Visual Analog Scale Pain Scores Research Articles

Unification and orificing of two functional noncommunicating uterine horns through the created neovagina using peritoneum

ObjectiveTo demonstrate the surgical approach for Müllerian agenesis with bilateral uterine remnants containing functional endometrium. DesignStepwise demonstration of the technique with narrated video footage SettingA Tertiary University Hospital, Reproductive Surgery Unit. PatientAn 18-year-old adolescent was admitted to a tertiary university hospital with complaints of primary amenorrhea and cyclic pelvic pain. Physical examination and MRI scans suggested a complex Müllerian abnormality. The patient had uterine remnants with bilateral functional endometrium and cervico-vaginal agenesis. InterventionAn operation was planned to reconstruct her anatomy by providing a neovagina and anastomosing the uterine remnants. GnRH analogs were prescribed to suppress her menstruation until the procedure. The operation was performed in the third month after the initial diagnosis. A laparoscopy was conducted, revealing approximately 5x6 cm bilateral uterine horns with healthy adnexa.As the first step, a neovagina was created using a modified peritoneal pull-down technique, a standard approach in our clinic. A vaginal incision was made, and a blind vaginal dissection was performed to reach the peritoneum vaginally. Subsequently, an acrylic vaginal mold was inserted. The vaginal orifice was laparoscopically incised using ultrasonic energy with guidance from the inserted vaginal acrylic mold. The orifice was gradually dilated with larger molds. The entire pelvic peritoneum was dissected circularly, and the distal part of the dissected peritoneum was pulled down using four 2.0 Vicryl sutures at 0, 90, 180, and 270 degrees from the opened vaginal orifice. The uterine cavities of both remnants were incised, and two separate Foley catheters were placed in both cavities. A mold with a hole was used to insert the catheters through the vagina. Both catheters were secured in the cavities with Prolene sutures pulled up from the anterior abdominal wall.The next step involved uterine anastomosis. The uterine remnants were unified through continuous suturing, resulting in the formation of a normally shaped uterus. In the final step, the created uterus and neovagina were anastomosed. The patient received instructions on how to perform mold exercises and follow-up care. Main Outcome MeasureDescription of a laparoscopic management of a rare mullerian abnormality. ResultsThe postoperative MRI scan at one month revealed healed unified uterine cavities and vagina. The patient experienced spontaneous menstruation in the second month after surgery and now maintains regular menses with an approximately 9-10 cm functional vagina. Within three months after surgery, the VAS (visual analog scale) scores for chronic pelvic pain and dysmenorrhea decreased from 9 to 2-3. ConclusionsMüllerian abnormalities are exceptionally rare, and their spectrum is broad, making it challenging to identify an exact surgical method to restore functional anatomy. Therefore, a customized surgical approach should be designed for each patient based on their unique condition.

Efficacy of Hydrocortisone, Povidone-Iodine, and Normal Saline as an Irrigating Solution During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Trial.

Background The surgical removal of mandibular third molars is one of the most common procedures in dentistry. Researchers have extensively studied the treatment of postoperative sequelae such as pain, edema, trismus, and alveolar osteitis throughout the past six decades. Many approaches have been used to address clinical difficulties after third molar surgery, including various flap designs and irrigating solutions.The aim of this study was to compare the effects of three irrigating solutions, hydrocortisone, povidone-iodine, and normal saline, on pain, trismus, and edema following surgical removal of the impacted mandibular third molar. Methodology The study involved 105 participants who required surgical extraction of mandibular third molars. The patients' ages ranged from 18 to 40 years, and they fulfilled the inclusion criteria. Using a simple random sampling technique, they were divided into three groups (group 1: hydrocortisone, group 2: povidone-iodine, group 3:normal saline). The parameters evaluated were edema, pain, and trismus on the second and seventh postoperative days. All data were input into Microsoft Excel (Microsoft® Corp., Redmond, USA) worksheets and analyzed using Stata17.0 (StataCorp LLC, College Station, USA). The visual analog scale (VAS) score was used to measure postoperative pain, and postoperative swelling was measured using linear measurements from four fixed anatomical points and compared to preoperative values. To assess trismus, the inter-incisal distance was measured in millimeters with a caliper. A p-value of <0.01 was considered statistically significant. Results The mean VAS score for pain in group 1 was lower than the other two groups. The effect of group 1 was significant on the second postoperative day but insignificant on the seventh postoperative day for swelling. The effect of all three groups on trismus was significant on the second and seventh days. Conclusions Hydrocortisone as an irrigating solution showed promising results in managing postoperative swelling in the first 48 hours, but its effect gradually declined by the seventh postoperative day. Additionally, it was effective in controlling postoperative pain and trismus. This suggests that utilizing hydrocortisone as an irrigating solution, compared to povidone-iodine, has been proven to be a significantly effective option in reducing postoperative pain, edema, and trismus resulting from the surgical removal of impacted teeth.

