Influence of compression stockings on the sensation of discomfort and the volume of the lower legs in healthy subjects during standing load

BACKGROUND: Edema caused by orthostasis is a common clinical picture in the medical and occupational context. Medical compression therapy with compression stockings (CS) is considered a conservative therapeutic standard in edema therapy. The effect of CS on leg discomfort and the increase of the lower leg volume during a standing load still remains questionable. In addition, it is not entirely known whether there is a correlation between volume increase and discomfort in these individuals. METHOD: A timed, controlled standing load of 15 min was conducted by the participants in this non-randomized controlled study to analyze the change in and correlation between lower leg volume increase and the occurrence of lower leg discomfort under compression therapy. Below-knee CS with an interface pressure of 23–32 mmHg were used. The lower leg volume was measured following previous studies using an optical three-dimensional volume (ml) measurement system, and sensations of discomfort and the urge to move were asked about using a numerical rating scale (NRS) of 0–10. The subjects conducted a leg movement for 15 s immediately after the standing period; the data were collected again subsequently. A correlation was calculated between the lower leg volume and the data regarding the discomfort and urge to move for each participant. The experiments had already been performed as part of a previous study including the same subjects who did not wear CS. The results of the study conducted here were compared with those of the participants who did not wear CS to investigate the effect of the CS. RESULTS: Lower leg volume increased by an average of 27 ml (p < 0.001) (without CS: by 63 ml) during standing load in the right leg. During the leg movement after standing load, the lower leg volume increased by 5 ml (n.s.). The sensations of discomfort during the orthostasis increased by 2.6 points on the NRS (p < 0.001) (without CS: by 3.46 points) and decreased by 1.67 points (p < 0.001) during the leg movement shortly after the standing period. Participants’ urge to move increased by 3.73 points on the NRS (p < 0.001) (without CS: by 3.47 points) while the participants performed the standing period and decreased by 2.73 points (p < 0.001) during the final movement exercise. A weakly significant correlation could be demonstrated between the increase in the lower leg volume and the occurrence of discomfort in 6 out of 13 subjects (p < 0.1), and between the increase in the lower leg volume and the urge to move in 8 out of 15 subjects (p < 0.1). CONCLUSION: Standing loads and lack of movement lead to an increase in the lower leg volume and sensation of discomfort in venous healthy subjects wearing CS, which are reduced by wearing them (p < 0.001). A weakly significant mathematical correlation (Pearson’s correlation coefficient) could be shown between the increase in the lower leg volume and the occurrence of the urge to move in 8 out of 15 subjects (p < 0.1) and between the increase in lower leg volume and the occurrence of leg discomfort in 6 out of 13 subjects (p < 0.1).

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Light medical compression stockings reduce symptoms when standing equally well as firm ones

Phlebologie ◽

10.12687/phleb2287-1-2016 ◽

2016 ◽

Vol 45 (01) ◽

pp. 25-28 ◽

Cited By ~ 1

Author(s):

H.-J. Thomä ◽

C. Winkler ◽

F. Amsler ◽

W. Blättler

Keyword(s):

Rating Scale ◽

Stress Test ◽

Lower Leg ◽

Numeric Rating Scale ◽

Second Phase ◽

Compression Stockings ◽

Volume Increase ◽

Prolonged Standing ◽

Numeric Rating ◽

Medical Compression Stockings

SummaryBackground In Germany, therapy with medical compression stockings (MCS) relies almost completely on stockings exerting an ankle pressure of 23-32 mmHg. There is, however, strong evidence that MCS exerting a pressure <20 mmHg are at least as effective offering great advantages in use.Methods We expanded prolonged standing to a stress test. The lower leg volume increase was monitored and, in parallel, the emergence of symptoms. Twenty-four healthy volunteers experienced symptoms in an initial test with bare legs and were therefore asked to take further tests with low (18-21 mmHg, D1) and high pressure (23-32 mmHg, D2) MCS. Leg volume was assessed with the Bodytronic 600 and symptoms with a numeric rating scale (1-10).Results Lower leg volume increased with no MCS to 22 ml after 2 min and to 44 ml after 10 min. D1 reduced the volume increase in the second phase only, by 16 ml (p=0.020), D2 in the first phase already, by 9 ml (p=0.006), and by 22 ml (p<0.001) after 10 min. Symptoms increased continuously to 2.93 scale points. The various symptoms were equally reduced by either stocking.Conclusions Prolonged standing leads to leg volume increase and symptoms. We found neither a cause-and-effect relationship between volume increase and symptoms nor between compression strength or volume increase prevention and symptoms.

