Terms Of Patient Comfort Research Articles

Parasagittal Interlaminar and Transforaminal Epidural Steroid Injections for Radicular Low Back Pain; Which is More Comfortable?

This study aimed to compare parasagittal interlaminar (PS) and transforaminal (TF) epidural steroid injections for unilateral L5 and S1 radicular lower back pain in terms of patient comfort, efficacy, safety, contrast enhancement, and radiation exposure. This was a prospective randomized single-blind study. A total of 59 participants were included in this study. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were obtained. A comfort questionnaire was administered to all participants. The total fluoroscopy time and contrast distribution levels were recorded. Pre- and post-treatment VAS scores were similar between the groups. The ODI scores increased in favor of the PS group at week 2 (P < 0.041); however, there was no difference between the two groups at other times. The VAS and ODI scores improved significantly with treatment in both the groups (P < 0.001). Total fluoroscopy time was shorter in the PS group (P < 0.001). PS application was more comfortable (P < 0.001). While no complications were observed in the PS group, three complications occurred in the TF group. Anterior epidural contrast spread to three or more levels was observed in 57% of the participants in the PS group, whereas no spread to more than two levels was observed in the TF group. The PS epidural approach is superior to the TF approach in terms of a low incidence of side effects, less radiation exposure, better patient comfort, higher epidural contrast spread, and single-level needle access.

Comparative Clinical Study of Suprathel® and Jelonet® Wound Dressings in Burn Wound Healing after Enzymatic Debridement.

Following the enzymatic debridement of deep dermal burns, the choice of wound dressing is crucial for providing an adequate environment and suitable conditions for rapid wound healing. As Suprathel® and fatty gauze (Jelonet®) are the most commonly used dressings in burn centers, the aim of this study is to compare Suprathel® and Jelonet® in the treatment of deep dermal burns after enzymatic debridement with respect to wound healing, patient comfort, and pain. A total of 23 patients with deep dermal burns of the hand or foot (mean total body surface area of 4.31%) were included in this prospective, unicentric, open, comparative, and intra-individual clinical study. After enzymatic debridement, wounds were divided into two areas: one was treated with Suprathel® and the other with Jelonet®. Suprathel® remained on the wounds without dressing changes while Jelonet® was regularly changed. Wound healing, infection, bleeding, exudation, time for dressing changes, and pain were documented (from days 2 to 48) after injury. Satisfactory results were obtained in 22 cases; only one patient had to undergo a second debridement followed by skin grafting. No significant difference in time to final wound healing could be observed (18-19 d). Patients reported significantly less pain during the dressing changes for Suprathel® compared to Jelonet®. Furthermore, the wound areas treated with Suprathel® showed significantly less exudation and bleeding. Wound infections rarely occurred in both groups. In conclusion, the authors found that both wound dressings could be used to achieve safe and rapid wound healing after the enzymatic debridement of deep dermal burns of the hands and feet. However, compared to Jelonet®, Suprathel® showed superior results in terms of patient comfort and pain reduction.

Are 7.5 Gy×2 fractions more efficient than 6 Gy×3 in exclusive postoperative endometrial cancer brachytherapy? A clinical and dosimetrical analysis

