Visual Analog Pain Scores Scores Research Articles

High Preoperative Pain Score is a Predictor of Cheilectomy Failure in Hallux Rigidus

Hallux rigidus (HR) is a prevalent arthritic condition in the foot. Cheilectomy is a common joint-preserving procedure for HR, involving the removal of prominent osteophytes to relieve impingement of the 1st MTPJ. This study aims to identify factors associated with the failure of cheilectomy in the treatment of HR. A retrospective review of a prospectively collected database from 2007 to 2021 identified all cheilectomy cases. The minimum follow-up was 2 years. Preoperative demographic data, patient-reported outcome measures (PROMs) and foot radiographs were collected. PROMs were reassessed in post-operative reviews, and cases were categorized as successes or failures. Failure was defined by meeting at least one of the following criteria at the latest review: 1) Visual analog pain score (VAS) more than or equal to 4, 2) undergoing subsequent revision procedures, or 3) reporting poor or terrible satisfaction with the surgery. The analysis involved 66 patients, with 19 failure and 47 success cases. Both groups showed similar age, BMI, and gender profiles. Preoperative radiographic parameters were comparable between groups. However, preoperative VAS was significantly higher in the failure group: 7.16 vs. 5.23 (P = 0.0029). Logistic regression confirmed preoperative VAS as a predictor of non-response (P = 0.023). Receiver Operating Characteristic analysis established an optimal cut-off VAS score of 7.0. Patients with a preoperative VAS score of more than 7 had an odds ratio of 5.11 (P = 0.0055) for failure. A higher preoperative VAS score is significantly associated with cheilectomy failure in HR treatment, suggesting a cutoff score of 7.0.

Mid-Term Functional Outcomes Of Arthroscopic Rotator Cuff Repair In Patients With Or Without Frozen Shoulder: A Single-Center Retrospective Cohort Study

Rotator cuff tear (RCT) accompanied by frozen shoulder is a challenge for orthopedic surgeons as RCTs are often treated with surgical repair which need protection of repair, whereas the treatment for frozen shoulder is physical therapy to restore the range of motion of the shoulder joint. There is no consensus for the ideal treatment if those pathologies occur at the same time. The primary aim of the study is to compare the mid-term functional surgical outcomes of RCT repair in patients with or without frozen shoulder. Patients who underwent arthroscopic repair for full-thickness RCT in our institution between January 2021 and January 2023 were retrospectively reviewed. Patients were divided into two groups: with or without frozen shoulder at the time of arthroscopic repair. Patients with frozen shoulder underwent manipulation under general anesthesia and their rotator interval was released with a radiofrequency prior to RCT repair. Patients’ visual analog pain score (VAS), Constant score, ASES score, and University of California Los Angeles (UCLA) scores were compared at their latest follow-up. A total of 39 patients (19 frozen and 20 non-frozen shoulders) with a mean 23.9 ± 2.7 months of follow-up were included in the study. At the latest follow-up, there was no statistical difference in frozen and non-frozen groups in the mean VAS, ASES, UCLA, and Constant scores. The findings of the present study suggest that preoperative frozen shoulder does not have a negative impact on arthroscopic RCT repair, if frozen shoulder pathology is addressed during surgery.

Combined, Single-Anchor Subscapularis Tendon Repair and Proximal Biceps Tenodesis Leads to Improved Function and Decreased Pain at 1 Year

PurposeThe purpose of this study was to evaluate the 1-year clinical outcomes of patients treated with combined proximal biceps tenodesis and repair of type II-III subscapularis tendon injuries according to Lafosse et al, using the Loop ‘N’ Tack (LNT) technique. MethodsAll patients undergoing proximal biceps tenodesis and rotator cuff repair (RCR) between March 1st, 2020 and January 30th, 2022 were retrospectively identified. Only patients undergoing combined proximal biceps tenodesis and repair of grade II or III SST injuries with a minimum follow-up of 1 year were included. All patients underwent combined single anchor proximal biceps tenodesis and SST repair using the Loop ‘N’ Tack (LNT) technique. The following outcome scores were recorded at a final follow-up of 1-year postoperatively and were compared to baseline, preoperative values: American Shoulder and Elbow Score (ASES), Single Assessment Numerical Evaluation (SANE), Veterans Rand 12 Item Health Survey (VR-12), and Visual Analog Score (VAS). The minimal clinically important difference (MCID) for all outcome indices was determined with a distribution-based method. ResultsA total of 41 consecutive patients were included. The MCID value for VAS pain, ASES, SANE, and VR-12 mental scores were 0.97, 8.5, 10.9, and 6.0 respectively. At 1-year final follow-up, approximately 95% (39/41) of patients exceeded the MCID for VAS pain scores, 90% (37/41) of patients for ASES scores, 85.4% (34/41) of patients for SANE scores, and 75.6% (31/41) of patients for VR-12 mental health scores. On average, ASES and SANE scores improved by 37 (Pre: 45.2, 1yr: 82.4, p<0.001) and 38 points (Pre: 38.0, 1yr: 75.7, p<0.001) respectively while VAS scores decreased by 4 points (Pre: 5.49, 1yr: 1.48, p<0.001). Approximately 88% (36/41) of patients were satisfied at 1 year post-operatively. Treatment failure was observed in one patient (2.4%). ConclusionPatients treated with combined, single-anchor SST repair and LNT proximal biceps tenodesis achieved significant improvements in function, high satisfaction, and low rates of re-operation at 1 year postoperatively. Additionally, 76% to 95% of patients met the MCID for VAS pain, ASES, SANE, and VR-12 mental health scores. Level of EvidenceLevel IV, retrospective case series

