Pub Date : 2018-01-01DOI: 10.4172/2167-0846.1000318
Doaa Abd Eltwab M Tueki, I. Ibrahim, Alaa Ali M. Elzohry
Background and Objectives: The gold standard for acute postoperative pain management in major abdominal surgeries is thoracic epidural analgesia (TEA) and this was proved by a lot of studies, systematic reviews and metaanalyses. However, TEA is sometimes contraindicated and may cause serious risks. Rectus Sheath Block (RSB) is effective for the abdominal surgeries with midline abdominal incisions as local anesthetics will be injected within the posterior rectus sheath bilaterally leading to intense pain relief for the middle anterior wall extending from the xiphoid process to the symphysis pubis. The aim of the study was to assess intra and post-operative RSB versus intra and post-operative TEA, in patients undergoing elective major abdominal cancer surgery with midline incisions. Methods: This randomized, blinded, was registered at www.clinicaltrials.gov at no.: “NCT03460561” and was approved by local ethics committee of South Egypt Cancer Institute, Assiut University, Egypt. One hundred adult patients, (ASA grade II and III), scheduled for major elective abdominal cancer surgery with Medline incision, were randomly divided into two groups, (50 patients each); TEA group: patients in this group received TEA with standard GA and intra-operative analgesia was started before skin incision by injecting epidural bolus dose of 0.1 ml/kg of (0.125% levo-bupivacaine+fentanyl 2 μg/ml). Postoperative analgesia was provided through PCEA by injecting a bolus dose of 3 ml then continuous infusion of 0.1 ml/kg of mixture of (0.0625% levo-bupivacaine+fentanyl 2 μg/ml) for 48 hours postoperative. RSB group: patients in this group received standard GA plus ultrasound (U/S) guided rectus sheath block by a volume of 20 mL of (0.25% levo-bupivacaine+fentanyl 30 μg) in saline on either side. Before end of surgery and before closure of abdominal wall, bilateral surgically placed catheters in rectus sheath plane aiming to provide post-operative analgesia using the following; 20 mL of (0.125% levo-bupivicaine+Fentanyl 30 μg) every 12 hours in to each catheter for 48 hours. Perioperative hemodynamics (MAP and HR) were recorded. Postoperative pain was assessed over 48 hour post operatively using (VAS). Total fentanyl consumption, Peak expiratory flow rate (PEFR), postoperative and side effects of the drugs and duration of ICU and hospital stay were recorded. Results: We found a significant reduction in VAS pain scores (at rest and during cough) in both group at all postoperative period but fentanyl consumption was significantly lower in TEA group. Also we found a significant reduction in intra-operative hemodynamics (mean arterial pressure and heart rate) in TEA group in comparison to RSB group while there was minimal statistically significant reduction in postoperative MAP and heart rate. The incidence of other postoperative complications such as sedation, nausea and vomiting were comparable in both groups. Conclusion: Rectus sheath block was not inferior to thoracic
{"title":"Peri-operative Rectus Sheath Fentanyl-levobupivacaine Infusion vs. Thoracic Epidural Fentanyl Levobupvacaine Infusion in Patients Undergoing Major Abdominal Cancer Surgeries with Medline Incision","authors":"Doaa Abd Eltwab M Tueki, I. Ibrahim, Alaa Ali M. Elzohry","doi":"10.4172/2167-0846.1000318","DOIUrl":"https://doi.org/10.4172/2167-0846.1000318","url":null,"abstract":"Background and Objectives: The gold standard for acute postoperative pain management in major abdominal surgeries is thoracic epidural analgesia (TEA) and this was proved by a lot of studies, systematic reviews and metaanalyses. However, TEA is sometimes contraindicated and may cause serious risks. Rectus Sheath Block (RSB) is effective for the abdominal surgeries with midline abdominal incisions as local anesthetics will be injected within the posterior rectus sheath bilaterally leading to intense pain relief for the middle anterior wall extending from the xiphoid process to the symphysis pubis. The aim of the study was to assess intra and post-operative RSB versus intra and post-operative TEA, in patients undergoing elective major abdominal cancer surgery with midline incisions. Methods: This randomized, blinded, was registered at www.clinicaltrials.gov at no.: “NCT03460561” and was approved by local ethics committee of South Egypt Cancer Institute, Assiut University, Egypt. One hundred adult patients, (ASA grade II and III), scheduled for major elective abdominal cancer surgery with Medline incision, were randomly divided into two groups, (50 patients each); TEA group: patients in this group received TEA with standard GA and intra-operative analgesia was started before skin incision by injecting epidural bolus dose of 0.1 ml/kg of (0.125% levo-bupivacaine+fentanyl 2 μg/ml). Postoperative