scholarly journals A Prospective Randomized Comparison of the Efficacy of Ultrasound- vs FluoroscopyGuided Genicular Nerve Block for Chronic Knee Osteoarthritis

2019 ◽  
Vol 2 (22.2) ◽  
pp. 139-146
Author(s):  
Seong-Soo Choi
Keyword(s):  
Pain Relief ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Nerve Block ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Pain Clinic ◽  
Nerve Blocks ◽  
Numeric Rating

Background: Recently, genicular nerve block and radiofrequency ablation were introduced to alleviate knee pain in patients with chronic knee osteoarthritis. Both ultrasound- and fluoroscopyguided genicular nerve blocks have been used. However, whether one is superior to the other remains unknown. Objectives: The present study compares the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. Study Design: This research used a prospective randomized comparison design. Setting: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea. Methods: From July 2015 to September 2017, a randomized controlled study was performed to analyze the difference in the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. The Numeric Rating Scale (NRS-11), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Global Perceived Effect Scales (GPES), and complications were evaluated preprocedure, and 1 and 3 months after genicular nerve block. Results: A total of 80 patients were enrolled and randomly distributed to groups U (ultrasoundguided, n = 40) and F (fluoroscopy-guided, n = 40). Those who were lost to follow-up or had undergone other interventions were excluded, resulting in 31 and 30 patients in groups U and F, respectively. No differences in NRS-11 or WOMAC were observed between the 2 groups at baseline or during the follow-up period. GPES and complication rates were also similar between both groups. Limitations: We were unable to perform double-blind randomization and did not evaluate patients’ baseline emotional states. Conclusions: Pain relief, functional improvement, and safety were similar between groups receiving ultrasound- and fluoroscopy-guided genicular nerve blocks. Therefore, either of the 2 imaging devices may be utilized during a genicular nerve block for chronic knee pain relief. However, considering radiation exposure, ultrasound guidance may be superior to fluoroscopic guidance. The study protocol was approved by our institutional review board (2015-0369), and written informed consent was obtained from all patients. The trial was registered with the Clinical Research Information Service (KCT 0002846). This work was presented in part as D-H Kim’s MS thesis at the University of Ulsan College of Medicine (2018). Key words: Genicular nerve block, ultrasound, fluoroscopy, knee osteoarthritis, Numeric Rating Scale, The Western Ontario and McMaster Universities Osteoarthritis Index

scholarly journals Genicular Nerve Radiofrequency Ablation for Chronic Knee Pain Using a Three-Tined Electrode: A Technical Description and Case Series

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3344-3349
Author(s):  
Edvin Koshi ◽  
Cole W Cheney ◽  
Beau P Sperry ◽  
Aaron Conger ◽  
Zachary L McCormick
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Vastus Medialis ◽  
The Novel ◽  
Chronic Knee Pain ◽  
Numeric Rating

Abstract Background Genicular nerve radiofrequency ablation (RFA) for the treatment of chronic knee pain has traditionally targeted the superomedial, superolateral, and inferomedial genicular nerves. However, recent cadaveric studies of knee neuroanatomy demonstrate varied locations of these specific nerves as well as additional articular nerves. This work suggests that traditional genicular nerve RFA lesion locations may be inadequate. Objective 1) To describe a novel protocol utilizing a three-tined RFA electrode to target the superomedial (SMGN), superolateral (SLGN), and inferomedial genicular nerves (IMGN), as well as the terminal articular branches of the nerves to the vastus medialis (NVM), intermedius (NVI), and lateralis (NVL). 2) To assess the ability of this technique to reduce chronic knee pain. Methods Case series of consecutive patients with six or more months of refractory knee pain who underwent genicular nerve RFA according to the novel protocol described. Seven discrete RFA lesions were placed to target the SMGN, NVM, NVI, NVL, SLGN, and IGMN. Results Eleven patients underwent RFA, nine with knee osteoarthritis and two postarthroplasty. At one month, 91% (95% CI = 59–100%), 82% (95% CI = 48–98%), and 9% (95% CI = 2–41%), of patients reported ≥50%, ≥80%, and 100% improvement in knee pain on the numeric rating scale, respectively. These results were sustained at six months. There were no complications. Discussion/Conclusions These preliminary data suggest the feasibility and possible effectiveness of genicular nerve RFA using the described novel protocol including a three-tined electrode. Larger-scale studies with comparative groups are warranted.

