Scanner-Assisted CO2 Laser Fissurectomy: A Pilot Study

Introduction: Surgery for chronic anal fissure is challenging for every proctologist. Solving the pain by guaranteeing rapid and effective healing is the objective, but what is the price to pay today in functional terms? Though this result is nowadays partially achievable through interventions that include the execution of an internal sphincterotomy among the procedures, it is necessary to underline the high rate of patients who can present faecal incontinence. The aim of this study is to explore the effectiveness of scanner-assisted CO2 laser fissurectomy.Methods: From April 2021 to September 2021, all consecutive patients who affected by chronic anal fissure suitable for surgery, meeting the inclusion and exclusion criteria, were evaluated. All planned data were recorded before surgery, then at 24 h, 1 week, and 1 month follow-up. A scanner-assisted CO2 laser was used in this study to achieve a smooth and dried wound with a minimal tissue thermal damage, to ensure good postsurgical pain control, rapid and functional, elastic and stable healing, and to prevent potential relapses. Paracetamol 1 g every 8 h was prescribed for the first 24 h and then continued according to each patient's need. Ketorolac 15 mg was prescribed as rescue.Results: Mean pain intensity ≤3, considered as the principal endpoint, was recorded in 26 out of the 29 patients who enrolled in the study with a final success rate of 89.7% at 1-month follow-up. Pain and anal itching showed a statistically significant reduction while bleeding, burning, and maximum pain, and REALIS score showed a reduction too at the end of the follow-up period. Reepithelisation proved to be extremely fast and effective: 22 of 29 (75.9%) showed a complete healing and 5 showed a partial reepithelisation at 1-month follow-up.Discussion: Outcomes of this study showed that it is undoubtedly necessary to change the surgical approach in case of anal fissure. The internal sphincterotomy procedure must be most of all questioned, where the availability of cutting-edge technological tools must be avoided and offered only in selected cases. Scanner-assisted CO2 laser showed great results in terms of pain control and wound healing, secondary to an extremely precise ablation, vaporisation, and debridement procedures with minimal lateral thermal damage.

Comparative Analysis of Periodontal Pain Using Two Different Orthodontic Techniques, Fixed Multibrackets and Removable Aligners: A Longitudinal Clinical Study with Monthly Follow-Ups for 12 Months

The aim of this study was to evaluate the perception of periodontal pain in patients treated with either fixed multibrackets or removable alignment systems with a monthly follow-up over a period of twelve months. Materials and Methods: This longitudinal clinical study comprised a sample of 140 patients (72 women; 68 men) divided into two groups of 70 patients each: the bracket group (BG) with conventional fixed brackets using the MBT technique with a 0.022″ slot and the Invisalign group (IG) with aligners (Invisalign). The visual analog scale (VAS) was used to quantify patient-reported pain. Pain analysis was conducted monthly at 4 (T1), 8 (T2), and 24 h (T3) post-follow-up as well as at 2 (T4), 3 (T5), 4 (T6), 5 (T7), 6 (T8), and 7 days (T9) post-follow-up during the first twelve months after starting orthodontic treatment. Results: Statistically significant differences (p < 0.05) were observed between both study groups in the mean pain scores on the visual analog scale (VAS) during the twelve-month follow-up period, except for during the eighth month of treatment. In the first month, the group with conventional brackets reported higher pain scores. From the second month onwards, we observed that patients with aligners described a higher level of pain compared to the group of patients with conventional brackets. In both experimental groups, though at different evaluation periods, we found that the peak of maximum pain occurred between 24 and 48 h (T3–T4) after monthly follow-up appointments; from this point, the pain decreased until reaching minimum values from the fifth day onwards (T7). Conclusions: In the first month of treatment, the patients with conventional fixed multibrackets reported the highest levels of pain compared to those with removable aligners. From the second month on, this trend changed. The patients with removable aligners reported the highest levels of pain. Therefore, the orthodontic system used influenced the perception of pain in patients.

