2,199 results on '"pain control"'
Search Results
2. Intravenous(IV) vs. Erector Spinae Plane Blocks in Cardiac Surgery
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Archit Sharma, Clinical Associate Professor
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- 2024
3. Calciphylaxis and Intractable Pain in a Veteran with Psychological Trauma History.
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Kurniawan, Helena I., O'Malley, Kelly, Santana, Renée, Kowaleski, Jeff, and Skarf, Lara M.
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CALCIPHYLAXIS , *KIDNEY failure , *MORTALITY , *LEG , *CHRONIC pain , *HEMODIALYSIS , *HEMODYNAMICS , *PSYCHOLOGY of veterans , *EMOTIONAL trauma , *PAIN , *PAIN management , *SEPSIS , *BACKACHE - Abstract
Guidelines are lacking for patients with calciphylaxis on renal replacement therapy, often leading to difficulty optimally treating these patients. A 60-year-old male veteran receiving hemodialysis presented with calciphylaxis of the left lower extremity and intractable pain. His condition was complicated by chronic back pain, long-term opioid therapy, and psychological trauma history. He was ultimately transferred to a calciphylaxis treatment center but was unable to tolerate further treatments due to sepsis and hemodynamic instability. He was transitioned to comfort measures and died in the hospital. Addressing complicated pain physiologies and complex trauma is challenging even in well-resourced tertiary medical centers. Despite the availability of calciphylaxis therapies and trauma-informed care, there remains a high rate of suffering and mortality in this patient population. There is much work to be done in this cohort, particularly when considering the implications of past traumatic experiences on health care engagement and pain management. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Scalp Nerve Block for Enhanced Pain Control and Analgesic Optimization in Elective Craniotomy: A Randomized Controlled Trial with Analgesia Nociception Index Monitoring.
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Moharari, Reza Shariat, Emami, Pardis, Neishaboury, Mohamadreza, Sharifnia, Seyed Hamidreza, Kianpour, Parisa, Hatam, Maryam, Etezadi, Farhad, Khajavi, Mohammadreza, Najafi, Atabak, Pourrashidi, Ahmad, and Pourfakhr, Pejman
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PAIN management , *BLOOD pressure , *RANDOMIZED controlled trials , *HEART beat , *POSTOPERATIVE pain , *CRANIOTOMY , *NERVE block - Abstract
In patients who are candidates for craniotomy, scalp nerve blocks have been shown to be effective in relieving pain intensity as well as postoperative hemodynamic stability after surgery, but the results have been inconsistent. We aimed to assess the effect of scalp block on pain control, intraoperative drug use under Analgesia Nociception Index (ANI) monitoring, and postoperative pain in patients who were candidates for elective craniotomy. In this randomized, single-blinded clinical trial study, candidates for craniotomy were randomly (using the block randomization method) divided into 2 groups before entering the operating room. The first group received a scalp block with bupivacaine (intervention), and the second group did not receive a scalp block (control) besides the routine anesthetic procedure in these patients. ANI, hemodynamic parameters, and the amounts of received remifentanil were conducted and compared. Patients under scalp block received less dosage of fentanyl than the nonscalp block group (mean = 57.14 ± 15.59 mcg vs. 250.00 ± 65.04 mcg, respectively). Similarly, the dose of remifentanil required in the scalp block group was less (mean = 3.04 ± 1.95 mg and 5.54 ± 2.57 mg, respectively). No difference was observed in hemodynamic parameters such as blood pressure and heart rate (before, during, and after surgery). However, the group receiving scalp block had higher ANI means than the control group. Scalp nerve block has an effective role in pain control (increasing ANI), consequently reducing the need for analgesic drugs such as fentanyl and remifentanil following craniotomy without changing the hemodynamic condition. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Enhancing pediatric endodontic treatment: Intraosseous anesthesia with computer-controlled delivery system.
- Author
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Suciati, Khomsah, Indriyanti, Ratna, and Gunawan, Kirana Lina
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PEDIATRIC therapy ,PEDIATRIC dentistry ,ANESTHESIA ,INTRAOSSEOUS infusions ,LOCAL anesthesia ,PEDIATRIC clinics ,DECIDUOUS teeth - Abstract
Background: Pain control during endodontic treatment is essential but challenging, particularly in pediatric dentistry. Intraosseous anesthesia (IO) ensures adequate areas are anesthetized for endodontic treatment of the primary tooth with only a single injection site and a small amount of anesthetic solution required. Anesthesia should be delivered slowly to enhance the success rate, minimize pain and, for the IO technique, minimize risk of osteonecrosis. The IO anesthesia delivery system that meets such criteria is computercontrolled local anesthetic delivery (CCLAD). Purpose: To describe the enhancement of pediatric endodontic treatment with minimum risk intraosseous anesthesia using CCLAD. Case: An 8-year-old male patient came to the Pediatric Dentistry Clinic at Padjadjaran University Dental Hospital reporting pain on the lower right second molar deciduous teeth, indicated for vital pulpectomy. Case Management: The procedure of vital pulpectomy was done under local anesthesia. Patient was given intraosseous injection with CCLAD prior to opening access. The point of injection was at two mm apical from distal interdental papillae of the lower right second molar deciduous teeth. The patient remained calm throughout the local injection and vital pulpectomy procedure. Conclusion: Intraosseous anesthesia is beneficial when used for pain control during pediatric endodontic therapy. The use of CCLAD gives comfort to the patient while lowering the risk of necrotizing alveolar bone. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Nalbuphine versus morphine: an adjuvant to spinal anesthesia for controlling pain after total knee arthroplasty: a propensity score-matched analysis.
- Author
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nonsri, Chawisachon, Jongkongkawutthi, Rawee, Kositanurit, Inthiporn, Tewaritruangsri, Apirak, Rattanaprichavej, Piti, and Laoruengthana, Artit
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LEG physiology , *SPINAL anesthesia , *NALBUPHINE , *MORPHINE , *BODY mass index , *HEALTH status indicators , *T-test (Statistics) , *ANESTHESIA adjuvants , *POSTOPERATIVE pain , *VISUAL analog scale , *SEX distribution , *SPINAL infusions , *RETROSPECTIVE studies , *AGE distribution , *MANN Whitney U Test , *CHI-squared test , *DESCRIPTIVE statistics , *LONGITUDINAL method , *SURGICAL complications , *ODDS ratio , *TOTAL knee replacement , *DRUG efficacy , *PAIN management , *MEDICAL records , *ACQUISITION of data , *COMPARATIVE studies , *KNEE , *VOMITING , *LENGTH of stay in hospitals , *RANGE of motion of joints , *NAUSEA - Abstract
Background: Nalbuphine, a synthetic k-agonist and µ-antagonist, provides efficient pain relief while reducing opioid-related adverse effects. This study aims to compare the efficacy of intrathecal nalbuphine (ITN) with intrathecal morphine (ITM) for post-TKA pain. Methods: A retrospective cohort analysis of 131 patients who underwent TKA with spinal anesthesia (SA), a single shot of adductor canal block, and periarticular injections was conducted. The patients were divided into 2 groups, Group N received 0.8 mg nalbuphine, and Group M received 0.2 mg morphine as an adjuvant to SA. Propensity-score matching was employed to compare the visual analog scales (VAS) of postoperative pain intensity, cumulative morphine use (CMU), maximum knee flexion angle, straight leg raise (SLR) ability, incidence of postoperative nausea and vomiting (PONV), and length of hospital stay (LHS). Results: The mean VAS of group M were significantly lower than group N at 6, 12, 18, and 24 h (P < 0.01). Group M had lower CMU than group N at 24 h (P < 0.01) and 48 h (P < 0.01), while there was no significant difference between groups in terms of knee flexion angle and SLR at any time point. Additionally, 29.3 and 57.9% of patients in group N and M experienced PONV, respectively (p = 0.04), and group N had significantly shorter LHS compared to group M (P < 0.001). Conclusion: Although, intrathecal morphine (ITM) still provides better pain control particularly in the first 24 h, patients who received intrathecal nalbuphine (ITN) had significantly fewer incidence of PONV, and shorter LHS. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Comparative Analysis of Ketorolac and Parecoxib for Postoperative Pain Management in Uvulopalatopharyngoplasty.
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Hsieh, Cheng-Yu, Sun, Chuan-Hung, Lin, Chung-Ching, and Chou, Yi-Fan
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POSTOPERATIVE pain treatment , *SLEEP apnea syndromes , *POSTOPERATIVE pain , *POSTOPERATIVE period , *VISUAL analog scale - Abstract
Background/Objectives: Uvulopalatopharyngoplasty (UPPP) is a prevalent surgical procedure for treating obstructive sleep apnea. Effective postoperative pain management is crucial for patient comfort and recovery. This study aimed to compare the analgesic efficacies of parecoxib and ketorolac in patients undergoing UPPP. Methods: A prospective, randomized, double-blind study was conducted on 83 patients who received either parecoxib (40 mg intravenously every 12 h) or ketorolac (30 mg intravenously every 8 h) for 2 days following UPPP. Postoperative pain and swallowing discomfort were assessed using visual analog scales (VASs) at 4, 24, 48, and 72 h. The time to resume eating and adverse reactions were also recorded. Results: At 24 and 48 h postoperatively, the mean VAS score was significantly higher in the ketorolac group compared to the parecoxib group (5.0 ± 2.3 vs. 3.6 ± 2.2, p = 0.005 and 3.9 ± 2.2 vs. 2.5 ± 1.7, p < 0.001, respectively). However, no significant difference in the mean VAS scores was observed between the two groups at 72 h postoperatively. With regards to postoperative swallowing pain, the ketorolac group exhibited significantly higher mean VAS scores than the parecoxib group at 4, 24, 48, and 72 h postoperatively. Conclusions: Intravenous parecoxib may offer superior analgesic benefits in the early postoperative period, particularly in alleviating swallowing pain, compared to ketorolac in UPPP procedures. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Efficacy of Landmark-Guided Transverse Abdominis Plane (LTAP) Block in Pediatric Patients Undergoing Laparoscopic Appendectomy.
