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Recent literature suggests that the withdrawal of remifentanil (RF) infusion can be associated with hyperalgesia in clinical and nonclinical settings. We performed a systematic review and a meta-analysis of randomized controlled trials with cross-over design, to assess the effect of discontinuing RF infusion on pain intensity and areas of hyperalgesia and allodynia in healthy volunteers. Nine studies were included. The intervention treatment consisted in RF infusion that was compared with placebo (saline solution). The primary outcome was pain intensity assessment at 30 ± 15 minutes after RF or placebo discontinuation, assessed by any pain scale and using any quantitative sensory testing. Moreover, postwithdrawal pain scores were compared with baseline scores in each treatment. Secondary outcomes included the areas (% of basal values) of hyperalgesia and allodynia. Subjects during RF treatment reported higher pain scores after discontinuation than during treatment with placebo [standardized mean difference (SMD): 0.50, 95% confidence interval (CI): 0.03-0.97; P = 0.04, I² = 71%]. A significant decrease in pain scores, compared with baseline values, was found in the placebo treatment (SMD: -0.87, 95% CI: -1.61 to -0.13; P = 0.02, I² = 87%), but not in the RF treatment (SMD: -0.28, 95% CI: -1.18 to 0.62; P = 0.54, I² = 91%). The area of hyperalgesia was larger after RF withdrawal (SMD: 0.55; 95% CI: 0.27-0.84; P = 0.001; I² = 0%). The area of allodynia did not vary between treatments. These findings suggest that the withdrawal of RF induces a mild but nonclinically relevant degree of hyperalgesia in HVs, likely linked to a reduced pain threshold. [ABSTRACT FROM AUTHOR]

Background: Sore throat is a common complication after general anesthesia. Oral care solutions have been used to reduce the incidence of oral complications or ventilator-associated pneumonia, but their effect on postoperative sore throat (POST) is unclear. This study aims to investigate whether oral care solution can alleviate POST in patients undergoing i-gel laryngeal mask general anesthesia.Methods: A total of 120 patients who were scheduled for elective surgery under laryngeal mask general anesthesia were enrolled. The patients were randomly assigned to an experimental group (oral care solution) and a control group (0.9% saline) and gargled for 1 min with 10mL of oral care solution or saline 5 min before anesthesia induction. The primary outcomes were the overall incidence of sore throat within 24 h and incidence at 20 min, 1 h, 6 h, 24 h after removal of i-gel. The secondary outcomes were the severity of sore throat at the four time points and incidence of hoarseness, cough within 24 h after removal of i-gel.Results: A total of 111 patients were included in the analysis. The overall incidence of sore throat within 24 h in the experimental group was significantly lower than that in the control group, as was the incidence at four time points (P< 0.05). The VAS scores at the four time points in the experimental group were significantly lower than those in the control group (P< 0.05), and the results of repeated measurement analysis of variance showed that time effect and intergroup effect were statistically significant (P< 0.001). No differences were found between the groups in the incidence of hoarseness and cough.Conclusion: Gargling with oral care solution before anesthesia induction can significantly reduce the incidence and severity of POST in patients undergoing i-gel laryngeal mask general anesthesia. [ABSTRACT FROM AUTHOR]

Background: Research conducted by specialists does not show that oral misoprostol is more successful than vaginal misoprostol to manage early pregnancy loss, and vice versa. Objective: To compare oral versus vaginal misoprostol for managing early pregnancy loss. Subjects and Methods: A prospective randomized controlled trial that was performed on 102 women attending to. Obstetrics and Gynecology Department and diagnosed with missed abortion on ultrasound. They were divided into 2 groups. (Group A: Vaginal Misoprostol): Intravaginally into the posterior fornix, 51 patients were administered 600 μg of misoprostol soaked in normal saline solution, which was repeated three-hourly up to a maximum of two doses. Group B (Oral Misoprostol): Misoprostol 600 g was orally administered to 51 patients with a maximum of two doses, each separated by three hours. Results: All of incidence of hypotension, mean of satisfaction, and mean of successful rate were statistically significantly higher as compared with the cases in group B. incidence of side effects was statistically significantly higher in the cases of group B as compared with the cases in group A. Mean induction-expulsion interval in the cases of group A (9.5±3.3) was shorter as compared with the cases in group B (10.8±2.2) with non-statistically significant difference (p=0.078). Conclusion: Misoprostol use by the vaginal route is more efficacious than oral route. Vaginal route was found to have cervical ripening effect and did not need much monitoring to become the first choice even over surgical for induction of labor. [ABSTRACT FROM AUTHOR]