Biportal Endoscopic Trans-Kambin Lumbar Interbody Fusion: Surgical Techniques and Treatment Outcomes

Objective: Lumbar interbody fusion with cages is a commonly used surgical solution for spinal conditions that do not respond to conservative management. Biportal endoscopic trans-Kambin lumbar interbody fusion (BE-KLIF) is a modern technique that offers several benefits over prior techniques, including early ambulation, reduced postoperative pain, and shorter hospital stays.Methods: This retrospective study enrolled 128 patients who underwent BE-KLIF between March 2018 and August 2022. The primary indications for surgery were segmental lumbar listhetic instability, failed decompression with neuroforamen stenosis, adjacent segment disease, and burst fracture of the lumbar vertebrae. The outcome measures included Oswestry Disability Index (ODI) and visual analogue scale (VAS) scores, and postoperative fusion status at 1 year after the procedure was graded using the Bridwell fusion grading scale.Results: BE-KLIF yielded significant improvements in patient outcomes. Successful fusion was achieved in 91.8% of segments. The mean ODI score was significantly lower at the 1-year follow-up than before the procedure. Similarly, VAS scores for leg and back pain significantly improved after the procedure. Seven early and 3 late postoperative complications were observed. The mean length of hospital stay was shorter for BE-KLIF than for the older transforaminal lumbar interbody fusion technique.Conclusion: BE-KLIF resulted in less bone removal, preservation of the facet joint, facilitation of a more oblique trajectory, and potential for larger cages with wider effacements compared with prior techniques. However, the technique lacks central and contralateral decompression. We recommend performing same-side unilateral laminotomy with bilateral decompression to provide central and contralateral decompression.

Efficacy of balneotherapy on pain, function, and sleep quality in patients with chronic low-back pain: a prospective observational study.

The aim of this prospective observational study was to evaluate the efficacy of a cycle of sulfate-arsenical-ferruginous mud bath therapy on pain, function, and sleep quality in patients with chronic low-back pain (CLBP). One hundred twenty-three patients treated at Levico Spa Center (Italy) with 12 daily local mud packs and generalized thermal baths were included in this experience. General medical assessments were performed before starting the therapy, at the end of the treatment, and 3months later. Pain intensity and stiffness were measured by a 0 to 10cm visual analogue scale (VAS); the range of mobility of the lumbar spine was evaluated using the Schober test and functional disability by the Roland-Morris Disability Questionnaire (RMDI). The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. The VAS score for pain and stiffness showed a significant reduction (p < 0.0001) at the end of the treatment persisting for 3months of follow-up. Similarly, a significant improvement was found for the Schober test and RMDQ. Finally, we showed a significant decrease of PSQI score at the end of the cycle of mud bath and at 3months of follow-up. The Spearman analysis showed a significant positive correlation between the score of PSQI and VAS pain, VAS stiffness, and RMDQ. In conclusion, this preliminary study confirms the beneficial and long-term efficacy of balneotherapy on pain and function and, for the first one, shows the positive effect on quality of sleep in patients with CLBP treated with a cycle of mud bath therapy.

Zhuifeng Tougu capsules in the treatment of knee osteoarthritis (cold dampness obstruction syndrome): a randomized, double blind, multicenter clinical study

BackgroundIn Traditional Chinese Medicine (TCM) theory, cold dampness obstruction is one of the common syndromes of osteoarthritis. Therefore, in clinical practice, the main treatment methods are to dispel wind, remove dampness, and dissipate cold, used to treat knee osteoarthritis (KOA). This report describes a mulitercenter clinical study to assess Zhuifeng Tougu Capsule’s efficacy and safety in the treatment of patients who are cold dampness obstruction syndrome in KOA, and to provide evidence-based medical for the rational use of Zhuifeng Tougu Capsules in clinical practice.MethodsThis randomized, parallel group controlled, double-blind, double dummy trial will include a total of 215 KOA patients who meet the study criteria. 215 patients underwent 1:1 randomisation, with 107 cases assigned the experimental group (Zhuifeng Tougu Capsules + Glucosamine Sulfate Capsules Simulator) and 108 assigned the control group (Glucosamine Sulfate Capsules + Zhuifeng Tougu Capsules Simulator). After enrolment, patients received 12 weeks of treatment. The main efficacy measure is the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain score. Visual analogue scale (VAS) pain score, Self-condition assessment VAS score, WOMAC KOA score, TCM syndrome score and TCM syndrome efficacy, ESR level, CRP level, suprapatellar bursa effusion depth, use of rescue drugs, and safety indicators are secondary efficacy indicators.ResultsCompared with before treatment, WOMAC pain score, VAS pain score, Self-condition assessment VAS score, WOMAC KOA score, and TCM syndrome score decreased significantly in both groups (P < 0.01). Also, the experimental group showed significant differences in the above indicators compared to control (P < 0.01). However, after treatment, no significant differences were showed in the ESR level, CRP level, and suprapatellar bursa effusion depth between the two groups (P > 0.05). No any serious adverse effects showed in the experimental group and control group.ConclusionsZhuifeng Tougu Capsules can effectively improve knee joint function and significantly alleviate the pain of KOA.Trial registration: Clinical trial registration was completed with the China Clinical Trial Registration Center for this research protocol (No. ChiCTR2000028750) on January 2, 2020.