PurposeTo compare two vaginal brachytherapy (VBT) schedules in postoperative endometrial carcinoma (PEC) patients considering vaginal-cuff relapses (VCR), late toxicities, dosimetry analysis and vaginal dilator use. Material and methods110 PEC patients were treated with exclusive high-dose-rate VBT using two schedules. Group-1:44-patients received 6 Gy×3fractions (September-2011-April-2014); Group-2:66-patients were treated with 7.5 Gy×2fractions with a dose limit of equivalent total doses in 2-Gy fr (EQD2(α/β=3)) of 68 Gy in the most exposed 2 cm3 of clinical target volume (CTV) (July-2015-November-2021). The dose was prescribed at 5 mm from the applicator surface. Were evaluated the overall radiation dose delivered to 90% of the CTV (D90), the CTV receiving 100% of the prescription dose (V100) and the EQD2(α/β=3) received in the most exposed 2 cm3 to dose in CTV. Late toxicity was prospectively assessed using RTOG scores for bladder and rectum and objective LENT-SOMA criteria for late vaginal toxicity (LVT). Statistics: Descriptive analysis, Chi-square, Student’s t-tests and Kaplan and Meier method. ResultsThe median follow-up was 60 months (15.9–60). There were no VCR or late toxicities in bladder or rectum. LVT ≥ G1 appeared in 26/44 (59.1%) in Group-1 and 25/66 (37.9%) in Group-2. The mean EQD2(α/β=3) received by the most exposed 2 cm3 of CTV was 63.7 Gy ± 10.0 in Group-1 and 60.5 Gy ± 3.8 in Group-2 (p = 0.063). There were no differences in adherence to vaginal dilator use ≥9 months, overall D90 and V100. ConclusionConsidering the lack of vaginal relapses and similar LVT over time, 7.5 Gy×2fractions seem more efficient in terms of patient comfort, workload, and cost. This is the first study using dosimetry parameters to compare effectivity of schedules. Larger series are needed to confirm the present results.

Indocyanine green based antimicrobial photodynamic therapy as an adjunct to non-surgical periodontal treatment in periodontal maintenance patients: a clinico-microbiological study

Background: Antimicrobial Photodynamic therapy for the treatment of periodontitis is being increasingly gaining attention but at present, very limited data are available on the clinical and microbiological outcomes obtained following Indocyanine Green as the photosensitizer in Maintenance patients. The objective was to evaluate the efficiency of Indocyanine(ICG)-green based photodynamic therapy as an adjunct to scaling and root planing in patients enrolled in maintenance therapy. Methodology: Using a split mouth study design, 24 participants enrolled in the maintenance therapy, having diagnosed as Periodontitis, were randomly subjected to scaling and root planing(SRP). The test group additionally received ICG-based (Aurogreen®, Aurolabs, Madurai, India,1mg/ml) aPDT with an 810nm diode laser. Clinical assessment of Plaque index, modified Sulcus bleeding index, Probing pocket depth, Clinical loss of attachment and microbiological analysis of A. actinomycetemcomitans, P. gingivalis, T. forsythia and F.nucleatum were performed at baseline and 3 months after treatment. Results: It was observed that although there was no significant difference between the test and control group at baseline and 3 months, there was a statistically significant reduction in the mean values in both the groups at 3 months. Microbiological analysis showed substantial reduction in detection frequency of the bacteria assessed at 3 months in both the groups. Conclusion: Within the limits of the study, ICG-based aPDT did not show additional advantage over SRP alone at 3 months, though it could be a promising treatment modality in maintenance patients in terms of patient comfort and the treatment time taken. More randomised clinical trials should be employed to understand the exact mode of action of ICG based aPDT and its role in treatment of periodontal disease.

A Prospectiv ospective-Randomiz e-Randomized Study: The Impact of F ed Study: The Impact of Four Diff our Different Caries Remo Caries Removal Method on P al Method on Pain and Clinical E ain and Clinical Evaluations aluations

Objective: There are many different methods for removing caries. In this study, to evaluate four caries removal methods in terms of patient comfort and to evaluate the clinical success of restorations according to modified-USPHS criteria. Methods: In 31 patients with at least 4 Class II caries in their posterior teeth, 4 teeth were randomly divided into four groups and 4 different methods (conventional method, Carisolv, Papacarie, Er-Cr:YSGG Laser) were used for caries removal. Pain formation during caries removal was determined by FACE Pain Scale questionnaire. The restorations were controlled with Modified-USPHS criteria in 3-6-12 months period. Mann-Whitney U test for two-group comparisons, Kruskal Wallis H test for comparison of three or more groups, Wilcoxon Sign test was used to examine the changes according to time (p &lt; 0.05). Results: A significant difference was found between conventional methods and alternative methods in terms of pain tolerance. In the 1-year clinical evaluation of the restorations, there was a significant decrease in the postoperative sensitivity in all groups. A significant difference was detected in Carisolv and laser groups between 6-months and 12-months for marginal coloration. A significant difference was found between the conventional and laser groups between 6-months and 12-months in terms of color match. Conclusion: The success of restorations, efficacy and efficiency of the methods used in the evaluation of all groups were found to be successful. In terms of patient comfort, all alternative methods gave positive results.

