Visual Analog Pain Scores Scores Research Articles

Retrospective analysis of modified Karlsson surgery for chronic calcaneofibular ligament injury

Objective: To retrospectively evaluate the therapeutic effect and influencing factors of the modified Karlsson operation (anchor method) in treating chronic rupture of the calcaneofibular ligament (CFL). Methods: From August 2010 to May 2014, the data of 24 patients with calcaneofibular ligament rupture treated in Institute of Sports Medicine, Third Hospital of Peking University were retrospectively analyzed. All cases were repaired with modified Karlsson operation (anchor method). There were 14 males and 10 females, with an average age of (30±9) years, and the average body mass index (BMI) was (25±5) kg/m(2). Visual analogue pain score (VAS), American Foot and Ankle Surgery Association score (AOFAS), Tegner knee motion score, ankle stability and mobility were followed up and analyzed. The paired t test was used to compare the normal distribution data before and after the operation. Results: The average follow-up time was (41±13) months. Compared with pre-operation, VAS score decreased significantly at the last follow-up [0(0,7) vs 5(0,8), Z=4.13,P=0.000], AOFAS score increased significantly (94±10 vs 70±14, t=8.94, P<0.05), Tegner score increased significantly (4.7±1.5 vs 2.8±1.3, t=6.87, P<0.05), all improved significantly. AOFAS score was excellent in 19 cases, good in 4 cases and moderate in 1 case, the excellent and good rate was 95.8%. Among them, 20 cases (83.3%) were satisfied with the recovery effect after the operation. Postoperative sprain occurred in 5 cases (20.8%) and ankle mobility was limited in 3 cases (12.5%). Conclusions: The modified Karlsson operation (anchor method) can restore the stability of the ankle joint by treating the chronic rupture of CFL. It is an effective therapy for lateral ankle instability.

Parturient on Magnesium Infusion and Its Effectiveness as an Adjuvant Analgesic after Cesarean Delivery: A Retrospective Analysis.

Background Perioperative use of intravenous magnesium as part of multimodal analgesia has been increasing in recent years in an effort to decrease the use of opioids. The aim of this study was to evaluate the effectiveness of magnesium sulfate infusion in lowering analgesic requirement and decreasing the intensity of pain score after cesarean delivery. Methods Sixty-four patients who underwent cesarean delivery under spinal anesthesia were included in this medical record review: 32 patients received magnesium infusion after cesarean delivery for treatment of mild preeclampsia (Mg group); 32 patients received routine post-cesarean delivery care (control group). Primary outcome was total analgesic consumption and secondary was visual analogue scores (VAS) of pain in each group during the first 24 hours following delivery. These measures were compared using Student's t-tests and Mann-Whitney U-tests. Results Our study found that patients in the Mg group had significantly less requirement for analgesia than the control group. In the 24 h after cesarean delivery, the Mg group received significantly less intravenous ketorolac (the standard initial rescue analgesic agent) when compared to the control group (79 ± 23 mg vs. 90 ± 0 mg; P = 0.008). The Mg group also received significantly less intravenous morphine equivalents than the control group (median 5.0 (IRQ: 0.0 – 10.0) vs. 9.3 (IRQ: 6.0 – 21.1); P = 0.001) during the first 24 h after cesarean delivery. The Mg group also had significantly lower VAS pain scores than the control group (median 1.75 (IRQ: 0.4 – 2.6) vs. median 3.2 (IRQ: 2.3 – 4.5); P < 0.001). Conclusions Our results suggest that magnesium sulfate infusion decreases total analgesic requirements and lowers VAS pain scores during the first 24 h after cesarean delivery.

Preoperative Mental Health Score and Postoperative Outcome After Hallux Valgus Surgery.

Preoperative mental health status as a predictor of operative outcome has been a growing area of interest. In this paper, the correlation between preoperative mental health status and postoperative functional outcome following scarf osteotomy for hallux valgus correction was explored. Parameters were tabulated preoperatively and postoperatively at a minimum of 1-year follow-up. They included the Short Form 36 (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) measurements and the visual analog score (VAS) to quantify pain. SF-36 mental component summary (MCS) score was used as a surrogate for patient's mental health status. Seventy-six consecutive cases were analyzed at a minimum of 1-year follow-up. There were significant improvements in all 8 domains of the SF-36, with the mean MCS score increasing from 52.3 ± 7.6 preoperatively to 55.7 ± 6.8 postoperatively. Preoperative MCS scores were not correlated to changes in AOFAS score, PCS score, VAS pain score, HVA or IMA. Preoperative MCS was observed to be correlated to postoperative AOFAS ( r = 0.381, P = .001) and PCS score ( r = 0.315, P = .006). Patients with a preoperative MCS score ⩾50 had a statistically higher postoperative AOFAS and PCS score than patients with MCS score <50. There was no correlation between preoperative MCS scores and improvements in radiologic parameters. There was also no correlation between the improvements in radiologic parameters and improvements in both the AOFAS and VAS pain scores. Preoperative mental health (as measured by the MCS score) was only correlated to postoperative functional outcome (as measured by the postoperative AOFAS and PCS score), but not other postoperative outcomes (VAS pain score, radiologic parameters). Level III, comparative study.

