Nerve Blocks Prior to Microfocused Ultrasound Treatment are Safe and Reduce Patient Discomfort

2020 ◽  
Vol 40 (8) ◽  
pp. 887-891
Author(s):  
Marc A Polacco ◽  
Daniel R Butz ◽  
Rachel Bass ◽  
Teresa Luu ◽  
Esra Kurum ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pain Score ◽  
Ultrasound Treatment ◽  
Patient Comfort ◽  
Control Group ◽  
Level Of Evidence ◽  
Nerve Blocks ◽  
Patient Discomfort ◽  
The Mean ◽  
Split Face

Abstract Background Microfocused ultrasound with visualization has become one of the more popular nonsurgical facial rejuvenation therapies available. Although the treatment has gained wide acceptance, providing adequate pain relief during the procedure can be challenging. Objectives The aim of this study was to test our hypothesis that nerve blocks prior to treatment would be well tolerated and significantly reduce patient discomfort. Methods Subjects undergoing microfocused ultrasound were offered the choice of participating in a split face nerve block, bilateral block, or a control group. Nerves targeted included infraorbital, supratrochlear, supraorbital, zygomaticofrontal, mental, great auricular, and cervical plexus. Pain assessment was based on a 10-point Wong-Backer FACES Pain score. Results A total of 65 patients were included in the study: 28 in the split face group, 19 in the bilateral block group, and 18 without a block. The mean [standard deviation] pain score of the bilateral block cohort was 3.9 [1.2], and that of the control group was 5.1 [1.7] (P = 0.001). Patients in the split face cohort reported a higher pain score on the unblocked side of the face (7.5 [1.3]) than on the blocked side (2.9 [1.0]) (P < 0.001). The mean pain score for local anesthetic injection was 2.7 and 1.4 for the split face and the bilateral groups, respectively. There were no adverse events. Conclusions Nerve blocks are well tolerated and significantly improve patient comfort during microfocused ultrasound treatment without compromising outcomes or increasing adverse events. Level of Evidence: 2

scholarly journals Are the First and Second Hip in Staged Bilateral Total Hip Arthroplasty Equal? A Hospital Adverse Event and Perioperative Risk Comparison

2021 ◽  
Author(s):  
Jesus M. Villa ◽  
Tejbir S. Pannu ◽  
Carlos A. Higuera ◽  
Juan C. Suarez ◽  
Preetesh D. Patel ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Adverse Events ◽  
Hip Arthroplasty ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Exact Test ◽  
Total Hip ◽  
Discharge Disposition ◽  
The Mean

AbstractHospital adverse events remain a significant issue; even “minor events” may lead to increased costs. However, to the best of our knowledge, no previous investigation has compared perioperative events between the first and second hip in staged bilateral total hip arthroplasty (THA). In the current study, we perform such a comparison. A retrospective chart review was performed on a consecutive series of 172 patients (344 hips) who underwent staged bilateral THAs performed by two surgeons at a single institution (2010–2016). Based on chronological order of the staged arthroplasties, two groups were set apart: first-staged THA and second-staged THA. Baseline-demographics, length of stay (LOS), discharge disposition, hospital adverse events, and hospital transfusions were compared between groups. Statistical analyses were performed using independent t-tests, Fisher's exact test, and/or Pearson's chi-squared test. The mean time between staged surgeries was 465 days. There were no significant differences in baseline demographics between first-staged THA and second-staged THA groups (patients were their own controls). The mean LOS was significantly longer in the first-staged THA group than in the second (2.2 vs. 1.8 days; p < 0.001). Discharge (proportion) to a facility other than home was noticeably higher in the first-staged THA group, although not statistically significant (11.0 vs. 7.6%; p = 0.354). The rate of hospital adverse events in the first-staged THA group was almost twice that of the second (37.2 vs. 20.3%; p = 0.001). There were no significant differences in transfusion rates. However, these were consistently better in the second-staged THA group. When compared with the first THA, our findings suggest overall shorter LOS and fewer hospital adverse events following the second. Level of Evidence Level III.