Comparison of Ultrasound-Guided Anterior and Posterior Approaches to Sciatic Nerve Block for Lower Limb Surgeries: A Randomised Clinical Study

Introduction: Sciatic nerve block is used for anaesthesia and analgesia in lower limb surgeries. The anterior approach to the sciatic nerve is rarely performed due to unreliable anatomical surface markings. Aim: To compare the anterior and posterior approaches to sciatic nerve block in terms of patient comfort and technical difficulty. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India. A total of 84 patients who underwent lower limb surgeries from November 2020 to August 2022 were included. Informed consent was obtained, and patients were randomised into two groups-Group-A and Group-P-using the card method. Ultrasound-guided sciatic nerve block was performed using the anterior approach in Group-A and the posterior approach in Group-P. Sensory and motor blockade, time to perform the block, number of attempts, duration of analgesia, and patient satisfaction were recorded. Statistical analysis was performed using the Chi-square test, Analysis of Variance (ANOVA), student t-test, and the results were represented in tables. Results: The median age in Group-A was 42.95±12.69 years, and in Group-P was 43.95±8.68 years. Males were higher in number with 26 (31%) in Group-A and 23 (27%) in Group-P, respectively. Patient satisfaction, duration of analgesia (10.3±3.5 years Group-P and 10.5±4.0 years Group-A), onset of sensory (11.85±7.35 years Group-P and 9.53±5.40 years Group-A), and motor blockade (18.67±7.05 years Group-P years and 17.82±5.70 years Group-A) were similar in both groups. The number of attempts (2.85±0.90 years Group-P and 3.05±0.91 years Group-A) and time taken for performing the sciatic nerve block (6.75±1.10 years Group-P and 7.44±1.00 years Group-A) was higher in the anterior approach compared to the posterior approach. Conclusion: Although both approaches to sciatic nerve block are equally effective, this study concludes that the posterior approach is simpler to perform, requires less time, and provides better patient comfort and satisfaction. Ultrasound-guided posterior sciatic nerve block offers effective anaesthesia and excellent post-operative analgesia.

The comparative analysis of transradial and transfemoral vascular approaches for chemoembolization of pancreatic cancer

BACKGROUND: Pancreatic cancer is one of the most aggressive malignant neoplasms, and the results of treatment of which remain extremely unsatisfactory. One of the methods to increase the effectiveness of surgical treatment of pancreatic cancer is selective oil chemoembolization of the pancreatic arteries. Transfemoral access is typically used as a vascular access during this type of intervention, in which complications from the vascular access are often observed.&#x0D; AIM: This study aimed to analyze the results of the use of transradial and transfemoral approaches for chemoembolization of pancreatic cancer.&#x0D; MATERIALS AND METHODS: We analyzed the results of chemoembolization of pancreatic arteries in 32 patients with pancreatic cancer. Transfemoral access was used in 16 (50%) patients and transradial access in 16 (50%) patients. According to the main clinical and anamnestic data, both groups were comparable. The endpoints of the study were technical success and complication rate of chemoembolization, total duration of the procedure, time needed for catheterization of the target artery, radiation exposure, and degree of discomfort for the patient.&#x0D; RESULTS: Chemoembolization of pancreatic arteries was successfully performed in 100% of patients in both groups. Major vascular complications were observed in three (18.8%) patients in the transfemoral access group and in one (6.3%) in the transradial access group (p=0.6). The total duration of the procedure and the time needed for catheterization of the target artery were 54.546.61 and 51.306.46 min (p=0.17) and 12.7 and 13.25 min (p=0.72), respectively. Radiation exposure was 0.680.10 mSv in the transfemoral access group and 0.650.10 mSv in the transradial access group (р=0.4). Transradial access was associated with a statistically significant reduction in all parameters of procedural discomfort.&#x0D; CONCLUSION: In terms of efficiency and safety of use, the transradial approach is not inferior to the traditional transfemoral approach, and in terms of patient comfort, it can be recommended as a priority for chemoembolization of the pancreatic arteries.