Minimally invasive surgery for the severe degenerative lumbar scoliosis: two stage protocol

Objective: To investigate the surgical outcome of minimally invasive surgery(MIS) for severe degenerative lumbar scoliosis(DLS) and put forward a two-stage MIS surgical strategy. Methods: Prospective study of MISDEF Ⅲ DLS patients from June 2016 to August 2017 in the Second Affiliated Hospital of Zhejiang University was carried out, excluding the patients whose apex vertebrae of scoliosis was above L(1/2) level or whose facet joint got spontaneous fusion. Fifty-three patients were included in this study for staging evaluation and MIS surgical treatment. Information was recorded, including gender, age, body mass index, follow-up period, pelvic incidence (PI), blood loss, operation time, visual analogue pain score (VAS), Oswestry disability index (ODI), complications in the perioperative period and follow-up period, and also the radiographic parameters such as scoliosis Cobb angle, the mismatch between pelvic incidence and lumbar lordosis (PI-LL), sagittalvertical axis (SVA), coronal balance (CB) before and after each stage of surgery or latest follow-up. The paired-samples t test was used to analyze the effectiveness of staging surgery. Results: Fifty-three patients (18 males and 35 females) were included in this study. All patients had completed clinical and the follow-up records, with an average follow-up period of 11.52 months (6-20 months). A total of 168 segments fusions were performed with CLIF, 113 segments were performed with anterior column realignment (ACR), the average correct angle was 15.6°±6.3°(7°-28°) in sagittal plane each level. After the stage Ⅰ surgery, lumbar scoliosis cobb had been corrected for 55.35%, after the stage Ⅱ surgery, rate of correction was 75.6%. PI-LL had been matched (-32.8°±14.9° to -2.5°±9.4°), SVA was changed from 5.7 cm to 0.6 cm, the stage Ⅰ rate of correction was 80.3 and stage Ⅱ was 88.8%, pelvic tilt (PT), lumbar lordosis (LL) and CB had been restored; 13 (24.5%) patients were performed paraspinal approach transforaminal decompression. The posterior minimally invasive fixation indexes: 11(20.8%) patients were performed paraspinal approach transforaminal multi-segment transforaminal osteotomy (TFO) and internal fixation; 36(67.92%) cases were performed paraspinal approach transforaminal multi-segment fixation; 6(11.33%) patients were treated with percutaneous pedicle screw fixation. The average fixed segments was 7.4±1.4 in each patient. The blood loss of stage Ⅰ and stage Ⅱ operation was (157±71) ml, (343±224)ml, respectively. The operation time was (214±60) min, (190±54)min respectively in the two stage operations. The low back pain and leg pain VAS score and ODI improved after the stage Ⅰ and Ⅱ surgery (t=17.948, 10.099, 14.619, all P<0.001). Conclusions: MIS for the severe degenerative lumbar scoliosis can achieve good clinical outcome and deformity correction. The two-stage protocol has the advantages of less complications and is well-tolerated.

Autologous stem cell implantation with core decompression for avascular necrosis of the femoral head

ObjectiveAvascular necrosis (AVN) of the femoral head is a painful, progressive disease that can lead to limited mobility and early hip replacement. Autologous stem cell implantation into the necrotic lesion of the femoral head has been described, on the basis that patients with AVN have a reduced number of stem cells in the marrow. In this study, we aim to describe our technique for decompression of the hip with autologous implantation of stem cells for AVN of the femoral head, as well as retrospectively analyze our results. MethodsThe records and imaging of patients with avascular necrosis of the femoral head treated by a single surgeon were retrospectively reviewed. All patients were treated with the combination of core decompression with autologous stem cell implantation from the iliac crest. Preoperatively, demographic information, stage of AVN per Association Research Circulation Osseous (ARCO) classification on magnetic resonance imaging and radiograph, and visual analogue pain scores (VAS) of the hip were recorded. Postoperatively, VAS were recorded and imaging was reviewed for progression of AVN or evidence of femoral head collapse. Statistical analysis was conducted comparing pre and postoperative VAS scores. ResultsOverall, we treated 43 hips in 28 patients with autologous stem cell implantation, with an average follow up of 16 months. Patients ranged from ARCO Ia to ARCO IIc classification of AVN. The average pre-operative visual analogue scale (VAS) of pain was 7.8. Post operatively, the average VAS score decreased to 2.5 (p < 0.0001), with 78% of patients reporting at least a 50% decrease in pain. 40 of the 43 operatively treated hips showed no radiologic progression of the disease during the follow up period, while 3 of the 43 hips had evidence of femoral head collapse and needed subsequent total hip arthroplasty at an average of 17 months after the initial decompression. ConclusionOur findings indicate that hip compression with autologous stem cell implantation for AVN of the femoral head provides significant symptomatic relief and may be beneficial in arresting progression of disease.

