Visual Analog Score Score In Group Research Articles

A comparative study of efficacy of fractional carbon dioxide laser with and without platelet rich plasma in treatment of facial acne scars

Scarring and facial disfigurement caused by severe acne can cause significant physical and psychosocial distress, particularly in adolescents. In treating acne scars, dermatologists face a therapeutic challenge. Ablative lasers Erbium YAG lasers or carbon dioxide lasers are effective, but they are associated with erythema, post-inflammatory hyperpigmentation, a longer recovery time, and scarring. With the introduction of fractional carbon dioxide lasers, acne scar treatment has become much more effective. PRP contains growth factors, which helps to speed up the natural healing process. As a result, combining fractional CO2 laser with platelet rich plasma has resulted in significant improvement of acne scars with good cosmetic results and skin rejuvenation. Through this study, we intend to assess the efficacy of fractional carbon dioxide laser with platelet rich plasma versus fractional carbon dioxide laser alone in the improvement of facial acne scars.To compare the efficacy of fractional carbon dioxide laser with and without platelet rich plasma (PRP) in treatment of facial acne scars.A total of 30 patients (18-40 years) with facial atrophic scars who attended the out-patient department at the Department of Dermatology, Venereology, and Leprosy, Adichunchanagiri Hospital and Research Centre, B.G. Nagara were randomly assigned to groups A (fractional CO2 with PRP group) and B (fractional CO2 group). Patients in both groups received four sequential treatments, with a four-week interval between each session. A side-by-side comparison of preoperative and post-operative photographs was used to assess the clinical improvement of atrophic scars one month after the last session, using Goodman and Baron's qualitative and quantitative grading system. Furthermore, patients were asked to provide feedback on scar improvement using the patient satisfaction Visual Analogue Score (VAS).Based on Goodman and Baron’s qualitative assessment one month after the last session (4 sessions), 13.33 percent (2) of patients in group A showed reduction by three grades compared to 6.66 percent (1) patient in group B, and 60 percent (9) of patients in both groups showed scar reduction by two grades. Based on Goodman and Baron’s quantitative assessment one month after the last session (4 sessions), 20 percent showed very good reduction in group A compared to 13.3 percent in group B, and 40 percent showed good reduction in group A compared to 33.3 percent in group B. [p=0.732, not statistically significant]. Patients treated with fractional carbon dioxide laser with PRP in group A had a slightly better mean percentage reduction of post acne scars at one month after the last session (4 sessions) compared to patients treated with fractional carbon dioxide laser in group B [75.83 vs 69.34 percent; p=0.72 which was statistically not significant]. At one month after the last treatment session (4 sessions), 66.67 percent (10) of patients in Group A were very satisfied with the treatment, compared to 46.67 percent (7) of patients in Group B. After four treatment sessions, the mean Patient Satisfaction VAS Score in Group A was 2.0, compared to 1.7 in Group B [p=0.000082, which was found to be statistically significant]. The result of this study shows that combination of fractional CO2 laser with intradermal PRP is slightly more efficacious than fractional carbon dioxide laser monotherapy in management of facial acne scars. Patients receiving fractional carbon dioxide laser with PRP were more satisfied with the treatment outcome.

A prospective randomised trial comparing the analgesic efficacy of postoperative infusion of epidural bupivacaine and ropivacaine in orthopaedic surgeries

