Does Paramedian Approach Preferentially Secure Optimal Drug Delivery Onto Ventral Epidural Space and Subsequent Superior Clinical Efficacy Over a Dorsal Midline Approach During Cervical Interlaminar Epidural Injection?

BACKGROUND: There is paucity in the literature directly comparing the clinical results between the paramedian and the midline interlaminar cervical epidural injections. OBJECTIVE: To compare the proportion of ventral epidural spread of injectate and consequent clinical outcome between the paramedian and midline approach during interlaminar epidural injection in patients with axial neck and/or interscapular pain triggered from the underlying cervical spine pathologic condition. STUDY DESIGN: Retrospective study. SETTING: Primary pain clinic and spine hospital. METHODS: Two hundred and twenty-three patients with axial neck and/or interscapular pain due to cervical problem underwent interlaminar epidural injection through either a paramedian approach (PM group, n = 93) or a midline approach (ML group, n = 130). We compared the portion of ventral epidural filling, Numeric Rating Scale (NRS), and McNab criteria between both groups. The NRS and McNab criteria were also separately compared between the ventrally spread (VS) group and non-ventral spread (non-VS) group inside each PM and ML group, respectively, at 2 weeks and 10 weeks post-injection. RESULTS: The PM group showed a significantly higher proportion of ventral spread, successful NRS reduction, and satisfactory McNab criteria than the ML group at 10 weeks. In the PM group, the VS group showed the same results as above compared to the non-VS group. LIMITATIONS: A retrospective analysis based on the relatively short-term follow-up period clinical results. CONCLUSIONS: The paramedian approach showed the better direct injectate transfer over the ventral epidural space and subsequently superior clinical efficacy for the patients suffering from axial neck and/or interscapular pain secondary to cervical spine problems. KEY WORDS: Cervical disease, epidural injection, interlaminar, paramedian, midline, ventral epidural spread, Numeric Rating Scale, McNab criteria

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Clinical Effectiveness of Percutaneous Adhesiolysis Using Navicath for the Management of Chronic Pain Due to Lumbosacral Disc Herniation

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/213 ◽

2012 ◽

Vol 3;15 (3;5) ◽

pp. 213-223

Author(s):

Juan Hwan Lee

Keyword(s):

Chronic Pain ◽

Disc Herniation ◽

Predictive Factors ◽

Rating Scale ◽

Clinical Effectiveness ◽

Epidural Injection ◽

Numeric Rating Scale ◽

Leg Pain ◽

Transforaminal Epidural Injection ◽

Numeric Rating

Background: Epidural steroid injection has been frequently performed to treat chronic pain due to lumbosacral disc herniation (L-HIVD). However, a considerable number of patients do not achieve pain relief using this method because perineural or epidural adhesions prevent the spread of injectate into the epidural space. Percutaneous adhesiolysis (PA) is thought to be a useful method because it can eliminate the deleterious effects of adhesion. Objectives: This study aimed to evaluate the effectiveness of PA in managing chronic pain due to L-HIVD and the clinical and radiological predictive factors for the effectiveness of PA using NaviCath®. Study design: Retrospective study Setting: Spine hospital Methods: From a group of patients diagnosed with L-HIVD, we selected the 86 patients who underwent PA with NaviCath who had experienced chronic lower back or leg pain for at least 3 months and had failed to respond to anti-inflammatory medications or physical therapy of at least 1 month’s duration and fluoroscopy guided transforaminal epidural injection. We recorded the Numeric Rating Scale for back pain (NRS back) and leg pain (NRS leg) and the Oswestry Disability Index (ODI) at pretreatment, 2 weeks, and 3 months after treatment. Clinical data and magnetic resonance imaging (MRI) findings were obtained to assess the possible predictive factors for PA efficacy. Limitations: Retrospective chart review without a control group. Results: At 2 weeks after PA, significant improvement was observed in NRS back, NRS leg, and ODI compared with pretreatment. This improvement was maintained until 3 months after treatment. Among 86 patients, 61 (70.9%), 53 (61.6%) and 61 patients (70.9%) showed successful outcomes in NRS back, NRS leg, and ODI at 2 weeks, respectively. Among 74 patients who were followed up at 3 months, 47 (63.5%), 44 patients (59.5%), and 50 patients (67.6%) showed successful results in NRS back, NRS leg, and ODI at 3 months, respectively. A significantly higher proportion of patients with a history of previous lumbar surgery showed unsuccessful results on NRS back, NRS leg, and ODI scores at 2 weeks and 3 months. Co-existence of spinal stenosis was associated with a significantly higher proportion of unsuccessful results in NRS back and ODI at 2 weeks and 3 months, as well as NRS leg at 3 months. Patients with spondylolisthesis also showed a significantly higher proportion of unsuccessful results in NRS and ODI at 2 weeks. Conclusion: PA with NaviCath showed clinical effectiveness in the treatment of chronic pain due to L-HIVD that was not responsive to transforaminal epidural injection. Previous surgery and the presence of spinal stenosis or spondylolisthesis were poor prognostic predictors. This procedure may enable the physician to place the catheter tip and deliver medicine more precisely. Key words: Percutaneous adhesiolysis, lumbosacral disc herniation, Numeric Rating Scale, Oswetry Disability Index

