scholarly journals A prospective study on pain score with transperineal prostatic gold seed fiducial implantation under local anesthetic alone

2013 ◽  
Vol 7 (3-4) ◽  
pp. e202-6 ◽  
Author(s):  
Colin I. Tang ◽  
Perakaa Sethukavalan ◽  
Patrick Cheung ◽  
Gerard Morton ◽  
Geordi Pang ◽  
...  
Keyword(s):  
Pain Score ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Seed Implantation ◽  
Pain Scores ◽  
Patient Pain ◽  
Procedural Complications ◽  
Gold Seed ◽  
The Mean ◽  
A Prospective Study

Background: The purpose of this study was to monitor patient pain score with transperineal prostatic gold seed implantation in the absence of conscious sedation.Methods: All patients who were scheduled for image-guided external beam radiation (IGRT) and referred for gold seed fiducials were eligible to participate. Gold seed implants were performed by two radiation oncologists between December 2007 and April 2008. Patients received only local and deep anesthetic. No patients had prophylactic IV cannulation for the procedure. Three gold seeds were inserted transperineally into the prostate. A visual analogue scale from 0 to 10 was used to assess the pain at baseline, local and deep anesthetic infiltration, with each seed drop, and after the completion of the procedure.Results: A total of 30 patients were accrued to this study. The highest recorded increase in pain score was at the time point of deep local anesthesia, at which the mean pain score was 3.8. The mean pain scores at each seed drop were 0.8 (standard deviation [SD]=1.24), 1 (SD=1.26), and 0.5 (SD=0.90), respectively. All gold seed insertion procedures were well-tolerated, with no patient shaving significant pain post-procedure, and no significant procedural complications. There were only slight increases in dysuria, urinary frequency, constipation, urinary retention and flatulence in 7 patients – none of which required intervention.Interpretation: Transperineal ultrasound-guided gold seed implantation without conscious sedation is well-tolerated and associated with a low complication rate. It is a convenient outpatient procedure obviating the need for resource intensive postoperative monitoring.

The analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: a systematic review and meta-analysis with trial sequential analysis

2021 ◽  
pp. rapm-2020-102427
Author(s):  
Hanns-Christian Dinges ◽  
Thomas Wiesmann ◽  
Berit Otremba ◽  
Hinnerk Wulf ◽  
Leopold H Eberhart ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Pain Score ◽  
Meta Analysis ◽  
End Points ◽  
Liposomal Bupivacaine ◽  
Bupivacaine Hydrochloride ◽  
Pain Scores ◽  
Score Difference ◽  
The Mean

Background/ImportanceLiposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection anesthesia. To this day, the benefit of the new substance on relevant end points is discussed controversial.ObjectiveThe objective was to determine whether there is a difference in postoperative pain scores and morphine consumption between patients treated with LB and bupivacaine hydrochloride in a systematic review and meta-analysis.Evidence reviewRandomized controlled trials (RCT) were identified in Embase, CENTRAL, MEDLINE and Web of Science up to May 2020. Risk of bias was assessed using Cochrane methodology. Primary end points were the mean pain score difference and the relative morphine equivalent (MEQ) consumption expressed as the ratio of means (ROM) 24 and 72 hours postoperatively.Findings23 RCTs including 1867 patients were eligible for meta-analysis. The mean pain score difference at 24 hours postoperatively was significantly lower in the LB group, at −0.37 (95% CI −0.56 to −0.19). The relative MEQ consumption after 24 hours was also significantly lower in the LB group, at 0.85 (0.82 to 0.89). At 72 hours, the pain score difference was not significant at −0.25 (−0.71 to 0.20) and the MEQ ratio was 0.85 (0.77 to 0.95).ConclusionThe beneficial effect on pain scores and opioid consumption was small but not clinically relevant, despite statistical significance. The effect was stable among all studies, indicating that it is independent of the application modality.

Safety and feasibility of rhenium-186 nanoliposome (186RNL) in recurrent glioma: The ReSPECT phase 1 trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2061-2061
Author(s):  
Andrew J. Brenner ◽  
Ande Bao ◽  
William Phillips ◽  
Gregory Stein ◽  
Vibhudutta Awasthi ◽  
...  
Keyword(s):  
Dose Escalation ◽  
Tumor Volume ◽  
Phase 1 ◽  
Absorbed Dose ◽  
External Beam Radiation ◽  
Whole Body ◽  
Recurrent Glioma ◽  
Normal Brain ◽  
Beam Radiation ◽  
The Mean

