Visual Analogue Scale Score In Group Research Articles

Estimation and influence of blood loss under endoscope for percutaneous endoscopic lumbar discectomy (PELD): a clinical observational study combined with in vitro experiment

PurposeThe purpose of this study is to come up with new methods to quantitate the blood loss under endoscope and explore the influence of blood loss on percutaneous endoscopic lumbar discectomy (PELD).MethodsClinical research and in vitro experiment are combined. In the in vitro experiment, 2.0-ml blood was diluted in different ratio to simulate the rinse solution of PELD, the hematocrit method (HCT-M) and red blood cell count method (RBC-M) were came up to estimate blood loss and the new methods were calibrated with the direct measurement method (Direct-M). In clinical research, 74 patients with L5/S1 disk herniation were treated with PELD, and HCT-M and the empirical method (EMP-M) were used to estimate the blood loss under endoscope. According to blood loss, all patients were divided into group A (≤ 10 ml) and group B (> 10 ml). The blood loss, operation time, fluoroscopy frequency, visual analog scale (VAS), and Oswestry Disability Index (ODI) scores were compared between the two groups.ResultsIn the in vitro experiment, the hematocrit of the rinse solution was always stable over time. The estimated blood loss by HCT-M was stable and quite approximate to actual blood volume (2.0 ml) whatever the blood dilution ratio, while according to RBC-M, the estimated blood loss was close to the actual blood volume only when the dilution ratio was greater than 300 times. In clinical research, the blood loss estimated by HCT-M was higher than that by EMP-M in both groups (P < 0.05). There was a significant difference between group A and group B in blood loss (7.40 ± 1.61 vs 19.91 ± 10.94 ml), operation time (80.51 ± 34.70 vs 136.51 ± 41.88 min), and fluoroscopy frequency (6.92 ± 1.52 vs 11.11 ± 2.32 times) (P < 0.05). The VAS and ODI scores in group B were higher than that in group A 1 week after operation (P < 0.05); however, the scores were not different between the two groups at pre-operation (P > 0.05).ConclusionHCT-M is a reliable method to estimate endoscopic blood loss in PELD. The amount of endoscopic blood loss affects the operative procedure in operation time and fluoroscopy frequency, as well as clinical effects in VAS and ODI scores after operation in short term.

Clinical observation of herb-separated moxibustion combining western medication on allergic rhinitis of kidney-yang deficiency type and correlation with infrared thermal imagining

To observe the therapeutic effect of herb-separated moxibustion combined with budesonide nasal spray (rhinocort) on moderate to severe persistent allergic rhinitis (AR) of kidney-yang deficiency type, and to explore the correlation between nasal temperature and condition of allergic rhinitis. A total of 70 patients with moderate to severe persistent AR were randomized into an observation group (35 cases) and a control group (35 cases, 3 cases dropped off). Both groups were treated with rhinocort, one spray on each side of the nostril (approximately 64 μg each spray), once in the morning and once in the evening, for 4 weeks. On the basis of the above treatment, the observation group was treated with herb-separated moxibustion at Shenshu (BL 23), Feishu (BL 13), Zhiyang (GV 9), Dazhui (GV 14), 3 moxibustions per acupoint, a single treatment lasting about 30 min. This treatment was given once every other day, 3 times every week, and totally continuous 4 weeks. The changes of AR symptom visual analogue scale (VAS) scores were observed before and after treatment and at 3 months follow-up after treatment. The heat variation (temperature, range) on projection areas of the nose, lungs, large intestine and kidneys of the two groups' patients before and after treatment were detected by the infrared thermal imaging diagnostic system, and the correlation between the VAS scores and nasal temperature before and after treatment was analyzed. The clinical effects of both groups were evaluated according to the VAS score. The total effective rate in the observation group after treatment was 85.7% (30/35), which was higher than 71.9% in the control group (23/32, P<0.05). After treatment and at follow-up, the VAS scores of both groups were lower than those before treatment (P<0.05), and the VAS score of the observation group was lower than that of the control group at follow-up (P<0.05). After treatment, the nasal temperature, pulmonary range, large intestinal range and renal range of the observation group were all lower than those before treatment (P<0.05), the nasal temperature and nasal range of the control group were lower than before treatment (P<0.05), and the reduction of nasal temperature, nasal range and renal range in the observation group was greater than that of the control group (P<0.05). Before and after treatment, there was a correlation between VAS score and nasal temperature (P<0.05). The herb-separated moxibustion combining western medication has a better effect and long-term effect than western medication alone for moderate to severe persistent AR, which can improve heat variation on projected areas of the nose, lung, large intestine and kidney of patients. In addition, nasal temperature can reflect the severity of the symptoms of patients with moderate to severe persistent AR, or it can be used as a secondary indicator to evaluate condition of AR.