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Motta, Monique, Siretskiy, Rachel, Avila, Azalia, Samuels, Shenae, and Levene, Tamar
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APPENDECTOMY , *TRANSVERSUS abdominis muscle , *SURGERY , *CHILD patients , *FISHER exact test , *PEDIATRIC surgery - Abstract
Introduction: Optimizing perioperative analgesia in patients undergoing abdominal surgery remains a challenge given the side effects of narcotics and the potential for abuse. While transversus abdominis plane block has been shown to improve clinical outcomes, such as decreased opioid consumption and pain scores among adult patients, there is limited data regarding its efficacy for pediatric patients. This study evaluates efficacy amongst pediatric patients undergoing landmark-guided transversus abdominis plane (LTAP) during laparoscopic appendectomy. Methods: A retrospective chart review of patients, ages 0-18 years old, who underwent laparoscopic appendectomy for uncomplicated appendicitis at a single institution from January 2021 to December 2022 was conducted. Pearson's chi-square test or Fisher's exact test and Welch's t test were used to assess differences between the two cohorts for categorical and continuous variables, respectively. Results are statistically significant at P <.05. Results: Of the 90 patients who met inclusion criteria, 40% (n = 36) underwent LTAP block. Those with LTAP block had a shorter average operative time than those without LTAP block (.6 vs.7 hours; P =.009). Similarly, patients with LTAP block had a shorter average time to discharge (4.1 vs 11.0 h; P =.039). There were no other statistically significant differences in postoperative outcomes including narcotic use between both cohorts. Discussion: Landmark-guided transversus abdominis plane blocks did not increase operative times yet reduced time to discharge for pediatric patients who underwent laparoscopic appendectomy at our institution. Larger studies are needed to evaluate the relationship between LTAP administration and postoperative narcotic consumption to make clinical recommendations. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Effects of Periarticular Multimodal Drug Injection on Pain Control, Early Mobilization, and Length of Hospital Stay in Patients Undergoing Total Knee Arthroplasty.
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Chen, Jian-Jiun, Wu, Yun-Che, Hung, Chuan-Yu, Lee, Cheng-Hung, and Wang, Jun-Sing
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POSTOPERATIVE pain treatment , *LENGTH of stay in hospitals , *TOTAL knee replacement , *BUPIVACAINE , *PAIN management - Abstract
We investigated the effects of periarticular multimodal drug injection (PMDI) on postoperative pain control, patients' mobilization, and length of hospital stay in patients undergoing total knee arthroplasty (TKA). We retrospectively enrolled patients who underwent unilateral TKA between 2019 and 2020. The formula for PMDI included 0.5 mL epinephrine (1 mg/mL), 1 mL ketorolac (30 mg/mL), 0.5 mL morphine (10 mg/mL), and 20 mL bupivacaine hydrochloride (5 mg/mL), mixed with 60 mL normal saline. The outcomes of interest included (1) the amount of patient-controlled anesthesia (PCA) consumption in the first 24 h after the surgery, (2) early mobilization within 24 h after the surgery, and (3) the length of hospital stay. A total of 127 patients were analyzed. Compared with patients who did not receive PMDI, those who received PMDI had lower consumption of PCA in the first 24 h (β coefficient −29.9, 95% CI −51.9 to −7.9, p = 0.008), higher odds of early mobilization within 24 h (odds ratio 8.263, 95% CI 3.041 to 22.453, p < 0.001), and shorter length of hospital stay (β coefficient −0.705, 95% CI −1.158 to −0.252, p = 0.003). We suggest that PMDI may be considered for patients undergoing TKA to improve the quality of care and shorten their length of hospital stay. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Methadone versus other opioids for refractory malignant bone pain: a pilot randomised controlled study.
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Sulistio, Merlina, Gorelik, Alexandra, Tee, Hoong Jiun, Wojnar, Robert, Kissane, David, and Michael, Natasha
- Abstract
Purpose: Refractory cancer-induced bone pain (CIBP) affects a patient’s functional capacity and quality of life, but there is limited evidence to guide opioid choice. We assessed the feasibility, tolerability and possible efficacy of methadone rotation (MR) compared to other opioid rotations (OOR) in this cohort. Methods: Adults with CIBP and worst pain intensity ≥ 4/10 and/or opioid toxicity graded ≥ 2 on the Common Terminology Criteria for Adverse Events were randomised 1:1 to methadone or another opioid rotation. Standardised assessment tools were used at pre-defined study time points up to 14 days. Results: Of 51 eligible participants, 38 (74.5%) consented, and 29 (76.3%, MR: 14, OOR: 15) completed the fourteen days follow-up post-opioid rotation. Both groups displayed significant reduction in average (MR: d = − 1.2, p = 0.003, OOR: d = − 0.8, p = 0.015) and worst pain (MR: d = − 0.9, p = 0.042, OOR: d = − 0.6, p = 0.048) and total pain interference score (MR: d = − 1.1, p = 0.042, OOR: d = − 0.7, p = 0.007). Oral morphine equivalent daily dose was reduced significantly in MR compared to the OOR group (d = − 0.8, p = 0.05). The incidence of opioid-related adverse events following MR was unchanged but lower in the OOR group (d = 0.9, 95% CI 0.1,1.7, p = 0.022). There were no within-group or between-group differences in satisfaction with analgesia at the end of the study. Conclusion: This pilot study demonstrated that MR and OOR in patients with refractory CIBP are feasible, safe and acceptable to patients. Appropriately powered multi-centre randomised controlled studies are needed to confirm the efficacy of MR and OOR in this cohort. Trial registration: ACTRN12621000141842 registered 11 February 2021. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Pain and Coping Strategies as Determinants of Malnutrition Risk in Lung Cancer Patients: A Cross-Sectional Study.
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Polański, Jacek, Tański, Wojciech, Dudek, Krzysztof, and Jankowska-Polańska, Beata
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Progressive cachexia and malnutrition severely impact the physical and mental condition of cancer patients. Pain is a prognostic factor for shorter survival in cancer patients, and coping strategies are crucial for adapting to treatment and dietary regimens. This study assessed pain levels, pain-related beliefs, and coping strategies as factors increasing malnutrition risk in 257 lung cancer patients. Sociodemographic and clinical data were collected from medical records. The Mini Nutritional Assessment (MNA), Visual Analog Scale (VAS), Beliefs about Pain Control Questionnaire (BPCQ), and Coping Strategies Questionnaire (CSQ) were used. Overall, 42.8% of patients were at risk of malnutrition, and 17.5% were malnourished. Nutritional status negatively correlated with CSQ domains: reinterpretation of pain (RP: rho = −0.194; p = 0.002), catastrophizing (CP: rho = −0.414; p = 0.001), ignoring pain (IP: rho = −0.198; p = 0.001), praying/hoping (PH: rho = −0.253; p < 0.001), and coping self-statements (CS: rho = −0.172; p = 0.006); and BPCQ domains: the power of doctors (PD: rho = −0.196; p = 0.002) and VAS (rho = −0.451; p < 0.001). Nutritional status positively correlated with CSQ domains: pain control (PC: rho = 0.499; p < 0.001) and the ability to reduce pain (AR: rho = 0.512; p < 0.001). In multivariate regression analysis, a better nutritional status was associated with a younger age (β = −0.094; p < 0.001), non-small-cell lung cancer (NSCLC) (β = 1.218; p = 0.037), a greater ability to reduce pain (CSQ-AR) (β = 0.901; p < 0.001), lower catastrophizing (CSQ-CP) (β = −0.165; p = 0.001), and lower pain perceived (VAS) (β = 0.639; p < 0.001). Statistical analyses included Spearman's correlation and multivariate regression with a significance level of p < 0.05. Patients with a normal nutritional status had reduced doctor involvement in pain control, less frequent negative coping strategies, and more common positive coping strategies. A normal nutritional status correlates with lower perceived pain. A better nutritional status is linked to a younger age, NSCLC, lower pain levels, greater pain reduction ability, and lower scores in pain catastrophizing. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Perioperative non-opioid analgesia strategies after high tibial osteotomy: a systematic review of prospective studies.
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Ifarraguerri, Anna M., Trofa, David P., Piasecki, Dana P., Fleischli, James E., and Saltzman, Bryan M.
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TIBIA surgery , *CINAHL database , *DESCRIPTIVE statistics , *OSTEOTOMY , *ANALGESIA , *SYSTEMATIC reviews , *MEDLINE , *PAIN management , *MEDICAL databases , *HEALTH outcome assessment , *ONLINE information services , *DATA analysis software , *QUALITY assurance , *PERIOPERATIVE care - Abstract
Purpose: Little is known about the optimal analgesia regimen after HTO. Thus, this study systematically reviewed the literature on clinical and patient-reported outcomes of pain management strategies for patients after HTO. Methods: A comprehensive search of the PubMed, Cochrane CENTRAL, and CINAHL databases was conducted from inception through September 2023. Studies were included if they evaluated pain reduction with analgesia strategies after HTO and were excluded if they did not report pain control outcomes. Results: Five studies with 217 patients were included. Patients with a multimodal intraoperative injection cocktail to the knee, femoral nerve block (FNB), or adductor canal block (ACB) for HTO had significant improvement in visual analog scale (VAS) and numerical rating scale (NRS) scores in the first 12 h postoperatively compared to controls. Patients on duloxetine had significantly lower NRS scores at 1, 7, and 14 days postoperatively and significantly lower nonsteroidal anti-inflammatory drug (NSAID) usage throughout the two-week postoperative period than the control group. Patients receiving an ACB had significantly lower opioid consumption than controls at 12 h postoperative. In patients with an FNB or ACB, no significant difference in quadriceps strength or time to straight leg raise postoperatively was observed compared to controls. Conclusion: A multimodal periarticular injection cocktail, FNB, or an ACB effectively reduces pain on the first day after HTO, with an ACB able to reduce opioid consumption on the first postoperative day. Duloxetine combined with an ACB effectively decreases pain for two weeks postoperatively while reducing NSAID consumption in patients after HTO. Level of evidence: IV. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Intrathecal dexamethasone-bupivacaine combination with bupivacaine alone in spinal anesthesia for cesarean delivery.