Clinical study of propacetamol and dezocine for the prevention and treatment of vascular crisis in preemptive analgesia after digit replantation

Objective To explore the clinical effect of propacetamol and dezocine for the prevention and treatment of vascular crisis in the preemptive analgesia after digit replantation. Methods 85 cases of patients treated with digit replantation were selected for the study and divided into the propacetamol group (n=45) and the dezocine group (n=40) according to the different postoperative preemptive analgesic method. The two groups were given with propacetamol or dezocine and fentanyl and ondansetron patient-controlled intravenous analgesia (PCIA) respectively. The analgesic and sedative effects were observed between the two groups, and the occurrence of vascular embolism and vascular crisis and the survival rate of replantation were counted. Results There was no significant difference between the two groups in the visual analogue pain score (VAS) at 3 hours after operation (P<0.05). The VAS scores of the two groups were significantly increased at 6 h and 24 h after operation while the VAS score was significantly decreased at 48 h after operation (P<0.05), and the VAS scores were significantly lower in the propacetamol group than those in the dezocine group at 6 h, 24h and 48 h after operation (P<0.05). The difference of the Ramsay sedation scores distribution at 3 hours after operation was statistically significant between the two groups (P<0.05), and the sedative effect was more satisfactory in the propacetamol group. Within 48 h after operation, PCI effective times/actual sub values of the propacetamol group were significantly higher than the dezocine group (P<0.05). The incidence rates of postoperative vascular thrombosis and arterial or venous crisis were 4.44%, 6.67% and 6.67% respectively in the propacetamol group, which were significantly lower than those in the dezocine group with 20.00%, 22.50% and 27.50% (P<0.05). The survival rate of digit replantation, digit replantation at 6 months after treatment were 97.78%, 85.00% which was higher than that of the dezocine group with 91.11%, 75.00% (P<0.05). Conclusions Compared with dezocine, propacetamol can attain the ideal analgesic and sedative effects and improve the survival rate of replantation, which has a significant role in the prevention and treatment of vascular crisis in the adjuvant treatment of postoperative analgesia in digit replantation. Key words: Acetaminophen/AA; Acetaminophen/AD; Morphinans/AA; Morphinans/AD; Analgesia; Finger injuries/SU; Replantation; Vascular diseases/PC

Intra-articular dexmedetomidine with bupivacaine versus bupivacaine alone for postoperative analgesia after knee arthroscopy

Background: Optimal relief of pain after knee arthroscopy is essential for early rehabilitation and mobilisation and to minimise postoperative morbidity. This study’s aim was to assess dexmedetomidine as an additive to intra-articular (IA) bupivacaine in terms of analgesic duration and postoperative rescue analgesic consumption following arthroscopic knee surgery.Methods: A total of 70 patients, ASA physical status I and II, undergoing knee arthroscopy under general anaesthesia were enrolled in this double-blinded randomised controlled study, after Pan African Clinical Trial Registry (PACTR201507001048242) approval was obtained. Patients were randomly assigned into two groups; the bupivacaine group (B) received IA 19 ml bupivacaine 0.5% + 1 ml normal saline, bupivacaine dexmedetomidine group (BD) received IA injection of 19 ml bupivacaine 0.5% + dexmedetomidine 100 μg (1 ml). Postoperative visual analogue pain score (VAS), duration of analgesia and postoperative analgesic requirement were assessed.Results: VAS scores at rest and on mobilisation were significantly lower in the BD group at 4 h, 6 h and 8 h postoperatively in comparison with group B (p < 0.05). VAS scores were comparable between studied groups during the first 2 h, and at 12 h and 24 h postoperatively. Duration of analgesia was significantly longer in group BD (458.9 ± 93.5 min) than in the B group (229.1 ± 83.7 min) (p < 0.05). Postoperative analgesic consumption was lowered in the BD group compared with the B group (p < 0.05).Conclusions: Adding dexmedetomidine to IA bupivacaine after knee arthroscopy prolongs analgesic duration and decreases postoperative analgesic requirement.Keywords: arthroscopy, dexmedetomidine, intra-articular, postoperative pain

A comparison of the “All-Inside” arthroscopic Broström procedure with the traditional open modified Broström-Gould technique: A review of 62 patients