Effect Of Respiratory Training On Vas Pain Rating And Via Thickness In Patients Withrating And Via Thickness In Patients With Chronic Non-specific Lumber Pain

PURPOSE: Non-specific low back pain(NLBP) is defined as a lumber pain that does not belong to an identifiable specific pathology. The probability of experiencing lumber pain in one's lifetime is as high as 84 %. According to the most accurate estimate, the prevalence of NLBP is 23 %, and 11 % of them have disabilities as a result. Compared with conventional physical therapy methods, core strength training can effectively relieve patients 'pain. Due to the overlap of the core muscle group and respiratory muscle in the anatomical structure, there is also a certain relationship in its function. But it is easy to ignore the training of respiratory muscle during the core force training. Therefore, this study compared the effect between respiratory training combined with core strength training and single core strength training in patients with NLBP, in order to confirm the effect of respiratory training on NLBP. METHODS: 26 patients with NLBP were equitably distributed into observation group and control group according to random number table method. All the patients were taken in 3*40min exercise intervention for 8 weeks. The observation group adopted breath training combined with core strength training, while the control group only conducted core strength training. The VAS score measured with pain visual analog scale (VAS) and the thickness of transverse abdominis of patients were determined with Bone Ultrasound Instrumentbefore and after the intervention. RESULTS: The difference of VAS scores (4.40±1.30 vs. 4.45±1.29,P=0.92)and thickness of transverse abdominis (0.35±0.03 vs.0.37±0.03,P=0.12)between groups were not obvious before intervention. But VAS score in observation group was significantly lower than that in the control group (3.20±1.15 vs. 4.18±1.17,P<0.05), and the thickness in myalgia side of transverse abdominis was significantly higher than that in the control group (0.42±0.03 vs. 0.39±0.01,P=0.00) after intervention. CONCLUSIONS: The effect of respiratory training combined with core strength training on patients with NLBP is significantly better than that of the single core strength training, suggesting that respiratory training plays an important role in the treatment of NLBP.

Clinical Efficacy of Ultrasound-Mediated Transdermal Lidocaine and Capsaicin Delivery for the Treatment of Allodynia Caused by Herpes Zoster.

To investigate the efficacy of ultrasound-mediated drug delivery for allodynia caused by herpes zoster. Unblinded randomized controlled study with two treatment groups and an additional control group. Patients hospitalized with allodynia caused by herpes zoster were enrolled. Patients were randomly assigned to three groups: ultrasound-mediated transdermal drug delivery (group U), lidocaine intradermal injection (group I), or control group (group C). The primary outcome was pain intensity associated with allodynia, assessed with the visual analog scale (VAS) while brushing the skin with clothing after treatment stimulated allodynia. The secondary outcomes included an emotional functioning score (ES), average gabapentin consumption, and incidence of adverse events of each group. Sixty patients were enrolled in the study, but two of them failed to complete the treatment process. Therefore, 58 patients were included in the final analysis. All groups had lower VAS and ES scores after treatment compared with baseline. The VAS scores in groups U and I decreased significantly more than in group C (P < 0.05). Mean VAS scores in group U on days 1, 2, and 3 were lower than in group C (P < 0.01). ES was significantly lower in group U compared with groups I and C after treatment (P < 0.001). Average gabapentin consumption and incidence of adverse events in group C were higher than in the other two groups. In this study of treatment of allodynia caused by herpetic zoster, ultrasound-mediated lidocaine and capsaicin delivery provided better pain relief and improved emotional functioning compared with intradermal blockade with local anesthetics.

Application of dexmedetomidine-assisted intravertebral anesthesia in hip replacement and its influence on T-lymphocyte subsets.

Application of dexmedetomidine-assisted intravertebral anesthesia for elderly patients with hip replacement and its influences on T-lymphocyte subsets in peripheral blood were assessed. Eighty-six patients undergoing intravertebral anesthesia in hip replacement were treated as group A, and one hundred patients undergoing intravertebral anesthesia combined with dexmedetomidine were treated as group B. Hemodynamic changes in both groups were compared 5 min before anesthesia (T0), immediately after skin incision (T1) and after surgery (T2). General operation conditions of patients in both groups were recorded. T-lymphocyte subsets, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), visual analogue scale (VAS) pain scores and mini-mental state examination (MMSE) cognitive function changes before surgery and 24 h after surgery were compared between the groups, and the incidence of complications in both groups after 24 h was recorded. The recovery time of patients in group B was shorter than that of group A (P<0.05). Changes of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate fluctuations in group B were lower than those in group A (P<0.05). At 24 h after surgery, VAS scores of group B were lower than those of group A (P<0.05); levels of IL-6 and TNF-α were lower than those of group A (P<0.05); CD3+ cells, CD4+ cells, CD8+ cells, and CD4/CD8 ratio were higher than those of group A (P<0.05), and MMSE score was higher than that of group A (P<0.05). The incidence of gastrointestinal reactions and postoperative cognitive dysfunction (POCD) in group B was lower than that in group A (P<0.05). In conclusion, administration of dexmedetomidine can effectively shorten the recovery time of patients, stabilize intraoperative hemodynamics of patients, protect immune function, and reduce postoperative pain and POCD occurrence during anesthesia of hip replacement.

