Significant Reduction In Pain Scores Research Articles

A Comparison between Pre-Incisional and Intraoperative Lidocaine Infiltration on Post-Incisional Surgical Pain in Microdiscectomy Surgery: A Randomized Clinical Trial Study.

Effective postoperative pain control in microdiscectomy surgery is crucial to managing the disease and improving the patient's quality of life. Therefore, this study aimed to assess the potential effectiveness of 2% lidocaine in reducing pain immediately after discectomy surgery. A total of 60 patients who underwent microdiscectomy surgery were enrolled in this randomized clinical trial study. They were randomly assigned to three groups: one group received lidocaine just before the incision, another group received lidocaine just before closing the incision, and the third group served as the control. Pain scores were measured at 1, 2, 3, 4, 8, and 12 h after the surgery using a Visual Analogue Scale. The demographic and clinical characteristics of the study population, including age, weight, length of surgery, gender, and history of diabetes, hypertension, and previous surgery, were comparable across all three groups (P>0.05). There was a significant reduction in pain scores over time in the groups that received lidocaine before (P<0.001) and during surgery (P=0.002). Moreover, there were significant differences in pain scores at all time points among the three groups. Both groups receiving lidocaine showed significantly lower pain scores than the control group (Pbefore surgery=0.005 and Pduring surgery<0.001). However, no significant difference was observed between the groups receiving lidocaine (P=0.080). These findings highlight the effectiveness of a local injection of 2% lidocaine either before or during the surgery in managing post-incisional surgical pain after discectomy.

Relationship between Time Elapsed Since Pain Onset and Efficacy of Pain Relief in Patients Undergoing Lumbar Percutaneous Epidural Adhesiolysis.

The aim of this study was to investigate the relationship between pain duration and pain relief after epidural adhesiolysis. Patients with low back pain who underwent lumbar epidural adhesiolysis were enrolled. A clinically significant reduction in pain score was defined as a ≥30% reduction at 6-month follow-up evaluation. Variables were compared based on pain duration categories. Changes in pain scores and pain outcome were also compared. Logistic regression analysis was conducted to identify factors associated with pain relief after adhesiolysis. A total of 169 patients, including 77 (45.6%) patients with a favorable pain outcome, were included for analysis. Patients with a pain duration ≥3 years reported lower baseline pain scores and showed more frequent severe central stenosis. Pain scores significantly decreased over time after the procedure except in patients with a pain duration ≥3 years. Most patients who experienced pain for ≥3 years showed poor pain relief (80.8%), unlike other pain duration categories (pain duration <3 months=48.1%, 3 months-1 year=51.8%, 1-3 years=48.6%). A pain duration ≥3 years and lower baseline pain score were independent factors associated with an unfavorable pain outcome. Pain lasting ≥3 years prior to lumbar epidural adhesiolysis was associated with worse outcomes in terms of pain relief. Therefore, this intervention should be considered early before pain chronification in patients with low back pain.

The Feasibility of Hysteroscopic Endomyometrium Resection combined with concomitant Insertion of LNG-IUD for Treatment of Symptomatic Adenomyosis; A 36 Case Series with 5-year follow up result.

Background: Treatment for patients with symptomatic adenomyosis has been mainly by hysterectomy. The aim of this 5-year observational study was to assess the feasibility of Hysteroscopic Endomyometrium Resection with concomitant Insertion of LNG-IUD for symptomatic adenomyosis. Methods: From May 2015 and December 2022, a group of 36 women with symptomatic adenomyosis underwent this combined modality treatment at a community hospital. The core outcomes of the study were effective rate of dysmenorrhea, menorrhagia, secondary outcomes as hysterectomy, IUD expulsion, or premature removal, repeated the procedures. Results: The study followed the progress of 36 women, aged 42.9±4, over a period of five years. The procedures were performed safely, and no complications were observed. The total successful rate of amenorrhea was 27 of 36 (75%). For the Pain Control, the intervention led to a significant reduction in pain scores, with the mean pain score decreasing by approximately 63.4% (95% CI: -64.3% to -62.5%). For the Blood Loss, with the mean blood loss decreasing by approximately 75.77% (95% CI: 32.93% to 118.61%). The study also showed reduced CA-125 level, reduction in uterine length and volume, about 70% of patients reported being very satisfied and satisfied of this combined treatment. Conclusion: We demonstrated this combined modality is feasible and safe for treatment of symptomatic adenomyosis.