Smokers Achieved Minimal Clinically Important Difference for Visual Analog Scale and American Shoulder and Elbow Surgeons Scores at a Lower Rate Than Nonsmokers Even When Repaired Supraspinatus Tendons Were Intact on Postoperative Magnetic Resonance Imaging

To investigate the impact of smoking on clinical outcomes after repair of supraspinatus tendon in patients who had an intact repair found on postoperative magnetic resonance imaging. Patients who received primary complete repair of supraspinatus tendon tear between 2014 and 2020 were retrospectively identified. Patients were excluded if a postoperative magnetic resonance imaging scan was not available or if the follow-up was less than 2 years. Visual analog score (VAS), American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion were assessed at the 2-year follow-up. The percentage of patients acquiring minimal clinically important difference (MCID) was reported. One hundred primary supraspinatus tendon repairs were included. The healing rate was 77% in smokers and 90% in nonsmokers. Smoking was the independent predictor of a poorer 2-year VAS (P < .001) and ASES (P < .001) scores. Significant improvement in clinical outcomes was observed between preoperation and the 2-year follow-up, regardless of the integrity of the repair or smoking status (P < .001). When the repaired tendon was intact, nonsmokers had a greater chance of achieving MCID in 2-year VAS and ASES scores than smokers. Ninety-nine percent of nonsmokers, compared with 82% of smokers, achieved MCID in VAS at the 2-year follow-up (P= .023). The corresponding figures for ASES were 98% and 71%, respectively (P= .004). In this study, smoking was associated with poorer clinical outcomes, including a greater 2-year VAS pain score and a lower 2-year ASES score, when compared with nonsmokers, even in cases in which there was no full-thickness retear of the repaired supraspinatus tendon. Level III, retrospective cohort study.

Miserable malalignment syndrome associated knee pain: a case for infra-tubercle tibial de-rotation osteotomy using an external fixator

IntroductionMiserable malalignment syndrome is a complex torsional lower limb deformity with limited consensus on surgical treatment. We present the outcome of de-rotation of the tibia alone using an external fixator.MethodsFifteen patients (22 segments) were operated on between 2012 and 2020; 13 presented with anterior knee pain, and two presented with out-toeing. Gait analysis was done in nine patients, and CT scan rotational profile, including tibial tubercle–trochlear groove distance, femoral version, and tibial torsion, were calculated. Kujala knee pain score and visual analogue pain score (VAS) were recorded. All underwent infra-tubercular osteotomy of the tibia and midshaft osteotmy of the fibula and application of a hexapod circular frame to gradually internally rotate the tibia until the foot aligned with the patella.ResultsThere was no preoperative clinical or radiographic evidence for patellar instability, femoral anteversion 30° (21°–54°), and external tibial torsion 50° (37–70). The mean age at surgery was 21 years (12–37) with a mean follow-up of 20 months (9–83). All osteotomies healed, and the frames were removed at a mean of 111 days (80–168). The mean VAS score improved from 8(5–9) to 1(0–4) postoperatively (P < 0.001). The mean Kujala knee pain score increased from 53 (30–75) to 92 (54–100) postoperatively (P < 0.001). The mean preoperative foot progression angle (FPA) was 37° (20°–50°), with 13 postoperatively walking with neutral FPA. One patient walked with symmetrical + 10° and the other with − 5° FPA. All patients reported relief of knee pain and were satisfied with the alignment.ConclusionGradual correction of severe external tibia torsion with a hexapod external fixator and an infra-tubercle tibial osteotomy could provide an optimum method to eliminate knee pain and improve limb alignment in miserable malalignment syndrome.