analgesia was provided through PCEA by injecting a bolus dose of 3 ml then continuous infusion of 0.1 ml/kg of mixture of (0.0625% levo-bupivacaine+fentanyl 2 μg/ml) for 48 hours postoperative. RSB group: patients in this group received standard GA plus ultrasound (U/S) guided rectus sheath block by a volume of 20 mL of (0.25% levo-bupivacaine+fentanyl 30 μg) in saline on either side. Before end of surgery and before closure of abdominal wall, bilateral surgically placed catheters in rectus sheath plane aiming to provide post-operative analgesia using the following; 20 mL of (0.125% levo-bupivicaine+Fentanyl 30 μg) every 12 hours in to each catheter for 48 hours. Perioperative hemodynamics (MAP and HR) were recorded. Postoperative pain was assessed over 48 hour post operatively using (VAS). Total fentanyl consumption, Peak expiratory flow rate (PEFR), postoperative and side effects of the drugs and duration of ICU and hospital stay were recorded. Results: We found a significant reduction in VAS pain scores (at rest and during cough) in both group at all postoperative period but fentanyl consumption was significantly lower in TEA group. Also we found a significant reduction in intra-operative hemodynamics (mean arterial pressure and heart rate) in TEA group in comparison to RSB group while there was minimal statistically significant reduction in postoperative MAP and heart rate. The incidence of other postoperative complications such as sedation, nausea and vomiting were comparable in both groups. Conclusion: Rectus sheath block was not inferior to thoracic ","PeriodicalId":16641,"journal":{"name":"Journal of Pain and Relief","volume":"21 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85502708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2167-0846.1000331
Naoki Aoyama, N. Kubota, O. Fujii
Introduction: Trigeminal neuralgia is sudden-onset, sharp, stabbing, and recurrent pain that is provoked by trigger factors within the distributed branch area of the trigeminal nerve. Although surgical intervention, which primarily comprises micro vascular decompression (MVD), and medication are mainstream treatment options to relieve pain, the indication and efficacy of these approaches depend on each case. Recently, tenderness in the greater occipital nerve area in patients with craniofacial pain has been reported, indicating a vital role of nociceptive afferents with the involvement of trigeminal branches through the trigeminocervical complex (TCC). Here, we present two improved cases of trigeminal neuralgia with parietal acupoint therapy (PAPT) by treating the muscle stiffness of the posterior cervical region. Case Reports: In Case 1, a 64-year-old female who presented with right typical trigeminal neuralgia symptom with posterior cervical muscle stiffness and occipital numbness on the same side. Remarkably, her pain was triggered by head flexion. The unusually dilated greater occipital artery was suspected to be associated with the greater occipital nerve (GON) stimulation, resulting in the exacerbation of pain during head flexion. The pain was effectively controlled with parietal acupoint therapy and occipital nerve block (ONB). In Case 2, a 63-year-old female presented with trigeminal neuralgia after dental treatment with the posterior cervical muscle stiffness. Three cycles of PAPT performed once a week completely relieved her muscle stiffness and trigeminal pain without medication. Conclusions: The nociceptive stimuli from the posterior cervical region are vital contributory factors to initiate trigeminal neuralgia. This report reveals that relieving the posterior cervical muscle stiffness by parietal acupoint therapy for the treatment of trigeminal neuralgia is effective. Hence, this noninvasive treatment for trigeminal neuralgia should be considered before prescribing medication or performing surgical interventions.
{"title":"Treatment of Trigeminal Neuralgia by Relieving the Posterior Cervical Muscle Stiffness with Parietal Acupoint Therapy: Case Reports","authors":"Naoki Aoyama, N. Kubota, O. Fujii","doi":"10.4172/2167-0846.1000331","DOIUrl":"https://doi.org/10.4172/2167-0846.1000331","url":null,"abstract":"Introduction: Trigeminal neuralgia is sudden-onset, sharp, stabbing, and recurrent pain that is provoked by trigger factors within the distributed branch area of the trigeminal nerve. Although surgical intervention, which primarily comprises micro vascular decompression (MVD), and medication are mainstream treatment options to relieve pain, the indication and efficacy of these approaches depend on each case. Recently, tenderness in the greater occipital nerve area in patients with craniofacial pain has been reported, indicating a vital role of nociceptive afferents with the involvement of trigeminal branches through the trigeminocervical complex (TCC). Here, we present two improved cases of trigeminal