Impact of hidradenitis suppurativa-specific wound dressing system on patient quality of life and dressing-related pain: pilot study.

It is theorised that adhesive-free wound care developed specifically for patients with hidradenitis suppurativa (HS) can improve their quality of life (QoL). Our study aimed to investigate the impact of a novel wound care device on Dermatology Life Quality Index (DLQI) scores, and other factors related to experienced pain, time spent changing dressings, comfort, ease of use and body image. A 21-day, single-arm, unblinded, pilot trial was conducted to assess ease of use and the impact of effective wound care on various aspects of wound management in patients with HS. Participants were provided two trial garments and trial dressings as required, to use over a 21-day period in the home setting. A seven-item questionnaire and the DLQI questionnaire was completed on days 0, 7, 14 and 21. All 15 participants were female, aged >18 years old and with a diagnosis of HS. Mean DLQI score at baseline (day 0) was 19.3, which was reduced to 4.53 on day 21, a significant improvement in 100% of participants (p<0.001). High levels of dressing-related pain, assessed using an 11-point Visual Analogue Scale, reduced from 5.53 at baseline to 0.8 on day 21. Other significant improvements in terms of patient comfort, time spent on changing dressings, body confidence and the dressing's ability to retain exudate were also noted. The results illustrated the improvement made to study participants' day-to-day activities and QoL when effective HS-specific wound care products were provided. Wound care is an essential component in the treatment journey of patients.

Comparison of intravenous ibuprofen and tenoxicam efficiency in ankle injury: a randomized, double-blind study.

Pain after soft tissue injuries in and around the ankle is a troublesome process in terms of patient comfort and mobilization. The aim of this study was to compare the analgesic efficacy of intravenous ibuprofen and intravenous tenoxicam in patients with acute musculoskeletal pain due to ankle injury. We conducted a prospective, double-blind, randomized controlled study in a tertiary hospital. The patients were divided into two groups as those administered IV 400mg ibuprofen and IV 20mg tenoxicam. After the treatment of the patients, visual analog scale (VAS) scores were recorded at 15, 30, 60, and 120min. VAS scores were compared with the effectiveness of drugs, their side effects, and the need for rescue drugs. One hundred and twenty-four patients were included in the study. There were 62 patients in the tenoxicam group and 62 patients in the ibuprofen group. When VAS scores were compared, it was found that the VAS scores of the ibuprofen group were statistically significantly lower (p < 0.001). When the ΔVAS scores were compared, it was observed that the ΔVAS scores of the ibuprofen group were statistically significantly higher from 30min (p < 0.001). There was a statistically significant difference in favor of ibuprofen between the two drug groups in terms of the need for rescue analgesics (p < 0.001). Conclusıon. The analgesic efficacy of intravenous ibuprofen and tenoxicam is equal after an ankle injury. However, after 30min of drug administration, ibuprofen provides more effective analgesia than tenoxicam.

Who is suitable for natural orifice specimen extraction (NOSE) following laparoscopic colorectal surgery: a narrative review

Background and Objective: Minimally invasive methods in colon and rectum surgery have been widely applied in the last decades. After laparoscopic resections, a new incision in the anterior abdominal wall is required to remove the specimen from the abdomen. This incision reduces the benefits of minimally invasive surgery. Natural orifice specimen extraction (NOSE) enabled the removal of resection materials without additional incisions. The specimen is removed from the abdomen using the transanal or transvaginal route. This procedure has advantages in terms of patient comfort and postoperative morbidity. However, there is no clarity in the literature about which patients and specimens are suitable for removal in this way. The purpose of this review is to evaluate which patients might be more suitable for NOSE.