Screw Only Fixation vs Plate Fixation For 1st MTPJ Arthrodesis: A Comparative Retrospective Study

Category: Midfoot/Forefoot; Other Introduction/Purpose: First metatarsolphalangeal joint (MTPJ) arthrodesis is a commonly performed surgical procedure for end- stage arthritis. Various fixation techniques have been described. The most commonly used are screw-only fixation (either crossed or parallel) or plate fixation (with or without independent lag-screws). A recent systematic review reported that union rates for screw fixation were lower compared to plate constructs. The aim of this study was to compare union rates, complication rates and functional outcomes between screw-only fixation and plate fixation in a recent cohort of patients undergoing first MTPJ arthrodesis at a tertiary foot ankle orthopaedic institution. Methods: This was a retrospective cohort study. After institutional review board approval, a database search was conducted to identify patients who underwent primary first MTPJ arthrodesis between 2015 and 2022. All patients had a dorsal approach, preparation of joint surfaces with cup and cone reamers and fixation with either crossed cannulated screws or a dorsal pre- contoured locking plate (with or without an independent lag-screw). Demographic, operative (fixation type) and outcome data was collected. The primary outcome was the incidence of arthrodesis at 6 months postoperatively. Secondary outcomes included complications at 6 months postoperatively and change in functional outcome scores from preoperatively to 6 months postoperatively as assessed by the Functional Ankle Ability Measure (FAAM) and Visual Analog Pain scores (VAS). Statistical analyses included descriptive statistics as well as univariable and multivariable analyses to determine if one fixation method was associated with a higher incidence of arthrodesis. Results: There were 108 patients identified, 54 in the screw-only group (mean age 62.9 years, 79.6% female, mean body-mass index (BMI) 28.6 kg/m2) and 54 in the plate-fixation group (mean age 63.2 years, 81.5% female, mean BMI 30.0kg/m2). Arthrodesis at 6 months in the screw-only group occurred in 52 of 54 patients (96.3%) and in 50 of 54 patients (92.6%) in the plate-fixation group, p=0.68. Fixation type was not a predictor of non-union on multivariable analysis. The complication rate was 11.1% (n=6) in screw-only patients (four hardware removals, two non-unions) and 14.8% (n=8) in plate-fixation patients (four non-unions, two hardware removals, two wound infections), p=0.57. Both groups reported increases in VAS and FAAM scores at 6 months from baseline, with no significant between-group differences. Conclusion: The arthrodesis rate for screw-only fixation was higher than patients receiving plate-fixation, however, this difference did not reach statistical significance. Similar complication rates were observed in each group. These results provide evidence for the safety and efficacy of screw-only fixation constructs, however, further adequately powered prospective studies are required. Future studies should also include a cost effectiveness analysis and a comparison of radiation exposure and operative time between groups to determine the optimal fixation method for patients undergoing this procedure.

Comparative Study of Percutaneous Kyphoplasty and Hyperextension Reduction Combined with Percutaneous Vertebroplasty in the Treatment of Osteoporotic Thoracolumbar Compression Fractures in the Elderly

Objective: This paper aims to explore the clinical effects of percutaneous kyphoplasty (PKP) and hyperextension reduction combined with percutaneous vertebroplasty (PVP) in elderly patients with osteoporotic thoracolumbar compression fractures (OVCF). Methods: A sample of 62 elderly OVCF patients was selected. The admission time was from June 2022 to June 2023. They were randomly divided into a study group (n = 31) and a control group (n = 31) using computer software lottery method. Patients in the control group were treated with PKP, while patients in the study group were treated with hyperextension reduction combined with PVP. The operation time, hospitalization time, the number of fluoroscopy, treatment costs, visual analog pain score (VAS), vertebral body height, and Cobb angle of the injured vertebra were compared between the two groups. Results: The operation time, hospitalization time, number of fluoroscopy, and treatment costs of the patients in the study group were all lower than those in the control group (P &lt; 0.05). The VAS scores of the two groups after surgery were lower than those before surgery, and there was no significant difference between the groups (P &gt; 0.05). After surgery, the vertebral body heights in both groups were more significant than before surgery, and the Cobb angle of the injured vertebra was smaller than before surgery. There was no significant difference between the groups (P &gt; 0.05). Conclusion: PKP and hyperextension reduction combined with PVP treatment in elderly patients with OVCF can relieve pain and restore vertebral body height and Cobb angle. However, hyperextension reduction combined with PVP treatment can shorten the operation time and hospitalization time, with low treatment cost, which has the potential value to be widely applied.