neuralgia with parietal acupoint therapy (PAPT) by treating the muscle stiffness of the posterior cervical region. Case Reports: In Case 1, a 64-year-old female who presented with right typical trigeminal neuralgia symptom with posterior cervical muscle stiffness and occipital numbness on the same side. Remarkably, her pain was triggered by head flexion. The unusually dilated greater occipital artery was suspected to be associated with the greater occipital nerve (GON) stimulation, resulting in the exacerbation of pain during head flexion. The pain was effectively controlled with parietal acupoint therapy and occipital nerve block (ONB). In Case 2, a 63-year-old female presented with trigeminal neuralgia after dental treatment with the posterior cervical muscle stiffness. Three cycles of PAPT performed once a week completely relieved her muscle stiffness and trigeminal pain without medication. Conclusions: The nociceptive stimuli from the posterior cervical region are vital contributory factors to initiate trigeminal neuralgia. This report reveals that relieving the posterior cervical muscle stiffness by parietal acupoint therapy for the treatment of trigeminal neuralgia is effective. Hence, this noninvasive treatment for trigeminal neuralgia should be considered before prescribing medication or performing surgical interventions.","PeriodicalId":16641,"journal":{"name":"Journal of Pain and Relief","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84254272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2167-0846.1000326
M. Mf, Othman Ah, Darwish Amm, Elzohry Aam
Background: Breast surgeries are among the common forms of surgeries that conducted daily in hospitals. Multimodal analgesia, which combines analgesics with variable pharmacodynamics to target multiple underlying mechanisms of pain, is evolving as an acceptable approach to pain treatment for acute pain. So Transdermal fentanyl patch (TDF) can ameliorate severe pain in breast surgery. Objective: To examine the efficacy and safety of adding Transdermal fentanyl patch (TDF) to multimodal analgesia in controlling acute postoperative pain after breast surgery if applied 12 hours prior surgery. Methods: This randomized, blinded, study was conducted after approval of local ethics committee of South Egypt Cancer Institute, Assiut University, Assiut–Egypt, and registered at www.clinicaltrials.gov at no.: “NCT03051503”. After obtaining written informed consent, Sixty four adult female patients (ASA II) were scheduled for elective breast cancer surgeries in the form of modified radical mastectomy. Patients were classified randomly into two groups (32 patients each) to receive beside standard GA, Transdermal fentanyl patch (TDF) 50 μg/hr applied 12 hours prior surgery in one group (TDF group), while the second group (control group) received standard GA alone. Both group treated by morphine PCA for postoperative pain. Visual analogue scale (VAS), side effects, and serum levels of cortisol and prolactin were assessed over 24 h. postoperatively. The intra and post-operative heart rate (HR) and mean arterial pressure (MAP), Ramsay sedation score and total morphine consumption via PCA postoperatively were also recorded. Results: MAP and heart rate during intra and early post-operative periods were significantly reduced in TDF group in comparison to control group (P ≤ 0.005) but not over the remaining post-operative period (P>0.01). And, there was significant decrease in both VAS scores (p<0.05) and hence the total amount of morphine consumed postoperatively (7.43 ± 4.39) in TDF group in comparison to control group (13.47 ± 4.73) without significant change in side effects, except sedation scores, which were statistically increased but clinically not effective, in early post-operative hours. Finally, levels of prolactin and cortisol hormones were significantly decreased in TDF group indicating less stress and better pain control. Conclusion: Applying Transdermal fentanyl patch (TDF) 50 μg/hr 12 hours prior surgery as a part of multimodal analgesia to control acute postoperative pain after modified radical mastectomy was associated with less stress response, better pain control and decreased total amount of postoperative morphine consumption.