Therapeutic effect of heat-sensitive moxibustion plus medications for senile osteoporosis and its effect on serum BMP-2 and OPG levels

To observe the clinical efficacy of heat-sensitive moxibustion plus medications on senile osteoporosis (SOP), and to explore the related mechanisms. A total of 70 elderly participants with osteoporosis were randomly divided into an observation group and control group, with 35 cases in each group. The control group was treated with conventional drugs, and the observation group was treated with heat-sensitive moxibustion on the basis of the conventional drugs. Both groups were treated for 3 months. Before and after treatment, assessed the visual analog scale (VAS) and Oswestry disability index (ODI) scores, determined the bone mineral density of the participants’ lumbar spine (L2-L4) and left femoral neck, and detected the participants’ serum bone morphogenetic protein-2 (BMP-2) and osteoprotegerin (OPG) levels. After treatment, the VAS scores of both groups were lower than before treatment (both P<0.05), and the VAS score of the observation group was significantly lower than that of the control group (P<0.05). After treatment, the bone mineral density values of the lumbar spine and left femoral neck in both groups were significantly higher than before treatment (both P<0.05), and the bone mineral density values of the observation group were higher than those of the control group (P<0.05). After treatment, the ODI scores of the two groups were lower than those before treatment (both P<0.05), and the ODI score of the observation group was lower than that of the control group (P<0.05). After treatment, the serum BMP-2 and OPG levels in the observation group were significantly higher than those in the control group (both P<0.05). Heat-sensitive moxibustion plus medications for SOP can significantly relieve patients’ pain, improve dysfunction, and increase bone density, which may be related to the improvement of the serum BMP-2 and OPG levels.

Investigation of a New Catheter on Relieving Pain During Male Cystoscopy - A Randomized Clinical Trial.

To investigate the pain intensity and tolerability of a new catheter applied to urethral surface anesthesia during rigid cystoscopy in male patients, and explore the prospects of its application and the anesthetic method in hospitals at primary levels. 252 adult male patients were randomly divided into the experimental group and the control group.1% lidocaine solution was irrigated into the posterior urethra of the experimental group using the new catheter before cystoscopy, while the control group was administered with lidocaine gel. Both groups were assessed by visual analogue scale(VAS) with their pain perceived during administration of lidocaine (control group) /during insertion of catheter and administration of lidocaine (experimental group) (T1),during the insertion of cystoscope (T2),at the beginning of cystoscopy (T3),The third minute of cystoscopy (T4), during the first urination after the procedure (T5), as well with the maximum pain(Pmax) perceived during the whole procedure. The fluctuations of blood pressure and heart rate in each group before, after and during the procedure were recorded, and the anesthesia costs in both groups were calculated. Except a slightly higher score in T1, the scores of VAS in experimental group were lower than those of control group in T2,T3 and T4. The Pmax of the control group was 4.92(SD=1.20), which was higher than in the experimental group of 3.89(SD=0.95,P<0.01).There was no significant difference onblood pressure variation in both groups. While heart rate variation in experimental group was lower than that in control group (16.3%,SD=3.4 vs. 22.6%,SD=5.0, P<0.01).No obvious complications were found in both groups. The anesthesia cost of the experimental group is about 1.53 dollars, with 1.75 dollars lower than that of the control group. It is tolerable and beneficial to apply the new catheter for male urethral anesthesia. It can significantly relieve the pain during rigid cystoscopy in male patients, and is low in cost and easy in operation. Thus this method is worth being recommended to hospitals, especially at communityhospitals or primary hospitals.

Minimally versus conventional-invasive transforaminal lumbar interbody fusion in patients with failed back surgery syndrome.