Clinical Efficacy of Traditional Chinese Medicine Orthopedic in the Treatment of Senile Osteoarthritis

Objective: This paper aims to explore and analyze the clinical effect of traditional Chinese medicine (TCM) orthopedic treatment on elderly patients with osteoarthritis. Methods: The study period is from January 2021 to June 2023. 62 elderly patients with osteoarthritis admitted to our hospital were selected and divided into the study group (n = 31) and the control group (n = 31) using the random number table scheme. The patients in the control group were treated with conventional Western medicine acemetacin, and the patients in the study group were treated with traditional Chinese medicine orthopedic. The treatment options included manual massage, traditional Chinese medicine fumigation, and oral administration of traditional Chinese medicine. The clinical effective rate, osteoarthritis function Japanese Orthopedic Association score (JOA), visual analogue pain score (VAS), and incidence of adverse reactions were compared between the two groups. Results: The clinical effective rate of patients in the study group was higher than that of the control group (P &lt; 0.05), the JOA score of the patients in the study group was higher than that of the control group after treatment (P &lt; 0.05), while the VAS score of the patients in the study group was lower than that of the control group after treatment (P &lt; 0.05). Plus, the incidence of adverse reactions in the study group was lower than that in the control group (P &lt; 0.05). Conclusions: TCM orthopedic treatment for elderly patients with osteoarthritis has a significant effect, it can improve joint function, relieve pain, with a low incidence of adverse reactions, which can be widely applied in clinical practice.

Clinical Value of Tranexamic Acid Combined with Total Knee Arthroplasty in the Treatment of Knee Osteoarthritis

This paper aims to explore the clinical value of tranexamic acid combined with total knee arthroplasty (TKA) in patients with knee osteoarthritis (KOA). The research period was from March 2020 to December 2022. A total of 50 samples of KOA patients were selected and divided into the study group (n = 25) and the control group (n = 25) by lottery method of medical record envelopes. The patients in the control group were treated with TKA, and the patients in the study group were treated with tranexamic acid combined with TKA. The surgery-related indicators, visual analogue pain score (VAS), inflammatory factor levels, motor function scores, and incidence of complications were compared between the two groups. The intraoperative blood loss in the study group was lower than that in the control group (P &lt; 0.05), and there was no significant difference in postoperative hospital stay between the two groups (P &gt; 0.05). The postoperative VAS scores in the study group were lower than those in the control group (P &lt; 0.05), while the postoperative inflammatory factor levels of the study group were lower than those of the control group (P &lt; 0.05). The postoperative motor function scores of the study group were higher than those of the control group (P &lt; 0.05), and the incidence of complications in the study group was lower than that in the control group (P &lt; 0.05). The treatment of KOA patients with tranexamic acid combined with TKA can reduce intraoperative blood loss, relieve pain, reduce the level of inflammatory factors, improve postoperative motor function, and reduce the incidence of complications, which can be widely applied in clinical practice.

To resurface or not to resurface? Investigating the impact of patellar resurfacing on anterior knee pain in rheumatoid arthritis patients undergoing total knee replacement

BackgroundRoutine patellar resurfacing is a controversial issue in total knee replacement (TKR), especially for rheumatoid arthritis (RA). Anterior knee pain (AKP) is a common complaint after TKR that may be related to patellofemoral joint condition. The aim of this study was to investigate the prevalence and factors associated with AKP after TKR for RA compared between non-resurfaced patella (NRP) and resurfaced patella (RP). MethodsThis retrospective study included RA patients who underwent TKR at our institute from 2002 to 2019. All included patients had at least 1 year of follow up. Patients were divided into the NRP and RP groups. At the last follow up visit, the prevalence of AKP, and the severity of AKP, including visual analogue pain score (VAPS) and Kujala score, were compared between groups. Univariate and multivariate logistic regression analysis was performed to identify independent predictors of AKP. ResultsA total of 141 RA patients (median age: 60 years, 90% female, 219 knees) were included. There was no significant difference in AKP between the NRP and RP groups (12.7% vs. 7.3%, P = 0.185). Regarding AKP severity, there was no significant difference in VAPS or Kujala score between groups (P = 0.147 and P = 0.067, respectively). No independent predictors of AKP were identified. ConclusionAlthough patellar resurfacing is recommended in TKR for RA, this study found no significant difference in prevalence of AKP, VAPS and Kujala score between those with and without patellar resurfacing during TKR.

