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Purpose: Many techniques are used to treat fistula-in-ano (FIA). The major problems associated with conventional surgical techniques are postoperative complications like sepsis, incontinence, etc. Therefore, several sphincter-saving techniques have been developed in recent years including laser diodes.Methods: This study presents an early experience of the use of diode lasers with a capacity of 360° radial energy emission endofistula laser ablation (EFLA) of FIA to treat patients with primary low anal fistulas. The primary and secondary success rates were assessed and the factors affecting these rates were evaluated in patients (n=31) who presented with primary, uncomplicated, and low anal fistulas.Results: Out of 31 patients, 19 (61.3%) were males and 12 (38.7%) were females with a mean age of 38.6±11.5 years. Twenty-one patients (67.7%) had intersphincteric fistula, 9 (29.0%) had transsphincteric fistula, and 1 (3.2%) had suprasphincteric fistula. Thirteen patients (41.9%) had undergone some surgery in the past for FIA. Eleven patients (35.5%) developed postoperative complications. The patients had a low median pain score of 3 on the numeric pain rating scale. The primary success rate was 67.7% (21 of 31) and the secondary success rate was 80.0% (8 of 10) over a median follow-up of 2 years. A significantly higher primary healing rate was observed in patients who did not undergo any prior surgical treatments (P=0.01).Conclusion: EFLA resulted in moderate primary and high secondary success rates and was not associated with major postoperative complications. Therefore, EFLA can be considered as a preferred noninvasive efficient technique for FIA treatment.

OBJECTIVE Precise and accurate targeting is critical to optimize outcomes after stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). The aim of this study was to compare the outcomes after SRS for TN in which two different techniques were used: mask-based 4-mm cone versus frame-based 5-mm cone. METHODS The authors performed a retrospective review of patients who underwent SRS for TN at their institution between 1996 and 2019. The Barrow Neurological Institute (BNI) pain score and facial hypesthesia scale were used to evaluate pain relief and facial numbness. RESULTS A total of 234 patients were included in this study; the mean age was 67 years. In 97 patients (41.5%) radiation was collimated by a mask-based 4-mm cone, whereas a frame-based 5-mm cone was used in the remaining 137 patients (58.5%). The initial adequate pain control rate (BNI I–III) was 93.4% in the frame-based 5-mm group, compared to 87.6% in the mask-based 4-mm group. This difference between groups lasted, with an adequate pain control rate at ≥ 24 months of 89.9% and 77.8%, respectively. Pain relief was significantly different between groups from initial response until the last follow-up (≥ 24 months, p = 0.02). A new, permanent facial hypesthesia occurred in 30.3% of patients (33.6% in the frame-based 5-mm group vs 25.8% in the mask-based 4-mm group). However, no significant association between the BNI facial hypesthesia score and groups was found. Pain recurrence occurred earlier (median time to recurrence 12 months vs 29 months, p = 0.016) and more frequently (38.1% vs 20.4%, p = 0.003) in the mask-based 4-mm than in the frame-based 5-mm group. CONCLUSIONS Frame-based 5-mm collimator SRS for TN resulted in a better long-term pain relief with similar toxicity profiles to that seen with mask-based 4-mm collimator SRS.

The aim of this study was to determine the rate of persistent pain following total TMJ replacement and to identify potential predictive risk factors. A retrospective review of case notes treated by a single surgeon in a tertiary unit was performed. For each patient a number of variables were recorded including visual analogue pain scores (0 to 10) and opioid usage pre surgery and at 12 months or last follow up beyond 12 months. Persistent pain scores of 5 to 7 were regarded as moderate and 8 to 10 as severe. The mean pain score at last follow-up was significantly lower than preoperatively (2.1 vs. 6.3, p 0.001) with a mean follow-up time of 40.1 months (range 12-44). 16.4% of the patients reported moderate to severe pain and 13.7% were still on regular opioids at the last follow-up. Therefore 15 patients (20.5%) suffered from chronic postoperative pain after TMJ replacement surgery. Patients reporting severe preoperative pain scores (p = 0.04), regular opioid use (p = 0.001) or multiple previous open TMJ surgeries (p = 0.03) were more likely to suffer from chronic persistent pain and these should be regarded as predictive risk factors. The identification of these factors allows for better risk stratification of patients, informed consent and the agreement of expected outcomes. Patients with true articular disease and a single failed surgery should be considered for early total TMJ replacement to minimise multifactorial persistent pain.

OBJECTIVE Spinal cord stimulation (SCS) has been considered an ineffective procedure for patients with central poststroke pain (CPSP). However, recent case series that included small numbers of patients reported the possible efficacy of SCS as a treatment of CPSP. This multicenter retrospective study aimed to examine the outcomes of using SCS to treat patients with CPSP and to explore factors related to outcomes. METHODS The authors reviewed the medical records of patients with CPSP who underwent SCS to collect data regarding their background, surgical information, and outcomes of SCS at trial stimulation and last follow-up after long-term implantation in six study centers. Outcomes were evaluated with a pain score for intensity (range 0–10) and the Patient Global Impression of Changes (PGIC) scale. Factors associated with outcomes were explored with univariable and multivariable analyses. RESULTS The authors collected data from a total of 166 patients (mean age 63.4 years; mean pain score at baseline 8.2). Of these patients, 163 underwent trial stimulation. The mean pain score decreased by 42.0%, 104 (64%) patients had ≥ 30% decrease in pain score, and 96 (59%) reported much or very much improved condition on the PGIC scale at trial stimulation. Moreover, 106 (64%) patients underwent long-term implantation of SCS devices. The mean decrease in pain score was 41.4%, 63 (59%) patients continued to show ≥ 30% decrease in pain score at last follow-up, and 60 (56%) reported much or very much improved condition on the PGIC scale at last follow-up (median [range] follow-up period 24 [24–63] months). Eleven device-related complications and 10 permanent explantations were observed. Univariable and multivariable analyses suggested that young age, less sensory disturbance, implantation of cervical leads, treatment of upper-limb pain, and extensive treated regions were associated with satisfactory outcomes at last follow-up after long-term implantation. CONCLUSIONS These findings indicate that SCS may modestly benefit patients with CPSP. SCS has therapeutic potential for patients with intractable CPSP owing to the lower invasiveness of the SCS procedure and refractory nature of CPSP. Nevertheless, trial stimulation is necessary because of the high initial failure rate.

BACKGROUND: Arthrodesis and metallic hemiarthroplasty are two surgical interventions for the treatment of end-stage osteoarthritis of the first metatarsophalangeal (MTP1) joint. This systematic review and meta-analysis aims to compare the two operations with regards to patient-reported outcomes, pain reduction, complications and revision rates. METHODS: A systematic literature search identified all relevant studies. The methodological quality was assessed using two validated tools. Data of interest were derived and presented. For non-comparative studies, data was assessed for trends, while for comparative studies pooling statistics were performed. RESULTS: A total of 33 studies were included for analysis. The majority of studies (>75%) reported an AOFAS-HMI score greater than 80 points after both metallic hemiarthroplasty and arthrodesis. The lowest VAS pain score was observed after arthrodesis (weighted mean difference -1.58, 95% confidence interval (CI) -2.16 to -1.00 P< 0.00001). Comparable numbers of complications (odds radio 1.48, 95% CI 0.81 to 2.73, P = 0.21, favoring: hemiarthroplasty) and revisions (odds ratio 1.16, 95% CI 0.62 to 2.15 P = 0.64, favoring: hemiarthroplasty) were observed after both interventions. The included non-comparative studies seem to confirm these findings of the comparative studies. CONCLUSION: Metallic hemiarthroplasty and arthrodesis have excellent clinical outcomes and acceptable complication- and revision rates. Arthrodesis seems to be superior in pain reduction, while metallic hemiarthroplasty is a suitable alternative for patients performing activities that requires motion in the first metatarsophalangeal joint.