scholarly journals The Long Term Effectiveness of Genicular Nerve Blocks for Chronic Knee Pain: A Retrospective Study

2018 ◽  
pp. 75-77
Author(s):  
Laura Anne Lynem
Keyword(s):  
Retrospective Study ◽  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Knee Pain ◽  
Nerve Block ◽  
Nerve Blocks ◽  
Chronic Knee Pain ◽  
Post Procedure

Chronic knee pain is a leading cause of chronic disability and its symptoms have a profound impact on the lives of those suffering from it. Current treatment modalities for chronic knee pain include pharmacologic and nonpharmacologic interventions. Genicular nerve blocks are a new therapeutic alternative that have been shown to relieve chronic knee pain and may provide significant relief in patients who are either poor surgical candidates or are unwilling to accept the risks associated with surgery. Genicular nerve blocks may provide long term pain relief for chronic knee pain and radiofrequency ablation (RFA) may not be necessary. This Institutional Review Board (IRB) approved retrospective study conducted at a single center university hospital involved 44 patients aged 43 to 87 who received genicular nerve blocks for chronic knee pain. The primary purpose of this study was to determine if genicular nerve blocks provide effective long term pain relief for patients with chronic knee pain. The numeric rating scale was used to measure the patient’s knee pain at baseline, 30, 90, and 120 days post procedure. Patients experienced a mean pain level of 7.43 out of 10 before the genicular nerve block and 4.02 afterward representing an average improvement of 42.6% in pain relief overall post procedure follow-up. A t-test revealed a statistically significant difference between the mean pain score before and after the blocks (t = 8.534, P < 0.01). Overall, the patients experienced significant pain relief of an average of 111.9 days resulting in an average of 42.6 percent pain relief post procedure follow-up. Out of the 44 patients, 15 (34.1%) underwent a RFA after receiving a genicular nerve block procedure to further manage their chronic knee pain symptoms. In conclusion, we have found statistically significant evidence that genicular nerve blocks provide effective long-term pain relief for patients with chronic knee pain. Therefore, for patients who are not surgical candidates, genicular nerve blocks represent a viable alternative treatment for knee pain. Key words: Genicular nerve blocks, chronic knee pain, genicular nerves, genicular nerve radiofrequency ablation

scholarly journals High-Voltage Intraarticular Pulsed Radiofrequency for Chronic Knee Pain Treatment: A Single-Center Retrospective Study

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. E549-E558
Author(s):  
Peng Yao
Keyword(s):  
Knee Pain ◽  
High Voltage ◽  
Rating Scale ◽  
Low Voltage ◽  
Oxford Knee Score ◽  
Numeric Rating Scale ◽  
Pulsed Radiofrequency ◽  
Chronic Knee Pain ◽  
Numeric Rating

Background: Intraarticular pulsed radiofrequency (IAPRF) for the treatment of painful knee osteoarthritis (KOA) is a less invasive treatment method. It has fewer adverse effects and can quickly reduce KOA-related pain and improve knee joint dysfunction. Objectives: We compared the effectiveness of high- and low-voltage IAPRF for the treatment of chronic knee pain. Study Design: Retrospective comparative study design. Setting: This study took place at Shengjing Hospital of China Medical University. Methods: A total of 57 patients with KOA who were hospitalized between July 2018 and July 2019 were randomly allocated into the high-voltage (n = 29) and low-voltage (n = 28) IAPRF groups. IAPRF was performed under the guidance of computed tomography (CT). Numeric Rating Scale (NRS-11), Oxford Knee Score (OKS), degree of pain relief, global perceived effect, and side effects at baseline and 1 week, 2 weeks, 1 month, 3 months, and 6 months after the procedure were recorded and analyzed. Results: NRS-11 scores decreased significantly in both groups after the procedure, but gradually increased after the 6-month follow-up period. There was a significant difference in NRS-11 scores between the 2 groups at all follow-up periods postprocedure. OKS were similar between the 2 groups. Patients with pain relief rate 50% or greater at 1, 3, and 6 months after the procedure accounted for 72.41%, 72.41%, and 55.17% in the high-voltage group, and 46.43%, 46.43%, and 28.57% in the low-voltage group, respectively. The difference between the 2 groups was statistically significant. No significant adverse reactions were observed in the 2 groups, however, patient satisfaction in the high-voltage group was significantly higher compared with patients in the low-voltage group. Limitations: This study was a single-center retrospective study with a relatively small sample cohort and short follow-up period. Conclusions: CT-guided high-voltage IAPRF is more beneficial in reducing knee pain and improving knee function compared with low-voltage IAPRF. In addition, patients who received high-voltage IAPRF were more satisfied with their treatment. Key words: Pulsed radiofrequency, knee osteoarthritis, intraarticular, high voltage, Oxford Knee Score, Numeric Rating Scale

scholarly journals Twelve-month analgesia and rescue, by cooled radiofrequency ablation treatment of osteoarthritic knee pain: results from a prospective, multicenter, randomized, cross-over trial