The value of right heart contrast echocardiography combined with migraine rating scale in evaluating the efficacy of patent foramen ovale closure

ObjectivesTo investigate the clinical values of right heart contrast transthoracic echocardiography (cTTE) combined with migraine rating scale in evaluating the efficacy of patent foramen ovale (PFO) closure.MethodsFrom January 2018 to December 2021, a total of 68 hospitalized patients, 21 males and 47 females, who were treated with transcatheter closure of PFO-induced migraine in the Heart Center of the First Affiliated Hospital of Tsinghua University were selected, with the age of 38.4 ± 11.9 years old. The changes of right heart contrast transthoracic echocardiography (cTTE), visual analogue pain score(VAS), headache impact test-6(HIT-6) and migraine disability assessment questionnaire(MIDAS) before and 6 months after PFO occlusion were compared.ResultsPre-operative cTTE data show that 36 patients (52.9%) had moderate right-to-left shunt (RLS), and 32 patients (47.1%) had massive RLS. cTTE was reexamined 6 months after operation and 1 case in the moderate RLS group had minimal RLS, 2 cases in the large RLS group had minimal RLS, and no shunts were seen for the rest. The VAS, HIT-6 and MIDAS scores before and 6 months after the operation were 7.65 ± 1.39 vs. 1.28 ± 1.53, 70.78 ± 6.82 vs. 41.53 ± 6.07, and 30.60 ± 13.24 vs. 1.93 ± 3.87, respectively. All the indexes 6 months after the operation significantly improved compared with the preoperative baseline (P < 0.05).ConclusionscTTE combined with migraine evaluation scale could be used as an objective index to evaluate the clinical effect of PFO occlusion.

ROLE OF PERCUTANEOUS VERTEBROPLASTY IN VERTEBRAL COMPRESSION FRACTURES: EFFICACY AND SAFETY

Background: Percutaneous Vertebroplasty (PVP) is a minimally invasive interventional procedure performed by injecting bone cement or other therapeutic material into a painful osteoporotic or neoplastic compression fracture for pain or disability improvement. There is conflicting evidence regarding the use of vertebroplasty in osteoporotic vertebral compression fractures (VCFs) in the available literature. Objectives: To evaluate the efficacy and safety of Percutaneous Vertebroplasty in painful vertebral compression fractures in terms of pain alleviation and disability improvement, and thereby, study the profile of complications. Study design: Prospective observational study Study Participants: Patients with clinically symptomatic VCFs, who received various forms of treatment (interventional/conservative) were enrolled for the study. Patients who met the inclusion/exclusion criteria were finally selected. Methodology: Out of the selected patients, two groups were made, one who received the Intervention (PVP) and another group who received conservative management (Bed rest, medications, physiotherapy, etc.). Out of 31 patients selected, 11 were treated by PVP and 20 were treated by conservative management. These patients were followed up at 1-month, 3-month and 6-month intervals to record the Visual analog pain scores (VAS), Ronald Morris disability scores (RDQ) and any complication. Results: VAS scores in the vertebroplasty group decreased from (8.09±0.539) to (3.64 ± 0.674) at 1-month to (3.27±1.009) at 3-month to (3.09±0.831) at 6-month. VAS scores also decreased in the conservative group from (7.6±0.598) to (5.95±0.999) at 1-month to (5.1±1.294) at 3-month to (5.15±1.424) at 6-month. Vertebroplasty group showed the steep fall (-4.45) in VAS values as compared to a gradual decrease in VAS (-1.65) in the conservative group at 1 month follow up, concluding that conservative treatment has a slower effect on pain relief compared with the early response after PVP. Disability scores (RDQ) follow a similar trend with early and better improvement in the vertebroplasty group. RDQ scores: Vertebroplasty group (18.45±1.572 at baseline to 12.27±1.421 at 1-month to 11.82±1.079 at 3-month to 11.82±1.471 at 6-month), Conservative group (17.95±1.146 at baseline to 14.3±1.418 at 1-month to 12.9±1.518 at 3-month to 12.85±2.207 at 6-month). Subgroup analysis showed more benefit in malignant VCFs treated by PVP. The procedure was largely uneventful. An immediate complication was noted in one patient with cement extravasation into the venous channels, however, the patient showed pain and disability improvement without any adverse effects. Furthermore, no additional complication was noted during the follow-up period in any other patient. Conclusion: Percutaneous Vertebroplasty provides early and significant pain and disability improvement in vertebral compression fractures to comparison to conservative management. Implication: Minimal invasive technique for pain relief in osteoporotic and malignant vertebral compression fractures.

Effectiveness and safety of new umbilical paramedian semilunaris approach for transverse abdominis plane block: a prospective, single-arm, observational, evaluation study.