Background There are well-documented racial and ethnic disparities in treatment and perioperative outcomes for patients with adolescent idiopathic scoliosis. Aims We hypothesize that implementation of a coordinated care pathway for pediatric patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis may be associated with a reduction in racial and ethnic disparities in perioperative outcomes. Methods This is a retrospective pre- and post-test cohort study of patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis at our institution between July 1, 2013 and August 5, 2019. We implemented a coordinated care pathway in March 2015. Patient demographics included age, race, ethnicity, weight, gender, insurance status, ASA class, time between the date surgery was ordered and the date surgery occurred, degree of scoliosis, and number of spinal levels fused. The primary outcome was length of stay. Secondary outcomes included transfusion rates, pain scores, and postoperative complications. Multivariable regression models compared outcome medians across race/ethnicity. Disparities were defined as the difference in adjusted outcomes by race/ethnicity. Results 424 patients underwent posterior spinal fusion for adolescent idiopathic scoliosis at our institution (116 pre-pathway and 308 post-pathway). The median length-of-stay of Black patients was 1.0 day (95% CI: 0.4, 1.5; p=0.006) longer than White patients pre-pathway. Pre-pathway patients who self-identified as Other had a 1.2 (95% CI: 0.5, 1.9; p=0.004) higher median average pain score on postoperative day 1 compared to White patients. On postoperative day 2, patients who identified as Other had 2.0 (95% CI: 0.8, 3.2; p=0.005) higher pain score compared to White patients pre-pathway. Post-pathway, there were no significant differences in outcomes by race/ethnicity. Conclusions Our study supports the hypothesis that use of a coordinated care pathway is associated with a reduction in racial and ethnic disparities in length of stay and pain scores in pediatric patients undergoing posterior spinal fusion.

Purpose This study assessed adherence to, feasibility of, and barriers and facilitators of implementation of an app developed to monitor and follow-up with pain in children with cancer at home. Methods Children (8–18 years) receiving cancer treatment (all diagnoses) or their parents (of children aged 0–7 years) used the KLIK Pain Monitor app for 3 weeks. Pain was assessed twice daily using an 11-point numeric rating scale (NRS-11) (ranging from 0 to 10). Healthcare professionals (HCP’s) from the hospital’s Pediatric Pain Service were instructed to follow-up with clinically significant pain scores (≥ 4) within 120 min (scores 4–6) or 30 min (scores 7–10). Adherence, feasibility, and implementation outcomes were assessed using questionnaires, app log data, and interviews. Results Twenty-seven children (M age = 7.3 years, 51.8% male) and six HCP’s participated. Sixty-three percent (N = 17) of families used the app on a daily basis during three weeks, and 18.5% (N = 5) reported pain scores twice daily during that time (family adherence). Twelve out of 27 children (44.4%) reported a clinically significant pain score at least once. In 70% (14/20) of clinically significant pain scores, HCP’s followed-up with families within the set timeframe (HCP adherence). Outcomes reveal feasibility for the majority of app functions (i.e., positive evaluation by ≥ 70% families/HCP’s), and non-feasible aspects could be resolved. Identified barriers and facilitators were used to improve future implementation efforts. Conclusion Use of the KLIK Pain Monitor app seems feasible. Future research will determine its effectiveness in reducing pain in children with cancer at home.

Present study was aimed to explore the impact of ginger and peppermint in adolescents suffering with primary dysmenorrhea. For that purpose, 150 adolescents, aged 13-22 years, with regular menstruation suffering with moderate to severe dysmenorrhea (scoring 3-5 on pain scale) and preferably not taking any medication were enrolled and randomly divided into three groups i.e. control, ginger and peppermint. Baseline data was collected with help of self-administered questionnaire. To determine comparative analgesic effect of ginger and peppermint, capsules were formulated, and each group received total number of 15 capsules in a month (3 capsules/day for consecutive 5 days). Compared with baseline data, ginger was found more effectual than peppermint in releasing dysmenorrhea i.e. observed scoring in case of ginger was reduced from mean value of 4.13 ± 0.63 to 2.10 ± 1.52 (p = 0.001). Similarly, ginger intervention exhibited gradual betterment of 10% in symptoms of dysmenorrhea but also affected blood pressure positively (p < 0.05). However, blood hemoglobin and serum calcium levels acted as independent variables in ginger and peppermint groups (p > 0.05), not affected by any mode of intervention. It was concluded that ginger exhibited superior impact in lowering pain as compared to peppermint and control groups.

Objective: To explore the effect of modified nasogastric tube placement and Rehabilitation New Liquid Spray in patients with indwelling gastric tube. Methods: Eighty-six cases with indwelling gastric tube in our hospital from January 2020 to May 2021 were randomly selected and divided into the reference group and the research group. The reference group was treated by modified gastric tube placement, and the research group was given the Rehabilitation New Liquid Spray intervention. The effect of the interventions on two groups was observed. Results: The incidence of nasal mucosal injury in the research group was lower than that in the reference group, and the incidence of pharyngeal mucosal injury in the research group was lower than that in the reference group (P < 0.05). The pain score of the study group was lower than that of the reference group at 8 h, 12 h and 24 h after replacement, and the incidence of hoarseness, swallowing discomfort and dry oropharynx was lower than that of the reference group (P < 0.05). Conclusion: The application of modified gastric tube placement and Rehabilitation New Liquid Spray intervention in patients with indwelling gastric tube can effectively reduce the nasopharyngeal injury and improve the pain of catheterization.

Purpose: To compare postoperative opioid consumption, inflammatory response, survival/clinical outcomes and safety profile of epidural combined with general anesthesia (GA) versus GA in stage 1 gastric cancer patients undergoing surgical intervention by laparoscopy.Method: Chinese patients with early-stage gastric cancer undergoing laparoscopic-assisted tumor resection were enrolled and received either epidural combined with general anesthesia (group EA + GA) or general anesthesia only (group GA) in allocation ratio of 1:1. The following efficacy variables were assessed: 1) Pain score was measured on VAS scale; 2) post-operative consumption; 3) Quality of recovery; 4) inflammatory response; and 5) survival outcome. Safety was assessed throughout the study period.Results: Data for 200 subjects were analyzed. Compared to GA alone, combination of EA + GA demonstrate significantly greater reduction in post-operative pain with decrease postoperative opioid consumption. Also, the combination of GA and EA inhibited inflammatory response when compared to patients who received GA only. Moreover, the combination of GA and EA did not demonstrate any clinical benefit in survival outcome, when compared to patients who received GA alone, indicating that GA + EA has no role in improving survival outcome among patients undergoing gastric cancer surgery. Additionally, EA + GA was also associated with a shorter length of hospital stay, compared to GA.Conclusion: Overall, the results favor the use of GA + EA in Chinese patients with early-stage gastric cancer undergoing laparoscopic-assisted tumor resection. GA + EA combination improves immune response by inhibiting the inflammatory response but has no significant effect on survival outcome.

The aim of this study was to present a systematic review of the effectiveness of discopexy in managing internal derangement of the temporomandibular joint (TMJ).We searched MEDLINE through PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials and grey literature accessed through Google Scholar, Openthesis, and hand-searching from inception to July 2020. The search strategy yielded 363 potentially relevant studies. After screening titles and abstracts, 41 full-text articles were assessed for eligibility and 7 studies were included in the meta-analysis.There was an overall decrease in visual analog scale (VAS) pain score of 4.59 cm (95% confidence interval [CI], 2.03-7.16; P.001) during the follow-up time and an overall increase of 10 mm (95% CI, 6.93-13.01; P.001) in mouth opening after TMJ surgeries with discopexy.The available evidence showed an overall decrease in VAS pain score and an improvement in mouth opening after TMJ surgeries with discopexy. Changes in maximal interincisal opening were greater after arthroscopic disk repositioning compared to open-joint procedure.

