Significant Difference In Postoperative Pain Research Articles

Effect of Enhanced Recovery after Surgery (ERAS) Protocol on Maternal Outcomes Following Caesarean Delivery

Background: Caesarean Section is a commonly performed surgical procedure in obstetric practice, with its incidence rising every year. This increase has led to higher bed occupancy and cost burdens. Conventional Caesarean Sections have several drawbacks, including patients being kept nil per oral overnight before surgery and for 12-24 hours after surgery, immobilization for up to 24 hours or more, continuation of catheter use for 24 hours or more, and the use of opioid-based anesthetics. To address these issues, Enhanced Recovery after Surgery (ERAS) has been introduced. ERAS consists of multimodal pathways during the pre-, intra-, and post-operative periods. Numerous clinical trials, systematic reviews, and meta-analyses have shown that applying ERAS in Caesarean delivery reduces the length of hospital stay, decreases the use of opioid-based anesthetics, improves patient satisfaction, reduces post-operative pain scores, and increases compliance with breastfeeding. Objectives: To determine the outcome of Enhanced Recovery after Surgery (ERAS) pathway in Caesarean Delivery. Methodology: This was a prospective observational study conducted at Paropakar Maternity and Women’s Hospital. Total duration of study period was 3 months from July 2024 to September 2024. A total of 106 patients meeting the inclusion criteria were included in the study. Those receiving care as per the ERAS protocols and standard conventional protocols were observed throughout pre, intra and post-operative period. The two groups were compared in terms of demographic characteristics, intravenous fluid requirement, duration of surgery, length of hospital stay, post-operative pain scores and other post-operative characteristics such as nausea, vomiting, headache, urinary retention, hospital readmission and neonatal outcome. Results: Total of 106 patients were included in the study with 53 in each of ERAS and SC group. In this study, there was no statistical difference in age group, Body Mass Index (BMI), co morbid conditions, gravidity, duration of gestation, indication of CS, duration of surgery and estimated blood loss. The average amount of intravenous fluid required intra operatively in ERAS group was 1350 ml and in SC group was 1650 ml with difference of 300 which was statistically significant, p < .001. The mean length of post-operative hospital stay was 54 hrs. in ERAS group and 71 hrs. in SC group with difference of 17 hrs. which was statistically significant with p = 0.023. The mean post-operative score in ERAS group on Day 0, Day 1 and Day 2 were lower than in SC group with p value < .001. There was no significant difference in post-operative complications between two groups. Conclusion: This study showed that implementation of ERAS protocol is associated with decrease in intra operative fluid requirement, decrease in post-operative length of hospital stay and is associated with significant difference in post-operative pain with use of multi modal analgesia. ERAS can be implemented in Caesarean delivery for addressing the issues of prolonged immobilization, delayed discharge, increased bed occupancy and many more issues associated with it.

Effect of preoperative oral cannabidiol-rich Cannabis extract on anxiety and postoperative pain after endodontic treatment: A double-blind randomized clinical trial

The aim of the present study was to evaluate the effectiveness of cannabidiol-rich Cannabis extract in reducing anxiety and postoperative pain in patients submitted to endodontic treatment METHODS: The study was carried out after approval by the Research Ethics Committee (Registration No. 5.075.961). The following groups were tested: cannabidiol (CBD) and placebo. Pain was measured using a Visual Analog Scale (VAS) before the start of treatment and 24, 48 and 72 h and 7 days after the session. Anxiety was assessed using the Modified Dental Anxiety Scale and a VAS, before and immediately after treatment. In addition, salivary cortisol was measured before drug administration and after anesthesia. Data were analyzed descriptively using absolute frequencies and percentages, with a 5% margin of error. The mean anxiety scores were higher in the Cannabidiol group than in the placebo group in each assessment (pre: 5.06 versus 3.07, respectively; post: 4.61 versus 2.60). However, there was no significant difference in the reduction of dental anxiety at the beginning of the consultation and throughout the procedure. We did not find statistically significant differences in postoperative pain between the Cannabidiol and placebo groups at any of the time points. There was no evidence of an exposure-response relationship between the intervention and control groups. However, more studies are needed to determine clinical outcomes.

Postoperative pain in oncological patients subjected to nonsurgical root canal treatment: a prospective case-control study.