Failed back surgery syndrome is an important cause of back and leg pain after spinal surgery. Transforaminal lumbar interbody fusion (TLIF) is commonly used in revision surgery for failed back surgery syndrome. In the literature, there is a lack of evidence concerning the minimally and conventional-invasive TLIF and debates are ongoing. The purpose of the present study was to compare efficacy and safety of minimally versus conventional-invasive TLIF for failed back surgery syndrome. This study was conducted according to the STROBE Statement. Between 2011 and 2014, thirty patients with failed back surgery syndrome underwent TLIF. Group I (15 patients) received minimally invasive TLIF through paramedian approach using microscopy and fluoroscopy. Group II (15 patients) received conventional-invasive TLIF. Minimum follow-up was 12months. There was a significant improvement of Oswestry Disability Index (ODI) and visual analogue scale (VAS) in both groups postoperatively. There was no statistically significant difference between both groups regarding ODI, VAS, leg and back pain pre- and postoperatively. There was a tendency to better postoperative ODI and VAS scores in group I; however this did not reach the statistical significance. One case showed adjacent segment degeneration in group I. In group II, one case had screw mal-positioning with foot drop. Another case had dural injury with postoperative fistula. TLIF is a valuable option after failed back surgery syndrome providing statistically significant improvement postoperatively. Both minimally and conventional-invasive TLIF represent a safe and reliable treatment of patients with failed back syndrome, achieving satisfactory outcome along with low rate of complications. Although the minimally invasive TLIF scored better, these differences did not reach the threshold of significance.

Efficacy of lidocaine 7 %, tetracaine 7 % self-occlusive cream in reducing MAL-cPDT-associated pain in subjects with actinic keratosis: A randomized, single-blind, vehicle-controlled trial (The "3P-Trial").

Conventional photodynamic therapy (cPDT) is considered a very effective treatment of actinic keratosis (AK) lesions. However, its use is limited by the fact that this procedure could be very painful. The use of topical anesthetics such as tetracaine or lignocaine/prilocaine has shown disappointing results in term of pain reduction. A self-occlusive topical 7% lidocaine/7% tetracaine anesthetic cream (LT-C) approved by the FDA to provide local topical anesthesia in adults undergoing superficial dermatological procedures is available. There are no data regarding its pain reducing effect during cPDT. We perform a prospective, randomized, single-blind, two-center trial (The 3P-Trial) to assess the pain reduction effect of LT-C versus vehicle in subjects with AK undergoing cPDT. Fifty AK subjects (74 ± 10 years, 32 men, 18 women) with on average 17 lesions were enrolled after their written informed consent. Eight subjects presented also a total of 16 basal cell carcinoma lesions. Twenty-five were randomized to LT-cream, applied 1 h before the Methyl amino levulinate (MAL)-cPDT session and 25 to cream vehicle. The main outcome was the patient-assessed evaluation of pain score during and just after the conclusion of cPDT session (mean of the two values) using a 10-point visual analog scale (VAS). The cPDT session (LED Red light 630 nm) was performed with a duration of 6 ± 2 min with a standard fluence of 37 J/cm2. All treated lesions were prepared by gentle superficial curettage. All the randomized subjects concluded the trial. The mean ± SD of VAS score in vehicle group was 6.2 ± 2.7 (95 % CI of the mean: 5.0-7.5). In the group treated with LT-cream the VAS score was 3.3 ± 1.9 (95 % CI of the mean: 2.5-4.1). The active cream reduced the VAS score by 47 %. Median values of pain VAS score in the active group was reduced by 60 % in comparison with vehicle group (3.0 vs 7.5). The difference between the two groups was statistically significant (p = 0.0009; Mann-Whitney test). The 3P-trial has demonstrated that the preventive application of the self-occlusive lidocaine 7%-tetracaine 7% cream is very effective in reducing the procedure-associated pain during MAL-cPDT for the treatment of AK lesions.

Effectiveness of tumescent solution combined with negative pressure wound therapy in traditional high ligation and stripping of the great saphenous vein.

Traditional high ligation and stripping (THLS) is a routine operation for varicose veins. However, THLS is accompanied with postoperative subcutaneous ecchymosis and pain. In this current study, we aimed to explore the effect of tumescence solution (TS) combined with negative pressure wound therapy (NPWT) on the relief of subcutaneous ecchymosis and pain after THLS of great saphenous vein.A total of 180 patients receiving THLS were enrolled in group A, and 120 patients undergoing THLS and TS combined with NPWT were assigned into group B. The occurrences of subcutaneous ecchymosis and pain were recorded. Moreover, the total area of subcutaneous ecchymosis was estimated by the grid method. Visual analogue scale (VAS) score was used to assess the pain level of both groups.Preoperative characteristics were not significantly different between 2 groups. Postoperative ecchymosis occurred in 112 cases (62.2%) of group A and 41 cases (34.2%) of group B. The area of ecchymosis in group A (66.6 ± 44.5) cm2 was larger than that in group B (25.2 ± 19.9) cm2. The number of patients without obvious pain in group A (57, 31.7%) was significantly less than that in group B (77, 64.2%) after operation. In addition, VAS score in group A (3.1 ± 2.6) was higher than that in group B (2.2 ± 1.9).In conclusion, the application of TS combined with NPWT in THLS can not only alleviate subcutaneous ecchymosis and pain, but also prevent the occurrence of subcutaneous ecchymosis and pain after operation. Therefore, it is conducive to postoperative recovery and is suitable for clinical application.