Efficacy of Bupivacaine Infiltration in Post Tonsillectomy Pain Relief

Background: Tonsillectomy is a common surgical procedure required to prevent recurrent infection, inflammation and related distress to the patients. Intervention in this highly vascularized area results in inflammatory responses and subsequent pain. Due to inadequate management 30-70% patients suffer from post-operative pain. Post tonsillectomy pain has its impact on analgesic consumption, hospital stay and return to normal activity. Methodology: This randomized control trial study design is a prospective randomized controlled including convenience sample of 32 patients of both genders, aged 4-30 years undergoing tonsillectomy.Tonsillectomy was performed by standard dissection method after giving general anesthesia to the patients. After completing the tonsillectomy on right side, surgeon infiltrated 6ml of 0.25 % bupivacaine in the tonsillar fossa on the right side. The surgeon did not infiltrate into the left side being observed as control. Postoperative pain score was recorded by asking patients on a VAS graded 1-10 scale (0= no pain and 10= maximum pain) after half an hour in recovery, 2 hours, 4 hours and 6 hours after the operation. Results: The mean age of the study patients was 14.08±7.32 years which included 20 (62.5%) females and 12(37.5%) males. The mean of duration of operation was 42.03±14.75 minutes. There was statistically significant difference between pain scores on VAS in infiltrated bupivacaine (right side) and control (left side) after ½, 2,4 and 6 hours respectively. Conclusion: Infiltration of 0.25% bupivacaine significantly reduces post tonsillectomy pain. Keywords: Tonsillectomy, Bupivacaine infiltration, Pain

The association of postoperative dexmedetomidine with pain, opiate utilization, and hospital length of stay in children post–Chiari malformation decompression

OBJECTIVE The aim of this study was to determine the association of postoperative dexmedetomidine with markers of pain in children undergoing Chiari malformation decompression. The authors hypothesized that patients receiving dexmedetomidine postoperatively would have decreased cumulative opiate use. They further hypothesized that there would be no difference in median pain scores, outcomes, or medication adverse events. METHODS An IRB-approved retrospective cohort study of patients undergoing Chiari malformation decompression from December 1, 2015, to December 31, 2018, was performed. Patients aged 0–21 years who underwent intradural Chiari malformation decompression at a single institution were included. Data for those who used dexmedetomidine postoperatively were compared with those who did not use dexmedetomidine. The primary outcome was cumulative opiate use throughout hospitalization. Secondary outcomes included pain scores, ancillary medication use, adverse events, hospital and ICU length of stay, readmission rates, and hospital cost. RESULTS The authors reviewed the records of 172 patients who underwent Chiari malformation decompression. Of those patients, 86 received dexmedetomidine postoperatively and 86 did not. Demographics were not different between the groups. Patients who received dexmedetomidine postoperatively received more doses of dexamethasone and were also more frequently exposed to dexmedetomidine intraoperatively (p = 0.028). Patients who received dexmedetomidine postoperatively used fewer morphine equivalents during their admission (1.02 mg/kg vs 1.43 mg/kg, p = 0.003). The patients who received dexmedetomidine postoperatively also had lower median pain scores on postoperative day 0 (0 vs 2, p < 0.001), lower median pain scores throughout the entire admission (1 vs 2, p < 0.001), and lower maximum pain scores recorded (6 vs 8, p = 0.005). Adjusting for steroid dose number and intraoperative dexmedetomidine exposure, postoperative dexmedetomidine remained associated with lower opiate dosing, lower pain scores on postoperative day 0, lower scores throughout hospital stay, and lower maximum pain scores. Patients who received dexmedetomidine had shorter hospital lengths of stay by 19 hours (p < 0.001). There were no statistically significant differences in medication adverse events or hospital costs between the two groups. CONCLUSIONS Postoperative dexmedetomidine use was associated with decreased opiate use, lower pain scores, and shorter hospital length of stay in this cohort. Dexmedetomidine may be considered as a safe adjuvant medication that may have opiate-sparing effects for this patient population.

Post Operative Pain Management and Patient Satisfection : Experience at a Tertiary Care Hospital

Background: Pain is an inevitable part of the postoperative experience. Current study was designed to assess the pattern of analgesic use, the adequacy of post operative pain control by documenting pain scores and patient satisfaction by documenting the pain perception score of the postoperative patients 48 hours after surgery. Materials and methods: This was a formative research and includes a mix of descriptive cross-sectional study carried out in the Department of Gynecology and Obstetrics, General Surgery and Orthopedics Surgery of Chattagram Maa-O-Shishu Hospital Medical College (CMOSHMC) during the month of January, 2018 to July, 2019. Results: A total of 180 patients underwent surgery were included in this study. Baseline data were collected both retrospectively and prospectively. Only analgesic used immediately after operation in three departments were Pethidine (100%). Diclofenac sodium suppository were used in appendectomy and cesarean section (50/60, 83%) and (26/60, 43%) respectively. Mostly, Diclofenac Sodium IV (55/60, 91%) was used in lower limb surgery. The maximum pain score were 5.3 (SD=2.3), 5.6 (SD =1.9), and 6.1 (SD =1.3) during coughing in the first 8 hour and minimum pain score 2.4 (SD =1.0), 2.2 (SD = 0.8) and 1.7 (SD=1.3) at rest 48 hours after cesarean section, appendectomy and lower limb surgery respectively. But pain score eventually increased during coughing 48 hours after surgery. After 48 hours of surgery maximum pain perception score 3.9 (SD = 0.9) in lower limb surgery and minimum perception score were 3.5 (SD =1.8) in cesarean section. Majority of the appendectomy patient (76%) satisfied with pain management where as only 43% satisfied in case of cesarean section. Conclusion: This study enabled the researchers to get a precise picture of the current state of POPM in different hospitals, as well as identify particular needs for improving such practices in health care facilities and implementing an educational intervention in order to improve the post operative pain management. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 69-73