Aims Studies on long-term patient-reported outcomes after open surgery for triangular fibrocartilage complex (TFCC) are scarce. Surgeons and patients would benefit from self-reported outcome data on pain, function, complications, and satisfaction after this surgery to enhance shared decision-making. The aim of this study is to determine the long-term outcome of adults who had open surgery for the TFCC. Methods A prospective cohort study that included patients with open surgery for the TFCC between December 2011 and September 2015. In September 2020, we sent these patients an additional follow-up questionnaire, including the Patient-Rated Wrist Evaluation (PRWE), to score satisfaction, complications, pain, and function. Results A total of 113 patients were included in the analysis. At ≥ 60 months after an open TFCC reinsertion, we found a mean PRWE total score of 19 (SD 21), a mean PRWE pain score of 11 (SD 11), and a PRWE function score of 9 (SD 10). The percentage of patients obtaining minimum clinically important difference rose from 77% at 12 months to 83% at more than 60 months (p < 0.001). Patients reported fewer complications than surgeons, and overall complication rate was low. Conclusion Outcomes of patient-reported pain, function scores, and satisfaction are improved five years after open surgery for the TFCC. Cite this article: Bone Jt Open 2021;2(11):981–987.

Background and Purpose Fibrocystic disease (FCD) of the breast as a very common health problem in women has estrogen-dependent and proliferative features. No effective management strategy has been validated for this disorder, so far. The anti-hyperglycemic agent metformin has both anti-proliferative and estrogen-suppressing effects. Thus, we investigated metformin as a management strategy for FCD. Methods The study was a double-blind placebo-controlled randomized clinical trial. Premenopausal women with FCD according to history, physical exam and ultrasound, who had measurable microcyst clusters on ultrasound (US) were entered the study. Oral placebo and metformin tablets (500 mg) were used twice daily by participants in the intervention and control groups. Size and number of microcyst clusters on US and the subjective pain score were recorded before and after the intervention. Results 154 participants were randomly allocated into two groups of 77 interventions and 77 controls. The decrease in size of the largest microcyst cluster in each patient and the mean decrease in number of microcyst clusters were not statistically significant (P = 0.310 and P = 0.637, respectively). However, those microcyst clusters which were ≥ 14 mm became significantly smaller after metformin use (P = 0.006). Additionally, in the subset of participants with pain at baseline, a larger proportion in the intervention group experienced at least 50% reduction in pain score (63.8% (30/47) in the intervention vs. 44.2% (19/43) in the placebo groups, P = 0.031). Conclusion Our study showed that metformin might be effective in the management of FCD. Further studies are proposed for confirmation of this subject. Graphical abstract

PURPOSE Auricular pseudocyst (AP) is a benign, noninflammatory swelling to the ear, located on either the front or side surface. Deroofing surgery with variable compression methods is considered the most effective method. However, post-operative wound pain is the main drawback following compression. We are introducing a novel painless surgical procedure which involves deroofing technique followed by Merocel® compression dressing. METHODS From 2015 to 2020, thirty-one patients with AP received this new surgical compression method in our university-affiliated tertiary hospital. Retrospective chart review and the analysis of the results were conducted. RESULTS All patients had unilateral lesions, with left side lesions (58.1%) predominant. The concha cymba (38.7%) and concha cavum (35.8%) were the most common sites. Previous aspiration or drainage had been performed for the cysts in eight patients (25.8%). Only one patient had the recurrence after post-operative 3 months and received the revised surgery without following recurrence and discomfort. Among all patients, 29 (93.5%) patients claimed minimal pain around 0 or 1 in numeric rating scale of pain score. Three patients had mild ecchymosis but recovered after conservative treatment. One patient had mild auricular deformity after surgery due to pre-treatment partial cartilage necrosis. All patients had follow-up for at least 6 months. CONCLUSION This novel Merocel® compression dressing technique to treat AP after deroofing is an effective procedure. Minimal pain, simple to do and easily acquired materials were the advantages of this novel procedure.

BackgroundThe development of anterior hip neurolysis has made an appreciable impact on the management of patients with inoperable hip fracture. Nonetheless, suboptimal analgesic benefit was still observed in some patients. We therefore developed a novel posterior hip pericapsular neurolysis (PHPN) to complement anterior hip neurolysis in inoperable hip fracture.MethodsIn this retrospective review, we analyzed patients who responded suboptimally (defined as composite pain score moderate or higher on hip flexion 80°) to the anterior hip neurolysis from July 2019 to March 2021. The patients received additional PHPN if the composite pain score was suboptimal. The percentage of patients with dynamic composite pain scores on hip flexion to 80° and on gentle hip external and internal rotation on post-intervention day 5 was then evaluated.ResultsAmong the 70 patients who were reviewed in the study period, 20 patients who partially responded to anterior hip neurolysis received an addition of diagnostic posterior hip pericapsular block. Eighteen patients were the positive responders and PHPN was then performed. Among the PHPN recipients, a high percentage with satisfactory dynamic pain control was observed with 78% on hip flexion 80° and 83% on hip external/internal rotation on day 5 following the intervention. No procedural adverse event was noted.ConclusionsWhile most patients responded satisfactorily to anterior hip neurolysis, we concluded PHPN could be an effective adjunct to manage suboptimal pain control after anterior hip neurolysis in inoperable hip fracture.Trial registration numberNTWC/REC/21061.

Purpose We assessed hypertrophy of preserved long head of the biceps tendon (LHBT) and vascularity in the bicipital groove after arthroscopic rotator cuff repair in ≤55-year-old patients and compared postoperative pain between shoulders with or without vascularity in the bicipital groove. Methods Patients who underwent arthroscopic rotator cuff repair between 2015 and 2017 were reviewed. Inclusion criteria were arthroscopic rotator cuff repair and ≤55 years old. Exclusion criteria were a history of contralateral rotator cuff repair, revision surgery, partial repair or superior capsular reconstruction, shoulder dislocation or fracture, torn LHBT at surgery, LHBT tenodesis, retears

Purpose To determine short- to midterm patient-reported outcomes of arthroscopic soft-tissue interposition arthroplasty using acellular dermal allograft with a minimum follow-up of 1 year and to assess outcomes in patients with and without flattening of the humeral head. Methods Patients with a diagnosis of primary glenohumeral arthritis who underwent arthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft from July 2010 to November 2019 were retrospectively enrolled. Inclusion criteria were a primary diagnosis of glenohumeral arthritis and Outerbridge 4 full-thickness cartilage loss of ≥50% of the glenoid articular surface. Patients underwent arthroscopic debridement, microfracture, and biological arthroscopic soft-tissue interposition arthroplasty with an acellular dermal matrix. Postoperative outcomes included American Shoulder and Elbow Surgeon (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Penn Shoulder Score (PSS), numeric rating scale (NRS) pain score, analgesic use, and conversion to total shoulder arthroplasty (TSA). Results were stratified according to humeral head morphology on preoperative radiographs. Results A total of 25 patients were included, with a mean age of 56.0 years (range 19.2 to 74.8) and a mean follow-up of 3.36 years (range 1.03 to 8.98). The mean postoperative ASES score was 64.1 (range 11.7 to 100.0), SANE score was 62% (range 5% to 100%), and PSS was 61.2 (range 10.6 to 97.9). Additionally, 56% of patients rated their shoulder function as improved or much improved, and 36% of patients converted to TSA at a mean of 2.35 years. Patients with and without humeral flattening had similar postoperative ASES scores (P = .44), SANE scores (P = .90), PSS (P = .73), and conversions to TSA (P = .83). Patients with humeral flattening were more likely to have shoulder pain at night (83.3% versus 28.6%, P = .02). Conclusion Arthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft resulted in satisfactory short- to mid-term postoperative outcomes for younger patients with glenohumeral arthritis but demonstrated a TSA conversion rate of 36%. Patients with humeral head flattening also had satisfactory shoulder function but were more likely to experience shoulder pain at night. Level of Evidence Level IV, therapeutic case series