scholarly journals A Rapid and Effective Method to Prolong Pain Relief in Sheep Using Bupivacaine and Intralipid ® Combination

2019 ◽  
Vol 4 (3) ◽  
pp. 1-6
Author(s):  
Farzin Sahebjam
Keyword(s):  
Nerve Block ◽  
Final Concentration ◽  
Noxious Stimulus ◽  
Control Group ◽  
Multiple Time ◽  
Treatment Results ◽  
Time Intervals ◽  
Nerve Blocks ◽  
Duration Of Action ◽  
The Mean

Background : To compare the duration of action of a local anesthetic block using a lipid formulation of bupivacaine to the commercially available aqueous formulation. Bupivacaine 0.5% was mixed with an equal volume of either lipid emulsion (Intralipid, Fresenius Kabi) or normal saline resulting in a final concentration of 0.25% bupivacaine. Eighteen sheep were administered a n erve block of either control or treatment at the metacarpal region of each forelimb to compare the efficacy of the injected formulations. The nociceptive test was determined by applying a blunt noxious stimulus to the foot below the nerve block at multiple time intervals until the sheep responded by withdrawing its foot. The person assessing the response to the noxious stimulus was blinded to the treatment. Results: The Intralipid formulation significantly extended the duration of the nerve block compared to the control group. The mean analgesic period (mean±SD) in the control legs was 4.23±1.8 hr. compared to 5.81±1.78 hr. in the Intralipid injected legs (p=0.013). Conclusions : In conclusion, an Intralipid® - based formulation provided a more prolonged dura tion of local anesthesia after nerve blocks in the sheep metacarpal region compared to aqueous bupivacaine.

scholarly journals Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Nonoperatively Treated Foot and Ankle Patients

2018 ◽  
Vol 39 (12) ◽  
pp. 1444-1448 ◽  
Author(s):  
Kevin D. Martin ◽  
Trevor McBride ◽  
Jeffrey Wake ◽  
Jeffrey Preston Van Buren ◽  
Cuyler Dewar
Keyword(s):  
Pain Score ◽  
Operative Procedure ◽  
Patient Reported Outcome Measures ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Vas Score ◽  
Pain Scores ◽  
Patient Reported ◽  
The Mean

Background: Patient-reported outcome measures (PROMs) are taking a more prominent role in orthopedics as health care seeks to define treatment outcomes. The visual analog scale (VAS) is considered a reliable measure of acute pain. A previous study found that operative candidates’ VAS pain score was significantly higher when reported to the surgeon compared to the nurse. This study’s aim is to examine whether this phenomenon occurs in patients that do not undergo an operative procedure. We hypothesized that patients’ VAS pain scores reported to the surgeon vs the nurse would be the same. Methods: This study is a retrospective cohort of 201 consecutive nonoperative foot and ankle patients treated by a single surgeon. Patients were asked to rate pain intensity by a nurse followed by the surgeon using a horizontal VAS, 0 “no pain” to 10 “worst pain.” Differences in reported pain levels were compared with data from the previous cohort of 201 consecutive operative foot and ankle patients. Results: The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the surgeon was 4.2 ( P < .001). The mean difference in VAS scores reported for operative patients was 2.9, whereas the mean difference for nonoperative patients was 1.0 ( P < .001). Conclusion: This study found statistically significant differences between VAS pain scores reported to the surgeon vs the nurse in nonoperative patients. These results support the trend found in our previous study, where operative patients reported significantly higher pain scores to the surgeon vs the nurse. The mean difference between reported pain scores was significantly higher for operative patients compared to nonoperative patients. Level of Evidence: Level III, comparative study.

scholarly journals Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation

2021 ◽  
Vol 51 (6) ◽  
pp. E3
Author(s):  
Gaetano De Biase ◽  
Shaun E. Gruenbaum ◽  
James L. West ◽  
Selby Chen ◽  
Elird Bojaxhi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Minimally Invasive ◽  
General Anesthesia ◽  
Pain Score ◽  
Operating Room ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Procedure Time ◽  
The Mean