To determine whether the local administration of insulin glargine compared with placebo in nondiabetic patients with venous ulcers (VUs) leads to increased wound healing. A randomized controlled trial using a split-plot design was performed in 36 adults with leg VUs >25 cm2 and more than 3 mo of evolution. Each hemi-wound received either 10 UI insulin glargine or saline solution once a day for 7 d. Size of the wounds, thermal asymmetry, the number of blood vessels, and the percentage area of collagen content in wound biopsies were assessed at baseline and after 7 d of treatment. Blood capillary glucose was monitored once a day after the insulin injection. After 7 d of treatment, the hemi-wounds treated with insulin glargine were significantly smaller, had less thermal asymmetry, more blood vessels, and more collagen content than the saline-treated side. Correlation between thermal asymmetry and the number of blood vessels was also found (r2 = 66.2, P < 0.001). No patient presented capillary glucose levels ≤3.3 mmol/L nor any adverse effects. In nondiabetic patients with chronic VUs, the topical administration of insulin glargine seems to be safe and promotes wound healing and tissue repair after 7 d of treatment. [ABSTRACT FROM AUTHOR]

Background and aim: Central venous catheters (CVC) are widely used in critical care units. Due to the high prevalence of central venous catheter dysfunction, the cost, and the complications of their replacement, finding the right way to prevent catheter occlusion becomes important. The current study aimed to evaluate the effect of an intermediate dose of heparin solution in the prevention of central venous catheter occlusion in ICU-admitted patients. Method: This randomized controlled trial was performed in the Adult Intensive Care Unit (AICU) of Imam Reza Hospital from 2019 to 2020. In each patient (153 patients), the lines were divided into two categories: active or inactive. Inactive lines in the intervention group (76 patients) were washed every 8 hours with 10 ml of saline solution and then filled with 1.5 ml of heparin solution (at a concentration of 100 units per ml). In the control group (77 patients) only washing with 10 ml of saline solution was performed. The active lines in the intervention group were first washed with 10 ml of saline solution after each use and filled with 1.5 ml of heparin solution if not used immediately. In the control group, only saline washing was performed. Each line was examined once daily during the morning shift to determine whether it was open or closed. Result: In the studied lines in 153 patients admitted to the intensive care unit who were divided into two groups of intervention (heparin) and control (saline), no significant difference was observed in the occlusion of the catheter lines (p>0.05). Conclusion: After 14 days of examination of central venous catheters in patients, the effectiveness of an intermediate dose of heparin in preventing catheter obstruction was not more than the saline solution. [ABSTRACT FROM AUTHOR]

This study assessed the effects of botulinum toxin type A (BoNT-A) in mandibular range of motion and muscle tenderness to palpation in persistent myofascial pain (MFP) patients (ReBEC RBR-2d4vvv). Eighty consecutive female subjects with persistent MFP, were randomly divided into four groups (n = 20): three BoNT-A groups with different doses and a saline solution group (placebo control group). Treatments were injected bilaterally in the masseter and anterior temporalis muscle in a single session. Clinical measurements of mandibular movements included: pain-free opening, maximum unassisted and assisted opening, and right and left lateral excursions. Palpation tests were performed bilaterally in the masseter and temporalis muscle. Follow-up occurred 28 and 180 days after treatment. For the statistical analysis the Mann–Whitney U-test with Bonferroni correction was used for groups comparisons. Regardless of dose, all parameters of mandibular range of motion significantly improved after 180 days in all BoNT-A groups, compared with the control group. Palpation pain over the masseter and temporalis muscles were significantly reduced in all BoNT-A groups regardless of dose, compared with the control group, after 28 and 180 days of treatment. Independent of doses, BoNT-A improved mandibular range of motion and muscle tenderness to palpation in persistent MFP patients. [ABSTRACT FROM AUTHOR]