The use of stabilization repositioning splints (SRS) to treat muscular TMDs is a growing practice owing to its’ effectiveness and simplicity. The conventional construction procedure requires meticulous occlusal adjustments which consumes considerable chairside time. Changing the procedure to a full digital approach might decrease the chair side time. Aim: To evaluate the chairside time required to construct SRS with conventional impression procedure compared to intra oral scanning and printing. Materials and methods: 30 patients suffering from muscular TMDs were allocated into 2 groups. Group 1 received SRS made out of a vacuum sheet formed over a dental model and modified with cold cured resin. Group 2 received SRS made from intra oral scans and digitally constructed and 3D printed. The time needed in the impression appointment and SRS fitting appointment was calculated. Patients were followed for 8 weeks to evaluate improvement of pain scores and range of mandibular opening. Results: regarding the treatment time the impression appointment time was statistically insignificant for both groups (13.15±1.77) and (12.47±1.96) minutes for groups 1 and 2 respectively. For the fitting appointment the duration showed statistical significant decrease when comparing group 2 (4.49±1.42 min) to group 1 (36.51±6.21min). For both group there was a statistical improvement in pain score and maximum incisal opening, yet there was no statistical significant difference between group 1 and 2. Conclusion: construction SRS with intra oral scans yielded the same patient improvement when compared to conventional construction technique but with significant decrease in the required chairside time

Chronic rheumatological manifestations similar to those of rheumatoid arthritis (RA) are described after chikungunya virus infection. We aimed to compare the relevance of joint counts and symptoms to clinical outcomes in RA and chronic chikungunya disease. Forty patients with chronic chikungunya arthralgia and 40 patients with RA were enrolled in a cross-sectional study. The association of tenderness and swelling, clinically assessed in 28 joints, and patient evaluations of pain and musculoskeletal stiffness with modified Health Assessment Questionnaire (HAQ) and quality of life (QoL) assessments were investigated. Tender and swollen joint counts, pain and stiffness scores were all associated with the HAQ disability index in RA (all r > 0.55, p ≤ 0.0002), but only stiffness was significantly associated with disability in chikungunya (r = 0.38, p = 0.02). Joint counts, pain and stiffness were also associated with most QoL domains in RA patients. In contrast, in chikungunya disease, tender joint counts were associated only with one QoL domain and swollen joints for none, while pain and stiffness were associated with several domains. Our results confirm the relevance of joint counts in RA, but suggest that in chronic chikungunya disease, joint counts have more limited value. Stiffness and pain score may be more important to quantify chikungunya arthritis impact.

Vertebral compression fractures are the most common osteoporotic fractures, 30-50% of all women develop vertebral compression fractures. In this study the mean age of 64 years with youngest case of age of 55 years and oldest case. 55 % of patients included in the study are female. One case had systemic hypertension, one case had Parkinsonism, and one case had Coronary Artery Disease. A significant reduction in analgesic intake was revealed. The patients without any analgesics increased from 0.5% (n=2) pre operative to 85.7% (n=30) at the six months follow-up (P less than 0.0001). pain score of ODS for immediate, 1month, 2 month, 3rd month and 6 month and found that(patient active measure) pam is reduced after immediate to 1 month till 6 month(p

Objective To examine impact of pre-existing and incident problematic musculoskeletal (MSK) areas after total knee replacement (TKR) on postoperative 60-month Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain/function scores. Methods Using data from a randomized controlled trial of subjects undergoing TKR for osteoarthritis, we assessed problematic MSK areas in six body regions before TKR and 12, 24, 36, and 48 months after TKR. We defined the following two variables: 1) density count (number of problematic MSK areas occurring after TKR; range 0-24) and 2) cumulative density count (problematic MSK areas both before and after TKR, categorized into four levels: no preoperative areas and density count of 0-1 [reference group]; no preoperative areas and density count of 2 or more; one or more preoperative areas and density count of 0-1; and one or more preoperative areas and density count of 2 or greater). We evaluated the associations between categorized 60-month WOMAC and cumulative density count by ordinal logistic regression. Results Among 230 subjects, 24% reported one or more preoperative problematic MSK area. After TKR, 75% reported a density count of 0 to 1; 25% reported a density count of 2 or more. Compared with the reference group, each cumulative density count category was associated with an increased odds of having a higher category of 60-month WOMAC pain score, as follows: 2.97 (95% confidence interval [CI], 1.48-5.98) for no preoperative problematic areas and density count of 2 or greater, 3.31 (95% CI, 1.64-6.66) for one or more preoperative problematic areas and density count of 0 to 1, and 2.85 (95% CI, 0.97-8.39) for one or more preoperative problematic areas and density count of 2 or greater. Similar associations were observed with 60-month WOMAC function score. Conclusion In TKR recipients, the presence of problematic musculoskeletal areas beyond the index knee-preoperatively and/or postoperatively-was associated with worse 60-month WOMAC pain/function score.

Context: Skin-to-Skin Contact (SSC) immediately after cesarean section uncommon in Egypt. It is anticipated that this type of care is a successful approach for both maternal and neonatal outcomes. The aim of this study was to investigate the effect of immediate skin to skin contact on maternal and neonatal physiological outcomes after cesarean delivery. Methods: A Quasi-experimental design was utilized at the operative delivery and postpartum unit at El-kasr El-Ainy and El -Manial university hospitals, Egypt. A purposive sample of 100 primiparous women who underwent elective CS and their newborns (100) were included and divided into study and control groups. Six tools were used to collect data of this study, 1) characteristics of the studied mothers. 2) Newborns' medical records, 3) Infant breastfeeding assessment tool, 4) Successful breastfeeding assessment tool, 5) Maternal satisfaction self-report questionnaire and 6) Visual Analogue Scale (VAS). Results: 96% of neonates in the study group manifested no signs of hypothermia compared to 58% of the control group. There was highly statistical significant differences between both groups regarding the total mean pain score after 6 hrs. from cesarean delivery. Also, regarding total mean score of successful breastfeeding (11.68 ± 2.19 & 9.62 ± 2.41) in the study and control group respectively. Conclusion: the present study concluded that implementation of an immediate skin to skin contact after cesarean delivery had a significant effect on maternal and newborn physiological outcomes. Recommendations. Skin to skin contact nursing intervention should be importantly applied in all maternity units in each hospital immediately after cesarean deliveries for its great benefits.

OBJECTIVES To evaluate the hysteroscopic morcellation service in office-setting in everyday practice outside the context of clinical trials. The primary objectives were to assess level of acceptability and factors affecting women satisfaction. The secondary objectives included assessment of complete resection rate, complications rate, pain score during the procedure and on discharge, and the correlation between the lesion size as subjectively estimated by the hysteroscopists versus the volume of morcellated tissues as semi-quantitively measured by the laboratory. METHOD The clinical data was compiled for 287 consecutive women undergoing hysteroscopic morcellation in office-setting from 1 January 2017 to 31 March 2021 in a teaching hospital in the UK. A questionnaire, formulated on the Visual Analogue Scale (VAS), was completed immediately after the procedure by the last 110 women undergoing the procedure. RESULTS The mean age of the cohort (n = 278) was 54.5 years (SD ± 12.5). Only 7 (2.4%) women required two-stage procedure because of size (fibroid ≥ 4 cm), vascularity or multiplicity of lesions. No complications were encountered. The majority of women completing the questionnaire (n = 110) found office procedure acceptable (105, 95.5%, VAS ≥ 7), were willing to have it again if indicated (102, 92.7%, VAS ≥ 7), would recommend it to family and friends (105, 95.5%, VAS ≥ 7) and confirmed receiving adequate preoperative information by doctors and nurses (107, 97.3%, VAS ≥ 7). The level of preoperative explanation and information-giving showed significant (p

