Terms Of Pain Scores Research Articles

Spinal Anestezi Altında Sezaryen Doğumda Postoperatif Analjezi için Transversalis Fasya Plan Bloğunun Transversus Abdominis Plan Bloğuyla Karşılaştırılması: Retrospektif Bir Çalışma

Objective: Transversalis fascia plane (TFP) and transversus abdominis plane (TAP) blocks are used for postoperative analgesia in many lower abdominal procedures such as cesarean section. This study aimed to retrospectively compare the postoperative effects of TFP and TAP blocks for postoperative multimodal analgesia in patients who underwent cesarean section under spinal anesthesia. Methods: We retrospectively searched electronic medical records to identify patients who underwent cesarean section under spinal anesthesia between November 2021 and June 2022. A total of 497 patients were identified, and 120 patients were included that meet our criteria in our analysis. The patients were divided into three groups: TFP, TAP, and control. Data were obtained from the files of the patients. Results: The block groups had significantly lower numeric rating scale (NRS) scores, less non-steroidal anti-inflammatory drug consumption, and lower complications than the control group. No opioid consumption was observed in the block groups. Although no non-steroidal anti-inflammatory drug consumption until the 4th hour and no opioid consumption until the 8th hour were observed in the control group, the need for additional analgesics increased as time passed. While the TFP group needed analgesics later than the TAP group, the NRS scores and total analgesic consumption were lower (p<0.001). Patient satisfaction was higher in the block groups than in the control group (p<0.001). Conclusion: Transversalis fascia plane and TAP blocks are effective as part of multimodal analgesia in cesarean section. The TFP block is superior to the TAP block in terms of pain scores, additional analgesic requirements, and patient satisfaction. Keywords: Cesarean section, postoperative pain, ultrasound-guided regional anesthesia, transversus abdominis plane block, transversalis fascia plane block

Effect of non-pharmacological interventions on pain in preterm infants in the neonatal intensive care unit: a network meta-analysis of randomized controlled trials

ObjectiveTo evaluate the effectiveness of different non-pharmacological interventions for pain management in preterm infants and provide high-quality clinical evidence.MethodsRandomized controlled trials (RCTs) of various non-pharmacological interventions for pain management in preterm infants were searched from PubMed, Web of Science, Embase, and the Cochrane Library from 2000 to the present (updated March 2023). The primary outcome was pain score reported as standardized mean difference (SMD). The secondary outcomes were oxygen saturation and heart rate reported as the same form.ResultsThirty five RCTs of 2134 preterm infants were included in the meta-analysis, involving 6 interventions: olfactory stimulation, combined oral sucrose and non-nutritive sucking (OS + NNS), facilitated tucking, auditory intervention, tactile relief, and mixed intervention. Based on moderate-quality evidence, OS + NNS (OR: 3.92, 95% CI: 1.72, 6.15, SUCRA score: 0.73), facilitated tucking (OR: 2.51, 95% CI: 1.15, 3.90, SUCRA score: 0.29), auditory intervention (OR: 2.48, 95% CI: 0.91, 4.10, SUCRA score: 0.27), olfactory stimulation (OR: 1.80, 95% CI: 0.51, 3.14, SUCRA score: 0.25), and mixed intervention (OR: 2.26, 95% CI: 0.10, 4.38, SUCRA score: 0.14) were all superior to the control group for pain relief. For oxygen saturation, facilitated tucking (OR: 1.94, 95% CI: 0.66, 3.35, SUCRA score: 0.64) and auditory intervention (OR: 1.04, 95% CI: 0.22, 2.04, SUCRA score: 0.36) were superior to the control. For heart rate, none of the comparisons between the various interventions were statistically significant.ConclusionThis study showed that there are notable variations in the effectiveness of different non-pharmacological interventions in terms of pain scores and oxygen saturation. However, there was no evidence of any improvement in heart rate.