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Evaluation of Contrast Flow Patterns with Cervical Interlaminar Epidural Injection: Comparison of Midline and Paramedian Approaches

Medicina ◽

10.3390/medicina57010008 ◽

2020 ◽

Vol 57 (1) ◽

pp. 8

Author(s):

Byeongcheol Lee ◽

Sang Eun Lee ◽

Yong Han Kim ◽

Jae Hong Park ◽

Ki Hwa Lee ◽

...

Keyword(s):

Epidural Space ◽

Epidural Injection ◽

Spinal Pain ◽

Contralateral Side ◽

Intervertebral Disc Space ◽

Disc Space ◽

Lateral Group ◽

Medial Group ◽

Midline Approach ◽

Interlaminar Epidural Injection

Background and objectives: The purpose of this study was to compare and to analyze contrast spread patterns between the paramedian and midline approaches to cervical interlaminar epidural injection (CIEI). Materials and Methods: We retrospectively enrolled 84 CIEI cases that had been performed for unilateral cervical spinal pain from April 2019 to April 2020. After 3 mL of contrast had been injected into the epidural space, fluoroscopic images were obtained. The CIEI was divided into a midline (Group M, n = 42) and a paramedian (Group P, n = 42) approach by anteroposterior imaging. The P Group was classified into a more medial (Group Pm, n = 26) and a more lateral (Group Pl, n = 16) group. Using ImageJ on an anteroposterior image, we assessed the grayscale brightness ratio of the ipsilateral or contralateral side of the vertebral body as well as the intervertebral disc space one level just above the needle location. We identified the dispersion of contrast into the ventral epidural space. Results: The grayscale brightness ratio was significantly higher in Group P than in Group M (p < 0.001). The incidence of ventral epidural spread in Group M was 57.1% versus 88.1% in Group P, which was significantly different (p = 0.001). Conclusions: The fluoroscopic CIEI finding in the paramedian approach predominantly showed an excellent delivery of the injectate to the ipsilateral side in comparison to the contralateral side. This showed a greater advantage in delivery toward ventral epidural space as compared to the midline approach.

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Anatomical Flow Pattern of Contrast in Lumbar Epidural Space: A Human Study with a Midline vs. Parasagittal Interlaminar Approach under Fluoroscopy

January 2018 - Pain Physician ◽

10.36076/ppj.2015/18/317 ◽

2015 ◽

Vol 18;4 (4;18) ◽

pp. 317-324

Author(s):

Morteza Kazempour Kazempour

Keyword(s):