{"title":"Reducing Postoperative Opioid Consumption by Adding Transdermal Fentanyl Patches to Multimodal Analgesia after Breast Cancer Surgery","authors":"M. Mf, Othman Ah, Darwish Amm, Elzohry Aam","doi":"10.4172/2167-0846.1000326","DOIUrl":"https://doi.org/10.4172/2167-0846.1000326","url":null,"abstract":"Background: Breast surgeries are among the common forms of surgeries that conducted daily in hospitals. Multimodal analgesia, which combines analgesics with variable pharmacodynamics to target multiple underlying mechanisms of pain, is evolving as an acceptable approach to pain treatment for acute pain. So Transdermal fentanyl patch (TDF) can ameliorate severe pain in breast surgery. Objective: To examine the efficacy and safety of adding Transdermal fentanyl patch (TDF) to multimodal analgesia in controlling acute postoperative pain after breast surgery if applied 12 hours prior surgery. Methods: This randomized, blinded, study was conducted after approval of local ethics committee of South Egypt Cancer Institute, Assiut University, Assiut–Egypt, and registered at www.clinicaltrials.gov at no.: “NCT03051503”. After obtaining written informed consent, Sixty four adult female patients (ASA II) were scheduled for elective breast cancer surgeries in the form of modified radical mastectomy. Patients were classified randomly into two groups (32 patients each) to receive beside standard GA, Transdermal fentanyl patch (TDF) 50 μg/hr applied 12 hours prior surgery in one group (TDF group), while the second group (control group) received standard GA alone. Both group treated by morphine PCA for postoperative pain. Visual analogue scale (VAS), side effects, and serum levels of cortisol and prolactin were assessed over 24 h. postoperatively. The intra and post-operative heart rate (HR) and mean arterial pressure (MAP), Ramsay sedation score and total morphine consumption via PCA postoperatively were also recorded. Results: MAP and heart rate during intra and early post-operative periods were significantly reduced in TDF group in comparison to control group (P ≤ 0.005) but not over the remaining post-operative period (P>0.01). And, there was significant decrease in both VAS scores (p<0.05) and hence the total amount of morphine consumed postoperatively (7.43 ± 4.39) in TDF group in comparison to control group (13.47 ± 4.73) without significant change in side effects, except sedation scores, which were statistically increased but clinically not effective, in early post-operative hours. Finally, levels of prolactin and cortisol hormones were significantly decreased in TDF group indicating less stress and better pain control. Conclusion: Applying Transdermal fentanyl patch (TDF) 50 μg/hr 12 hours prior surgery as a part of multimodal analgesia to control acute postoperative pain after modified radical mastectomy was associated with less stress response, better pain control and decreased total amount of postoperative morphine consumption.","PeriodicalId":16641,"journal":{"name":"Journal of Pain and Relief","volume":"11 suppl_1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83254182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-13DOI: 10.4172/2167-0846.1000307
S. Bayar, Pratima Mahaseth, Q. Feng
Aim: To investigate the value of 3.0 T MRI in the diagnosis of solid pancreatic tumor. Materials and Methods: Aggregate of 36 patients were enlisted with suspected or proven as solid pancreatic tumors were collected from the first affiliated Hospital of Anhui Medical University Teaching Hospital during the period of January 2012 to August 2015, contained 20 cases of pancreatic adenocarcinoma, 7 cases of pancreatic neuroendocrine tumors (PNETs), 5 cases of pancreatic metastases, 4 cases of solid pseudopapillary tumors (SPTP). All the patients performed with plain scan and multiphasic contrast enhanced imaging on 3.0 T MR, 23 cases performed with MRCP. The data of clinic and imaging were retrospectively analyzed. Results: Pancreatic adenocarcinoma was irregular in shape, lesion was hypo intense in 10 cases, slightly hypo intense in 9 cases and isointense in one case on T1WI. 10 tumor showed slightly enhancement in arterial phase, and all of tumors showed moderate enhancement during portal and delayed phase; 19 cases showed double duct sign, and one case showed distal pancreatic duct dilation. Of the 7 cases with PNETs, the margin was well defined in six well differentiated lesions and ill-defined in one pancreatic neuroendocrine carcinoma; six tumors were marked enhancement in arterial phase and one tumor was moderate enhancement in pancreatic parenchyma in all of three phases. The mean diameter of SPTP was 5.2 cm. The solid part of tumors was hyperintense on T1WI and slightly hyper intense on T2WI, with progressively enhancement. 4 SPTPs had capsule which were hyperintense on T1WI and T2WI exhibited moderate enhancement. Of the 5 pancreatic metastases, one cases had only one lesion, two cases had multiple lesions and two cases showed diffuse pancreatic enlargement, one case showed heterogenous slightly enhancement, two case showed peripheral rim enhancement, two case showed marked enhancement in arterial, then wash-out in delayed and portal phases. Conclusion: MRI is valuable for diagnosis and distinguishing solid pancreatic tumors.