Efficacy of 2 Nonpharmaceutical (Non-nutritive Sucking and Human Care Contact) Pain Relief Measures for Idiopathic Clubfoot Casted Using Ponseti Technique.

This study aimed at exploring the pain and physiological responses exhibited during Ponseti manipulation and casting in clubfoot infants. In addition, we compared the efficacy of 2 nonpharmaceutical techniques (non-nutritive sucking and human care contact) for tackling these responses. The study included children with unilateral and bilateral idiopathic clubfeet between 15 days to 6 months of age. For comparisons, children were divided into control group without any intervention (group A), non-nutritive sucking group (group B), and human care contact group (group C). Pain score (Neonatal Infant Pain Score), heart rate (HR), and oxygen saturation (SpO2) was assessed before, during and 1 minute after casting. These measurements were compared using statistical methods. There were 16 children (11 bilateral) in group A, 17 (10 bilateral) in group B, and 18 (8 bilateral) in group C. Before casting, the baseline parameters (Neonatal Infant Pain Score, HR, and SpO2) of the 3 groups were comparable. Groups B and C had a significant reduction in pain score at casting and in postcasting period when compared with group A (P<0.05). Group B (at casting-mean: 174.1/min, postcasting-mean: 168.2/min) had the lowest HR both during and after cast application. Group B had the highest SpO2 among all the 3 groups, both during casting (mean: 95.7%) and after casting (mean: 97.4%) (P<0.05). Infants exhibit moderate pain response and altered physiological responses during and after Ponseti casting. Non-nutritive sucking emerged as a better method to lessen these parameters when compared with the conventional technique and human care contact. Level II.

Methylene blue for intractable pain from oral mucositis related to cancer treatment: a randomized phase 2 clinical trial

BackgroundOral mucositis (OM) in patients receiving cancer therapy is thus far not well managed with standard approaches. We aimed to assess the safety and effectiveness of methylene blue (MB) oral rinse for OM pain in patients receiving cancer therapy.MethodsIn this randomized, single-blind phase 2 clinical trial, patients were randomized to one of four arms: MB 0.025%+conventional therapy (CTx) (n = 15), MB 0.05%+CTx (n = 14), MB 0.1%+CTx (n = 15), or CTx alone (n = 16). Intervention groups received MB oral rinse every 6 h for 2 days with outcomes measured at days 1–2; safety was evaluated up to 30 days. The primary outcome measured change in the pain numeric rating scale (0–10) from baseline to day 2. Secondary outcome measured change in oral function burden scores from baseline to day 2, World Health Organization OM grades, morphine equivalent daily doses, and adverse events. The trial was registered with ClinicalTrials.gov ID: NCT03469284.ResultsSixty patients (mean age 43, range 22–62 years) completed the study. Compared with those who received CTx alone, those who received MB had a significant reduction of pain scores at day 2 of treatment (mean ± SD); 0.025%: 5.2 ± 2.9, 0.05%: 4.5 ± 2.9, 0.1%: 5.15 ± 2.6) and reduction of oral function burden scores (0.025%: 2.5 ± 1.55, 0.05%: 2.8 ± 1.7, 0.1%: 2.9 ± 1.60). No serious adverse events were noted, but eight patients reported burning sensation of the oral cavity with the first dose, and this caused one patient to discontinue therapy.ConclusionsMB oral rinse showed significant pain reduction and improved oral functioning with minimal adverse effects.Trial registrationClinicalTrials.gov ID: NCT03469284.

The Analgesic Efficacy of Ultrasound-guided Quadratus Lumborum Block Transmuscular or Posterior Approach After Hip Surgery: A Systematic Review and Meta-analysis with Trial Sequential Analysis.