Analgesic effect of oral ibuprofen 400, 600, and 800 mg; paracetamol 500 and 1000 mg; and paracetamol 1000 mg plus 60 mg codeine in acute postoperative pain: a single-dose, randomized, placebo-controlled, and double-blind study

Purpose Effect size estimates of analgesic drugs can be misleading. Ibuprofen (400 mg, 600 mg, 800 mg), paracetamol (1000 mg, 500 mg), paracetamol 1000 mg/codeine 60 mg, and placebo were investigated to establish the multidimensional pharmacodynamic profiles of each drug on acute pain with calculated effect size estimates. Methods A randomized, double-blind, single-dose, placebo-controlled, parallel-group, single-centre, outpatient, and single-dose study used 350 patients (mean age 25 year, range 18 to 30 years) of homogenous ethnicity after third molar surgery. Primary outcome was sum pain intensity over 6 h. Secondary outcomes were time to analgesic onset, duration of analgesia, time to rescue drug intake, number of patients taking rescue drug, sum pain intensity difference, maximum pain intensity difference, time to maximum pain intensity difference, number needed to treat values, adverse effects, overall drug assessment as patient-reported outcome measure (PROM), and the effect size estimates NNT and NNTp. Results Ibuprofen doses above 400 mg do not significantly increase analgesic effect. Paracetamol has a very flat analgesic dose–response profile. Paracetamol 1000/codeine 60 mg gives similar analgesia as ibuprofen from 400 mg, but has a shorter time to analgesic onset. Active drugs show no significant difference in maximal analgesic effect. Other secondary outcomes support these findings. The frequencies of adverse effects were low, mild to moderate in all active groups. NNT and NTTp values did not coincide well with PROMs. Conclusion Ibuprofen doses above 400 mg for acute pain offer limited analgesic gain. Paracetamol 1000 mg/codeine 60 mg is comparable to ibuprofen doses from 400 mg. Calculated effect size estimates and PROM in our study seem not to relate well as clinical analgesic efficacy estimators. Trial registration NCT00699114.

SPSS Analysis of Pain Factors in Rotator Cuff Repair

In this study, the matched case-control study was used. Nineteen cases of severe pain in the early postoperative period among 55 patients were set as the observation group, and 57 cases of simultaneous rotator cuff repair without severe pain were matched in a 1 : 3 ratio as the control group. Patients’ general information, disease characteristics, anesthesia and analgesia scheme, and operation information were collected. Frequency statistics, Wilcoxon signed rank sum test, regulatory effect analysis, and Poisson regression analysis were performed on these data. Some findings are included in the analysis. (1) There was a markable difference of 0.01 between the preoperative 48 h maximum pain value and the postoperative 48 h maximum pain value in the observation group. (2) There was a markable difference of 0.01 between the size and shape of the wound tear and the maximum pain value at 48 h after operation in the observation group. (3) When the number of opioid use affected the maximum pain value at 48 h after operation, the regulatory variables (type, quantity, and number of days of postoperative analgesics) were at different levels, and the impact amplitude had markable differences. (4) Age has a markable negative impact on the postoperative hospital stay. (5) The operation duration has a markable positive relationship with the postoperative hospital stay. (6) The analgesic pump had a markable positive impact on the postoperative hospital stay. (7) The location of injury did not affect the postoperative hospital stay.

