Verbal Numerical Rating Scale Scores Research Articles

Use of continuous interscalene brachial plexus block and rehabilitation to treat complex regional pain syndrome of the shoulder

ObjectivesTo evaluate the use of continuous interscalene brachial plexus block with bupivacaine to treat complex regional pain syndrome (CRPS) type 1 of the shoulder in adult patients who were refractory to standard therapies. Patients and methodsWe performed a prospective, cross-sectional study of 59 cases of treatment-refractory CRPS type 1 of the shoulder. The patients were treated with one week of continuous interscalene brachial plexus block with bupivacaine and concomitant rehabilitation in a specialist centre. After withdrawal of the catheter, rehabilitation was continued for a further 3 weeks.The outcomes at 1, 6 and 12 months were evaluated in terms of the Constant score, the verbal numeric rating scale (VNRS) for pain, joint range of motion and medication use. Patients were later interviewed by telephone and asked to state their professional situation, the current VNRS score for pain and the status of their CRPS. ResultsIn the first month of treatment, the mean VNRS pain score fell from 7.4 to 3.6, the Constant score rose from 21.7 to 56.6% and the joint range of motion increased from 5.4 to 29.9° for external rotation (ER) position 1 and from 38.6 to 74.2° for abduction. These improvements persisted over time, despite a very slight reduction at 6 months. 86% of the interviewed patients reported that the treatment protocol had improved or greatly improvement their condition. 46% of the respondees had been able to return to work. ConclusionTreatment with a combination of a 1-week continuous interscalene brachial plexus block and rehabilitation may be a good option for patients with CRPS type 1 of the shoulder and who are refractory to standard therapies.

Perioperative administration of pregabalin for pain after robot-assisted endoscopic thyroidectomy: a randomized clinical trial

Perioperative administration of pregabalin, which is effective for neuropathic pain, might reduce early postoperative and chronic pain. This randomized, double-blinded, placebo-controlled trial (Clinical Trials.gov ID NCT00905580) was designed to investigate the efficacy and safety of pregabalin for reducing both acute postoperative pain and the development of chronic pain in patients after robot-assisted endoscopic thyroidectomy. Ninety-nine patients were randomly assigned to groups that received pregabalin 150 mg or placebo 1 h before surgery, with the dose repeated after 12 h. Assessments of pain and side effects were performed 48 h postoperatively. The incidences of chronic pain and hypoesthesia in the anterior chest were recorded 3 months after surgery. Ninety-four patients completed the study. Verbal numerical rating scale scores for pain and the need for additional analgesics were lower in the pregabalin group (n = 47) than the placebo group (n = 47) during 48 h postoperatively (P < 0.05). However, incidences of sedation and dizziness were higher in the pregabalin group (P < 0.05). There were no differences between the groups in the incidences of chronic pain and chest hypoesthesia at 3 months after surgery. Perioperative administration of pregabalin (150 mg twice per day) was effective in reducing early postoperative pain but not chronic pain in patients undergoing robot-assisted endoscopic thyroidectomy. Caution should be taken regarding dizziness and sedation.

Effect of Single-injection Femoral Nerve Block Using Real-time Ultrasound on the Postoperative Pain after Bilateral Total Knee Arthroplasty: 0.25% vs 0.5% Levobupivacaine

Background: The purpose of this study was to compare the analgesic effect of 0.25% and 0.5% levobupivacaine for real time ultrasound guided single-injection femoral nerve block for the patients who are undergoing bilateral total knee arthroplasty (TKA). Methods: Femoral nerve block was done to all patients with 20 ml of 0.9% normal saline on one leg and 20 ml of 0.25% levobupivacaine on the other leg for group I (n = 16) and 0.5% levobupivacaine for group II (n = 15) with 1：200,000 epinephrine and using real-time ultrasound and a nerve stimulator. The data concerning the verbal numerical rating scale (VNRS) for each leg, the consumption of the intravenous patient-controlled analgesia (IV PCA) and the demands for the additional analgesics was collected at 0, 1, 6, 12, 24 and 48 hours after the operation. Results: The legs on which femoral nerve block was done with levobupivacaine showed a lower VNRS score than the legs with normal saline in either group I or group II. The VNRS scores between the two legs, the consumption of the IV PCA and the demand for additional analgesics showed no significant differences between the groups. Conclusions: Our results demonstrate that single-injection femoral nerve block using real-time ultrasound with either 0.25% levobupivacaine or 0.5% levobupivacaine 20 ml provides a good effect for the postoperative pain control after TKA. (Korean J Pain 2009; 22: 234-240)

Epidemiology of Complex Regional Pain Syndrome: A Retrospective Chart Review of 150 Korean Patients

Complex regional pain syndrome (CRPS) is a chronically painful and disabling disorder. However, no data are available even on the epidemiology of CRPS in Korea. This study was undertaken to retrospectively assess the epidemiologic characteristics of CRPS in 150 consecutive patients at a tertiary chronic pain center from March 2002 to February 2006. Information was obtained regarding patients' demographics, nature of injury, and treatment modalities. Seventy-one percent of patients had CRPS type I. The mean 11-point verbal numerical rating scale score at initial examinations and at the time of study were 8.0 and 5.7, respectively. Thirty-two percent of patients showed no change or increase in pain intensity during follow-up at our pain center. The mean duration of CRPS symptoms prior to our pain center evaluation and prior to the time of study were 27 months and 50 months, respectively. These patients had seen on average 5 different physicians before being referred to our center. This study shows that the majority of CRPS patients were referred to our center after more than 2 yr of symptoms. The clinical implication of such delayed transfer and strategies to avoid this problem are discussed.