No review or meta-analysis exists to elucidate the efficacy and safety of quadratus lumborum block (QLB) on the pain intensity, opioid requirement, and mobilization in patients undergoing hip surgery. This systematic review and meta-analysis of randomized controlled trials were designed to compare QLB with no block or placebo (without other nerve/plexus blocks) for patients undergoing hip surgery. Two individual researchers conducted the platform searches on the PubMed, Cochrane Library, and Embase databases from inception to June 12, 2021. Only English publications were included. The pain at rest score at 12 postoperative hours was designated as the primary outcome. Secondary outcomes included rest pain at rest scores at 6 and 24 postoperative hours, dynamic pain score at 6, 12, and 24 postoperative hours, total opioid consumption, postoperative nausea and vomiting, and patient satisfaction. Seven trials including 514 patients were included. When compared with controls, the QLB technique significantly reduced pain at rest scores at 12 hours after surgery (mean difference -1.15, -1.52 to -0.77, P <0.0001). The secondary outcomes were limited by heterogeneity: secondary pain outcomes and opioid consumption were consistently improved with QLB ( P <0.05); patient satisfaction and postoperative nausea and vomiting were similar between the groups based on the Inverse Variance Heterogeneity model ( P >0.05). The overall quality of evidence was moderate. There is moderate evidence that QLB employment in hip surgery produces significant reduction in pain scores and opioid consumption within 24 hours. QLB appears to be an appropriate option for postoperative analgesia after hip surgery.

Effectiveness of electromyography guided botulinum toxin injection and dextrose prolotherapy in recurrent TMJ dislocation (radiographic and clinical study)

Objectives: This study was conducted to assess effectiveness of dextrose prolotherapy, Electromyography (EMG) Guided Botulinum Toxin – A (BTX-A) Injection, and combination between them in treatment of recurrent TMJ Dislocation cases. Subjects and methods: This current study was carried out on 60 adult patients suffering from recurrent TMJ Dislocation. The patients divided equally into three groups, Group I: 20 patients were treated with EMG guided BTX-A injection. Group II: 20 patients were treated with dextrose prolotherapy. Group III: 20 patients were treated with combination of EMG guided BTX-A injection and dextrose prolotherapy. The clinical evaluation preoperatively and postoperatively (at 1week , 3 months , 6 months) included visual analog scale of TMJ pain, maximum mouth opening (MMO), and frequency of luxations . Radiographic evaluation using MRI was done preoperatively, and at 6 months. The collected data were then statistically analyzed. Results: best results were recorded in group III compared with other groups; at all intervals of study with significant reduction of pain score, and frequency of luxations beside to improvement of MMO measurements. Conclusion: the combination of EMG guided BTX-A injection and dextrose prolotherapy is a promising treatment in recurrent TMJ dislocation cases.

Therapeutic Efficacy of Great Plantain (Plantago major L.) in the Treatment of Second-Degree Burn Wounds: A Case-Control Study.

Background Great plantain (Plantago major L. or P.major) is a medicinal plant that is available all around the world. The whole plant has several bioactive compounds including terpenoids, flavonoids, phenolic compounds, alkaloids, fatty acids, iridoid glycosides, polysaccharides, and vitamins. Scientific studies have recognized several medical benefits like wound healing, anti-inflammatory, antimicrobial, antiulcerative, and antioxidative agents. The wound-healing capacity of this plant has been investigated under in vivo and ex vivo conditions. In the current study, we aim to compare the therapeutic effect of the P.major extract with 1% sulfadiazine on the healing of second-degree burn wounds. Method Second-degree burn victims were included in our study. The investigation and control group, respectively, received P. major ointment 10% and silver sulfadiazine ointment 1%. The bacterial culture from the wound site was taken on days 3, 7, 10, 13, and last day of hospitalization. Patients' subjective complaints were obtained through the visual analog scale (VAS). All patients were treated and evaluated in the hospital. Result Among the 15 patients, 11 were male, and the mean age was 33.3 years. The average complete healing duration was 11.73 vs. 13 days in the P. major and control group, respectively (P=0.166). On the third day, infection control was similar between the two groups, and on the seventh day, all bacterial cultures were negative. Although there was a significant reduction in pain scores during the recovery time, no significant differences in pain reduction were noted between the two groups (P=0.849). Conclusion We showed that P.major ointment is a safe and suitable herbal compound in the treatment of second-degree burn wounds that not only has wound-healing properties but also is an analgesic and antimicrobial compound.

Robotic computed tomography-guided celiac plexus neurolysis: our experience of technique and outcomes.

