scholarly journals Influence of maintaining apical patency in post-endodontic pain

2020 ◽  
Author(s):  
Snigdha Shubham ◽  
Manisha Nepal ◽  
Ravish Mishra ◽  
Kishor Dutta
Keyword(s):  
Postoperative Pain ◽  
Linear Regression Analysis ◽  
Secondary Outcome ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Number Of Patients ◽  
Significant Difference ◽  
Number Of Visits

Abstract BackgroundThe concept of instrumentation beyond the apical foramen by small flexible file to prevent apical blockage is apical patency. However, this procedure might endow postoperative pain, thus to maintain apical patency or not is the matter of dilemma. Hence, the primary objective of this study was to compare postoperative pain between apical patency and non-patency groups and secondary objective was to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain.MethodsOne hundred sixty patients were included in the study. Patients were randomly divided into: Group A (n = 80) contained apical patency maintained and Group B (n = 80) contained those treated without apical patency. Each group was subdivided into equal number of patients treated in single visit (n = 40) and multiple visits (n = 40), including vital (n=20) and non-vital teeth (n=20) and single- rooted (n=10) and multiple-rooted teeth (n=10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using a Numerical Rating Scale (NRS-11). Statistical analysis was done using Mann -Whitney U test, Spearman correlation and Multiple linear regression analysis.ResultsThe primary outcome of this study showed statistically significant difference (p<0.05) in postoperative pain scores between patency and non-patency groups with higher pain scores in patency group on 1st, 2nd and 7th day follow up. The secondary outcome showed postoperative pain in patency maintained group was influenced by status of the pulp and preoperative pain only. Vital teeth of patency-maintained group treated in multiple visits showed statistically significant (p=0.02) post-operative pain in day 1 follow up. Pre-operative pain showed positive correlation with postoperative pain with statistically significant difference.ConclusionsOur study concluded that maintenance of apical patency increased postoperative pain. Evaluation of influence of number of visits, status of pulp, group of tooth and preoperative pain revealed status of pulp and preoperative pain as influencing factors for postoperative pain in patency group.

scholarly journals Influence of maintaining apical patency in post-endodontic pain

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Snigdha Shubham ◽  
Manisha Nepal ◽  
Ravish Mishra ◽  
Kishor Dutta
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Linear Regression Analysis ◽  
Secondary Outcome ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Number Of Visits

Abstract Background The concept of instrumentation beyond the apical foramen by small flexible file to prevent apical blockage is apical patency. However, this procedure might endow postoperative pain, thus to maintain apical patency or not is the matter of dilemma. Hence, the primary objective of this study was to compare postoperative pain between apical patency and non-patency groups and secondary objective was to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain. Methods Preselected (n = 178) patients based on group of teeth and status of pulp were randomly divided into 2 groups, apical patency and non-patency which was further treated in either single or multiple visits. After exclusion, 160 patients were included. Each group (n = 80) was subdivided in single visit (n = 40) and multiple visits (n = 40), including vital (n = 20) and non-vital teeth (n = 20) and single-rooted (n = 10) and multiple-rooted teeth (n = 10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using Numerical Rating Scale (NRS-11). Statistical analysis was done using Mann–Whitney U test, Spearman correlation and Multiple linear regression analysis. Results The primary outcome of this study showed statistically significant difference (p < 0.05) in postoperative pain scores between patency and non-patency groups with higher pain scores in patency group on 1st, 2nd and 7th day follow up. The secondary outcome showed postoperative pain in patency-maintained group was influenced by status of the pulp and preoperative pain only. Vital teeth of patency-maintained group treated in multiple visits showed statistically significant (p = 0.02) post-operative pain in day 1 follow up. Pre-operative pain showed positive correlation with postoperative pain with statistically significant difference. Conclusions Our study concluded that maintenance of apical patency increased postoperative pain. Evaluation of influence of number of visits, status of pulp, group of tooth and preoperative pain revealed status of pulp and preoperative pain as influencing factors for postoperative pain in patency group.

scholarly journals Influence of maintaining apical patency in post-endodontic pain

2020 ◽  
Author(s):  
Snigdha Shubham ◽  
Manisha Nepal ◽  
Ravish Mishra ◽  
Kishor Dutta
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Linear Regression Analysis ◽  
Secondary Outcome ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Number Of Visits