Postoperative pain relief quality after cesarean section using a stress monitor (Neon FSC system): prospective single-center randomized clinical comparative study

BACKGROUND: The objective assessment of pain levels during labor, postpartum period, and effectiveness of analgesic response remains difficult. We suppose that the dynamics of the activity of the sympathetic nervous system by measuring the galvanic skin response may become a promising method for solving this problem.&#x0D; OBJECTIVE: To evaluate the effectiveness of various multimodal analgesia regimens after cesarean section using the NeonFSC stress monitoring system.&#x0D; MATERIALS AND METHODS: A prospective single-center clinical comparative study was conducted to evaluate the effectiveness of various postoperative multimodal analgesia regimens in 48 postpartum women who underwent elective cesarean section under spinal anesthesia. For postoperative analgesia, group 1 (n=24) underwent a TAP block, and ketorolac and tramadol were prescribed, and group 2 (n=24) received only ketorolac and tramadol. Randomization was made using the envelope method. The visual analog scale (VAS) and NeonFSC system were used to assess the effectiveness of postoperative pain relief. The observation time was 19–22 h.&#x0D; RESULTS: The patients were comparable in age, gestational age, physical status, method of pain management and delivery. At baseline and during the 2-h postoperative period, the median and distribution of visual analogue scale pain scores did not show a statistically significant difference between groups. During the study period, the highest level of spectral power of skin conductance (SC) was recorded in group 2. Baseline skin conductance variability (SCV) values were comparable between groups (p 0.001). Lower SCV values were noted in patients of group 1, compared to group 2, at night (p=0.003 vs p 0.001). The median values of the level of total spectral power of skin conductivity (DASS) in patients of group 1 were 1.5–2 times lower, starting from the second hour until the end of observation.&#x0D; CONCLUSION: The NeonFSC system can be a component of an objective assessment of the effectiveness of analgesia after cesarean section.

The Effect of Unintended Facet Arthrodesis on the Treatment Outcome of Dynamic Neutralization System for Lumbar Degenerative Diseases.

This study aimed to examine the influence of unintended facet arthrodesis on the therapeutic effectiveness of the dynamic neutralization system (Dynesys). This retrospective study enrolled consecutive patients who underwent posterior decompression and dynamic stabilization for lumbar spondylosis or spinal stenosis. Follow-up assessments included lumbar radiography, lumbar vertebral computerized tomography (CT), visual analog scale (VAS), and Oswestry disability index (ODI). Patients were classified into the facet fusion and non-fusion groups. The differences in the VAS scores for back pain and leg pain, ODI, intervertebral range of motion (ROM) at the surgical segments, and upper adjacent segments were assessed before and after treatment. A total of 49 patients (29 males and 20 females) aged 31-65years were enrolled and followed-up for over 40months. Among the patients, 16 (32.7%) experienced unintended facet arthrodesis and were assigned to the fusion group, whereas the remaining patients were assigned to the non-fusion group. There was a significant increase in the incidence of facet arthrodesis in the surgical segments over time post-surgery (χ2 = 6.2, p < 0.05). The ROM of the surgical and upper adjacent segments, VAS scores for back pain and leg pain, and ODI were all significantly different before and after the operation (p < 0.05), but not between the fusion and non-fusion groups (p > 0.05). Although unintended facet arthrodesis is common after Dynesys procedure, the presence of facet arthrodesis does not significantly affect the efficacy of Dynesys in treating lumbar degenerative diseases.

Lumbar Total Disc Replacements for Degenerative Disc Disease: A Systematic Review of Outcomes With a Minimum of 5 years Follow-Up.

Systematic Review. To systematically review the clinical outcomes, re-operation, and complication rates of lumbar TDR devices at mid-to long-term follow-up studies for the treatment of lumbar degenerative disc disease (DDD). A systematic search was conducted on PubMed, SCOPUS, and Google Scholar to identify follow-up studies that evaluated clinical outcomes of lumbar TDR in patients with DDD. The included studies met the following criteria: prospective or retrospective studies published from 2012 to 2022; a minimum of 5years post-operative follow-up; a study sample size >10 patients; patients >18years of age; containing clinical outcomes with Oswestry Disability Index (ODI), Visual Analog Scale (VAS), complication or reoperation rates. Twenty-two studies were included with data on 2284 patients. The mean follow-up time was 8.30 years, with a mean follow-up rate of 86.91%. The study population was 54.97% female, with a mean age of 42.34years. The mean VAS and ODI pain score improvements were 50.71 ± 6.91 and 30.39 ± 5.32 respectively. The mean clinical success and patient satisfaction rates were 74.79% ± 7.55% and 86.34% ± 5.64%, respectively. The mean complication and reoperation rates were 18.53% ± 6.33% and 13.6% ± 3.83%, respectively. There was no significant difference when comparing mid-term and long-term follow-up studies for all clinical outcomes. There were significant improvements in pain reduction at last follow-up in patients with TDRs. Mid-term follow-up data on clinical outcomes, complication and reoperation rates of lumbar TDRs were maintained longer term.