Aim: We report the use of robot assistance for computed tomography-guided celiac plexus neurolysis for the first time. Materials & methods: Four patients of upper abdominal cancer with intractable pain despite opioids were positioned prone on the PET-computed tomography scanner, which measured the accurate coordinates for the entry, depth and angle of the target point. The robot positioned its arm over the patient in accordance with the set needle path. The physician manually inserted needle through it and injected 20ml of 0.75% alcohol after dye confirmation. Results: Significant reduction in pain scores and oral morphine consumption were observed in patients during 3months follow-up. Conclusion: The robot precisely orients and helps in accurate placement of the needle through the robotic arm.

Efficacy and safety of micronized purified flavonoid fractions for the treatment of postoperative hemorrhoid complications: A systematic review and meta-analysis

Hemorrhoids, a common anorectal disease, seriously affects patients' quality of life. Micronized purified flavonoid fractions (MPFF) have been shown to improve hemorrhoid symptoms. To evaluate the efficacy and safety of MPFF in treating postoperative hemorrhoid complications. A systematic review and meta-analysis of existing literature on natural compounds for treating postoperative complications of hemorrhoids. A literature search was conducted using five databases, namely PubMed, WanFang, CNKI, Embase, and the Cochrane Library, to identify randomized controlled trials (RCTs) on the effects of MPFF treatment on hemorrhoids. Stata 15.1 and Revman 15.4 were used to assess the data, while subgroup and sensitivity analyses were performed to evaluate potential heterogeneity, and trial sequential analysis (TSA) and Egger test were used to evaluate the reliability of each trial. A total of 22 RCTs, including 2,335 participants were included in the analysis. MPFF improved the clinical efficacy of post-hemorrhoidectomy and reduced the bleeding rate, pain score, and edema score, although no substantial effect on adverse reactions was reported. Subgroup analyses showed a significant reduction in pain score and bleeding rate in trials with duration of 4-10 days and an improvement in clinical efficacy. Treatment for ≥ 10 days significantly improved the edema score; a dosage range of 1,800-2,700 mg/day of MPFF significantly reduced edema and pain scores, whereas < 1,800 mg/day significantly improved clinical efficacy. Based on searching the relevant literatures, this is the first meta-analysis on MPFF treatment of postoperative hemorrhoid complications. Our findings, validated by TSA, suggest that MPFF is safe and effective in reducing postoperative hemorrhoid complications, and that dose and duration are key factors in its efficacy, as illustrated by subgroup analysis. However, due to the small sample size, the standardized treatment regimen of MPFF could not be obtained; therefore, further research is warranted.

Evaluating Outcomes of a Pharmacist-Driven Pain Management Consult Service

The opioid crisis continues to place a significant burden on American families and the healthcare system. To date, there is an evolving body of evidence demonstrating that pharmacists can positively impact patient care in the pain management specialty. The purpose of this study is to evaluate 24-hour average pain scores before and after a clinical pharmacist completes a physician-ordered pain consult in a community hospital setting. For the primary outcome, there was a statistically significant reduction in pain scores 48 hours post consult (6.5 vs. 5.2; p < 0.001; Table 3) and 24 hours prior to discharge (6.1 vs. 4.5; p < 0.001; Table 3) when compared to pain scores 24 hours prior to consult. Additionally, there was a statistically significant reduction in the number of morphine milligram equivalents (MMEs) at 48 hours post consult (149.4 vs. 133.8; p < 0.001; Table 4) and 24 hours prior to discharge (136.5 vs. 100.6; p < 0.001; Table 4) when compared to 24 hours prior to consult. This pharmacist-driven pain consult service demonstrated a statistically significant reduction in pain scores while simultaneously reducing MME utilization and the number of opioids ordered, using a multimodal evidence-driven approach to pain management in a community hospital.

Efficacy and safety of combined oral sucrose and nonnutritive sucking in pain management for infants: A systematic review and meta-analysis.