Background: Epidural administration of local anaesthetic provides effective pain relief. Commonly used epidural local anaesthetics are bupivacaine and ropivacaine. Most studies compared these drugs along with an opioid or any other adjuvants like clonidine, dexmedetomidine etc. Our aim was to compare the analgesic efficacy and safety of continuous infusion of epidural ropivacaine and bupivacaine without any adjuvants in postoperative patients. Materials and methods: A prospective randomized clinical study was conducted in a tertiary care hospital in 60 patients between the age groups of 20-years and 60-years undergoing elective lower limb orthopaedic procedures. Total patients were divided into two groups (A and B) of 30 each. Continuous epidural infusion was started with 6ml per hour of 0.125% bupivacaine in Group A and 6ml per hour of 0.2% ropivacaine in Group B postoperatively. After the commencement of epidural infusions, heart rate, blood pressure, Visual Analogue Score (VAS) and supplementary analgesic requirement were monitored postoperatively for 48 hrs. Results: Our observations showed no significant difference in haemodynamic parameters like heart rate and blood pressure. VAS showed a statistically significant difference with higher mean VAS score in Group B patients at one hour (p value = 0.0126), 12 hrs (p value = 0.031) and 24 hrs (p value = 0.0421) as compared to Group A. Add on analgesic requirement was also higher for Group B patients. Conclusions: Both bupivacaine and ropivacaine can be used effectively for postoperative analgesia but bupivacaine has a superior analgesic efficacy than ropivacaine with similar safety profile.

Ultrasound-guided monopolar versus bipolar radiofrequency ablation for genicular nerves in chronic knee osteoarthritis pain: A randomized controlled study

BackgroundThis study compared between monopolar and bipolar radiofrequency (RF) ablation of the genicular nerves using ultrasound guidance (USG) in chronic knee osteoarthritis pain. Material and methodsThis was a prospective, randomized, double-blind study. Fifty patients with knee osteoarthritis pain were equally randomized to either monopolar or bipolar groups. The primary outcome was visual analogue score (VAS). The secondary outcomes were the proportion of successful responders with a reduction of 50% of VAS score at 12 and 24 weeks, the procedure time and pain and oxford knee score (OKS).VAS and OKS were recorded at 1, 4, 12, 24 weeks after intervention. Any complications were reported. ResultsMean VAS score in bipolar group was (p < 0.05) lower than monopolar group at 12 weeks [4.84 ± 0.62 Vs. 3.56 ± 0.71] and 24 weeks [5.44 ± 0.82 Vs. 3.96 ± 0.79]. The Proportion of successful responders with a reduction of at least 50% of VAS score were more in bipolar group than monopolar group at 12 weeks (80% Vs. 12%) and 24 weeks (44% Vs. 4%). Mean OKS score in bipolar group was (p < 0.05) lower than monopolar group at 12 weeks [26 ± 3 Vs. 34 ± 3] and 24 weeks [27 ± 3 Vs. 35 ± 3].The procedure time and pain were (p < 0.05) lower in monopolar than bipolar group. The complications were similar in both groups. ConclusionUSG bipolar RF ablation is more effective than monopolar RF ablation in controlling knee osteoarthritis pain as for the duration and severity of pain without fluoroscopic confirmation.

Autologous adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistula: a prospective case-control study

BackgroundComplex cryptoglandular perianal fistula (CPAF) is a kind of anal fistula that may cause anal incontinence after surgery. Minimally invasive surgery of anal fistula is constantly emerging. Over the past 20 years, there are several sphincter-sparing surgeries, one of which is autologous adipose-derived stem cell (ADSC) transplantation. However, to date, there is no study regarding the treatment of complex CPAF with ADSC in China. This is the first study in China on the treatment of complex CPAF with ADSC to evaluate its safety and efficacy.MethodsTotally, 24 patients with complex CPAF were enrolled in this prospective case-control study from January 2018 to December 2019 in the National Colorectal Disease Center of Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine. Patients were divided into ADSC group and endorectal advancement flap (ERAF) group according to their desire. The healing of fistulas (healing of all treated fistulas at baseline, confirmed by doctor’s clinical assessment and magnetic resonance imaging or transrectal ultrasonography) was evaluated at week 12 after treatment. In addition to their safety evaluation based on adverse events monitored at each follow-up, the patients were also asked to complete some scoring scales at each follow-up including pain score with visual analog score (VAS) and anal incontinence score with Wexner score.ResultsThe closure rates within ADSC group and ERAF group at week 12 were 54.55% (6/11) and 53.85% (7/13), respectively, without significant difference between them. VAS score in ADSC group was significantly lower than that in ERAF group at the 5th day postoperatively [1(0,2) VS 2(2,4), p = 0.011], but no differences were observed at the other time. Wexner score of all patients was not increased with no significant differences between the two groups. Adverse events were observed fewer in ADSC group (27.27%) than that in ERAF group (53.85%), but there was no significant difference between them.ConclusionThis study indicated safety and efficiency of ADSC for the treatment of complex CPAF in the short term, which is not inferior to that of ERAF. ADSC may provide a promised and potential treatment for complex CPAF conforming to the future of the treatment, which is reconstruction and regeneration.Trail registrationChiCTR, ChiCTR1800014599. Registered 23 January 2018—retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=24548