Single-Plane Retroperitoneoscopic Adrenalectomy Guided by Indocyanine Green Dye: An Optimized Step.

Background: The objective of this study was to explore the perioperative outcomes of single-plane posterior retroperitoneoscopic adrenalectomy (SPRA) guided by indocyanine green dye (ICG) fluorescence imaging. Methods: A retrospective analysis of patients who underwent SPRA from April to September 2023 in our center was conducted. Patients were divided into the ICG group and the non-ICG group, based on whether they received intraoperative ICG fluorescence guided or not. Baseline and perioperative data were recorded and analyzed by R software (R 4.3.1). Results: A total of 23 patients were enrolled in the study, with 12 in the ICG group and 11 in the non-ICG group. The demographics including age, gender, body mass index, or American Society of Anesthesiologists classification showed no significant differences between groups. There were obvious advantages in shortening adrenal gland localization time and total operative time, as well as reducing estimated blood loss in the ICG group compared with the non-ICG group (5.58 ± 0.36 minutes vs 7.55 ± 0.62 minutes, p < 0.001; 27.50 ± 5.46 minutes vs 45.00 ± 10.99 minutes, p < 0.001; 22.91 ± 7.57 mL vs 54.54 ± 18.90 mL, p < 0.001; respectively). Furthermore, patients in the ICG group exhibited significantly lower visual analog pain scale scores at 24 hours postoperatively and at discharge (p = 0.001 and p = 0.006, respectively). The oral intake intervals, hospital stays, and perioperative complications were comparable between groups. Conclusions: ICG-guided SPRA could be a safe and effective procedure for patients with adrenal tumors. This technique improves the accuracy and efficacy of adrenal gland localization and has shown benefits in perioperative outcomes. The use of ICG fluorescence guidance represents a promising clinical application.

Erector Spinae Plane Block versus Transversus Abdominis Plane Block for Robotic Inguinal Hernia Repair: A Blinded, Active-Controlled, Randomized Trial

BACKGROUND: Regional anesthetic nerve blocks are widely used in the treatment of pain after outpatient surgery to reduce opioid consumption. Erector spinae plane (ESP) block is a recently described technique with promising results in different scenarios. OBJECTIVES: To compare ESP block efficacy with the commonly used transversus abdominis plane (TAP) block in patients undergoing robot-assisted inguinal hernia repair. STUDY DESIGN: This was a randomized, blinded, active controlled, superiority trial with 2 parallel groups. The study was approved by the local ethics committee. Registration took place on www.clinicaltrials.gov with the identifier NCT04750512. SETTING: Adults undergoing robotic inguinal hernia repair were recruited between January 2021 and April 2022 in a single referral center of southern Switzerland. METHODS: To ensure blinding, the study employed a “double dummy” design, where all patients underwent both TAP and ESP blocks, but only one block was therapeutically active. The therapeutic block contained ropivacaine 0.2%, while the other infiltration contained placebo. The therapeutic intervention varied between groups, with one group receiving the TAP block as the active treatment and the other group receiving the ESP block as the active treatment. Computer generated 1:1 randomization determined allocation, which took place immediately prior to the intervention. As a result, blinding included patients, anesthesia, and surgery providers, outcome assessors and statistical analysts. The main outcome measure was the highest reported pain score on a Visual Analog Scale (VAS) during the 6 hours following the end of general anesthesia. Secondary outcomes included pain scores at set intervals, analgesic consumption, and complications. RESULTS: A total of 50 patients (25 per arm) were enrolled and included in the analysis. The study found no significant difference in the mean maximal VAS scores between the 2 groups (TAP block 22.2, ESP block 20, difference 2.2, 95% CI is -12.1 to 16.5). Secondary endpoints, including VAS pain scores at different time points, use of rescue analgesics, time to first walk, duration of stay, and frequency of adverse events, did not show any significant differences between the 2 groups. However, post-hoc analysis suggested a more stable effect over time for the ESP block compared to the TAP block. LIMITATIONS: The main limitation is a higher variance in VAS scores than expected in the power calculations. CONCLUSIONS: ESP block was not superior to TAP block in the treatment of post-operative pain among patients undergoing robotic inguinal hernia repair. KEY WORDS: Inguinal hernia, conduction anesthesia, postoperative pain, robotic surgical procedures, ESP block

Trends in Opioid Use during Hospitalization following Revision Total Hip Arthroplasty from 2016 to 2021