Pain management is currently important in neonatal intensive care unit (NICU). The superiority in pain relief of the combined oral sucrose (OS) and nonnutritive sucking (NNS) to other single intervention has not been well established. The administration of sucrose has been considered to potentially induce adverse events, which has been controversial. This study aims to investigate the combined effects and safety in comparison with other single intervention methods, including NNS, OS alone, breast milk and oral glucose. We searched databases including Medline (via Pubmed), Embase (via Ovid), web of science, and Cochrane Library for randomized controlled trials from Jan 1, 2000 to Mar 31, 2021. The data were analyzed in the meta-analysis using Review manager Version 5.3. Pain score was the primary outcome in this meta-analysis. The adverse events were assessed qualitatively. A total of 16 studies were eligible in the meta-analysis. The results demonstrated a significant reduction in pain score in the NNS+OS group compared with NNS alone (SMD = -1.69, 95%CI, -1.69,-0.65) or sucrose alone (SMD = -1.39, 95% CI, -2.21,-0.57) during the painful procedures. When compared NNS+OS with breast milk, no significant difference was detected (SMD = -0.19, 95% CI: -0.5, 0.11). The combined effects of NNS and OS might be superior to other single intervention method. However, the effects might be mild for moderate-to-severe pain.

Adalimumab Effect on Pain in Hidradenitis Suppurativa Patients: Systematic Review and Meta-Analysis.

IntroductionPain is experienced by most patients with hidradenitis suppurativa (HS) and has a severe impact on their quality of life. Its management still presents a challenge. Adalimumab, a TNF-a antagonist, has shown promising results in HS-related pain reduction.ObjectivesTo aggregate and synthesize all existing evidence regarding the effect of adalimumab on HS-associated pain.MethodsWe identified original controlled and uncontrolled studies with participants receiving adalimumab, which included change in pain score post-treatment compared to baseline as an end-point. We searched MEDLINE, ScienceDirect, the Cochrane Library, ClinicalTrials.gov and International Clinical Trials Registry Platform. The primary endpoint of our study was the mean change (continuous variable) of pain scores at week 12 compared to baseline.ResultsWe performed a meta-analysis of 4 randomized controlled trials (282 patients in the intervention group and 266 patients in the control group). Adalimumab brought about a 0.418 reduction in mean pain score at its worst with 95%CI [−0.588, −0.248] and P = 0.000 at 12 weeks after treatment commencement. Four more studies were included in a qualitative synthesis, 2 of which reported statistically significant reduction in pain scores at week 12.ConclusionsAdalimumab could be prescribed more readily in cases of HS associated with significant pain.

Postoperative pain treatment after spinal fusion surgery: a systematic review with meta-analyses and trial sequential analyses.

Patients undergoing spinal surgery are at high risk of acute and persistent postoperative pain. Therefore, adequate pain relief is crucial. This systematic review aimed to provide answers about best-proven postoperative analgesic treatment for patients undergoing lumbar 1- or 2-level fusions for degenerative spine diseases. We performed a search in PubMed, Embase, and The Cochrane Library for randomized controlled trials. The primary outcome was opioid consumption after 24 hours postoperatively. We performed meta-analyses, trial sequential analyses, and Grading of Recommendations assessment to accommodate systematic errors. Forty-four randomized controlled trials were included with 2983 participants. Five subgroups emerged: nonsteroidal anti-inflammatory drugs (NSAIDs), epidural, ketamine, local infiltration analgesia, and intrathecal morphine. The results showed a significant reduction in opioid consumption for treatment with NSAID (P < 0.0008) and epidural (P < 0.0006) (predefined minimal clinical relevance of 10 mg). Concerning secondary outcomes, significant reductions in pain scores were detected after 6 hours at rest (NSAID [P < 0.0001] and intrathecal morphine [P < 0.0001]), 6 hours during mobilization (intrathecal morphine [P = 0.003]), 24 hours at rest (epidural [P < 0.00001] and ketamine [P < 0.00001]), and 24 hours during mobilization (intrathecal morphine [P = 0.03]). The effect of wound infiltration was nonsignificant. The quality of evidence was low to very low for most trials. The results from this systematic review showed that some analgesic interventions have the capability to reduce opioid consumption compared with control groups. However, because of the high risk of bias and low evidence, it was impossible to recommend a "gold standard" for the analgesic treatment after 1- or 2-level spinal fusion surgery.