Purpose: Nasal irrigation is recommended as add-on therapy in patients with intermittent allergic rhinitis (AR). We aimed to evaluate the clinical efficacy of adding hyaluronic acid (HA) or normal saline solution (NSS) to nasal corticosteroid (NC) therapy as add-on therapy in improving quality of life and reducing nasal symptom scores of children with intermittent AR compared to NC therapy. Method: In this 28-day long, open-label, randomized controlled trial, one puff of NC was administered once a day through both nostrils of 76 children with SAR (6–12 years old), whose Total Nasal Symptom Score (TNSS) was ≥ 4. Twenty-six patients received NC only (Group 1); 24 patients received NSS (Group 2), and 26 patients received HA (Group 3) twice a day by means of nasal douche device. Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and TNSS were measured as subjective parameters, and nasal eosinophil count (NEC) in nasal cytology, nasal airflow (NAF), and resistance were measured as objective parameters. Results: No significant difference was found in post-treatment between groups in terms of TNSS, PRQLQ, and NEC values. Mean values of post-treatment left NAF of the groups were significantly different (p = 0.030), and the mean value of Group 3 was the highest (mean ± SD = 247.62 ± 155.8 ccm/sn). In comparing pre- and post-treatment intragroup mean total NAR (TNAR) values, a statistically significant decrease was recorded only in group three (p = 0.025). Conclusion: The addition of HA to NC as an adjunct therapy in children with intermittent AR has limited beneficial effects in our study and deserves further investigation. Trial Registry: The clinical trial registration number ID:NCT04752956. [ABSTRACT FROM AUTHOR]

Adhesions are a common consequence of abdomino-pelvic surgery. Efficacy of available adhesion prevention agents is discussed controversially. Here, we used the adhesion barrier 4DryField PH: a powder, which is transformed into a barrier gel with saline solution. The study includes 40 consecutive patients with surgeries for adhesiolysis, endometriosis and other gynaecological pathologies and subsequent second look interventions. The intervention group (n = 17) received 4DryField PH gel while control patients (n = 23) did not receive any adhesion prevention. Severity and extent of adhesion formation were scored during both interventions using an established score. Direct comparison between first and second interventions showed that extent and severity of adhesions could be reduced significantly using 4DryField PH gel. In contrast, in the control group, extent was not reduced and severity was even significantly higher. Direct comparison of second look laparoscopies revealed that adhesion extent and severity were significantly lower in the 4DryField PH than in the control group. What is already known on this subject? Adhesion formation after gynaecologic surgeries is known to be frequent and highly problematic as it directly induces complications and additionally makes subsequent surgeries more difficult. The effectiveness of established adhesion barriers is not sufficient to tackle these problems adequately. What the results of this study add? This is the first controlled study using the relatively new adhesion barrier 4DryField PH. It yields a significant reduction of extent as well as severity of adhesions, while adhesiolysis surgery alone does not solve the problem. What the implications are of these findings for clinical practice and/or further research? Usage of 4DryField PH gel seems to be a good approach to solve the adhesion problem of gynaecologic surgery in general and the reformation problem of adhesiolysis surgery specifically. The results should be confirmed in a larger prospective randomised controlled trial. [ABSTRACT FROM AUTHOR]

Background: Nowadays, with or without sugar, balanced electrolyte solutions are used to prevent hyponatremia, hypoglycemia, and hyperglycemia for neonatal fluid therapy. Objectives: This study aimed to compare the effects of two types of fluid therapy with normal saline and 5% dextrose in half amount of normal saline (DW5% NaCl 0.45%) solution on plasma electrolytes and blood glucose during and after surgery in neonates. Methods: The research population consisted of 1-day to 30-day-old infants who were candidates for surgery under general anesthesia; 70 infants were selected and assigned by block randomization in two groups of 35. Patients in Group A received fluid therapy with normal saline 0.9% (10 cc/kg/h) and DW 5% NaCl 0.45% solution in Group B (10 cc/kg/h). Results: There was no significant difference in the mean value of bicarbonate level (HCO3), base excess and blood acidity (pH) in the study groups (P > 0.05). In Group A, there was no significant difference in sodium (Na) and mean arterial pressure (MAP) over time (P > 0.123), while in Group B, Na level decreased and MAP increased significantly (P < 0.05) with time. Blood sugar levels increased significantly in both groups over time, although this increase was greater in Group B. Conclusion: In general, the results of the study showed that both fluid therapy with normal saline and DW5% NaCl 0.45% solutions can be used in neonatal surgery, but based on the studied variables in this work, normal saline has a lower risk of hyperglycemia than DW5% NaCl 0.45% solution and therefore it is preferred. [ABSTRACT FROM AUTHOR]