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Nasiri, Ali, Abutorabi, Seyed Mohammad, and Sane, Shahryar
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CESAREAN section ,SPINAL anesthesia ,GENERAL anesthesia ,POSTOPERATIVE pain treatment ,SPINAL infusions ,BUPIVACAINE ,POSTOPERATIVE period - Abstract
Background: Postoperative pain management can be achieved by adjuvant medications during the analgesia procedure. The study investigated the effect of intrathecal dexamethasone-bupivacaine combination with bupivacaine alone in spinal anesthesia for cesarean delivery. Methods: This randomized, double-blind clinical examination included 50 females who had previously experienced a cesarean section. The participants were assigned randomly into two categories: the intervention group, received intrathecal bupivacainedexamethasone, and the control group, received intrathecal bupivacaine-normal saline. Levels of pain were evaluated using a 10 cm visual analog scale (VAS) at intervals of 30 minutes, 1 hour, 2 hours after the operation. The span of the sensory block and postoperative analgesia were assessed. Results: The inclusion of intrathecal dexamethasone with bupivacaine resulted in a significant enhancement in the duration of pain relief during the intervention, lasting for an average of 473.4 ± 39.95 minutes (p<0.001). The duration of sensory and motor block analgesia in the intervention group was more than the control group (128.32 ± 7.30 vs. 92.84 ± 7.84) and (155.6±12.34 vs. 126.16±11.89), respectively (p<0.001). Pain score on the VAS scale at 30, 60, and 120 minutes was significantly lower in the intervention group (p<0.001). There was no difference in side effects and onset time between the study groups. Conclusion: The inclusion of intrathecal dexamethasone alongside bupivacaine has demonstrated enhancement in the duration of sensory block during spinal anesthesia. This improvement was observed without any alterations in the time it takes for the anesthesia to take effect and without any adverse effects during the postoperative period. [ABSTRACT FROM AUTHOR]
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- 2024
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14. Enhancing pediatric endodontic treatment: Intraosseous anesthesia with computer-controlled delivery system
- Author
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Khomsah Suciati, Ratna Indriyanti, and Kirana Lina Gunawan
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cclad ,intraosseus injection ,pain control ,painless pediatric endodontic ,Dentistry ,RK1-715 - Abstract
Background: Pain control during endodontic treatment is essential but challenging, particularly in pediatric dentistry. Intraosseous anesthesia (IO) ensures adequate areas are anesthetized for endodontic treatment of the primary tooth with only a single injection site and a small amount of anesthetic solution required. Anesthesia should be delivered slowly to enhance the success rate, minimize pain and, for the IO technique, minimize risk of osteonecrosis. The IO anesthesia delivery system that meets such criteria is computer-controlled local anesthetic delivery (CCLAD). Purpose: To describe the enhancement of pediatric endodontic treatment with minimum risk intraosseous anesthesia using CCLAD. Case: An 8-year-old male patient came to the Pediatric Dentistry Clinic at Padjadjaran University Dental Hospital reporting pain on the lower right second molar deciduous teeth, indicated for vital pulpectomy. Case Management: The procedure of vital pulpectomy was done under local anesthesia. Patient was given intraosseous injection with CCLAD prior to opening access. The point of injection was at two mm apical from distal interdental papillae of the lower right second molar deciduous teeth. The patient remained calm throughout the local injection and vital pulpectomy procedure. Conclusion: Intraosseous anesthesia is beneficial when used for pain control during pediatric endodontic therapy. The use of CCLAD gives comfort to the patient while lowering the risk of necrotizing alveolar bone.
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- 2024
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15. ITM vs QL for Pediatric Open Lower Abdominal Procedures
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Natalie Barnett, Principal Investigator
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- 2023
16. A comparative evaluation of the efficiency of warm local anesthetic solution delivered on precooled injection sites with the conventional local anesthetic technique in 7–9-year-old children: A randomized split-mouth cross-over trial
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Megha Chittora, Dinesh Rao, Sunil Panwar, Krittika Samaddar, and R. V. Remi
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inferior alveolar nerve block ,pain control ,precooled injection sites ,warm local anesthesia ,Dentistry ,RK1-715 - Abstract
Background: Both precooling the site and injecting a warm anesthetic solution have proven to be efficient in reducing pain individually. However, there is insufficient data on evaluating the efficiency of precooling the site of injection along with the simultaneous administration of a warm local anesthetic solution on the same site in a single patient. Aim: The aim of this study was to evaluate and compare the efficacy, pain perception, hemodynamic changes, and adverse effects of a warm local anesthetic solution injected on precooled injection sites using 2% lignocaine with the conventional local anesthetic technique during inferior alveolar nerve block in 7–9-year-old children. Methods: A split-mouth, double-blinded, randomized clinical trial was conducted on 70 children who received 2% lignocaine with either technique A or B during the first or second appointment of the treatment procedure. The pain perception, anesthetic efficacy, pulse rate, oxygen saturation levels, and adverse events were evaluated. Results: Pain during injection and treatment after administration of the warm local anesthesia (LA) technique was less as compared to the conventional block technique. Anesthetic success was observed with a faster onset of action (212.57 ± 32.51 s) and shorter duration of LA (165.16 ± 33.09 min) in the warm local technique as compared to the conventional technique. No significant differences were found with regard to heart rate and oxygen saturation levels between the two techniques. Administrating warm LA solutions at precooled injection sites revealed fewer adverse events. Conclusion: Injecting warm LA solution on precooled injection sites causes less discomfort and anxiety in children, which makes it more suitable for the child as well as the pediatric dentist.
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- 2024
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17. The effects of smoking on pain scores, vital signs, and analgesic consumption in patients undergoing tympanomastoidectomy surgery
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Murat Tekin, Kadriye B. Ceylan, and Murat Ozturk
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smoking ,pain scales ,postoperative pain ,tympanomastoidectomy ,pain control ,Diseases of the respiratory system ,RC705-779 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Introduction In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. Methods A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18–55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. Results There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. Conclusions Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke.
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- 2024
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18. Intrathecal dexamethasone-bupivacaine combination with bupivacaine alone in spinal anesthesia for cesarean delivery
- Author
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Ali Nasiri, Seyed Mohammad Abutorabi, and Sharyar Sane
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pain control ,intrathecal dexamethasone ,spinal anesthesia ,bupivacaine ,Internal medicine ,RC31-1245 - Abstract
Background: Postoperative pain management can be achieved by adjuvant medications during the analgesia procedure. The study investigated the effect of intrathecal dexamethasone-bupivacaine combination with bupivacaine alone in spinal anesthesia for cesarean delivery. Methods: This randomized, double-blind clinical examination included 50 females who had previously experienced a cesarean section. The participants were assigned randomly into two categories: the intervention group, received intrathecal bupivacaine-dexamethasone, and the control group, received intrathecal bupivacaine-normal saline. Levels of pain were evaluated using a 10 cm visual analog scale (VAS) at intervals of 30 minutes, 1 hour, 2 hours after the operation. The span of the sensory block and postoperative analgesia were assessed. Results: The inclusion of intrathecal dexamethasone with bupivacaine resulted in a significant enhancement in the duration of pain relief during the intervention, lasting for an average of 473.4 ± 39.95 minutes (p
- Published
- 2024
19. Factors conditioning pain control and reduction in post-cesarean section parturients: a cross-sectional study
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Anna Bogusława Pilewska-Kozak, Magdalena Dziurka, Agnieszka Bałanda –Bałdyga, Marta Joanna Monist, Ewelina Kopiel, Krzysztof Jurek, Anna Francesca Łęcka, and Beata Dobrowolska
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Cesarean section ,Beliefs ,Pain control ,Pain coping strategies ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Pain experienced by women in the perinatal period constitutes a complex and multifaceted phenomenon. The aim of the study was to assess conditions of pain locus of control and pain reduction in post-cesarean section parturients. Materials and methods A cross-sectional quantitative study with convenience sampling was performed among 175 hospitalized post-cesarean section women in hospitals in Eastern Poland in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. A self-design questionnaire regarding general information and obstetrics/gynaecology medical interview, The Pain Coping Strategies Questionnaire (CSQ) and The Beliefs about Pain Control Questionnaire (BPCQ) were used. The inclusion criteria were as follows (1) age of ⩾18 years old; (2) cesarean section (CS); (3) period from the 13th hour to the end of the 72nd hour after the procedure; and (4) informed consent. The data was analyzed with IBM SPSS Statistics. Results Internal locus of control (M = 14.02) was provided the highest value by the parturients and followed by chance events (M = 12.61) and doctors’ power (M = 12.18). Dominant coping with pain strategies in the post-cesarean parturients were coping self-statements (M = 19.06), praying or hoping (M = 18.86). The parturients assessed their pain coping (M = 3.31) strategies along with pain reduction (M = 3.35) at the moderate level. Higher pain control was correlated with cognitive pain coping strategies (β = 0.305; t = 4.632; p
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- 2024
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20. Histopathologic Study of the Effects of Surgically Applied Cryoanalgesia on Intercostal Nerves in a Live Porcine Model.
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Guitron, Julian
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INTERCOSTAL nerves , *NEURODEGENERATION , *NERVE fibers , *CONNECTIVE tissues , *NERVES - Abstract
Background/Objectives: The aim of this study was to establish a histologic baseline for cryoanalgesia of 2 min duration and evaluate the effects of different freeze durations. Methods: A porcine model was used in which the application of bilateral cryoanalgesia from intercostal spaces T3–T7 was completed via partial median sternotomy. The animals were kept alive for 7 days and the ribcages were sent to a specialized center for histopathologic analysis of the freezing injury. Results: Forty freezing lesions were completed and analyzed histologically. Thirty-eight (95%) of the cryo-lesions presented 100% nerve fiber degeneration at or distal to the ablation site, with preservation of the perineural connective tissue, as intended. The two unaffected nerves were found to be physically located outside of the freezing area. Conclusions: The complete axonal degeneration with preservation of the perineural tissue opens the possibility to shorter freezing times than the recommended 2 min. Visualization of the nerve and positioning of the probe is important in ensuring the proper effect on the nerve. This histologic analysis confirms the process triggered by cryoanalgesia that, until now, had only been assumed. [ABSTRACT FROM AUTHOR]
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- 2024
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21. The effects of smoking on pain scores, vital signs, and analgesic consumption in patients undergoing tympanomastoidectomy surgery.
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Tekin, Murat, Ceylan, Kadriye B., and Ozturk, Murat
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MIDDLE ear surgery , *PAIN measurement , *VITAL signs , *MASTOIDECTOMY , *OXYGEN saturation , *SURGERY , *PATIENTS , *SMOKING , *POSTOPERATIVE pain , *SURGICAL therapeutics , *ANALGESICS , *CARBOXYHEMOGLOBIN , *TRAMADOL , *PAIN management , *POSTOPERATIVE period , *EVALUATION - Abstract
INTRODUCTION In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. METHODS A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18-55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. RESULTS There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. CONCLUSIONS Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke. [ABSTRACT FROM AUTHOR]
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- 2024
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22. Does the addition of post-operative gabapentin reduce the use of narcotics after orthopedic surgery?