2061 Background: While external beam radiation therapy (EBRT) remains a central component of the management of primary brain tumors, it is limited by tolerance of the surrounding normal brain tissue. Rhenium-186 NanoLiposome (186RNL) permits the delivery of beta-emitting radiation of high specific activity with excellent retention in the tumor. We report the results of the phase 1 study in recurrent glioma. Methods: A Phase 1 dose-escalation study of 186RNL in recurrent glioma utilizing a standard 3+3 design was undertaken to determine the maximum tolerated dose of 186RNL. 186RNL is administered by convection enhanced delivery (CED). Infusion is followed under whole body planar imaging and SPECT/CT. Repeat SPECT/CT imaging is performed immediately following, and at 1, 3, 5, and 8 days after 186RNL infusion to obtain dosimetry and distribution. Subjects were followed until disease progression by RANO criteria. Results: Eighteen subjects were treated across 6 cohorts. The mean tumor volume was 9.4 mL (range 1.1 – 23.4). The infused dose ranged from 1.0 mCi to 22.3 mCi and the volume of infusate ranged from 0.66 mL to 8.80 mL. From 1 – 4 CED catheters were used. The maximum catheter flow rate was 15 µl/min. The mean absorbed dose to the tumor volume was 239 Gy (CI 141 – 337; range 9 - 593), to normal brain was 0.72 Gy (CI 0.34 – 1.09; range 0.005 – 2.73), and to total body was 0.07 Gy (CI 0.04 – 0.10; range 0.001 – 0.23). The mean absorbed dose to the tumor volume when the percent tumor volume in the treatment volume was 75% or greater (n = 10) was 392 Gy (CI 306 – 478; range 143 – 593). Scalp discomfort and tenderness related to the surgical procedure did occur in 3 subjects. The therapy has been well tolerated, no dose-limiting toxicity has been observed, and no treatment-related serious adverse events have occurred despite markedly higher absorbed doses typically delivered by EBRT in patients with prior treatment. Responses have been observed supporting the clinical activity. Final results from the dose escalation will be presented. Conclusions: 186RNL administered by CED to patients with recurrent glioma results in a much higher absorbed dose of radiation to the tumor compared to EBRT without significant toxicity. The recommended Phase 2 dose is 22.3 mCi in 8.8 mL of infusate. Clinical trial information: NCT01906385. [Table: see text]

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.

Postoperative Opioid Use in Rhinoplasty Procedures: A Standardized Regimen

2020 ◽  
Author(s):  
Ryan V. Marshall ◽  
Nicholas J. Rivers ◽  
Sudhir Manickavel ◽  
Jessica W. Grayson ◽  
Artemus J. Cox
Keyword(s):  
Linear Regression Analysis ◽  
Tertiary Hospital ◽  
Clinic Visit ◽  
Prescribing Patterns ◽  
Opioid Use ◽  
Patient Demographics ◽  
Pain Scores ◽  
Pill Counts ◽  
The Mean ◽  
A Prospective Study

AbstractThe objective of this study was to create a standardized regimen for preoperative and postoperative analgesic prescribing patterns in rhinoplasty. A prospective study including patients (n = 35) undergoing rhinoplasty by a single surgeon at a tertiary hospital was conducted. Patients were enrolled in this study from August 2018 to November 2019. Patients then completed a diary documenting pain scores and analgesic use for 14 days postoperatively. Patient demographics, complications, rhinoplasty technique performed, and medical history were noted. At the second postoperative clinic visit, the diaries were submitted and pill counts were conducted to ensure accuracy. A total of 23 patients completed this study. The average age of the cohort was 39.07 ± 15.01 years, and 48% were females. The mean number of opioids consumed was 6.15 ± 4.85 pills (range: 0–18). Females consumed an average of 7.2 ± 5.2 pills and males consumed 4.5 ± 3.96 pills. The mean number of acetaminophen and ibuprofen tablets consumed were 7.48 ± 8.52 pills (range: 0–36) and 10.83 ± 10.99 pills (range 0–39), respectively. No postoperative nosebleeds were reported. Males had significantly higher pain scores than females on postoperative days 1 to 8. The mean pain score for postoperative days 8 to 14 was less than 1. Linear regression analysis showed that there was no association between the rhinoplasty technique used and the number of opioids consumed. Rhinoplasty is typically associated with mild pain even when osteotomies are included with the procedure. Our results suggest that surgeons can limit rhinoplasty opioid prescriptions to around seven pills and achieve sufficient pain control in most patients. Preoperative counseling suggesting a low postoperative pain level and the encouragement of nonsteroidal anti-inflammatory drug use will help reduce the risk and misuse of opioid prescriptions.