BackgroundThe open Broström-Gould lateral ankle stabilization procedure has been the gold standard for primary lateral ankle stabilization. A new minimally invasive all-inside arthroscopic technique has been described for the correction of lateral ankle instability. MethodsWe performed a review of patients who underwent lateral ankle stabilization by either the traditional open Broström-Gould (BG) or the All-Inside Bröstrom (AIB) technique to compare and identify any discrepancies between functional and/or patient satisfaction outcomes. A total of 62 patients underwent a lateral ankle stabilization. Of those 62 patients, 32 received a traditional open Broström-Gould procedure and 30 patients underwent an All-Inside Bröstrom type procedure. The two groups were compared preoperatively with AOFAS ankle-hindfoot scoring system and Visual Analog Score (VAS) for pain. Postoperatively, AOFAS, Karlsson Peterson and VAS scores were compared. ResultsThe mean preoperative VAS pain score for the open Broström-Gould was 7.28, the All-Inside Broström was 8.18. The mean postoperative VAS pain score for the open Broström-Gould was 1.2, the All-Inside Broström was 1.5. The mean preoperative AOFAS score for the Broström-Gould was 35.44, the All-Inside Broström was 35.07. The mean postoperative AOFAS score for the open Broström-Gould was 93.53, the All-Inside Broström was 95.33. The mean postoperative Karlsson Peterson score for the open Broström-Gould was 93.41, the All-Inside Broström was 91.80. The mean time to weight bearing for the Broström-Gould was 22 days, the All-Inside Broström was 12 days. ConclusionThere were no statistically significant differences identified in any of the functional or patient satisfaction outcome scores using either technique. This review suggests the minimally invasive arthroscopic technique using bone anchors for lateral ankle stabilization may be comparable to the traditional open Broström-Gould with the added advantage of earlier time to weight bearing.

Medial Displacement Osteotomy Performed Concurrently with Triple Arthrodesis Improves Pain and Mobility in Patients with Rigid Flatfoot Deformity and Hindfoot Valgus

Category: Hindfoot, Midfoot/Forefoot, Flatfoot Introduction/Purpose: Progression of flatfoot deformity and arthritis affects 6-38% of patients with posterior tibial tendon dysfunction treated with a triple arthrodesis. Current theory suggests that undercorrection of hindfoot valgus places abnormal stresses on the deltoid ligament and tibiotalar joint, contributing to the development of increased valgus tilt of the ankle joint or collapse of the medial arch. No large series to our knowledge has attempted to assess the potential benefit of the prospective correction of hindfoot valgus at the time of the triple fusion. Here we analyze the outcomes of 31 unilateral Stage III or IV rigid flatfoot corrections performed with concurrent medial displacement osteotomies. Methods: In an institutional review board approved retrospective study, a total of 31 feet in 31 patients were operated upon from 1/1/2009 to 1/1/2016 by a single surgeon at a large academic medical center. American Orthopaedic Foot &amp; Ankle Society hindfoot scores and visual analog pain scores (VAS) were obtained prior to surgery and at the final post-operative follow-up where available). Foot and Ankle Ability Measure (FAAM) scores were available for 17 (54.8%) of patients. Patient demographic data, including age, body mass index (BMI), charlson comorbidity score, smoking status, and HbA1c where available were recorded. Additional surgical outcomes of interest included a return to unassisted mobility in a shoe or boot, infection and wound complication rate, 90 day re-admissions and revision/subsequent procedures. Pre-and post-operative data were analyzed using Student’s t-test for continuous variables, and Fisher’s exact test for categorical variables using Graphpad Prism (LaJolla, CA). Results: Patient demographic data is demonstrated in figure 1. Average follow-up was 1.3 ± 1.1 years (range .5 to 6.0 years). Average Pre-operative AOFAS scores available from 23/31 (74.2% of patients) averaged 33.5, with 1-year post-operative scores (8/31, 25.8%) of 76.8 ± 4.6 (p &lt; .0001). VAS scores decreased from 6 ± 2.9 to 2 ± 2.7 (p &lt; .0001). Superficial infections were treated in 3/31 (9.7%) of patients, while wounds developed in 6.5%. Mobility without assistive modality in a shoe or boot was reported by 30/31 (96.8%) patients, with one patient requiring a walker. No 90-day readmissions occurred, no amputations occurred, and a single patient returned to the OR 393 days after admission for symptomatic hardware removal. Conclusion: Here we demonstrate in a large retrospective analysis that performing a medial displacement osteotomy in patients with hindfoot valgus in the setting of rigid flatfoot deformity results in nearly universal remobilization, substantially improved functional outcomes, and significantly decreased pain. Few patients had wound complications or infections, and no revision reconstructions were required. Limitations to this study include inconsistent post-operative reporting, and a lack of long term post-operative outcomes. Further work includes a re-surveying of this patient base for updated patient outcomes, as well as quantitative radiographic analysis.