Prehospital analgesia in adults using inhaled methoxyflurane

For many years, ambulance services throughout Australia have been administering methoxyflurane as a first-line analgesic agent. However, there is a paucity of literature regarding its efficacy, safety and usage profile. The present study was designed to examine the efficacy of methoxyflurane in adults. An observational case series was conducted over a 10 month period. Adults to whom methoxyflurane was administered while traveling by ambulance to an urban teaching hospital were enrolled. Data analysed included indications for use, verbal numerical pain scores, depth of sedation and adverse effects. Data were collected via paramedic, patient and ED staff surveys. Eighty-three adult patients were enrolled over a 10 month period. A mean reduction in verbal numerical rating scale (VNRS) scores of 2.47 +/- 0.24 (on a 10-point scale) was recorded 5 min post methoxyflurane, with a total reduction of 3.21 +/- 0.24 at time of arrival at the ED. Both VNRS scores were significantly different from baseline (P < 0.0001). Fifteen patients (18.1%, 95% CI 9.8-26.4%) reported mild side-effects either during or shortly after administration. A total of 68 (81.9%, 95% CI 72.0-89.5%) of the paramedics and 60 (72.3%, 95% CI 61.4-81.6%) of the patients interviewed said that they felt satisfied with the level of analgesia provided by methoxyflurane. The use of methoxyflurane as a prehospital analgesic significantly reduced pain in patients, with no significant side-effects attributed to its use. The majority of patients and paramedics interviewed were satisfied with its effects and indicated a willingness to use it again.

Comparison of 0.15% Ropivacaine/Fentanyl and 0.1% Levobupivacaine/Fentanyl Infused for Postoperative Epidural Analgesia

Background: In this study we compared the analgesic effects and the incidences of motor weakness and other side effects of postoperative continuous epidural infusion of 0.15% ropivacaine/fentanyl or 0.1% levobupivacaine/fentanyl. Methods: Sixty seven patients scheduled for elective knee arthroplasty or revision surgery under combined spinal-epidural anesthesia were randomized to receive either 0.15% ropivacaine with 2/ml fentanyl (the ropivacaine group) or 0.1% levobupivacaine with 2/ml fentanyl (the levobupivacaine group) for postoperative epidural analgesia using a PCA pump at a rate of 5 ml/h during the 48 hour period following surgery. Verbal numerical rating scale (VNRS) scores on rest and movement, Bromage scores, additional analgesic requirements and side effects were assessed. Results: In the ropivacaine group, rest VNRS scores were lower than in the levobupivacaine group on the second postoperative day, and movement VNRS scores were also lower in the ropivacaine group during the first and second postoperative days. Bromage scores, additional analgesic requirements and side effects were similar in the two groups. Conclusions: Both 0.15% ropivacaine with 2/ml fentanyl and 0.1% levobupivacaine with 2/ml fentanyl provided effective postoperative epidural analgesia, but ropivacaine group members were able to exercise more effectively.

A Study on the Preemptive Analgesic Effect of Low Dose Intravenous Ketamine and Combined Ketamine-Clonidine

Background: The purpose of this study was to evaluate the preemptive analgesic effect of a single intravenous infusion of low dose ketamine-clonidine. We compared the placebo with low dose ketamine and low dose ketamine-clonidine in patients undergoing an appendectomy. Methods: Sixty ASA class 1 or 2 patients who received general anesthesia for an appendectomy were allocated randomly to three groups. Group 1 received intravenous normal saline 6 ml and group 2 received ketamine 0.15 mg/kg in normal saline 6 ml and group 3 received ketamine 0.15 mg/kg and clonidine 1/kg in normal saline 6 ml 5 minutes before surgical incision. In the recovery room postoperative analgesia was assessed by the verbal numerical rating scale (VNRS) at 0 min, 15 min, 30 min, 60 min, 90 min and 120 min. Vital signs, sedation score and side effects were also checked. For postoperative analgesia, morphine 2 mg was given intravenously whenever a patient complained of pain, or the VNRS score was above 7. Results: There were no intergroup differences of individual morphine requirements for postoperative pain control among the three groups. VNRS score, blood pressure, heart rate, sedation score and side effects were not significantly different among the three groups. Conclusions: A single low dose of ketamine-clonidine may not produce a postoperative analgesic effect in the recovery room, and a single low dose of ketamine also may not produce the preemptive effect for at least 2 hours.