Randomized controlled study for comparison of efficacy and safety between thermocoagulation and cryotherapy in visual inspection with acetic acid positive cervical lesions.

Less literature is available on the performance of thermocoagulation for treatment of premalignant cervical lesions and its comparison with cryotherapy from low- and middle-income countries like India. : A prospective randomized controlled study was done in the Department of Obstetrics and Gynecology from August 2018 to September 2019 after obtaining ethical clearance from Institutional Review Board (Reg no: ECR/262/Inst/Up/2013/RR/16) Ref no: 278/Ethics/R. cell-18). A total of 68 women with Visual inspection with acetic acid (VIA) positive cervical lesion were randomized into two groups. Group A was treated with cryotherapy and Group B was treated with thermocoagulation. Estimates of cure, adverse effects or complications were presented as frequencies, percentages, and mean ± standard deviation. Out of 667 patients, 624 patients underwent VIA testing among which 68 were VIA positive (10.89%, 68/624). The efficacy of thermocoagulation was 93.54% and that of cryotherapy was 90.32%. Immediate side effects were significantly lesser in thermocoagulation group (P = 0.008) in comparison to cryotherapy. Thermocoagulation is better treatment modality than cryotherapy for VIA-positive cervical lesions may not be in terms of efficacy but definitely in terms of patient comfort and safety.

A PROSPECTIVE COMPARATIVE STUDY OF OPEN VS LAPAROSCOPIC APPENDICECTOMY

To compare laparoscopic and open method of performing appendicectomy with regard to several variables like symptoms at the time of presentation, method of surgery, complications, duration of antibiotic and analgesic treatment, commencement of oral feeds, hospital stay and recovery time.60 patients with appendicitis (acute and recurrent), admitted in the department of General Surgery, KIMS General Hospital from October 2020 to July 2021 were included in the study. The patients were above 10 years of age of both sexes and presented with signs and symptoms of appendicitis. In our study a total of 28 female (OA/LA: 18/10) and 32 male (OA/LA: 12/20) were included. The indication for surgery was pain in the right iliac fossa in 50 patients of our study. Remainder of the patients presented with periumbilical or right lumbar pain. In LA,we had a success rate of 100% as no cases were converted to open appendectomy. The mean operating time in our series was LA= 50.16 minutes and OA= 65.80 minutes (p=0.016). The average postoperative hospital stay was 6.6 days (LA) and 9.06 days (OA) (p=0.001). Total recovery time was 24.96 days in OAas compared to 13.93 days with LA.This study shows that in terms of patient comfort, complications and post-operative recovery, laparoscopic appendicectomy is superior to open appendicectomy (p=0.01) and we would recommend that laparoscopy be the procedure of choice in all patients with suspected appendicitis.

Comparison of Diode Laser and Conventional Method in Treatment of Gingival Melanin Hyperpigmentation

Purpose: The goal of this study is to compare the scalpel and diode laser methods for treating gingival hyperpigmentation in terms of postoperative discomfort and wound healing. Materials &amp; Methods: Sixteen systemically healthy individuals diagnosed with light or moderate gingival hyperpigmentation were enrolled for this study. Patients were randomly assigned to one of two treatment groups: scalpel or laser. Dummett’s oral pigmentation index was recorded at baseline. Early wound healing and post-operative discomfort were evaluated on the 7th day by using the VAS form. Comparisons between the groups were tested using the Mann-Whitney U test and P-value &lt; 0.05 was considered significant. Results: Total epithelization was observed in the laser group, whereas the epithelization was incomplete in the scalpel group at the end of the observation period. The pain perception on the first two days after the surgery was significantly higher in the scalpel group than in the laser group. (p=0,002 and p=0,038, respectively). No significant differences were found between the fourth- and seventh-day when surgical techniques were compared regarding pain perception (p&gt;0,05). Similarly, pain perceptions of female and male individuals showed no significant difference (p&gt;0,05). Conclusion: In the treatment of gingival hyperpigmentation, both surgical techniques were clinically successful. Although the treatment process was long, according to the results of our study, the laser technique is superior to the scalpel method in terms of patient comfort. The choice of the method may vary depending on the available equipment and the clinician’s preference or request of the patient.