Background: Whether the use of balanced multielectrolyte solution (BMES) in preference to 0.9% sodium chloride solution (saline) in critically ill patients reduces the risk of acute kidney injury or death is uncertain.Methods: In a double-blind, randomized, controlled trial, we assigned critically ill patients to receive BMES (Plasma-Lyte 148) or saline as fluid therapy in the intensive care unit (ICU) for 90 days. The primary outcome was death from any cause within 90 days after randomization. Secondary outcomes were receipt of new renal-replacement therapy and the maximum increase in the creatinine level during ICU stay.Results: A total of 5037 patients were recruited from 53 ICUs in Australia and New Zealand - 2515 patients were assigned to the BMES group and 2522 to the saline group. Death within 90 days after randomization occurred in 530 of 2433 patients (21.8%) in the BMES group and in 530 of 2413 patients (22.0%) in the saline group, for a difference of -0.15 percentage points (95% confidence interval [CI], -3.60 to 3.30; P = 0.90). New renal-replacement therapy was initiated in 306 of 2403 patients (12.7%) in the BMES group and in 310 of 2394 patients (12.9%) in the saline group, for a difference of -0.20 percentage points (95% CI, -2.96 to 2.56). The mean (±SD) maximum increase in serum creatinine level was 0.41±1.06 mg per deciliter (36.6±94.0 μmol per liter) in the BMES group and 0.41±1.02 mg per deciliter (36.1±90.0 μmol per liter) in the saline group, for a difference of 0.01 mg per deciliter (95% CI, -0.05 to 0.06) (0.5 μmol per liter [95% CI, -4.7 to 5.7]). The number of adverse and serious adverse events did not differ meaningfully between the groups.Conclusions: We found no evidence that the risk of death or acute kidney injury among critically ill adults in the ICU was lower with the use of BMES than with saline. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; PLUS ClinicalTrials.gov number, NCT02721654.). [ABSTRACT FROM AUTHOR]