OBJECTIVE There has been increasing interest in the use of spinal anesthesia (SA) for spine surgery, especially within Enhanced Recovery After Surgery (ERAS) protocols. Despite the wide adoption of SA by the orthopedic practices, it has not gained wide acceptance in lumbar spine surgery. Studies investigating SA versus general anesthesia (GA) in lumbar laminectomy and discectomy have found that SA reduces perioperative costs and leads to a reduction in analgesic use, as well as to shorter anesthesia and surgery time. The aim of this retrospective, case-control study was to compare the perioperative outcomes of patients who underwent minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF) after administration of SA with those who underwent MIS-TLIF under GA. METHODS Overall, 40 consecutive patients who underwent MIS-TLIF by a single surgeon were analyzed; 20 patients received SA and 20 patients received GA. Procedure time, intraoperative adverse events, postoperative adverse events, postoperative length of stay, 3-hour postanesthesia care unit (PACU) numeric rating scale (NRS) pain score, opioid medication, and time to first ambulation were collected for each patient. RESULTS The two groups were homogeneous for clinical characteristics. A decrease in total operating room (OR) time was found for patients who underwent MIS-TLIF after administration of SA, with a mean OR time of 156.5 ± 18.9 minutes versus 213.6 ± 47.4 minutes for patients who underwent MIS-TLIF under GA (p < 0.0001), a reduction of 27%. A decrease in total procedure time was also observed for SA versus GA (122 ± 16.7 minutes vs 175.2 ± 10 minutes; p < 0.0001). No significant differences were found in intraoperative and postoperative adverse events. There was a difference in the mean maximum NRS pain score during the first 3 hours in the PACU as patients who received SA reported a lower pain score compared with those who received GA (4.8 ± 3.5 vs 7.3 ± 2.7; p = 0.018). No significant difference was observed in morphine equivalents received by the two groups. A difference was also observed in the mean overall NRS pain score, with 2.4 ± 2.1 for the SA group versus 4.9 ± 2.3 for the GA group (p = 0.001). Patients who received SA had a shorter time to first ambulation compared with those who received GA (385.8 ± 353.8 minutes vs 855.9 ± 337.4 minutes; p < 0.0001). CONCLUSIONS The results of this study have pointed to some important observations in this patient population. SA offers unique advantages in comparison with GA for performing MIS-TLIF, including reduced OR time and postoperative pain, and faster postoperative mobilization.

scholarly journals EFFECTIVENESS OF MUSIC PLAYBACK ON INTRAVENOUS CANNULATION PAIN AMONG CHILDREN

THE GENESIS ◽  
2020 ◽  
Vol 7 (3) ◽  
Author(s):  
Ms. Reshma P. S* s ◽  
Mrs. Anju A r ◽  
Mrs. Evangeline j ◽  
Mrs. Sabitha r
Keyword(s):  
Pain Score ◽  
Sampling Technique ◽  
Pain Scale ◽  
Control Group ◽  
Nursing Theory ◽  
Chi Square ◽  
Quasi Experimental ◽  
The Mean ◽  
Level Of Significance ◽  
Experimental Group