PREOPERATIVE INTRAVENOUS TRAMADOL FOR PERCUTANEOUS NEPHROSTOMY TO REDUCE INTRAOPERATIVE PAIN

Objective: To evaluate the effect of additional preoperative intravenous tramadol for reducing intraoperative pain. Material &amp; Methods: This study was a double blind randomized controlled study from April - June 2017 in Urology Department in Hasan Sadikin Hospital. Inclusion criteria were cervical cancer patients who were performed percutaneous nephrostomy. Exclusion criteria were patients with infection and pain before the procedure. Written informed consent was obtained from each patient and the study protocol was approved by the local human ethics committee. The subjects were randomly divided into 2 groups. Group A were given 100 ml dripped normal saline 1 hour before the procedure and intraoperative local anesthesia with lidocaine 2% and group B were given preoperative intravenous tramadol 100 mg dripped within 100 ml of normal saline 1 hour before the procedure and intraoperative lidocaine 2%. Visual Analogue Score (VAS) were used to evaluate the pain score. All calculation were done using SPSS version 20. Results: There were 60 cervical cancer patients who were performed percutaneous nephrostomy (29 patients in Group A and 31 patients in Group B). The mean age in group A was 48.86 ± 8.524 (years old) and the mean age in group B was 51.90 ± 6.76 (years old). The median VAS score in group A was 4, with the minimum score was 2.00, maximum score was 6.00. The median VAS score in group B was 2, with the minimum score was 0.00, maximum score was 4.00. In group A, 11 patients (18.3%) were mild pain, 16 patients (26.7%) were moderate pain, 2 patients (3.3%) were severe pain. In group B, 29 patients (48.3%) were mild pain, 2 patients (3.3%) were moderate pain, 0 patients (0.0%) were severe pain. Based on Mann-Whitney U test, there was a significant pain score reduction in group B compared to group A (p=0.0001). There were no significant differences in the prevalence or proportion of patients with nausea and vomiting in group A and B (10% and 12%, respectively). There were no other adverse events and other complications observed in both groups. Conclusion: Preoperative intravenous tramadol significantly reduced intraoperative pain in cervical patients who were performed percutaneous nephrostomy compare to those who were only given intraoperative local anesthesia.

The Effect of Adding Dexmedetomidine or Fentanyl to Levobupivacaine for Ultrasound-guided Supraclavicular brachial plexus block in Upper Extremity Sugeries