The purpose of this prospective study was to evaluate the incidence and intensity of postoperative pain in oncological patients with infected teeth subjected to nonsurgical root canal treatment or retreatment. Teeth with apical periodontitis from healthy control patients and oncological patients (n = 70 per group) were root canal treated/retreated and evaluated for the development of postoperative pain. Patients from the two groups were matched for tooth type, gender, clinical manifestation of apical periodontitis, and intervention type. A visual analogue scale (VSA) was used to evaluate the incidence of postoperative pain at 24h, 72h, 7d, and 15d after chemomechanical procedures. Data were statistically analyzed for the incidence and intensity of postoperative pain in the two groups. Preoperative pain occurred in 10% of the individuals and in all these cases pain showed a reduction in intensity or was absent after endodontic intervention at 24-h evaluation. The overall incidence of postoperative pain at 24h was 14% in oncology patients and 30% in controls (p = 0.03). At 72h, the respective corresponding figures were 4% and 8.5% (p > 0.05). At 7 and 15 days, all patients were asymptomatic, irrespective of the group. No significant differences in postoperative pain were found between control and oncological patients. The low incidence of postoperative pain observed in both groups supports the routine use of nonsurgical root canal treatment/retreatment as valid options in oncological patients. Oncological patients had no increased risk of postoperative pain in comparison with control patients.

The effects of tourniquet use in elbow surgery: a retrospective analysis

BackgroundPneumatic tourniquets are frequently employed in extremity surgeries, aiming to enhance intraoperative visibility and minimize blood loss. While their benefits and drawbacks have been extensively studied in lower limb operations, their impact on upper limb procedures, particularly elbow surgery, remains poorly understood. This study investigates the advantages and risks associated with pneumatic tourniquet utilization in elbow surgery. MethodsA retrospective analysis was conducted on 183 patients who underwent elbow surgery for fractures between January 2019 and September 2023. Patients were categorized into two groups: those who underwent surgery with a tourniquet (WT) and those without a tourniquet (NT). Subgroup analyses were performed based on fracture complexity. Data collected included patient characteristics, tourniquet usage, surgical duration, pre- and postoperative hemoglobin levels, C-reactive protein levels, pain assessments, opioid administration, hospital stay duration, follow-up, complications, and revisions. Statistical analyses were used to identify significant differences and correlations. ResultsThe use of a tourniquet in elbow surgery yielded several notable outcomes. Patients in the WT group experienced significantly shorter surgical durations and hospital stays. Hemoglobin drop was lower in the WT group, indicating reduced blood loss. However, there were no significant differences in postoperative pain, opioid consumption, or complications between the WT and NT groups. Subgroup analysis revealed that the recorded differences, particularly shorter surgical durations, were more pronounced in complex fractures. ConclusionsThis study shows promising results in the use of pneumatic tourniquets in elbow surgery in terms of enhanced efficiency, reduced blood loss, and overall safety, without compromising patient outcomes. However, the potential influence of perioperative decision-making on tourniquet usage underscores the need for further research to elucidate its role and optimize its application, especially in complex elbow fractures.

The effect of bioactive glass-based, bioceramic based and epoxy amine resin based root canal sealers on post-obturation pain: A double blinded randomized controlled trial.

The aim of this study was to compare the effect of two calcium silicate-based and an epoxy resin-based root canal sealers on postoperative pain and analgesic intake following single-visit root canal treatment. Ninety patients with at least one first or second molar tooth diagnosed as symptomatic irreversible pulpitis and symptomatic apical periodontitis were selected and allocated into three groups (n=30) according to the sealer used. Root canals were prepared using Protaper Gold instruments (Dentsply Sirona) in a crown down technique and irrigated with 2.5% NaOCl (Calyx, India) and saline solution. Root canal filling was then accomplished with a single cone obturation technique and treated in a single visit by the same endodontist. Patients were told to use a Visual Analog Scale (VAS) to rate their postoperative pain severity as none, minimal, moderate, or severe after 6 h, 24 h, 48 h, 5 days and 7 days following obturation using the appropriate sealers. The need for analgesic intake was also recorded. The data were statistically analyzed. Results showed a significant difference among the studied groups. Bio-C Sealer Ion+ reported the least pain score followed by Nishika Canal Sealer BG and AH plus sealer at all the time intervals recorded. The intergroup analysis, revealed was a significant difference in postoperative pain at 6 h (p=0.000) and 24 h (p = 0.028), but not at 48 h, 5 day or 7 days (P > 0.05). VAS ratings for all the three groups decreased over time. Also, there were significant differences between the means of analgesic intake among 3 groups (p=0.022). Analgesic intake in group BIO-C Sealer Ion+ is significantly lesser than AH Plus and Nishika Canal Sealer BG group. Calcium silicate-based sealer (Nishika Canal Sealer BG and Bio-C Sealer Ion+) resulted in significantly lower levels of pain as compared to epoxy resin-based sealer (AH Plus) at 6h and 24-h interval, there was no significant difference in postoperative pain occurrence at 48-h, 5 day and 7-day period. The analgesic intake in Bio-C Sealer Ion+ group is significantly lesser than Nishika Canal Sealer BG and AH Plus group.