Root canal treatment in primary teeth is quite difficult and time-consuming, especially canal preparation. Pain is the most common negative outcome following root canal treatment, occurring hours or days after treatment. It is an unpleasant experience for both the patient and the dentist.The objective of this study was to assess the severity and duration of pain following the endodontic treatment of primary molars with the use of rotary and reciprocating preparation systems compared to the traditional manual method.The research sample consisted of 157 asymptomatic primary lower second molars with non-vital pulp that were indicated for root canal treatment. The patients were randomly divided into 3 groups: in the 1st group, the molars (n = 52) were prepared using the manual method; in the 2nd group (n = 53), a reciprocating automated preparation system (WaveOne®) was used; and in the 3rd group (n = 52), a rotary preparation system (ProTaper Next®) was used. Pain assessment was carried out after 6, 12, 24, 48, and 72 h, and after 1 week, using a four-face facial pain scale.The manual method provided a higher pain score through 6, 12 and 24 h (p0.05) as compared to the 2 automated preparation systems. The intensity of pain did not vary between the 2 machine preparation systems after 6, 12 , 24, and 48 h (p0.05). There were no differences between the 3 methods after 72 h and after 1 week (p0.05).The manual method caused more pain than the other 2 preparation systems, but there was no difference between the 2 automated methods. Automated root canal preparation systems could be used to reduce the intensity of postoperative pain after the endodontic treatment of primary teeth.

OBJECTIVE The aim of this study was to review the use of patient-controlled analgesia (PCA) in sickle cell disease (SCD) for pediatric patients with vaso-occlusive crisis (VOC) in our institution and to compare the effect of early vs late PCA start on pain relief and LOS. METHODS This retrospective study included all pediatric patients treated with PCA for a severe VOC from 2010 to 2016. “Early-PCA” was defined as start of PCA within 48 hours of arrival. Time to reach adequate analgesia was defined as the time to reach 2 consecutive pain scores less than 5/10 at 4-hour interval. RESULTS During the study period, 46 patients presented 87 episodes of VOC treated with PCA. Sixty-three patients with VOC were treated with Early-PCA and 24 with Late-PCA. Both groups were comparable except for median pain score at admission; the Early-PCA group had higher scores: 9.0/10 vs 7.0/10. Time to reach adequate analgesia could be evaluated only in a subset of patients (n = 32) but was shorter in the Early-PCA group with a median difference of 41.0 hours (95% CI −82.0 to −6.0). Early-PCA was associated with a median reduction in LOS of 3.4 days (95% CI −4.9 to −1.9). There was no difference between the 2 groups in terms of side effects and occurrence of acute chest syndrome during hospitalization. CONCLUSIONS In this study, a reduced time to reach adequate analgesia and LOS was noted in the Early-PCA group for severe VOC. A prospective study is required to confirm these results.

Purpose To compare the short-term complaints of postoperative pain, and other ocular discomfort symptoms in patients who underwent photorefractive keratectomy (PRK) with alcohol-assisted epithelial removal in one eye versus mechanical debridement in the other eye. Method A prospective, interventional, contralateral double blind clinical trial was performed on 164 eyes of 82 candidates of PRK surgery. The patients were divided into two groups. The first group was alcohol-assisted PRK group in which the epithelial removal was performed on their right eye. The second group was mechanical PRK group in which epithelial removal was performed on their left eye. A numerical rating scale was given to the patients to describe the severity of postoperative pain on the first day following PRK. Postoperative discomfort symptoms including the complaints of light sensitivity, tearing, blurring, and foreign body sensation was also provided by the survey form. Results One day following PRK, the mean pain score of the alcohol-assisted PRK group and the mechanical PRK group was 3.4±3.1 and 4.1±3.3, respectively (P=0.019). The highest scores recorded for alcohol-assisted and mechanical treated groups were burning (5.22) and light sensitivity (5.46), respectively. Sixty-eight (82.9%) of all patients experienced postoperative pain, and in 52 (76.5%) of them, the time of pain onset was less than 2 hrs. Conclusion We found less pain and discomfort using alcohol-assisted technique compared with mechanical epithelial removal that was provided by a detailed pain and ocular discomfort symptoms assessment one day following PRK surgery.

This study aimed to determine and compare the perception, painfulness, and usability of the minimally invasive Dried Blood Spot (DBS) collections from fingertip vs. upper arm from different athlete populations: males and females representing sports dependent on hand/arm, sports less dependent on hand/arm and para-athletes. To accomplish this, 108 national level athletes from Denmark were recruited (♀ = 49, ♂ = 59, 25 ± 6 years; mean±SD) and 11 Doping Control Officers (DCOs) collected manual fingerprick DBS (HemaSpot HF) and automated upper-arm DBS (Tasso-M20) from each athlete. Athletes and DCOs responded to questionnaires regarding the perception of sample collection procedures. On a 0-10 scale, the athletes reported a low pain score and a very good general experience for both sampling sites but following upper-arm DBS collection the associated pain was rated lower (-0.4 ± 1.6, p < 0.05) and the general experience rated better (+0.6 ± 2.3, p ≤ 0.001) than after the fingerprick DBS collection. The DCOs rated the general experience with the upper-arm DBS collection better (+1.6 ± 1.1, p ≤ 0.01) than the fingerprick DBS collection, partly because problems occurred more frequently during the DBS collection from the fingertip (28%) than from the upper arm (6%). In conclusion, it appears that DBS sampling is affiliated with minimal sensation of pain and is preferred by both DCOs and athletes, independent of gender and discipline, over conventional sample collection methods. Collection of DBS from the upper arm was preferred over fingerprick by both athletes and DCOs.

Aim: To determine the opinion of patients on the use of operating theatre background music in tertiary health care facilities in Port Harcourt. Background: Music finds application in almost all spheres of society due to some beneficial effects. It has been used among patients in the intensive care setting, among hypertensives with associated lowering the systolic blood pressure, among endoscopy patients with significantly improved pain score and significantly reduced anxiety, for pain relief and relaxation, and also for expectant mothers in labour. Materials and Methods: The cross-sectional descriptive study was carried out among patients from March to June 2020 in two multispecialty tertiary healthcare facilities in Port Harcourt Nigeria. Using semi-structured questionnaires and convenience sampling method, 425 respondents were recruited. Data collected was analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Four hundred and two (94.6%) respondents loved listening to music at home. Two hundred and seventy-three (64.2%) respondents preferred to listen to music in operating theatre. Preference for timing of music usage in theatre was variable: before, during and after surgery. One hundred and forty-four (33.9%) respondents asserted that they would love to listen to music in theatre during surgery. Two hundred and thirty-three (55.5%) respondents asserted that there was no background music during their last surgery. Conclusion: Majority of patients were desirous of the use of music in the operating theatre, while a few others thought otherwise.

Objective: To determine the effects of intra articular platelet rich plasma (PRP) injection on level of pain of knee joint in patients with knee osteoarthritis. Study Design: Prospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Aug 2018 to Jan 2019. Methodology: Forty patients with pain due to knee osteoarthritis for intra-articular injection were included in this observational clinical trial after informed consent and fulfilling inclusion criteria. After measuring pain by numerical rating scale, patients received intra articular platelet rich plasma (10ml) therapy in affected knee under fluoroscopy. Using the Numerical rating scale level of pain was evaluated and recorded for each patient at different intervals. Results: There was dramatic improvement in pain score after first and second injection of platelet rich plasma. There was 33.33% improvement at 3rd week, 54.32% at 6th week and 71.60% at 6th month. Conclusion: Platelet rich plasma is safe, cost effective and minimally invasive in reducing pain scores and functional limitation in knee osteoarthritis.