Are positive clinical gains observed following physiotherapy treatment for persistent pelvic pain sustained to 12 months following programme completion? A follow up study

Introduction: Persistent pelvic pain is a common and often debilitating health condition, which is associated with significant healthcare costs. A three-treatment arm clinical trial investigating the impact of physiotherapy in the management of persistent pelvic pain demonstrated positive clinical outcomes, as measured at the conclusion of the programmes, in terms of pain score and pain impact. This study aimed to test the sustainability of the clinical gains observed through to 12 months post-programme completion. Methods: Participants who completed the clinical trial ( N = 66) were contacted as they neared the 12 months anniversary of the completion of their treatment programme. Returned data was collated and analysed against data obtained during the trial, allowing comparison pre-treatment, post-treatment and at 12 months following programme completion. Results: There were 24 returned outcome measurement documents, representing a 38% response rate. Of the three treatments arms piloted in the trial, one arm demonstrated further clinical improvement across a range of domains in the 12 months following treatment, while participants in the other two treatment arms returned data suggesting mild clinical decline. However, when comparing pre-treatment baseline data with data obtained at 12 months post treatment, all three treatment cohorts returned positive clinical gains across all measures. This effect was more pronounced in those who maintained three to six monthly contact with the department following treatment programme completion. Discussion: Physiotherapy treatment – either individual sessions, or a series of individual sessions coupled with group education ± group exercise – results in positive clinical gains from baseline assessment that are sustained through to 12 months following treatment programme completion. Universal trial number: U1111-1228-4810 ANZCTR.

Effect of photobiomodulation on the efficacy of anesthesia in maxillary permanent molar teeth with molar incisor hypomineralization: A randomized clinical trial.

Difficulty in anesthetizing teeth that have been diagnosed with molar incisor hypomineralization (MIH) is a frequently reported clinical problem. The effects of low-level laser application (photobiomodulation) on the efficacy of anesthesia during the dental treatment of patients with MIH have not yet been studied. To assess the effects of photobiomodulation therapy (PBMT) on the efficacy of anesthesia in maxillary permanent molar teeth with MIH. This prospective, parallel-arm control, randomized, triple-blind clinical trial included children aged 7-12 years. Maxillary permanent first molar teeth with MIH that required pulpotomy treatment were included. Seventy participants were randomly divided into two groups: experimental (with PBMT) and control (placebo). In the experimental group, before the administration of local infiltration anesthesia, PBMT (diode laser: 940 nm; continuous mode; 0.5 W; 78 J/cm2) was applied to the oral mucosa for 60 s each. In the control group, the laser probe was channeled toward the mucosa but was not activated. Pain scores were evaluated during the access cavity preparation of the pulpotomy treatment (when using the dentin cutting handpiece and while entering into the pulp) using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Additional anesthesia requirements were assessed in both groups. The data obtained were analyzed for statistical significance (p < .05). The chi-squared test was used to determine the effect of PBMT on categorical outcomes. The no-pain scores of the experimental group were higher than those of the control group (29% vs. 20%). Moderate-to-high pain was more frequent in the control group than in the experimental group (43% vs. 20%). While 31% of the experimental group required supplemental anesthesia, 49% of the control group required supplemental anesthesia during pulpotomy of the tooth with MIH. No statistical difference, however, was found between the two groups in terms of pain scores and the need for supplemental anesthesia (p = .235, p = .143). Anesthesia with and without PBMT caused no difference in pain during the treatment of maxillary molar teeth with MIH.

Hydrogel burn dressing effectiveness in burn pain

Severe burns are painful and dramatic injuries. Studies show that pain is underestimated and often not adequately treated. This study aims to evaluate the analgesic efficacy of hydrogel burn dressing and silver sulfadiazine, which are two agents commonly used in first-aid dressings for burn patients. This study, designed as a prospective, observational, and cross-sectional study. Study included 64 pediatric patients admitted to our burn center between 01.03.2020 and 01.09.2020 who were examined by our burn service after their first treatment in the emergency dressing room. Two groups of patients were included in the study. Pain level was assessed in the dressing room before and 10 min after the procedure using the Visual Analog Scale and FLACC (Face, Legs, Activity, Cry, Consolability) pain assessment scales.During the study period, Burnaid® was applied to 62.5% of patients (40 patients) and silver sulfadiazine to 37.5% (24 patients). In terms of pain scores, pre-dressing FLACC values were higher in Group B (p = 0.039); post-dressing VAS and FLACC values were significantly lower in group B (p 0.001; p 0.001). In terms of additional analgesia, we found more patients in Group S received analgesics (p 0.001).We believe that its effect on burn wound pain is superior to that of silver sulfadiazine.