Post-operative pain in non-surgical root canal treatment after sealer-based obturation versus warm vertical compaction: A randomized clinical trial.

Post-operative pain may occur after non-surgical root canal treatment (NSRCT). The root filling technique and choice of sealer may be contributing factors. This randomized controlled clinical trial compared post-operative pain and analgesics intake after NSRCT using a sealer-based obturation technique (SBO) with single-cone gutta-percha and calcium silicate sealer (CSS) versus a warm-vertical compaction (WVC) technique with gutta-percha and a resin-based sealer (RBS). This study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www. gov (NCT04753138). Patients referred for NSRCT fulfilling the inclusion criteria participated in this study. Pre-operative periapical radiographs and CBCT scans were taken and numerical rating scale (NRS) pain scores were recorded. Upon completion of canal instrumentation, participants were randomly allocated to either Group SBO: SBO with CSS or Group WVC: Warm-vertical compaction with RBS. Post-operative pain and analgesics intake were recorded at 1, 3 and 7 days after endodontic treatment completion. Non-parametric Mann-Whitney U and Friedman tests and a generalized estimating equation were used to assess differences in pain scores between the groups, within each treatment group at different time points and for correlations, respectively. The study included 195 participants (212 teeth). One participant declined to submit the NRS form. Therefore, 194 participants (211 teeth) were included in the final analysis (99.5% response rate). No statistically significant differences in post-operative pain or analgesic intake existed between the two groups at any time point (p > .05). Age, pre-operative pain, apical diagnosis and post-operative analgesic intake were significantly related to post-operative pain (p < .05). Sealer-based obturation technique with CSS was associated with similar post-operative pain levels and analgesics intake as WVC with RBS. Regarding post-operative pain, SBO with CSSs may be a suitable clinical alternative.

3-Dimensional versus standard 2-D laparoscopy for benign hysterectomy: A randomized clinical trial

ObjectiveOur aim was to evaluate possible short and long-term benefits of 3-dimensional (3-D) compared to 2-dimensional (2-D) laparoscopy for benign hysterectomy.Primary outcomes were long-term quality of life and postoperative pain. Secondary outcomes were operative time, surgical complications, time to return to work and length of hospitalization. Study designA randomized controlled trial conducted at two Danish university hospitals. In each arm, 190 patients were needed for an alpha of 3.3 % and a power of 90 %. For various reasons, however, the study was prematurely terminated after including 97 patients. Patients were randomized to either 2-D (n = 48) or 3-D (n = 49) laparoscopy. A laparoscopic hysterectomy was performed. Quality of life was assessed by the Short Form Health Survey 36 (SF-36) questionnaire at the time of inclusion and 6 weeks postoperatively. Postoperative pain was assessed using a Numeric Rating Scale (NRS) and by monitoring the amount of analgesic consumption. ResultsOut of the 97 randomized patients, 77 patients completed both SF-36 questionnaires. No significant differences in mental (p = 0.5) and physical status (p = 0.9) were found. The 2-D group had significantly higher pain-score registered in the post anesthesia care unit (PACU) (p = 0.004) and higher consumption of oral morphine equivalent dose (MEqD) (p = 0.003) than the 3-D group. This regardless a higher rate of minilaparotomies in the 2D (n = 7) than in the 3D (n = 1) group (p < 0.03). The 2-D group had also higher rate of Clavien-Dindo 2 (CD2) (n = 2) and Clavien-Dindo 3 (CD3) complications (n = 3) (p = 0.03) than 3-D (n = 0). The other secondary outcome parameters did not vary between groups. ConclusionsThe results are severely hampered by the premature termination of the study, as less than 25 percent of the patients were recruited. Thus, no firm conclusions can be drawn regarding the quality of life and many of the secondary outcomes, as the lack of difference may be attributed to a type 2 error. However, the significant differences in postoperative pain and in complication rates suggest a greater advantage of 3-D laparoscopy than originally expected. Despite the methodological problems, the current data deserve attention in a sparsely investigated field, emphasizing the urgent need for further studies.

