Eighth Cervical Nerve Root Block During Interscalene Brachial Plexus Block Decreases Pain Caused by Posterior Portal Placement but Increases Horner Syndrome in Patients Undergoing Arthroscopic Shoulder Surgery: A Randomized Controlled Trial.

PURPOSE: To compare the intensity of pain on posterior portal placement between a C5-C7 root block (conventional interscalene brachial plexus block [ISBPB]) and a C5-C8 root block in patients undergoing arthroscopic shoulder surgery. METHODS: In this prospective, single-blinded, parallel-group randomized controlled trial, patients were randomized to receive either a C5-C7 root block (C5-C7 group, n = 37) or a C5-C8 root block (C5-C8 group, n = 36) with 25 mL of 0.75% ropivacaine. The primary outcome was the pain intensity on posterior portal placement, which was graded as 0 (no pain), 1 (mild pain), or 2 (severe pain). The secondary outcomes were the bilateral pupil diameters measured 30 minutes after ISBPB placement; the incidence of Horner syndrome, defined as a difference in pupil diameter (ipsilateral - contralateral) of less than -0.5 mm; the onset of postoperative pain; and the postoperative numerical rating pain score, where 0 and 10 represent no pain and the worst pain imaginable, respectively. RESULTS: Fewer patients reported mild or severe pain on posterior portal placement in the C5-C8 group than in the C5-C7 group (9 of 36 [25.0%] vs 24 of 37 [64.9%], P = .003). Less pain on posterior portal placement was reported in the C5-C8 group than in the C5-C7 group (median [interquartile range], 0 [0-0.75] vs 1 [0-1]; median difference [95% confidence interval], 1 [0-1]; P = .001). The incidence of Horner syndrome was higher in the C5-C8 group than in the C5-C7 group (33 of 36 [91.7%] vs 22 of 37 [59.5%], P = .001). No significant differences in postoperative numerical rating pain scores and onset of postoperative pain were found between the 2 groups. CONCLUSIONS: A C5-C8 root block during an ISBPB reduces the pain intensity on posterior portal placement. However, it increases the incidence of Horner syndrome with no improvement in postoperative pain compared with the conventional ISBPB (C5-C7 root block). LEVEL OF EVIDENCE: Level I, randomized controlled trial.

COVID-19 Vaccines #ForYou: Analyzing COVID-19 Vaccine Videos on TikTok During the Early Phase of the Vaccine Rollout in the U.S.

This study examined COVID-19 vaccine videos on TikTok (n = 216 collected in March 2021) during the early days of the vaccine rollout in the U.S., including video source, overall stance toward COVID-19 vaccines, Health Belief Model (HBM)-related content, message features (i.e. humor, video type, message sensation value, on-screen text, and unoriginal sound), and user engagement indices (number of views, shares, comments, and likes). Regarding source, health professionals and general users were two of the main sources, which varied depending on video stance. Pro-vaccine videos occurred the most often from health professionals whereas anti-vaccine videos occurred the most often from general users. Health professionals (vs. general users) generated more views, shares, comments, and likes. Regarding stance, we found more pro- than anti-vaccine videos (57.9% vs. 37.5%). Stance was not related with any user engagement index. Though many videos were pro-vaccine, the content corresponding to HBM-specified factors, which likely facilitate a positive behavioral change, was largely lacking, such as mentions of COVID-19 severity (5.6%), susceptibility (2.8%) and information boosting vaccination self-efficacy (3.7%). Mentions of side effects (34%) emerged as the major vaccination barrier. HBM-related mentions were not related with any user engagement index. COVID-19 vaccine videos used several features, which varied across stance. Pro-vaccine videos featured more musical performance, while anti-vaccine videos used more humor, playacting, sound effects, and unoriginal sound. Several message features (e.g. humor and on-screen text) were positively associated with users' engagement with a video. Practical and theoretical implications of the findings are discussed.

Neurofeedback Effect on Symptoms of Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis.

