The Role of Preemptive Infiltration Anesthesia in the Management of Postoperative Pain Following Septoplasty

Abstract Introduction Septoplasty is one of the most common surgical procedures in rhinology practice. Two major problems encountered after septoplasty are pain and bleeding. Preoperative administration of analgesics before the surgical stimulus, which is the main concept of preemptive analgesia, decreases postoperative pain. Objective The present study was designed to investigate whether preincisional lidocaine infiltration to the subperichondrial area during septoplasty surgery reduced or not postoperative pain and analgesic use. Methods The present prospective, randomized, placebo controlled, double-blind trial was conducted on 64 consecutive patients with nasal septum deviation. Patients were randomly divided into 2 groups; the study group received 2% 20 mg lidocaine/cc (n = 31), and the control group received 6 cc 0.9% NaCl (n = 33). A standard questionnaire was given to each patient to mark his or her pain score between 0 and 10 at the 1st, 3rd, 6th, 12th, and 24th hours. Results The mean and the range of visual analogue scale (VAS) scores of the patients in the study group at the 1st, 3rd, 12th, and 24th hours were 4.03 ± 3.08 (0-10); 3.42 ± 2.39 (0-8); 2.97 ± 2.22 (0-8); 2.87 ± 2.61 (0-9); and 1.94 ± 2.06 (0-9) respectively. The mean and the range of VAS scores of the patients in the control group at the 1st, 3rd, 12th, and 24th hours were 4.12 ± 2.7 (0-10); 3.45 ± 2.4 (0-10); 2.94 ± 2.7 (0-10); 2.79 ± 2.34 (0-10); and 1.5 ± 1.8 (0-6), respectively. The statistical analysis revealed no significant difference among the groups. Conclusion The preemptive local anesthetic administration to the incision area and under the mucoperichondrial flap before septoplasty does not decrease the level of postoperative pain.

A Study Comparing the Efficacy of Different Non-pharmacological Methods to Reduce Pain in Neonates Admitted in A Tertiary Care Hospital

Aim : To compare the efficacy of different non-pharmacological methods for reducing pain in Neonates. Methodology : During the study period of one year from July, 2019 to July, 2020, a total of 70 infants were consecutively recruited and divided into two groups. One group received 2ml of EBM and other group 2ml of 25% D is administered which was given 1 minute before Venepuncture. The outcome variables are the duration of cry after Venepuncture & NIPS score for both group. Result : The duration of cry was found to be higher in the group receiving EBM. The neonates in 25%D groups had lower Neonatal Infant Pain Scale (NIPS) score than EBM group (chi-sqr-10.34 & p-0.0057). Conclusion : In our study we found 25% Dextrose to be a better non-pharmacological Analgesic as compared to EBM during painful procedure in newborn.

Serratus plane block versus local infiltration anesthesia in closed tube thoracostomy insertion: Cohort study

Background@#Serratus anterior plane block (SPB) is a relatively new regional anesthetic technique that provides long-lasting anesthesia, extended postoperative analgesia, and demonstrates less consumption of opioid analgesic compared to local infiltration anesthesia (LIA). @*Objective@#To compare the outcomes of SPB and LIA as anesthetic techniques among patients undergoing chest tube thoracostomy (CTT) insertion. @*Design@#Cohort study. @*Setting@#Department of Surgery, Southern Philippines Medical Center, from October 2017 to May 2019. @*Participants@#110 male and female patients aged >18 years old undergoing CTT given either SPB or LIA. @*Main outcome measures@#Mean VAS during the procedure, at PACU, and 4, 8, 12, 16, 18, and 24 hours postoperatively. @*Main results@#Of the 110 patients undergoing CTT in this study, 55 (50%) where under SPB, and the remaining 50% where under LIA. Compared to those under LIA, patients under the SPB group had significantly lower mean VAS during the procedure (4.02 ± 1.43 vs 2.76 ± 1.35; p<0.0001), and at post-anesthesia care unit (4.25 ± 1.87 vs 3.15 ± 1.56; p=0.0010). The mean level of physician's satisfaction on the procedure was significantly higher in the SPB group than in the LIA group (3.56 ± 0.50 vs 2.96 ± 0.33; p<0.0001). The mean dose of fentanyl as supplemental anesthetic agent was significantly higher in the LIA group than those in the SPB group (1.38 ± 0.59 vs 0.95 ± 0.29; p<0.0001). Similarly, the mean dose of nalbuphine, as rescue opioid dose, was significantly higher in the LIA group than in the SPB group (2.16 ± 0.57 vs 1.53 ± 0.57; p<0.0001). @*Conclusion@#Patients under SPB who underwent CTT had less pain during the procedure and at the PACU, and used lower doses of the supplemental anesthetic agent (fentanyl) during the procedure, and of the rescue opioid analgesic (nalbuphine), postoperatively.