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Acupuncture for Low Back Pain in Pregnancy – a Prospective, Quasi- Randomised, Controlled Study

Acupuncture in Medicine ◽

10.1136/aim.22.2.60 ◽

2004 ◽

Vol 22 (2) ◽

pp. 60-67 ◽

Cited By ~ 36

Author(s):

João Bosco Guerreiro da Silva ◽

Mary Uchiyama Nakamura ◽

José Antonio Cordeiro ◽

Luiz Kulay

Keyword(s):

Pelvic Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Real Life ◽

Acupuncture Group ◽

Controlled Study ◽

Control Group ◽

Study Group ◽

Low Back ◽

Average Pain

This study was undertaken to investigate the effects of acupuncture in low back and pelvic pain during pregnancy under real life conditions, as compared with patients undergoing conventional treatment alone. A total of 61 conventionally treated pregnant women were allocated randomly into two groups to be treated or not by acupuncture. Twenty-seven patients formed the study group and 34 the control group. They reported the severity of pain using a Numerical Rating Scale from 0 to 10, and their capacity to perform general activities, to work, and to walk. We also assessed the use of analgesic drugs. Women were followed up for eight weeks and interviewed five times, at two-week intervals. All women completed the study. In the study group the average pain during the study period showed a larger reduction (4.8 points) than the control group (−0.3 points) (P<0.0001). Average pain scores decreased by at least 50% over time in 21 (78%) patients in the acupuncture group and in five (15%) patients in the control group (P<0.0001). Maximum pain and pain at the moment of interview were also less in the acupuncture group compared with the control group. The capacity to perform general activities, to work and to walk was improved significantly more in the study group than in the control group (P<0.05). The use of paracetamol was lower in the acupuncture group (P<0.01). These results indicate that acupuncture seems to alleviate low back and pelvic pain during pregnancy, as well as to increase the capacity for some physical activities and to diminish the need for drugs, which is a great advantage during this period.

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Intravesical dexmedetomidine instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study

BMC Anesthesiology ◽

10.1186/s12871-020-01189-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hong Chen ◽

Bin Wang ◽

Qin Li ◽

Juan Zhou ◽

Rui Li ◽

...

Keyword(s):

Patient Satisfaction ◽

General Anesthesia ◽

Normal Saline ◽

Rating Scale ◽

Numerical Rating Scale ◽

Intravesical Instillation ◽

Controlled Study ◽

Control Group ◽

Post Operation ◽

Male Patients

Abstract Background The catheter-related bladder discomfort (CRBD) of male patients is a common clinical problem, albeit lacking effective solutions. The present study aimed to investigate whether intravesical dexmedetomidine instillation alleviates the postoperative urinary discomfort in male patients with catheter under general anesthesia. Methods This single-blinded, prospective, randomized study included a total of 167 male patients American Society of Anesthesiologists (ASA) physical status I-II scheduled for surgery under general anesthesia were allocated to two groups: 84 in the dexmedetomidine group and 83 in the control group. Dexmedetomidine group patients received intravesical instillation of the drug 0.5 μg/kg and normal saline 20 mL, while the control group received intravesical instillation of 20 mL normal saline. The catheter was clamped for 30 min after intravesical instillation for all patients. CRBD scores and urethra pain numerical rating scale (NRS) scores were measured at admittance to post-anesthesia care unit (PACU) (T0), intravesical instillation (T1), 30 min (T2), 60 min (T3), 2 h (T4) after intravesical instillation, discharged from PACU (T5), and 6 h (T6) and 24 h (T7) after the operation. Patient satisfaction at discharge from PACU and 24 h post-operation were compared between the two groups. Results CRBD scores and urethra pain NRS scores after 30 min of intravesical dexmedetomidine instillation to 24 h post-operation were significantly lower than the control group (p < 0.001), and patient satisfaction was higher at discharge from PACU and 24 h post-operation (p < 0.001). No differences were detected in Steward score out of PACU (p = 0.213) and from the time of the end of operation to fully awake (p = 0.417). Conclusion Intravesical dexmedetomidine instillation reduces postoperative urinary discomfort and urethra pain and improves satisfaction in male patients under general anesthesia. Trial registration Chinese Clinical Trial Registry (No. ChiCTR1800016429), date of registration 1st June 2018.