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Giakas, Julian A., Israel, Heidi A., Ali, Ashley H., and Kaar, Scott G.
- Abstract
To evaluate the efficacy of post-operative gabapentin administration as an analgesic agent and its effect on narcotic use after orthopedic surgery in an outpatient sports medicine practice by comparing patients prior to and after initiating the routine use of gabapentin as part of a standardized post-operative pain medication regimen. We hypothesized that adding gabapentin to a multimodal post-operative pain regimen would decrease the number of requested pain medication refills and have no detrimental effect on Visual Analogue Scale and Single Assessment Numerical Evaluation scores at these early post-operative visits. All outpatient surgical patients, <90 years of age, undergoing outpatient orthopedic surgery by the study's senior author were included between 08/05/2021 and 02/22/2022. Patients were allowed 1 narcotic refill post-operatively and only in the first 3 weeks. The primary outcome was difference in percentage of patients who requested a narcotic refill within 3 weeks post-op. Two- and 6-week Visual Analogue Scale and Single Assessment Numerical Evaluation scores, and baseline health and demographic data. T-tests were run on continuous variables, Chi-Square or Fisher's Exact Test were run on dichotomous variables, and Mann–Whitney U test was run on all other categorical variables. Statistical significance was set at P <.05 for all tests. There was a significant difference in narcotic refills at 3 weeks: 23 pre-gabapentin patients and 9 post-gabapentin patients (22.8% vs 9.0%, respectively: P =.006). There were no differences between 2- and 6-week Visual Analogue Scale and 2-week Single Assessment Numerical Evaluation scores. There was a significant difference in 6-week SANE between groups: mean difference = 6.4 (P =.027) though less than the established MCID. Addition of gabapentin to a post-operative multimodal pain regimen reduced the use of narcotics after orthopedic sports medicine surgeries while also providing equivalent pain control. [ABSTRACT FROM AUTHOR]
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- 2024
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23. Factors conditioning pain control and reduction in post-cesarean section parturients: a cross-sectional study.
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Pilewska-Kozak, Anna Bogusława, Dziurka, Magdalena, Bałanda –Bałdyga, Agnieszka, Monist, Marta Joanna, Kopiel, Ewelina, Jurek, Krzysztof, Łęcka, Anna Francesca, and Dobrowolska, Beata
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PREGNANT women , *PAIN management , *COPING Strategies Questionnaire , *CONVENIENCE sampling (Statistics) , *CESAREAN section - Abstract
Background: Pain experienced by women in the perinatal period constitutes a complex and multifaceted phenomenon. The aim of the study was to assess conditions of pain locus of control and pain reduction in post-cesarean section parturients. Materials and methods: A cross-sectional quantitative study with convenience sampling was performed among 175 hospitalized post-cesarean section women in hospitals in Eastern Poland in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. A self-design questionnaire regarding general information and obstetrics/gynaecology medical interview, The Pain Coping Strategies Questionnaire (CSQ) and The Beliefs about Pain Control Questionnaire (BPCQ) were used. The inclusion criteria were as follows (1) age of ⩾18 years old; (2) cesarean section (CS); (3) period from the 13th hour to the end of the 72nd hour after the procedure; and (4) informed consent. The data was analyzed with IBM SPSS Statistics. Results: Internal locus of control (M = 14.02) was provided the highest value by the parturients and followed by chance events (M = 12.61) and doctors' power (M = 12.18). Dominant coping with pain strategies in the post-cesarean parturients were coping self-statements (M = 19.06), praying or hoping (M = 18.86). The parturients assessed their pain coping (M = 3.31) strategies along with pain reduction (M = 3.35) at the moderate level. Higher pain control was correlated with cognitive pain coping strategies (β = 0.305; t = 4.632; p < 0.001), internal pain control β = 0.191; t = 2.894; p = 0.004), cesarean section planning (β = -0.240; t = -3.496; p = 0.001) and past medical history of CS (β = 0.240; t = 3.481; p = 0.001). The skill of reduction of pain was positively associated with cognitive pain coping strategies (β = 0.266; t = 3.665; p < 0.001) and being in subsequent pregnancy (β = 0.147; t = 2.022; p = 0.045). Catastrophizing and hoping were related to lower competences of coping with pain (B = − 0.033, SE = 0.012, β = − 0.206, T = -2.861). Conclusions: The study allowed for identification and better comprehension of factors conditioning pain control and pain reduction in parturients after the cesarean section. Furthermore, a stronger belief that pain can be dealt with is found in the parturients characterized by cognitive pain coping strategies and internal pain locus of control. The skill of reduction of pain is related to cognitive coping strategy and procreation status. [ABSTRACT FROM AUTHOR]
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- 2024
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24. Efficacy of a Lidocaine-Impregnated Elastrator Band for Castration and Tail Docking in Lambs.
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Roche, Steven M., Ralston, Brenda J., Olson, Barbara, Sharpe, Brendan D., Schatz, Crystal, Beaugrand, Kendall, Ross, Joseph A., Broomfield, Madeleine A., Allan, Nicolas, and Olson, Merle
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CASTRATION , *LAMBS , *SCROTUM , *WEIGHT gain , *PAIN management , *ANALGESIA - Abstract
Simple Summary: Tail docking and castration are common procedures performed in lambs but are considered painful. Mitigation of the pain associated with these procedures is difficult, especially when using rubber ring castration. The objectives of this study were to compare castration and tail docking efficacy between lidocaine-impregnated ligation bands (LLBs) and control bands (CBs) under field conditions and identify the benefits of pain control provided by LLBs. In this study, 238 male lambs were randomly assigned to receive either LLBs or CBs on both their tail and scrotum. CBs and LLBs were both 100% effective with respect to casting success of the tail and scrotum. Lambs receiving LLBs gained more weight from d −3 to 7 following application, which may be an indication of pain control during the first week following band application. However, there were no differences observed in average daily gain over the entire study period. The primary objective of this study was to demonstrate the non-inferiority between lidocaine-impregnated ligation bands (LLBs) and control bands (CBs) with respect to the efficacy of castration and tail docking. Secondary objectives were to compare castration and tail-docking success, evaluate local site reactions, and compare average daily gain (ADG) between the treatment groups. A total of 238 male lambs were enrolled and randomly assigned to receive LLBs or CBs on their tail and scrotum. Lambs were weighed, had a health assessment, and the band site was observed on −3, 7, 14, 21, 28, 35, and 42 days after the bands were applied. A linear regression model was built to assess average daily gain, whereas a repeated measures model was used to evaluate body weight differences at each of the measured timepoints. Furthermore, logistic regression models were used to evaluate associations with casting outcomes. Few differences were noted between treatment groups with respect to casting success for the scrotum and tail and ADG over the entire experimental period. Non-inferiority calculations demonstrated no differences in tail docking and scrotal casting success, with casting occurring for the majority of animals by d 21 and d 42 for castration and tail docking, respectively. However, lambs receiving LLBs gained more weight from d −3 to 7 (+0.03 kg/d; 95% CI: 0 to 0.07), which may be an indication of effective pain control during the first week following band application. Overall, the use of an LLB does not affect the time to successful casting of the tail and could improve short-term growth when compared to a control band. Further studies are needed to compare LLBs to multimodal methods of pain relief. [ABSTRACT FROM AUTHOR]
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- 2024
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25. Pregabalin and amitriptyline as first-line drugs among patients with painful peripheral diabetic neuropathy: a systematic review and meta-analysis.
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ALHOWITI, A. M. and MIRGHANI, H. O.
- Abstract
OBJECTIVE: Painful peripheral diabetic neuropathy (PRDN) is a common disabling condition. Pregabalin and amitriptyline are commonly prescribed as the first-line for PPDN despite the contradicting recommendations. There is a need to inform the scientific community regarding first-line pain control among patients with PPDN. This meta-analysis assessed pregabalin and amitriptyline effects on PPDN. PATIENTS AND METHODS: We searched PubMed, MEDLINE, Cochrane Library, EBSCO, and Google Scholar; the terms used were amitriptyline, pregabalin, painful diabetic neuropathy, antidepressant, gabapentinoids, quality of life, and adverse events. Boolean operators like AND, and OR were used. Six hundred and thirty-one studies were retrieved, and 37 full texts were screened. However, only six randomized controlled trials fulfilled the inclusion and exclusion criteria. RESULTS: No significant statistical differences between amitriptyline and pregabalin regarding pain score and significant pain reduction (odd ratio, -0.82, 95% CI, -2.21-0.58, and odd ratio, 1.16, 95% CI, 0.76-1.76 respectively). Quality of life, total adverse events, and drug discontinuation were not different between the two drugs (odd ratio, 0.89, 95% CI, -2.11-3.89, odd ratio, 0.98, 95% CI, 0.52-1.85, and odd ratio, 0.51, 95% CI, 0.08-3.15, respectively). CONCLUSIONS: No significant statistical differences between amitriptyline and pregabalin regarding their effects on pain and quality of life. The drugs showed similar total adverse events and drug withdrawal. Further larger real-world studies are needed. [ABSTRACT FROM AUTHOR]
- Published
- 2024
26. Critical Care of the Pediatric Burn Patient.
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Naber, Catherine and Sheridan, Robert
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PEDIATRIC therapy , *CRITICAL care medicine , *BURN patients , *BURN care units , *CHILDREN'S hospitals , *ARTERIAL catheterization - Abstract
Life-saving pediatric burn care is often initiated in hospitals that are not designated as a pediatric burn center. Therefore, familiarity with critical care of pediatric burn patients is crucial for physicians working in all healthcare settings equipped to care for children. Management of airway, mechanical ventilation, preservation of ideal circulatory status, and establishment of vascular access in pediatric burn patients requires many unique considerations. This article aims to summarize important principles of critical care of children with significant burn injuries for review by physicians and surgeons working in hospitals designated as a pediatric burn center and those that stabilize these patients prior to referral. [ABSTRACT FROM AUTHOR]
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- 2024
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27. Advances in Local Anesthesia and Pain Management for Practicing Dentists: A Comprehensive Review.