Abstract Background The concept of instrumentation beyond the apical foramen by small flexible file to prevent apical blockage is apical patency. However, this procedure might endow postoperative pain, thus to maintain apical patency or not is the matter of dilemma. Hence, the primary objective of this study was to compare postoperative pain between apical patency and non-patency groups and secondary objective was to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain.Methods Preselected (n=178) patients based on group of teeth and status of pulp were randomly divided into 2 groups, apical patency and non- patency which was further treated in either single or multiple visit. After exclusion, 160 patients were included. Each group (n=80) was subdivided in single visit (n = 40) and multiple visits (n = 40), including vital (n=20) and non-vital teeth (n=20) and single- rooted (n=10) and multiple-rooted teeth (n=10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using Numerical Rating Scale (NRS-11). Statistical analysis was done using Mann -Whitney U test, Spearman correlation and Multiple linear regression analysis.Results The primary outcome of this study showed statistically significant difference (p<0.05) in postoperative pain scores between patency and non-patency groups with higher pain scores in patency group on 1st, 2nd and 7th day follow up. The secondary outcome showed postoperative pain in patency maintained group was influenced by status of the pulp and preoperative pain only. Vital teeth of patency-maintained group treated in multiple visits showed statistically significant (p=0.02) post-operative pain in day 1 follow up. Pre-operative pain showed positive correlation with postoperative pain with statistically significant difference.Conclusions Our study concluded that maintenance of apical patency increased postoperative pain. Evaluation of influence of number of visits, status of pulp, group of tooth and preoperative pain revealed status of pulp and preoperative pain as influencing factors for postoperative pain in patency group.

scholarly journals Influence of maintaining apical patency in post-endodontic pain

2020 ◽  
Author(s):  
Snigdha Shubham ◽  
Manisha Nepal ◽  
Ravish Mishra ◽  
Kishor Dutta
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Preoperative Pain ◽  
Post Operative Pain ◽  
Number Of Patients ◽  
Significant Difference ◽  
Number Of Visits ◽  
Group B

Abstract Background The purpose of this study was to compare postoperative pain between apical patency and non-patency groups and to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain. Methods One hundred sixty patients were included in the study. Patients were randomly divided into: Group A (n = 80) contained apical patency maintaining group and Group B (n = 80) contained those treated without maintaining apical patency. Each group was subdivided into equal number of patients treated in single visit (n = 40) and multiple visits (n = 40), including vital (n = 20) and non-vital teeth (n = 20) and single- rooted teeth (n = 10) and multiple-rooted teeth (n = 10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using a numerical rating scale. Statistical analysis was done using Mann -Whitney U test and Spearman correlation. Results There was statistically significant difference (p < 0.05) in postoperative pain scores between the groups on 1st, 2nd and 7th day follow up. Postoperative pain in patency maintaining group was not influenced by number of visit and group of teeth treated. Whereas, vital teeth when patency was maintained in multiple visits root canal treatment post-operative pain was statistically significant (p = 0.02) in day 1 follow up. Pre-operative pain also influenced postoperative pain with statistically significant difference and positive correlation between the groups. Conclusions Our study concluded that maintenance of apical patency increased postoperative pain. Post-operative pain was not influenced by number of visits, and group of teeth. However, for patency group, vital tooth treated in multiple visits results in more postoperative in 1st day follow up. In addition, pre-operative pain also has influence on post-operative pain.

Medicaid Payer Status Is a Predictor of Early Postoperative Pain Following Upper Extremity Procedures

Hand ◽  
2020 ◽  
pp. 155894472091256
Author(s):  
Michael T. Scott ◽  
Allison L. Boden ◽  
Stephanie A. Boden ◽  
Lauren M. Boden ◽  
Kevin X. Farley ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Upper Extremity ◽  
Private Insurance ◽  
Insurance Status ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Patient Reported ◽  
Before And After ◽  
Subjective Pain

Background: The purpose of this study was to investigate the relationship between insurance status and patient-reported pain both before and after upper extremity surgical procedures. We hypothesized that patients with Medicaid payer status would report higher levels of pre- and postoperative pain and report less postoperative pain relief. Methods: In all, 376 patients who underwent upper extremity procedures by a single surgeon at an academic ambulatory surgery center were identified. Patient information, including insurance status and Visual Analog Scale pain score (VAS-pain) at baseline, 2 weeks, and 1, 3, and 6 months, were collected. VAS-pain scores were compared with t-tests and linear regression. Results: Preoperatively and at 2-week, 1-month, and 3-month follow-up, Medicaid patients reported statistically significant higher pain levels than patients with Private insurance, finding a mean adjusted increase of 0.51 preoperatively, 0.39 at 1 month, and 0.79 at 3 months. Preoperatively and at 3-month follow-up, Medicaid patients reported statistically significant higher pain than patients with Medicare, finding increases in VAS-pain of 0.99 preoperatively and 0.94 at 3 months. There was no difference in pain improvement between any insurance types at any time point (all P values > .05). Conclusions: Patients with Medicaid report higher levels of preoperative pain and early postoperative pain, but reported the same improvement in pain as patients with other types of insurance. As healthcare systems are becoming increasingly dependent on patient-reported outcomes, including pain, it is important to consider that differences may exist in subjective pain depending on insurance status.