Polyurethane Versus Calcium Alginate Dressings for Split-Thickness Skin Graft Donor Site: A Systematic Review and Meta-Analysis.

Herein, we compare the outcomes of polyurethane and calcium alginate dressings for split-thickness skin graft (STSG) donor sites.A systematic review and meta-analysis were conducted with a search of electronic databases to identify all randomised controlled trials (RCTs) and observational studies comparing the outcomes of polyurethane dressing versus calcium alginate for STSG donor sites. Primary outcomes were pain intensity, convenience for staff and patients, and adverse effects (namely, excessive exudate, infection rate, and hematoma). Secondary outcome measures included the assessment of healing, dressing changes, cosmetic appearance, and cost. Fixed and random-effect models were used for the analysis.Four RCTs enrolling 127 subjects were identified. There was no significant difference between polyurethane and calcium alginate in terms of pain intensity on Day 1 (mean difference (MD) 0.13, P = 0.80) and Day 5 (MD = 0.20, P = 0.38), as well as the ease of application (odds ratio (OR) = 3.08, P = 0.47). However, there was a statistically significant improvement in patient comfort, favouring the polyurethane group (OR = 44.11, P < 0.00001). In addition, no statistically significant differences were noted in terms of adverse effects between the two dressings. In terms of cost, the calcium gluconate dressing had an overall higher cost compared to polyurethane.Polyurethane is a more favourable dressing compared to calcium alginate for STSG donor sites in terms of patient comfort, healing, and cosmetic outcomes. However, comparable results were noted in terms of pain intensity, ease of application, and adverse effects profile. Cost-effectiveness analysis studies are required to justify its routine use.

Endoscopic septoplasty without nasal packing: our technique and outcomes

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Septoplasty is one of the common procedures performed in otorhinolaryngology practice for treatment of nasal obstruction caused by deviated nasal septum. Septoplasty is traditionally performed using a headlight and nasal speculum. However Endoscopic technique using rigid endoscopes has gained widespread popularity in recent years. Traditionally after correction of septal deviation the mucosal flaps are opposed and held together by some kind of nasal packing to prevent bleeding and septal hematoma. But the nasal pack causes significant morbidity in the post-operative period and also bleeding and pain while pack removal. In the present study we describe our technique of endoscopic septoplasty without nasal packing, in terms of patient comfort and complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;It was a descriptive study, conducted at Subbaiah institute of medical sciences, Shimoga from January 2017 to December 2020 on 50 subjects and the results were analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All 50 patients included in the study had reduced NOSE scores on the 2&lt;sup&gt;nd&lt;/sup&gt; post-operative day itself. None of the patients had septal hematoma, reduced oxygen saturation or post-op sinusitis. 3 out of 50 patients had minimal bleeding in the post-operative period. 12 out of 50 patients had crusting post operatively on 2&lt;sup&gt;nd&lt;/sup&gt; day but none had at 2 weeks. One patient had synechiae and one patient had residual septal deviation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Endoscopic septoplasty is preferred over conventional septoplasty. Trans septal quilting sutures has less complication rate, good quality of life and can be practiced easily and hence a valid alternative to intranasal packing following septal surgery.&lt;/p&gt;

Transradial approach using a distal access catheter without guiding support for symptomatic intracranial vertebral artery and basilar artery stenosis: a multicenter experience and technical procedure

BackgroundThere is little consensus on endovascular treatment for symptomatic intracranial posterior circulation stenosis via the transradial approach (TRA). We report our multicenter experience and technical procedures that directly used a...