Comparison of the therapeutic effect of different anticoagulation regimens after total hip arthroplasty based on enhanced recovery after surgery: A retrospective study

This retrospective study investigated the efficacy and economic outcomes of low molecular weight heparin (LMWH), fondaparinux sodium (FPX), and rivaroxaban after total hip arthroplasty (THA) under Enhanced Recovery After Surgery (ERAS). The clinical data of patients who underwent primary THA due to hip joint disease in our Hospital from October 2020 to June 2022 were retrospectively collected and analyzed. According to different anticoagulant methods, patients were divided into LMWH group (42 cases), FPX group (24 cases), and Rivaroxaban group (39 cases). Perioperative blood coagulation-related factors, D-dimer, platelet (PLT) changes, blood routine, blood loss, lower limb vein thrombosis (DVT), pulmonary embolism, and allogeneic blood transfusion were compared among the three groups. There was no statistical significance difference for coagulation indexes and Visual Analog Scale score before the operation among the three groups, but there were statistical significance differences for prothrombin time and international normalized ratio levels at 3 days after the operation. The postoperative drainage volume and blood loss of the three groups were different, but there were no significant differences in intraoperative blood loss, hidden blood loss, total blood loss, blood transfusion rate, DVT incidence rate and Visual Analog Scale score score 3 days after surgery among the three groups. Besides, the treatment cost in the LMWH group was significantly lower than that of the FPX group and the rivaroxaban group. Hence, Based on the ERAS concept, the use of LMWH, FPX, and Rivaroxaban after THA can effectively and safely prevent the occurrence of VTE and has no significant difference in postoperative pain, perioperative blood loss, and coagulation function. However, Rivaroxaban can be taken orally and has more advantages in some pharmacological effects, while LMWH is cheaper.

Bupivacaine Local Infiltration at Trocar Insertion Sites after Gynecologic Laparoscopic Surgery: A Randomized, Double-blind, Placebo-Controlled Trial

Objective: To compare local infiltration of bupivacaine with placebo for reducing pain at trocar insertion sites after gynecologic laparoscopic surgery (GLS). Materials and Methods: A prospective, randomized, double-blind, placebo-controlled trial was conducted on women who underwent GLS at Buddhachinaraj Phitsanulok Hospital, Thailand between September 2021 and March 2022. Eighty subjects were included for this trial. Bupivacaine 0.5% 10-mL was infiltrated at each port site after removing the trocars compared with placebo. Pain intensity was evaluated by visual analog scale (VAS) for four pain points including abdominal parietal pain (APP), abdominal visceral pain (AVP), and right and left shoulder pain at 2, 4, 8, 12, and 24 hours postoperatively. Results: There were no significant differences in baseline characteristics between the two groups except for parity. APP and AVP had no significant difference in postoperative pain (mean difference –0.23, 95% CI –0.58 to 0.10, p=0.169 and –0.35, 95% CI -0.72 to 0.02, p=0.063, respectively). Only mild pain, with a VAS of 0 to 2, on both sides of shoulder were found in most participants, which had no significant difference between the two groups. Opioid consumption and adverse events were also not a significant difference. Multivariate analysis showed the APP had no significant difference between the two groups after adjusting confounding factors. However, gynecologic cancer and increased age were the significant factors associated with postoperative pain (mean difference 0.60, 95% CI 0.12 to 1.08, p=0.014 and –0.02, 95% CI –0.04 to –0.01, p=0.010, respectively). Conclusion: Locally infiltrated bupivacaine at trocar insertion sites after GLS did not significantly improve postoperative analgesia. Keywords: Gynecologic laparoscopic surgery; Postoperative analgesia; Bupivacaine

The Effects of a Laparoscopy by Single-Port Endoscopic Access in Benign Adnexal Surgery: A Randomized Controlled Trial

To evaluate whether laparoendoscopic single-site surgery (LESS) offers advantages over conventional laparoscopy (CL) in benign adnexal surgery. Randomized controlled study. Gynecology-Obstetrics Unit of the University Hospital of the Conception in Marseille, France. Patients older than 18 years requiring ovarian cystectomy or salpingo-oophorectomy by laparoscopy for symptomatic ovarian cysts requiring benign or prophylactic surgery. In the case of ovarian cysts, premenopausal patients typically undergo a unilateral cystectomy, whereas postmenopausal patients undergo a unilateral or bilateral salpingo-oophorectomy upon a patient's request. In cases requiring prophylactic surgery, a bilateral salpingo-oophorectomy was performed. All participants were randomly assigned to either the LESS or the CL group. Patients in both groups reported similar levels of pain at 24 hours: Simple Numerical Scale was 1.3 (standard deviation, 1.5) in the LESS group vs 1.7 (standard deviation, 1.5) in the CL group (p = .12), and there were no significant differences in postoperative pain at 2 hours, 4 hours, 6 hours, and 7 days. Furthermore, there was no difference in analgesic consumption. Regarding intraoperative criteria, the only difference was the longer operating time in the LESS group than the CL group. We also found that patients' satisfaction with their scar at 1 month may be higher with LESS than with CL. There was no significant difference between the 2 techniques in postoperative pain, although the LESS technique necessitated a longer operative time than the CL technique, while providing better aesthetic result patients.