目的:探讨3.0 T MRI对胰腺实性肿瘤的诊断价值。材料与方法:收集2012年1月至2015年8月安徽医科大学附属第一医院疑似或证实为实体性胰腺肿瘤的患者36例，其中胰腺腺癌20例，胰腺神经内分泌肿瘤(PNETs) 7例，胰腺转移瘤5例，实体性假乳头状肿瘤(SPTP) 4例。所有患者均行3.0 T MR平扫及多相增强成像，其中23例行MRCP。回顾性分析临床及影像学资料。结果:胰腺腺癌形态不规则，T1WI呈低强度病变10例，轻度低强度病变9例，等强度病变1例。10例肿瘤动脉期轻度强化，门脉期和延迟期均中度强化;双管征19例，远端胰管扩张1例。在7例PNETs中，6例分化良好的病变边界清晰，1例胰腺神经内分泌癌边界不清;6个肿瘤在动脉期表现为明显强化，1个肿瘤在三个阶段均表现为胰腺实质中度强化。SPTP平均直径为5.2 cm。肿瘤实部T1WI呈高影，T2WI呈微高影，呈渐进式增强。4例sptp患者T1WI呈高信号，T2WI呈中度增强。5例胰腺转移灶中，1例单发灶，2例多发灶，2例胰腺弥漫性增大，1例表现为异质性轻度强化，2例表现为外周边缘强化，2例表现为动脉明显强化，后表现为延迟期和门脉期消失。结论:MRI对胰腺实体瘤的诊断和鉴别具有重要价值。
{"title":"The Value of MRI in Diagnosis of Solid Pancreatic Tumors","authors":"S. Bayar, Pratima Mahaseth, Q. Feng","doi":"10.4172/2167-0846.1000307","DOIUrl":"https://doi.org/10.4172/2167-0846.1000307","url":null,"abstract":"Aim: To investigate the value of 3.0 T MRI in the diagnosis of solid pancreatic tumor. \u0000Materials and Methods: Aggregate of 36 patients were enlisted with suspected or proven as solid pancreatic tumors were collected from the first affiliated Hospital of Anhui Medical University Teaching Hospital during the period of January 2012 to August 2015, contained 20 cases of pancreatic adenocarcinoma, 7 cases of pancreatic neuroendocrine tumors (PNETs), 5 cases of pancreatic metastases, 4 cases of solid pseudopapillary tumors (SPTP). All the patients performed with plain scan and multiphasic contrast enhanced imaging on 3.0 T MR, 23 cases performed with MRCP. The data of clinic and imaging were retrospectively analyzed. \u0000Results: Pancreatic adenocarcinoma was irregular in shape, lesion was hypo intense in 10 cases, slightly hypo intense in 9 cases and isointense in one case on T1WI. 10 tumor showed slightly enhancement in arterial phase, and all of tumors showed moderate enhancement during portal and delayed phase; 19 cases showed double duct sign, and one case showed distal pancreatic duct dilation. Of the 7 cases with PNETs, the margin was well defined in six well differentiated lesions and ill-defined in one pancreatic neuroendocrine carcinoma; six tumors were marked enhancement in arterial phase and one tumor was moderate enhancement in pancreatic parenchyma in all of three phases. The mean diameter of SPTP was 5.2 cm. The solid part of tumors was hyperintense on T1WI and slightly hyper intense on T2WI, with progressively enhancement. 4 SPTPs had capsule which were hyperintense on T1WI and T2WI exhibited moderate enhancement. Of the 5 pancreatic metastases, one cases had only one lesion, two cases had multiple lesions and two cases showed diffuse pancreatic enlargement, one case showed heterogenous slightly enhancement, two case showed peripheral rim enhancement, two case showed marked enhancement in arterial, then wash-out in delayed and portal phases. \u0000Conclusion: MRI is valuable for diagnosis and distinguishing solid pancreatic tumors.","PeriodicalId":16641,"journal":{"name":"Journal of Pain and Relief","volume":"85 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2017-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80325680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-30DOI: 10.4172/2167-0846.1000305
Aazam Soltaninejad, Esmat Nouhi, Hossein Safizade
Background: According to Wessel, infantile colic is defined as excessive crying which lasts more than three hours a day for more than three days a week for at least three weeks in an otherwise healthy baby. Prevalence of infantile colic has been reported to vary within the 10-40% range in different studies depending on data collection, study design and definition of colic. Despite 50 years of research about infantile colic its etiology is unknown. Some causes are mother's stress under pregnancy, postpartum depression, social factors like mother's occupation and fulltime education and other factors such as lactose intolerance, cow's milk allergy, gut contraction and parentsinfant relationship. Aim: To compare the effective interventions of mothers in colicky and non-colicky infants Method: In this cross-sectional study, 400 infants under 3 months whom had been brought to a health center for vaccination and growth monitoring were enrolled. The criteria which were taken into consideration to recognize instances of colicky infants were: the age of the infant had to be less than 3 months, colic in infants had to be diagnosed by pediatrics and infants had to be healthy otherwise. Diarrhea, vomiting, constant abdominal distention and failure to thrive were excluded as non-colic problems. Cluster sampling and then convenience sampling methods were used to gather data. A researcher-made questionnaire was also used. Result: Among all of the neonates 49% were colic and 51% were non-colic. 52.5% were boys and 47.5% were girls. Formula fed infants were more colicky than breastfed infants (62.2% vs. 53%). Conclusion: Mothers in this study used three kinds of behavioral, nutritional and medicinal interventions (either herbal remedies or chemical drugs) to control colic. In the non-colic group, mothers used more behavioral and nutritional interventions while in the colic group both herbal and chemical drugs were used more.