Wide awake local anesthesia no tourniquet (WALANT) – a revolutionary improvement in hand surgery

Abstract Objective Wide awake local anesthesia no tourniquet (WALANT) hand surgery offers the opportunity to create a bloodless field without using an arm tourniquet. Lidocaine for anesthesia mixed with epinephrine for hemostasis is frequently used without concerns in the hand and finger. This is a major improvement for the patient and the surgeon in terms of patient comfort and having the opportunity to test the hand and finger function intraoperatively. The movement away from tourniquet surgery, which often requires sedation or general anaesthesia is one of the most significant recent advances in hand surgery. Methods A subcutaneous infiltration of a mixture (1:100’000) of lidocaine (1%) and epinephrine (buffered 10:1 with 8.4% bicarbonate) is done with a 27 G canula. The mixture is infiltrated wherever surgical dissection, k-wire insertion, or manipulation of fractured bones will occur. The local anesthetic results in an extravascular Bier block. The injection is done slowly from proximal to distal to minimize injection pain. After the last injection a minimum time of 30 minutes should be waited for maximal epinephrine vasoconstriction in the finger. Results In the beginning WALANT was only used for small procedures like trigger finger or carpal tunnel release. Meanwhile also major hand surgical procedures like finger fractures, flexor tendon repairs, tendon transfers, arthroscopies, arthroplasties and open triangular fibrocartilage complex (TFCC) repair are performed in WALANT. Even procedures like trapeziectomy have been described using wide awake hand surgery, which involves numbing the joint itself. Conclusion The use of WALANT is a proven safe technique that can be used in up to 95% of hand surgical procedures. The benefits for patients and surgeons are obvious. Patients prefer the technique because there are no side effects of opiates or sedation. The anesthetic risk is minimized. Time at hospital is reduced. Patients do not have to suffer tourniquet pain. Surgeons prefer the technique because of the bloodless surgical field without tourniquet, the possibility of intraoperative testing of stability of prosthesis or fracture stabilization, strength of a tendon repair, the movement and gliding properties in the flexor tendon sheath after repair or testing the tension of tendon transfers. These are probably the reasons for the continuously growing popularity of this technique worldwide.

Conventional vs. digital impression technique for manufacturing of three-unit zirconia bridges: Evaluation of patients’ perception, preference, and treatment comfort

INTRODUCTION: Taking an impression of the oral cavity, which accurately recreates the prosthetic field, the surrounding hard dental and soft tissues, is one of the main and most important stages in the process of making any fixed prosthetic structure. AIM: The aim of the present study is to compare the comfort and satisfaction of patients in need of prosthetic restoration of a defect in the dentition, using conventional and digital impression techniques and to determine their preference for any of them. MATERIALS AND METHODS: The satisfaction of 36 patients in need of prosthetic rehabilitation treatment with conventional and digital impression techniques was analyzed and compared. After completing the stages of conventional and digital impressions, patients were asked to complete a comparative questionnaire of 9 questions using a numerical rating scale (NRS), stating their preference for one of the two techniques. RESULTS: Regarding the conventional impression technique, we obtained the lowest average values according to the criteria “general discomfort” (6.44±2.09), “total time for execution of the impression technique” (6.14±1.53), and “nausea” (6.17±2.86). The results of the same criteria in digital impression technology showed a significantly better response. All examined patients preferred the digital impression technique in cases where more than one impression had to be taken. DISCUSSION: Our results show that patients identify digital impressions as more comfortable for them. Differences in the level of comfort, which included nausea, difficulty breathing, discomfort in the TMJ with a wide open mouth, were statistically significant (p <0.001). CONCLUSION: In terms of patient comfort and satisfaction, the digital impression technique is better perceived than the conventional one.