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Rout, Manisha, Tomar, Nitin, Kaushik, Mayur, and Singh, Soundarya
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PAIN management ,LOCAL anesthesia ,DENTISTS ,LITERATURE reviews ,LOCAL anesthetics ,TOOTHACHE - Abstract
One of the most frequent problems that patients bring to a dental clinic is pain in the orofacial region or within the tooth. To identify and solve the issue, a proficient practitioner needs to be equipped with the necessary information and resources. Comprehending the history of pain control in dentistry can provide valuable understanding into the development of the present techniques. Newer and more effective pain management treatments have been created as dentistry continues to advance. Several modalities have been developed to reduce and eliminate this, including pharmacological and nonpharmacological treatment modalities. The goal of the present review of the literature's findings is to provide dentists with reliable information regarding the application of contemporary local anesthetics, alternative methods, and strategies to reduce pain during anesthesia administration, thereby improving patient comfort. [ABSTRACT FROM AUTHOR]
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- 2024
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28. Pain control is comparable between opioid versus non‐opioid management after otolaryngology procedures.
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Sarathy, Ashwini, An, Clemens, Bever, Ty, Callas, Peter, Fujii, Mayo H., and Sajisevi, Mirabelle
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PAIN management , *HEMITHYROIDECTOMY , *OPIOID epidemic , *OTOLARYNGOLOGY , *ACADEMIC medical centers - Abstract
Objective: The current study aims to measure patient‐reported satisfaction with pain control using opioid and non‐opioid medications after undergoing the following otolaryngology procedures: parathyroidectomy, thyroid lobectomy, total thyroidectomy, and bilateral tonsillectomy. Materials and Methods: A prospective cohort study was performed at an academic medical center that included a telephone questionnaire and chart review. Opioid prescriptions, usage, and patient‐reported pain outcomes were recorded. Bivariate analyses were used to compare opioid and non‐opioid users. Results: Of the 107 total patients undergoing otolaryngology procedures included in the study, 49 (45.8%) used an opioid for pain management postoperatively and 58 (54.2%) did not. Among the 81 patients who underwent endocrine procedures (parathyroidectomy, total thyroidectomy/lobectomy), most patients reported being "very satisfied" or "satisfied" with pain control whether they used opioids (n = 27/30, 90%) or not (n = 50/51, 98%). Of the 26 patients who underwent bilateral tonsillectomy, 19 (73%) were prescribed opioids and among these, most (n = 17/19, 89%) reported they were "very satisfied" or "satisfied" with pain control. In the non‐opioid usage group, all patients (n = 7/7, 100%) reported they were "satisfied" with pain control. There was no statistically significant difference in patient‐reported satisfaction with pain control between opioid and non‐opioid users for any of the procedures listed. Conclusion: The results of our study suggest that patients who did not use opioids have a similar level of satisfaction with pain control compared to those using opioids after thyroid, parathyroid and tonsillectomy surgeries. Considering the magnitude of the opioid crisis, providers should reassess the need for opioid prescriptions following certain ENT procedures. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]
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- 2024
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29. A comparative evaluation of the efficiency of warm local anesthetic solution delivered on precooled injection sites with the conventional local anesthetic technique in 7–9‑year‑old children: A randomized split‑mouth cross‑over trial.
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Chittora, Megha, Rao, Dinesh, Panwar, Sunil, Samaddar, Krittika, and Remi, R. V.
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MANDIBULAR nerve ,NERVE block ,LOCAL anesthetics ,OXYGEN saturation ,PAIN perception ,LOCAL anesthesia - Abstract
Background: Both precooling the site and injecting a warm anesthetic solution have proven to be efficient in reducing pain individually. However, there is insufficient data on evaluating the efficiency of precooling the site of injection along with the simultaneous administration of a warm local anesthetic solution on the same site in a single patient. Aim: The aim of this study was to evaluate and compare the efficacy, pain perception, hemodynamic changes, and adverse effects of a warm local anesthetic solution injected on precooled injection sites using 2% lignocaine with the conventional local anesthetic technique during inferior alveolar nerve block in 7–9‑year‑old children. Methods: A split‑mouth, double‑blinded, randomized clinical trial was conducted on 70 children who received 2% lignocaine with either technique A or B during the first or second appointment of the treatment procedure. The pain perception, anesthetic efficacy, pulse rate, oxygen saturation levels, and adverse events were evaluated. Results: Pain during injection and treatment after administration of the warm local anesthesia (LA) technique was less as compared to the conventional block technique. Anesthetic success was observed with a faster onset of action (212.57 ± 32.51 s) and shorter duration of LA (165.16 ± 33.09 min) in the warm local technique as compared to the conventional technique. No significant differences were found with regard to heart rate and oxygen saturation levels between the two techniques. Administrating warm LA solutions at precooled injection sites revealed fewer adverse events. Conclusion: Injecting warm LA solution on precooled injection sites causes less discomfort and anxiety in children, which makes it more suitable for the child as well as the pediatric dentist. [ABSTRACT FROM AUTHOR]
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- 2024
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30. CMRA for US-guided-MWA of Liver Tumors
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Lu Wang, Attending physician
- Published
- 2023
31. Therapeutic potential of physical stabilization in VATS pain control: a randomized controlled trial
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Fan, Cheng-Yi, Lin, Chi-Wei, Sung, Chih-Wei, and Huang, Edward Pei-Chuan
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- 2024
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32. Nonsteroidal anti-inflammatory drugs for analgesia in intensive care units: a survey of Canadian critical care physicians
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Tworek, Kimberly B., Ma, Chen-Hsiang, Opgenorth, Dawn, Baig, Nadia, Zampieri, Fernando G., Basmaji, John, Rochwerg, Bram, Lewis, Kimberley, Kilcommons, Sebastian, Mehta, Sangeeta, Honarmand, Kimia, Stelfox, H. Tom, Wilcox, M. Elizabeth, Kutsogiannis, Demetrios J., Fiest, Kirsten M., Karvellas, Constantine J., Sligl, Wendy, Rewa, Oleksa, Senaratne, Janek, Sharif, Sameer, Bagshaw, Sean M., and Lau, Vincent I.
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- 2024
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33. Trends in pain undertreatment among lung cancer patients at the EOL: Analysis of urban city medical insurance data in China
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Jiani Zheng, Yihua Huang, Junyi He, Huaqiang Zhou, Tingting Liu, Jie Huang, Mengting Shi, Yuanyuan Zhao, Wenfeng Fang, Yunpeng Yang, and Li Zhang
- Subjects
end‐of‐life (EOL) ,lung cancer ,opioids ,pain control ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Cancer‐related pain is one of the common priority symptoms in advanced lung cancer patients at the end‐of‐life (EOL). Alleviating pain is undoubtedly a critical component of palliative care in lung cancer. Our study was initiated to examined trends in opioid prescription‐level outcomes as potential indicators of undertreated pain in China. Methods This study used data on 1330 patients diagnosed with lung cancer of urban city medical insurance in China who died between 2014 and 2017. Opioid prescription‐level outcomes were determined by annual trends of the proportion of patients filling an opioid prescription, the total dose of opioids filled by decedents, and morphine milligram equivalents per day (MMED) at the EOL (defined as the 60 days before death). We further analyzed monthly changes in the number of opioid prescriptions filled, MMED, and mean daily dose of opioids per prescription (MDDP) of the last 60 days of life by year at death and age, respectively. Results A total of 959 patients with exact dates of death were included, with 432 cases (45.06%; 95% CI: 44.36%–45.77%) receiving at least one opioid prescription at the EOL. The declining trends were shown in the proportion of patients filling any opioid prescription, the total dose of opioids filled by decedents and MMED, with an annual decrease of 0.341% (p = 0.01), 104.23 mg (p = 0.011) and 2.84 mg (p = 0.014), respectively. Within the 31–60 days to the 0–30 days of life, the MMED declined 6.08 mg (95% CI: −7.14 to −5.03; p = 0.000351), while the number of opioid prescriptions rose 0.66 (95% CI: 0.160–1.16; p = 0.025). Like the MMED, the MDDP fell 4.11 mg (95% CI: −5.86 to −2.37; p = 0.005) within the last month before death compared to the previous month. Conclusion Terminal lung cancer populations in urban China have experienced reduced access to opioids at the EOL. The clinicians did not prescribe a satisfactory dose of opioids per prescription, while the patients suffered increasing pain in the last 30 days of life. Sufficient opioid analgesic administration should be advocated for lung cancer patients during the EOL period.
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- 2024
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34. The efficacy of pregabalin for pain control after thoracic surgery: a meta-analysis
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Li Zhang and Hong Zhang
- Subjects
Thoracic Surgery ,Pain control ,Pregabalin ,Neuropathic pain ,Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background Pregabalin may have some potential in alleviating pain after thoracic surgery, and this meta-analysis aims to explore the impact of pregabalin on pain intensity for patients undergoing thoracic surgery. Methods PubMed, EMbase, Web of science, EBSCO and Cochrane library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of pregabalin on pain intensity after thoracic surgery. Results Five RCTs were finally included in the meta-analysis. Overall, compared with control intervention for thoracic surgery, pregabalin was associated with significantly reduced pain scores at 0 h (mean difference [MD]=-0.70; 95% confidence interval [CI]=-1.10 to -0.30; P = 0.0005), pain scores at 24 h (MD=-0.47; 95% CI=-0.75 to -0.18; P = 0.001) and neuropathic pain (odd ratio [OR] = 0.24; 95% CI = 0.12 to 0.47; P
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- 2024
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35. Short-term clinical outcomes of transarterial embolization for symptomatic hand osteoarthritis refractory to conservative treatment
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Sieh-Yang Lee, Wei-Xiong Lim, Kuan-Ting Wu, Cheng-Ta Wu, Chung-Cheng Huang, and Ching-Di Chang
- Subjects
embolization ,hand ,musculoskeletal ,osteoarthritis ,pain control ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
PURPOSE: The present study aims to assess the short-term clinical outcomes and safety of transarterial embolization (TAE) for symptomatic hand osteoarthritis (OA) refractory to conservative treatment. METHODS: The present retrospective cohort pilot study included nine patients who underwent TAE for symptomatic OA-associated hand pain in a single tertiary center between November 2022 and January 2023. The baseline and post-procedural OA-associated hand pain and function were assessed using the visual analog scale (VAS) and the Australian Canadian Hand Osteoarthritis Index (AUSCAN). The use of conservative treatment and pain medications was also recorded. Post-procedural adverse events were evaluated according to the Society of Interventional Radiology classification. RESULTS: Compared with the baseline, the overall VAS scores were significantly decreased at 1-week, 1-month, 3-months, and 6-months after TAE (76 ± 15 mm versus 34 ± 18 mm, P < 0.001; 32 ± 11 mm, P < 0.001; 21 ± 15 mm, P < 0.001; 18 ± 19 mm, P = 0.002). Similarly, improvement in the mean total AUSCAN scores (22.0 ± 10.0 versus 13.2 ± 6.6, P = 0.007; 14.11 ± 7.3, P = 0.004; 9.8 ± 6.8, P = 0.004; 9.3 ± 7.4, P = 0.011) were documented. The use of other conservative treatment methods also gradually decreased. There were no severe adverse events reported during the follow-up period. CONCLUSION: TAE is a feasible and safe treatment method for symptomatic hand OA refractory to conservative treatment. This minimally invasive procedure effectively relieves debilitating OA-associated joint pain and restores hand function with a durable treatment effect.