Effect of patient-controlled analgesia on development of postoperative nausea and vomiting in patients undergoing microvascular decompression: a prospective randomized controlled trial.

Postoperative nausea and vomiting (PONV) occurs frequently after microvascular decompression (MVD). Fentanyl, an opioid, is strongly related to the development of PONV, and ketorolac, a nonsteroidal anti-inflammatory drug, has been approved for postoperative pain management. However, how ketorolac-based patient-controlled analgesia (PCA) causes PONV or how its efficacy differs from that of fentanyl-based PCA after MVD is unclear. In this study, the authors compared ketorolac-based with fentanyl-based PCA in terms of the incidence and severity of PONV and analgesia after MVD. This prospective, double-blind, single-center, randomized controlled trial conducted from December 2021 to February 2023 included patients with MVD who were randomly allocated to the ketorolac- or fentanyl-based PCA group postoperatively. The incidence (primary outcome) and severity of PONV and rescue antiemetic requirements were determined during the first 48 hours postoperatively. Additionally, postoperative pain scores, rescue analgesic requirement, PCA usage, and satisfaction scores were assessed during the study period. PONV severity and postoperative pain scores were assessed using an 11-point numeric rating scale (0 = none, 10 = extremely). Satisfaction scores for PONV and pain were determined (0 = very dissatisfied, 10 = very satisfied). Categorical variables were analyzed using the chi-square or Fisher's exact test. Continuous variables were analyzed using the Student t-test or Mann-Whitney U-test based on normal distribution. Of 185 screened patients, 91 were excluded based on predetermined exclusion criteria; 87 patients (43 in the ketorolac group and 44 in the fentanyl group) were analyzed and showed no significant differences in demographic data between groups. PONV incidence (48.8% vs 79.5%, p = 0.003) and severity (p = 0.004) were lower in the ketorolac-based PCA group than in the fentanyl-based PCA group. In the ketorolac group, there was a significant reduction in rescue antiemetic requirements compared with the fentanyl group (p = 0.049). The number of discontinuations was lower in the ketorolac-based PCA group than in the fentanyl-based PCA group (p = 0.001), whereas no significant differences in postoperative pain were found between the two groups. In patients with MVD, ketorolac-based PCA resulted in a decrease in PONV incidence and severity compared with fentanyl-based PCA, with analgesic effects similar to those of fentanyl-based PCA. This study provides clinical evidence that ketorolac-based PCA may be a valid alternative to fentanyl-based PCA in postoperative care.

Comparison Between Esketamine and Alfentanil for Hysteroscopy: A Prospective, Double-Blind, Randomized Controlled Trial.

This study aimed to establish the 95% effective dose (ED95) of esketamine in combination with propofol for hysteroscopy and then to evaluate its efficacy and safety profile. This prospective, double-blind, randomized controlled trial consisted of two cohorts. In cohort 1, 45 women aged 18-65 years undergoing hysteroscopy were randomly assigned to either group E (esketamine + propofol) or group A (alfentanil + propofol). Dixon's up-and-down method was used to determine the ED95 of esketamine and alfentanil. In cohort 2, 86 patients were randomized to group E and group A, with the calculated ED95 dose of the study drugs used for induction. The success rate of anesthesia using the ED95% dose, along with parameters related to anesthesia induction, recovery, and adverse events were also recorded. The ED95 of esketamine was 0.254 mg/kg (95% CI: 0.214-1.004), while that of alfentanil was 9.121 μg/kg (95% CI: 8.479-13.364). The anesthesia success rate was 93.0% in group E and 95.2% in group A (p = 0.664). After resuscitation, both groups achieved a 100% success rate. The induction time was significantly shorter in group E (60.0 [55.0-70.0] s) compared to group A (67.0 [61.0-79.3] s) (p = 0.006). Group E had lower rates of respiratory depression (p < 0.001), hypoxia (p = 0.006), minimum perioperative SpO2 (p = 0.010), and hypotension (p = 0.001). Esketamine had less effect on respiratory rate, heart rate, mean blood pressure, and end-tidal carbon dioxide compared to alfentanil (all p < 0.001). There were no significant differences in postoperative pain between the two groups. This study determined the ED 95 dose of esketamine for intravenous general anesthesia during hysteroscopy. Esketamine showed less respiratory and hemodynamic depression, as well as fewer adverse effects compared to alfentanil. Esketamine is an ideal anesthetic agent compared to alfentanil for hysteroscopic anesthesia. www.chictr.org.cn, (ChiCTR2300077283); registered November 3, 2023.