The transversus abdominis plane (TAP) block is a widely used, safe and effective technique for abdominal surgery analgesia, but its range of blocking is not sufficient for some surgeries requiring a large incision. Here we present the novel concept of an ultrasound-guided linea semilunaris block, a modified approach to TAP block, which can potentially offer a wider blocking range. Patients undergoing open colorectal surgery at the Shanghai Jiaotong University Affiliated Sixth People's Hospital between May and July 2021 were enrolled to receive ultrasound-guided linea semilunaris block. All blocks were performed in the holding area of the operating theater under routine hemodynamic monitoring while patients were conscious with low-dose opioids. All patients were supine, and a linear probe identified the semilunar line as the connection between the transverse and rectus muscles. Next, 20 mL of 0.25% ropivacaine was injected in the semilunar line using the in-plane technique bilaterally. The main indicator of the blocking range was measured. Postoperatively, the visual analog score (VAS) from 4 to 24 h (every 2 h), the time of the first remedial analgesia, the bowel movement starting time and complications were also recorded. A total of 31 potentially eligible studies were identified for inclusion. The extent of the cutaneous sensory block was: 3.46±0.59 cm below the xiphoid, 1.74±0.37 cm above the symphysis pubis, 2.02±1.24 cm outside the left midclavicular line, and 2.19±1.25 cm outside the right midclavicular line. The highest and lowest median [interquartile range (IQR)] VAS pain scores were 4 [4-5] of 10 h and 2 [1-2] of 4 h postoperatively. The bowel movement starting time was 3.7±1.1 days after gastrointestinal surgery. There were four patients with nausea and vomiting but none had adverse reactions attributable to local anesthetic (LA) poisoning. The ultrasound-guided umbilical paramedian semilunaris approach to TAP block is a safe and effective technique in clinical practice, which may provide more effective analgesia than traditional TAP block for open colorectal surgery with a median abdominal incision. Further randomized controlled trials are needed to confirm our results.

A multimodal intraosseous infusion of morphine and ketorolac decreases early postoperative pain and opioid consumption following total knee arthroplasty

BackgroundMultimodal pain management regimens and intraosseous infusion of morphine are two novel techniques that show promise in decreasing postoperative pain and opioid consumption following total knee arthroplasty. However, no study has analyzed the intraosseous infusion of a multimodal pain management regimen in this patient population. The purpose of our investigation was to examine the intraosseous administration of a multimodal pain regimen comprised of morphine and ketorolac during total knee arthroplasty with regard to immediate and 2-week postoperative pain, opioid pain medication intake, and nausea levels. MethodsIn this prospective cohort study with comparisons to a historical control group, 24 patients were prospectively enrolled to receive an intraosseous infusion of morphine and ketorolac dosed according to age-based protocols while undergoing total knee arthroplasty. Immediate and 2-week postoperative Visual Analog Score (VAS) pain scores, opioid pain medication intake, and nausea levels were recorded and compared against a historical control group that received an intraosseous infusion of morphine alone. ResultsDuring the first four postoperative hours, patients who received the multimodal intraosseous infusion experienced lower VAS pain scores and required less breakthrough intravenous pain medication than those patients in our historical control group. Following this immediate postoperative period, there were no additional differences between groups in terms of pain levels or opioid consumption, and there were no differences in nausea levels between groups at any time. ConclusionsOur multimodal intraosseous infusion of morphine and ketorolac dosed according to age-based protocols improved immediate postoperative pain levels and reduced opioid consumption in the immediate postoperative period for patients undergoing total knee arthroplasty.

The Efficacy of Patient Controlled Analgesia for Acute Non Traumatic Abdominal Pain in Emergency Department

INTRODUCTION: Patient-Controlled Analgesia (PCA) is an intravenous selfadministration of small doses of opioids (such as morphine) using a programmable pump, The goal of PCA is to efficiently reduce patients’ pain at patient's preferred dose and schedule. Thus, we conducted a study to compare patient PCA morphine with intravenous bolus morphine for acute abdominal pain of non-traumatic origin in the emergency department (ED). MATERIALS AND METHODS: A randomised, non-blinded clinical trial was conducted in patients presented with severe acute non traumatic abdominal pain of less than 24 hours requiring opioid analgesic based on numerical pain score of more than seven at triage. The primary outcome was visual analogue pain score (VAS) recorded at 0, 30th, 60th and 120th minutes during the management in the ED and after admission to wards, and the secondary outcomes were total dosage of morphine used and degree of patient satisfaction. RESULTS: A total of 62 participants who fulfilled study criteria were randomized into PCA morphine group or bolus morphine group. The average amount of analgesic used for bolus morphine group was lower compared to PCA morphine (4.23 mg)(s.d 1.89 vs 5.29 mg)(s.d 2.16) (p=0.027). Despite of significant VAS score changes within group analysis, between group repeated measure ANOVA (RMA) VAS score analysis was not statistically significant. [Bolus group (6.7+2.03) compared to PCA group (5.83 + 2.38)](p=0.089). Patient satisfaction was statistically significant for the PCA group [PCA (1.65+0.709) compared to bolus group (2.23+0.920)](p=0.007). CONCLUSIONS: There was no significant difference in pain score reduction between PCA and intravenous bolus of morphine for the management of severe acute non traumatic abdominal pain in ED. However, PCA provided more patient satisfaction and should be considered as an alternative modality of acute pain management in ED.