Posttraumatic stress disorder (PTSD) encompasses various psychological symptoms and a high early dropout rate due to treatment unresponsiveness. In recent years, neurofeedback has been implemented to control PTSD's psychological symptoms through physiological brain regulation. However, a comprehensive analysis concerning its efficacy is lacking. Therefore, we conducted a systematic review and meta-analysis to determine neurofeedback's effect on reducing PTSD symptoms. We analyzed randomized and non-randomized controlled trials (RCTs) from 1990 to July 2020, evaluating neurofeedback treatments for those diagnosed with PTSD and their symptoms. In addition, we calculated the standardized mean difference (SMD)using random-effects models to estimate effect sizes. We assessed ten articles comprising 276 participants, with a - 0.74 SMD (95% confidence interval = - 0.9230, - 0.5567), 42% I2, moderate effect size, and - 1.40 to -0.08 prediction intervals (PI). Neurofeedback was more effective for complex trauma PTSD patients than single trauma. Increasing and lengthening sessions are more effective than fewer, condensed ones. Neurofeedback positively affected arousal, anxiety, depression, and intrusive, numbing, and suicidal thoughts. Therefore, neurofeedback is a promising and effective treatment for complex PTSD.

Photobiomodulation-Based Synergic Effects of Pt-Coated TiO2 Nanotubes and 850 nm Near-Infrared Irradiation on the Osseointegration Enhancement: In Vitro and In Vivo Evaluation.

Photobiomodulation (PBM) therapy is known to have the potential to improve bone regeneration after implant surgery. However, the combinatory effect of the nanotextured implant and PBM therapy on osseointegration has not yet been proved. This study evaluated the photobiomodulation-based synergistic effects of Pt-coated titania nanotubes (Pt-TiO2 NT) and 850 nm near-infrared (NIR) light on osteogenic performance in vitro and in vivo. The FE-SEM and the diffuse UV-Vis-NIR spectrophotometer were used to perform the surface characterization. The live-dead, MTT, ALP, and AR assays were tested to perform in vitro tests. The removal torque testing, the 3D-micro CT, and the histological analysis were used to conduct in vivo tests. The live-dead and MTT assay resulted in Pt-TiO2 NTs being biocompatible. The ALP activity and AR assays demonstrated that the combination of Pt-TiO2 NT and NIR irradiation significantly enhanced osteogenic functionality (p < 0.05). The results of in vivo test, employing the removal torque testing, the 3D-micro CT, and histological analysis, showed overall improved outcomes; however, no significant difference was observed between the control and experimental groups (p > 0.05). Therefore, we confirmed the possibility of the combination of Pt-TiO2 NT and NIR light as a promising technology for implant surgery in dentistry.

Evaluation of the machinability and machining accuracy of polymer-based CAD/CAM blocks using merlon fracture test model.

The aims of this study were to estimate the machinability and machining accuracy of polymer-based CAM blocks using the merlon fracture test model specified in ISO 18675: 2022. Three hybrid disc blanks (MazicDuro, HC Disk, and Enamic) and three polymethyl methacrylate (PMMA) disc blanks (PMMA Disk, PMMA Block, and MazicTemp Hybrid) were tested in this study. The machinability was evaluated by assigning scores according to the fracture range of merlons with areas divided by ten vertical planes. The machining accuracy was evaluated by superimposing methods via CAD reference data and CAD specimen data. Within the limits of this study, a thickness of 0.3 mm is recommended for the clinical application of polymer-based CAD/CAM blocks in dental restorations that require superior machinability and accuracy. In addition, the machinability and machining accuracy tests of polymer-based CAM blocks are expected to provide guidelines for preparing accurate dental restorations.

Effect of Nonsurgical Spinal Decompression on Intensity of Pain and Herniated Disc Volume in Subacute Lumbar Herniated Disc.

Objective: Nonsurgical spinal decompression therapy (NSDT) is a conservative treatment for the lumbosacral herniated intervertebral disc (L-HIVD). This study aimed to evaluate the clinical effectiveness of the NSDT and change in disc volume through magnetic resonance imaging (MRI) in subacute L-HIVD. Methods: Sixty patients with subacute L-HIVD were randomized into either the decompression group (group D, n = 30) or the nondecompression group (group N, n = 30). In group D, NSDT was performed ten times in eight weeks. In group N, pseudodecompression therapy (no force) was performed with the same protocol. Lower back and lower leg pain intensities and functional improvements were measured by the visual analog scale and the Korean Oswestry Disability Index (K-ODI). The change in the lumbosacral disc herniation index (HI) was evaluated through a follow-up MRI three months after the therapy. Results: The lower leg pain intensity in group D was lower than that in group N at two months (p=0.028). Additionally, there were significantly lower K-ODI scores in group D at two and three months (p=0.023, 0.019) than in group N. The change in HI after the therapy was -27.6 ± 27.5 (%) in group D and -7.1 ± 24.9 (%) in group N, with a significant difference (p=0.017). Approximately 26.9% of patients in group D and no patients in group N showed over 50% reduction in HI (p=0.031). Conclusion: NSDT may be a suitable treatment option for conservative treatment of subacute L-HIVD.