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Transdermal opioids for cancer pain control in patients with renal impairment

Journal of Opioid Management ◽

10.5055/jom.2014.0197 ◽

2014 ◽

Vol 10 (2) ◽

pp. 85 ◽

Cited By ~ 8

Author(s):

Giuseppe Melilli, MD ◽

Boaz Gedaliahu Samolsky Dekel, MD, PhD, MA ◽

Catia Frenquelli, MD ◽

Rita Mellone, MD ◽

Franco Pannuti, MD

Keyword(s):

Adverse Effects ◽

Renal Impairment ◽

Cancer Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Study Groups ◽

Controlled Study ◽

Opioid Use ◽

Opioid Dose ◽

Rescue Dose

Objectives: As guidelines for opioid use in renal-impaired patients with cancer are limited, the authors sought to assess the efficacy, safety, and tolerability, of transdermal buprenorphine for moderate/severe cancer pain in renal-impaired outpatients.Methods: In a prospective parallel-group active-controlled study, n = 42 consecutively recruited outpatients with or without renal impairment (serum creatinine >=1.3 or <=1.2 mg/dL, respectively) were treated with transdermal buprenorphine (group BUP) or fentanyl (group FEN), respectively. Patients were followed up, at home, by the nonprofit ANT-Italia-foundation physicians in Bologna, Italy. Measurements at 10 (T1), 30 (T2), and 90 (T3) days after enrollment (T0) were pain intensity (Numerical Rating Scale [NRS]), Karnofski score, opioid dose (µg/h), rescue-dose consumption, and occurrence of adverse effects. Patients recorded subjective measurements in a personal diary. Upon data analysis, investigators were blinded to the patient group.Results: At T0, in groups BUP and FEN, median NRS score was 8.0 (CI, 7.4-8.4); its reduction over time (T3; NRS = 3.0; CI, 2.1-3.8 and 2.0-4.0, respectively) was significant and constant in both groups (t-test; T0-T1, T1-T2, and T2-T3; p < 0.0001, p < 0.001, and p < 0.05, respectively). At all times, there were no significant differences in pain scores between the groups. In all evaluations, adverse effects were reported n = 73/126 times (60.8 percent) and showed no significant association (χ2, p > 0.05) with the study groups. Conclusions: Transdermal buprenorphine, in outpatients with cancer and renal impairment, is as effective, safe, and tolerable as fentanyl in patients without such impairment. These results add further evidence to the notion that buprenorphine, with its peculiar pharmacokinetics, may be an appropriate choice for opioid treatment in patients with renal impairment.

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Acupuncture for Insomnia in Pregnancy – a Prospective, Quasi-Randomised, Controlled Study

Acupuncture in Medicine ◽

10.1136/aim.23.2.47 ◽

2005 ◽

Vol 23 (2) ◽

pp. 47-51 ◽

Cited By ~ 38

Author(s):

João Bosco Guerreiro da Silva ◽

Mary Uchiyama Nakamura ◽

José Antonio Cordeiro ◽

Luiz Kulay

Keyword(s):

