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BMC Complementary Medicine and Therapies Jun 2024The clinical symptoms of Lumbar Disc Herniation (LDH) can be effectively ameliorated through Lever Positioning Manipulation (LPM), which is closely linked to the brain's...
INTRODUCTION
The clinical symptoms of Lumbar Disc Herniation (LDH) can be effectively ameliorated through Lever Positioning Manipulation (LPM), which is closely linked to the brain's pain-regulating mechanisms. Magnetic Resonance Imaging (MRI) offers an objective and visual means to study how the brain orchestrates the characteristics of analgesic effects. From the perspective of multimodal MRI, we applied functional MRI (fMRI) and Magnetic Resonance Spectrum (MRS) techniques to comprehensively evaluate the characteristics of the effects of LPM on the brain region of LDH from the aspects of brain structure, brain function and brain metabolism. This multimodal MRI technique provides a biological basis for the clinical application of LPM in LDH.
METHODS AND ANALYSIS
A total of 60 LDH patients and 30 healthy controls, matched by gender, age, and years of education, will be enrolled in this study. The LDH patients will be divided into two groups (Group 1, n = 30; Group 2, n = 30) using a random number table method. Group 1 will receive LPM treatment once every two days, for a total of 12 times over 4 weeks. Group 2 will receive sham LPM treatment during the same period as Group 1. All 30 healthy controls will be divided into Group 3. Multimodal MRI will be performed on Group 1 and Group 2 at three time points (TPs): before LPM (TP1), after one LPM session (TP2), and after a full course of LPM treatment. The healthy controls (Group 3) will not undergo LPM and will be subject to only a single multimodal MRI scan. Participants in both Group 1 and Group 2 will be required to complete clinical questionnaires. These assessments will focus on pain intensity and functional disorders, using the Visual Analog Scale (VAS) and the Japanese Orthopaedic Association (JOA) scoring systems, respectively.
DISCUSSION
The purpose of this study is to investigate the multimodal brain response characteristics of LDH patients after treatment with LPM, with the goal of providing a biological basis for clinical applications.
TRIAL REGISTRATION NUMBER
https://clinicaltrials.gov/ct2/show/NCT05613179 , identifier: NCT05613179.
Topics: Humans; Magnetic Resonance Imaging; Intervertebral Disc Displacement; Adult; Male; Female; Brain; Middle Aged; Multimodal Imaging; Young Adult; Intervertebral Disc Degeneration
PubMed: 38915038
DOI: 10.1186/s12906-024-04549-4 -
Journal of Indian Association of... 2024Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body's reaction to surgical...
Safety and Efficacy of Enhanced Recovery after Surgery Protocol in Pediatric Patients Undergoing Hepato-Pancreatico-Biliary Surgery: A Prospective Randomized Control Study.
INTRODUCTION
Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body's reaction to surgical stress by optimizing the perioperative nutritional status, promoting analgesia without opioids, and early postoperative feeding. In pediatric patients, very limited literature is available for the application of ERAS protocol. This study was done to evaluate the application of ERAS protocol in pediatric hepatobiliary and pancreatic patients.
MATERIALS AND METHODS
This is a randomized prospective study conducted over a period of 2 years at a tertiary center in North India. A total of 40 hepatobiliary and pancreatic patients who were willing to participate in the study were included in the study. Patients were randomized by computer-generated method and data were collected regarding demography, clinical diagnosis, preoperative and postoperative workup, and peri-operative care including analgesia, pain scores, postoperative recovery, hospital stay, and complications. These patients were followed for 6 months postoperatively and the results were evaluated using SPSS software.
RESULTS
The study included 20 patients each in both the conventional and ERAS group with median ages of 11.5 years and 7.1 years, respectively. The data analysis showed that the ERAS group of patients had better outcomes in terms of hospital stay and drain removal time with significant statistical differences. Pain scores and complications are almost the same in both groups.
CONCLUSION
Principles of ERAS can be safely applied in pediatric patients undergoing major surgery in the present era of emerging infections and also increasing patient burden without morbidity.
PubMed: 38912029
DOI: 10.4103/jiaps.jiaps_238_23 -
Annals of Surgery Open : Perspectives... Jun 2024This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes...
OBJECTIVE
This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery.
BACKGROUND
ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear.
METHODS
This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (>70% of components), length of stay (LOS), readmissions, and 30-day complications.
RESULTS
A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; 0.001), preoperative blocks (+8.0%; 0.02), preoperative multimodal analgesia (+18.0%; 0.001), early regular diet (+15.9%; 0.001), and postoperative multimodal analgesia (+6.4%; 0.001). High-level ERP adherence was 13.4% higher ( 0.01) and LOS was 2.0 days shorter ( 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence.