Intramuscular Clodronate in Long-Term Treatment of Symptomatic Knee Osteoarthritis: A Randomized Controlled Study.

Background and ObjectiveClodronate is a nitrogen-free bisphosphonate that is widely and effectively used in the treatment of many osteo-metabolic disorders. The objective of our study was to evaluate the effectiveness of clodronate in reducing pain and bone marrow edema in knee osteoarthritis.MethodsIn total, 74 patients were included in the study. Group 1 received intramuscular clodronate 200 mg daily for 15 days and then once weekly for the next 11.5 months; group 2 received intramuscular clodronate 200 mg daily for 15 days and then once weekly for the next 2.5 months. Visual analog scale (VAS) scores were recorded at baseline (T0) and after 30 days (T1), 3 months (T2), 6 months (T3), 9 months (T4), and 12 months (end of study; T5). We also evaluated functional status and use of paracetamol (T0, T1, T2, T3, T4, and T5) and changes in Whole Organ Magnetic Resonance Imaging Score (WORMS; T0, T2, and T5).ResultsBoth groups had a statistically significant reduction in VAS score until 3 months. Group 1 then experienced further VAS reductions, whereas VAS scores for group 2 progressively increased. Pain, stiffness, and physical function also showed the same trend, as did bone marrow edema extension, which was evaluated with WORMS.ConclusionOur study indicates that intramuscular administration of a therapeutic dose of clodronate followed by a maintenance dose is effective in the management of symptomatic knee osteoarthritis, improving functional outcomes and reducing pain and bone marrow edema. Prolonged treatment increases the long-term efficacy of clodronate compared with the shorter schedule.

Effect of Different Musical Types on Patient's Relaxation, Anxiety and Pain Perception during Shock Wave Lithotripsy: A Randomized Controlled Study.

The aim of this study was to investigate the effects of listening to different music types during extracorporeal shock wave lithotripsy (SWL) on the patients' pain control, anxiety level, and satisfaction. This study was a prospective single-blinded, paral-lel-group randomized clinical trial with balanced ran-domization [1:1]. A total of 150 patients who underwent first-session SWL were included in the study. The patients were randomly divided in to five groups (30 participants in each group) as follows: headphones were not put on and no music was played in Group 1 (control group); headphones were put on but no music was played in Group 2; Turkish art music was listened to with headphones in Group 3; Western classical music was listened to with headphones in Group 4; thetype of music the patient liked was listened to with headphones in Group 5. Demographic data related to patients and procedure, State-Trait Anxiety Inventory-State Anxiety (STAI-SA), Visual Analog Scale (VAS) scores, willingness to repeat procedure (0: never 4: happily), and patient satisfaction rates (0: poor 4: excellent) were recorded immediately after the procedure. There was a statistically significant difference between groups in terms of median VAS scores (7, 6, 4.5, 5, and 4, respectively, P<.001), whereas the VAS scores in Groups 3, 4, and 5 were significantly lower than those in Group 1 and 2 (P<.001). The median STAI-SA scores between the groups were significantly different (45, 45, 42, 45, and 40, respectively, P<.001), while the anxiety levels in Groups 3, 4, and 5 were significantly lower than those in Group 1 (P=.008, P=.018, and P<.001, respectively). Moreover, there were statistically significant differences between the groups in terms of willingness to repeat the procedure and patient satisfaction rates (P<.001). Music therapy during SWL reduced the patients' pain and anxiety scores, moreover listening to the patient's preferred music type provided greater satisfaction. Listening to the patient's preferred music type could be standardized and routinely used during SWL.