Patients who undergo bilateral medial patellofemoral ligament reconstruction return to sport at a similar rate as those that undergo unilateral reconstruction.

Lateral patellar instability is a debilitating condition not only to athletes, but also to a wide range of highly active individuals. Many of these patients experience symptoms bilaterally, though it is unknown how these patients fair with return to sports following a second medial patellofemoral ligament reconstruction (MPFLR). The purpose of this study is to evaluate the rate of return to sport following bilateral MPFLR compared to a unilateral comparison group. Patients who underwent primary MPFLR with minimum 2-year follow-up were identified from 2014 to 2020 at an academic center. Those who underwent primary MPFLR of bilateral knees were identified. Pre-injury sport participation and Tegner score, Kujala score, Visual Analog Score (VAS) for pain, satisfaction, and MPFL-Return to Sport after Injury (MPFL-RSI) scale were collected. Bilateral and unilateral MPFLRs were matched in a 1:2 ratio based on age, sex, body mass index, and concomitant tibial tubercle osteotomy (TTO). A sub-analysis was performed regarding concomitant TTO. The final cohort consisted of 63 patients, including 21 patients who underwent bilateral MPFLR, matched to 42 unilateral patients at mean follow-up of 47 ± 27months. Patients who underwent bilateral MPFLR returned to sport at a rate of 62% at a mean of 6.0 ± 2.3months, compared to a unilateral rate of 72% at 8.1 ± 4.2months (n.s.). The rate of return to pre-injury level was 43% among bilateral patients and 38% in the unilateral cohort. There were no significant differences in VAS pain, Kujala, current Tegner, satisfaction, and MPFL-RSI scores between cohorts. Approximately half of those (47%) who failed to return to sport cited psychological factors and had significantly lower MPFL-RSI scores (36.6 vs 74.2, p = 0.001). Patients who underwent bilateral MPFLR returned to sports at a similar rate and level compared to a unilateral comparison group. MPFL-RSI was found to be significantly associated with return to sport. III.

Comparison of efficacy of pregabalin with duloxetine in the management of patients with painful diabetic neuropathy.

Objectives: To compare pregabalin with duloxetine in terms of mean reduction in pain score, in the management of patients with painful diabetic neuropathy. Study Design: Randomized Controlled Trial. Setting: Department of Medicine, FMU &amp; Affiliated Hospitals, Faisalabad. Period: 1st March, 2020 to 3rd March 2021. Material &amp; Methods: A total of 180 patients with known diabetics of at least 5 years duration, 18 to 75 years of age were included. Patients with ischemic pain or other types of pain not related to diabetes such as arthritic pain or phantom pain secondary to amputations, CRF &amp; CLD were excluded. Group A received 150mg of Pregabalin at night before sleeping and was increased to 150mg twice daily after 02 week if VAS pain score reduction was found to be less than 50% from baseline. Group B received 60mg Duloxetine at bed time and it was increased to 120mg after 04 weeks if the VAS pain score was less than 50% after 04 weeks. The patients were again assessed after another 04 weeks to assess VAS Pain Score reduction. The primary outcome is pain as assessed by the Visual Analogue Score (VAS) at the end of 04 weeks from start of medications. Results: Age range in this study was from18 to75 years with mean age of 40.87±13.67 years. The mean age of patients in pregabalin group was 38.80 ± 13.01 years and in duloxetine group was 41.07 ± 13.85 years. Majority of the patients 34 (56.67%) were between 20 to 40 years of age. Mean reduction in pain in pregabalin group was 1.63 ± 1.07 while in duloxetine group was 3.23 ± 1.38 (p-value =0.0001). Conclusion: This study concluded that duloxetine had significantly greater pain reduction than pregabalin in the management of patients with painful diabetic neuropathy.