AbstractThough opioids can be very effective for postoperative pain management after revision total hip arthroplasty (rTHA), many physicians have made an effort to decrease usage of these medications by focusing on alternative pain management strategies to reduce opioid dependence and unwanted side effects. This study sought to investigate trends in opioid consumption during hospitalization following rTHA from 2016 to 2021. We retrospectively reviewed all patients who received rTHA from January 2016 to April 2021. Baseline demographic variables including age, gender, race, body mass index, and American Society of Anesthesiologists classification were recorded. Additional information including patient-reported outcome measures (PROMs), postoperative outcomes, dosage, and type of opioid medication prescribed postoperatively were also collected. Opioid dosage and type were converted to milligram morphine equivalents (MMEs) per day of hospitalization and compared across the 6 years studied. Linear regression as well as t-tests were utilized to determine significant trends in MME consumption over time. In total, 1,096 patients met inclusion and exclusion criteria. The greatest daily average opioid consumption per patient was in 2017 (61.6 ± 155.4 MME per day) and the lowest was in 2021 (31.8 ± 105.8 MME per day). Linear regression analysis detected a downward trend of 4.97 MME per day each year, though these results were not statistically significant (R 2: 0.444, p = 0.089). t-Test analysis, however, did reveal a significant decrease in opioid consumption in the postprotocol cohort (38.41 ± 90.5 vs. 52.18 ± 120.2; p = 0.034). There was a significant increase in preoperative Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores (p = 0.007) over time as well as a significant decrease in preoperative visual analog scale pain scores (p = 0.012). The results of this study show that opioid consumption in 2021 was lower than in 2016 and 2017. This result emphasizes the effectiveness of protocols limiting opioid usage during hospitalization following rTHA. Moreover, the relatively consistent patient-reported outcome scores over time demonstrate that this decrease in opioid consumption per year does not impact patient-reported outcomes and satisfaction.

Efficacy and safety of different bupivacaine concentrations in periarticular infiltration combined with adductor canal block for bilateral total knee arthroplasty: a randomized controlled trial

BackgroundPain management for bilateral total knee arthroplasty (BTKA) often combines adductor canal block (ACB) with periarticular infiltration (PAI). However, concerns arise regarding local anesthetic toxicity. This study evaluated the efficacy and safety of different bupivacaine concentrations in simultaneous BTKA.MethodsPatients undergoing simultaneous BTKA under spinal anesthesia were included in the study. They received ACB with 50 mg bupivacaine for each thigh. The patients were then randomized into two groups. Group A was administered a PAI of 100 mg bupivacaine per knee (totaling 300 mg bupivacaine for ACB and PAI). Group B received a PAI with 50 mg bupivacaine per knee (totaling 200 mg bupivacaine for ACB and PAI). Postoperative pain was assessed using a visual analog scale at 4-h intervals for 48 h after surgery. Plasma bupivacaine concentrations were measured at eight specified times. Postsurgery walking ability was also evaluated.ResultsAmong the 57 participants analyzed, visual analog scale pain scores revealed no significant differences between the two groups. An interim analysis of plasma bupivacaine concentrations in both groups indicated no significant disparities. In group B, 93.1% managed to walk with assistance within 48 h, as opposed to group A’s 71.4% (P = 0.041).ConclusionsCombining ACB with 100 mg bupivacaine and PAI with another 100 mg bupivacaine provided effective pain relief. This combination also had a better safety profile and led to more patients walking postsurgery than when combining ACB with 100 mg bupivacaine and PAI with 200 mg bupivacaine. Thus, ACB combined with PAI with a total dose of 200 mg bupivacaine appears suitable for simultaneous BTKA.Trial registration: ClinicalTrials.gov (NCT03249662).

Clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion and modified posterior lumbar interbody fusion in the treatment of lumbar degenerative disease

BackgroundTo compare the early clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) and modified posterior lumbar interbody fusion (MPLIF) in the treatment of lumbar degenerative disease (LDD).MethodsA total of 37 patients who underwent PE-PLIF and 58 patients who underwent MPLIF from March 2019 to January 2022 were retrospectively reviewed. The operation time, intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were recorded. The visual analogue scale (VAS) scores of leg pain and low back pain, Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI) scores were evaluated and compared before the operation, 3 days after the operation, 1 week after the operation, 1 month after the operation, 6 months after the operation and at the last follow-up. The modified MacNab’s criteria were applied at the last follow-up. The fusion rate and surgical-related complications during follow-up were recorded.ResultsThe average operation time in the PE-PLIF group was highly significant longer than that in the MPLIF group (P < 0.01). The intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were significantly less in the PE-PLIF group than those in the MPLIF group (P < 0.01). There were highly significant differences in VAS scores of leg pain, VAS scores of low back pain, JOA scores, ODI scores at the last follow-up compared with those before the operation in the two groups (P < 0.01). Three days after the operation and 1 week after the operation, the VAS scores for low back pain and ODI were highly significant less in the PE-PLIF group than that in the MPLIF group (P < 0.01). Three days after the operation, the JOA scores were highly significant higher in the PE-PLIF group than that in the MPLIF group (P < 0.01). All patients showed intervertebral fusion at 6 months after the operation. Two patients (5.4%) in the PE-PLIF group experienced complications.ConclusionBoth PE-PLIF and MPLIF surgery were clinically effective and safe for patients with single-segment LDD. PE-PLIF surgery is a promising technique that can be used as an alternative treatment for single-segment LDD.

Transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy for apical prolapse after total/subtotal hysterectomy: Chinese surgeons' initial experience.

To introduce a novel technique of transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy (ESLS) for apical prolapse and to evaluate the feasibility and short-term outcomes of this technique. Sixteen patients were enrolled to undergo ESLS between January 2020 and May 2021. Perioperative outcomes were included. Short-term results were assessed by Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Organ Prolapse Quantification (POP-Q) scores, mesh exposure and prolapse recurrence. A total of 14/16 cases (87.5%) were successfully completed. The mean operation time was 118min (range 85-160), and the mean blood loss was 68ml (range 20-100). The mean postoperative visual analog scale (VAS) pain score at 24h was 0.7. No intraoperative complications occurred except for one patient who developed subcutaneous emphysema. All patients gained a significant improvement in both physical prolapse and quality of life at 12 months after surgery, and there was no mesh exposure or prolapse recurrence. Our experience showed that transvaginal ESLS is a feasible and effective technique for apical prolapse with a previous hysterectomy. However, this technique should be performed by surgeons with extensive experience both in vaginal surgery and laparoscopic single-port surgery.

Comparison of Efficacy of Lignocaine Jelly versus Lignocaine Injection during Perineum Repair in Normal Vaginal Delivery

Background: Normal vaginal delivery is frequently associated with perineal trauma that can be iatrogenic (episiotomy) or spontaneous. Episiotomy is the most common surgical procedure in obstetrics being performed in approximately 20% of deliveries&#x0D; Objective: To compare the efficacy of lignocaine Jelly versus lignocaine injection during perineum repair after episiotomy in normal vaginal delivery. &#x0D; Methods: Study was done at Department of Obstetrics &amp; Gynecology, Shalamar Hospital, Lahore during September 2020 - Feb 2021. For this randomized control trial, a total of 160 women fulfilling selection criteria were recruited for study from labour room. Informed consent was obtained from each case. Women were then segregated in group A&amp; B and treatment was randomly allotted using lottery method, while in group A 2% lignocaine Jelly was applied on their perineum during active phase of labour at 8-9 cm cervical dilatation, before estimated time of one hour pre delivery. Women in group B were administered 10 ml of 1% lignocaine injection locally at the proposed site of episiotomy just before crowning. Then females were observed for pain and discomfort or adverse reactions during delivery, perineal repair and in immediate post partum period. After 2 hours of delivery, females were asked for perineal pain using visual analogue scale (VAS) then females were followed up in post-delivery wards for 12 hours. After 12 hours, they were discharged and asked for satisfaction of procedure.&#x0D; Results: The average ages of the cases among Group-A i.e. Lignocaine Jelly group and Lignocaine injection group (group-B) was 26.20 ± 3.32 years and 26.46 ±3.47 years respectively. The mean gestational age in Lignocaine Jelly group was 38.65 ± 0.90 weeks and in Lignocaine injection group was 38.67 ± 0.87 weeks. The mean BMI in Lignocaine Jelly and injection group was 26.70 ± 1.39 and 26.46 ± 2.20 respectively. Average pain score observed in Lignocaine Jelly was 3.58±1.06, whereas in Lignocaine injection group was 4.39 ± 1.26. There was statistically significant difference in average pain scores as the mean pain score in the Lignocaine Jelly group was lower compared with Lignocaine injection group ( p-value ≤ 0.001). In Lignocaine Jelly group 77(96.2%) females were satisfied while in Lignocaine injection group 68(85%) cases were satisfied, higher satisfaction rate was seen in lignocaine Jelly group, p-value (0.015) &#x0D; Conclusion: Women to whom lignocaine Jelly was applied before episiotomy had less mean VAS Pain Score and higher satisfaction rate during perineal repair than women who were given lignocaine injection for perineal repair. So lignocaine Jelly can be used as a good alternative of local infiltration of lignocaine injection, in term of less pain, less adverse effects and more patient satisfaction during perineal repair of birth process.&#x0D;

Comparative study of orthopaedic robot-assisted minimally invasive surgery and open surgery for limb osteoid osteoma

