Effect of Neural Therapy on shoulder dysfunction and pain in supraspinatus tendinopathy

Objectives: To investigate the effect of 1% procaine injection, which is used in neural therapy, on shoulder pain and dysfunction in patients diagnosed with supraspinatus tendinopathy. Methods: The Range of Motion values, Visual Analog Scale and the QuickDASH Scale scores of 70 patients, who were diagnosed with musculus supraspinatus tendinitis based on magnetic resonance imaging findings, were analyzed. The data of the scales obtained before neural therapy and at the follow-up visit at four weeks after the end of therapy were compared, and a p-value of <0.05 was considered statistically significant. Results: After neural therapy, a statistically significant increase was observed in Range of Motion values and there was a statistically significant decrease in both the Visual Analog Scale and QuickDASH score averages. Conclusion: This is one of the rare studies showing the effects of neural therapy application on shoulder pain severity and dysfunction in patients with supraspinatus tendinitis who are resistant to medical therapy. doi: https://doi.org/10.12669/pjms.38.3.4823 How to cite this:Bashan I, Ozturk GY. Effect of Neural Therapy on shoulder dysfunction and pain in supraspinatus tendinopathy. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4823 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Efficacy of Curcuminoids in managing postoperative pain after total laparoscopic hysterectomy: A randomized controlled, open-label trial.

Background and aims: Curcuminoids, which are substances extracted from turmeric (Curcuma longa), have anti-inflammatory and analgesic effects and a good safety profile. This study aimed to evaluate the clinical efficacy of curcuminoid extracts on reducing pain among patients who underwent laparoscopic hysterectomy. Experimental procedure: From November 2016 to December 2017, 98 participants were included in this clinical trial, and they were randomly assigned to the experimental and control arms according to blocks of four. The intraoperative findings did not significantly differ between the two groups. The experimental group received one tablet of curcuminoid extract 250 mg four times a day on postoperative days 1–3. Pain was evaluated at 24 and 72 h postoperatively using a 10-point visual analog scale (VAS). Results and conclusion: The mean visual analog scale (VAS) scores at 24 h after surgery were 4.9 in the experimental group and 4.3 in the control group. Hence, the results did not significantly differ (p = 0.129). The mean VAS scores at 72 h after surgery were 1.8 in the experimental group and 2.8 in the control group (p = 0.001). The side effects in both groups were similar. Hence, curcuminoids can be an effective supplement for reducing pain after laparoscopic hysterectomy. The conclusion from this study is, that curcuminoids may be an effective supplement to reduce postoperative pain following laparoscopic hysterectomy.

A versatile method for dorsal-approach plantar plate repair using standard operative instruments

Background The plantar plate is an important static stabilizer of the lesser metatarsophalangeal joints, and disruptions of the plantar plate can lead to significant instability and lesser toe deformities. In recent years, direct plantar plate repair has been proposed. Although direct repair via a dorsal approach is attractive, a torn plantar plate is small and difficult to access using regular instruments in a restricted operative field. Methods In this report, a unique method for plantar plate repairs was used to repair various configurations of plantar plate tears with standard operative instruments that are available in most operating rooms. Results Using this method, 10 patients underwent plantar plate repairs, and the mean follow-up period was 24 (range, 14–38) months. The mean visual analog scale score for pain preoperatively was 4.1 (range, 0–6) and decreased to 0.6 (range, 0–3) at last follow-up. Postoperatively, the mean visual analog scale score for satisfaction was 9.6 (range, 8–10) and the mean American Orthopedic Foot and Ankle Society forefoot score was 88.8 (range, 75–100). Conclusions Our study proposes an inexpensive and versatile method for plantar plate repair via a dorsal approach that uses standard operative instruments. Trial registration ClinicalTrials.gov, NCT04949685. July 2, 2021 - Retrospectively registered, Level of clinical evidence 4

Đánh giá hiệu quả giảm đau bằng gây tê ngoài màng cứng trong phẫu thuật nội soi cắt đại, trực tràng