Pregnant Women ◽

Rating Scale ◽

Numerical Rating Scale ◽

Real Life ◽

Controlled Study ◽

Control Group ◽

Study Group ◽

Randomised Controlled Study ◽

Numerical Rating ◽

Randomised Controlled

Objective This study was undertaken to test the effects of acupuncture on insomnia in a group of pregnant women under real life conditions, and to compare the results with a group of patients undergoing conventional treatment alone (sleep hygiene). Methods A total of 30 conventionally treated pregnant women were allocated at random into groups with or without acupuncture. Seventeen patients formed the study group and 13 the control group. The pregnant women scored the severity of insomnia using a Numerical Rating Scale from 0 to 10. Women were followed up for eight weeks and interviewed five times, at two-week intervals. Results Eight women dropped out, five in the study group and three in the control group. The study group reported a larger reduction on insomnia rating (5.1) than the control group (0.0), a difference which was statistically significant (P=0.0028). Average insomnia scores decreased by at least 50% over time in nine (75%) patients in the study group and in three (30%) of the control group. Conclusion The results of this study suggest that acupuncture alleviates insomnia during pregnancy and further research is justified.

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Ea versus Sham Acupuncture and no Acupuncture for the Control of Acute and Delayed Chemotherapy-Induced Nausea and Vomiting: A Pilot Study

Acupuncture in Medicine ◽

10.1136/acupmed-2015-010781 ◽

2015 ◽

Vol 33 (4) ◽

pp. 277-283 ◽

Cited By ~ 10

Author(s):

Chris McKeon ◽

Caroline A Smith ◽

Kristen Gibbons ◽

Janet Hardy ◽

Corrine Haugstetter ◽

...

Keyword(s):

Standard Care ◽

Rating Scale ◽

Numerical Rating Scale ◽

Sham Acupuncture ◽

Nausea And Vomiting ◽

Controlled Study ◽

Acupuncture Points ◽

Numerical Rating ◽

Randomised Controlled ◽

Oncology Unit

Objective To assess the feasibility of undertaking a high-quality randomised controlled study to determine whether EA gives better control of delayed chemotherapy-induced nausea and vomiting (CINV) than sham EA or standard antiemetic treatment alone. Methods Patients having their first cycle of moderately or highly emetogenic chemotherapy were randomised to EA, sham EA or standard care. EA was given for 30 min on day 1 at the time of chemotherapy and on day 3 using standard acupuncture points bilaterally. Sham EA was given to points adjacent to true EA points. All patients received usual care, comprising antiemetics, according to hospital guidelines. The primary outcomes related to study feasibility, and the clinical outcome measure was the change in Functional Living Index Emesis (FLIE) score captured on days 1 and 7. Results 153 participants were screened between April 2009 and May 2011. Eighteen patients did not meet the inclusion criteria, 37 declined to participate and the absence of an acupuncturist or lack of consent from the treating oncologist excluded a further 38 patients; 60 patients were recruited. The FLIE was completed on day 7 by 49 participants; 33 of 40 patients returned on day 3 for treatment. The nausea and vomiting scores were low in all three arms. Adverse events were generally mild and infrequent. Conclusions It was feasible to undertake a randomised EA trial on a busy day oncology unit. As few patients experienced nausea with their first cycle of chemotherapy, it was not possible to determine whether EA improves CINV over standard care. An enriched enrolment strategy is indicated for future studies. A simple numerical rating scale may prove a better objective nausea measure than the FLIE. Trial Registration Number ACTRN12609001054202.

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Intravesical dexmedetomidine instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study

10.21203/rs.3.rs-39598/v3 ◽

2020 ◽

Author(s):

Hong Chen ◽

Bin Wang ◽

Qin Li ◽

Juan Zhou ◽

Rui Li ◽

...