Comparison of intraosseous access and central venous catheterization in Chinese adult emergency patients: A prospective, multicenter, and randomized study / 世界急诊医学杂志（英文）

@#BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous (IO) access and central venous catheterization (CVC) in critically ill Chinese patients. METHODS: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned above. RESULTS: A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group (91.7% vs. 50.0%, P<0.001; 52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion (1.5 vs. 0.0, P=0.044). Complications were not observed in the two groups. CONCLUSIONS: IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.

Effect of oral 25% dextrose on pain relief in newborn infants undergoing venepuncture

Background: Aim of this study was to study effect of oral 25% dextrose for pain relief in newborns undergoing venepuncture.Methods: This is a case control study conducted in NICU, Cheluvamba hospital attached to Mysore medical college and research institute during the period between September 2018 to November 2018. Babies with gestational age between 34 to 40 weeks of gestation who had clinical indication for blood sampling were included in the study. Neonates who are critically ill, suffered perinatal asphyxia and having congenital anomalies were excluded from the study. Hundred newborn babies admitted to NICU who had clinical indication for blood sampling were enrolled in the study. Study population were divided into 2 groups, dextrose (cases) and non-dextrose group (controls). The data analysis included gestational age, postnatal age, weight, sex, heart rate, oxygen saturation, crying time and behavioural pain assessment.Results: Mean pain score, crying time and heart rate at 5 minutes of venepuncture were studied in both the groups. Mean pain score in dextrose group was 2.68 and in non-dextrose group was 7.18 with significant p value of 0.0062. Mean crying time in dextrose group was 8.98 minutes and in non-dextrose group was 42 minutes with significant p value of 0.001. Mean heart rate in dextrose group was 142 beats/minute and in non-dextrose group was 146bpm with p value of 0.08.Conclusions: Pain in the newborns should be recognised and adequately treated. Lingual 25% dextrose can be used as safe and effective analgesia in neonates undergoing minor invasive procedures like venepuncture.

Comparison between intravenous injectable diclofenac and per rectal diclofenac suppository as analgesics in operated per anal and perianal benign pathologies

Background: Per anal and perianal surgeries are one of the bread and butter surgeries in a surgeons life, and satisfaction of patient matters a lot. Early miraculous recovery has always been patient’s expectations hence we decided to study standard IV method of diclofenac as analgesic with diclofenac suppository and compared their effects on patients with the help of pain scale of 0 to 10.Methods: 200 common per anal surgeries were considered in the study, and were divided in two groups group A post operatively IV diclofenac was given 12 hourly and in group B cases diclofenac suppository 100 mg was started daily twice and the pain score was noted for a week.Results: Diclofenac suppositories resulted in early pain relief and thus early discharges of these patients. The pain score had decreased to a larger extent by day 3 and was almost negligible by day 5 and a few cases to day 7. The hospital stay reduced as patient could manage suppository at home by themselves. IV site complications like thrombophlebitis leading to pain and fever could be easily avoided.Conclusions: Thus diclofenac suppositories proved to be an effective way to give a pain free satisfaction compared to intravenous painful analgesics, thus decreased their hospital stay and also it was a patient friendly.