A 12-month randomized controlled trial evaluating erythritol air-polishing versus curette/ultrasonic debridement of mandibular furcations in supportive periodontal therapy

BackgroundDue to complex morphology and limited access, the cleaning of the furcation area is extremely challenging. Therefore, novel therapeutic approaches need to be tested to potentially overcome debridement limitations. The aim of the present prospective 12-month study was to compare clinical and microbiological effects following erythritol air-polishing versus conventional mechanical debridement of furcation defects in a cohort of periodontal maintenance patients.MethodsTwenty patients with grade II mandibular molar furcation defects volunteered to enroll in this single-centre, examiner masked, randomized controlled trial. In a split-mouth study design, two furcation sites in each patient were randomly assigned to either receive subgingival debridement using erythritol air-polishing (test) or conventional ultrasonic/curette debridement (control) at baseline, and at 3, 6, 9 and 12 months. Probing depth, clinical attachment level and bleeding on probing were recorded at 3-month intervals. Subgingival microbiological samples obtained at baseline, 6 and 12 months were analyzed using checkerboard DNA–DNA hybridization. Discomfort from treatment was scored at 12 months using a visual analogue scale. The differences between treatments, and time-points, were tested using multilevel analysis (mixed effect models and robust variance estimates).ResultsA significant reduction in probing depth took place following both treatments (p < 0.001). Control sites experienced a significant mean gain in clinical attachment level of 0.5 mm (± 0.2) (p = 0.004), whereas a non-significant gain of 0.4 mm (± 0.3) was observed at test sites (p = 0.119). At 6 months, a significant between-treatment difference of 0.8 mm (± 0.4) was observed in favor of the control (p = 0.032). No significant between-treatment differences were observed in microbial load or composition. Notably, at 12 months patients experienced significantly less discomfort following air-polishing compared with control (p = 0.001).ConclusionsThe 12-month observations indicate that erythritol air-polishing and conventional mechanical debridement both support clinical improvements. A significant between-treatment difference in clinical attachment level was, however, detected in favour of control debridement at 6 months. In terms of patient comfort, erythritol air-polishing is superior.Trial Registration: The clinical trial was retrospectively registered in ClinicalTrial.gov with registration NCT04493398 (07/28/2020).

Dexmedetomidine vs Fentanyl for Awake Fiberoptic Intubation in Paediatric Patients with Temporomandibular Joint Ankylosis: A Retrospective Analysis

Introduction: For successful management of difficult paediatric airway intubation, proper preparation of airway along with a calm and sedated child with titrated doses of sedative agents is paramount. Aim: To compare two different classes of sedative agents (Dexmedetomidine vs Fentanyl) regarding intubating conditions and comfort score of paediatric population at the time of awake fiberoptic intubation. Materials and Methods: This retrospective study was carried out among 40 paediatric patients, aged between 5-14 years those who underwent surgery for Temporo-Mandibular Joint (TMJ) ankylosis. Clinical data relevant for this study was collected from the pre-format sheets of anaesthesia technique, attached with case files of the patients. Inj. dexmetedomidine bolus of 1 mcg/kg for 10 minutes followed by infusion at the rate 0.6 mcg/kg/hr in group A and Inj. fentanyl bolus dose of 2 mcg/kg followed by infusion 1 mcg/kg/hr in group B were compared in terms of intubating conditions and patient co-operation. For data analysis Statistical Package for the Social Sciences (SPSS) version 20 (IBM Inc.) was used. Patient characteristics in the two groups were compared using mean±SD and chi-square test. Results: All the patients had successful intubation in first attempt in both the groups. In terms of airway preparation, out of total, 14 (35%) patients in group A had no secretions as compare to 4 (10%) patients of group B (p-value was 0.002). In terms of cough score, 13 (32.5%) patients in group A had no cough as compared to 3 (7.5%) patients in group B. Patients in group A were more comfortable at the time of insertion of Flexible Fiberoptic Bronchoscopy (FOB) with no or less resistance to FOB insertion (p-value was 0.043). Vocal cord conditions were favourable in both the groups and there was no difference. Conclusion: Fiberoptic nasal intubation was found to be easier and safe in terms of patient comfort and preservation of patent airway with the use of dexmedetomidine, in paediatric TMJ ankylosis.