Background: Supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. It has gained importance as regional anesthetic technique for surgical, diagnostic and therapeutic purpose in interventional pain management. Aim: We aimed to study the effect of adding dexamedetomidine or fentanyl to levobupivacaine in ultrasound guided supraclavicular brachial plexus block in upper extremity surgeries as regard to onset and duration of sensory and motor block and postoperative pain. Methods and Material: The study was carried out in Tanta University Hospital on 90 patients of 18-60 years old with ASA physical status I/II scheduled for elective surgery of upper hand. Patients were divided into three equal groups. Group A: was given 30 ml of 0.5% levobupivacaine with fentanyl 100 µg. Group B: was given 30 ml of 0.5% levobupivacaine with dexamedetomidine 100 µg. Group C: was given 30 ml of 0.5% levobupivacaine with 1ml normal saline. The following data were measured for each patient: hemodynamic status (HR, MAP), onset of sensory and motor block, and duration of sensory and motor block, visual analogue score (VAS) and incidence of complications. Results: Our results showed that no significant difference between three groups according to hemodynamic changes, while there was significant prolongation in duration of sensory and motor block, significant decrease in VAS score in group B compared to group A and C. Conclusions: We concluded that the addition of dexmedetomidine was better than fentanyl when both used as adjuvants to levobupivacaine in ultrasound guided brachial plexus block as demonstrated by prolongation of duration of sensory block, improved quality of postoperative analgesia and provide of desirable sedation

A Comparative Study to Evaluate the Efficacy of Butorphanol as an Adjuvant to Epidural Analgesia for Rib Fractures

Abstract Introduction: Pain management via epidural catheters have emerged as an optimal method of pain control in patients with rib fractures (RF). This study was done to evaluate the efficacy of butorphanol in this subset of patients. Materials and methods: Sixty patients were randomly allocated in two groups R (ropivacaine only) and B (ropivacaine with butorphanol). Group R patients received 0.2% ropivacaine epidurally (10 mL) while group B patients received 0.2% ropivacaine and 1 mg butorphanol epidurally (10 mL). Baseline respiratory rate, oxygen saturation, partial pressure of oxygen (PaO2), visual analog score (VAS), peak inspiratory flow rate (PIFR) were noted in both the groups. Results: There was significant increase in duration of analgesia and nonsignificant reduction in VAS score in group B, and nonsignificant decrease in invasive ventilation cases and significant reduction in length of intensive care unit (ICU) stay in group B. There were no significant adverse effects in both the groups except for nausea in group B. Conclusion: Butorphanol as an adjuvant to epidural analgesia leads to better oxygenation, decrease in length of ICU stay and duration of mechanical ventilation without increase in significant side effects.

A comparative study to evaluate the efficacy of butorphanol as an adjuvant to epidural analgesia for rib fractures

Background: Pain management through epidural catheters has emerged as optimal method of pain control in patients with rib fractures. This study was done to evaluate the efficacy of butorphanol in this subset of patients. Materials and Methods: Sixty patients were randomly allocated in two Groups R and B. Group R patients received 0.2% ropivacaine epidurally (10 mL) while Group B patients who received 0.2% ropivacaine and 1 mg butorphanol epidurally (10 mL). Baseline respiratory rate, oxygen saturation, partial pressure of oxygen, visual analog score (VAS), and peak inspiratory flow rate were noted in both the groups. Results: There was a significant increase in duration of analgesia and nonsignificant reduction in VAS score in Group B and nonsignificant decrease in invasive ventilation cases and significant reduction in length of Intensive Care Unit (ICU) stay in Group B. There were no significant adverse effects in both the groups except for nausea in Group B. Conclusion: Butorphanol as an adjuvant to epidural analgesia leads to better oxygenation, decreased length of ICU stay, and duration of mechanical ventilation without increase in significant side effects.