Back Pain ◽

Study Design ◽

Epidural Space ◽

Rating Scale ◽

Human Study ◽

Epidural Injection ◽

Epidural Injections ◽

Interlaminar Approach ◽

Number Of Patients ◽

Midline Approach

Background: Epidural injections for managing chronic back pain are one of the most commonly performed interventions; however, controversy continues regarding the most effective method of epidural injections. A ventral distribution of epidural injected drug plays a significant role in its effectiveness. Objective: To determine the distribution of a drug in the epidural space after parasagital and midline epidural injection. Setting: Academic hospital. Study Design: In randomized double-blind clinical trial, patients with a diagnosis of low back pain (LBP) and unilateral lumbosacral radicular pains were randomized to receive drug through either parasagital or midline approach. Methods: Patients were assessed for anterior epidural spread of contrast under fluoroscopy in anteroposterior and lateral views. After epidural space confirmation, triamcinolone (80 mg) plus bupivacain was injected and patients were followed up for 2 weeks. Results: Fifty-six patients enrolled in the study. Successful infiltration of the drug into the ventral epidural space was successfully achieved in 75% of cases in the parasagital group but in only 25% of the cases in using a midline approach. Effective pain relief (numeric rating scale [NRS] < 3) was observed in 76.5% of patients in the parasagital group and 24.5% of patients in the midline group (P = 0.001) at 2 weeks. Number of patients with improved disability (measured by Oswestry Disability Index [ODI] < 20%) was significantly higher in the parasagital group (78%) compared to the midline group (26%) at 2 weeks (P = 0.002). Limitations: The results of the current study should be interpreted in relation to the study design and future studies should include larger patient numbers and longer follow-up time. However, the results are consistent with previous studies. Conclusion: Parasagital epidural injection showed higher infiltration of the drug to the ventral epidural space compared to the midline approach. The higher infiltration of the ventral epidural space provides better improvement of clinical disability and pain in the parasagital group. Key words: Epidural, midline, parasagital, ventral distribution, disc herniation

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Foot Massage Menurunkan Nyeri Post Operasi Sectio Caesarea Pada Post Partum

Jurnal Kesehatan Komunitas ◽

10.25311/keskom.vol6.iss2.528 ◽

2020 ◽

Vol 6 (2) ◽

pp. 164-170

Author(s):

Dewi Nurlaela Sari ◽

Aay Rumhaeni

Keyword(s):

Daily Living ◽

Rating Scale ◽

Post Partum ◽

Numeric Rating Scale ◽

Sectio Caesarea ◽

P Value ◽

Test Design ◽

Purposive Sampling ◽

Post Test ◽

Numeric Rating

ABSTRAK Sectio caesarea merupakan tindakan alternatif dalam proses persalinan untuk menyelamatkan ibu dan janin. Ibu Bersalin dengan operasi sectio caesarea dilakukan pembedahan pada dinding abdomen dan dinding rahim. Dampak yang paling sering muncul dirasakan oleh postpartum dengan post operasi sectio caesarea adalah nyeri. Nyeri akan berdampak pada bounding attachment terganggu, mobilisasi terbatas, Activity Daily Living (ADL) terganggu serta berpengaruh terhadap Inisiasi Menyusui Dini (IMD). Asuhan yang diberikan terbatas pada terapi farmakologi dibandingkan non farmakologi. Foot massage adalah salah satu terapi non farmakologi yang dapat membantu menutup gerbang di posterior horns dari sumsum tulang belakang dan memblokir bagian dari nyeri ke sistem saraf pusat. Tujuan penelitian ini untuk mengetahui pengaruh foot massage terhadap skala nyeri pada klien post operasi sectio caesarea di RS AMC. Penelitian ini merupakan penelitian pre eksperimen dengan pendekatan one group pre test post test design. Jumlah sampel yang digunakan berjumlah 27 orang dengan menggunakan teknik purposive sampling. Instrumen yang digunakan adalah Numeric Rating Scale (NRS) dan prosedur kerja foot massage. Responden dilakukan foot massage selama 20 menit selama 2 hari. Data di analisis dengan menggunakan uji wilcoxon. Hasil penelitian menunjukkan lebih dari setengah klien post operasi sectio caesarea berada di skala nyeri 6 sebelum dilakukan foot massage dan hampir setengah memiliki skala nyeri 3 sesudah dilakukan foot massage dan didapatkan nilai p value = 0.000, sehingga disimpulkan ada pengaruh foot massage terhadap skala nyeri pada klien post operasi sectio caesarea. Diharapkan rumah sakit dapat menjadikan foot massage sebagai salah satu alternatif manajemen non farmakologi dalam penanganan nyeri. Kata kunci: Foot Massage; Post Partum; Nyeri; Sectio Caesarea

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Efektivitas pencucian luka menggunakan daun jambu biji terhadap tingkat malodor klien luka kaki diabetik

Riset Informasi Kesehatan ◽

10.30644/rik.v8i2.251 ◽

2019 ◽

Vol 8 (2) ◽

pp. 152

Author(s):

Adi Antoni ◽

Yanna Wari Harahap

Keyword(s):