CONCLUSION
Preoperative education is associated with adherence to ERP components and improved surgical outcomes.
PubMed: 38911622
DOI: 10.1097/AS9.0000000000000432 -
Plastic and Reconstructive Surgery.... Jun 2024In this systematic review, we assessed the therapeutic efficacy and safety of collagenase (CCH) and tissue subcision (TS) for treating cellulite, which ranges from...
BACKGROUND
In this systematic review, we assessed the therapeutic efficacy and safety of collagenase (CCH) and tissue subcision (TS) for treating cellulite, which ranges from subtle to pronounced lesions.
METHODS
A systematic review was performed following PRISMA guidelines for CCH and TS treatment to the thigh and gluteal regions. A proportion meta-analysis was then conducted using Stata statistical software.
RESULTS
A total of 14 studies were incorporated into the final analysis. Nine focused on TS and five on CCH injection, collectively reporting outcomes for 1254 patients. Of these, 465 received CCH injection and 789 underwent subcision. For bruising, rates were 89% [95% confidence interval (CI), 71%-96%] with CCH injection and 99% (95% CI, 85%-99%) for subcision; pain requiring analgesic was reported at 74% (95% CI, 55%-87%) for CCH and 60% (95% CI, 43%-76%) for subcision; both showed induration at 7% (95% CI, 5%-11% for CCH, 95% CI, 2%-25% for subcision), whereas skin discoloration was higher post-CCH injection at 16% (95% CI, 10%-26%) compared with 7% (95% CI, 5%-10%) postsubcision.
CONCLUSIONS
Both CCH and TS seem effective treatments for cellulite. However, upon evaluating the adverse outcomes between the two modalities, subcision demonstrated a higher incidence of bruising, albeit similar rates of induration compared with CCH injection. Conversely, the CCH injection group manifested a higher propensity for pain requiring analgesia and notably exhibited increased instances of skin discoloration compared with their subcision patient group. Further standardized research is crucial for more informed cellulite treatment decisions and for comparing efficacy, safety, and cost-effectiveness between TS and CCH.
PubMed: 38911581
DOI: 10.1097/GOX.0000000000005857 -
Gynecology and Minimally Invasive... 2024The objectives of this study were to evaluate the visual analog scale (VAS) score in patients receiving port-site bupivacaine infiltration in gynecological laparoscopic...
OBJECTIVES
The objectives of this study were to evaluate the visual analog scale (VAS) score in patients receiving port-site bupivacaine infiltration in gynecological laparoscopic surgeries and to compare it with those receiving placebo and to evaluate the additional analgesic requirement in the first 24 h after surgery.
MATERIALS AND METHODS
A prospective interventional study was conducted on 60 women scheduled for benign gynecological laparoscopic surgeries. Patients were randomized into two groups using an alternative sequential method of allocation. Approval from the Institute's Ethics Committee was sought. Informed written consent was taken from all the patients. All laparoscopic surgeries were performed under general anesthesia. Double-blinding was done. A VAS with a 10 cm vertical score ranging from "no pain" to "worst possible pain" was used to assess the postoperative pain when the patient awakened in the operating room (2 h after surgery), then after 6 and 24 h. The primary outcome measured was pain perception by the patient (as VAS scores), and the secondary outcome was the need for additional analgesia.
RESULTS
Comparison of both groups with the VAS score shows > 0.001, i.e., nonsignificant in all the groups. Additional analgesics were required in 56% of the patients in the intervention group and 60% of the patients in the control group; however, 44% and 40% of the patients from the intervention and control groups, respectively, do not require any additional analgesic in the postoperative period.
CONCLUSION
The local infiltration of bupivacaine does not significantly reduce the port-site postoperative pain in gynecological laparoscopic surgeries.
PubMed: 38911315
DOI: 10.4103/gmit.gmit_77_22 -
Drug Design, Development and Therapy 2024We aimed to evaluate the effect of intravenous esketamine combined with dexmedetomidine as supplemental analgesia in reducing intraoperative visceral pain... (Randomized Controlled Trial)
Randomized Controlled Trial
Esketamine Combined with Dexmedetomidine to reduce Visceral Pain During elective Cesarean Section Under Combined Spinal-Epidural Anesthesia: A double-Blind Randomized Controlled Study.
PURPOSE
We aimed to evaluate the effect of intravenous esketamine combined with dexmedetomidine as supplemental analgesia in reducing intraoperative visceral pain during elective cesarean section under combined spinal-epidural anesthesia (CSEA).