scholarly journals Endoscopic Epidural Laser Decompression Versus Transforaminal Epiduroscopic Laser Annuloplasty for Lumbar Disc Herniation: A Prospective, Randomized Trial

2017 ◽  
Vol 7 (20;7) ◽  
pp. 633-670
Author(s):  
Chang Hong Park
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Secondary Outcome ◽  
Pain Scores ◽  
Number Of Patients ◽  
The Mean ◽  
Lumbar Radicular Pain

Background: Lumbar radicular pain often results from lumbar disc herniation, spinal stenosis, or degenerative spondylolisthesis. Minimally invasive disc decompression procedures, such as nucleoannuloplasty or epiduroscopic neural decompression by laser, have been devised to treat such pain. Objective: The short-term outcomes of disc decompression by endoscopic epidural laser decompression (EELD) or transforaminal epiduroscopic laser annuloplasty (TELA) were compared in patients with lumbar radicular pain due to disc herniation. Study Design: A randomized, prospective trial. Setting: The Department of Anesthesiology and Pain Medicine at Spine Health Wooridul Hospital in Daegu, Korea. Methods: A total of 97 patients were enrolled in this study; 48 patients underwent EELD and 49 underwent TELA. The pain relief was evaluated at baseline and at 1, 3, and 6 months post-procedure via the numeric rating scale (NRS). The Oswestry Disability Index (ODI) was recorded at baseline and at the final follow-up. Postoperative wound pain was assessed over a 24-hour period. Complications and side effects were also recorded, as were operative times (from local anesthetic infiltration at entry sites to suturing of skin). Results: At post-treatment months 1, 3, and 6 the mean pain scores of patients were significantly lower (relative to pre-treatment baseline) regardless of the procedure used. However, the mean pain scores did not differ significantly by procedure (EELD vs TELA). As well, the number of patients who obtained relief from their pain and needed analgesics was not statistically significant. The irrigation volume was significantly higher in the TELA group. Two patients undergoing TELA procedures experienced headache during the procedures; however, no serious complications such as bleeding, dural/neural injuries, or infection were recorded for either group. Limitation: The observed significant reductions in pain (from baseline) lacked secondary outcome substantiation and given the mid follow-up period, no long-term follow-up results were monitored. Conclusion: Both EELD and TELA provide similar outcomes and are reasonable treatment options for carefully selected patients with lower back or radicular pain. Key words: Epiduroscopy, laser, annuloplasty, disc, herniation, TELA

Clinical trial to assess role of ketamine in post operative analgesia after laparoscopic cholecystectomy

2021 ◽  
Vol 23 (05) ◽  
pp. 421-432
Author(s):  
Dr. Mohammad Kheiri Mahmod ◽  
◽  
Dr. Bashar Naser Hussein ◽  
Dr. Ammar Hamid Hanoosh ◽  
◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Analgesic Effect ◽  
Analgesic Requirement ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: The physiological consequences of post-operative pain including Stress response to surgery, Respiratory complications, cardiovascular complications, Thromboembolic complications, Gastrointestinal complications, Musculoskeletal complications and Psychological complications, all of which could delay or impair postoperative recovery and increase the economic cost of surgery as a result of the longer period of hospitalization. Inadequate post-operative pain control may also lead to the development of chronic pain after surgery .Aim of This study: is to evaluate the preemptive analgesic effect of intravenous ketamine in laparoscopic cholecystectomy. Patients and Methods: double blinded randomized clinical trial conducted at Al-Yarmouk teaching hospital, over a period of one year from March 2013 to March 2014 on a total of 120 adult patients scheduled for elective laparoscopic cholecystectomy, Patients were divided in to three groups of 40 patients each, the study drug administered intravenously during induction. Groups A and B received ketamine in a dose of 1 and 0.5 mg/kg, respectively, whereas group C received isotonic saline. The degree of pain at rest and deep breathing postoperatively were estimated using VAS, time of first analgesic dose, total opioid consumption, nausea, vomiting and hallucination were recorded for 24 h postoperatively. Results: postoperative pain scores were significantly low in group A when compared with the other groups at most times in the first 24 hours. Highest pain score was in group C at 0 h. Postoperative analgesic consumption was minimum in group A then group B and highest in group C. There was little significant difference in the pain scores between groups B and C. Group A had a significantly higher blood MAP than group B at 0, 0.5 and 1 h. 7.5% incidence of hallucinations were in group A. Conclusion: According to this study we conclude that preemptive ketamine in a dose of 1 mg/kg has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. A low dose of 0.5 mg/kg had little significant in preemptive analgesic effect and in reducing analgesic requirement.