Comparative Efficacy of Jaungo, A Traditional Herbal Ointment, and the Water-in-Oil Type Non-Steroidal Moisturizer for Radiation-Induced Dermatitis in Patients With Breast Cancer: A Study Protocol for a Prospective, Randomized, Single-Blinded, Pilot Study

Background: Radiation-induced dermatitis (RID) is a common complication of radiation therapy (RT). Although it has a high prevalence and can even trigger the premature end of conventional cancer therapies, there is no standard management. This study aims to evaluate whether topical use of Jaungo (Shiunko), a traditional herbal ointment mainly composed of Lithospermi radix and Angelica sinensis, could reduce RID compared to the water-in-oil type non-steroidal moisturizer in patients with breast cancer.Methods: This is a prospective, single-blinded, randomized controlled pilot trial that investigates the effect of topical application of Jaungo for the prevention of RID in postoperative breast cancer patients scheduled for RT, in comparison with the non-steroidal moisturizer, with a random distribution of 50 patients across the two groups. RT will be administered for 5–7 weeks with a biological equivalent dose (BED10) of 60 Gy or more, and the interventions will be applied 3 times a day during RT duration. Participants will be assessed a total of nine times, including eight visits during the period of RT and one visit at a 2-week follow-up period after the end of treatment. The incidence and severity of RID, quality of life, skin reaction symptoms, and maximum pain related to RID will be measured. The incidence rate of grade 2 or higher RID using the Radiation Therapy Oncology Group (RTOG) in the two groups will be statistically compared as the primary outcome. The types and frequencies of adverse events will be also collected and evaluated. All assessments will be performed by independent radiology oncologists.Discussion: This trial is currently ongoing and is recruiting. This study will determine the preventive efficacy of Jaungo in RID with postoperative breast cancer patients and provide evidence in traditional Korean medicine clinical practice.

Self-Rated Health and Pain Problems in Mothers of Healthy Children or Children Requiring Outpatient Observation or Hospitalisation: A Pilot Cross-Sectional Study

A child’s illness or disability is a considerable stressor for the mother and a risk factor for many psychological problems and somatic diseases. The purpose of the study was to (1) assess the prevalence of poor SRH and pain, (2) compare self-rated health and pain, (3) and identify the determinants of SRH and pain in mothers of healthy children and children requiring ambulatory observation or hospitalization. The study covered 234 mothers of both healthy and unhealthy children who required outpatient observation or treatment at an intensive care unit, neonatal intensive care unit, or oncology department. To analyse the variables obtained, the following tools were used: Self-Rated Health, Numerical Rating, Interpersonal Support Evaluation List, Peritraumatic Distress Inventory, Modified Hospital Anxiety and Depression Scale, and Impact of Effects Scale—Revised. The self-assessment of health in mothers of healthy children and those in need of outpatient observation or hospitalization at units with various specialities differed in a statistically significant way. The severity of the average and maximum pain among mothers of healthy children and those with a history of disease differed statistically significantly. Poor SRH co-occurred with severe maximum pain in all of the examined groups. Both in the control group and the group of mothers of children requiring outpatient observation, poor SRH co-occurred with a high level of anxiety. Only in the control group was a correlation found between the severity of the average and maximum pain and the severity of anxiety and depression symptoms.

An observational cohort study comparing ibuprofen and oxycodone in children with fractures

Objective To compare the effectiveness and safety of prescribing ibuprofen and oxycodone for at-home management of children’s fracture pain. Methods A prospective observational cohort was conducted at the Stollery Children’s Hospital pediatric emergency department (June 2010-July 2014). Children aged 4–16 years with an isolated fracture discharged home with advice to use either ibuprofen or oxycodone were recruited. Results A cohort of 329 children (n = 217 ibuprofen, n = 112 oxycodone) were included. Mean age was 11.1 years (SD 3.5); 68% (223/329) were male. Fracture distribution included 80.5% (264/329) upper limb with 34.3% (113/329) requiring fracture reduction. The mean reduction in Faces Pain Score-Revised score (maximum pain–post-treatment pain) for Day 1 was 3.6 (SD 1.9) (ibuprofen) and 3.8 (SD 2.1) (oxycodone) (p = 0.50); Day 2 was 3.6 (SD 1.8) (ibuprofen) and 3.7 (SD 1.6) (oxycodone) (p = 0.56); Day 3 was 3.7 (SD 1.7) (ibuprofen) and 3.3 (SD 1.7) (oxycodone) (p = 0.24). Children prescribed ibuprofen (51.2%, 109/213) experienced less adverse events compared to those prescribed oxycodone (70.5% 79/112) on Day 1 (p = 0.001). Children prescribed ibuprofen (71.8%, 150/209) had their function (eat, play, school, sleep) affected less than those prescribed oxycodone (83.0%, 93/112) (p = 0.03) on Day 1. Conclusion Children prescribed ibuprofen or oxycodone experienced similar analgesic effectiveness for at-home fracture pain. Oxycodone prescribing was associated with more adverse events and negatively impacted function. Oxycodone use does not appear to confer any benefit over ibuprofen for pain relief and has a negative adverse effect profile. Ibuprofen appears to be a safe option for fracture-related pain.