PATIENTS AND METHODS
A total of 269 parturients scheduled for elective cesarean section under CSEA between May 2023 and August 2023 were assessed. The parturients were randomly allocated to receiving either intravenous infusion of 0.3-mg/kg esketamine combined with 0.5-μg/kg dexmedetomidine (group ED, n=76), 0.5-μg/kg dexmedetomidine (group D, n=76), or normal saline (group C, n=76) after umbilical cord clamping. The primary outcome was intraoperative visceral pain. Secondary outcomes included the visual analog scale (VAS) score for pain evaluation and other intraoperative complications.
RESULTS
The incidence of visceral pain was lower in group ED [9 (12.7%)] than in group D [32 (43.8%)] and group C [36 (48.6%), <0.0001]. The VAS score was also lower in group ED when exploring abdominal cavity [0 (0), <0.0001] and suturing the muscle layer [0 (0), =0.036]. The mean arterial pressure was higher in group D [83 (9) mmHg] and group ED [81 (11) mmHg] than in group C [75 (10) mmHg, <0.0001] after solution infusion. The heart rate after infusion of the solution was lower in group D [80 (12) bpm] than in group C [86 (14) bpm] and group ED [85 (12) bpm, = 0.016]. The incidence of transient neurologic or mental symptoms was higher in group ED compared to group C and group D (76.1% vs 18.9% vs 23.3%, <0.0001).
CONCLUSION
During cesarean section, 0.3-mg/kg esketamine combined with 0.5-μg/kg dexmedetomidine can alleviate visceral traction pain and provide stable hemodynamics. Parturients receiving this regimen may experience transient neurologic or mental symptoms that can spontaneously resolve at the end of the surgery.
Topics: Humans; Dexmedetomidine; Ketamine; Double-Blind Method; Cesarean Section; Female; Adult; Visceral Pain; Anesthesia, Spinal; Pregnancy; Anesthesia, Epidural; Drug Therapy, Combination; Elective Surgical Procedures
PubMed: 38911034
DOI: 10.2147/DDDT.S460924 -
Frontiers in Pain Research (Lausanne,... 2024
PubMed: 38911022
DOI: 10.3389/fpain.2024.1421548 -
Proceedings (Baylor University. Medical... 2024We hypothesized that increasing our intrathecal fentanyl dose for cesarean delivery from 10 µg to 15 µg would result in fewer patients receiving a rescue analgesia...
BACKGROUND
We hypothesized that increasing our intrathecal fentanyl dose for cesarean delivery from 10 µg to 15 µg would result in fewer patients receiving a rescue analgesia intervention.
METHODS
Patients who had a cesarean delivery from February 15, 2021 to February 14, 2023 and received a single injection spinal or combined spinal-epidural anesthetic for cesarean delivery were eligible for inclusion. We defined a rescue analgesia intervention as administration of local anesthetic through an epidural catheter, administration of systemic anesthetic adjuvant medication, or conversion to general anesthesia.
RESULTS
A total of 520 and 556 patients received 10 µg and 15 µg of intrathecal fentanyl for cesarean delivery, respectively, of which 154 (29.6%) and 122 (21.9%) patients required rescue analgesia interventions, respectively ( = 0.004). The odds ratio for receiving a rescue analgesia intervention was 0.668 (95% confidence interval 0.507 to 0.880; = 0.004) for patients who received 15 µg of intrathecal fentanyl compared to 10 µg.
CONCLUSION
Following implementation of an increased dose of intrathecal fentanyl, patients who received 15 µg of intrathecal fentanyl for cesarean delivery were approximately 33% less likely to require a rescue analgesia intervention during cesarean delivery compared to patients who received 10 µg.
PubMed: 38910802
DOI: 10.1080/08998280.2024.2349985 -
Proceedings (Baylor University. Medical... 2024
PubMed: 38910795
DOI: 10.1080/08998280.2024.2352344 -
Cureus May 2024Adductor canal block is a widely used regional anesthesia technique for total knee arthroplasty that helps in reducing post-surgical pain and opioid use. Anatomically,...
Adductor canal block is a widely used regional anesthesia technique for total knee arthroplasty that helps in reducing post-surgical pain and opioid use. Anatomically, the adductor canal extends from the apex of the femoral triangle proximally to the adductor hiatus distally and is roofed by the sartorius and vasto-adductor fascia. All these serve as a potential path for the spread of the local anesthetic when it is injected inside the adductor canal during the block. Subsartorial space is of unique interest as it lies between the sartorius and vasto-adductor fascia, carrying the subsartorial plexus that can provide additional analgesia to the knee when the adductor canal block injectate spreads into it. While the spread can be variable, ultrasound can be a useful tool to evaluate this spread. This is a case series of patients who underwent total knee arthroplasty under spinal anesthesia and adductor canal blocks. We present the findings of ultrasound evaluation of the injectate spread following adductor canal blocks and evaluation of their analgesia effects.
PubMed: 38910653
DOI: 10.7759/cureus.60849