scholarly journals Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

2019 ◽  
Author(s):  
Guangyou Duan ◽  
Guiying Yang ◽  
Jing Peng ◽  
Zhenxin Duan ◽  
Jie Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Pain ◽  
Cesarean Section ◽  
Visceral Pain ◽  
Postoperative Patient ◽  
Cesarean Deliveries ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Intravenous Analgesia

Abstract Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: Women who underwent cesarean deliveries under spinal anesthesia were included, and postoperative patient-controlled intravenous analgesia was performed. Postoperative incision and visceral pain within 48 hours after the surgery were evaluated. Serum leukocyte and neutrophil counts before and 24 hours after the surgery were retrospective collected. Additionally, the patients’ pain statuses on postoperative week 1 and week 4 were also assessed during follow-up via telephone. Results: A total of 168 patients (67 primipara and 101 multipara) were included. The multipara showed less risk for experiencing moderate to severe incision pain during the 48 hours after the surgery than the primipara (15.8%vs.37.3%; P=0.001). In patients under 30 years old, inadequate treatment of the visceral pain in the multipara was higher than that of the primipara (22.7%vs.6.4%; P=0.026). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multipara and primipara (33.7%vs.40.2%, P=0.381). Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (55.4%vs.36.1%, P=0.015). Conclusions: Individual differences between the primipara and multipara should be considered in the management of postoperative analgesia for those who have undergone Cesarean deliveries.

scholarly journals Endoscope-Assisted Minimally Invasive Interlaminar Lumbar Decompression for Spinal Stenosis

2019 ◽  
Vol 6 (22;6) ◽  
pp. E573-E578
Author(s):  
Chan Hong Park
Keyword(s):  
Rating Scale ◽  
Numeric Rating Scale ◽  
Secondary Outcome ◽  
Lumbar Stenosis ◽  
Lumbar Decompression ◽  
Pain Scores ◽  
Number Of Patients ◽  
Study Setting ◽  
Numeric Rating

Background: Lumbar stenosis is characterized by a narrowing of the spinal canal in association with progressive degenerative changes in the lumbar spine and surrounding structures, including hypertrophy of the ligamentum flavum (LF). Objectives: The aim of this study was to examine the usefulness of endoscope-assisted interlaminar lumbar decompression (EILD) for patients with lumbar stenosis and hypertrophy of the LF. Study Design: Retrospective study. Setting: Department of Anesthesiology and Pain Medicine, Neurosurgery at Wooridul Spine Hospital. Methods: A total of 51 patients were enrolled in this study. Outcomes were evaluated at baseline and at 2 weeks and 6 months postprocedure via the Numeric Rating Scale, Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ). Results: Mean posttreatment pain scores at 2 weeks and 6 months were significantly lower, and ODI scores were significantly decreased compared with baseline. ZCQ scores were also significantly decreased compared with pretreatment surveys. Two patients required reoperation within one month. At postprocedure 6 months, a ≥ 50% reduction in pain score was recorded in 26 (80%) of 51 patients, and there was ≥ 40% reduction in ODI score in 82% of patients. No serious complications including epidural bleeding, dural or neural injuries, or infection were recorded. Limitations: This study lacked secondary outcome substantiation. In addition, the follow-up period was short (< 6 months), and no patients had postprocedure magnetic resonance imaging. The number of patients was also small. Conclusions: EILD provided good outcomes and may be a reasonable treatment option for carefully selected patients with hypertrophy of the LF.

scholarly journals A comparison of bupivacaine lavage and diclofenac suppository effects on post-operative pain of laparascopic transabdominal pre-peritoneal herniorrhaphy: a randomized clinical trial study