Comparative Study, Walant vs Axillary Block in Carpal Tunnel Surgery

Objectives: Wide awake local anesthesia no tourniquet (WALANT) is a local anesthetic technique that, in theory, reduces costs and surgical waiting periods. The purpose of this study was to compare axillary block (AXB) with WALANT in terms of pain scores, duration of hospital stay, and hand function in patients who underwent CTR surgery. Methods: Between January 2015 and February 2020, a retrospective analysis was conducted on the outcomes of 410 patients who underwent CTS surgery. The Walant technique was utilized on 210 patients, while the AXB technique was utilized on 200 patients. These two groups were compared regarding operative time, hospital stay, VAS score at specific intervals before and after surgery, and hand function recovery. Results: The mean operation time is 11 min (8-18) for WALANT group and 13 min (7-43) for AXB group. Average time of length of hospitalization is 4.2 hours (2-6) for WALANT and 14.2 hours (9-26) for AXB groups. The VAS scores of WALANT group is significiantly less than AXB group (p&lt;0.05). The percentages of being able to use their hands compared to their nonoperative hands were evaluated. These rates were higher in the WALANT group than in the AXB group (65-75% vs. 45-60%). Conclusion: Increased patient comfort was associated with the WALANT technique. It is superior to AXB in terms of patient satisfaction, postoperative long-term pain management, and hand function recovery. Assuming all safety recommendations are adhered to, WALANT is an alternative to tourniquets in CTS surgeries for obtaining a bloodless surgical field without the discomfort of tourniquet application.

A randomized controlled trial of iliopsoas plane block vs. femoral nerve block for hip arthroplasty

BackgroundIliopsoas plane block (IPB) is a novel analgesic technique for hip surgery that retains quadriceps strength. However, evidence from randomized controlled trial is remains unavailable. We hypothesized that IPB, as a motor-sparing analgesic technique, could match the femoral nerve block (FNB) in pain management and morphine consumption, providing an advantage for earlier functional training in patients underwent hip arthroplasty.MethodsWe recruited ninety patients with femoral neck fracture, femoral head necrosis or hip osteoarthritis who were scheduled for unilateral primary hip arthroplasty were recruited and received either IPB or FNB. Primary outcome was the pain score during hip flexion at 4 h after surgery. Secondary outcomes included quadriceps strength and pain scores upon arrival at post anesthesia care unit (PACU) and at 2, 4, 6, 24, 48 h after surgery, the first time out of bed, total opioids consumption, patient satisfaction, and complications.ResultsThere was no significant difference in terms of pain score during hip flexion at 4 h after surgery between the IPB group and FNB group. The quadriceps strength of patients receiving IPB was superior to those receiving FNB upon arrival at PACU and at 2, 4, 6 and 24 h after surgery. The IPB group showed a shorter first time out of bed compared to the FNB group. However, there were no significant differences in terms of pain scores within 48 h after surgery, total opioids consumption, patient satisfaction and complications between the two groups.ConclusionIPB was not superior to FNB in terms of postoperative analgesia for hip arthroplasty. However, IPB could serve as an effective motor-sparing analgesic technique for hip arthroplasty, which would facilitate early recovery and rehabilitation. This makes IPB worth considering as an alternative to FNB.Trial registrationThe trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry (ChiCTR2200055493; registration date: January 10, 2022; enrollment date: January 18, 2022; https://www.chictr.org.cn/searchprojEN.html).