Acupuncture combined with other therapies for osteoporosis: A network meta-analysis / 中国组织工程研究

BACKGROUND: Comparative study results between the treatment efficiency of acupuncture plus other combination therapy and western medicine therapy in the treatment of knee osteoarthritis remain controversial. Currently, meta-analysis studies mainly focus on comparison of the efficacy between single acupuncture treatment, acupuncture plus western medicine combination therapy and western medicine, but there is a lack of investigation on acupuncture combined with other therapies. It is difficult to fully understand the efficacy of acupuncture. OBJECTIVE: To compare the effects of acupuncture therapy, conventional western medicine and Chinese medicine on osteoporosis treatment by network meta-analysis. METHODS: A search was performed on the CNKI, VIP, WanFang, SinoMed, PubMed, and Cochrane Library databases to include the randomized controlled trials of different acupuncture treatments for osteoporosis. Relevant data were extracted after screening the literature according to relevant inclusion and exclusion criteria, and the quality of the included literature was evaluated. Literature data analysis and mapping were performed using Stata 14.0 software. RESULTS AND CONCLUSION: Thirty-four randomized controlled trials were included, involving seven interventions, such as single acupuncture treatment, single western medicine treatment, single Chinese medicine treatment, acupuncture plus western medicine combination therapy, acupuncture plus Chinese medicine combination therapy, Chinese medicine + western medicine treatment, acupuncture + Chinese medicine + western medicine combined treatment. (1) In the treatment efficiency, acupuncture combined with traditional Chinese medicine is the best in the treatment of primary osteoporosis, and acupuncture combined with traditional Chinese medicine, acupuncture combined with western medicine and acupuncture combined with traditional Chinese medicine western medicine were significantly better than traditional Chinese medicine combined with western medicine (P 0.05). In the included studies, a very small number of patients developed acupuncture and blood stasis after acupuncture, but no fainting or unreported, and no other side effects were found. To conclude, acupuncture combined with other therapies can improve the efficiency, increase the bone mineral density and alleviate pain.

Comparative study of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery for the treatment of non-small cell lung cancer / 中国胸心血管外科临床杂志

@#Objective    To investigate the effects of subxiphoid uniportal video-assisted thoracoscopic surgery (SUVATS) and intercostal uniportal VATS (IUVATS) in lobectomy for non-small cell lung cancer (NSCLC). Methods    A total of 428 patients with NSCLC who underwent lobectomy via SUVATS or IUVATS from July 1st to 31st, 2019 in Shanghai Pulmonary Hospital were enrolled. Patient characteristics, perioperative outcomes and postoperative pain scores at different time points were collected. The patients were divided into a SUVATS group (80 patients, 42 males and 38 females with an average age of 58.8±9.6 years) and an IUVATS group (348 patients, 161 males and 187 females, with an average age of 61.2±10.0 years). The clinical effectiveness of the two groups was compared. Results    There was no significant difference in sex (P=0.314), age (P=0.052), preoperative pulmonary function (P=0.701), combined chronic comorbidities (chronic cardiovascular disease, P=0.775; chronic obstructive pulmonary disease, P=0.678) and postoperative pathology (P=0.132) between the two groups. Compared with the IUVATS group, patients in the SUVATS group had longer operation time (155.6±34.4 min vs. 141.3±27.0 min, P<0.001), less intraoperative blood loss (165.2±160.6 mL vs. 223.7±272.4 mL, P<0.001), shorter time of chest tube use (4.3±2.0 d vs. 4.9±1.9 d, P=0.011) and less postoperative pain score at different time points (postoperative 8 h, P<0.001; postoperative day 1, P=0.019; postoperative day 2, P=0.015; the day before discharge, P<0.001). Conclusion    SUVATS is a safe and effective technique for lobectomy in NSCLC patients with less postoperative pain and can promote postoperative recovery.

Outcome of total laparoscopic hysterectomy in relation to the size of the uterus

Background: Laparoscopic hysterectomy is a safe and feasible technique to manage benign uterine pathology as it offers minimal postoperative discomfort; with shorter hospital stay, rapid convalescence and early return to the activities of daily living. However, to date very few studies have been reported on safety and feasibility of total laparoscopic hysterectomy (TLH) in large sized uteri. The present study was planned to evaluate the intra-operative and post-operative parameters in relation to size of the uterus during TLH.Methods: This study was a comparative study. Fifty women with uterine size less than 12 weeks (Group 1) and fifty women with uterine size more than or equal to 12 weeks (Group 2) for whom TLH was planned for benign indications were included in the study. Intra-operative and post-operative parameters like blood loss, duration of surgery, post-operative pain and complications were compared between the two groups. Comparison was done using independent sample t test. A probability (‘p’ value) of less than or equal to 0.05 at 95% confidence interval was considered as statistically significant.Results: The mean age of the patients in both the groups was matched (44.82 years vs. 43.96 years). The mean operative time (48.80±14.12 minutes vs. 77.3±35.11 minutes; p <0.001) and blood loss (40.10±18.25ml vs. 70.6±65.46 ml; p=0.002) were significantly high in Group 2 compared to Group 1. The mean pain scores were similar in both the groups at 6 hours, 24 hours and at the time of discharge. No significant complications were noted in both the groups.Conclusions: TLH is safe, feasible and acceptable for large size uterus (>12 weeks). However, it is associated with longer operative time, and greater amount of blood loss.