A Comparative Study of Additive and Subtractive Manufacturing Techniques for a Zirconia Dental Product: An Analysis of the Manufacturing Accuracy and the Bond Strength of Porcelain to Zirconia.

This study was aimed at preparing zirconia samples via additive manufacturing (AM) and subtractive manufacturing (SM) and testing the following aspects: (1) the manufacturing accuracy of the zirconia samples and (2) the bond strength of porcelain to zirconia to evaluate the applicability of the zirconia fabricated by AM in dental clinics. We used three milling machines for SM (AR, K5, and UP) and a 3D printer for AM (AO). The manufacturing accuracy of the zirconia specimen in the internal and marginal areas was evaluated by superimposing techniques to calculate the root mean square (RMS) values. The bond strengths of porcelain to zirconia prepared via SM and AM were measured using a universal testing machine. The internal and marginal RMS values of the zirconia prepared by AM (AO) were within the range of those of the zirconia prepared by SM (AR, K5, and UP). Moreover, the bond strength value of the zirconia prepared by AM (35.12 ± 4.09 MPa) was significantly higher than that of the zirconia prepared by SM (30.26 ± 5.20 MPa). Therefore, AM technology has significant potential for applications in dentistry.

The Outcome of a New Teledentistry Initiative in Response to the COVID-19 Pandemic: A Cross-sectional Study.

AIM: The purpose of this study was to assess the overall satisfaction of a new learning experience and evaluate the outcome of LLUSD's educational teledentistry initiative through a survey based on Kirkpatrick's multidimensional model of training evaluation. MATERIALS AND METHODS: An IRB application was approved (#5210385) for a cross-sectional study that included Loma Linda University School of Dentistry (LLUSD) dental students of the class of 2022 and 2023. The 9-question survey consisted of three sections. The first section included demographic questions on gender and the graduating class. The second section was related to perceived teaching effectiveness, attitude, behavior, and significance. The third section included an open-ended question. The survey was distributed by three student investigators. Descriptive statistics were calculated, and categorical variables were compared using the Chi-squared test (χ2 test). RESULTS: The perceived teaching effectiveness of the newly implemented educational initiative was high for increasing the ability to communicate with patients and for screening and identifying the need for referrals. A majority of students believed that teledentistry is an important means to improve patients' access to dental care and that the School has been providing a good educational environment in providing teledentistry sessions to patients. There were no significant differences in the frequencies of positive and negative responses to all questions (N = 6) by gender and by class (p >0.05, in all instances). CONCLUSIONS: Teledentistry eVisits allowed the continuation of patient contact and initial assimilation of patient information. There is potential for this educational initiative to be more actively and comprehensively implemented in the future. CLINICAL SIGNIFICANCE: New educational initiatives allow the continuation of patient contact that will ensure that students will graduate as competent oral health care providers despite challenges imposed by the pandemic.

Impact of regional anesthesia on outcomes of geriatric patients undergoing lower extremity revascularization: A propensity score-matched cohort study.

Lower extremity revascularization (LER) for peripheral artery disease in elderly patients is associated with a high risk of perioperative morbidity and mortality. This study aimed to a conduct retrospective review and propensity score matching analysis to determine whether the use of regional anesthesia (RA) instead of general anesthesia (GA) in geriatric patients undergoing LER for peripheral artery disease results in improved short-term mortality and health outcomes. We reviewed medical records of 1271 patients aged >65 years who underwent LER at our center between May 1998 and February 2016. According to the anesthesia method, patients were grouped in the GA and RA groups. The primary outcome was short-term mortality (7-day and 30-day). The secondary outcomes were 5-year survival rate, intraoperative events, postoperative morbidity, and postoperative length of stay. A propensity score-matched cohort design was used to control for potentially confounding factors including patient demographics, comorbidities, American Society of Anesthesiologists physical status, and preoperative medications. After propensity score matching, 722 patients that received LER under GA (n = 269) or RA (n = 453) were identified. Patients from the GA group showed significantly higher 7-day mortality than those from the RA group (5.6% vs 2.7% P = .048); however, there was no significant difference in 30-day mortality between the groups (GA vs RA: 6.3% vs 3.6%, P = .083). The 5-year survival rate and incidence of arterial and central venous catheter placement or intraoperative dopamine and epinephrine use were significantly higher in the GA group than in the RA group (P < .05). In addition, the frequency of immediate postoperative oxygen therapy or mechanical ventilation support was higher in the GA group (P < .05). However, there was no difference in the postoperative cardiopulmonary and cerebral complications between the 2 groups. These results suggest that RA can reduce intraoperative hemodynamic support and provide immediate postoperative respiratory intensive care. In addition, the use of RA may be associated with better short-term and 5-year survival rates in geriatric patients undergoing LER.