A quasi experimental study was conducted to assess the effectiveness of music playback on intravenous cannulation pain among children in a selected hospital. Objectives: to assess the mean posttest pain score among children in the experimental and control group, to find out the effectiveness of music playback on intravenous cannulation pain among children and to find out the association between posttest pain score and selected socio demo graphic variables of children in control group. Quasi experimental posttest only controls group design and convenience sampling technique was used to select 60 children in a selected hospital at Alappuzha district. Conceptual framework: Ernestine Wiedenbach’s Helping Art of Clinical Nursing Theory (1969). Posttest was conducted in the control and the experimental group by using FLACC Behavioral Pain Scale and Socio demographic proforma. Music playback was played to the experimental group for 10 minutes during intravenous cannulation. The data were tabulated and analysed using descriptive and inferential statistics. The mean posttest pain score of children in the experimental group was 4.1 with SD 1.33 which was significantly lower than the mean posttest pain score of children in the control group which was 7.8 with SD 1.27 with a mean difference of 3.6. The calculated ‘t’ value 10.910 was greater than the table value 2.00, is significant at p<0.05 level with degree of freedom 58. Hence, we can conclude that the music playback was effective in reducing the pain level of children during intravenous cannulation. The analysis showed that the calculated chi square value for family monthly income, number of previous hospitalisations, previous exposure of cannulation were greater than that of the table value at p < 0.05 level of significance. Hence null hypothesis (H02) can be rejected and research hypothesis (H2) can be accepted. So, it can be concluded that there was significant association between posttest pain score an

scholarly journals Failure Rates of 5-Strand and 6-Strand vs Quadrupled Hamstring Autograft ACL Reconstruction: A Comparative Study of 413 Patients With a Minimum 2-Year Follow-up

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094632
Author(s):  
Ahmed Khalil Attia ◽  
Hazem Nasef ◽  
Kareem Hussein ElSweify ◽  
Mohammed A. Adam ◽  
Faris AbuShaaban ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Control Group ◽  
Failure Rates ◽  
Hamstring Autograft ◽  
Level Of Evidence ◽  
Increased Risk ◽  
The Mean ◽  
Anterior Cruciate ◽  
Graft Diameter

Background: Anterior cruciate ligament reconstruction (ACLR) with hamstring autograft has gained popularity. However, an unpredictably small graft diameter has been a drawback of this technique. Smaller graft diameter has been associated with increased risk of revision, and increasing the number of strands has been reported as a successful technique to increase the graft diameter. Purpose: To compare failure rates of 5-strand (5HS) and 6-strand (6HS) hamstring autograft compared with conventional 4-strand (4HS) hamstring autograft. We describe the technique in detail, supplemented by photographs and illustrations, to provide a reproducible technique to avoid the variable and often insufficient 4HS graft diameter reported in the literature. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed prospectively collected data of all primary hamstring autograft ACLRs performed at our institution with a minimum 2-year follow-up and 8.0-mm graft diameter. A total of 413 consecutive knees met the study inclusion and exclusion criteria. The study population was divided into 5HS and 6HS groups as well as a 4HS control group. The primary outcome was failure of ACLR, defined as persistent or recurrent instability and/or revision ACLR. Results: The analysis included 224, 156, and 33 knees in the 5HS, 6HS, and 4HS groups, respectively. The overall ACLR failure rate in this study was 11 cases (8%): 5 cases for 5HS, 3 cases for 6HS, and 3 cases for 4HS. No statistically significant differences were found among groups ( P = .06). The mean graft diameter was 9 mm, and the mean follow-up was 44.27 months. Conclusion: The 5HS and 6HS constructs have similar failure rates to the conventional 4HS construct of 8.0-mm diameter and are therefore safe and reliable to increase the diameter of relatively smaller hamstring autografts. We strongly recommend using this technique when the length of the tendons permits to avoid failures reportedly associated with inadequate graft size.

The effect of natural matrix biopolymer membrane on hard-to-heal venous leg ulcers: a pilot randomised clinical trial

2020 ◽  
Vol 29 (5) ◽  
pp. 295-302
Author(s):  
Ziva Atias ◽  
John M Pederson ◽  
Hemant K Mishra ◽  
Shoshana Greenberger
Keyword(s):  
Pain Score ◽  
Test Group ◽  
Final Analysis ◽  
Percentage Change ◽  
Control Group ◽  
Therapeutic Effects ◽  
Leg Ulcers ◽  
Ulcer Size ◽  
Venous Leg Ulcers ◽  
The Mean