Diabetic Foot ◽

Rating Scale ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Numeric Rating Scale ◽

P Value ◽

Consecutive Sampling ◽

Guava Leaves ◽

Guava Leaf ◽

Numeric Rating

Abstrak Latar belakang: Diabetes mellitus (DM) merupakan penyakit kronik dan menjadi masalah global. Salah satu komplikasi yang ditimbulkan dari DM adalah luka kaki diabetic. Langkah awal dalam perawatan luka kaki diabetic adalah mencuci luka. Tujuan penelitian ini adalah mengetahui keefektifan dari rebusan daun jambu biji sebagai cairan pencuci luka terhadap tingkat malodor pada luka kaki diabetic. Metode: Desain penelitian yang digunakan adalah quasy experiment dengan rancangan one group pretests-posttest only. Teknik sampling yang digunakan adalah consecutive sampling dengan jumlah sampel 16 orang. Kriteria sampel yang digunakan adalah klien luka kaki diabetic, tingkat malodor 1-10 dengan NRS. Alat ukur yang digunakan adalah Numeric Rating Scale (NRS). Analisa data yang digunakan dalam penelitian ini menggunakan uji paired t test. Hasil: tingkat malodor sebelum intervensi pencucuan luka menggunakan rebusan daun jambu biji rata-rata sebesar 4.40 dan sesudah intervensi sebesart 2.44 dengan p value < 0.001. Selisih tingkat malodor antara sebelum dan sesudah intervensi sebesar 1.96. Hasil penelitian ini menunjukkan bahwa daun jambu dapat digunakan sebagai cairan pencuci luka dalam mengatasi tingkat malodor pada luka kaki diabetik. Kesimpulan : daun jambu biji dapat digunakan sebagai cairan pencuci luka pada luka kaki diabetic. Perawat diharapkan dapat memanfaatkan daun jambu biji sebagai salah satu alternatif dalam pencucian luka kronik khususnya luka kaki diabetik. Kata kunci: Daun Jambu Biji, Tingkat Malodor, Luka Kaki Diabetik Abstract Background: Diabetes mellitus (DM) is a chronic disease and a global problem. One of the complications that arise from DM is diabetic foot ulcer. The first step in treating diabetic foot ulcer is washing the wound. The purpose of this study was to determine the effectiveness of guava leaf decoction as a washing fluid for malodor levels in diabetic foot ulcer. Method: The research design used was quasy experiment with one group pretests-posttest only design. The sampling technique used was consecutive sampling with a sample of 16 people. Sample criteria used were diabetic foot ulcer clients, malodor level 1-10 with NRS. The measuring instrument used is the Numeric Rating Scale (NRS). Analysis of the data used in this study used paired t test. Results: the level of malodor before intervening in wound washing using guava leaf decoctions on average was 4.40 and after the intervention was 2.44 with p value <0.001. The difference in the level of malodor between before and after the intervention was 1.96. The results of this study indicate that guava leaves can be used as a washing fluid in dealing with malodor levels in diabetic foot ulcer. Conclusion: Guava leaves can be used as a washing fluid for diabetic foot wounds. Nurses are expected to be able to use guava leaves as an alternative in washing chronic wounds, especially diabetic foot injuries. Key words: Guava Leaf, Malodor Level, Diabetic foot ulcer.

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RCT on the effectiveness of the intraligamentary anesthesia and inferior alveolar nerve block on pain during dental treatment

Clinical Oral Investigations ◽

10.1007/s00784-021-03787-x ◽

2021 ◽

Author(s):

Bahaa R. Youssef ◽

Andreas Söhnel ◽

Alexander Welk ◽

Mohamed H. Abudrya ◽

Mohamed Baider ◽

...