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- 2024
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36. Hepatic Hilar Nerve Block Versus Sham in Pain Control During Liver Ablation and TACE Procedures
- Author
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Louis-martin Boucher, Assistant Professor Diagnostic Radiology - Interventional Radiology Division
- Published
- 2023
37. Postoperative Pain Reported to Nurses and Physicians
- Author
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Benjamin K. Wilke, Assistant Professor of Orthopedics
- Published
- 2023
38. Trends in pain undertreatment among lung cancer patients at the EOL: Analysis of urban city medical insurance data in China.
- Author
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Zheng, Jiani, Huang, Yihua, He, Junyi, Zhou, Huaqiang, Liu, Tingting, Huang, Jie, Shi, Mengting, Zhao, Yuanyuan, Fang, Wenfeng, Yang, Yunpeng, and Zhang, Li
- Subjects
- *
MEDICAL prescriptions , *DATA analysis , *RESEARCH funding , *HEALTH insurance , *CANCER patients , *DESCRIPTIVE statistics , *CANCER pain , *LUNG tumors , *METROPOLITAN areas , *OPIOID analgesics , *UNDERTREATMENT , *PHYSICIAN practice patterns , *TERMINAL care , *CONFIDENCE intervals , *DRUG prescribing , *DISEASE complications - Abstract
Background: Cancer‐related pain is one of the common priority symptoms in advanced lung cancer patients at the end‐of‐life (EOL). Alleviating pain is undoubtedly a critical component of palliative care in lung cancer. Our study was initiated to examined trends in opioid prescription‐level outcomes as potential indicators of undertreated pain in China. Methods: This study used data on 1330 patients diagnosed with lung cancer of urban city medical insurance in China who died between 2014 and 2017. Opioid prescription‐level outcomes were determined by annual trends of the proportion of patients filling an opioid prescription, the total dose of opioids filled by decedents, and morphine milligram equivalents per day (MMED) at the EOL (defined as the 60 days before death). We further analyzed monthly changes in the number of opioid prescriptions filled, MMED, and mean daily dose of opioids per prescription (MDDP) of the last 60 days of life by year at death and age, respectively. Results: A total of 959 patients with exact dates of death were included, with 432 cases (45.06%; 95% CI: 44.36%–45.77%) receiving at least one opioid prescription at the EOL. The declining trends were shown in the proportion of patients filling any opioid prescription, the total dose of opioids filled by decedents and MMED, with an annual decrease of 0.341% (p = 0.01), 104.23 mg (p = 0.011) and 2.84 mg (p = 0.014), respectively. Within the 31–60 days to the 0–30 days of life, the MMED declined 6.08 mg (95% CI: −7.14 to −5.03; p = 0.000351), while the number of opioid prescriptions rose 0.66 (95% CI: 0.160–1.16; p = 0.025). Like the MMED, the MDDP fell 4.11 mg (95% CI: −5.86 to −2.37; p = 0.005) within the last month before death compared to the previous month. Conclusion: Terminal lung cancer populations in urban China have experienced reduced access to opioids at the EOL. The clinicians did not prescribe a satisfactory dose of opioids per prescription, while the patients suffered increasing pain in the last 30 days of life. Sufficient opioid analgesic administration should be advocated for lung cancer patients during the EOL period. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
39. Assessment of the Effective Tissue Concentrations of Injectable Lidocaine and a Lidocaine-Impregnated Latex Band for Castration in Calves.
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Ross, Joseph A., Roche, Steven M., Beaugrand, Kendall, Schatz, Crystal, Hammad, Ann, Ralston, Brenda J., Hanson, Andrea M., Allan, Nicholas, and Olson, Merle
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CASTRATION , *LIDOCAINE , *CALVES , *LOCAL anesthetics , *SCROTUM , *LATEX - Abstract
Simple Summary: Castration is commonly performed in young dairy calves and results in pain and discomfort. This study aimed to assess the effective tissue concentrations of the current standard of care for pain mitigation in calves during castration (injectable lidocaine) and to assess the ability of lidocaine-loaded bands (LLBs) to deliver effective concentrations into the scrotal tissue over time. The injectable lidocaine provided effective anesthesia for up to 60 min, highlighting the importance of finding additional strategies to manage long-term pain. A ligation band impregnated with lidocaine could provide a suitable alternative, as it appears to deliver effective lidocaine concentrations starting as early as 2 h following application and lasting at least 28 days after application. Further studies are warranted to compare the use of LLBs to injectable local anesthetics. This study aimed to assess the effective tissue concentrations of the current standard of care for pain mitigation in calves during castration (injectable lidocaine) and to assess the ability of a lidocaine-loaded elastration band (LLB) to deliver effective concentrations into the scrotal tissue over time. This study comprised two different trials: (1) effective concentrations of injectable lidocaine in the scrotal tissue; and (2) the in vivo delivery of effective concentrations of lidocaine from LLBs placed on the calf scrotums. Sensation in the scrotal tissue was assessed by electrocutaneous stimulation. Injectable lidocaine allowed for short-term anesthesia for up to 60 min, highlighting the importance of finding additional strategies to mitigate long-term pain. An elastomeric ligation band impregnated with lidocaine could provide a suitable alternative, as it yielded tissue levels of lidocaine that approached EC50 and exceeded EC95 at 2 and 72 h following application, respectively, and remained above those levels for at least 28 days after application. Further studies are warranted to compare the use of LLBs to injectable local anesthetics. [ABSTRACT FROM AUTHOR]
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- 2024
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40. Efficacy of Cyclocryotherapy on Pain in Patients with Absolute Glaucoma.
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Yelmi, Burcu, Ağaçkesen, Anıl, Tanyıldız, Burak, and Şimşek, Şaban
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ANGLE-closure glaucoma , *GLAUCOMA , *CONGENITAL glaucoma , *OPEN-angle glaucoma , *INTRAOCULAR pressure , *PAIN management - Abstract
Objective: The aim of this study was to evaluate the short-term efficacy of cyclocryotherapy in pain control in 63 patients with absolute glaucoma who had pain and no vision despite maximum medical treatment. Methods: 63 eyes of 63 glaucoma patients defined as absolute glaucoma were included in the study. The intraocular pressures, number of drops used, pain status and need for recurrent therapy were compared before and after the procedure at 1 and 3 months Results: 13 of the patients were female and 40 were male. The mean age was 59.4±17.5 years. 50 of the patients were diagnosed with neovascular glaucoma, 3 with congenital glaucoma, 1 with primary open-angle glaucoma and 9 with angle-closure glaucoma. Preoperative mean intraocular pressure was 50.7±12 mmHg, while it was found to be 37.9±15.4 mmHg in the 1st month and 28.5±15.8 mmHg in the 3rd month postoperatively. The decrease in intraocular pressure before and after the procedure was statistically significant at 1 and 3 months. (p<0.0001) Pain control was received 85% at the first month and 96% at the third month after the procedure. Number of medications that were used was found 3.00 and 2.3±0.9 respectively before and after the procedure and this was statistically significant. (p<0.0001) While no phthisis was observed in any patient, evisceration was applied to 2 patients because of uncontrolled pain. Conclusion: Cyclocryotherapy may be a preferred treatment option before evisceration, as it is a non-invasive, inexpensive and easily applicable method in patients whose pain control cannot be achieved, although it has lost its former popularity with the discovery of new options in the surgical and medical treatment of glaucoma [ABSTRACT FROM AUTHOR]
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- 2024
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41. Long‐term benzodiazepine usage and mortality in patients with chronic non‐cancer musculoskeletal pain: A Nationwide cohort study.
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Oh, Tak Kyu, Hwang, Insung, and Song, In‐Ae
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- *
BENZODIAZEPINES , *RISK assessment , *NONSTEROIDAL anti-inflammatory agents , *STATISTICAL models , *SUBSTANCE abuse , *POST-traumatic stress disorder , *WOUNDS & injuries , *MUSCULOSKELETAL pain , *CHRONIC pain , *DIAZEPAM , *TRIAZOLAM , *T-test (Statistics) , *DISEASE duration , *STATISTICAL sampling , *CHLORDIAZEPOXIDE , *MULTIPLE regression analysis , *INSOMNIA , *MUSCULOSKELETAL system diseases , *QUESTIONNAIRES , *TRANQUILIZING drugs , *CAUSES of death , *DESCRIPTIVE statistics , *ALPRAZOLAM , *CHI-squared test , *AGE distribution , *SEVERITY of illness index , *RESPIRATORY diseases , *LONGITUDINAL method , *ODDS ratio , *NEUROLOGICAL disorders , *CHRONIC diseases , *ANALGESICS , *OPIOID analgesics , *GABAPENTIN , *DATA analysis software , *CLONAZEPAM , *SURVIVAL analysis (Biometry) , *CONFIDENCE intervals , *ANXIETY disorders , *COMORBIDITY , *PREGABALIN , *ACETAMINOPHEN , *PROPORTIONAL hazards models , *CLOBAZAM , *LORAZEPAM , *POISONING ,CARDIOVASCULAR disease related mortality - Abstract
Objectives: The impact of benzodiazepine use on mortality in patients with chronic non‐cancer pain (CNCP) has not been identified. We aimed to examine the factors associated with benzodiazepine use among patients with CNCP and examine whether long‐term benzodiazepine usage is associated with mortality in patients with CNCP. Methods: This study was conducted using data from the National Health Insurance Service database of South Korea. We selected 2.5% of all adult patients diagnosed with musculoskeletal diseases (MSD) in South Korea from 2010 to 2019 using a stratified random sampling technique and included them in the analysis as patients with CNCP. The risk of 10‐year all‐cause mortality in patients with CNCP was investigated using the 2010 cohort of patients with CNCP. Results: The proportion of the study population that used benzodiazepine during the 10‐year study period was 2.1% (390,683/18,770,234). Multivariable logistic regression showed that old age; increased Charlson comorbidity index (CCI); opioid, gabapentin or pregabalin, paracetamol, non‐steroidal anti‐inflammatory drugs, and Z‐drugs usage; and underlying psychiatric comorbidities were associated with increased benzodiazepine use. In addition, benzodiazepine use was associated with increased 10‐year all‐cause mortality (adjusted hazard ratio: 1.03, 95% confidence interval: 1.01, 1.06; p < 0.001). Conclusions: Benzodiazepine was prescribed to 2.1% of the patients with CNCP in South Korea from 2010 to 2019. Old age, increased CCI, underlying psychiatric comorbidities, and use of certain drugs are associated with increased use of benzodiazepines. In addition, benzodiazepine use is associated with 10‐year all‐cause mortality in patients with CNCP. [ABSTRACT FROM AUTHOR]
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- 2024
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42. Implementation of a nonopioid multimodal analgesia protocol significantly reduces opioids prescribed after total shoulder arthroplasty: a retrospective study.