2019 ◽  
Vol 44 (4) ◽  
pp. 499-506 ◽  
Author(s):  
Tim Davis ◽  
Eric Loudermilk ◽  
Michael DePalma ◽  
Corey Hunter ◽  
David A Lindley ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Clinical Trial Registration ◽  
Provide Pain Relief ◽  
Registration Number ◽  
The Mean ◽  
Numeric Rating

Background and objectivesAs a follow-up to the 6-month report,12 this study investigated the analgesic effect of cooled radiofrequency ablation (CRFA) in patients with knee osteoarthritis (OA) 12 months postintervention and its ability to provide pain relief in patients who experienced unsatisfactory effects of intra-articular steroid injection (IAS).MethodsSeventy-eight per cent (52/67) of patients originally treated with CRFA were evaluated at 12 months, while at 6 months post-IAS, 82% (58/71) of those patients crossed over to CRFA and assessed 6 months later.ResultsAt 12 months, 65% of the original CRFA group had pain reduction ≥50%, and the mean overall drop was 4.3 points (p<0.0001) on the numeric rating scale. Seventy-five per cent reported ‘improved’ effects. The cross-over group demonstrated improvements in pain and functional capacity (p<0.0001). No unanticipated adverse events occurred.ConclusionsThis study demonstrates that analgesia following CRFA for OA knee pain could last for at least 12 months and could rescue patients who continue to experience intolerable discomfort following IAS.Clinical trial registrationThe ClinicalTrials.gov registration number for this study is NCT02343003.

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

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

The efficacy of transcatheter arterial embolization for knee pain on patients with knee osteoarthritis: A case series

2021 ◽  
pp. 1-6
Author(s):  
Kun Yung Kim ◽  
Gi-Wook Kim
Keyword(s):  
Conservative Treatment ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Transcatheter Arterial Embolization ◽  
Rating Scale ◽  
Case Series ◽  
Arterial Embolization ◽  
Numeric Rating Scale ◽  
Knee Oa ◽  
Before And After

BACKGROUND: Knee osteoarthritis (OA) is accompanied by inflammation and angiogenesis. Modifying angiogenesis through transcatheter arterial embolization (TAE) can be a potential treatment for knee OA. OBJECTIVE: We subjected five OA knees in three patients to TAE and report the results of our post-treatment observations. CASE DESCRIPTION: Three patients that had experienced knee pain for a minimum of one year prior to the study, and whose pain had persisted despite conservative treatment, were included in this study. Patients more often chose conservative treatment over surgical treatment. Pain and functional scales were evaluated before, immediately, and 1 month after TAE using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). TAE was performed by an experienced interventional radiologist. The average values of NRS evaluated before and after 5 TAEs were 5.2 before TAE, 3 immediately after TAE, and 3.6 after 1 month of TAE, and the average values of WOMAC were 52, 38.4, and 36.4, respectively. There were no major adverse effects. CONCLUSION: The examined cases support the conclusion that TAE is an effective treatment for patients with knee OA. Substantial pain relief and WOMAC improvement were observed both immediately and one month after TAE.

CAN PATIENTS WITH SAGITTALLY WELL-COMPENSATED LUMBAR DEGENERATIVE KYPHOSIS BENEFIT FROM SURGICAL TREATMENT FOR INTRACTABLE BACK PAIN?