The role of preoperative oral pregabalin on acute post?operative pain after orthopedic lower limb surgery

Introduction: Postoperative pain after orthopedic surgery has remained a challenging problem, which prolongs hospital stay and early rehabilitation. Pregabalin comes under class of gabapentinoids that have been used in postoperative pain in arthroplasty and spine surgeries but studies regarding its role as preemptive analgesia in orthopedic limb surgeries are very few. Aim: To study the efficacy and safety of pregabalin as preemptive medication for acute postoperative pain management in patients undergoing orthopedic lower limb fracture surgeries. Materials and Methods: A randomized double blinded prospective study was undertaken. Sixty patients were enrolled with age between 18–70 years and were divided into 2 groups. Group A ­ received 150mg of oral pregabalin capsule, Group B – received matched colour empty capsules. Standard spinal anaesthesia was given. Breakthrough analgesia was given with Inj. Diclofenac 1.5 mg/kg i/m. Assessment of pain was done with visual analog scale (VAS). Results: There was marked reduction in postoperative VAS score in group A and the amount of breakthrough analgesia needed in the 24-hour postoperative period was also much lower in the Group A as compared to the Group B. Conclusion: 150mg of oral pregabalin as preemptive medication offers satisfactory postoperative analgesia in orthopaedic lower limb fracture surgeries with very few undesirable side effects. Keywords: Postoperative pain, Pregabalin, Gabapentinoids, Preemptive analgesia, Diclofenac, Visual analog scale.

Platelet-rich plasma and acute Achilles tendon rupture

Objective To study the clinical efficacy of platelet-rich plasma (PRP) in the treatment of acute Achilles tendon rupture. Methods A retrospective study was performed of the 21 patients who had been treated for acute Achilles tendon rupture at Department of Orthopaedics, The First Affiliated Hospital to Soochow University from January 2018 to January 2019. Of them, 15 were treated by modified Kessler suture combined with PRP injection (PRP group) and 6 by simple modified Kessler suture (control group). The 2 groups were compared in terms of plantar flexion, dorsal expansion, visual analogue scale (VAS), Victorian Institute of Sport Assessment (VISA), and ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) at 3, 6, and 9 months postoperation. Results The 2 groups were comparable due to insignificant differences between them in the preoperative general data (P>0.05). All patients were followed up for 9 to 12 months (mean, 11.3 months). At 3, 6, and 9 months postoperation, the degrees of plantar flexion (33.5°±1.8°, 38.1°±1.2° and 41.6°±1.6°) and dorsal expansion (10.3°, 16.5° and 21.5°) in the PRP group were all significantly larger than those in the control group (26.9°±2.0°, 31.5°±1.6° and 35.6°±1.4°; 5.3°, 12.7°±0.6° and 18.2°), and the VISA scores (41.2±6.5, 78.7±10.4 and 91.0±4.1) and the AOFAS scores (75.5±5.4, 88.6±5.2 and 95.2±3.5) in the PRP group were all significantly higher than those in the control group (29.8±2.5, 68.0±3.5 and 84.5±2.1; 66.8±4.8, 82.8±3.6 and 90.7±1.1) (all P<0.05). At 3 and 6 months postoperation, the VAS scores in the PRP group (1.7±0.9 and 1.3±0.4) were significantly lower than those in the control group (3.0±0.8 and 2.2±0.7) (all P<0.05). Conclusion As PRP can release a high concentration of growth factors to promote recovery of Achilles tendon rupture and accelerate recovery of foot and ankle function, it can be considered a safe, practical and reliable treatment to use modified Kessler suture plus PRP injection. Key words: Achilles tendon; Platelet-rich plasma; Wounds and injuries; Function recovery

Sarcopenia and Back Muscle Degeneration as Risk Factors for Back Pain: A Comparative Study.

Study DesignCase-control study.PurposeTo investigate the independent associations of back pain with sarcopenia and with back muscle degeneration, and to introduce a new risk index for back muscle degeneration.Overview of LiteratureThe Asian Working Group for Sarcopenia recommends diagnosis using handgrip strength, gait speed, and skeletal muscle mass. However, these criteria do not strongly reflect back muscle degeneration.MethodsPatients who completed a questionnaire on back-pain between October 2016 and October 2017 were enrolled in this study. Appendicular skeletal muscle index (ASMI), cross-sectional area (CSA) index, fatty infiltration (FI) rate of the paraspinal muscles, and lumbar extensor strength index (LESI) were measured and compared between no back-pain and back-pain group. Correlations between LESI and ASMI, CSA index, and FI rate were analyzed. The back-pain group was further divided according to ASMI into sarcopenia and non-sarcopenia subgroups and by our newly developed back muscle degeneration risk index based on correlation coefficients between LESI and CSA index, FI rate. Differences in ASMI, CSA index, FI rate, LESI, and Visual Analog Scale (VAS) score between subgroups were analyzed.ResultsThe ASMI, CSA index, FI rate, and LESI differed significantly between back-pain and pain-free groups. The LESI demonstrated the strongest correlation with FI rate. There were no significant differences in VAS score and back muscle degeneration index in the back-pain group when divided according to the presence of sarcopenia. However, there was a significant difference in VAS score between back-pain patients when classified according to high and low back muscle degeneration risk index.ConclusionsWe suggest that the degree of back pain is more strongly associated with back muscle degeneration than with sarcopenia. This back muscle degeneration risk index, reflecting both back muscle morphology and function, could be a useful parameter for evaluation of back pain and muscle degeneration.