Assessment of Results of Sutureless Mesh Repair of Inguinal Hernia: An Institutional Based Study

Background: Hernia is generally defined as the protrusion of aviscus from the cavity in which it is normally contained or moreprecisely, as the protrusion of a loop or knuckle of an organ ortissue through an abnormal opening. Hence; the present studywas undertaken for assessing results of sutureless mesh repairof inguinal hernia.Materials & Methods: A total of 20 patients with inguinalhernia were enrolled in the present study. Patients who fulfilledthe inclusion criteria were included into the study after takingdetailed consent for the procedure. Inguinal hernia repair wasperformed by placing mesh on posterior inguinal wall andwithout applying fixation suture or glue. Postoperative follow-upwas done and Visual analogue scale (VAS) was used forassessment of postoperative pain on follow-up. All the resultswere recorded in Microsoft excel sheet and were analyzed bySPSS software.Results: Majority of the patients i.e. 45 percent of the patientsbelonged to the age group of 41 to 50 years, followed by 35percent of the patients who belonged to the age group of 20 to30 years. Punched out/diverticular defect in transversalis fasciawas present in 10 percent of the cases while normal posteriorwall was present in 90 percent of the cases. Mean duration ofoperative procedure was 41.25 minutes. Mean postoperativepain score at 12 hour and 24 hours was 2.95 and 1.84respectively.Conclusion: Sutureless tension free mesh repair in thetreatment of inguinal hernia cases is an effective technique.However; further studies are recommended.

Clinical observation of warm acupuncture combined with yoga posture method in the treatment of periarthritis with frozen period / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of warm acupuncture combined with yoga posture method in the treatment of periarthritis with frozen period.@*METHODS@#Ninety patients with periarthritis who met the inclusion criteria were randomly divided into a control group 1, a control group 2 and an observation group, 30 cases in each group. Warm acupuncture was applied in the control group 1 (Jianzhen (SI 9), Jianyu (LI 15), Jianliao (TE 14), etc were selected), yoga posture method was applied in the control group 2, warm acupuncture combined with yoga posture method were given in the observation group, the treatment was given once a day, 10 times as a course with 2 days between courses and continuous for 2 courses. After 2 courses of treatment, the shoulder joint pain score and shoulder function grading were used to evaluate the clinical efficacy, and the clinical efficacy was observed.@*RESULTS@#①The pain scores of the three groups were significantly lower after treatment (all 0.05). ②After treatment, the functional classification of shoulder joints were significantly improved in the three groups (all 0.05). ③After 2 courses of treatment, the effective rate of the observation group was 86.7% (26/30), which was better than 70.0% (21/30) in the control group 1 and 76.7% (23/30) in the control group 2 (both <0.05).@*CONCLUSION@#Warm acupuncture combined with yoga posture method can effectively relieve shoulder pain and improve dysfunction. The clinical comprehensive effect is better than simple acupuncture and yoga posture method.

Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury / 世界急诊医学杂志（英文）

BACKGROUND@# Rapid and effective pain relief in acute traumatic limb injuries (ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous (IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI.@*METHODS@# In this double-blind randomized clinical trial, 307 patients with ATLI, who presented to the emergency department (ED) from February 2016 to April 2016, were randomly divided into two groups. One group (152 patients) received 0.1 mg/kg IV morphine. The other group (155 patients) received 1 mcg/kg IV fentanyl. Patients' demographic data, pain score at specific intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded.@*RESULTS@# Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up (P value=0.00). However, at 10, 30, and 60-minute follow-ups no significant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12 (7.7%) patients in the fentanyl group and in 48 (31.6%) patients in the morphine group (P value=0.00). No significant difference was observed regarding side effects, vital signs and patients' satisfaction between the two groups.@*CONCLUSION@# Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

Effect of massage combined withwarm acupuncture on early primary frozen shoulder / 中国基层医药

Objective@#To observe the clinical effect of massage combined with warm acupuncture and moxibustion on primary frozen shoulder.@*Methods@#From April 2018 to April 2019, 30 patients with primary frozen shoulder admitted and treated in Wenzhou Hospital of Traditional Chinese Medicine were selected in theresearch.According to different admission time, they were divided into observation group and control group, with 15 patients in each group.The control group was treated with warm acupuncture and moxibustion, while the observation group was combined with massage.The total effective rate and VAS pain score after treatment were compared and observed.@*Results@#The total effective rate in the observation group was 93.33%, which was higher than 73.33% in the control group (χ2=3.294, P<0.05). The VAS score of the observation group was (1.05±0.22)points after treatment, which was lower than (3.13±0.43)points of the control group, the difference between the two groups was statistically significant(t=2.493, P=0.000).@*Conclusion@#Massage combined with warm acupuncture and moxibustion in the treatment of primary frozen shoulder is more effective than the single treatment method, which can relieve the pain of patients and is a safe and effective treatment.

Therapeutic effect of minimally invasive small incision surgery on patients with early thoracic esophageal cancer and its in-fluence in pain / 实用肿瘤学杂志

Objective The aim of this study was to explore the effect of minimally invasive small incision surgery on early thoracic esophageal cancer patients and its impact on pain. Methods A total of 160 patients with early thoracic esophageal cancer who were treated in our hospital from March 2016 to March 2017 were randomly divided into the conventional surgery group and the minimally invasive small incision surgery group. Patients in the conventional surgery group were treated with routine operation,and pa-tients in the minimally invasive small incision surgery group were treated with minimally invasive small incision surgery. Vital capacity ( VC),forced expiratory volume 1(FEV1),visual analogue scale(VAS),hospitalization time,operation time and intraoperative bleed-ing volume were counted. Growth hormone(GH)was detected by ELISA. The levels of cortisol(Cor) and interleukin-8( IL-8) were measured by immunoassay and adverse reactions. Results The levels of VC and FEV1 in the minimally invasive small incision group were significantly higher than those in the conventional surgery group. The bleeding volume,operation time and hospitalization time were shorter than those in the conventional surgery group. The levels of GH and Cor,VAS score and incidence of adverse reaction rate were lower than those in the conventional surgery group,and the level of IL-8 was also higher in than that in the conventional surgery group. The difference was statistically significant(P<0. 05). Conclusion Minimally invasive small incision surgery is effective on the treatment of early thoracic esophageal cancer,relieving pain and reducing adverse reactions.

A randomized comparative study of diathermy incisions and scalpel incisions in subacute appendicitis

Background: Treating injuries with heat can increase blood flow and make connective tissue more flexible. It can also help minimize inflammation and reduce the incidence of edema or fluid retention. By increasing blood flow to the site of an injury, the deep heat generated with diathermy can accelerate healing. Diathermy is used to treat arthritis, back pain, fibromyalgia, muscle spasms, neuralgia, sprains and strains, tenosynovitis, tendonitis, bursitis. In the second, as an adjunct to surgery, diathermy is used to coagulate, prevent excessive bleeding, and seal off traumatized tissues. It is particularly effective in eye surgery, neurosurgery and dermatology. However, there is still not a lot of evidence to prove that diathermy is the most effective treatment for these conditions. Aim of the study: Aim was comparison of Diathermy incision and Scalpel incision in elective open appendectomy surgery. Materials and methods: 25 patients per group irrespective of sex was sample size. Study Group was subdivided into Study Group A – Patients were subjected to Diathermy incision. Study Group B – Patients were subjected to Scalpel incision. After obtaining pre-anesthetic check-up patients were posted for surgery. Data was collected using a proforma meeting the objectives of the study. Results: The treatment group was split into two, Twenty-five cases used diathermy for skin incision and the other twenty-five cases used a traditional scalpel for skin incisions in open appendectomy Mithun Govind Dandapani, Bharathidasan Rajamanikkam, Maheshwari Narayanan. A randomized comparative study of diathermy incisions and scalpel incisions in subacute appendicitis. IAIM, 2019; 6(7): 59-66. Page 60 procedures. 50 patients in the study groups were compared, 4 developed wound gaping which accounts for 8%. Wound gaping was considerably seen in scalpel incision with a highly significant P value of 0.0297 using Pearson-Chi square test. A hypertrophic scar was seen in scalpel incision with a significant P value of 0.074 using Pearson-Chi square test. Keloid was considerably seen in scalpel incision with a highly significant P value of 0.0149 using Pearson-Chi square test. The pain in POD-1 was compared, the mean value was 7.44 and 6.16 in scalpel and diathermy respectively, with a highly significant P value of <0.0001. The pain in POD-2 was compared, the mean value was 6.28 and 4.72 in scalpel and diathermy respectively, with a highly significant P value of <0.0001. Conclusion: All the patients were followed every day in the postoperative period until they were discharged. The following parameters were observed, that is a comparison of the two procedures with relation to the duration of incision, postoperative pain, post-operative complications in both the procedures. Diathermy is the first choice of incision for open appendectomy procedures as there is less chance of postoperative wound complications.