Neurosurgery ◽  
2009 ◽  
Vol 64 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee ◽  
Jung Mok Kim ◽  
Jun-Hong Min ◽  
Kyung-Mi Han ◽  
...  
Keyword(s):  
Back Pain ◽  
Oswestry Disability Index ◽  
Lumbar Lordosis ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Leg Pain ◽  
Compensatory Mechanisms ◽  
The Mean ◽  
Numeric Rating

Abstract OBJECTIVE To analyze pre- and postoperative x-rays of sagittal spines and to review the surgical results of 21 patients with lumbar degenerative kyphosis whose spines were sagittally well compensated by compensatory mechanisms but who continued to suffer from intractable back pain METHODS We performed a retrospective review of 21 patients treated with combined anterior and posterior spinal arthrodesis. Inclusion criteria were: lumbar degenerative kyphosis patients with intractable back pain and whose spines were sagittally well compensated by a compensatory mechanism, defined as a C7 plumb line to the posterior aspect of the L5–S1 disc of less than 5 cm. Outcome variables included: radiographic measures of preoperative, postoperative, and follow-up films; clinical assessment using the mean Numeric Rating Scale, Oswestry Disability Index, and Patient Satisfaction Index; and a review of postoperative complications. RESULTS All patients were female (mean age, 64.5 years; age range, 50–74 years). The mean preoperative sagittal imbalance was 19.5 (± 17.6) mm, which improved to −15.8 (± 22.2) mm after surgery. Mean lumbar lordosis was 13.2 degrees (± 15.3) before surgery and increased to 38.1 degrees (± 14.4) at follow-up (P &lt; 0.0001). Mean thoracic kyphosis was 5.5 degrees (± 10.2) before surgery and increased to 18.9 degrees (± 12.4) at follow-up (P &lt; 0.0001). Mean sacral slopes were 12.9 degrees (± 11.1) before surgery and increased to 26.3 degrees (± 9.6) at follow-up (P &lt; 0.0001). The mean Numeric Rating Scale score improved from 7.8 (back pain) and 8.1 (leg pain) before surgery to 3.0 (back pain) and 2.6 (leg pain) after surgery (P &lt; 0.0001). The mean Oswestry Disability Index scores improved from 56.2% before surgery to 36.7% after surgery (P &lt; 0.0001). In 18 (85.5%) of 21 patients, satisfactory outcomes were demonstrated by the time of the last follow-up assessment. CONCLUSION This study shows that even lumbar degenerative kyphosis patients with spines that are sagittally well compensated by compensatory mechanisms may suffer from intractable back pain and that these patients can be treated effectively by the restoration of lumbar lordosis.

Correlation between the Likert Scale and the Numeric Rating Scale for Evaluating Knee Pain

2011 ◽  
Vol 23 (1) ◽  
pp. 14 ◽  
Author(s):  
Choong-Hyeok Choi ◽  
Suk-Hwan Kim ◽  
Young-Seok Lee ◽  
Chang-Nam Kang
Keyword(s):  
Knee Pain ◽  
Rating Scale ◽  
Likert Scale ◽  
Numeric Rating Scale ◽  
Numeric Rating

scholarly journals Exploration of the Clinical Effect of Modified Peroneal Nerve Block in Foot Operation Under the Plane of the Ankle joint: A Non-Randomized Clinical Feasibility Observational Study.

2020 ◽  
Author(s):  
ya tuo ◽  
XUEQIANG FU ◽  
YI QIU ◽  
XIAODONG WANG ◽  
SHENGJUAN YAN ◽  
...  
Keyword(s):  
Visual Analogue Scale ◽  
Scale Score ◽  
Nerve Block ◽  
Analogue Scale ◽  
Peroneal Nerve ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Deep Peroneal Nerve ◽  
Pain Visual Analogue Scale ◽  
Numeric Rating

Abstract Background This study was aimed at exploring the clinical effect of a modified dorsal peroneal nerve block in foot operation under the ankle plane. Methods The study was observational study, thirty patients ( n =30) were observed with single-center and non-randomized. The patients were treated with an ankle nerve block (including the posterior tibial nerve, superficial peroneal nerve, saphenous nerve, and sural nerve block in the plane of the ankle) and a deep peroneal nerve block (7.5 mg/ml). The primary outcomes were intraoperative visual analogue scale score (0-10 points), numeric rating scale score (0-10 points), and Neuropen score (0-2 points). The secondary outcomes were postoperative pain visual analogue scale and numeric rating scale scores (0-10). Histograms and normal probability QQ plots were used to test the distribution of normality. Results We analyzed the data of 30 patients. It was found that after 20 min of ankle block and deep peroneal nerve block, 23 patients achieved a perfect block effect (visual analogue scale and Neuropen scores = 0), and the operation was performed smoothly. Six patients experienced slight pain (visual analogue scale score: ≤ 3, Neuropen score = 1). An intravenous sedative drip (dexmedetomidine 4 µg/ml, 1 µg/kg dexmedetomidine hydrochloride injection 2 ml:0.2 g; Jiangsu Nhwa Pharmaceutical Co., Ltd . , China) was used. The block failed in one patient, and the operation was performed under general anesthesia with a laryngeal mask in this patient. Conclusions The modified deep peroneal nerve block combined with an ankle nerve block can meet the anesthesia needs for foot surgery under the ankle plane. However, due to the limited number of patients evaluated, it is difficult to accurately predict the effect and a large degree of uncertainty exists regarding these findings. Trial registration This study had been registered at http://www.chictr.org.cn/index.aspx with No. ChiCTR2000037880 on Sep 3, 2020.It was a retrospectively registered.