Evaluation of diffusion effect of bone cement in vertebral body fracture in percutaneous vertebroplasty

Objective To evaluate the therapeutic effect of percutaneous vertebroplasty good cement dispersion within the vertebral body fracture line. Methods The clinical data of 105 osteoporotic compression fracture patients with single vertebral fractures treated by vertebroplasty were retrospectively analyzed.Including 51 males, 54 females, aged 61 to 82 years, mean 75.18 years, duration of 1d to 2 months, compressed segments distributed in the T9-L3.Preoperative patients received X-ray film, routine CT scan and reconstruction and MRI examination to determine the responsibility of patients with vertebral fracture line position, intraoperative puncture position to the fracture line in the C arm guidance, and bone cement was injected, puncture used unilateral or bilateral, injection of bone cement in an amount of 3-5mL.The visual analogue pain score (VAS) was recorded before and after surgery for 48h and at the last follow-up. Results All patients were successfully completed without serious complications, intraoperative real-time C-arm fluoroscopy and postoperative review X-ray showed that bone cement in the fracture line was well dispersed.Operation time was 25-50min, average 36min.The amount of injection of bone cement within the vertebral body was 3-5mL, average 3.6mL.2 cases of bone cement leakage vertebrae forward, leakage to posterior vertebral body (vertebral canal) in 1 cases, cement leakage rate was 2.8%(3/105), no clinical symptoms.The follow-up period was 6-12 months and the mean follow-up was 7 months.The VAS score between postoperative 48 h and before operation had statistically significant difference[(2.3±0.4)points vs.(7.7±0.7)points, t=-38.72, P<0.05]. The VAS score of the last follow-up was (2.2±0.5)points, which was significantly different compared with that before operation (t=-39.21, P<0.05). Conclusion PVP can effectively alleviate the pain caused by osteoporotic compression fractures and improve dysfunction, bone cement manipulation operation preferably dispersed in the fracture line can better improve efficacy. Key words: Fractures, bone; Vertebroplasty

Orthopaedic Surgeon

Objectives:Results of revision labral repair and labral debridement of irreparable issue have been poor. A circumferential labral reconstruction (CLR) with ITB allograft between the transverse acetabular ligament antero-inferiorly to the 7-8 o’clock position postero-inferiorly eliminates any tissue damaged beyond repair, restores stability and eliminates any high stress junction points. This study seeks to compare outcomes with this technique relative to our patients with hip problems that are reliably fixed with simple labral repair.Methods:We retrospectively examined 34 consecutive patients undergoing arthroscopic surgery of the hip with CLR with a fascia lata allograft and compared them with 49 consecutive patients undergoing simple labral repair during the same 4 month period. Pre- and post-op surveys included Visual Analog Pain Score (VAS), International Hip Outcome Tool (IHOT-12), modified Harris Hip Score (mHHS), 12-item Short Form Health Survey (SF-12) and Hip Outcome Score (HOS-ADL and HOS-SSS). Pre-op Tonnis grade was recorded. Severity of labral damage was evaluated in separate sidearm study of 20 patient videos not involved in current study to assess intra-observer reliability for grading of severity of labral damage.Results:The mean age of the reconstruction patients was 43.0 vs. 29.1 for the repair patients (p<0.001). The repair group had 45% mild and 55% moderate tears; the CLR group had 80% severe tears or segmental defects and 20% moderate tears. 3.9% of the repair group were revision procedures, while 35% of the CLR group were revision procedures. Pre-op Tonnis grade in the CLR group was 0.44 vs. 0.11 (P<0.001). Follow-up rate was 82% with a minimum follow-up of 23 months (range: 23-28 months). In the CLR group, 5 patients failed; 1 for core muscle repair procedure, 2 went on to subsequent hip arthroplasty, 2 in need of hip arthroplasty. All 4 conversions to arthroplasty had pre-op tonnis grade of 2. 3 procedures failed in the repair group with one subsequent core muscle repair and 2 revisions to labral reconstruction. In the reconstruction group, the mean Pain VAS score decreased from 4.78 preoperatively to 1.9 postoperatively (P<0.001), IHOT-12 scores increased from 32.38 to 68.9 (P<0.001), and mHHS increased from 48.67 to 74.63 (P<0.001). The SF-12 survey exhibited an increase from 36.29 to 43.15 (P=0.028), HOS-ADL scores increased from 56.28 to 87.47 (P<0.001), and HOS-SSS scores increased from 32.40 to 68.55 (P=0.0028). These improvements were not statistically different from those observed in the repair group (Pain VAS: P=0.361; HOS-ADL: P=0.314; HOS-SSS: P=0.288; mHHS: P=0.996; IHOT: P=0.192; SF: P=0.642). Intra-observer reliability of sidearm video study Kappa = 0.66 indicating moderately good reliability in the grading of severity of labral damage.Conclusion:This study shows that patients undergoing circumferential labral reconstruction with ITB allograft exhibit favorable outcome at 2 years postoperatively with respect to pain and activities of daily living—comparable to the results achieved in patients undergoing repairs of labra with lower severity of damage in a more challenging patient population (14 yrs older with far worse labral damage, a higher Tonnis grade, and far higher percentage of revisions). These data suggest that circumferential arthroscopic labral reconstruction is a viable option for patients with missing or severely compromised labral tissue.