Keyword(s):

Postoperative Complications ◽

Nerve Block ◽

Rating Scale ◽

Dental Treatment ◽

Inferior Alveolar Nerve ◽

Numeric Rating Scale ◽

Inferior Alveolar Nerve Block ◽

Posterior Teeth ◽

Mandibular Posterior Teeth ◽

Numeric Rating

Abstract Objective To compare the effectiveness and complications of intraligamentary anesthesia (ILA) with conventional inferior alveolar nerve block (IANB) during injection and dental treatment of mandibular posterior teeth. Materials and methods In this randomized, prospective clinical trial, 72 patients (39 males, 33 females), scheduled for dental treatment of mandibular posterior teeth, were randomly allocated to ILA group (n = 35) received ILA injection or IANB group (n = 37) received the conventional IANB. Our primary outcome was to assess pain and stress (discomfort) during the injection and dental treatment, using the numeric rating scale (NRS) from 0 to 10 (0 = no pain, 10= the worst pain imaginable), whereas recording 24-h postoperative complications was our secondary outcomes. Results Patients in ILA group reported significantly less pain during injection when compared with IANB group (p = 0.03), while pain during dental treatment was similar in both groups (p = 0.2). Patients in both groups also reported similar law values of discomfort during treatment (p = 0.7). Although no signs of nerve contact or any other postoperative complications were observed, five patients in IANB group (none in ILA group) reported temporary irritations. Conclusion This study showed equivalent effectiveness of both intraligamentary anesthesia and conventional inferior alveolar nerve block, for pain control during routine dental treatment of mandibular posterior teeth. Nevertheless, ILA showed significantly less pain during injection. No major postoperative complications in both groups were observed. Clinical relevance ILA could be considered as an effective alternative for routine dental treatment. Trial registration NCT04563351

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Prevalence of Psychological Distress and Its Risk Factors in Patients with Primary Bone and Soft Tissue Tumors

Healthcare ◽

10.3390/healthcare9050566 ◽

2021 ◽

Vol 9 (5) ◽

pp. 566

Author(s):

Masato Ise ◽

Eiji Nakata ◽

Yoshimi Katayama ◽

Masanori Hamada ◽

Toshiyuki Kunisada ◽

...

Keyword(s):

Risk Factors ◽

Psychological Distress ◽

Soft Tissue ◽

Rating Scale ◽

Numeric Rating Scale ◽

Soft Tissue Tumors ◽

Number Of Patients ◽

Primary Bone ◽

Associated Risk Factors ◽

Numeric Rating

Psychological distress is common in patients with soft tissue and bone tumors. We first investigated its frequency and the associated risk factors in patients with pre-operative bone and soft tissue tumors. Participants included 298 patients with bone and soft tissue tumors who underwent surgery in our institution between 2015 and 2020. Psychological distress was evaluated by the Distress and Impact Thermometer (DIT) that consists of two types of questions (questions about the severity of the patient’s distress (DIT-D) and its impact (DIT-I)). We used a cut-off point of 4 on the DIT-D and 3 on the DIT-I for screening patients with psychological distress. We therefore investigated: (1) the prevalence of psychological distress as assessed with DIT or distress thermometer (DT), which can be decided by DIT-D ≥ 4, (2) what are the risk factors for the prevalence of psychological distress, and (3) what is the number of patients who consulted a psychiatrist for psychological distress in patients with pre-operative bone and soft tissue tumors. With DIT and DT, we identified 64 patients (21%) and 95 patients (32%), respectively, with psychological distress. Multivariate logistic regression revealed that older age, sex (female), malignancy (malignant or intermediate tumor), a lower Barthel Index, and higher numeric rating scale were risk factors for psychological distress. Two patients (3%) consulted a psychiatrist after surgery. In conclusion, careful attention to psychological distress is needed, especially for female patients, older patients, and those with malignant soft or bone tissue tumors who have more than moderate pain.

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Frequency, severity, and impact on daily life of delayed and intercycle chemotherapy-induced nausea, vomiting, and retching

Tumori Journal ◽

10.1177/0300891621990434 ◽

2021 ◽

pp. 030089162199043

Author(s):

Silvia Gonella ◽

Dino S. Di Massimo ◽

Marinella Mistrangelo ◽

Gianmauro Numico ◽

Paola Berchialla ◽

...