Objective: The aim of this study was to evaluate the therapeutic effects of natural matrix biopolymer membrane (NMBM) in the treatment of venous leg ulcers (VLUs). Method: Patients exhibiting one or more VLU were assigned to a test group receiving NMBM or to a control group receiving conventional treatment. Patients exhibiting venous insufficiency-related ulcers within 0.1–170cm 2 were included. Efficacy was assessed based on ulcer size and visual analogue scale (VAS) pain scores at baseline and at weeks one, two and four. Ulcer size and pain were compared between groups using a two-way ANOVA. Results: In this study, 25 patients with 32 VLUs (NMBM group: 14 patients with 17 ulcers; control group: 11 patients with 15 ulcers) were included in the final analysis. At four weeks after baseline measurements, the mean percentage change in VLU area of patients in the NMBM group was 61.6% (95% CI: 40.3–82.9) compared with 84.1% (95% CI: 56.5–111.7) for control group patients. Additionally, the mean percentage change in VLU volume of NMBM group patients was 51.2% (95% CI: 31.8–70.6) compared with 84.0% (95% CI: 57.0–121.0) for control group patients. The NMBM group patients exhibited a mean decrease of 0.38 (95% CI: –0.85–1.61) in VAS pain score over four weeks, compared with a mean decrease of 0.13 (95% CI: –1.32–1.58) for control group patients. No significant differences in VLU area (p=0.210), volume (p=0.122) or VAS pain score (p=0.460) were shown between groups. Conclusion: NMBM was found to be as effective and safe as the control group treatments. This pilot study suggests NMBM can be used safely to promote ulcer healing.

scholarly journals Efficacy and Safety of Tongning Gel for Knee Osteoarthritis: A Multicentre, Randomized, Double-Blinded, Parallel, Placebo-Controlled, Clinical Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Ye Zhao ◽  
Zhi Bi Shen ◽  
Ji Rong Ge ◽  
Wen Gang Liu ◽  
Jun Xing Yang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Adverse Events ◽  
Knee Osteoarthritis ◽  
Physical Function ◽  
Pain Score ◽  
Adverse Reactions ◽  
Control Group ◽  
Womac Pain ◽  
Womac Pain Score ◽  
Experimental Group

Objective. To evaluate the efficacy and safety of Tongning Gel (TNG) compared to placebo-controlled (PC) for knee osteoarthritis (KOA). Methods. A multicentre, randomized, double-blinded, parallel, placebo-controlled, clinical trial was performed in 576 patients (432 patients in the TNG group, 144 patients in the PC group), and 1 in the experimental group withdrew due to nonuse of drug. Patients were randomized to receive TNG or PC applied to knee skin at 3g per time, 2 times per day, which lasted for 3 weeks. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score was used to evaluate the primary efficacy of TNG and WOMAC stiffness and physical function and total scores were used to evaluate the secondary efficacy of TNG. All participants who received at least one dose of study drug were included in the safety analysis. This trial has been registered in Chinese Clinical Trial Registry (no. CTR20131276). Results. Primary efficiency outcome: there were significant differences in the decreased value of WOMAC pain score between two groups (P<0.05), and the decreased value of WOMAC pain score in the TNG group were better than those in the PC group (P<0.05). Secondary efficiency outcome: the WOMAC total score, WOMAC stiffness score, WOMAC physical function score, and the decrease of the above indexes of the two groups of patients after treatment were statistically significant (P<0.05), and the improvement of the above indexes in the TNG group was better than that of the PC group (P<0.05). Safety Evaluation. A total of 42 adverse events were reported by 29 patients: 25 adverse events reported by 16 patients (3.71%) in the experimental group and 17 adverse events were reported by 13 patients (9.03%) in the control group. And 8 adverse reactions were reported by 6 patients including 2 adverse reactions by 2 patients (0.46%) in the experimental group and 6 adverse reactions by 4 patients (2.78%) in the control group. Two cases of significant adverse events occurred in the experimental group. Both groups had one serious adverse event, respectively, which were not relevant to the intervention. Conclusion. These results of the trial demonstrate that TNG is superior to placebo in the treatment of patients with KOA, and TNG can improve other symptoms of KOA, such as stiffness and physical function. TNG is safe for the treatment of knee osteoarthritis as a whole.