(106) Concept of Enhanced Recovery Implant Care (ERIC) in Inflatable Penile Prosthesis Surgery: A Double-blind, Randomized, Controlled Trial on Clinical Outcomes and Patient Satisfaction Rate

Abstract Introduction ERAS (Enhanced Recovery After Surgery) is considered a standard of care intended to achieve earlier recovery and reduce stress response following surgery. While inflatable penile prosthesis (IPP) surgery is a safe and effective treatment for males with erectile dysfunction, complications such as significant postoperative pain and scrotal hematoma are not uncommon and can result in delayed IPP cycling and lower patient satisfaction rate Objective To evaluate the concept of ERIC (Enhanced Recovery Implant Care) on clinical outcomes and patient satisfaction rate following IPP surgery. Methods This prospective double-blind, randomised, controlled clinical trial received internal ethics approval and 60 males were randomised to receive “normal care” (NC) vs ERIC pathway which consisted of a strict perioperative regime of intra-operative regional nerve block and device analgesia elution, meticulous haemostatic corporotomy closure and multi-layered scrotal closure as well as postoperative 7 days of fitted scrotal support following IPP surgery. An independent third-party survey with objective measurement of pain score (visual analogue scale, VAS), analgesic requirement (conversion to opioid dose equivalence), time to IPP cycling and overall patient satisfaction rates (on a 5-point scale) were collected and compared on Day 1, 7, 14, 28 and 42 postoperatively. Results There was no significant difference in patient demographics between the 2 groups. No intraoperative complication was documented. Males in the ERIC group reported lower VAS scores (p&amp;lt;0.05), less analgesic requirement (p&amp;lt;0.05) and shorter time to IPP cycling (p=0.08). Twelve (40%) patients in NC had a scrotal hematoma (Clavien-Dindo grade 1) compared to 2 (7%) patients in the ERIC group on days 1 and 7 postoperative. The overall patient satisfaction rate (rated 4 or 5) was higher in the ERIC compared to NC groups (93% vs. 70%; p&amp;lt;0.05). Conclusions The ERIC pathway appears to improve clinical outcomes and postoperative recovery following IPP surgery in terms of pain score, the analgesic requirement, and time to IPP cycling, as well as the overall patient satisfaction rate. Disclosure No

Effectiveness of ketorolac-soaked bandage contact lens for pain management after photorefractive keratectomy

Objective To evaluate the effect of ketorolac-soaked contact lenses (CLs) on postoperative pain after photorefractive keratectomy (PRK) and their potential side effects including conjunctival hyperaemia and delayed epithelial healing. Methods This is a prospective, randomised, double-blind, contralateral eye study. A total of 310 eyes of 155 patients who underwent PRK in both eyes were included in the study. After photoablation, a 0.4% ketorolac-soaked bandage CL was placed over the cornea in Group 1, while a drug-free soft bandage CL was placed over the cornea in Group 2. The postoperative pain was evaluated using a verbal numerical rating scale. The ocular redness was compared using the black pixels (veins, and areas of redness) and white pixels (remaining areas) of the images. The complications and time to corneal wound healing were also recorded. Results The mean pain score was significantly lower in Group 1 (2.7 ± 1.3) than in Group 2 (7.4 ± 1.4) on postoperative day 1 (p < 0.001). However, on the 3rd postoperative day, there was no significant difference between the groups in terms of pain scores (p = 0.42). Preoperative eye redness was 199.2 ± 16.0 pixels in Group 1 and 200.1 ± 17.6 pixels in Group 2 (p = 0.65). There was no statistically significant difference between the two groups in terms of eye redness at the postoperative 24th and 72nd hours (p = 0.43 and p = 0.39, respectively). Conclusion Soaking the bandage CL in a solution containing ketorolac 0.4% for 15 minutes could significantly lower pain scores on the first postoperative day after PRK, with no serious complications.