Objective: To determine the efficacy of transforaminal epidural steroid injection (TFESI) using conventional versus Kambin’s triangle approaches in patients of lumbar radiculopathy. Study Design: Quasi experimental study. Place and Duration of Study: Department of Pain Medicine, Combined Military Hospital Rawalpindi Pakistan, from Oct 2019 to Apr 2020. Methodology: Eighty patients suffering from lumbar radiculopathy fulfilling the inclusion criteria were included in this study and were randomly assigned to undergo transforaminal epidural steroid injection using either conventional approach (group C) or the Kambin’s triangle (group K) approach. Pain scores and patient satisfaction levels were recorded at 4 and 8 weeks after the procedure. Results: In both groups, the pain score (group C pre-procedure NRS =7.28 ± 1.26 vs post-procedure NRS = 2.14 ± 0.81, group K pre-procedure NRS = 7.33 ± 1.16 vs post-procedure NRS=2.70 ± 0.94) and patient satisfaction improved 4 and 8 weeks after the procedure. The pain score (p-value=0.21) and patient satisfaction score (p-value=0.88) however were not significantly different between groups. Conclusion: This study demonstrated that using conventional or Kambin’s approach exhibits no difference in decreasing pain score or patient satisfaction level.

Topical povidone-iodine (PI) is widely used as an ocular surface antiseptic for intravitreal injections (IVIs). Although PI is generally well tolerated, it can be associated with significant ocular irritation. Aqueous chlorhexidine (AqCHX) has been described as a possibly better tolerated antimicrobial for ophthalmic procedures. We compared patient pain scores, ocular surface characteristics, and antimicrobial efficacy between PI 5% and AqCHX 0.1% during IVIs.Prospective single-center, randomized clinical trial.Patients receiving same-day bilateral intravitreal anti-vascular endothelial growth factor (VEGF) injections.Each patient had 1 eye randomized to PI or AqCHX, and the second eye received the other agent. Both eyes received topical proparacaine 0.5%.After IVIs, participants rated their pain (Wong-Baker, scale 0-10) for each eye 1 minute after PI or AqCHX instillation and 1 day after the procedure. Each eye was assessed using a standardized quantitative grading system of corneal epitheliopathy (ocular staining score). Microbial swab cultures of the conjunctiva both before instillation of topical antisepsis and 10 minutes after IVIs were given.A total of 100 eyes of 50 patients were included. The mean patient age was 68 years (range, 39-92), and 30 of 50 (60%) were male. Compared with AqCHX, eyes receiving PI had a greater mean pain score immediately after injection (1.44 vs. 0.44, P0.001) but not on postprocedure day 1 (1.04 vs. 0.48, P = 0.06). Eyes that received PI had a higher ocular staining score indicating worse corneal epitheliopathy (4.22 vs. 3.10, P0.001). There was no difference in rates of positive microbial cultures between groups. There was no difference in rates of adverse events between groups (P = 0.99), and no cases of endophthalmitis occurred.Povidone-iodine demonstrated greater ocular surface discomfort and corneal epitheliopathy compared with AqCHX during same-day bilateral IVIs. The 2 agents otherwise demonstrated no difference in positive microbial cultures or adverse events. Aqueous chlorhexidine may be a better tolerated alternative to PI for antimicrobial prophylaxis during IVIs for some patients.

There have been several studies that explore the anxiolytic effects of music during cataract surgery. This is the first systematic review of literature highlighting the effects of music on patients undergoing cataract surgery without pharmacological anxiolytics. A systematic review of literature using PRISMA methodology identified randomized controlled trials involving patients undergoing cataract surgery with music as an intervention during the procedure with outcomes measured using at least one assessment of anxiety level, pain score, satisfaction, or vital sign measurements. Studies using pharmacological anxiolytics or additional pain-relieving medications besides local anesthetic were excluded. Three studies, involving 523 patients, were included with patients undergoing cataract surgery with music intervention. Music intervention during cataract surgery has demonstrated use in reducing perceived pain, reducing anxiety, and improving vitals with increased benefit of reduced heart rate and blood pressures with binaural beat embedded music. The clinical implications of this review identify non-traditional approaches to reducing anxiety intraoperatively for cataract surgeries, offering clinicians alternatives to minimizing benzodiazepine and medication use risks.

BACKGROUND: Clinical studies assessing the impacts of ozone on the musculoskeletal framework are slowly expanding. OBJECTIVE: In this study, we analyzed the impact of paravertebral ozone treatment (OT) injection treatment on distress and disability in patients with lumbar disc hernia (LDH). METHODS: The records of 432 patients with L4-5 and L5-S1 LDH were examined retrospectively. 298 patients who met the inclusion criteria and who provided written informed consent were divided into two groups. Each group received 15 sets of physiotherapy at a rate of five sets every week (study group (n= 139), control group (n= 159)). Six OT injections were applied solely to the study group, two days per week. A visual pain score (VAS) was set up for distress and the Oswestry Disability Questionnaire (ODI) for disablement was administered when the groups were called to control before treatment, towards the end of the treatment, and three months after the treatment ended. RESULTS: The groups had significantly reduced (p< 0.05) VAS and ODI scores following and three months after the treatment contrasted with their scores before the treatment. The Physiotherapy + OT group had significantly lower (p< 0.05) VAS and ODI scores than the physiotherapy group following and three months after the treatment. CONCLUSIONS: Paravertebral OT injection is quite a safe and helpful treatment technique in LDH patients. Further studies should be conducted to investigate the long-term outcomes of the paravertebral OT application.

Summary The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique that aims to provide hip analgesia with preservation of motor function, although evidence is currently lacking. In this single‐centre, observer‐masked, randomised controlled trial, patients undergoing total hip arthroplasty received pericapsular nerve group block or no block (control group). Primary outcome measure was maximum pain scores (0–10 numeric rating scale) measured in the first 48 h after surgery. Secondary outcomes included postoperative opioid consumption; patient mobilisation assessments; and length of hospital stay. Sixty patients were randomly allocated equally between groups. The maximum pain score of patients receiving the pericapsular nerve group block was significantly lower than in the control group at all time‐points, with a median (IQR [range]) of 2.5 (2.0–3.7 [0–7]) vs. 5.5 (5.0–7.0 [2–8]) at 12 h; 3 (2.0–4.0 [0–7]) vs. 6 (5.0–6.0 [2–8]) at 24 h; and 2.0 (2.0–4.0 [0–5]) vs. 3.0 (2.0–4.7 [0–6]) at 48 h; all p

Purpose: To compare between laser and conventional cavity preparation techniques in children, to assess clinical presentation of bulk fill composite and high viscous glass ionomer restoration. Materials and Method: In vivo study included 20 children aged from 4-8 years using split mouth technique (a total of 40 teeth was treated). Group I: 20 teeth treated by turbine. Group II: 20 teeth treated with laser. Each group was subdivided into two subgroups. The teeth were filled with Equia forte in groups IA and IIA or filled with REVEAL HD Bulk composite in groups IB and IIB. Results: Results of the study showed that conventional technique need less time than Laser. It also showed higher mean pain score than Laser although it was not significant. Tooth materials displayed excellent clinical evaluation. Conclusion: laser minimize the onset of pain during caries removal compared with drilling. A longer treatment time was the main disadvantage of this technique. Equia, and bulk fill composite, showed acceptable clinical performance.

Introduction Distinguishing intraarticular lesion from extraarticular lesion need a thorough clinical evaluation in case of atraumatic knee pain. The main objective of this case report was to describe about the clinical course of a patient with unrelenting symptoms with suspected lateral meniscus lesion. Case description A 48-year old man was diagnosed with suspected lesion in the anterior horn of lateral meniscus for 9 months had received pharmacological and physiotherapy interventions. Yet the patient did not respond favourably to former symptomatic treatment. As the history and objective evaluation consistently matched with abnormal neurodynamics, in the similar line, the patient was treated with neural mobilization in a modified slump position, 15 repetitions per session for three consecutive days combined with postural correction exercises. Result The outcomes were measured with numeric pain rating scale (NPRS) and knee society scale (KSS). The patient responded very well to neural mobilization combined with postural correction exercises. The NPRS (4 at rest; 7 on activity) before our intervention reduced to (0 at rest, 1 on activity) at the end of 3 rd consecutive day intervention and the KSS improved to 75 from 55 in pain score & 90 from 80 on function score. At 2-months follow-up, the patient completely recovered from pain and knee dysfunction. Conclusion This case report signifies that abnormal neurodynamics can be a factor for lateral knee pain. Neural mobilization with postural correction exercises may be recommended as an appropriate treatment for patient with lateral-knee-pain due to abnormal neurodynamics.