Outcomes of Core Decompression and Bone Marrow Aspirate Concentrate Injection for Osteonecrosis of the Femoral Head

AbstractWithout intervention, 80% of hips with osteonecrosis (ON) will progress. Core decompression (CD) has shown favorable results (60–80% survivorship) in early stage ON, and recently, bone marrow aspirate concentration (BMAC) injection into the decompressed femoral head has been proposed to stimulate healing of the necrotic lesion and improve outcomes and survivorship. We reviewed the clinical and radiographic outcomes of 51 Steinberg stage 2 hips in 31 patients who underwent CD + BMAC for ON with a minimum of 1 year follow-up. We evaluated preoperative visual analog pain scores (VAS), Steinberg stage based on radiographs, and Kerboul angle as measured on magnetic resonance imaging. Clinical outcomes were reported as a change in VAS at final follow-up, hip and disability osteoarthritis score for joint replacements (HOOS, JR) score at final follow-up, advancement in Steinberg stage based on radiographs, or decision to proceed with total hip arthroplasty (THA). At an average of 27 months, VAS scores improved from 7 to 2.3 (p &lt; 0.001). In total, 38 of 51 hips (75%) had stable radiographs, while 13 of 51 hips (25%) progressed radiographically or proceeded to THA. The average HOOS JR score in patients at final follow-up was 87.5, indicating excellent hip function. Of the patients that went on to THA, all were preoperative Steinberg stage 2C and the preoperative Kerboul angle in this cohort was 241, compared with 163 in those hips that did not go on to THA (p &lt; 0.001). In preoperative hips that were Steinberg stage 2B or less, there was no advancement in the radiographic stage, whereas 67% of patients with preoperative stage 2C hips progressed (p &lt; 0.001). CD + BMAC significantly improves pain and helps prevent the progression of ON when performed on patients in whom ON is classified as Steinberg stage 2B or less or in whom the Kerboul angle is 180 or less. Level of evidence was level III.

Comparison of the effects of intravenous lignocaine and ketamine on postoperative pain after lower abdominal surgeries under general anaesthesia.

As a component of multimodal analgesia, the administration of systemic lignocaine and ketamine is a well-known technique. This study was designed to compare the effect of intravenous lignocaine and ketamine on postoperative pain in the patients undergoing lower abdominal surgeries under general anaesthesia. Total 126 patients, aged between18 to 60 years, American Society of Anesthesiologists (ASA) physical status I and II, were randomly allocated into lignocaine (Group L), ketamine (Group K), or control (Group C). We assessed the mean fentanyl consumption 24 hours postoperatively, visual analogue score (VAS), time to first rescue analgesia, haemodynamic parameters, postoperative complications patient satisfaction score, and duration of hospital stay among three groups. The mean fentanyl consumption in first 24 hours postoperatively was higher in group C (194.65 ± 48.48 μg) compared to group L (139.69 ± 46.96 μg) and group K (161.37 ± 46.31 μg) (P < 0.05). The VAS pain scores were lower in group L and group K compared to group C (P < 0.05). The time to first rescue analgesia was prolonged in group L and group K as compared to group C (P < 0.05). The patients were more satisfied in group L and group K as compared to group C (P < 0.05). The mean fentanyl consumption in 24 hours postoperatively and pain intensity were less with intraoperative lignocaine and ketamine infusion with improved patient satisfaction in patients undergoing lower abdominal surgery under general anaesthesia.

Full-Endoscopic Lumbar Foraminotomy for Foraminal Stenosis in Spondylolisthesis: Two-Year Follow-Up Results.

Full-endoscopic lumbar foraminotomy (FELF) under local anesthesia has been developed as a minimally invasive alternative for lumbar foraminal stenosis. Some authors have described this technique for treating various lumbar spondylolisthesis. However, few studies have reported the outcomes of FELF for foraminal stenosis in patients with stable spondylolisthesis. This study aimed to demonstrate the specific technique and clinical outcomes of FELF for foraminal stenosis in patients with spondylolisthesis. Twenty-three consecutive patients with foraminal stenosis and stable spondylolisthesis were treated with FELF. Among them, 21 patients were followed up for 2 years. Full-endoscopic foraminal decompression via the transforaminal approach was performed by a senior surgeon. Clinical outcomes were evaluated using the visual analog pain score (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. The VAS and ODI scores significantly improved at the two-year follow-up. The global effects were excellent in six patients (28.6%), good in 13 (61.9%), and fair in two (9.5%). Therefore, all patients showed clinical improvement, with a success (excellent/good) rate of 90.5%. No significant surgical complications or signs of further instability were observed. FELF can be used for foraminal stenosis in patients with stable spondylolisthesis. A specialized surgical technique is required for foraminal decompression of spondylolisthesis.