{"title":"Effective Interventions of Mothers in Colicky and Non-colicky Infants","authors":"Aazam Soltaninejad, Esmat Nouhi, Hossein Safizade","doi":"10.4172/2167-0846.1000305","DOIUrl":"https://doi.org/10.4172/2167-0846.1000305","url":null,"abstract":"Background: According to Wessel, infantile colic is defined as excessive crying which lasts more than three hours a day for more than three days a week for at least three weeks in an otherwise healthy baby. Prevalence of infantile colic has been reported to vary within the 10-40% range in different studies depending on data collection, study design and definition of colic. Despite 50 years of research about infantile colic its etiology is unknown. Some causes are mother's stress under pregnancy, postpartum depression, social factors like mother's occupation and fulltime education and other factors such as lactose intolerance, cow's milk allergy, gut contraction and parentsinfant relationship. Aim: To compare the effective interventions of mothers in colicky and non-colicky infants Method: In this cross-sectional study, 400 infants under 3 months whom had been brought to a health center for vaccination and growth monitoring were enrolled. The criteria which were taken into consideration to recognize instances of colicky infants were: the age of the infant had to be less than 3 months, colic in infants had to be diagnosed by pediatrics and infants had to be healthy otherwise. Diarrhea, vomiting, constant abdominal distention and failure to thrive were excluded as non-colic problems. Cluster sampling and then convenience sampling methods were used to gather data. A researcher-made questionnaire was also used. Result: Among all of the neonates 49% were colic and 51% were non-colic. 52.5% were boys and 47.5% were girls. Formula fed infants were more colicky than breastfed infants (62.2% vs. 53%). Conclusion: Mothers in this study used three kinds of behavioral, nutritional and medicinal interventions (either herbal remedies or chemical drugs) to control colic. In the non-colic group, mothers used more behavioral and nutritional interventions while in the colic group both herbal and chemical drugs were used more.","PeriodicalId":16641,"journal":{"name":"Journal of Pain and Relief","volume":"205 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83572658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-27DOI: 10.4172/2167-0846.1000304
M. Marković, N. Živković, S. Ruetten, S. Ozdemir, D. Goethel
Introduction: Full-endoscopic operations of lumbar spine are truly minimally invasive surgical procedures and they have become the standard because of their intraoperative and postoperative advantages.Aim: To compare clinical outcomes of full-endoscopic interlaminar technique to conventional microdiscectomy performed during 3 year period.Materials and Methods: A series of 350 patients underwent full-endoscopic interlaminar lumbar discectomy, comparing 220 patients with microdiscectomy and spinal canal decompression, during a 3-year period, is analysed. Oswestry Disability Index (ODI), visual analogue scores (VAS) of back and leg pain were measured preoperatively and at 1, 6, 12, 24 months.Results: All outcome measures improved significantly in both groups (p<0.001). In the full-endoscopic group 88% of the patients no longer had leg pain, and 7% had only occasional pain, postoperatively. In the microdiscectomy (MI) group 78.1% had significant improvement, 13.6% had improvement with occasional pain, and 8% had no improvement. The recurrence rate was 8%. Resection of the herniated disc and sufficient decompression was technically possible in all cases. The overall complication rate (16.4%), and recurrence-reoperation rate (11.8%) was significantly higher in the MI group.Conclusion: The clinical results of the full-endoscopic technique are at least equal to those of the conventional microsurgical discectomy with advantages such as reduced traumatization, improved patient mobility, and lower complication and recurrence rate. With the possibility of selecting the most adequate approach, lumbar disc herniations inside and outside the spinal canal, can be sufficiently removed using the full-endoscopic technique, when taking the appropriate indication criteria into account.
{"title":"Full-Endoscopic Interlaminar Versus Microsurgical Operations in Lumbar Compressive Lesions Surgery: Prospective Randomized Trial of Overall 570 Patients","authors":"M. Marković, N. Živković, S. Ruetten, S. Ozdemir, D. Goethel","doi":"10.4172/2167-0846.1000304","DOIUrl":"https://doi.org/10.4172/2167-0846.1000304","url":null,"abstract":"Introduction: Full-endoscopic operations of lumbar spine are truly minimally invasive surgical procedures and they have become the standard because of their intraoperative and postoperative advantages.Aim: To compare clinical outcomes of full-endoscopic interlaminar technique to conventional microdiscectomy performed during 3 year period.Materials and Methods: A series of 350 patients underwent full-endoscopic interlaminar lumbar discectomy, comparing 220 patients with microdiscectomy and spinal canal decompression, during a 3-year period, is analysed. Oswestry Disability Index (ODI), visual analogue scores (VAS) of back and leg pain were measured preoperatively and at 1, 6, 12, 24 months.Results: All outcome measures improved significantly in both groups (p<0.001). In the full-endoscopic group 88% of the patients no longer had leg pain, and 7% had only occasional pain, postoperatively. In the microdiscectomy (MI) group 78.1% had significant improvement, 13.6% had improvement with occasional pain, and 8% had no improvement. The recurrence rate was 8%. Resection of the herniated disc and sufficient decompression was technically possible in all cases. The overall complication rate (16.4%), and recurrence-reoperation rate (11.8%) was significantly higher in the MI group.Conclusion: The clinical results of the full-endoscopic technique are at least equal to those of the conventional microsurgical discectomy with advantages such as reduced traumatization, improved patient mobility, and lower complication and recurrence rate. With the possibility of selecting the most adequate approach, lumbar disc herniations inside and outside the spinal canal, can be sufficiently removed using the full-endoscopic technique, when taking the appropriate indication criteria into account.","PeriodicalId":16641,"journal":{"name":"Journal of Pain and Relief","volume":"8 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2017-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85080089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-17DOI: 10.4172/2167-0846.1000303
Shashi Vadhanan
Introduction: Using advanced imaging, neurophysiologic and precision diagnostic techniques spinal pain can be diagnosed in only 50 to 80% of the patients. 20 to 50% remain incorrectly diagnosed. Furthermore axial and periaxial pattern of pain from ligaments, muscles, intervertebral discs and facet joints overlap significantly. Therefore patients continue to suffer because of diagnostic dilemma and also pose a therapeutic challenge. Rarely does low back pain involve only a single pain generator, therefore it is unlikely that a single treatment, such as surgery will result in the best outcome for the majority of the causes of low back pain.Materials and method: All cases of Low back Pain reporting to tertiary care service hospital from 2012 to 2016 were evaluated. Cases which responded to conservative management were excluded.Observation: A total of 374 cases were offered pain intervention procedure. Of these 45 (12%) required a second interventional procedure as the pain relief was poor. All cases were followed up for 6 months and pain relief was recorded as Good, satisfactory or poor as told by the patient. We found that 78% reported good relief, 18% reported satisfactory relief while 4% reported poor relief from pain.Conclusion: Scientific evaluation of interventional pain treatments is difficult due to lack of any objective test for pain. Also we cannot have true controls. A single interventional procedure may not suffice in all cases. The Surgeon needs to adopt other modalities to provide pain relief to the ailing patient.