Comparison of extraoral and intraoral routes of glossopharyngeal nerve block for pain relief in patient with carcinoma tongue: A prospective randomized study.

Glossopharyngeal nerve block (GNB) technique has been used as alternative of treatment of cancer and noncancer pain of the oral cavity. The objective of the study is to compare the two approaches (extraoral and intraoral) of GNB in patients of carcinoma of the tongue in terms of efficacy, duration, and complications. This was a prospective comparative randomized study over a period of 1 year. Fifty patients of either sex of ASA physical status and 2, between 21 and 70 years of age, suffering from carcinoma of the tongue, were selected. The patients were randomly divided into two groups. Group I received 4 mL of 0.5% bupivacaine combined with 40 mg, of triamcinolonacetonide by extraoral approach of GNB, and Group II received the same amount of drug by intraoral approach of GNB. Hemodynamic parameters, degree of pain relief using visual analog scale (VAS), number of attempts, effect on quality of life (QOL), and complication were noted during the performance of GNB. Demographic profile in both groups was comparable. Rate of complication and number of attempts to complete intervention were higher in Group I, which was found to be statistically significant. However, mean VAS scores in Group I were significantly higher as compared to those in Group II during most of the study period starting from the 1st follow-up at 30 min to the 2nd month postintervention (P < 0.05). No statistically significant difference in mean QOL scores of two groups was observed for the entire study period except at 1 week when mean scores in Group I were higher as compared to those in Group II (P = 0.011). The intraoral approach of GNB was better with respect to pain control and improvement in QOL whereas the rate of complication and number of attempts was lower in extraoral approach of GNB.

Comparison of postoperative analgesic effect of transversus abdominis plane block versus direct wound infiltration with local anesthetic for lower segment cesarean section

Background: Various drugs and regional blocks are available for providing suitable postoperative analgesia after lower segment cesarean section (LSCS), however commonly used techniques are conventional wound infiltration with local anesthetic and the current technique of transversus abdominis plane (TAP) block. This study aims to compare the analgesic efficacy of TAP block with that of direct infiltration of local anesthetic into a surgical incision in LSCS patients. Materials and Methods: A total of 80 patients for LSCS under subarachnoid block were allocated in two groups; Group A (TAP block, n = 40). TAP block was done by the Anesthesiologist and Group B (wound site infiltration, n = 40); wound site infiltration was done by the operating Surgeon. Postoperative pain, assessed by the Visual Analog Scale (VAS) levels at 2, 6, 12, and 24th h, the requirement of rescue analgesia and patient satisfaction was analyzed. Results: The VAS scores were lower at the 2nd and 4th h (statistically significant) of the postoperative period but at 6th, 12th, and 24th h, though VAS scores in Group A were lower in comparison to Group B, differences were statistically insignificant. The time to administer the first dose of rescue analgesia (421 ± 118.8 min) was longer in Group A in comparison to Group B (187 ± 148.3 min) with significantly fewer cumulative dose and delayed requirement of rescue analgesia in the first 24 h. Conclusions: Wound site infiltration and TAP block did not significantly differ regarding postoperative pain score in post-LSCS patients except the initial 4 h, but the TAP block showed an advantage with significantly reduced cumulative dose and delayed requirement of rescue analgesia in first 24 h.

Comparison of simple discectomy and uninstrumented lumbar interbody fusion in patients with lumbar disc herniation

Aim: This study aimed to compare the surgical outcomes of simple discectomy (SD) and uninstrumented posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) in patients with lumbar disc herniation (LDH). Materials and Methods: The files of randomly selected 100 patients with LDH, who underwent SD, were analyzed. The patients were divided into two groups as Group 1 involving 50 patients undergoing SD alone and Group 2 involving 50 patients undergoing SD plus unilateral PLIF and TLIF without posterior lumbar instrumentation. The pain was measured by the visual analog scale (VAS) and the functionality of the patients was measured by the Oswestry disability index (ODI).Results: In both groups, leg and low back pain VAS scores and ODI scores improved significantly one year after surgery (p0.001). There was a significant increase in the VAS scores of Group 2 in the first month compared to Group 1 (p0.05). Conclusion: This study has shown that PLIF and TLIF performed following unilateral SD without posterior lumbar instrumentation support in single-distance LDH treatment will not be sufficient.