TÓM TẮT Đặt vấn đề: Gây tê ngoài màng cứng để giảm đau trong và sau mổ được áp dụng rộng rãi trên thế giới từ nhiều thập niên qua. Kết quả của nhiều công trình nghiên cứu cho thấy phương pháp này làm giảm những biến chứng trong và sau mổ, giảm tỉ lệ tử vong sau mổ của các phẫu thuật nặng. Nghiên cứu nhằm đánh giá hiệu quả và các tác dụng phụ của gây tê ngoài màng cứng trong phẫu thuật ung thư đại, trực tràng. Phương pháp: Nghiên cứu mô tả cắt ngang trên 28 bệnh nhân được gây tê ngoài màng cứng trong mổ ung thư đại, trực tràng có phối hợp gây mê nội khí quản. Sinh hiệu và tình trạng sức khỏe của bệnh nhân được theo dõi trước và sau khi tiêm thuốc giảm đau. Ghi nhận mức độ giảm đau theo Visual Analog Scale (VAS), mức độ liệt vận động theo Bromage và các tác dụng phụ sau mổ. Kết quả: Hiệu quả giảm đau sau mổ tốt, tại các thời điểm sau mổ VAS đều ≤ 1,5. Tỉ lệ các biến chứng: tụt huyết áp: 7,14%, đau đầu: 7,14%, lạnh run: 10,71%, buồn nôn, nôn: 17,86%. Kết luận: Kỹ thuật gây tê ngoài màng cứng phối hợp với gây mê toàn thân là kỹ thuật giảm đau hiệu quả và an toàn cho phẫu thuật vùng bụng trong mổ và 24 giờ sau mổ. ABSTRACT THE EFFICIENCY OF SPINAL EPIDURAL ANESTHESIA FOR LAPAROSCOPIC COLORECTAL CANCER SURGERY Background: Epidural anesthesia for pain relief during and after surgery has been widely applied in the world for decades. The results of many studies show that this method reduces intra - and postoperative complications and reduces the postoperative mortality rate of major surgery. The study aimed to evaluate epidural anesthesia’s effectiveness and side effects in colorectal cancer surgery. Methods: A cross - sectional descriptive study on 28 patients receiving epidural anesthesia in surgery for colorectal cancer in combination with endotracheal anesthesia. The patient’s vital signs and health status were monitored before and after the injection of pain medication. Record the level of pain relief according to the Visual Analog Scale (VAS), the degree of motor paralysis according to Bromage, and the side effects after surgery. Results: Good postoperative pain relief effect, at all times after surgery, VAS was ≤ 1.5. Rate of complications: hypotension: 7.14%, headache: 7.14%, shiver: 10.71%, nausea, vomiting: 17.86%. Conclusion: The epidural anesthesia combined with general anesthesia is an effective and safe analgesia technique for abdominal surgery during surgery and 24 hours after surgery. Keywords: Epidural anesthesia, colorectal cancersurgery

Can ultrasound-guided infraclavicular block be an alternative option for forearm reduction in the emergency department? A prospective randomized study

Objective Ultrasound-guided infraclavicular nerve block (IB) has become a well-established method in several outpatient procedures; however, its use in emergency departments (EDs) remains limited. The aim of this study was to compare procedural sedation and anlagesia (PSA) and IB in the pain management for patients who underwent forearm fracture reduction in the ED.Methods This prospective randomized study included 60 patients aged 18 to 65 years, who visited the ED with forearm fractures. They were randomly divided into two groups: Group PSA (n=30) and Group IB (n=30). The pain scores of patients were evaluated before and during the procedure with the visual analog scale. Complications and patient and operator satisfaction levels were recorded.Results There was no difference between the two groups in terms of demographic characteristics. The median (interquartile range) pain scores observed during the procedures were significantly higher in Group PSA than in Group IB (4 [4–6] vs. 2 [0–2], respectively; P<0.001). Patient and operator satisfaction levels were significantly higher in Group IB (P<0.001). Oxygen desaturation was statistically higher in Group PSA than in Group IB (40.00% vs. 3.33%, respectively; P=0.002).Conclusion IB was an effective alternative for reducing pain and increasing patient satisfaction in ED patients undergoing forearm fracture reduction.

A study to analyse the effect of Mckenzie’s method of exercise to treat upper cross syndrome associated with cervicogenic headache

Introduction: Upper cross syndrome (UCS) occurs when the muscle in the neck, shoulders, and chest become deformed usually as a result of poor posture. The aim of the study is to analyse the effect of McKenzie’s method of exercise to treat upper cross syndrome associated with cervicogenic headache. Materials and Methods: This experimental study was conducted in outpatient department physiotherapy A.C.S. Medical College and Hospital. Fifty subjects were selected for the study of the age group between 20 to 50 years of both male and female sex. Duration of this study was about 3 months. Each patient was trained about three session per week, 30 minutes per session. The session included McKenzie’s method of exercise to improve the shoulder and neck movements and postural corrections of the subjects. The outcome measure done using visual analogue scale (VAS) for cervicogenic headache and upper cross syndrome questionnaire (UCS). Results: The results on comparing upper cross syndrome questionnaire score and Visual Analog Scale score showed that between the pre-test (4.93) and post-test (3.43) mean values with group McKenzie’s exercise showed highly significant difference. Thus, it is appropriate that McKenzie’s method of exercise to treat upper cross syndrome associated with cervicogenic headache is effective.