{"title":"Management of Low Back Pain - Call for an Integrated Interventional Approach","authors":"Shashi Vadhanan","doi":"10.4172/2167-0846.1000303","DOIUrl":"https://doi.org/10.4172/2167-0846.1000303","url":null,"abstract":"Introduction: Using advanced imaging, neurophysiologic and precision diagnostic techniques spinal pain can be diagnosed in only 50 to 80% of the patients. 20 to 50% remain incorrectly diagnosed. Furthermore axial and periaxial pattern of pain from ligaments, muscles, intervertebral discs and facet joints overlap significantly. Therefore patients continue to suffer because of diagnostic dilemma and also pose a therapeutic challenge. Rarely does low back pain involve only a single pain generator, therefore it is unlikely that a single treatment, such as surgery will result in the best outcome for the majority of the causes of low back pain.Materials and method: All cases of Low back Pain reporting to tertiary care service hospital from 2012 to 2016 were evaluated. Cases which responded to conservative management were excluded.Observation: A total of 374 cases were offered pain intervention procedure. Of these 45 (12%) required a second interventional procedure as the pain relief was poor. All cases were followed up for 6 months and pain relief was recorded as Good, satisfactory or poor as told by the patient. We found that 78% reported good relief, 18% reported satisfactory relief while 4% reported poor relief from pain.Conclusion: Scientific evaluation of interventional pain treatments is difficult due to lack of any objective test for pain. Also we cannot have true controls. A single interventional procedure may not suffice in all cases. The Surgeon needs to adopt other modalities to provide pain relief to the ailing patient.","PeriodicalId":16641,"journal":{"name":"Journal of Pain and Relief","volume":"22 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73538678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-30DOI: 10.4172/2167-0846-C1-013
H. Koning
{"title":"Tinnitus: A pain syndrome in search for good therapy","authors":"H. Koning","doi":"10.4172/2167-0846-C1-013","DOIUrl":"https://doi.org/10.4172/2167-0846-C1-013","url":null,"abstract":"","PeriodicalId":16641,"journal":{"name":"Journal of Pain and Relief","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79408430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-25DOI: 10.4172/2167-0846.1000302
D. Genç, N. Zibandeh, Y. Yildiz, S. Aslan, E. Karaoz, T. Akkoç, Faruk Demirtaş
Background: Neuropathic pain remains a persistent clinical problem and characterized by mechanical allodynia and heat hyperalgesia. Chronic pain conditions are among the major health problems which are difficult to treat. Bone marrow-derived mesenchymal stromal cells (BMSCs) have generated great interest as an option for cell-based therapy. BMSCs are easy to isolate and expand ex vivo. Clinical studies show that direct injection of BMSCs does not produce side effects as rejection and is well tolerated by the immune system. Methods: Neuropathic pain model in rats was developed with the ligation of the sciatic nerve. BMSCs were isolated from femur and tibia aspirates of rats and kept in culture media. rBMSCs were injected locally into injured sciatic nerve area of rats and efficiency of the therapy was observed with thermal sensitivity and motor functions for 4 weeks after injection of rBMSCs. Results: After injection into injured area rBMSCs were located in sciatic nerve tissue. In the present study, we showed that a single systemic local injection (into the lesion site) of rBMSCs reversed pain hypersensitivity in rats after injury and decreased the pain symptoms for 2 weeks and these effects got back in 4 weeks. Discussion: Our results revealed that single injection of rBMSCs showed relief of pain in short-term follow-up and further booster injection needed for long term prolonged therapeutic approach.