The aim of this study was to explore the treatment of knee osteoarthritis (KOA) with combined exercise therapy and to evaluate the curative effect through CT imaging technology based on optimized reconstruction algorithms. A total of 60 patients with osteoarthritis admitted to our hospital from September 2020 to March 2021 were randomly recruited as the research objects. Patients were rolled into the routine treatment group and exercise group (routine treatment + targeted exercise therapy) according to different treatments they received, with 30 cases in each group. Then, the CT imaging results of the two groups were compared after treatment. The positive rates of peripheral osteogenesis, joint space narrowing, cartilage lesions, and synovial lesions in the exercise group were inferior to those in the routine group, and the difference was statistically significant P < 0.05 . However, the change rate of positive indicators before and after treatment was not statistically significant P > 0.05 . The change range of digital pain score and Lysholm knee function score in the exercise group was significantly superior to that in the routine group, and the difference was statistically significant P < 0.05 . CT images with optimized reconstruction algorithms still had certain limiting factors in the evaluation of the curative effect of KOA and still needed to be improved. It was also proved that exercise therapy had good application value in the treatment of KOA through other methods.

This study described the subcapsular technique for primary closure castration in donkeys with special regard to its efficiency and welfare impacts. The study was conducted on twelve adult male donkeys, allocated randomly into two groups; subcapsular castration (SC) and open castration (OC) groups, whether the donkeys were subjected to surgical castration either by subcapsular or open castration techniques, respectively. Testosterone, cortisol, lactate, glucose, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglyceride (TG), and nitric oxide (NO) were measured before and after castration. Pain-associated behavioral activities were recorded post-castration. The SC was successfully performed in donkeys through a single paramedian scrotal incision. The SC was efficient as OC in reducing testosterone levels. The pain score decreased in the SC compared to the OC over time. The SC was an efficient and reliable technique for primary closure castration in donkeys with minimal postoperative complications and care and good cosmetic, physiological, and behavioral outcomes. It can be an alternative to other castration techniques in equines.

Nine participants undergoing primary TKA submitted to spinal anesthesia, sedation, ultrasound-guided obturator and Femoral nerve Block analgesia, and photobiomodulation Therapy (FBMT) were evaluated regarding postoperative pain and morphine consumption. FBMT sessions were performed in the Immediate Postoperative period (IPO) and after 24 hours. Participants received 16.7±15 mg of morphine up to the third postoperative day. At IPO, mean pain score was 4.8 ± 3.2 and 5.6 ± 3.5, at rest and on movement, respectively. Photo biomodulation therapy can be considered an option for mitigating pain for patients undergoing TKA.

We present the findings of a prospective cohort study in a single tertiary hospital to review the patient experience and economic benefit of ambulatory hysteroscopy (AH). Data were collected between May 2017 and February 2020. Patient satisfaction was measured with qualitative survey. Hospital level financial data were obtained over two financial years (2017/18 and 2018/19) to identify seasonal variation. The primary outcome was patient satisfaction and the secondary outcome was cost of AH compared to hysteroscopy under GA. Three hundred and twenty-nine patients underwent AH. Two hundred and ninety-eight responses (91%) were collected. Ninety-five percent of procedures were successful. Median pain score was five out of 10. Despite pain, 94% of patients would undergo AH again and 97% would recommend it. The average hospital cost for AH was $259 compared with $3098 for hysteroscopy under GA. These findings support AH as a safe, well-tolerated and economically viable alternative to hysteroscopy under GA.Impact StatementWhat is already known on this subject? Hysteroscopy is traditionally performed in an operating theatre under general anaesthesia (GA). Technological advancements allow for the procedure to be performed in an outpatient setting. Despite advantages of ambulatory hysteroscopy (AH), GA hysteroscopy is still the predominant intervention in Australia.What the results of this study add? Patient satisfaction in AH was assessed. The median pain score was five out of 10. Despite pain, 94% of patients would undergo AH again and 97% would recommend it.What the implications are of these findings for clinical practice and/or further research? AH is a well-tolerated alternative to hysteroscopy under GA with significant cost benefits to the hospital and high patient satisfaction. Further research should focus on direct comparison of the two procedure approaches using randomised controlled trials.

OBJECTIVE This study compares post-operative hearing outcomes and morbidity after pediatric total ossicular replacement prosthesis (TORP) ossiculoplasty with transcanal totally endoscopic ear surgery (TEES) versus a post-auricular microscope-guided (PAM) approach. PATIENTS Forty-four children who underwent ossiculoplasty with titanium TORP after previous cholesteatoma surgery. INTERVENTION Ossiculoplasty using TEES or PAM approach. MAIN OUTCOME MEASURES Hearing outcome after ossiculoplasty was determined by post-operative air-bone gap (ABG) on audiogram nearest to 1 year after surgery. Post-operative morbidity was measured by total number of opiate doses the child received during hospital stay, along with the highest documented post-operative pain score. Comparisons were made with Mann-Whitney U test. RESULTS Hearing data were available for 41 patients: 21 had undergone TEES (median preoperative ABG 39 dB) and 20 had PAM surgery (median preoperative ABG 39 dB). Post-operatively at 1 year, ABG closed significantly in each group (TEES 21 dB, p = 0.003; PAM 23 dB, p = 0.01), and there was no difference between groups (p = 0.6). 57% who underwent TEES and 50% who underwent PAM surgery experienced serviceable hearing post-operatively, defined as air conduction pure-tone average (PTA) ≤ 30 dB HL. Visual analogue pain scores from 0 (no pain) to 10 (worst pain imaginable) were available for 13 who underwent TEES and 18 who underwent PAM surgery. In children undergoing TEES, only two reported pain above 0, with the highest pain score being 4. Children undergoing PAM surgery had a median pain score of 3 (median difference = 3, p

Background: Hemorrhoidal disease is a very prevalent disorder that arises from engorgement of internal and/or external vascular plexuses surrounding the anal canal. Hem-orrhoidectomy is the standard treatment for grade III or grade IV internal hemorrhoids; in spite of this, pain after conventional hemorrhoidectomy is still a major challenge. Aim of Study: To compare the outcome of hemorrhoidec-tomy using Harmonic scalpel without ligation of the pedicle versus electrocautery with ligation of the pedicle as regarding cost, operative time, post-operative bleeding, pain, and healing process. Patients and Methods: This study was a prospective, clinical, randomized, trial that included 50 patients grade III internal hemorrhoids with external components or grade IV disease. The patients were divided into two groups: Group I that included 25 patients underwent electrocautery with ligation of the pedicle and Group II which included 25 patients under-went Harmonic scalpel hemorrhoidectomy without ligation of the pedicle. Results: There was statistically significant association between type of procedure and operative time (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statistically significant lower pain score at day 1, 3, 7, 15, and 30. There was statistically significant association between type of procedure and time to heal (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statistically significant shorter time to complete healing. On the contrary, there was statistically significant association between type of procedure and hospital stay (p=0.18). There was statistically significant association between type of procedure and late complications (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statisti-cally significant less incidence of late complications. Conclusion: It is concluded that there was significantly reduced post-operative pain after Harmonic Scalpel hemor-rhoidectomy compared with electrocautery controls. The diminished post-operative pain in the Harmonic Scalpel group likely results from the avoidance of lateral thermal injury.