Objectives: To compare the effects of atosiban (oxytocin antagonist) on uterine peristalsis and pregnancy outcomes in the frozen embryo transfer (FET) cycle.Setting: Srinagarind Hospital, a university hospital, Khon Kaen, Thailand.Design: A randomized, double-blinded, controlled trial.Methods: Fifty infertile women were randomized into the atosiban (n = 25) and placebo group (n = 25). Women in the study group received intravenous atosiban 6.75 mg, 30 min before embryo transfer, and continued infusion at 18 mg/h for 1 h. The dose was reduced to 6 mg/h for another 2 h. Saline solution was applied in the placebo group. The uterine peristalsis frequency was measured by transvaginal ultrasound 30 min before and 3 h after the embryo transfer.Results: The respective mean baseline uterine peristalsis frequency (time) in the atosiban and placebo group was 10.3 ± 2.4 and 9.2 ± 3.4. The respective duration of uterine peristalsis in the atosiban and placebo group after receiving the intervention was reduced to 7.9 ± 2.1 and 6.9 ± 2.7. The implantation rate and clinical pregnancy rate were not statistically significant different between atosiban group and placebo group (37.5% versus 31.0%, RR 1.21, 95%CI: 0.60-2.44 and 44% versus 36%, RR 1.22, 95%CI: 0.62-2.42, respectively). Subgroup analysis indicated that the clinical pregnancy rate in those >35 years of age was not significantly different between both groups (31.6% and 18.8 %, RR 1.68, 95%CI: 0.50-5.68).Conclusion: Adding atosiban in FET did not reduce uterine peristalsis but may benefit the advanced age group. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous epidural adhesiolysis (epidural decompressive neuroplasty, percutaneous epidural neuroplasty) is treatment method for drug-resistant back pain, including post-surgery syndrome, sciatica or spinal canal stenosis. Aim: To describe the method and outcomes of epidural adhesiolysis. Material and methods: The review of the literature on the topic of epidural adhesiolysis. Results and discussion: This procedure is usually performed in the lumbo-sacral part of the spine, although it can be also done in the cervical or thoracic parts as well. Its purpose is to administer anesthetic drugs, steroids, saline solution or hyaluronidase into the epidural space via one of the three approaches: caudal, interlaminar and transforaminal. The efficacy of epidural adhesiolysis was proven in numerous randomized controlled trials. Conclusions: The efficacy of epidural adhesiolysis was proven in numerous randomized controlled trials. When performed by an experienced physician, epidural adhesiolysis is a safe and effective method with infrequent adverse events. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the bleeding control of skin graft donor site between normal saline soaked gauze with adrenaline and conventional technique having no adrenaline. METHODS: This open-label randomized control trial was conducted at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan from October 2020 to March 2021. Seventy-five patients were randomized to interventional (n=36, 48%) and control group (n=39, 52%) through sealed envelopes. Diluted solution was prepared by adding 30cc of Ringer's lactate and 10cc of lignocaine 2%, with 1cc of adrenaline of 1:200000 with 200 ml of normal saline solution. Solution for control group was containing only normal saline. Following the skin harvesting at donor site, a gauze piece soaked with tumescent solution was applied at the donor site wound. Bleeding severity and epithelialization were assessed. Data was recorded in a pre-designed performa and analyzed through SPSS version-25. RESULTS: There was no significant differences in baseline characteristics like age (p=0.823), gender (p=0.984) and nature of injury (p=0.936) among two groups. Severe, moderate and mild bleeding was noted in 20/39 (51.3%), 15/39 (38.5%) and 4/39 (10.3%) cases in control group as compared to 0/36 (0%); 2/36 (5.6%) and 25/36 (69.4%) cases in interventional group respectively (**<0.001). No bleeding was noted in 9/36 (25%) cases of interventional group. Complete epithelialization was observed in 24/36 (66.7%) and 17/39 (43.6%) cases in adrenaline and control groups respectively (p=0.045). CONCLUSION: Application of adrenaline was more effective in bleeding control and early epithelialization at donor site following the skin harvesting as compared to conventional technique. Clinical Trials Registry Number: NCT04590638 [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the changes in visual function and anterior surface aberrations during soft contact lens (SCL) wear after the instillation of hyaluronic acid (HA) eye drops with different viscosity.Methods: A prospective, randomized, and participant-masked study was performed. Twenty healthy participants (25.4 ± 2.6 years) were evaluated. Hydrogel (Ocufilcon D) and silicone-hydrogel (Somofilcon A) SCL were randomly assigned to both eyes of the same participant. Visual function in terms of high- and low-contrast corrected distance visual acuity (CDVA) and anterior contact lens surface aberrations (RMS HOA) were measured before and after the instillation, at different times, of different eye drops: saline (control) and 0.1%, 0.2%, and 0.3% HA.Results: Compared with the saline solution, during hydrogel SCL wear, there was an improvement (P < 0.05) in high-contrast CDVA after 3 and 10 min with 0.1% HA, and after 5 and 20 min with 0.2% HA. During silicone-hydrogel SCL wear, there was a deterioration (P < 0.05) in high-contrast CDVA after 1 and 30 min with 0.3% HA. Additionally, during silicone-hydrogel SCL wear, there was also a deterioration (P < 0.05) in low-contrast CDVA after 5 and 20 min with 0.3% HA. In terms of RMS HOA, there were no clinically relevant changes with both SCL.Conclusions: The instillation of HA eye drops could have a different effect on visual quality depending on their concentration of HA, the contact lens material, its surface ionicity, or other physicochemical properties that should be studied in future studies. [ABSTRACT FROM AUTHOR]