Visible Light-Mediated Sustainable Antibacterial Activity and Osteogenic Functionality of Au and Pt Multi-Coated TiO2 Nanotubes.

The visible light reactions of noble metal-based photocatalysts have been increasingly utilized to investigate their antibacterial activities. Furthermore, the photoreactions at various visible light wavelengths for specific combinations of titania nanotubes and noble metal nanoparticles have been found to promote osteogenic functionality. In this investigation, a novel multi-coating combination of noble metals (gold and platinum) on titania nanotubes was assessed using plasmonic photocatalysis and low-level laser therapy at 470 and 600 nm. The results showed that this coating on the nanotubes promoted antibacterial activity and osteogenic functionality. The order in which the gold and platinum coatings were layered onto the titania nanotubes strongly affected the osteogenic performance of the human mesenchymal stem cells. These results have identified a new approach for the development of efficient novel combinations of noble metal nanoparticles and titania nanotubes with visible light responses, sustainable antimicrobial activity, and osteogenic functionality.

Effect of epidural polydeoxyribonucleotide in a rat model of lumbar foraminal stenosis.

BACKGROUND: We aimed to investigate the effect of epidural polydeoxyribonucleotide (PDRN) on mechanical allodynia and motor dysfunction in a rat model of lumbar foraminal stenosis (LFS). METHODS: This study was conducted in two stages, using male Sprague-Dawley rats. The rats were randomly divided into eight groups. In the first stage, the groups were as follows: vehicle (V), sham (S), and epidural PDRN at 5 (P5), 8 (P8), and 10 (P10) mg/kg; and in the second stage, they were as follows: intraperitoneal PDRN 8 mg/kg, epidural 3,7-dimethyl-1-propargilxanthine (DMPX) (0.1 mg/kg), and DMPX (0.1 mg/kg). The LFS model was established, except for the S group. After an epidural injection of the test solutions, von Frey and treadmill tests were conducted for 3 weeks. Subsequently, histopathologic examinations were conducted in the V, S, P5, and P10 groups. RESULTS: A total of 65 rats were included. The P8 and P10 groups showed significant recovery from mechanical allodynia and motor dysfunction at all time points after drug administration compared to the V group. These effects were abolished by concomitant administration of DMPX. On histopathological examination, no epineurial inflammation or fibrosis was observed in the epidural PDRN groups. CONCLUSIONS: Epidural injection of PDRN significantly improves mechanical allodynia and motor dysfunction in a rat model of LFS, which is mediated by the spinal adenosine A2A receptor. The present data support the need for further research to determine the role of epidural PDRN in spinal stenosis treatment.

The mediating effect of life satisfaction and the moderated mediating effect of social support on the relationship between depression and suicidal behavior among older adults.

OBJECTIVES: This study aimed to investigate the effect of depression on suicidal behavior among older adults and identify the mediating effect of life satisfaction on the relationship between depression and suicidal behavior. The moderated mediating effects of social support through life satisfaction were also verified in the relationship between depression and suicidal behavior among older adults. METHODS: A total of 1375 people aged 65 years or older living in J city, South Korea, were recruited to complete a survey on depression, life satisfaction, suicidal behavior, and social support. Data were analyzed using SPSS24.0 and SPSS PROCESS Macro. RESULTS: The results showed that the effect of depression on suicidal behavior was mediated by life satisfaction, and the effect of life satisfaction on suicidal behavior varied according to the level of social support. Moreover, depression negatively affected life satisfaction, increasing the risk of suicidal behavior, and social support decreased suicidal behavior. Finally, the mediating effect of depression leading to suicidal behavior through life satisfaction was moderated by social support. CONCLUSIONS: These findings suggest that it is necessary not only to find interventions for older adults to increase their physical, mental, and socioeconomical satisfaction with life, but also to build social networks that increase social support for them.