To compare the accuracy and effectiveness of orthopaedic robot-assisted minimally invasive surgery versus open surgery for limb osteoid osteoma. A clinical data of 36 patients with limb osteoid osteomas admitted between June 2016 and June 2023 was retrospectively analyzed. Among them, 16 patients underwent orthopaedic robot-assisted minimally invasive surgery (robot-assisted surgery group), and 20 patients underwent tumor resection after lotcated by C-arm X-ray fluoroscopy (open surgery group). There was no significant difference between the two groups in the gender, age, lesion site, tumor nidus diameter, and preoperative pain visual analogue scale (VAS) scores ( P>0.05). The operation time, lesion resection time, intraoperative blood loss, intraoperative fluoroscopy frequency, lesion resection accuracy, and postoperative analgesic use frequency were recorded and compared between the two groups. The VAS scores for pain severity were compared preoperatively and at 3 days and 3 months postoperatively. Compared with the open surgery group, the robot-assisted surgery group had a longer operation time, less intraoperative blood loss, less fluoroscopy frequency, less postoperative analgesic use frequency, and higher lesion resection accuracy ( P<0.05). There was no significant difference in lesion resection time ( P>0.05). All patients were followed up after surgery, with a follow-up period of 3-24 months (median, 12 months) in the two groups. No postoperative complication such as wound infection or fracture occurred in either group during follow-up. No tumor recurrence was observed during follow-up. The VAS scores significantly improved in both groups at 3 days and 3 months after surgery when compared with preoperative value ( P<0.05). The VAS score at 3 days after surgery was significantly lower in robot-assisted surgery group than that in open surgery group ( P<0.05). However, there was no significant difference in VAS scores at 3 months between the two groups ( P>0.05). Compared with open surgery, robot-assisted resection of limb osteoid osteomas has longer operation time, but the accuracy of lesion resection improve, intraoperative blood loss reduce, and early postoperative pain is lighter. It has the advantages of precision and minimally invasive surgery.

The Effect of Ice Massage Applied to the SP6 Point on Labor Pain, Labor Comfort, Labor Duration, and Anxiety: A Randomized Clinical Trial.

Acupressure and cold application are nonpharmacologic methods that midwives can use for labor pain. The purpose of this study was to determine the effects of ice massage applied to the SP6 acupressure point during labor on labor pain, labor comfort, labor duration, and anxiety. A single-masked, randomized controlled trial was conducted with 100 nulliparous women, including 50 in the intervention group and 50 in the control group. Rotational ice massage was applied to the SP6 point on both legs of the pregnant women in the intervention group at 4 to 5 cm, 6 to 7 cm, and 8 to 9 cm dilation amounts during 3 contractions. Routine oxytocin was administered to all pregnant women to promote progress of labor. Standard midwifery care was provided to the control group. Data were collected using a Personal Information Form, the Visual Analog Scale (VAS), a partograph form, the Childbirth Comfort Questionnaire (CCQ), and the State-Trait Anxiety Inventory State subscale. The VAS pain scores of the pregnant women in the intervention group were significantly lower compared with the control group following the intervention at dilatations of 4 to 5 cm, 6 to 7 cm, and 8 to 9 cm (P = .001, P = .003, P <.001, respectively). The total CCQ and comfort level scores of the pregnant women in the intervention group at 8 to 9 cm cervical dilatation were significantly higher than the control group (P = 0.044, P = .027, respectively). Additionally, as the anxiety levels of the pregnant women increased, their total comfort scores decreased (P <.05). Ice application to the SP6 point during stage 1 of childbirth reduced labor pain, increased comfort, and reduced anxiety levels. No adverse events were found in the intervention group with ice massage applied to the SP6 point. Therefore, this method can be used as a safe and effective midwifery intervention in childbirth.

Exploring the impact of mild-to-moderate foraminal stenosis at L5−S1 on clinical outcomes following L4−5 posterior lumbar interbody fusion

BACKGROUND CONTEXTPatients scheduled for L4−5 PLIF often have FS at L5-S1. However, data on the clinical and radiographic outcomes of cases with mild-to-moderate L5−S1 FS are lacking, which may affect clinical outcomes or require additional surgery after L4−5 fusion. PURPOSETo evaluate the clinical and radiographic outcomes of L4−5 PLIF in patients with and without mild-to-moderate L5−S1 FS, with a primary focus on the association between L5−S1 FS and postoperative clinical outcomes including back pain, leg pain, and scores on the oswestry disability index (ODI) and EuroQol 5-dimension (EQ-5D). STUDY DESIGNRetrospective comparative study. PATIENT SAMPLEA retrospective review of patients who underwent L4−5 PLIF from 2014 to 2018. The patients were divided according to the presence of mild-to-moderate FS at L5−S1. OUTCOME MEASURESClinical assessment included the pain visual analog scale (VAS), ODI, and EQ-5D score. Radiographic assessments included spinopelvic parameters and grades for central and foraminal stenosis. METHODSClinical outcomes were assessed using validated outcome measures at preoperative, 6-month, 12-month, and 36-month follow-up visits. Radiographic evaluations were performed using preoperative and postoperative radiographs. Foraminal stenosis was assessed qualitatively using MRI with a grading system from none to severe and quantitatively by measuring changes in the foraminal area on CT. RESULTSAmong 186 patients, 55 were categorized as the FS group and 131 as the non-FS group. The FS group was older (p=0.039) and had more severe central stenosis at L5−S1 (p=0.007) as well as more severe FS at both L4−5 and L5−S1 (both p<0.001). Preoperative disc height (p<0.001), C7-S1 sagittal vertical axis (p=0.003), lumbar lordosis (p=0.005), and pelvic incidence–lumbar lordosis mismatch (p=0.026) were more aggravated in the FS group. The FS group showed inferior clinical outcomes at the final follow-up in terms of back pain (p=.010) and ODI score (p=.003). CONCLUSIONThe presence of mild-to-moderate FS at L5–S1 was associated with more aggravated sagittal balance in terms of smaller preoperative disc height, larger sagittal vertical axis, smaller lumbar lordosis, and larger pelvic incidence–lumbar lordosis mismatch. Patients with L5−S1 FS also had poorer clinical outcomes including back pain and ODI score after L4−5 PLIF. Patients with L5−S1 FS need to be carefully examined before L4−5 fusion considering their adverse outcomes due to underlying degenerative changes.