Keyword(s):

Patient Satisfaction ◽

General Anesthesia ◽

Normal Saline ◽

Rating Scale ◽

Numerical Rating Scale ◽

Intravesical Instillation ◽

Controlled Study ◽

Control Group ◽

Post Operation ◽

Male Patients

Abstract Background: The catheter-related bladder discomfort (CRBD) of male patients is a common clinical problem, albeit lacking effective solutions. The present study aimed to investigate whether intravesical dexmedetomidine instillation alleviates the postoperative urinary discomfort in male patients with catheter under general anesthesia. Methods: This single-blinded, prospective, randomized study included a total of 167 male patients American Society of Anesthesiologists (ASA) physical status I-II scheduled for surgery under general anesthesia were allocated to two groups: 84 in the dexmedetomidine group and 83 in the control group. Dexmedetomidine group patients received intravesical instillation of the drug 0.5 μg/kg and normal saline 20 mL, while the control group received intravesical instillation of 20 mL normal saline. The catheter was clamped for 30 min after intravesical instillation for all patients. Bladder stimulation scales and urethra pain numerical rating scale (NRS) scores were measured at admittance to post-anesthesia care unit (PACU) (T0), intravesical instillation (T1), 30 min (T2), 60 min (T3), 2 h (T4) after intravesical instillation, discharged from PACU (T5), and 6 h (T6) and 24 h (T7) after the operation. Patient satisfaction at discharge from PACU and 24 h post-operation were compared between the two groups. Results: Bladder stimulation scales and urethra pain NRS scores after 30 min of intravesical dexmedetomidine instillation to 24 h post-operation were significantly lower than the control group (p<0.001), and patient satisfaction was higher at discharge from PACU and 24 h post-operation (p<0.001). No diﬀerences were detected in Steward score out of PACU (p=0.213) and from the time of the end of operation to fully awake (p=0.417). Conclusion: Intravesical dexmedetomidine instillation reduces postoperative urinary discomfort and urethra pain and improves satisfaction in male patients under general anesthesia.

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Postoperative analgesic efficacy of the thoracoabdominal nerves block through perichondrial approach (TAPA) and modified-TAPA for laparoscopic cholecystectomy: a randomized controlled study

10.22514/sv.2022.004 ◽

2022 ◽

Keyword(s):

Laparoscopic Cholecystectomy ◽

Rating Scale ◽

Numerical Rating Scale ◽

Open Cholecystectomy ◽

Analgesic Efficacy ◽

Controlled Study ◽

Perioperative Analgesia ◽

Informed Consent Form ◽

Short Period ◽

Block Methods

Laparoscopic cholecystectomy is one of the most common surgical procedures. Even though there is less postoperative pain with laparoscopic cholecystectomy than with open cholecystectomy, severe pain can occur, particularly within the first 24 hours. Evaluation of the efficacy of ultrasound-guided interfascial plane blocks for postoperative analgesia of laparoscopic cholecystectomy has recently come to prominence. The aim of our study was to compare the postoperative analgesic efficacy of thoracoabdominal nerves block through perichondrial approach (TAPA) and modified-TAPA (m-TAPA) blocks in patients who underwent laparoscopic cholecystectomy. The present study included 56 patients who underwent laparoscopic cholecystectomy under general anesthesia and received TAPA or m-TAPA block for perioperative analgesia. Each patient signed a written informed consent form. Block times and numerical rating scale (NRS) scores 1, 2, 3, and 12 hours postoperatively, hourly and total tramadol amount of use via the patient-controlled analgesia device, and additional analgesic drug consumption were all recorded. The TAPA group had significantly longer block application times than the m-TAPA group. At 1 and 12 hours, NRS scores were lower in the TAPA group. However, the mean NRS scores, total tramadol use, and use of additional analgesics were comparable between the groups. TAPA and m-TAPA block methods reduced NRS scores by alleviating pain after laparoscopic cholecystectomy procedures, thereby reducing the need for additional analgesics. Block times for TAPA were significantly longer than those for m-TAPA. However, both block applications were completed in a short period, smoothly and safely. The analgesic effect of TAPA block was more distinctive at 1 and 12 hours, and NRS scores were lower. However, we think that both block methods, when used under ultrasound guidance, will provide effective analgesia by supplementing the multimodal analgesia planned for laparoscopic cholecystectomy and other abdominal operations.