Transforaminal Epidural Steroid Injection for Zoster-Related Pain: The Golden Period for the Best Outcome.

BACKGROUND: Zoster-related pain (ZRP) has many negative effects on a patient's quality of life. The transforaminal steroid injection (TFESI), which reduces neural inflammation and pain, has been advocated by pain physicians. Many reports demonstrated that early administration of TFESI showed better efficacy; however, the golden period during which TFESI is most effective remains unclear. OBJECTIVES: This multicentre retrospective cohort study aimed to identify the golden period by which TFESI yields the best outcome in patients with ZRP. STUDY DESIGN: Multicenter, retrospective cohort study. SETTING: University-affiliated hospitals. METHODS: After performing the TFESI in patients with ZRP, the patients were classified into two groups: the effective group (E) and the not effective group (N) based on the changes in the pain intensity 3 months after the TFESI. The receiver operating characteristic (ROC) curve analysis was used to assess the cut-off time point for predicting TFESI effectiveness. Furthermore, a logistic regression analysis was performed to identify patients' factors associated with a successful treatment outcome. RESULT: Of the 302 patients, 186 and 116 patients were classified into the E and N group, respectively. ROC curve analysis showed that the best cut-off time point for TFESI was 12 weeks (95% confidence interval [CI]; 10-14 weeks) after the onset of HZ. The only variable associated with a favorable outcome was a symptom duration of ? 12 weeks compared with > 12 weeks (Odd ratio, 0.107; 95% CI, 0.055-0.205; P < 0.001). Other patient variables were not significantly associated with the effectiveness of TFESI. TFESI was most effective when administered within 12 weeks of the onset of herpes zoster. LIMITATION: This study was not a prospective randomized controlled trial (RCT) and the follow-up period was only 3 months after TFESI. CONCLUSION: TFESI is more effective when administered within 12 weeks of onset of herpes zoster.

Changes in the Bronchial Cuff Pressure of Left-Sided Double-Lumen Endotracheal Tube by Lateral Positioning: A Prospective Observational Study.

Proper bronchial cuff pressure (BCP) is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. As positional change during endotracheal tube placement could alter cuff pressure, we aim to evaluate the change in BCP of DLT from the supine to the lateral decubitus position during thoracic surgery. A total of 69 patients aged 18-70 years who underwent elective lung surgery were recruited. BCP was measured at a series of time points in the supine and lateral decubitus positions after confirming the DLT placement. The primary outcome was change in the initial established BCP (BCPi), which is the maximum pressure at which the BCP did not exceed 40 cmH2O without air leak in the supine position, after lateral decubitus positioning. As the primary outcome, the BCPi increased from 25.4 ± 9.0 cmH2O in the supine position to 29.1 ± 12.2 cmH2O in the lateral decubitus position (p < 0.001). Out of the 69 participants, 43 and 26 patients underwent surgery in the left-lateral decubitus position (LLD group) and the right-lateral decubitus position (RLD group) respectively. In the LLD group, the BCPi increased significantly (p < 0.001) after lateral positioning and the beginning of surgery and the difference value, ∆BCPi, from supine to lateral position was significantly higher in the LLD group than in the RLD group (p = 0.034). Positional change from supine to lateral decubitus could increase the BCPi of DLT and the increase was significantly greater in LLD that in RLD.

Nursing students' extracurricular activity experiences of suicide prevention volunteering: A qualitative study.

BACKGROUND: Extracurricular activities of college students have been perceived as a means of developing competencies related to professional success. OBJECTIVES: This study aimed to explore the extracurricular activity experience of nursing students who participated in suicide prevention volunteering. DESIGN: Qualitative research. SETTING: This study was conducted at an undergraduate university in Gyeongsan-do, Korea. PARTICIPANTS: Participants in the study were 36 nursing college students who participated in suicide prevention volunteer activities for more than 4 months. METHODS: Data were collected by focus group interviewers, which were analyzed using content analysis. RESULTS: The experiences of participants in the study were identified by four sub-themes 'Developing sensitivity to suicide issues', 'Improving confidence in suicide prevention', 'Getting interested in mental health nursing', and 'Learning basic skills of practical nursing' that derived the theme 'Prepared for a competent nurse in mental health nursing'. CONCLUSION: A variety of activities and programs for extra-curriculum will serve as a foundation for nursing students to improve their basic competencies and qualities to become more competent in their future careers.

Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study.

BACKGROUND: The rapid response system has been implemented in many hospitals worldwide and, reportedly, the timing of medical emergency team (MET) attendance in relation to the duration of hospitalization is associated with the mortality of MET patients. We evaluated the relationship between duration of hospitalization before MET activation and patient mortality. We compared cases of MET activation for early, intermediate, and late deterioration to patient characteristics, activation characteristics, and patient outcomes. We also aimed to determine the relationship, after adjusting for confounders, between the duration of hospitalization before MET activation and patient mortality. MATERIALS AND METHODS: We retrospectively evaluated patients who triggered MET activation in general wards from March 2009 to February 2015 at the Asan Medical Center in Seoul. Patients were categorized as those with early deterioration (less than 2 days after admission), intermediate deterioration (2-7 days after admission), and late deterioration (more than 7 days after admission) and compared them to patient characteristics, activation characteristics, and patient outcomes. RESULTS: Overall, 7114 patients were included. Of these, 1793 (25.2%) showed early deterioration, 2113 (29.7%) showed intermediate deterioration, and 3208 (45.1%) showed late deterioration. Etiologies of MET activation were similar among these groups. The clinical outcomes significantly differed among the groups (intensive care unit transfer: 34.1%, 35.6%, and 40.4%; p < 0.001 and mortality: 26.3%, 31.5%, and 41.2%; p < 0.001 for early, intermediate, and late deterioration, respectively). Compared with early deterioration and adjusted for confounders, the odds ratio of mortality for late deterioration was 1.68 (1.46-1.93). CONCLUSIONS: Nearly 50% of the acute clinically-deteriorating patients who activated the MET had been hospitalized for more than 7 days. Furthermore, they presented with higher rates of mortality and ICU transfer than patients admitted for less than 7 days before MET activation and had mortality as an independent risk factor.

Bushveld superplume drove Proterozoic magmatism and metallogenesis in Australia.

Large-scale mantle convective processes are commonly reflected in the emplacement of Large Igneous Provinces (LIPs). These are high-volume, short-duration magmatic events consisting mainly of extensive flood basalts and their associated plumbing systems. One of the most voluminous LIPs in the geological record is the ~ 2.06 billion-year-old Bushveld Igneous Complex of South Africa (BIC), one of the most mineralised magmatic complexes on Earth. Surprisingly, the known geographic envelope of magmatism related to the BIC is limited to a series of satellite intrusions in southern Africa and has not been traced further afield. This appears inconsistent with the inferred large size of the BIC event. Here, we present new radiometric ages for alkaline magmatism in the Archean Yilgarn Craton (Western Australia), which overlap the emplacement age of the BIC and indicate a much more extensive geographic footprint of the BIC magmatic event. To assess plume involvement at this distance, we present numerical simulations of mantle plume impingement at the base of the lithosphere, and constrain a relationship between the radial extent of volcanism versus time, excess temperature and plume size. These simulations suggest that the thermal influence of large plume events could extend for thousands of km within a few million years, and produce widespread alkaline magmatism, crustal extension potentially leading to continental break-up, and large ore deposits in distal sectors. Our results imply that superplumes may produce very extensive and diverse magmatic and metallogenic provinces, which may now be preserved in widely-dispersed continental blocks.

Topical agents: a thoughtful choice for multimodal analgesia.

For over a thousand years, various substances have been applied to the skin to treat pain. Some of these substances have active ingredients that we still use today. However, some have been discontinued due to their harmful effect, while others have been long forgotten. Recent concerns regarding the cardiovascular and renal risk from nonsteroidal anti-inflammatory drugs, and issues with opioids, have resulted in increasing demand and attention to non-systemic topical alternatives. There is increasing evidence of the efficacy and safety of topical agents in pain control. Topical analgesics are great alternatives for pain management and are an essential part of multimodal analgesia. This review aims to describe essential aspects of topical drugs that physicians should consider in their practice as part of multimodal analgesia. This review describes the mechanism of popular topical analgesics and also introduces the most recently released and experimental topical medications.