Surgical Outcome of Tumescent Versus Non Tumescent Technique for Harvesting Split Skin Graft: A Prospective Cohort Study

Introduction: The technique for harvesting Split-thickness Skin Grafts (STSG) varies among surgeons. To control bleeding from split-thickness skin graft donor sites, the use of several haemostatic agents has been reported. The tumescent technique involves injecting tumescent fluid into the subcutaneous fat, obtaining swelling and firmness (tumescence) of the surgical area. This creates regional anaesthesia of the skin and subcutaneous tissue, allowing painless cutaneous surgery, with adrenaline acts as a haemostatic agent. Aim: To compare the surgical outcomes in terms of blood loss during the harvesting of STSG, postoperative pain experienced by the patient, healing of the donor site, and graft take rate with tumescent versus non tumescent techniques of STSG. Materials and Methods: The present prospective cohort study was conducted in the Department of General Surgery, M S Ramaiah Medical College, Bengaluru, Karnataka, India, from November 2017 to March 2019. A total of 56 patients were enrolled after applying inclusion and exclusion criteria. Patients were alternately assigned into the groups of tumescent or non tumescent technique groups. Intraoperative bleeding was assessed, postoperative pain was assessed using the Visual Analogue Score (VAS), and healing of the donor and recipient sites were assessed. Student’s t-test (two-tailed, independent) was used to find the significance of study parameters on a continuous scale between the two groups. The Chi-square/ Fisher’s-exact test was used to assess the significance of study parameters on a categorical scale between two or more groups. Results: The mean±Standard Deviation (SD) age of patients in the tumescent group was 48.25±12.79 years and in the non tumescent group was 52.79±12.91 years. Intraoperative bleeding ranged from 0-25% in all 28 patients in the tumescent group, while it ranged from 76-100% in all 28 patients in the control group (p-value&lt;0.001). When the authors compared the pain on Postoperative Day (POD) 1 using VAS we observed that 32.1% of cases (n=9) had a score of 5-7 compared to 28.6% of controls (n=8). There was no significant difference in postoperative pain, and the technique used for harvesting STSG did not affect the healing of the donor site or the graft take at the recipient site. Conclusion: The tumescent technique is a safer and better alternative to the non tumescent technique, as intraoperative bleeding is significantly lower with the former. Additionally, the tumescent technique does not affect the healing of the donor or recipient site.

A Randomized Controlled Trial Comparing Ultrasonography-Guided Needle Aspiration and Surgical Drainage for the Management of Breast Abscess.

Background A breast abscess is a localized collection of inflammatory exudate in breast tissue. It is more common in lactating women. Treatment of the breast abscess is usually by incision and drainage, which is accompanied by extensive trauma, lengthy surgical incisions, psychological distress, surgical scar, and discomfort during dressing changes. Recent research has shown that ultrasonography-guided needle aspiration is an alternative to incision and drainage for breast abscess treatment, has superior cosmetic outcomes, and has fewer costs. However, there are no clear guidelines for the same. The primary objective of this study was to assess and contrast the outcomes and efficacy of two approaches in the treatment of breast abscesses: ultrasonography-guided needle aspiration and conventional incision and drainage. Methods This was a single-center, prospective, randomized, controlled, non-inferiority trial. Patients with breast abscesses were randomized either to receive needle aspiration or incision drainage. Patients with lactational breast abscesses were encouraged to breastfeed from either breast. The antibiotic was given for 10 days to all the patients. The study's main focus was on the primary outcome, which was the failure rate. Additionally, several secondary outcomes were examined, including postoperative pain, time required for healing, presence of residual abscess or recurrence, formation of fistulas, and the assessment of scar appearance. Results A total of 44 patients were randomized to 23 and 21 in each arm. There was no statistical difference in treatment failure (p-value=0.862), fistula formation (p-value=1.00), and recurrence (p-value=1.00). There was a significant statistical difference in healing period (p-value <0.001), scar formation (p-value <0.0001), continuation of breastfeeding (p-value=0.005), and clinical resolution (p-value=0.002). There was a significant reduction in post-intervention pain in the needle aspiration group than in the other group (p-value <0.001). Conclusion This study showed a significant difference in postoperative pain, healing time, the continuation of breastfeeding, and scar formation in the needle aspiration group, favouring minimally invasive treatment for breast abscess. However, due to the small sample size, we could not conclude that ultrasonography-guided needle aspiration of the breast abscess is non-inferior to the conventional incision and drainage.