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Proof-of-Concept Randomized Controlled Study of Cognition Effects of the Proprietary ExtractSceletium tortuosum(Zembrin) Targeting Phosphodiesterase-4 in Cognitively Healthy Subjects: Implications for Alzheimer’s Dementia

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2014/682014 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 9

Author(s):

Simon Chiu ◽

Nigel Gericke ◽

Michel Farina-Woodbury ◽

Vladimir Badmaev ◽

Hana Raheb ◽

...

Keyword(s):

Healthy Subjects ◽

Rating Scale ◽

Vital Signs ◽

Camp Response Element Binding ◽

Alzheimer’S Dementia ◽

Controlled Study ◽

Double Blind ◽

Alzheimer's Dementia ◽

Female Ratio ◽

Element Binding Protein

Introduction. Converging evidence suggests that PDE-4 (phosphodiesterase subtype 4) plays a crucial role in regulating cognition via the PDE-4-cAMP cascade signaling involving phosphorylated cAMP response element binding protein (CREB).Objective. The primary endpoint was to examine the neurocognitive effects of extractSceletium tortuosum(Zembrin) and to assess the safety and tolerability of Zembrin in cognitively healthy control subjects.Method. We chose the randomized double-blind placebo-controlled cross-over design in our study. We randomized normal healthy subjects (totaln=21) to receive either 25 mg capsule Zembrin or placebo capsule once daily for 3 weeks, in a randomized placebo-controlled 3-week cross-over design. We administered battery of neuropsychological tests: CNS Vital Signs and Hamilton depression rating scale (HAM-D) at baseline and regular intervals and monitored side effects with treatment emergent adverse events scale.Results. 21 subjects (mean age: 54.6 years ± 6.0 yrs; male/female ratio: 9/12) entered the study. Zembrin at 25 mg daily dosage significantly improved cognitive set flexibility (P<0.032) and executive function (P<0.022), compared with the placebo group. Positive changes in mood and sleep were found. Zembrin was well tolerated.Conclusion. The promising cognitive enhancing effects of Zembrin likely implicate the PDE-4-cAMP-CREB cascade, a novel drug target in the potential treatment of early Alzheimer’s dementia. This trial is registered with ClinicalTrials.govNCT01805518.

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Prospective randomized controlled study of patient compliance in using a compression stocking: Importance of recommendations of the practitioner as a factor for better compliance

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516682886 ◽

2016 ◽

Vol 33 (1) ◽

pp. 36-43 ◽

Cited By ~ 12

Author(s):

Jean-François Uhl ◽

Jean-Patrick Benigni ◽

Maxime Chahim ◽

Delinotte Fréderic

Keyword(s):

Patient Compliance ◽

Compression Therapy ◽

Direct Result ◽

Controlled Study ◽

Compression Stocking ◽

Compression Stockings ◽

Thermal Probe ◽

Before And After ◽

Group 2 ◽

Group 1

Background Patient compliance is the cornerstone of compression therapy success. However, there has been up to now no tool to assess it other than self-reporting by the patient, which is not reliable. Material and methods Forty active females classified C2S were enrolled to wear compression stockings (CS) providing a pressure of 15–20 mmHg at the ankle. A thermal probe was inserted in the stocking (Thermotrack®), recording the skin temperature every 20 min for four weeks. The patients were randomized in two groups of 20: – Group 1: Receiving minimal recommendations by their physician at the office. – Group 2: Receiving in-depth recommendations by the physician reinforced with SMS message which were repeated once a week for four weeks. The basic CEAP classification and the quality of life (QoL) were recorded before and after four weeks. Results The two groups are similar for age, symptoms and type of CS. The analysis of the thermal curves showed a significant increase (+33%) in the average wearing time daily in the group 2: 8 h vs. 5.6 h (group1) p < 0.01. The average number of days worn per week is also increased: 3.4 (group 1) vs. 4.8 (group 2), thus improving patient compliance from 48.5% to 70% as a direct result of the physician recommendations ( p < 0.001). Conclusion This is the first study assessing the real compliance in CVD patients of using compression. It shows that better and repeated recommendations by the practitioner result in an increase in time the compression is used by 33%. The study also suggests that the number of days the compression stocking is worn is a good criterion of patient compliance.

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