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Castle, Joshua P., Kasto, Johnny, Jiang, Eric X., Evans, Hardy, Tsitlakidou, Despina, Akins, Jordan, Sanii, Ryan, and Muh, Stephanie J.
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RELATIVE medical risk ,ANALGESIA ,PAIN measurement ,CONFIDENCE intervals ,NONOPIOID analgesics ,INTRAOPERATIVE care ,ORAL drug administration ,DRUG overdose ,RETROSPECTIVE studies ,ACQUISITION of data ,SURGERY ,PATIENTS ,HEALTH outcome assessment ,TREATMENT duration ,MEDICAL protocols ,MEDICAL care use ,HUMAN services programs ,COMPARATIVE studies ,RISK assessment ,TREATMENT effectiveness ,DRUG prescribing ,DRUGS ,MEDICAL records ,INTRA-articular injections ,OPIOID analgesics ,PHYSICIAN practice patterns ,COMBINED modality therapy ,DRUG utilization ,SMOKING ,TOTAL shoulder replacement ,POSTOPERATIVE pain ,PAIN management ,OPIOID abuse ,DISEASE risk factors - Abstract
The purpose of this study was to evaluate the impact of a nonopioid multimodal pain protocol on the amount of opioids prescribed, pain level, and complications in patients undergoing total shoulder arthroplasty (TSA) compared to a standard opioid regimen. We retrospectively reviewed 2 consecutive cohorts who underwent either primary anatomic or reverse TSA by a single surgeon. The opioid cohort included patients from 2016 to 2020 who received an intraoperative periarticular injection (Ropivacaine, Epinephrine, and Ketorolac cocktail) and were prescribed Oxycodone/Acetaminophen 5/325 mg on discharge. The nonopioid cohort included patients from 2020 to 2022, consisting of preoperative oral analgesics (Celecoxib, Pregabalin, and Tramadol); intraoperative intravenous Dexamethasone and Acetaminophen and periarticular injection; and postoperative oral Dexamethasone and oral analgesics (Pregabalin, Tizanidine, Magnesium, Ibuprofen, and Acetaminophen). The nonopioid cohort had the option to ask for an opioid prescription postoperatively if needed. Patient-reported outcomes collected included visual analog scale scores for pain and Patient-Reported Outcome Measurement Information System up to 1 year after surgery. Opioid consumption using Morphine Milligram Equivalents were compared up to 3 months postoperatively. There were 232 patients in the opioid and 112 in the nonopioid cohorts, respectively. The nonopioid protocol had lower mean visual analog scale scores at preoperative (6.4 vs. 7.4, P <.05), 10-day (3.5 vs. 4.2, P <.05), and 6-week postoperative time points (2.1 vs. 2.8, P <.05), but no differences between the groups were noted 3 months postoperatively. No differences in Patient-Reported Outcome Measurement Information System–upper extremity, pain interference, or depression were found preoperatively and up to 1 year after surgery. Opioid consumption was lower in the nonopioid cohort at all time periods (P <.01). Patients in the nonopioid cohort had significantly lower Morphine Milligram Equivalents at discharge, 10-day, 6-week, and 90-day time periods (P <.01) when compared to the opioid cohort. When analyzing risk factors for continued opioid prescriptions for the whole cohort, preoperative opioid use within 90 days before surgery (relative risk 4.69 [95% confidence interval 3.18-6.91; P <.01) and current tobacco use (relative risk 2.61 [95% confidence interval 1.50-4.54]; P =.01) were associated with continued refills >30 days. Complications in the perioperative period and 90-day hospital readmissions were not significantly different between the groups. A nonopioid postoperative regimen for patients undergoing TSA significantly reduces opioid prescriptions with similar patient-reported outcomes, subjective pain scores, and without increased complication rates compared to an opioid-only regimen. [ABSTRACT FROM AUTHOR]
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- 2024
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43. Effects of high tibial osteotomy compared with unicondylar knee arthroplasty on the surgical site wound infection and pain in patients with medial knee osteoarthritis.
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Li, Jingcheng, Zhang, Yang, Chen, Yonghua, Li, Ying, Dai, Baifa, and Liu, Ping
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TIBIA surgery ,KNEE osteoarthritis ,MEDICAL information storage & retrieval systems ,SURGERY ,PATIENTS ,POSTOPERATIVE pain ,VISUAL analog scale ,TREATMENT effectiveness ,META-analysis ,AGE distribution ,OSTEOTOMY ,SYSTEMATIC reviews ,MEDLINE ,ODDS ratio ,SURGICAL complications ,TOTAL knee replacement ,MEDICAL databases ,PAIN management ,SURGICAL site infections ,ONLINE information services ,COMPARATIVE studies ,DATA analysis software ,CONFIDENCE intervals ,INDIVIDUALIZED medicine - Abstract
This study aims to comprehensively compare the effects of unicondylar knee arthroplasty (UKA) and high tibial osteotomy (HTO) on wound infection and pain in patients with medial knee osteoarthritis. A computerized search was conducted in Embase, PubMed, Google Scholar, China National Knowledge Infrastructure, Cochrane Library and Wanfang databases, from database inception to October 2023, for studies comparing UKA and HTO for medial knee osteoarthritis. Studies selection, data extraction and study quality evaluation were independently conducted by two researchers. Stata 17.0 software was employed for data analysis. Overall, 10 studies involving 870 patients with medial knee osteoarthritis were included. It was found that the UKA group had significantly lower wound visual analogue scale scores compared to the HTO group (SMD = ‐0.53, 95%CI: −0.87 to −0.20, p < 0.001). The incidence of wound infection in the UKA group was higher than in the HTO group (OR = 1.92, 95%CI: 0.65–5.69, p = 0.240), and the incidence of complications was lower (OR = 0.89, 95%CI: 0.52–1.54, p = 0.684), though these differences were not statistically significant. This study indicates that UKA is effective in alleviating postoperative wound pain in medial knee osteoarthritis. However, the rates of postoperative wound infection and complications are comparable to those of HTO. Clinicians should consider factors such as patient age and disease severity in making individualized treatment decisions. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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44. Postoperative Opioid Use and Prescribing Patterns among Patients Undergoing Cervical Laminectomy with Instrumented Fusion versus Cervical Laminoplasty with Reconstruction.
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Shankar, Dhruv S., Kim, Jinseong, Bienstock, Dennis M., Gao, Michael, Lee, Yunsoo, Zubizarreta, Nicole J., Poeran, Jashvant, Lin, James D., Chaudhary, Saad B., and Hecht, Andrew C.
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LAMINECTOMY ,LAMINOPLASTY ,DRUG prescribing ,OPIOIDS ,DATABASES ,LOGISTIC regression analysis - Abstract
Study Design: Retrospective cohort study. Objective: To compare patterns in opioid usage and prescriptions between patients who undergo cervical laminectomy with instrumented fusion (LF) vs cervical laminoplasty with reconstruction (LP) within single surgeon and national database cohorts. Methods: We identified patients with cervical myelopathy undergoing primary LF or LP in both a single-surgeon series cohort (2004-2018) and a nationally representative cohort drawn from the IBM
® Marketscan® database (2014-2016). We recorded opioid usage within 6 months of surgery and identified differences in unadjusted opioid use rates between LF and LP patients. Multivariable logistic regression was used to evaluate the association between procedure type and postoperative opioid use. Results: Without adjusting for covariates, LF patients had a higher rate of 6-month opioid use in the single-surgeon cohort (15.7% vs 5.1%, P =.02). After adjusting for covariates, LF patients had higher odds of 6-month postoperative opioid use (OR 2.8 [95% CI 1.0-7.7], P =.04). In the national cohort, without adjusting for covariates, there was no significant difference in 6-month opioid use between LF and LP patients. Even after adjusting for covariates, we found no significant difference in odds. Conclusions: Findings from a single-surgeon cohort reveal that LF is associated with a higher rate of 6-month opioid use than LP. This is at odds with findings from a national database cohort, which suggested that LP and LF patients have similar rates of opioid usage at 6-months postoperatively. To prevent overuse of narcotics, surgeons must consider the distinct pain requirements associated with different procedures even in treatment of the same condition. [ABSTRACT FROM AUTHOR]- Published
- 2024
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45. Assessment of the Pharmacokinetics and Pharmacodynamics of Injectable Lidocaine and a Lidocaine-Impregnated Latex Band for Castration and Tail Docking in Lambs.