MP39-15 IMPLEMENTATION OF AN OPIOID FREE PAIN PATHWAY IN MINIMALLY INVASIVE UROLOGICAL ONCOLOGIC SURGERIES

You have accessJournal of UrologyCME1 Apr 2023MP39-15 IMPLEMENTATION OF AN OPIOID FREE PAIN PATHWAY IN MINIMALLY INVASIVE UROLOGICAL ONCOLOGIC SURGERIES Abdulla Alameeri, Omar Almidani, Ammar Al Homsi, Rashed Rowaiee, Heather Brown, and Waleed Hassen Abdulla AlameeriAbdulla Alameeri More articles by this author , Omar AlmidaniOmar Almidani More articles by this author , Ammar Al HomsiAmmar Al Homsi More articles by this author , Rashed RowaieeRashed Rowaiee More articles by this author , Heather BrownHeather Brown More articles by this author , and Waleed HassenWaleed Hassen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An optimal pain management is essential to establish an effective fast-track surgery model. In patients undergoing minimally invasive oncological surgeries including radical prostatectomy (RP) and Radical Nephrectomy (RN), multiple studies have assessed the efficacy of various analgesic medications. Therefore, we aim in our study to compare the efficacy of post-operative analgesic regimen after the implementation of an opioid-free regimen at a large tertiary care center. METHODS: Mixed retrospective and prospective, non-randomized, pre and post interventional trial was performed at our institution between November 2015 and October 2022. Sample included patients undergoing RP and RN during that time frame. An opioid-free pain regimen was developed and instituted in April 2019, which included preoperative education and counseling regarding opioids and pain expectation management, round-the-clock intravenous acetaminophen as inpatient and prescriptions of oral acetaminophen as outpatients. Comparison was made between patients in the opioid-regimen group (pre-implementation) vs. the opioid-free regimen group (post-implementation) in terms of pain score and the need for additional analgesics. RESULTS: A total of 226 (44.66%) patients were in the pre-implementation group, with both RP and RN included in the total, and 280(55.33%) patients were in the post-implementation group. The intervention significantly reduced postoperative opioid administration from [Pre: 78.3% vs Post: 14.6%, p <0.001]. The post-implementation group had a significantly lower maximum pain score [Pre: 6.3± 2.1 vs Post: 4.5 ± 2.6, p= 0.04] and lower average pain score [Pre: 3.1 ± 1.4 vs Post: 2.0 ± 1.8, p < 0.001]. However, the post-implementation group had higher rates of return visits for postoperative pain management [Pre:1.2% vs Post: 5.1%, p = 0.274].Pre implementation patients followed up for uncontrolled pain were 1(0.44%) and 7 (2.5%) post implementation presented to the ER for uncontrolled pain. CONCLUSIONS: The results support the efficacy of opioid-free pain management regimen in patients undergoing minimally invasive upper tract and pelvic urologic surgery. To Date, this study is considered one of the largest highlighting the efficacy of opioid free regimen post op. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e541 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abdulla Alameeri More articles by this author Omar Almidani More articles by this author Ammar Al Homsi More articles by this author Rashed Rowaiee More articles by this author Heather Brown More articles by this author Waleed Hassen More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparative Study of Frequency of Alveolar Osteitis, with and without using Platelet-Rich Fibrin in Mandibular Third Molar Surgery.

Alveolar ostitis (AO) is the dissolution of blood clot due to enhanced local fibrinolysis and is caused by trauma to the jaw (direct) or because of bacterial involvement (indirect), which result in the activation of plasminogen pathway. Platelet-rich fibrin (PRF) is a platelet concentrate that comprises numerous autologous growth factors, and immune cells hence has the potential to expedite the healing process. The objective of the study was to determine the efficacy of PRF in the surgically extracted third molar in the context of its potential progress to AO. A total of 180 patients of 18-65 years with unilateral painful mandibular third molars due to caries, failed endodontics treatment, and pericoronitis were included in the study. Exclusion criteria were patients who were medically compromised, smokers, alcoholic, poor oral hygiene, third molar having associated periapical pathology, and receiving antibiotic regime in the last 2 weeks. Before starting surgical procedure, patients were randomly divided into two groups using lottery method. Group I received PRF in the extraction socket, while in Group II, the extraction site was left for normal healing as practiced in a standard procedure. Pain was assessed in terms of pain score, and it was recorded on a 10 mm visual analog scale on the first and third postoperative days. Mean age of the patients was 41.35 ± 9.87 years. The mean age in Group I was 42.84 ± 10.52 years, and in Group II, it was 40.54 ± 9.52 years. Out of 180 patients, 90 (50.0%) were male and 90 (50.0%) were female, with a male-to-female ratio of 1 : 1. Frequency of AO following mandibular third molar surgery in Group I receiving PRF was 2.22% and in non-PRF group 12.22% (p-value = 0.010). The incidence of AO following mandibular third molar surgery was lower when PRF was used.