PERIPROSTATIC NERVE BLOCK AND INTRAPROSTATIC INFILTRATION ON TRUS-P GUIDED BIOPSY

Objective: This study is aimed to determine the effectiveness and complications of periprostatic block and intraprostatic infiltration anesthesia for transrectal prostate biopsy. Material &amp; Method: Two consecutive group of patients, periprostatic block (group A) and intraprostatic infiltration (group B), underwent transrectal ultrasound (TRUS) guided prostate biopsy were entered into the study. Exclusion criteria were severe systemic infection, local infection (prostatitis, proctitis, anorectal abscess, and fissure), hemorrhoid (external and/or internal), and chronic pelvic pain (bladder pain syndrome (BPS) or other pelvic disease. Each group enrolled 58 patients. The patients were requested to choose indicate degree of pain on visual analog score (VAS) 3 times, during probe insertion (VAS1), during anesthesia (VAS2), and during the biopsy (VAS3). Complications from the procedures were recorded. The data were analyzed using Mann-Whitney and independent t-test. Results: There were no significant difference in average age of groups, 65,69 ± 7,019 years for group A and 65,34 ± 7,633 years for group B (p = 0,647). The VAS3 score of group B 5,17 ± 0,653 was significantly lower than group A 5,9 ± 0,612 (p &lt; 0,001). The change in VAS score (VAS3-VAS2) in group B 0,55 ± 0,535 also significantly lower than group A 1,00 ± 0,530 (p = 0,004). The average days with pain were not significant on both group, group A 1,16 ± 0,362 day and group B 1,12 ± 0,329 day (p = 0,594). The duration of bleeding was significantly higher on group B 1,32 ± 0,562 day than group A 1,10 ± 0,307 day (p = 0,026). Conclusion: Intraprostatic infiltration resulted in less pain during prostate biopsy, but also reported more bleeding after the procedure than the periprostatic block.Keywords: Intraprostatic infiltration, periprostatic nerve block, transrectal ultrasound guided prostate biopsy.

Intrasomatic injection of corticosteroid followed by vertebroplasty increases early pain relief rather than vertebroplasty alone in vertebral bone neoplasms: preliminary experience

In this prospective multicenter study, we evaluate the effectiveness of corticosteroid plus vertebroplasty rather than vertebroplasty alone in the analgesic treatment of single-level vertebral neoplasms or pathological fractures. From January 2009 to February 2011, we prospectively enrolled 20 consecutive patients (11 women, nine men; age range 46-78 years; mean age 65.1 years) with single-level vertebral neoplasm or pathological fractures totally or partially refractory to analgesic treatment, with indication to vertebroplasty. Institutional review board approval and informed consent were obtained. The inclusion criteria for the study were the presence of a single-level pathological fracture not extended to the posterior wall or symptomatic localization of primary or secondary neoplasms, visual analogue score (VAS) ≥5, and life expectancy more than 3 months. Exclusion criteria where all contraindications either to corticosteroid injection included allergy (local sepsis, bacteremia, allergy) or vertebroplasty included coagulopathy, etc. The population was randomly divided into two groups: in group A, patients underwent intrasomatic injections of 4 mg/ml of dexamethasone phosphate followed by a cement injection; patients in group B underwent standard vertebroplasty. VAS score was evaluated and compared between both groups of patients at 6 h, 24 h, 48 h, 7 days, 30 days, and 3 months after the intervention plus last available follow-up. Statistical analyses were performed by application of the t test. Technical success was achieved in all cases. In group A, we treated six male and six female patients (age range 46-73 years, average 60.2 years). Pre-intervention VAS in group A ranged between 7 and 10 points, average 8 points. In group B, we treated three male and five female patients (age range 52-78 years, average 67.3 years). Pre-intervention VAS score in group B ranged between 7 and 9 points, with an average 8 points. Patients in group A in respect to patients in group B had a higher reduction in VAS, with a difference of 25.4% (VAS reduction average 5.5 versus 4.1) at 6 h post-intervention, 24.5% (VAS average 5.7 versus 4.3) at 24 h, 25% (VAS average 6 versus 4.5) at 48 h, 23% (VAS average 6.5 versus 5) at 7 days, 16.4% (VAS average 6.7 versus 5.6) at 30 days, 8.9% (VAS average 6.7 versus 6, .1) at 3 months. The last available follow-up ranged from 3 to 24 months in group A and from 5 to 20 months in group B. In our preliminary experience, pre-vertebroplasty injection of intrasomatic corticosteroid in comparison to vertebroplasty alone is able to increase the early pain relief of the procedure.