Keyword(s):

Rating Scale ◽

Daily Life ◽

Numeric Rating Scale ◽

Cross Sectional Study ◽

Common Side Effect ◽

Cross Sectional ◽

Chemotherapy Administration ◽

Effect Of Treatment ◽

Numeric Rating ◽

Observation Period

Introduction: Chemotherapy-induced nausea, vomiting, and retching (CINVR) remains a common side effect of treatment. Most previous studies have focused on vomiting control; nausea and retching have been less explored. This study aimed at describing the incidence, severity, and impact on daily life (IDL) of CINVR in the acute (0–24 hours), delayed (>24–120 hours), and overall (0–120 hours) postchemotherapy periods and beyond 120 hours (until next chemotherapy administration); and the pharmacologic and nonpharmacologic strategies adopted by patients to relieve symptoms. Methods: This was a single-center, cross-sectional study of 60 patients undergoing chemotherapy. Participants reported the frequency, severity, and IDL of CINVR from the day of chemotherapy administration up to 120 hours thereafter and nausea and vomiting that occurred beyond 120 hours, as well as pharmacologic and nonpharmacologic remedies used. Results: Forty-seven (78.3%, 95% confidence interval [CI] 66.4–86.9), 37 (61.7%, 95% CI 49.0–72.9), and 35 (58.3%, 95% CI 45.7–69.9) patients reported no nausea (Numeric Rating Scale ⩽1), vomiting, or retching in the acute, delayed, and overall periods, respectively. Nausea was more frequent, more severe, and had a greater IDL than did vomiting and retching across the overall observation period; beyond 120 hours, 11 (18.3%, 95% CI 10.6–29.9) patients reported nausea and none reported vomiting, with a median IDL of 1/10 (interquartile range: 0.75–5.00; 95% CI 0–7.6). Metoclopramide (n = 57 administrations), dexamethasone (n = 28), eating small servings of food (n = 13), and aloe (n = 11) were the most commonly used rescue therapies. Conclusions: Future studies should set hard outcomes, such as the absence of any symptoms, as a primary end point, and these should be assessed across and beyond the 120-hour period.

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Comparison of Frenotomy Techniques for the Treatment of Ankyloglossia in Children: A Systematic Review

Otolaryngology ◽

10.1177/0194599820917619 ◽

2020 ◽

Vol 163 (3) ◽

pp. 428-443

Author(s):

Usman Khan ◽

Jake MacPherson ◽

Michael Bezuhly ◽

Paul Hong

Keyword(s):

Rating Scale ◽

Pediatric Population ◽

Meta Analysis ◽

Numeric Rating Scale ◽

Assessment Tools ◽

Future Research ◽

Randomized Controlled ◽

Comprehensive Search ◽

High Level ◽

Numeric Rating

Objective To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population. Data Sources A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed. Review Methods Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques. Conclusions Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.

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A prospective cohort register-based study of chronic postsurgical pain and long-term use of pain medication after otorhinolaryngological surgery

Scientific Reports ◽

10.1038/s41598-021-84788-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Nina Graf ◽

Katharina Geißler ◽

Winfried Meißner ◽

Orlando Guntinas-Lichius

Keyword(s):

Rating Scale ◽

Numeric Rating Scale ◽

Postsurgical Pain ◽

Average Pain Intensity ◽

Chronic Postsurgical Pain ◽

Average Pain ◽

Patients At Risk ◽

Perioperative Assessment ◽

Numeric Rating

AbstractData on chronic postsurgical pain (CPSP) after otorhinolaryngological surgery are sparse. Adult in-patients treated in 2017 were included into the prospective PAIN OUT registry. Patients’ pain on the first postoperative day (D1), after six months (M6) and 12 months (M12) were evaluated. Determining factor for CPSP was an average pain intensity ≥ 3 (numeric rating scale 0–10) at M6. Risk factors associated with CPSP were evaluated by univariate and multivariate analyses. 10% of 191 included patients (60% male, median age: 52 years; maximal pain at D1: 3.5 ± 2.7), had CPSP. Average pain at M6 was 0.1 ± 0.5 for patients without CPSP and 4.2 ± 1.2 with CPSP. Average pain with CPSP still was 3.7 ± 1.1 at M12. Higher ASA status (Odds ratio [OR] = 4.052; 95% confidence interval [CI] = 1.453–11.189; p = 0.007), and higher minimal pain at D1 (OR = 1.721; CI = 1.189–2.492; p = 0.004) were independent predictors of CPSP at M6. Minimal pain at D1 (OR = 1.443; CI = 1.008–2.064; p = 0.045) and maximal pain at M6 (OR = 1.665; CI = 1.340–2.069; p < 0.001) were independent predictors for CPSP at M12. CPSP is an important issue after otorhinolaryngological surgery. Better instrument for perioperative assessment should be defined to identify patients at risk for CPSP.

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