The effect of swaddling method applied to preterm infants during the aspiration procedure on pain

PurposeThe study was carried out to determine the effect of the swaddling method on pain in preterm infants (between 27 and 36 weeks) hospitalized in the Neonatal Intensive Care Unit during the aspiration procedure. Preterm infants were recruited by convenience sampling from level III neonatal intensive care units in a city in Turkey. MethodThe study was conducted in a randomized controlled trial manner. The study consisted of preterm infants (n = 70) receiving care or treatment at a neonatal intensive care unit. While swaddling was applied to the infants in the experimental group before the aspiration process. The pain was assessed before, during, and after the nasal aspiration using the Premature Infant Pain Profile. ResultsNo significant difference was found in terms of pre-procedural pain scores whereas a statistically significant difference was detected in terms of pain scores during and after the procedure between the groups. ConclusionIt was determined in the study that the swaddling method reduced the pain of the preterm infants during the aspiration procedure. Implications for practiceThis study emphasized that swaddling had pain-reducing during the aspiration procedure in the neonatal intensive care unit in preterm infants. It is recommended that future studies be conducted using different invasive procedures in preterm infants born earlier.

INTRAOPERATIVE COOLED RADIOFREQUENCY NERVE ABLATION DOES NOT IMPROVE POSTOPERATIVE TOTAL KNEE ARTHROPLASTY PAIN MANAGEMENT

Total Knee Arthroplasty (TKA) is a successful treatment for end stage osteoarthritis of the knee joint. However, post-operative pain can lead to patient dissatisfaction and poorer outcomes. Cooled radiofrequency nerve ablation (CRNA) has reportedly been effective at treating pain osteoarthritic knee pain by targeting the periarticular nerves of the knee. We undertook a prospective, controlled pilot study to determine if CRNA provides effective post-operative analgesia when utilised intra-operatively during total knee arthroplasty.Participants were recruited from January 2019 to February 2020. Those meeting inclusion criteria underwent TKA with intraoperative CRNA to 6 target sites prior to the cementing of implants. The primary outcomes were pain scores and opiate usage in the first 4 days post-operatively, then weekly up to 6 weeks. A total of 62 patients were screened and allocated sequentially; 18 were recruited to the control group and 12 recruited to the study group. The two groups did not have any significant difference in demographics.There were no clinically significant differences between the two groups in terms of pain scores nor opiate usage. There were complications as a result of the intervention.This study demonstrated no benefit of using intraoperative CRNA for improving post-operative pain scores or reducing opiate use after TKA.

Ligasure versus harmonic scalpel tonsillectomy.

Objective: To determine whether harmonic scalpel has any advantage over Ligasure tonsillectomy or not in terms of blood loss, duration of surgery, pain scores and slough separation time. Study Design: Double Blind Cross Sectional study. Setting: Faisalabad Medical University and Affiliated Institutions. Period: January to June 2022. Material &amp; Methods: Seventy patients in total were selected and divided by Random sampling into two groups to be operated either with Ligasure or Harmonic Scalpel. The difference between the two groups was assessed in terms of pain scores, slough separation time, duration of surgery and blood loss between the two groups. Results: Patients results showed statistical significant difference in the two groups in terms of slough separation time and pain scores but there was no significant difference in terms of blood loss and duration of surgery. Conclusion: Harmonic scalpel does have an advantage over Ligasure tonsillectomy as far as early healing is concerned and thus certainly helps in reducing the morbidity of the patients.