Assessment of the Need for Routine Distolingual Local Anesthetic Infiltration in Addition to Traditional Inferior Alveolar, Lingual and Long Buccal Nerve Blocks in Mandibular Third Molar Extractions.

Background and Objectives:Persistent pain during the removal of mandibular third molars is often due to accessory nerve supply causing inadequate local anesthesia. This study aims to assess the requirement of routine distolingual infiltration anesthesia in addition to traditional inferior alveolar, lingual, and long buccal nerve block in mandibular third molar extractions.Methodology:Sixty patients requiring mandibular third molar extraction were randomly divided into two equal groups; Group A (Classic inferior alveolar, lingual, and buccal nerve block) and Group B (with an additional 0.2 ml distolingual infiltration). During various steps of the procedure, any complaint of pain was recorded and graded on a subjective Visual Analog Scale (VAS).Results:There was no significant difference between the two groups in regard to age (P = 0.666) and sex (P = 0.432). And also, no difference was found in angulation (P = 0.757), class (P = 0.417) and position (P = 1.000) of third molars. Mean VAS scores in Group B (0.153) were significantly lower (P = 0.004) than that of Group A (0.600). VAS scores during procedural steps were significantly lower in Group B during mucoperiosteal elevation (P = 0.050), bone guttering (P = 0.037), and tooth splitting (P = 0.052).Conclusion:Routine distolingual infiltration anesthesia, in addition to classic inferior alveolar, lingual, and long buccal nerve block, is recommended for the extraction of mandibular third molars.

Safety and efficacy of 5.3 mm intervertebral endoscopy in minimally invasive technique for lumbar disc herniation

Objective To study the application value of nerve root decompression through posterior approach in minimally invasive surgery of lumbar disc herniation (LDH). Methods From June 2016 to June 2018, 80 patients with unilateral single segment LDH were selected and diagnosed in Yunnan Puer People′s Hospital.The patients were divided into control group and observation group according to the random number table method, 40 cases in each group.The control group was treated with posterior fenestration and nucleus pulposus extraction, and the observation group was treated with posterior neurolysis and decompression through 5.3 mm intervertebral foramen.The incision length, operation time, intraoperative blood loss and postoperative hospital stay were compared between the two groups.The visual analog scale (VAS) of pain before operation and 1, 2, 7 days after operation was compared.The Japanese Orthopedic Association (JOA) score and the Oswestry disability index (ODI) questionnaire score before operation and 1, 3, 12 months after operation were compared.The effect of lumbar function recovery 12 months after operation was compared. Results The incision length, operation time, days in-hospital after operation, and bleeding amount in observation group were (0.9±0.2) cm, (50.8±8.6) min, (16.5±5.9) ml, (4.3±0.5)d, and in control group were (4.6±0.8) cm, (72.3±15.2) min, (52.5±10.3) ml, (7.2±0.9)d.The differences between the two groups were statistically significant (t=8.625, 14.623, 32.625, 6.524, all P<0.001). The VAS scores of the observation group and the control group were (5.7±1.1), (3.3±0.6), (1.2±0.3), (0.5±0.1) and (5.5±1.2), (4.2±0.8), (1.9±0.4), (1.1±0.3) before and 1, 3 and 7 days after the operation, respectively.The differences 1, 3, 7 days after operation between the observation group and the control group were statistically significant (all P<0.05). The JOA scores of the observation group were (8.1±1.6), (19.3±4.2), (23.2±4.9), (25.8±5.2) before and 1, 3 and 12 months after operation, respectively, and those of the control group were (8.3±1.5), (15.2±3.3), (19.3±4.2), (20.6±5.5) after operation.The differences 1, 3, 12 months after operation between the observation group and the control group were statistically significant (all P<0.05). The ODI scores of the observation group were (43.7±10.6), (18.3±5.2), (10.2±3.9), (1.8±0.5) before and 1, 3 and 12 months after the operation, respectively, and those of the control group were (42.5±9.4), (25.2±5.3), (14.3±4.2), (4.6±0.9) after the operation.The differences 1, 3, 12 months after operation between the observation group and the control group were statistically significant (all P<0.05). The effective rate of the observation group was significantly higher than that of the control group (92.5%(30/40) vs.75.0%(37/40), χ2=4.501, all P=0.034). Conclusion It can bring less trauma and faster recovery with 5.3mm intervertebral endoscopy by posterior approach of nerve root decompression for LDH patients, which is better safety and efficacy. Key words: Intervertebral endoscopy; Nerve root decompression; Lumbar disc herniation; Lumbar function