Analgesic effects of ibuprofen soft and flexible absorbent foam dressing after colorectal surgery: A single-center comparative study

Abstract Background Postoperative wound care and pain management are crucial components of the postoperative recovery process. This study aims to evaluate whether the analgesic effects of the ibuprofen soft and flexible absorbent foam dressing are superior to those of traditional gauze after colorectal surgery. Materials and Methods Data pertaining to patients who underwent colorectal surgery between May 2021 and January 2022 were extracted from the electronic medical records database archive of a single institution. The ibuprofen soft and flexible absorbent foam dressing was applied to 62 patients for postoperative wound care, whereas gauze was used for 78 patients. Primary outcome measurements included the count of dressings, visual analog scale pain scores, analgesic dosage, complications, and length of hospitalization. Results The mean pain score on the 5th day postoperation was significantly lower for the ibuprofen group (2.03 ± 1.55) than for the control group (2.63 ± 1.72, p = 0.035). The mean dosage (mg) of parecoxib on the 3rd day postoperation was significantly lower for the ibuprofen group (2.58 ± 12.27) than for the control group (10.26 ± 21.80, p = 0.01). The cumulative number of dressing changes during the 1st week postoperation was significantly lower for the ibuprofen group (mean ± standard deviation, 3.00 ± 0.98) than for the control group (7.55 ± 2.68, p &lt; 0.001). No significant differences were observed in the complication rate or length of hospitalization between the groups. Conclusions The ibuprofen soft and flexible absorbent foam dressing can either enhance the analgesic effect during postoperative recovery or reduce the cost and dressing time associated with postoperative wound care.

Factors Affecting Patient Reported Outcomes Following Tibial Plateau Fracture

Background/Objective: &#x0D; Tibial Plateau Fractures (TPFs) account for ~1% of all fractures and ~8% of all fractures in the elderly. Despite the frequency and severity of TPFs there is a paucity of data evaluating factors that affect patient recovery after injury and surgical fixation. We hypothesized that patient reported outcomes are modulated by several variables including patient demographics, comorbidities, injury characteristics, and Social Determinants of Health (SDH). &#x0D; Methods: &#x0D; In this retrospective cohort study, we collected the interval patient reported outcome scores (PROs) of patients with TPFs treated with open reduction internal fixation occurring between February 2013 and November 2020. PROs included 1) Visual Analog Scale (VAS) pain scores, 2) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) scores, and 3) Physical Function (PF) survey scores. Patient demographics, comorbidities, fracture characteristics, insurance status, and area deprivation index (ADI) of the patient’s residence were collected via electronic medical record review. Bivariate analyses of PRO scores to the aforementioned factors were performed using generalized estimating equations to account for participant repeated measures, with p&lt;0.05 being considered significant. &#x0D; Results: &#x0D; 196 patients were evaluated with &gt;1 year follow-up. It was determined that patients’ insurance status affected their VAS (p0&lt;.001), PI (p&lt;0.001), and PF (p&lt;0.001) scores. Patient ADI affected VAS (p&lt;0.001) and PI (p=0.0026), with increased ADI scores resulting in worse PROs. Diabetes and depression were found to negatively impact VAS (p=0.010 &amp; 0.008 respectively) and PI (p=0.0044 &amp; 0.0048, respectively). Additionally, age and sex both influence VAS (p=0.0006 &amp; 0.0033, respectively), and compartment syndrome was associated with decreased PF (p=0.0206). &#x0D; Conclusion and Potential Impact: &#x0D; To our knowledge, this is the first investigation to evaluate the effect of SDH on patient recovery following surgical fixation of TPFs—suggesting that insurance status and residence ADI scores are associated with worsened PROs. Further investigation is necessary to identify if these factors are independent of other covariates.