Clinical control study of water colonoscopy and gas colonoscopy / 中国实用内科杂志

OBJECTIVE: To evaluate the satisfaction and performance of water colonoscopy and gas colonoscopy. METHODS: 240 continuous cases were randomly divided into two groups(gas colonoscopy group, water colonoscopy group). Record the general condition, success rate, period of performance and abdominal pain score. Investigate the degree of abdominal pain, distension and the will of receiving anesthetic colonoscopy next time in the follow-up. RESULTS: There were no significant difference between two groups in the general condition, success rate, depth of insertion, abdominal pain after examination or the will of receiving anesthetic colonoscopy next time(P>0.05). The period of insertion, period of withdrawal and period of performance in water colonoscopy group was longer than those in the gas colonoscopy group(P<0.001, P=0.013, P<0.001). The degree of abdominal distension at 1 hour after colonoscopy in water colonoscopy group was higher than those in the gas colonoscopy group(P<0.001), but no significant difference was found at6 hours after examination. CONCLUSION: Patients undergoing water colonoscopy have better outcomes with less abdominal pain and abdominal distension except for longer time of performance.

The effect of three desensitizing agents on dentin hypersensitivity: A randomized, split-mouth clinical trial

This randomized clinical trial tested the effect of three different desensitizing agents on reduction of pain due to hypersensitive cervical dentin lesions. Materials and Methods: Twenty-eight individuals with 84 teeth diagnosed with cervical dentin hypersensitivity (DH) in at least one tooth in any three of the four quadrants were selected. Patients exhibiting pain scores of two or more on the visual analog scale (VAS) were included in the study. Each quadrant in an individual was randomly assigned to one of the three treatment groups based on computer-generated random number. The desensitizing agents used were Profluorid Varnish (Voco: Cuxhaven Germany), Admira Protect (Voco: Cuxhaven Germany), and PRG-Barrier Coat (Shofu: japan). One operator recorded the baseline sensitivity scores after evaporative and tactile stimuli by visual analog score system. The second operator who was not aware of the baseline values applied the desensitizing agents and recorded the sensitivity scores. VAS scores for both the stimuli were noted immediately after application, 1 week, and after 1 month. The data were analyzed using repeated measure ANOVA and post hoc Tukey's multiple comparison tests (P < 0.05 was considered statistically significant). Results: There was a significant reduction in VAS scores from baseline in all the three groups at all the time intervals (P < 0.001). Admira Protect showed significant reduction of hypersensitivity scores at 1 month compared to other groups (P < 0.001). Conclusion: Admira Protect was proved to be better in reducing pain due to DH than PRG-Barrier Coat and Profluorid Varnish after 1 month of application.

