Ultrasound and electrical stimulator-guided obturator nerve block with phenol in the treatment of hip adductor spasticity in long-term care patients: a randomized, triple blind, placebo controlled study.

OBJECTIVE: To evaluate the effectiveness of ultrasound-guided phenol nerve block in the treatment of severe hip adductor spasticity in long-term care patients. METHODS: Double-blind placebo-controlled trial with a 9-month follow-up period. SETTING: A 250-bed long-term care hospital and the infirmary units of 5 regional hospitals. PARTICIPANTS: Twenty-six long-term care patients with bilateral severe chronic hip adductor spasticity affecting perineal hygiene and nursing care. INTERVENTIONS: Patients were randomized to 2 groups that received ultrasound and electrical stimulator guided obturator nerve block using either 5% phenol in aqueous solution or saline. MAIN OUTCOME MEASURES: The primary outcome measure was the Modified Ashworth Scale, which reflected the severity of hip adductor spasticity. Secondary outcomes included Goal Attainment Scale (GAS), hygiene score, distances between the knees during fast and slow passive hip abductions; passive range of movement for hip extension and knee extension. Pain was assessed using the Pain Assessment in Advanced Dementia Scale. RESULTS: Twenty-six patients (7 males; mean age = 77, standard deviation = 14) were recruited. At week 6 post-injection, 12/16 (75%) patients in the treatment group vs 1/10 (10%) patients in the control group had at least 1-point reduction of Modified Ashworth Scale (P = .001) on both hip adductors. There was also significant improvement in the GAS, as well as the hygiene score, resting position, and distances between the knees during fast and slow passive hip abductions in the treatment group, which persisted until week 36. No significant difference in the Pain Assessment in Advanced Dementia Scale was found between the 2 groups. No serious phenol nerve block related adverse effects were reported. CONCLUSIONS: Obturator neurolysis with 5% aqueous phenol as guided by both ultrasound and electrical stimulation can safely and effectively reduce hip adductor spasticity, thus, improving hygiene scores and patient-centered outcomes measured by the GAS in affected long-term care residents.

Towards painless colonoscopy: a randomized controlled trial on carbon dioxide-insufflating colonoscopy.

BACKGROUND: Carbon dioxide (CO2) insufflation during colonoscopy was reported to reduce pain, but data are limited. The objective of this randomized controlled trial was to assess the effect of CO2 insufflation on pain during and after colonoscopy. METHODS: Patients were randomized into CO2 insufflation (CO2i) or air insufflation (AIRi) groups. Pain during and after the examination were recorded using a visual analogue scale. Other outcomes included the caecal intubation rate, time to reach the caecum and complication. With questionnaire, patients' satisfaction and acceptance of the procedure were assessed. RESULTS: Over a 4-month period, 96 patients were recruited. The caecal intubation rate was 96 and 98% in the CO2i group and the AIRi group, respectively. No complication occurred in the CO2i group whereas one patient from the AIRi group developed late haemorrhage after polypectomy. Patients in the CO2i group had a lower pain score during (P < 0.01) and 30 min after (P = 0.02) the examination. Significantly more patients in the CO2i group reported the examination as painless (visual analogue scale 0) during the procedure (45 vs 14%, P < 0.01) and 30 min after (70 vs 51%, P = 0.04). In both groups, high satisfaction scores were recorded. Most patients (93% for the CO2i group and 98% for the AIRi group) would accept another colonoscopy if indicated. CONCLUSION: Insufflation with CO2 during colonoscopy results in less pain during and after the examination. Because of better tolerance, colonoscopy with CO2 insufflation might gain wide acceptance in the community to be used as a screening tool.

Hot summers and heart failure: seasonal variations in morbidity and mortality in Australian heart failure patients (1994-2005).

BACKGROUND: There are minimal reports of seasonal variations in chronic heart failure (CHF)-related morbidity and mortality beyond the northern hemisphere. AIMS AND METHODS: We examined potential seasonal variations with respect to morbidity and all-cause mortality over more than a decade in a cohort of 2961 patients with CHF from a tertiary referral hospital in South Australia subject to mild winters and hot summers. RESULTS: Seasonal variation across all event-types was observed. CHF-related morbidity peaked in winter (July) and was lowest in summer (February): 70 (95% CI: 65 to 76) vs. 33 (95% CI: 30 to 37) admissions/1000 at risk (p<0.005). All-cause admissions (113 (95% CI: 107 to 120) vs. 73 (95% CI 68 to 79) admissions/1000 at risk, p<0.001) and concurrent respiratory disease (21% vs. 12%, p<0.001) were consistently higher in winter. 2010 patients died, mortality was highest in August relative to February: 23 (95% CI: 20 to 27) vs. 12 (95% CI: 10 to 15) deaths per 1000 at risk, p<0.001. Those aged 75 years or older were most at risk of seasonal variations in morbidity and mortality. CONCLUSION: Seasonal variations in CHF-related morbidity and mortality occur in the hot climate of South Australia, suggesting that relative (rather than absolute) changes in temperature drive this global phenomenon.