal approach is the optimal percutaneous cholecystostomy approach. A systematic review and meta-analysis was undertaken in which the Medline, EMBASE, and PubMed databases were searched for studies that compared both approaches in patients undergoing percutaneous cholecystostomy. Statistical analysis of dichotomous variables was carried out using odds ratio as the summary statistic. Four studies totalling 684 patients (396 [58%] males, mean age 74 years) who had undergone percutaneous cholecystostomy via the transhepatic (n=367) and transperitoneal (n=317) approach were analysed. Although the overall risk of bleeding was low (4.1%), it was significantly higher in the transhepatic approach compared with the transperitoneal approach (6.3% versus 1.6% respectively, odds ratio=4.02 [1.56, 10.38]; p=0.004). There were no significant differences in pain, bile leak, tube-related complications, wound infection, or abscess formation between the approaches. Percutaneous cholecystostomy can be performed safely and successfully via the transhepatic and transperitoneal approaches. Although the overall rate of bleeding was significantly higher with the transhepatic approach, there were confounding factors due to technical differences between the studies. The small number of the included studies, in addition to variability of the definitions of outcomes, imposed other limitations. Further large-volume cases series and ideally a randomised trial with well-defined outcomes are required to confirm these findings.