Investigation on the significance of pressure pain thresholds before and after treatment in female with myofascial chronic pelvic pain / 中国医师进修杂志

Objective To explore the therapeutic effect and clinical significance of pelvic floor rehabilitation technique in female with myofascial chronic pelvic pain (MCPP) by detecting the pressure pain thresholds (PPTs). Methods One hundred healthy female (control group) and 324 female MCPP patients (observation group) from January 2009 to December 2016 were selected. Automatic body surface and vaginal pressure pain detector was applied to detect two groups′PPTs of the 34 spots. The difference of PPTs at each spot was analyzed in two groups. In addition, 51 patients with moderate and severe MCPP were selected to record the changes of PPTs and pain scores before and after the treatment of pelvic floor rehabilitation technique. Results The average PPTs of the abdomen, vulva, pelvic floor and vaginal front and back fornix, bilateral adnexa uteri and sacrouterine ligament in the observation group were significantly lower than those in the control group (P<0.01 or<0.05). The average PPTs of the abdomen, vulva, pelvic floor muscles and vaginal front and back fornix, bilateral adnexa uteri and sacrouterine ligament of 51 MCPP patients after treatment were significantly higher than those before treatment (P<0.01). After treatment, PPTs and pain scores of the pelvic floor muscles, bilateral adnexa uteri, bilateral sacrouterine ligament, bilateral sacral spine ligament and vaginal front and back fornix were negatively correlated (r =- 0.78 to- 0.19, P = 0.01 to 0.04); there was a negative correlation between the PPTs and pain scores of the left and right latissimus dorsi (r=-0.28, P=0.04;r=-0.32, P=0.02). The complete remission rate with the pelvic floor rehabilitation technique in 51 patients with MCPP was 9.8％(5/51), the significant remission rate was 90.2％(46/51), and the total remission rate was 100.0％ (51/51). Conclusions Compared with the normal healthy ones, female with MCPP has lower PPTs in the abdomen, perineum, vagina and pelvic floor. The effect of pelvic floor rehabilitation technique on MCPP is well, which can increase patients′PPTs to reduce pain scores. It is a worthwhile method to treat these diseases.

Therapeutic Observation of Bai Xiao Moxibustion plus Electroacupuncture for Lumbar Intervertebral Disc Herniation / 上海针灸杂志

Objective To observe the clinical efficacy of Bai Xiao moxibustion plus electroacupuncture in treating lumbar intervertebral disc herniation (LIDH). Method Ninety-six LIDH patients were randomized into a treatment group and a control group, 48 cases each. The treatment group was intervened by Bai Xiao moxibustion plus electroacupuncture, while the control group was intervened by electroacupuncture alone. Before and after the treatment, the lower back pain scores of Japanese Orthopedic Association (JOA) and Visual Analogue Scale (VAS) were evaluated, and the clinical efficacies of the two groups were compared. Result The JOA and VAS lower back pain scores were changed significantly after the treatment in both groups (P<0.05). After the treatment, the JOA and VAS lower back pain scores of the treatment group were significantly different from those of the control group (P<0.05). The pain release time was (2.95±0.59)d after the intervention in the treatment group versus (4.26±0.68)d in the control group, and the between-group difference was statistically significant (P<0.05). The total effective rate was 95.7％ in the treatment group versus 91.7％ in the control group, and the between-group difference was statistically significant (P<0.05). Conclusion Bai Xiao moxibustion plus electroacupuncture is an effective method in treating LIDH and it can reduce the lower back pain.

Comparison of surgical effect and postoperative patient experience between laparoendoscopic single-site and conventional laparoscopic varicocelectomy: A systematic review and meta-analysis / 亚洲男科学杂志(英文版)

The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy (LESSV) and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design (RCT and non-RCT). The odds ratio (OR) or standardized mean difference (SMD) and their 95% confidence intervals (95% CIs) were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work (overall: SMD = -1.454, 95% CI: -2.502-0.405, P = 0.007; non-RCT: SMD = -2.906, 95% CI: -3.796-2.017, P = 0.000; and RCT: SMD = -0.841, 95% CI: -1.393-0.289, P = 0.003) and less pain experience at 3 h or 6 h (SMD = -0.447, 95% CI: -0.754-0.139, P = 0.004), day 1 (SMD = -0.477, 95% CI: -0.905-0.05, P = 0.029), and day 2 (SMD = -0.612, 95% CI: -1.099-0.125, P = 0.014) postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect (improvement of semen quality and scrotal pain relief), and complications (hydrocele and recurrence) yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.