PP16 Prehospital recognition and antibiotics for 999 patients with sepsis: feasibility study results

2019 ◽  
Vol 36 (10) ◽  
pp. e8.1-e8
Author(s):  
Jenna Bulger ◽  
Susan Allen ◽  
Jan Davies ◽  
Timothy Driscoll ◽  
Gemma Ellis ◽  
...  
Keyword(s):  
Adverse Events ◽  
Early Recognition ◽  
Randomised Trial ◽  
Intervention Group ◽  
Final Diagnosis ◽  
Outcome Data ◽  
Control Group ◽  
Serious Adverse Events ◽  
Study Results ◽  
The Mean

BackgroundSepsis is a common condition which kills approximately 44,000 people annually in the UK. Early recognition and management of sepsis has been shown to reduce mortality and improve outcomes. Paramedics frequently attend patients with sepsis, and are well placed to provide early diagnosis and treatment. We aimed to assess whether a multi-centre randomised trial to evaluate pre-hospital antibiotics was feasible.MethodsVolunteer paramedics used scratchcards to allocate patients with ‘Red Flag’ Sepsis at random between experimental and control arms. The primary outcome was mortality at six months. We also measured: adverse events, costs, final diagnosis, length of stay in hospital, and quality of care; and collected qualitative data about acceptability to patients in interviews, and paramedics in focus groups. We pre-specified criteria for deciding whether to progress to a fully powered trial based on: recruitment of paramedics and patients; retrieval of outcome data; safety; acceptability; and diagnostic accuracy.ResultsFifty-four paramedics completed their training and were issued scratchcards to randomly allocate patients to trial arms. Patients were recruited from 1.12.17 to 31.5.18. In total, 118 patients were randomly allocated to trial arms; four patients dissented to be included in the trial, leaving 114 patients to follow-up. Sixty-two patients (54%) were allocated to the intervention arm. The mean age of the control arm was 71.2 years (range 28–97); 33 (65%) control participants were female. In the intervention arm the mean age was 75.6 years (range 30–99) and 38 patients (61%) were female. Nine patients in the control group (18%) and 17 in the intervention group (28%) were already taking antibiotics at the time of their 999 call. Twenty-three questionnaires were received. No serious adverse events were reported.ConclusionsComplete results will be presented at the time of the conference, when routine linked anonymised outcomes are available.

scholarly journals Patient Discomfort and Resident Confidence After Knee Intra-articular Injection Simulation Training: A Randomized Control Trial Study

2018 ◽  
Vol 11 ◽  
pp. 117954411878290 ◽  
Author(s):  
Adae O Amoako ◽  
George GA Pujalte ◽  
Neha Kaushik ◽  
Timothy Riley
Keyword(s):  
Primary Care ◽  
Simulation Training ◽  
Intervention Group ◽  
Primary Care Providers ◽  
Comfort Level ◽  
Control Group ◽  
P Value ◽  
Care Providers ◽  
Patient Discomfort ◽  
The Mean

Teaching primary care providers how to perform musculoskeletal procedures has become increasingly important as more and more patients with orthopedic conditions present in primary care clinics. This study aims to evaluate whether targeted simulation model training in residency can increase residents’ comfort level in performing intra-articular knee injections and decrease the pain of the procedure, as reported by patients injected. Residents were randomized into intervention and control groups. The comfort level of the residents as well as the pain levels from the procedures, as reported by patients, was recorded. The mean comfort level for the intervention group was 1.2, compared with that in the control group, which was 2.13; P value was .047. The mean pain level in the intervention group was 1.8, whereas in the control group was 3.63; P value was .156. Simulation training may boost residents’ comfort level, but not necessarily decrease patient discomfort during intra-articular knee injections.

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