Associations between Music Therapy, Pain and Heart Rate for Children Receiving Palliative Care

Abstract Music therapy (MT) is a widely used non-pharmacological intervention in pediatric health care, an integral part of pediatric palliative care (PPC). Yet, there is a lack of evidence of efficacy, and best practices are not well established. The nature and extent of physiologic impacts of MT in PPC have not previously been reported. This study explores how MT contributes to psycho-physiological changes in children receiving palliative care. We used a convergent mixed-methods feasibility study with a pre–post design. MT sessions were delivered to children (0–18 years), who were registered with a statewide Pediatric Palliative Care Service. Pre–post measures of pain and heart rate were collected using validated and objective measures and analyzed using mixed-model analysis. Analysis of 36 MT sessions demonstrated a statistically significant reduction in pain scores and heart rate after MT sessions. Post measures of pain measured with Face, Legs, Activity, Cry, Consolability scale (FLACC scale) scores were −1.57 (95% confidence interval [CI] −2.31 to −0.83) and by Likert pain scale −2.03 (95% CI −2.79 to −1.27). Heart rate reduced by a mean of −7.6 beats per minute (95% CI −10.74 to −3.37). Five parents participated in semi-structured interviews. Following thematic analysis, two major themes emerged: (1) MT has a positive impact on physiological symptoms and (2) MT enhances the opportunity to experience joy. Results demonstrate the feasibility of study components and may inform future research design for a larger study. This research contributes to the limited evidence about non-pharmacological interventions enhancing the quality of life for children receiving PPC.

A Randomized Controlled Pilot Study of Topical Ropivacaine for Prevention of Post-POEM Pain.

Background and AimsAlthough usually mild to moderate in severity, postoperative pain after peroral endoscopic myotomy (POEM) is common. There are no studies that have addressed minimizing postoperative pain in patients undergoing POEM for achalasia. We hypothesized that intraoperative topical intra-tunnel irrigation with ropivacaine would result in a significant reduction in pain scores in the postoperative period.MethodsA double-blind, randomized, placebo-controlled trial was conducted at the Kingston Health Sciences Center. Patients received either 30 mL of 0.2% ropivacaine or 30 mL of placebo irrigated topically into the POEM tunnel after completing the myotomy and prior to closing the mucosal incision. The primary outcome was pain post-POEM at 6 h assessed by the Numeric Rating Scale (NRS). Secondary objectives included assessing pain score at 0.5, 1, 2, 4 h post-POEM and on discharge, Quality of Recovery (QoR-15) scores at discharge, narcotic requirement, adverse events, and patients’ willingness to have the procedure done on an outpatient basis.ResultsA total of 20 patients were enrolled. For the primary outcome of pain post-POEM at 6 h, the NRS was 1.1 in the placebo group and 2.4 in the ropivacaine group (95% CI of the difference: −3.2 to 0.6, P = 0.171). No statistical difference was seen in the pain scores. Overall usage of post-procedural narcotics was low with no differences between the two groups. Fifty percent of patients in both groups were willing to have the procedure done as an outpatient.ConclusionThe addition of intra-procedural tunnel irrigation with 30 mL 0.2% ropivacaine did not lead to reduced post-POEM pain.

Treatment efficacy using occlusal splint for anterior disc displacement without reduction of temporomandibular joint

Management of TMDs with occlusal splint is a reversible, non- invasive modality which causes minimum damage to tissues, when compared to other irreversible treatment modalities. Objectives of this study is to assess the effectiveness of flat occlusal splint in patients with anterior disc displacement without reduction by evaluating reduction in pain and improvement in mouth opening. 35 participants with mean age 35 years who does not have any systemic diseases and not undergoing treatment for ADD without reduction were selected for study. After recording pain score on VAS scale and maximum mouth opening, flat occlusal splint was fabricated for maxillary arch. Patients were advised to wear the splint for all the time except on meal times. Maximum mouth opening and pain score were again evaluated after 3 weeks. Statistical results showed that there is highly significant reduction in pain score and increase in maximum mouth opening. Mean VAS score before treatment was 7.26±0.88. After treatment with splint therapy, VAS score was reduced to 2.94±1.41. The mean value of maximum mouth opening before treatment was 23.09±4.25. After treatment with splint therapy, it was increased to 30.37±5.43. Both parameters had p value &amp;#60;0.001, which is highly significant statistically. Significant reduction in pain score and improvement in mouth opening noted after using flat occlusal splint in patients having ADD without reduction. However, further studies are needed on a long term basis for better results.

A Preliminary Study of the Efficacy of Transcranial Direct Current Stimulation in Trigeminal Neuralgia.