Effect of Sphenopalatine Ganglion Nerve Block on Bleeding and Pain During and After Rhinoplasty and Septoplasty Surgeries: A Double-Blind Randomized Clinical Trial

Background: The sphenopalatine ganglion nerve block (SPGB) in endoscopic sinus surgeries has been shown to reduce postsurgery narcotic consumption. Objectives: This study aimed to investigate the effect of SPGB on bleeding and pain during and after rhinoplasty and septoplasty. Methods: This study was conducted as a double-blind, randomized clinical trial and included 30 patients who were scheduled for elective rhinoplasty and septoplasty. All the participants received propofol/remifentanil anesthesia and similar intraoperative care. The patients were divided into 2 groups: The SPGB group, which received 0.5% bupivacaine, and the placebo group, which received normal saline. The study compared the amount of narcotics used during and after the operation, pain levels during and after the operation (at 2, 4, 6, and 24 hours after the operation), and bleeding during the operation between the 2 groups. The surgeon's satisfaction with bleeding control was also recorded at 30, 60, and 90 minutes. Results: In the SPGB group, 86% of the participants had ASA (American Society of Anesthesiologists) class I, while in the placebo group, 80% had ASA class I. There was no significant difference in postoperative pain between the control and intervention groups (P &gt; 0.05). However, the SPGB group showed a significant decrease in intraoperative pain based on the amount of narcotics received (P &lt; 0.05). According to the Boezaart criterion, the control group had significantly higher rates of severe and moderate bleeding (P &lt; 0.05), whereas the bupivacaine group had a lower total bleeding rate (P &lt; 0.05). Conclusions: The administration of bupivacaine was effective in reducing pain, bleeding, and the need for narcotics during surgery. The SPGB has the potential to decrease bleeding and drug utilization, making it a preferable option for anesthesiologists aiming to minimize the use of anesthetics.

Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial

BackgroundNeuroinflammation may be a potential mechanism of postoperative delirium (POD) in geriatric patients, and hypertonic saline (HS) has immunomodulatory properties. The purpose of this study was to investigate whether HS could reduce the incidence of POD in elderly patients and its effect on neutrophil activation and inflammatory cytokine expression.MethodsWe studied the effect of pre-infusion of 4 mL/kg 3% hypertonic saline vs. 4 mL/kg 0.9% normal saline on POD in patients undergoing shoulder arthroscopy in a prospective, randomized, double-blind, controlled trial. Neutrophil surface molecules (CD11b, CD66b and CD64) were analyzed by flow cytometry. Circulating concentrations of inflammatory factors IL-1β, IL-6, TNF-α and neurological damage factor S100β were assessed by enzyme immunoassay. The Confusion Assessment Method-Chinese Revision (CAM-CR) was applied for the assessment of POD 1–3 days after surgery.ResultsThe incidence of POD in group H was significantly lower than that in group N (7.14% vs 26.83%, P = 0.036). The expression levels of inflammatory cytokines ( IL-6 and TNF-α) and neutrophil surface markers (CD11b and CD66b) were significantly lower in group H than in group N at 24 h after surgery (P = 0.018, P < 0.001, P < 0.001, P = 0.024). There were no significant differences in postoperative pain, nausea and vomiting, infection, phlebitis, and patients satisfaction between the two groups.ConclusionPre-infusion of HS can reduce the incidence of POD and the immune-inflammatory response.Trial registrationChinese Clinical Trial Registry (14/4/2022, registration number: ChiCTR2200058681.

Early Post-Cesarean Rehabilitation in A Tertiary Hospital in Burkina Faso

Introduction: early post-caesarean rehabilitation could be an ideal alternative in terms of direct health savings for the parturient and indirect for the community. Objective: Studying the effects of early rehabilitation after caesarean section in women at Yalgado Ouedraogo teaching hospital (YOTH) Methodology: This was a cohort study comparing two groups of patients who underwent a scheduled caesarean section from 7th May to 4th September, 2020 in the obstetrics department of YOTH. Group 1 consisted of women benefiting from the early rehabilitation protocol (n=124) and group 2 consisted of non-rehabilitated women (n=124). Results: The times of first getting up (p=0.01), walking (p&lt;0.05), first drink (p=0.0001), removal of the urinary catheter (p&lt;0.05), and urination (p&lt;0.05) were significantly reduced in group 1. There was no statistically significant difference in postoperative pain. The mean time to first urination after removal of the urinary catheter was 18.8 ± 4.3 hours in the rehabilitated operated group versus 28 ± 10.5 hours in the non-rehabilitated group (p &lt; 0.05). The first rise took place on average 7.2 ± 1.5 hours after the cesarean section in the rehabilitated group versus 8.1 ± 3.7 hours in the non-rehabilitated group (p=0.01). There was a significant reduction in length of stay (p &lt; 0.05) and cost of treatment (p=0.) Conclusion: The early rehabilitation protocol after caesarean allows a significant improvement in terms of functional recovery, length of stay and cost of treatment.