Multicenter clinical and imaging evaluation of targeted radiofrequency ablation (t-RFA) and cement augmentation of neoplastic vertebral lesions

BackgroundTreatment of spinal metastatic lesions by radiofrequency ablation (RFA) before cementation can potentially help in local tumor control and pain relief. This is often limited by access and tumor location....

Effectiveness of interventions for pain relief in hysterosalpingographyAnetwork meta-analysis and systematic review.

Objective:We aimed to evaluate the effectiveness of placebo, oral opioid analgesic (OOA), intravenous opioid analgesic (IOA), non-opioid analgesic (NOA), topical anesthetic (TA) and locally injected anesthetic (LIA) for pain relief duringhysterosalpingography (HSG) using a Bayesian network meta-analysis of data from randomized controlled trials.Methods:PUBMED, EMBASE, and CENTRAL search engines were used to search and identify clinical trials that evaluated interventions for pain relief in HSG. Methodological studies quality was assessed by the Cochrane Collaboration tool for assessing risk of bias.Result:Sixteen trials involving 1263 participants were included in this study. IOA got excess but not statistically significant lower visual analogue score (VAS) pain score during HSG or more than 30 minutes after HSG compared with the other groups. OOA resulted in excess but not statistically significant higher VAS pain score during HSG compared with the other groups except placebo group. According to SUCRA regarding the lower VAS pain score during HSG, the treatments rank was the following: IOA, TA, NOA, LIA, OOA and placebo; as regard lower VAS pain score at 30 minutes or more after HSG, the treatments rank was the following: IOA, LIA, OOA, TA, NOA and placebo.Conclusion:This new Bayesian data network meta-analysis from randomized controlled trials demonstrated that IOA resulted in the highest probability to reduce the pain during HSG or at 30 minutes or more after HSG among the six interventions considered.

Ultrasound-Guided Serratus Anterior Plane Block Versus Thoracic Epidural Analgesia for Thoracotomy Pain

Thoracotomy is one of the most painful surgical procedures. The aim of this study was to assess the efficacy and safety of ultrasound-guided serratus anterior plane block (SAPB) compared with thoracic epidural analgesia (TEA) for controlling acute thoracotomy pain. A prospective, randomized, observer-blinded, controlled study. The study was performed as a single-institution study in the National Cancer Institute, Cairo University, Egypt. All participants were cancer patients scheduled for thoracotomy. This study was conducted from February to December 2015. Forty patients scheduled for thoracotomy under general anesthesia were allocated randomly into 1 of 2 groups with 20 patients each. SAPB was performed before extubation with an injection of 30 mL of 0.25% levobupivacaine followed by 5 mL/hour of 0.125% levobupivacaine. In the TEA group, thoracic epidural catheters were inserted preoperatively to be activated before extubation using a lower dose regimen to the SAPB group. Heart rate, mean arterial pressure, and the visual analog pain score (VAS) measurements were recorded for 24 hours. Rescue analgesia using intravenous morphine, 0.1 mL/kg, was administered if the VAS was >3. Compared with preoperative values, the mean arterial pressure in the SAPB group did not change significantly (p = 0.181), whereas it decreased significantly (p = 0.006) in the TEA group. VAS scores and the total dose of morphine consumed were comparable in the 2 groups. SAPB appeared to be a safe and effective alternative for postoperative analgesia after thoracotomy.

Psychosocial Risk Factors for Postoperative Pain in Ankle and Hindfoot Reconstruction.

The purpose of this study was to examine factors associated with pain after elective ankle and hindfoot reconstruction. Patients who underwent major ankle or hindfoot reconstruction over a 3-year period were identified. Retrospective chart review determined patient demographics, comorbidities, surgeries, tobacco, alcohol, and narcotic use, chronic pain, and mood disorders. Primary outcomes were cumulative amount of narcotic prescribed (morphine milligram equivalent dose) in the initial 90-day postoperative period, beyond 90 days, and visual analog pain score (VAS) at a minimum of 1-year follow-up. One hundred thirty-two patients (139 operations) met the inclusion criteria. The average narcotic amount prescribed in the initial 90 days after surgery was 1711 mg (morphine equivalent), and narcotic prescriptions were required after 52 surgeries (35%) past 90 days. Preoperative narcotic use (P < .01), chronic pain disorder (P = .02), and mood disorder (P < .01) were significant risk factors for continued narcotic use past 90 days. Tobacco use (P = .01) and chronic pain disorder (P < .01) also were significant risk factors for increased initial postoperative narcotic use. The average VAS score in 91 patients at an average of 2.7-year follow-up was 2.1. Mood disorder was a risk factor for increased VAS (P < .01). No other associations were noted. Patients being treated for chronic pain, diagnosed with a mood disorder, taking any amount of narcotics preoperatively, or using tobacco products had a statistically significant increased risk for pain postoperatively. The presence of risk factors should prompt physicians to discuss pain management strategies before surgery. Level III, comparative series.