Comparison between GlideRite® rigid stylet and Parker Flex-It™ stylet to facilitate GlideScope intubation in simulated difficult intubation: a randomized controlled study

Background: The GlideScope® videolaryngoscope (GVL) is widely used in patients with difficult airways and provides a good glottic view. However, the acute angle of the blade can make insertion and advancement of an endotracheal tube (ETT) more difficult than direct laryngoscopy, and the use of a stylet is recommended. This randomized controlled trial compared Parker Flex-It™ stylet (PFS) with GlideRite® rigid stylet (GRS) to facilitate intubation with the GVL in simulated difficult intubations. Methods: Fifty-four patients were randomly allocated to undergo GVL intubation using either GRS (GRS group) or PFS (PFS group). The total intubation time (TIT), 100-mm visual analog scale (VAS) for ease of intubation, success rate at the first attempt, use of laryngeal manipulation, tube advancement rate by assistant, and complications were recorded. Results: There was no significant difference between the GRS and PFS groups regarding TIT (50.3 ± 12.0 s in the GRS group and 57.8 ± 18.8 s in the PFS group, P = 0.108). However, intubation was more difficult in the PFS group than in the GRS group according to VAS score (P = 0.011). Cases in which the ETT was advanced from the stylet by an assistant, were more frequent in the GRS group than in the PFS group (P = 0.002). The overall incidence of possible complications was not significantly different. Conclusions: In patients with a simulated difficult airway, there was no difference in TIT using either the PFS or GRS. However, endotracheal intubation with PFS is more difficult to perform than GRS.

Comparative analysis of visual analog scales for assessing acute pain in women after radical mastectomy

BACKGROUND: Effective quantitative assessment of acute pain as an urgent problem in clinical medicine. One of the solutions to this problem is a color discrete scale (CDS). AIM: To determine the efficacy of the clinical usage of color discrete scale compared with linear visual analog scale to assess acute pain in women after radical mastectomy. MATERIALS AND METHODS: This study includes a prospective, observational, and non-randomized clinical trial. A total of 110 females who underwent radical mastectomy (RM) were interviewed. We used a 100-point linear visual analog scale (lVAS) and CDS with monotonic (mCDS) and random (rCDS) color arrangement. Pain was assessed 2, 6, 12, 24, 48, and 72 h after surgery. RESULTS: Pain scores obtained 2 h after RM were 6 (0; 30), 12 (0; 24), 8 (0; 20) points according to IVAS, mCDS, and rCDS, respectively (p 0.05). Furthermore, the pain scores were gradually reduced on all three scales and had no statistically significant difference (p 0.05). In women who underwent paravertebral blockade (PVB), pain scores were significantly less at 2, 6, 12, and 48 h after surgery (p 0.05). Spearmans correlation coefficient for lVAS and mCDS is 0.90, 0.86 for lVAS and rCDS, and 0.90 for mCDS and rCDS (all p 0.05). CONCLUSIONS: The CDS is an alternative, independent, and sufficient tool for quantifying pain. A strong correlation was found between the pain assessments according to CDS and lVAS. PVB significantly improves the quality of pain relief after RM.

Comparison between Tramadol and Butorphanol for Treating Postoperative Catheter-Related Bladder Discomfort: A Randomized Controlled Trial

Background. Intraoperative catheterization often leads to postoperative catheter-related bladder discomfort (CRBD) during the restoration period. This study aimed to assess the curative effect of butorphanol as a K receptor agonist in the treatment of postoperative CRBD. Patients and Approaches. Sixty patients with CRBD who underwent elective nonurological surgery at the postanesthesia care unit were randomly and evenly assigned to two groups. The control group was slowly injected with tramadol 1.5 mg/kg using a Murphy dropper, whereas the experimental group was intravenously injected with butorphanol 0.02 mg/kg. Severity, pain score, and sedation score of CRBD were evaluated at 0 min, 5 min, 15 min, 30 min, 1 h, and 6 h later. Results. The severity score of CRBD and visual analog scale pain score were lower in the butorphanol group than in the control group, whereas the sedation score was higher in the butorphanol group than in the control group. Conclusion. Butorphanol relieves on postoperative urination discomfort and pain compared with tramadol.