Is the Location of a Septal Deviation Associated with the Degree of Postoperative Pain after Septoplasty?

2016 ◽  
Vol 95 (10-11) ◽  
pp. E37-E39
Author(s):  
Gül Soylu Özler
Keyword(s):  
Postoperative Pain ◽  
Systemic Disease ◽  
Septal Deviation ◽  
Vasomotor Rhinitis ◽  
Pain Scores ◽  
Final Study ◽  
Study Population ◽  
The Mean ◽  
A Prospective Study ◽  
Pain Patients

The author conducted a prospective study of patients who underwent septoplasty for nasal obstruction secondary to a septal deviation to determine if the location of the deviation had any association with the degree of postoperative pain. Patients with an anteroposterior deviation were not included in this study, nor were patients with vasomotor rhinitis, allergic rhinitis, nasal polyposis, turbinate pathologies, or a systemic disease; also excluded were patients who were taking any medication and those who had undergone any previous nasal surgery. The final study population included 140 patients, who were divided into two groups on the basis of the location of their deviation. A total of 64 patients (35 men and 29 women; mean age: 29.8 yr) had an anterior deviation, and 76 patients (35 men and 41 women; mean age: 30.3 yr) had a posterior deviation; there were no statistically significant differences between the two groups in terms of sex (p = 0.309) or age (p = 0.848). During the postoperative period, pain intensity in both groups was self-evaluated on a visual analog scale on days 1, 3, and 7 and again at 3 and 6 months. The mean postoperative pain scores on days 1, 3, and 7 were significantly higher in the posterior deviation group than in the anterior group; scores in the two groups were similar at 3 and 6 months.

PROSTATE SPECIFIC ANTIGEN BOUNCE AFTER RADIOACTIVE SEED IMPLANTATION FOLLOWED BY EXTERNAL BEAM RADIATION FOR PROSTATE CANCER

2000 ◽  
pp. 1085-1089 ◽  
Author(s):  
FRANK A. CRITZ ◽  
W. HAMILTON WILLIAMS ◽  
JAMES B. BENTON ◽  
A. KEITH LEVINSON ◽  
CLINTON T. HOLLADAY ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Seed Implantation ◽  
Radioactive Seed

Hemangiopericytoma: long-term outcome revisited

2011 ◽  
Vol 114 (3) ◽  
pp. 747-755 ◽  
Author(s):  
Marco Schiariti ◽  
Pablo Goetz ◽  
Hussien El-Maghraby ◽  
Jignesh Tailor ◽  
Neil Kitchen
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Long Term Outcome ◽  
Free Interval ◽  
Initial Surgery ◽  
The Mean

Object Hemangiopericytomas are rare tumors that behave aggressively with a high rate of local recurrence and distant metastases. With the aim of determining the outcome and response to various treatment modalities, a series of 39 patients who underwent microsurgical resection for primary meningeal hemangiopericytoma over a 24-year period is presented. Methods Patients with hemangiopericytoma were identified from histopathology records and their medical records were analyzed retrospectively by 2 independent reviewers to collect data on surgical treatment, adjuvant therapy, postoperative course, local or distant recurrence, and follow-up. Results Of the 39 patients, 19 were male and 20 were female. Mean patient age was 44.1 years. Thirty-four tumors were intracranial and 5 were spinal. The mean follow-up period was 123 months. Twenty-eight patients developed local recurrence. The recurrence rate at 1, 5, and 15 years was 3.5%, 46%, and 92%, respectively. Extraneural metastasis occurred in 8 patients (26%) at an average of 123 months after initial surgery. Recurrences and metastases were treated by surgical excision, external beam radiation therapy (EBRT), chemotherapy, and/or stereotactic radiosurgery. Adjuvant EBRT following initial surgery was found to extend the disease-free interval from 154 months to 254 months, although it did not prevent the development of metastasis. In those patients with EBRT and complete resection, the mean recurrence-free interval was found to be 126.3 months longer (p = 0.04) and overall survival 126 months longer than without EBRT. Furthermore, adjusting for resection, patients undergoing EBRT had 0.33 times increased risk of recurrence compared with those who did not (p = 0.03). A majority of patients remained able to live independently despite revision surgery for recurrence. Conclusions The mean follow-up of this patient series represents the longest follow-up duration published to date and demonstrates extended survival in a significant number of patients with hemangiopericytoma. Gross-total resection followed by adjuvant EBRT provides patients with the highest probability of an increased recurrence-free interval and overall survival. Prolonged survival justifies long-term follow-up and aggressive treatment of initial, recurrent, and metastatic disease.

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