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Ross, Joseph A., Roche, Steven M., Beaugrand, Kendall, Schatz, Crystal, Hammad, Ann, Ralston, Brenda J., Hanson, Andrea M., Allan, Nicholas, and Olson, Merle
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- *
PHARMACOKINETICS , *CASTRATION , *PHARMACODYNAMICS , *LIDOCAINE , *LOCAL anesthetics , *LAMBS , *ABIRATERONE acetate , *OPIOIDS - Abstract
Simple Summary: Tail docking and castration in lambs are common husbandry practices, both of which cause pain and discomfort, for which many industries recommend or require pain management. The objectives of this study were to assess the effects of the current standard-of-care for pain mitigation in lambs (injectable lidocaine) and assess the ability of a lidocaine-impregnated elastration ligation band to deliver the drug into the contacted tissues over time. The use of injectable lidocaine provides effective short-term anesthesia for 120 to 180 min following the injection; however, additional strategies are needed to manage long-term pain. The use of a ligation band impregnated with lidocaine could provide a useful alternative, as it appears to offer local anesthesia for at least 3 days when compared to a control band. Further studies are needed to compare the use of an injectable local anesthetic to the Lidocaine-Loaded Bands (LLBs). The objectives of this study were to assess the pharmacokinetics and pharmacodynamics of the current standard-of-care for pain mitigation in lambs during castration and tail docking (injectable lidocaine) and assess the ability of Lidocaine-Loaded Bands (LLBs) to deliver therapeutic concentrations into the contacted tissues over time. The study was comprised of four different trials: (1) investigation of in vitro release of lidocaine from LLBs; (2) pharmacokinetics and pharmacodynamics of injectable lidocaine in scrotal and tail tissue; (3) pharmacokinetics and pharmacodynamics of in vivo delivery of lidocaine with LLBs placed on the tail and scrotum of lambs; and (4) a "proof-of-concept" study comparing the sensation of control- versus LLB-banded tail tissue over time. The use of injectable lidocaine provides effective short-term anesthesia for 120 to 180 min following the injection; however, additional strategies are needed to manage long-term pain. The use of an LLB could provide an alternative where tissue lidocaine concentrations meet or exceed the EC50 for at least 21–28 days and, based on electrostimulation data, provides local anesthesia for at least 3 days when compared to a control band. Further studies are needed to compare the use of an injectable local anesthetic to the LLBs. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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46. The efficacy of pregabalin for pain control after thoracic surgery: a meta-analysis.
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Zhang, Li and Zhang, Hong
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PAIN management , *PREGABALIN , *THORACIC surgery , *CHEST pain , *RANDOMIZED controlled trials , *NEURALGIA - Abstract
Background: Pregabalin may have some potential in alleviating pain after thoracic surgery, and this meta-analysis aims to explore the impact of pregabalin on pain intensity for patients undergoing thoracic surgery. Methods: PubMed, EMbase, Web of science, EBSCO and Cochrane library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of pregabalin on pain intensity after thoracic surgery. Results: Five RCTs were finally included in the meta-analysis. Overall, compared with control intervention for thoracic surgery, pregabalin was associated with significantly reduced pain scores at 0 h (mean difference [MD]=-0.70; 95% confidence interval [CI]=-1.10 to -0.30; P = 0.0005), pain scores at 24 h (MD=-0.47; 95% CI=-0.75 to -0.18; P = 0.001) and neuropathic pain (odd ratio [OR] = 0.24; 95% CI = 0.12 to 0.47; P < 0.0001), but demonstrated no obvious impact on the incidence of dizziness (OR = 1.07; 95% CI = 0.15 to 7.46; P = 0.95), headache (OR = 1.00; 95% CI = 0.30 to 3.35; P = 1.00) or nausea (OR = 1.24; 95% CI = 0.46 to 3.35; P = 0.68). Conclusions: Pregabalin may be effective to alleviate the pain after thoracic surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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47. Opioid-sparing Anesthesia Decreases In-hospital and 1-year Postoperative Opioid Consumption Compared With Traditional Anesthesia: A Propensity-matched Cohort Study.
- Author
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Ahmad, Amer H., Carreon, Leah Y., Glassman, Steven D., Harpe-Bates, Jennifer, Sampedro, Benjamin C., Brown, Morgan E., Daniels, Christy L., Schmidt, Grant O., Hines, Bren, and Gum, Jeffrey L.
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OPIOID epidemic , *OPIOIDS , *SPINAL fusion , *BODY mass index , *RECOVERY rooms , *COHORT analysis , *ANALGESIA - Abstract
Study design: Propensity-matched cohort. Objective: The aim of this study was to determine if opioid-sparing anesthesia (OSA) reduces in-hospital and 1-year postoperative opioid consumption. Summary of background data: The recent opioid crisis highlights the need to reduce opioid exposure. We developed an OSA protocol for lumbar spinal fusion surgery to mitigate opioid exposure. Materials and methods: Patients undergoing lumbar fusion for degenerative conditions over one to four levels were identified. Patients taking opioids preoperatively were excluded. OSA patients were propensity-matched to non-OSA patients based on age, sex, smoking status, body mass index, American Society of Anesthesiologists grade, and revision versus primary procedure. Standard demographic and surgical data, daily in-hospital opioid consumption, and opioid prescriptions 1 year after surgery were compared. Results: Of 296 OSA patients meeting inclusion criteria, 172 were propensity-matched to non-OSA patients. Demographics were similar between cohorts (OSA: 77 males, mean age=57.69 yr; non-OSA: 67 males, mean age=58.94 yr). OSA patients had lower blood loss (326 mL vs. 399 mL, P =0.014), surgical time (201 vs. 233 min, P <0.001) emergence to extubation time (9.1 vs. 14.2 min, P< 0.001), and recovery room time (119 vs. 140 min, P =0.0.012) compared with non-OSA patients. Fewer OSA patients required nonhome discharge (18 vs. 41, P =0.001) compared with the non-OSA cohort, but no difference in length of stay (90.3 vs. 98.5 h, P =0.204). Daily opioid consumption was lower in the OSA versus the non-OSA cohort from postoperative day 2 (223 vs. 185 morphine milligram equivalents, P =0.017) and maintained each day with lower total consumption (293 vs. 225 morphine milligram equivalents, P =0.003) throughout postoperative day 4. The number of patients with active opioid prescriptions at 1, 3, 6, and 12 months postoperative was statistically fewer in the OSA compared with the non-OSA patients. Conclusions: OSA for lumbar spinal fusion surgery decreases in-hospital and 1-year postoperative opioid consumption. The minimal use of opioids may also lead to shorter emergence to extubation times, shorter recovery room stays, and fewer discharges to nonhome facilities. [ABSTRACT FROM AUTHOR]
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- 2024
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48. Efficacy of peritonsillar infiltration with dexmedetomidine versus tramadol in comparison to placebo for pain control and sedation after tonsillectomy in pediatric patients: A randomized clinical trial.
- Author
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MODIR, HESAMEDDIN, MOSHIRI, ESMAIL, and NAGHAVI, FAEZEH
- Abstract
Objective: This article aimed to assess the efficacy of peritonsillar infiltration with dexmedetomidine-ropivacaine versus tramadol-ropivacaine for pain control and sedation after tonsillectomy in pediatric patients. Materials and Methods: This double-blind clinical trial recruited 99 eligible children (4-8 years old) undergoing tonsillectomy and assigned to three block-randomized groups, receiving dexmedetomidine-ropivacaine (group A), tramadol-ropivacaine (group B), or placebo-ropivacaine (group C). The vital signs included blood pressure, heart rate, and SaO
2 before anesthesia induction, during surgery at regular intervals until 24 h after surgery. The duration of surgery and recovery, complications, and analgesic consumption were recorded and pain scores were measured by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Oucher scales as well as sedation scores by the Wilson sedation scale. Data were analyzed within SPSS 20 at a significance level of 0.05. Results: The lowest pain scores were measured by the CHEOPS scale in the dexmedetomidine-ropivacaine group (P < 0.05). Statistically significant difference was observed in the CHEOPS pain score between the first two groups at 30 min, 1 h, 2 h, and 4 h after surgery (P < 0.01). The differences were revealed in the Oucher pain assessments among all groups from the time of recovery to four postoperative hours (P < 0.05), with the lowest in the dexmedetomidine-ropivacaine group whose sedation score was greater during recovery and 5 min after surgery (P < 0.05). Subjects in tramadol group had six cases of dizziness and nausea, while no side effects were observed in two other groups (P < 0.05). Only seven participants receiving dexmedetomidine required acetaminophen, but 29 in the tramadol group and all in the placebo group demanded to receive acetaminophen (P = 0.001). Conclusion: The authors concluded that dexmedetomidine as an adjuvant to ropivacaine has better performance in local infiltration for intra- and post-tonsillectomy analgesia and postoperative sedation, without any special side effects (like the placebo group), and that it hence is recommended to be used for local infiltration during tonsillectomy. [ABSTRACT FROM AUTHOR]- Published
- 2024
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49. Pain control is comparable between opioid versus non‐opioid management after otolaryngology procedures
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Ashwini Sarathy, Clemens An, Ty Bever, Peter Callas, Mayo H. Fujii, and Mirabelle Sajisevi
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opioids ,pain control ,thyroidectomy ,tonsillectomy ,Otorhinolaryngology ,RF1-547 ,Surgery ,RD1-811 - Abstract
Abstract Objective The current study aims to measure patient‐reported satisfaction with pain control using opioid and non‐opioid medications after undergoing the following otolaryngology procedures: parathyroidectomy, thyroid lobectomy, total thyroidectomy, and bilateral tonsillectomy. Materials and Methods A prospective cohort study was performed at an academic medical center that included a telephone questionnaire and chart review. Opioid prescriptions, usage, and patient‐reported pain outcomes were recorded. Bivariate analyses were used to compare opioid and non‐opioid users. Results Of the 107 total patients undergoing otolaryngology procedures included in the study, 49 (45.8%) used an opioid for pain management postoperatively and 58 (54.2%) did not. Among the 81 patients who underwent endocrine procedures (parathyroidectomy, total thyroidectomy/lobectomy), most patients reported being “very satisfied” or “satisfied” with pain control whether they used opioids (n = 27/30, 90%) or not (n = 50/51, 98%). Of the 26 patients who underwent bilateral tonsillectomy, 19 (73%) were prescribed opioids and among these, most (n = 17/19, 89%) reported they were “very satisfied” or “satisfied” with pain control. In the non‐opioid usage group, all patients (n = 7/7, 100%) reported they were “satisfied” with pain control. There was no statistically significant difference in patient‐reported satisfaction with pain control between opioid and non‐opioid users for any of the procedures listed. Conclusion The results of our study suggest that patients who did not use opioids have a similar level of satisfaction with pain control compared to those using opioids after thyroid, parathyroid and tonsillectomy surgeries. Considering the magnitude of the opioid crisis, providers should reassess the need for opioid prescriptions following certain ENT procedures. Level of Evidence IV.
- Published
- 2024
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50. Virtual reality to improve the experience of the outpatient cosmetic dermatologic patient: A prospective interventional pilot study.
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Pieper, Collin, Swali, Ritu, Lee, Erica B., Mata, Elizabeth, Huynh, Alisha, Zheng, Cheng, Wysong, Ashley, and Sulewski, Ronald J.
- Published
- 2024
- Full Text
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