The relationship between the orientation of the lateral decubitus position for spinal anesthesia and positioning pain in patients with a femoral neck fracture: randomized non-inferiority trial

BackgroundTo date, no clinical studies have investigated the relationship between positioning pain and orientation of the lateral decubitus position for hip fracture surgery. The aim of the present study was to test the hypothesis that performing spinal anesthesia in the lateral decubitus position with the fracture side up or down does not affect positioning pain in patients with a femoral neck fracture.MethodsThis single-center, prospective, randomized non-inferiority trial examined 78 patients who received surgery for a femoral neck fracture under spinal anesthesia. By performing spinal anesthesia in the left lateral decubitus position in all patients, the positioning of the fracture up or down was randomized. Pain score during spinal anesthesia was evaluated objectively (0, calm; 1, facial grimacing; 2, moaning; 3, screaming; or 4, unable to proceed because of restlessness or agitation).ResultsThe data from 66 patients (fracture side down [n = 35] and up [n = 31]) were analyzed. There were no significant differences between the fracture side down and fracture side up groups regarding the percentage of patients who were assessed to have intense pain (score ≥ 3) when changing position from the supine to lateral position (13/35 [37%] vs 12/31 [39%]; 95% confidence interval [95% CI] for the difference of the percentage of patients of intense pain between the groups − 25.0 to 2.2; p = 1.000).ConclusionsThere were no significant differences in the percentage of patients experiencing severe pain between the two groups. The 95% CI exceeded the preliminarily set a margin of inferiority of 20%; thus, the present study could not demonstrate the non-inferiority of the fractured side down group in terms of pain score.

Harmonic Scalpel vs Diathermy Tonsillectomy.

Objective: To determine whether harmonic scalpel has any advantage over monopolar diathermy tonsillectomy or not in terms of blood loss, duration of surgery, pain scores and slough separation time. Study Design: Double Blind Cross Sectional study. Setting: Faisalabad Medical University and Affiliated Institutions. Period: April 2022 to September 2022. Material &amp; Methods: Seventy patients were selected and divided by Random sampling into two groups to be operated either with Harmonic Scalpel or Monopolar Diathermy. The difference between the two groups was assessed in terms of pain scores, slough separation time, duration of surgery and blood loss between the two groups. Results: Patients results showed statistical significant difference in the two groups in terms of slough separation time and pain scores but there was no significant difference in terms of blood loss and duration of surgery. Conclusion: Harmonic scalpel does have an advantage over diathermy tonsillectomy as far as early healing is concerned and thus certainly helps in reducing the morbidity of the patients.

Comparison of thoracic epidural and thoracic erector spinae plane block for pain relief of posterolateral rib fractures—a retrospective cohort study

BackgroundPain from rib fractures (posterior/lateral/anterior) is associated with significant pulmonary morbidity. Earlier epidural and paravertebral blocks were implemented in the algorithm for multimodal pain management of rib fracture pain. Administration of these blocks are fraught with challenges encountered in intensive care unit (ICU). The erector spinae plane block (ESPB) is a viable alternative in ICU set up.This retrospective study compared continuous thoracic ESPB and continuous thoracic epidural analgesia (TEA) [n=28 versus n=24] for polytrauma patients who sustained unilateral multiple rib fractures (MRFs), i.e., more than 3 admitted in ICU. Demography data were noted and compared. Outcome measures were block efficacy in terms of pain scores, opioid consumption (intravenous fentanyl), technical difficulties, and complications.ResultsAge, gender, and sides of ribs fractures were comparable in all groups. Pain scores and fentanyl consumption were significantly better in patients who received TEA.ConclusionsThough statistically significant analgesic efficacy was observed with continuous TEA for managing pain due to unilateral posterolateral MRFs, the small sample size was a major limitation. Further prospective comparative study including effects on incentive spirometry and effectiveness of chest physiotherapy is warranted. However, continuous ESPB is simple and safe to perform with few theoretical contraindications.

Efficacy of Gabapentin vs Oxcarbazepine in terms of pain, sleep and quality of life in patients with diabetic peripheral neuropathy