The purpose of this study is to assess the efficacy of transcranial direct current stimulation (tDCS) in patients with treatment-refractory trigeminal neuralgia (TN) and examine the utility of neuroimaging methods in identifying markers of such efficacy. Six patients with classical TN refractory to maximal medical treatment, underwent tDCS (three cases inhibitory/cathodic and three cases excitatory/anodic stimulation). All patients underwent pre- and posttreatment functional magnetic resonance imaging (fMRI) during block-design tasks (i.e., Pain, Pain + tDCS, tDCS) as well as single-shell diffusion MRI (dMRI) acquisition. The precise locations of tDCS electrodes were identified by neuronavigation. Five therapeutic tDCS sessions were carried out for each patient with either anodic or cathodic applications. The Numeric Rating Scale of pain (NRS) and the Headache Disability Index (HDI) were used to score the subjective efficacy of treatment. Altered activity of regional sites was identified by fMRI and associated changes in the spinothalamocortical sensory tract (STCT) were measured by the dMRI indices of fractional anisotropy (FA) and mean diffusivity (MD). Fiber counts of the bilateral trigeminal root entry zone (REZ) were performed as an added measure of fiber loss or recovery. All patients experienced a significant reduction in pain scores with a substantial decline in HDI (P value < 0.01). Following a course of anodic tDCS, the ipsilateral caudate, globus pallidus, somatosensory cortex, and the contralateral globus pallidus showed a significantly attenuated activation whereas cathodic tDCS treatment resulted in attenuation of the thalamus and globus pallidus bilaterally, and the somatosensory cortex and anterior cingulate gyrus contralaterally. dMRI analysis identified a substantial increase (>50%) in the number of contralateral sensory fibers in the STCT with either anodic or cathodic tDCS treatment in four of the six patients. A significant reduction in FA (>40%) was observed in the ipsilateral REZ in the posttreatment phase in five of the six patients. Preliminary evidence suggests that navigated tDCS presents a promising method for alleviating the pain of TN. Different patterns of activation manifested by anodic and cathodic stimulation require further elaboration to understand their implication. Activation and attenuation of responses at various sites may provide further avenues for condition treatment.

Abstract No.: ABS0807 : Effects of intravenous Lignocaine infusion on Sevoflurane consumption in inhalation maintained anaesthesia by monitoring entropy: A randomised controlled study