Clinical Efficacy of Percutaneous Kyphoplasty at the Hyperextension Position for the Treatment of Osteoporotic Kümmell Disease.

Percutaneous kyphoplasty might be effective for osteoporotic Kümmell disease. To investigate the clinical efficacy of percutaneous kyphoplasty in hyperextension for osteoporotic Kümmell disease. Retrospective study. A retrospective analysis was carried out on data from downstream balloon kyphoplasty treatments in hyperextension for 18 patients with osteoporotic Kümmell disease. All cases were single-segment disease affecting T5 (1 case), T7 (1 case), T8 (2 cases), T11 (6 cases), T12 (4 cases), L1 (2 cases), L2 (1 case), or L4 (1 case). Dual-energy x-ray absorptiometry bone mineral density values ranged from -2.8 to -5.8 SD. The sagittal Cobb angle of the involved segment was measured before and after the operation and the final follow-up also included a visual analog pain score (VAS) and the Oswestry Disability Index (ODI) after comprehensive efficacy assessment. All patients were followed up for 12-36 months, with an average of 15.8 months. Patients showed lower back pain relief and improvement in daily life activities. The kyphosis Cobb angle improved from 32.60±3.82 degrees before surgery to 7.60±1.68 degrees after surgery, and VAS and ODI scores significantly improved from 8.7±0.96 points and 88.6±3.76% to 2.6±0.32 points and 28.6±2.67%, respectively. The last follow-up for the kyphosis Cobb angle yielded a value of 9.60±2.06 degrees, and VAS and ODI averaged 2.2±0.26 points and 26.4±2.46%, respectively. Compared with 2 days postoperatively, the differences were not statistically significant. Intervertebral cement leakage occurred in 1 case, but no symptom was observed and no treatment was performed. Percutaneous balloon kyphoplasty in the hyperextension position is an effective method for osteoporosis in Kümmell disease.

Arthroscopic suture bridge rotator cuff repair: functional outcome, repair integrity, and preoperative factors related to postoperative outcome

ABSTRACTObjectives: To assess the retear rate, retear size and location, the clinical impact of a retear, and preoperative patient factors related to postoperative outcome after arthroscopic suture bridge rotator cuff repair.Methods: Fifty six patients with an isolated, full-thickness supraspinatus tendon tear who underwent arthroscopic suture bridge rotator cuff repair were retrospectively identified. Patients were evaluated and rotator cuff integrity was assessed using ultrasonography. Visual analog score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, shoulder range of motion and strength were used for clinical evaluation. Retears were assessed for size and location on ultrasonography.Results: Forty two patients (75%) aged a mean 59.7 ± 8.6 years (range 41–79 years) were available for follow-up at a mean 13.5 months. Postoperative evaluation indicated significant improvements in ASES score (49.76 ± 18.2 to 86.57 ± 13.4, P < 0.001), VAS pain score (4.69 ± 2.17 to 0.63 ± 1.29, P < 0.001), forward elevation range of motion (144.1° ± 29.9 to 159.69 ° ± 13.9, P = 0.002), and internal rotation ROM (44.13° ± 12.0 to 52.09° ± 12.0, P = 0.003). The retear rate was 14.28% (6/42). Patients with retears were not older (P = 0.526) but had a larger preoperative tear size (3.25 cm ± 0.5 vs 2.05 cm ± 0.48, P < 0.001). Preoperative tear size was significantly associated with a postoperative retear (P < 0.001). The duration of preoperative symptoms was significantly associated with pain (P = 0.029), pain improvement (P = 0.013), internal rotation ROM (P = 0.002), and internal rotation strength (P = 0.004).Conclusions: Arthroscopic suture bridge repair provides good clinical results with a low retear rate. The duration of preoperative symptoms was associated with postoperative outcome, indicating that delaying surgery may result in inferior outcomes.Level of Evidence: IV, Case Series

Randomized clinical trial comparing the effect of paracetamol with diclofenac in combination with on request rescue analgesic tramadol: analgesic efficacy, safety and tolerability after abdominal surgery