scholarly journals Evaluasi Kepatuhan Pelaksanaan Standar Prosedur Operasional Manajemen Nyeri pada Pasien Luka Bakar di RSUP Dr. Hasan Sadikin Bandung

2019 ◽  
Vol 7 (2) ◽  
pp. 92-99
Author(s):  
Yudhanarko Yudhanarko ◽  
Suwarman Suwarman ◽  
Ricky Aditya
Keyword(s):  
Pain Management ◽  
General Hospital ◽  
Pain Assessment ◽  
Rating Scale ◽  
Emotional Experience ◽  
Numeric Rating Scale ◽  
Pain Scale ◽  
Standard Operating ◽  
Numeric Rating

Nyeri didefinisikan sebagai pengalaman sensorik dan emosional yang tidak menyenangkan terkait dengan kerusakan jaringan aktual atau potensial. Manajemen nyeri pada luka bakar merupakan bagian yang tidak terpisahkan dari terapi luka bakar. Nyeri pada luka bakar merupakan nyeri akut, penanganan yang tidak baik akan menyebabkan komplikasi, salah satunya nyeri kronik. Rumah Sakit Umum Pusat (RSUP) Dr. Hasan Sadikin Bandung telah membuat Standar Prosedur Operasional (SPO) manajemen nyeri yang berguna untuk meningkatkan kepatuhan dalam pelaksanaan manajemen nyeri. Penelitian ini bertujuan mengevaluasi kesesuaian teknik pengkajian, tindak lanjut dan evaluasi ulang nyeri pada pasien luka bakar dengan SPO manajemen nyeri. Penelitian menggunakan metode deskriptif observasional retrospektif terhadap 99 rekam medis pasien luka bakar yang memenuhi kriteria inklusi di RSUP Dr. Hasan Sadikin Bandung pada tahun 2018. Hasil penelitian didapatkankan bahwa pengkajian nyeri yang dilakukan sesuai dengan SPO menggunakan numeric rating scale atau Wong Baker faces pain scale ditemukan pada 99 pasien (100%). Tindak lanjut hasil pengkajian nyeri luka bakar yang dilakukan sesuai dengan SPO sebanyak 71 pasien (72%). Evaluasi ulang setelah tindak lanjut pengkajian nyeri yang sesuai SPO pada 93 pasien (94%). Simpulan, pengkajian nyeri di RSUP Dr. Hasan Sadikin Bandung sudah sesuai dengan SPO manajemen nyeri, namun tindak lanjut dan evaluasi ulang pada nyeri luka bakar belum sesuai dengan SPO manajemen nyeri.Evaluation of Compliance to Standard Operating Procedures for Pain Management in Patients with Burns in Dr. Hasan Sadikin General Hospital BandungPain is defined as an unpleasant sensory and emotional experience related to actual or potential tissue damage. Pain management for burns is an integral part of burn therapy. Pain in burns is an acute pain and poor management will lead to health complications including chronic pain. Dr. Hasan Sadikin General Hospital Bandung has made a standard operating procedure (SOP) for pain management to improve compliance to pain management standard. This study aimed to evaluate the compliance to the standards in assessment techniques, follow-up, and re-evaluation of pain in patients with burn according to the applicable pain management SOP. This was a retrospective descriptive observational study on 99 medical records of burn patients who met the inclusion criteria in Dr. Hasan Sadikin General Hospital Bandung in 2018. The results of the study revealed that the pain assessment for these patient was carried out according to the SOP which refers to the use of a numeric rating scale or Wong Baker face pain scale in 99 patients (100%). In the follow-up, 71 were performed according to the SOP (72%) while the re-evaluation was performed in compliance with the SOP in 93 patients (94%). In conclusion, pain assessment in Dr. Hasan Sadikin General Hospital Bandung is performed in accordance with SOP on pain management but not all patients receive follow-up and re-evaluation of burn pain in accordance with the SOP on pain management. 

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