Effect of Occlusal Reduction on Postoperative Pain during Root Canal Treatment in Teeth with Symptomatic Apical Periodontitis

INTRODUCTION: Pain management after root canal treatment is a very important issue in clinical practice. Occlusal reduction has been widely used after root canal treatment to reduce post treatment pain and flare up. The purpose of this study was to evaluate the effect of occlusal reduction on postoperative pain in teeth with symptomatic apical periodontitis. MATERIALS AND METHODS: Seventy mandibular molar teeth with symptomatic apical periodontitis requiring root canal treatment were included in this study. Each patient who met the inclusion criteria had a serial number allocated, ranging from 1 to 70. The patients were divided into two groups i.e, occlusal reduction group and without occlusal reduction group according to the odd and even numbers on the list. After administration of local anesthesia, the root canals were instrumented, and an intracanal calcium hydroxide dressing was placed. Following confirmation with articulating paper, occlusal reduction group received a 2 mm reduction in occlusal contacts. Preoperative pain before start of the procedure and postoperative pain 6 days after instrumentation were recorded on visual analogue scale. Data was evaluated by chi-square test and Man Whitney U test with p-value &lt;0.05 considered as statistically significant. RESULTS: There was no significant difference in postoperative pain between two groups (p&gt;0.05) after root canal preparation. CONCLUSIONS: Occlusal surface reduction did not provide any further reduction in postoperative pain for teeth with symptomatic apical periodontitis compared with no occlusal reduction

Biomaterial Material Applications in Postoperative Surgical Fields of Uvulopalatopharyngoplasty: A Comparative Study.

This retrospective study compared the effectiveness of different materials used in Uvulopalatopharyngoplasty (UPPP) for snoring or obstructive sleep apnea treatment, focusing on the impact on bleeding control, pain control, and healing ability. The study population comprised 213 patients who underwent UPPP at Wan-Fang Hospital between July 2018 and October 2022 divided into four groups based on the postoperative material used: No Material Use Group, Tissue Glue Group, Platelet-Rich Plasma (PRP) Group, and Polyglycolic Acid (PGA) Sheet Group. Results showed significant differences in operation time and intraoperative bleeding amount among the groups, with the Tissue Glue Group demonstrating the shortest operation time. While no significant differences in postoperative pain at 24 h were observed, PRP and PGA Sheet groups exhibited lower average pain scores in cases with higher pain levels. Postoperative complications and emergency room visits due to pain or bleeding varied among the groups, with the No Material Use Group having the highest incidence, although no statistical significance was achieved. This study provides insights into the potential benefits of using advanced materials in UPPP, guiding future research and clinical practice to improve patient care and outcomes.

Influence of Intraoperative Nociception during Hip or Knee Arthroplasty with Supplementary Regional Anaesthesia on Postoperative Pain and Opioid Consumption.

Background and Objectives: Early postoperative mobilization is central for postoperative outcomes after lower extremity joint replacement surgery. By providing adequate pain control, regional anaesthesia plays an important role for postoperative mobilization. It was the objective of this study to investigate the use of the nociception level index (NOL) to determine the effect of regional anaesthesia in hip or knee arthroplasty patients undergoing general anaesthesia with additional peripheral nerve block. Materials and Methods: Patients received general anaesthesia, and continuous NOL monitoring was established before anaesthesia induction. Depending on the type of surgery, regional anaesthesia was performed with a Fascia Iliaca Block or an Adductor Canal Block. Results: For the final analysis, 35 patients remained, 18 with hip and 17 with knee arthroplasty. We found no significant difference in postoperative pain between hip or knee arthroplasty groups. NOL increase at the time of skin incision was the only parameter associated with postoperative pain measured using a numerical rating scale (NRS > 3) after 24 h in movement (-12.3 vs. +119%, p = 0.005). There was no association with intraoperative NOL values and postoperative opioid consumption, nor was there an association between secondary parameters (bispectral index, heart rate) and postoperative pain levels. Conclusions: Intraoperative NOL changes may indicate regional anaesthesia effectiveness and could be associated with postoperative pain levels. This remains to be confirmed in a larger study.