{"title":"Effects of Mesenchymal Stromal Cells on the Neuropathic Pain Induced by Chronic Constriction Injury in Rats","authors":"D. Genç, N. Zibandeh, Y. Yildiz, S. Aslan, E. Karaoz, T. Akkoç, Faruk Demirtaş","doi":"10.4172/2167-0846.1000302","DOIUrl":"https://doi.org/10.4172/2167-0846.1000302","url":null,"abstract":"Background: Neuropathic pain remains a persistent clinical problem and characterized by mechanical allodynia and heat hyperalgesia. Chronic pain conditions are among the major health problems which are difficult to treat. Bone marrow-derived mesenchymal stromal cells (BMSCs) have generated great interest as an option for cell-based therapy. BMSCs are easy to isolate and expand ex vivo. Clinical studies show that direct injection of BMSCs does not produce side effects as rejection and is well tolerated by the immune system. \u0000Methods: Neuropathic pain model in rats was developed with the ligation of the sciatic nerve. BMSCs were isolated from femur and tibia aspirates of rats and kept in culture media. rBMSCs were injected locally into injured sciatic nerve area of rats and efficiency of the therapy was observed with thermal sensitivity and motor functions for 4 weeks after injection of rBMSCs. \u0000Results: After injection into injured area rBMSCs were located in sciatic nerve tissue. In the present study, we showed that a single systemic local injection (into the lesion site) of rBMSCs reversed pain hypersensitivity in rats after injury and decreased the pain symptoms for 2 weeks and these effects got back in 4 weeks. \u0000Discussion: Our results revealed that single injection of rBMSCs showed relief of pain in short-term follow-up and further booster injection needed for long term prolonged therapeutic approach.","PeriodicalId":16641,"journal":{"name":"Journal of Pain and Relief","volume":"123 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77229208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-22DOI: 10.4172/2167-0846.1000301
Eman M S Nada, Abdulmajeed Al-Abdulkareem
Background: Liver resection surgery results in significant postoperative pain. However, it is still not clear which opioids used by Patient Controlled Analgesia (PCA) provides the best pain control and results in the least side effect in a patient with impaired liver function. Our hypothesis was that fentanyl is a better choice than morphine as it is a potent analgesic that its elimination half-life does not depend on the hepatic uptake and metabolism. The Study Purpose: Is to compare Morphine and Fentanyl PCA in liver resection patients as regards the degree of pain control, the consumption of Opioids and the side effects. Methods: A retrospective case control study of hepatic resection patients who received postoperative morphine (Morph) or Fentanyl (Fent) (PCA). The study compared the pain scores, morphine equivalent dose (MED), the number of demands requested as recorded by the PCA infusion pump and the side effects every 12 hours for 48 hours. Results: The study yielded 40 patients; with the majority were living donor hepatic resection patients. There was no significant difference in the pain scores. However, the MED and the demands were significantly less in the Morph group. p value<0.000, 0.0001, 0.0005, 0,003, demands p<0.002, 0.006, 0.014, 0.013 at 12, 24, 48, 36 hours respectively. The overall side effects were not different between the 2 groups at all-time intervals measured, however Morph patients were significantly more sedated in the first 12 hours.
{"title":"Morphine vs. Fentanyl Patient Controlled Analgesia for Postoperative Pain Control in Major Hepatic Resection Surgeries Including Living Liver Donors","authors":"Eman M S Nada, Abdulmajeed Al-Abdulkareem","doi":"10.4172/2167-0846.1000301","DOIUrl":"https://doi.org/10.4172/2167-0846.1000301","url":null,"abstract":"Background: Liver resection surgery results in significant postoperative pain. However, it is still not clear which \u0000 opioids used by Patient Controlled Analgesia (PCA) provides the best pain control and results in the least side effect \u0000 in a patient with impaired liver function. Our hypothesis was that fentanyl is a better choice than morphine as it is a \u0000 potent analgesic that its elimination half-life does not depend on the hepatic uptake and metabolism. \u0000The Study Purpose: Is to compare Morphine and Fentanyl PCA in liver resection patients as regards the degree \u0000 of pain control, the consumption of Opioids and the side effects. \u0000Methods: A retrospective case control study of hepatic resection patients who received postoperative morphine \u0000 (Morph) or Fentanyl (Fent) (PCA). The study compared the pain scores, morphine equivalent dose (MED), the \u0000 number of demands requested as recorded by the PCA infusion pump and the side effects every 12 hours for 48 \u0000 hours. \u0000Results: The study yielded 40 patients; with the majority were living donor hepatic resection patients. There was \u0000 no significant difference in the pain scores. However, the MED and the demands were significantly less in the Morph \u0000 group. p value<0.000, 0.0001, 0.0005, 0,003, demands p<0.002, 0.006, 0.014, 0.013 at 12, 24, 48, 36 hours \u0000 respectively. The overall side effects were not different between the 2 groups at all-time intervals measured, \u0000 however Morph patients were significantly more sedated in the first 12 hours.","PeriodicalId":16641,"journal":{"name":"Journal of Pain and Relief","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82300259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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