Background: The study was planned to assess the efficacy and safety of paracetamol in comparison with diclofenac for post-operative analgesic pain in patients undergoing elective abdominal surgery. This, randomized clinical trial was conducted in an institution of medical education and tertiary care centre. Methods: 90 patients scheduled for elective abdominal surgery were assigned in a randomized manner in to two groups. Group P received 1 g paracetamol intravenously (IV) 8 hourly and group D received 75 mg intramuscular (IM) diclofenac 8 th hourly for 24 hr post‑operative period. The pain intensity was judged using pain visual analogue score (VAS) at time periods 2h, 4h, 6h, 12h, 18h and 24h post-surgery. Patient reported with a VAS pain score of greater than 3, a rescue analgesic IV tramadol 100 mg injection was given. The need of rescue analgesic, pain VAS, patient satisfaction score and adverse effects were recorded. Results: The data was expressed in mean +/-SD and analysed using unpaired t test, chi-square test, followed by Fisher’s exact post-hoc test. Total tramadol requirement were not significantly different between paracetamol and diclofenac groups. Gastrointestinal side effects were present in 6.6% and 17.7% of patients receiving paracetamol and diclofenac respectively. Patient satisfaction score till administration of rescue analgesics showed statistically significant difference (p=0.043) between the groups. Conclusions: Paracetamol is equally effective and safer which can be a practicable alternative compared to Diclofenac especially because of its highly encouraging risk benefit-ratio, which justify its role as a near-routine management for post-operative pain.

Vertebral augmentation by kyphoplasty and vertebroplasty: 8 years experience outcomes and complications.

Background and Context:Minimally invasive percutaneous vertebral augmentation techniques; vertebroplasty, and kyphoplasty have been treatment choices for vertebral compression fractures (VCFs). The purpose of this study is to evaluate the outcomes of the patients who underwent vertebroplasty or kyphoplasty regarding complications, correction of vertebral body height, kyphosis angle and pain relief assessment using visual analog score (VAS) for pain.Materials and Methods:A retrospective review of the hospital records for 100 consecutive patients treated with kyphoplasty or vertebroplasty in our department database. Patients with osteoporotic compression fractures, traumatic compressions, and osteolytic vertebral lesions, including metastases, hemangiomas, and multiple myeloma, were included in the study. Preoperative and postoperative VAS pain scores, percentages of vertebral compression and kyphotic angles were measured and compared as well as demographic characteristics and postoperative complications. Mobilization and length of stay (LOS) were recorded.Results:One hundred patients were treated by 110 procedures. 64 patients were operated on due to osteoporosis (72 procedures). Twelve patients were operated on because of metastasis (13 procedures), 8 patients were operated on because of multiple myeloma (9 procedures). Five patients had two surgeries, 1 patient had 3 surgeries, and 1 patient had 5 surgeries. The mean preoperative VAS was 74.05 ± 9.8. In total, 175 levels were treated, 46 levels by kyphoplasty and 129 by vertebroplasty. The mean postoperative VAS was 20.94 ± 11.8. Most of the patients were mobilized in the same day they of surgery. Mean LOS was 1.83 days. Six patients had nonsymptomatic leakage of polymethlymethacrylate, and patient had epidural hematoma, which was operated on performing hemi-laminectomy.Conclusions:Percutaneous vertebroplasty and balloon kyphoplasty are both effective and safe minimally invasive procedures for the stabilization of VCFs. However, complications should be kept in mind during decision making.

Cervical radiculitis presenting as shoulder pain

Background: Although cervical radiculitis is a well-known cause of referred shoulder pain, there is little information concerning its frequency and treatment. Methods: Retrospective review of the records of all new patients presenting to a single orthopaedic shoulder surgeon at a tertiary referral center from 2009 to 2012 identified 1169 patients with a chief complaint of shoulder pain; 60 (4%) with an isolated diagnosis of cervical radiculitis were included in the study; 48 were available for follow-up evaluation. If conservative therapy failed, MRI was done, followed by cervical epidural corticosteroid injection by a physiatrist (11 patients); three with persistent symptoms had anterior cervical fusion. Visual analog pain scores (VAS) were recorded at the initial visit, and VAS and National Disability Index Questionnaire (NDIQ) scores were obtained at a minimum of 1 yr. Results: Of 1169 patients with a chief complaint of shoulder pain, 60 (4%) were diagnosed with isolated cervical radiculitis. Of 48 available for follow-up evaluation, 34 were treated conservatively, 11 had cervical epidural injections, and three required anterior cervical discectomy and fusion (ACDF). At mean follow-up of 27 mo, the average overall pain score was 2 compared to 5.2 at the initial visit (P<0.0001). The differences between initial and follow-up VAS scores demonstrated improvements with all three treatments. Fifteen patients reported no disability, and 32 reported minimal disability. Conclusions: These findings suggest that, if correctly diagnosed and treated, patients with cervical radiculitis presenting as shoulder pain can obtain marked reductions in pain and disability with a step-wise multidisciplinary treatment strategy.