Background. The treatment of peripheral diabetic neuropathy is difficult to treat considering the pain is severe, long-lasting and does not respond to analgesics. Gabapentin has been recommended as the first line treatment for DPN but owing to cognitive dysfunction and other side effects the drug is discontinued. Recent studies suggest that oxcarbazepine; an antiepileptic drug has good-efficacy in management of DPN. This prospective, observational and comparative study was done to compare gabapentin and oxcarbazepine monotherapy in patient of DPN. Objectives. We assessed the efficacy of Oxcarbazepine monotherapy in terms of pain score, sleep score and quality of life and compared with gabapentin monotherapy. Methods. 100 patients with DPN or examinations suggesting DPN were divided into 2 groups to receive gabapentin 300-1200 mg/day or Oxcarbazepine 300-600mg/day. Assessment of pain scores, sleep score and quality of life were done at different duration during the course of therapy. Results. Out of total subject selected, the maximum (46%) subjects were between age group 60-90 years and the least effected were (24%) between age group 50-59 years. Male were more prevalent with 57% when compared to females with 43%. Improvement in Sleep was seen on using Group II with p value (0.0005). However, the correlation of Pain and Quality of life with the treatment shows p –value 0.24, 0.31 and 0.27 respectively showing non-significance. Conclusion. The sleep improved statistically correlated in patients with DPN, but not with quality of life and pain as the calculated p value was (p= 0.24, 0.31 and 0.27) respectively. Findings of this study suggest that oxcarbazepine can be used as an alternative treatment owing to its similar analgesic efficacy and improvement in sleep.

The efficacy of computed tomography-guided percutaneous microwave ablation in patients with osteoid osteoma according to nidus location in long bones: A single-centre initial experience

This study aims to assess the efficacy of microwave ablation (MWA) treatment in painful extra-articular osteoid osteoma (OO) in long bones in a consecutive series of patients and to compare the technical and clinical success in terms of pain scores according to their location. A total of 23 patients who were diagnosed with OO in long bones and treated with MWA between January 1, 2016, and June 1, 2020 were enrolled in this study. Medical data and images were reviewed for age, gender, size of the nidus and duration of pain. Patients were then categorized into three groups according to the location of nidus (pertrochanteric, metaphyseal or diaphyseal). Operation length and technical and clinical success rates were compared. Technical success was achieved in 100% of patients. Primary clinical success following MWA was 82.6%. The most common location was the pertrochanteric region (34.8%). In comparing the pain scores with the locations of the lesions, no statistically significant difference was found between the first-day (p = 0.504) and first-week (p = 0.648). However, significant difference was present between the first month (p = 0.016), third month (p &lt; 0.001) and sixth month (p = 0.001). The statistically significant differences between the sites were due to the difference between the pertrochanteric and diaphyseal lesions. CT-guided percutaneous MWA is safe and effective in the treatment of OO located in long bones without any recurrence. However, management of pertrochanteric OOs requires specific expertise and follow up. Further studies are expected in the future to assess the long-term efficacy and safety of MWA for the treatment of OO, especially for cases in pertrochanteric locations of the femur, which have an increased risk of local recurrence.

Radiofrequency thermoablation of the peripheral branches of trigeminal nerve versus the Gasserian ganglion for treating idiopathic trigeminal neuralgia: A systematic review and meta-analysis

BackgroundTrigeminal neuralgia is characterized by pain at the distribution of one or more of the trigeminal nerve branches and is usually treated with anti-epileptic medication. When first line treatment fails, patients receive other treatment modalities including radiofrequency thermoablation (RFT) of the Gasserian ganglion and peripheral branches of the trigeminal nerve. The aim of this study is to compare RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve in terms of efficacy and rate of complications. MethodsThis was a systematic review and meta-analysis that searched Medline, Cochrane Central Register of Controlled Trials, and Embase using Medical Subject Headings and the references of the enrolled studies with no restriction on date. We included only RCTs that compared the RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve with one of the following outcomes: pain scales, immediate effective rate, recurrence rate, and complications. ResultsFive articles were eligible for our review and showed that there was no difference between RFT of the peripheral nerves and the Gasserian ganglion in terms of pain scores. There was a non-significant trend for RFT of the peripheral nerve to have higher immediate effect rates and higher recurrence rates. RFT of the Gasserian ganglion group was associated with masticatory weakness, while the other group was associated with facial swelling and numbness of V2. ConclusionRFT of the peripheral branches is a safe and effective method to treat idiopathic trigeminal neuralgia but leads to a higher recurrence rate when compared with RFT of the Gasserian ganglion.