Introduction To improve the quality of life in nursing homes, meaningful activities and social contact are indispensable. Exergames can play a role addressing these needs. Methods In a randomized single blinded controlled intervention study, we investigated the effect of playing exergames on general wellbeing, fun and on social interaction. Results Thirty-five residents participated: 18 residents took part in the intervention group and 17 in the control group. The median mental wellbeing score of the intervention group increased from 42/50 to 45. The median sleep score of the intervention increased from 23/30 to 28. The median pain score of the intervention group improved from 18/20 to 20. The median score on subjective cognition increased from 24/30 to 26 while the mean scores on the objective assessment decreased from 1.8/2 to 1.7. Coaches gave an average fun score of 8.9/10 and an average intensity of exercise score of 11.6/20. Residents and coaches appreciated the social contact. Coaches reported a high feasibility (average of 4.1/5) but a low accessibility and a high intensity of supervision. Conclusions Exergaming is a feasible and pleasant complement to the usual activities with a positive impact on wellbeing, sleep, pain, and perceived cognition. Future research should focus on vulnerable groups and aim to develop a study in an implementation design.

Objective To investigate the effect of aqua therapy resistance exercise on arm volume, pain, and shoulder range of movements in post-mastectomy lymphedema.Methods This was a single-blind randomized controlled trial. Fifty eligible breast cancer survivors (median, 10 years after surgery) with lymphedema (median, 21% inter-limb difference) were assigned randomly to group A (n=25) or control group B (n=25). The study group underwent 60 minutes of aqua therapy exercise comprising of warm-up for 10 minutes, 40 minutes of strengthening exercises, and 10 minutes of cooling down, three times a week for 8 weeks. The control group underwent 60 minutes of land-based exercise three times a week for 8 weeks. Arm volume calculated by measuring the arm circumference, shoulder flexion, and abduction range of motion (ROM), and pain using a visual analog scale (VAS) were assessed at baseline and after 8 weeks of treatment.Results There was a statistically significant difference in limb volume, shoulder flexion and abduction ROM, and VAS scores in favor of the study group (p

OBJECTIVE: To develop and evaluate deep learning (DL) risk assessment models for predicting pain progression in subjects with or at risk for knee osteoarthritis (OA). MATERIALS AND METHODS: The incidence and progression cohorts of the Osteoarthritis Initiative, a multi-center longitudinal study involving 9348 knees in 4674 subjects with of at risk for knee OA that began in 2004 and is ongoing, was used to conduct this retrospective analysis. A subset of knees without and with pain progression (defined as nine point or greater increase in pain score between baseline and two or more follow-up time over the first 48-months) were randomly stratified into training (4200 knees with mean age of 61.0 years and 60% female) and hold-out testing (500 knees with mean age of 60.8 years and 60% female) datasets. A DL model was developed to predict pain progression using baseline knee radiographs. An artificial neural network was used to develop a traditional risk assessment model to predict pain progression using demographic, clinical, and radiographic risk factors. A combined model was developed to combine demographic, clinical, and radiographic risk factors with DL analysis of baseline knee radiographs. Area under the curve (AUC) analysis was performed using the hold-out testing dataset to evaluate model performance. RESULTS: The traditional model had an AUC of 0.692 (66.9% sensitivity and 64.1% specificity). The DL model had an AUC of 0.770 (76.7% sensitivity and 70.5% specificity), which was significantly higher (p

Background Skin prick testing (SPT) is the best initial diagnostic method for individuals of all ages who have potential allergies. Aim We aimed to investigate if recent breastfeeding has any effect on reducing the pain of children before SPT. Design Prospective, randomized, single-blinded study. Settings Academic hospital specialized in pediatrics. Participants/Subjects Sixty-four out of seventy-five children requiring SPT within ages 0-2 were included. Methods All participants in this study were breastfed children, and that group assignment randomized them to the control group (n = 32) if children breastfed 30-90 min. prior to arriving for SPT, and study group of children (n = 32) who were also breastfed 30-90 minutes prior to arriving for SPT who were then breastfed again just prior to the beginning of the SPT. The FLACC pain scale was used to test the sensitivity of all children for pain before, during, and 15 minutes after the SPT. The effect of breastfeeding on the pain score and the duration of crying were compared among groups. Results Both groups were similar according to age, gender, and other socio-demographic characteristics (p > .05). The percentage of children that cried during SPT was significantly higher in the control group than the study group (p = .002). The FLACC pain scale values were significantly lower in the study group (p Conclusion Recent breastfeeding before SPT is correlated with less crying by possibly reducing the perceived pain of children ages 0-2.

Objective To observe and compare the therapeutic effect on shoulder periarthritis between Fu's subcutaneous needling (FSN) and electroacupuncture (EA). Methods A total of 68 patients with periarthritis of shoulder were divided into a FSN group and an EA group according to the random number table, 34 cases in each one. In the FSN group, FSN was adopted, once every two days, totally for 10 times. In the EA group, EA was used once daily, consecutively for 20 times. Shoulder pain score and shoulder function score (Constant-Murley score) before and after treatment were compared between the two groups. The clinical therapeutic effect was analyzed and evaluated statistically. Results After 20-day treatment, shoulder pain score was reduced obviously as compared with that before treatment in the patients of either group (both P Conclusion Both FSN and EA are effective in treatment of periarthritis of shoulder, but FSN obtains a much higher remarkably effective rate in treatment of periarthritis of shoulder and its effects for relieving shoulder pain and improving shoulder function are superior to EA. Because of its effective treatment and simple operation, FSN deserves to be promoted in clinical practice for periarthritis of shoulder.

INTRODUCTION Paravertebral block (PVB) is generally used in breast cancer surgery in combination with general anesthesia. Only multi-injection PVB can decrease the volume of local anesthetic (LA) while maintaining the efficacy of the block. The use of small LA volumes in PVB prevents its undesirable distribution from the injection site. The objective of this study was to examine the effect of multi-injection paravertebral block for anesthesia in radical mastectomy in breast cancer patients. MATERIAL AND METHODS The study analyzed 130 cases of anesthesia in radical mastectomy. The patients were randomized to two groups: Group 1 (n = 65) received general anesthesia (GA), and Group 2 (n = 65) received PVB (Th1 to Th6) with GA. In Group 2, 0.75% ropivacaine solution at 1.5 to 3.0 mL per level was used. Serum cortisol levels were measured. The post-operative acute pain perception was measured using a 100-point visual analogue scale (VAS). RESULTS Fentanyl consumption in Group 1 was 70% higher than in Group 2 (P < 0.05). No increase in intra-operative cortisol levels was seen; 2 hours after surgery, cortisol levels were 3.3 times and 2.7 times higher than the baseline in Group 1 and Group 2, respectively (P < 0.05). VAS scores in Group 2 were lower at 2, 6, 12, and 48 hours after surgery (P < 0.05). CONCLUSIONS Supplementation of GA with multilevel PVB decreased the intra-operative fentanyl consumption. In radical mastectomy, the intra-operative cortisol levels do not increase. The highest VAS pain scores are seen within the first 24 hours after mastectomy.

Background: Non-steroidal anti-inflammatory drugs (NSAID) help relieve the discomfort of fever and reduce inflammation and associated pain. Post-surgery pain is most of the time unavoidable and NSAIDs are best strategies to combat the same as compared to opioids. Objective: In the present study we aimed to assess the analgesic efficacy and safety of paracetamol in comparison with diclofenac for postoperative pain relief when administered orally. Methods: Randomly selected 90 patients who underwent different surgery under general anesthesia. Patients were divided into three groups to receive paracetamol (500 mg/kg), diclofenac (100 mg/kg) and placebo. Participants were assessed for the level of pain prior to treatment and upto 8 hrs post-treatment using visual analogue scale to score from 0-5. Statistical analysis of continuous data was done by unpaired t‑test and one-way ANOVA. Results: Both paracetamol and diclofenac were effective for postoperative pain relief. We did not notice significant differences between paracetamol and diclofenac group at any time points, however, both treatments were effective in reducing pain score significantly from 1 hr to 6 hrs post treatment.