Background & Aims:The present study aimed to study the effect of intravenous Lignocaine infusion on Sevoflurane consumption required to maintain entropy between40 and 60 during anesthesia maintenance in humans. Pain scores using Numeric rating score (NRS) scale and incidence of post-operative nausea and vomiting were assessed postoperatively.Methods:The present study included 52 patients of either sex, of American Society of Anesthesiologists (ASA) grade I and II; aged between 18-70 years undergoing surgeries of >2 hours under general anaesthesia. Patients were randomly allocated into two groups using computer generated random number table into Lignocaine group, where lignocaine infusion was used and Control group, where equal volume of saline was infused. Anaesthesia regimens in both groups were standardised. Patient’s haemodynamics were monitored. Intraoperative Sevoflurane consumption (Value obtained from GE Avance CS2 machine) was noted at the end of surgery. Pain scores using NRS scale and postoperative nausea and vomiting incidence were assessed postoperatively.GroupMean±SD P PLSFAge49.62±14.554.7±11.380.19Bloodloss553.33±333.2545±466.160.937MAP185.9±16.5585.87±16.460.994HR 172.97±17.0772.23±12.020.848MAP3081.7±9.8585.27±16.870.322HR 3071.53±12.0268.47±13.090.348MAP6081.63±10.8188.07±12.470.037HR6071.1±13.0369.83±11.910.696MAP9081.07±14.7786.23±12.070.143HR9072.6±14.7170.1±13.230.492MAP12079.1±11.2185.87±10.830.021HR12070.83±15.4668.8±11.990.571MAP15079.93±9.0583.87±14.850.22HR15072±17.0470.63±13.810.734MAP18083.1±9.482.93±13.520.956HR18074.07±14.5272.83±12.390.725MAP21079.88±9.1985.21±150.144HR21076.25±16.2573±11.510.428MAP24085.41±14.0483.75±14.530.74HR24070.82±18.0377.56±15.980.266MAP27079.47±12.8183.4±14.030.486HR27071.93±16.8873.8±12.440.753MAP30079.1±15.5780.83±11.030.799HR30074.9±22.7278.33±14.990.722MAP33081.86±11.6474±5.230.16HR33076.14±21.2176.75±10.90.951MAP36078.33±9.8770±00.541HR36064±380±00.044ABG1pH7.38±0.057.37±0.030.578ABG2pH7.36±0.057.34±0.060.085@1pCo239.39±4.2439.63±5.310.852@2pCo240.18±4.2641.86±7.170.275@1pO2175.86±63.03178.67±68.030.869@2pO2204.57±43.82188.1±48.910.175@1Na134±4.11135.8±4.110.095@2Na135.07±2.42136.1±40.232@1K3.74±0.333.77±0.410.758@2K3.82±0.343.94±0.570.326@1Ca1.14±0.151.15±0.170.294@2Ca1.03±0.11.14±0.06<0.001@1Cl107.71±4.8109.27±3.150.155@2Cl107.17±3.68109.9±3.720.006@1Hb11.23±1.7110.82±2.290.431@2Hb10.17±1.7110.07±2.080.834@1glu132.48±42.14142.96±39.770.373@2glu157.23±38.88159.36±32.710.838@1HCo323.23±2.4522.64±3.350.463@2HCo322.33±3.0221.49±2.720.28@1BE-1.56±2.87-1.71±2.870.857@2BE-2.53±3.31-3.08±2.010.481Results:There was a statistically significant difference in hourly Sevoflurane consumption with reduced hourly consumption inLignocaine group, (P=0.03). There was no statistically significant difference in the total amount of sevoflurane consumption between the two groups, (p=0.52). The lignocaine group had lower pain score than control group 45min post extubation(P=0.04) and 1 day post surgery (P=0.01), with no significant difference in the incidence of post-operative nausea and vomiting.VariablesLignocaine GroupControl Group P Mean Sevoflurane Consumption (Per Hour) ml n(Per Hour) ml14±316±50.03Conclusion:Perioperative lignocaine infusion significantly reduces hourly Sevoflurane consumption in inhalation maintained anaesthesia. Perioperative lignocaine infusion causes significant reduction in pain scores but no difference in incidence of PONV. Lignocaine infusion is safe and further studies may provide a strong evidence for routine use of perioperative lignocaine.

217 Can Virtual Reality Enhance the Patient Experience During Awake Invasive Procedures? a Systematic Review and Meta-Analysis of Randomised Controlled Trials

Abstract Aim Procedural anxiety and pain negatively impacts surgical outcomes and contributes towards patient non-attendance for awake, invasive procedures (AIPs). Providing patients with virtual reality (VR) headsets may optimise their intraprocedural experience. This meta-analysis assesses the effect of VR on subjective pain, anxiety and satisfaction scores, and patient requirements for sedative and analgesic medication during AIPs. Method This review was performed according to PRISMA guidelines. PubMed, EMBASE, CENTRAL, and medrxiv databases were systematically searched for randomised controlled trials investigating the use of VR to enhance the patient experience in adults during AIPs. Meta-analyses were conducted for patient-reported anxiety (n=7), pain (n=7) and satisfaction (n=3) scores, and for total doses of sedative (n=3) and analgesic (n=3) medication administered to patients. Results 9 studies were included. Patients underwent endoscopic diagnostic procedures (n=5), minimally invasive surgery (n=2) or orthoplastic operations (n=2), under local (n=4) or regional anaesthesia (n=2), conscious sedation (n=2) or simple analgesia alone (n=1). Meta-analysis revealed a significant effect in favour of using VR to alleviate procedural anxiety (SMD: -0.51, 95%CI: -0.85 to -0.16, p=0.004), when one study was omitted. Sub-group analysis of studies where AIPs was performed without anaesthesia, showed a significant reduction in pain scores for VR cohorts (MD: -1.33, 95%CI: -2.57 to -0.09, p=0.04). No significant differences between groups were found for patient satisfaction or requirements for sedative and analgesic medication. Conclusions This review supports using VR to reduce procedural anxiety and attenuate pain during AIPs performed without anaesthesia. The effect of VR on patient satisfaction and requirements for sedative and analgesic medications remains unclear.