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Alireza Negahi ◽  
Seyed Hamzeh Mousavi ◽  
Vahid Abbasnezhad ◽  
Fatemeh Jahanshahi
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Randomized Clinical Trial ◽  
Laparoscopic Herniorrhaphy ◽  
Topical Anaesthetic ◽  
Time Points ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Duration Of Hospitalization

Abstract Objectives Injection of a topical anaesthetic has been proved to be helpful with reducing pain after laparoscopic herniorrhaphy. We aimed to assess the effect of bupivacaine lavage on postoperative pain and compare it with diclofenac suppository. In this randomized clinical trial, 60 patients—scheduled for laparoscopic herniorrhaphy—were enrolled and randomized into three groups of 20 each, including diclofenac suppository, bupivacaine lavage, and normal saline as a placebo.The patients were investigated for postoperative pain scores, vomiting, nausea, morphine request, and duration of hospitalization. Results In the bupivacaine group, pain levels in recovery room, 4, 8 and 12 h after surgery, were significantly lower than diclofenac group; at time points of 16, 20 and 24 h after surgery, difference between two groups was not significant. Regarding vomiting and nausea, at time points of 1 and 3 h after surgery, results show no significant difference between the groups. Incident of infection, 1 h and 1 week after the surgery, was not significantly different among the groups. Duration of hospitalization in the bupivacaine group was much lower than the diclofenac group. Based on our results, use of the bupivacaine lavage can reduce postoperative pain in patients undergoing laparoscopic herniorrhaphy. Trial Registration Randomized clinical trial IRCT20180522039782N2; date of registration:14/10/2018

scholarly journals Outcomes following repeat ankle arthroscopy for osteochondral lesions of the talus (OLTs)

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Brian Cusworth ◽  
Devon Nixon ◽  
Sandra Klein ◽  
Jeffrey Johnson ◽  
Jeremy J. McCormick
Keyword(s):  
Postoperative Pain ◽  
Retrospective Chart Review ◽  
Ankle Arthroscopy ◽  
Osteochondral Lesions ◽  
Repeat Surgery ◽  
Residual Pain ◽  
Pain Scores ◽  
Significant Difference ◽  
Reoperation Rates

Category: Ankle, Arthroscopy Introduction/Purpose: Management of symptomatic osteochondral lesions of the talus (OLTs) previously treated with arthroscopy remains controversial. Many advocate for open surgical intervention, particularly in patients with larger OLTs. Minimal data, however, exists on the role for repeat ankle arthroscopy. Here, we describe our experience with repeat arthroscopy for symptomatic OLTs, hypothesizing similar pain and satisfaction scores regardless of OLT size. Methods: Our surgical database was queried to identify patients who underwent repeat arthroscopy from February, 1997 – May, 2015. From that cohort, we identified a subset of patients with a diagnosis of symptomatic OLT who were treated with arthroscopic debridement and microfracture. We then performed a retrospective chart review. Phone surveys were conducted to assess clinical outcomes including pain and satisfaction scores as well as to record any subsequent surgery reported by the patient. Using previously defined criteria for size threshold, OLTs were categorized as either small (=150 mm2) or large (> 150 mm2) based on operative dimensions noted at the time of repeat surgery. Results: We identified 15 patients who underwent repeat arthroscopy for symptomatic OLTs. Patients reported reasonable satisfaction (average: 7.3, SD: 2.7) but moderate residual pain (average: 4.6, SD: 3.3) at midterm follow-up (average: 5.0 years, SD: 2.8). Further surgery after repeat arthroscopy was performed in 20% (3/15) of patients. Only 1 patient developed a postoperative complication (superficial DVT treated with observation). Small (n=6) and large OLTs (n=9) had similar postoperative pain scores (4.2 ± 3.7 versus 4.9 ± 3.2), postoperative satisfaction levels (7.5 ± 3.4 versus 7.2 ± 2.3), and reoperation rates (33% versus 22%) (P>.05). Patients with larger OLTs were younger at the time of repeat arthroscopy (P=.026) with no differences in sex or BMI (P>.05) between groups. Conclusion: At midterm follow-up, repeat arthroscopy for symptomatic OLTs demonstrated reasonable satisfaction but with moderate residual pain and a 20% rate of subsequent surgery. There was no statistically significant difference in postoperative pain scores, satisfaction scores, or reoperation rates between small and large OLTs. Repeat arthroscopy for symptomatic OLTs can be done safely – however, patients should be educated to have guarded optimism regarding their outcome.

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