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Labour is an extremely painful process. Labour pain can have deleterious effects on the mother, on the foetus and on the labour outcome. Among the current methods of obstetric analgesia, regional analgesia (the most widespread technique being epidural analgesia) offers the best effectiveness/safety ratio. The increased availability of epidural analgesia and the favourable experiences of women who have had painless labour with epidural block have reshaped the expectations of pregnant women entering labour. Compared with other forms of pain relief, epidural analgesia is associated with the highest level of maternal satisfaction. Taking into consideration this aspect, a study was performed in a tertiary care center over a period of 18 months.METHODS160 patients fulfilling the inclusion criteria were divided into two groups namely Group A and Group B. Group A was administered epidural analgesia while Group B was offered other analgesic agents (inj. tramadol hydrochloride) after obtaining well informed consent. Pain compliance is marked over VAS at this point of time. Once the effect of epidural starts waning off, top up dosages are administered by anaesthesiologists. Increments or derangements in pain compliance are noted timely. Any maternal side effects such as headache, hypotension, motor paralysis etc. are noted. Duration of first and second stage of labour is noted with the help of partogram. In the end, mode of delivery, indication of instrumental delivery/caesarean section, neonatal outcome in terms of APGAR scores were noted.RESULTSProlongation of first and second stage of labour, increase in the rate of instrumental/caesarean delivery was not statistically significant between both the groups. (p>0.05). p Value calculated using unpaired t test (p= 0.5116). Maternal requests for caesarean section were significantly higher in control group compared to epidural group (p<0.05). This may be due to non/less efficacy of other analgesic drugs than epidural analgesics. The difference in VAS score between both the study groups was statistically significant (p<0.001) indicating that pain was significantly less in epidural group.CONCLUSIONSEpidural analgesia provides excellent labour analgesia compared to other agents with no significant prolongation of first and second stage of labour or mode of delivery. Study also shows that there is no significant rise in the number of instrumental or caesarean deliveries due to epidural analgesia. There are no serious maternal or foetal side effects of the epidural analgesia. Hence, it can be safely recommended in labour. The analgesic effect can be maintained as long as needed and even after delivery to relieve postoperative pain.
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BACKGROUND: Steroids have strong anti-inflammatory, anti-emetic and analgesic effects and are widely used in perioperative analgesia. Studies have shown that periarticular injection of steroid-containing cocktail analgesic therapy in knee arthroplasty can relieve postoperative pain, improve knee activity, and reduce complications. However, the other studies show that steroids can increase the risk of postoperative infection, and tendon rupture. Therefore, the safety and efficacy of steroid-containing cocktail periarticular injection in knee arthroplasty is still controversial. OBJECTIVE: To evaluate the safety and efficacy of steroid-containing cocktail periarticular injection after knee arthroplasty by meta-analysis. METHODS: The published literatures were searched on the databases of PubMed/Medline, Cochrane Central Register of Controlled Trials, and EMBASE until April 2019. All randomized controlled trials of topical steroid analgesia after knee arthroplasty were collected and eligible articles were screened. Two researchers independently assessed the risk of bias and methodological quality of included studies by the Cochrane 5.0. The outcome data were extracted and a meta-analysis was conducted by Review Manager 5.2 software. RESULTS AND CONCLUSION: (1) A total of 10 randomized controlled articles involving 820 patients were included. (2) The meta-analysis showed that visual analogue scale score was lower in the steroid group than in the control group at postoperative 1 day [MD=-1.52, 95%C/(-2.94, -0.10), P=0.04]. Motion range was higher in the steroid group than in the control group at postoperative 1, 2, 3,4 and 5 days [MD=11.57, 95%C/(9.85, 13.30), P < 0.000 01; MD=9.03, 95%C/(B.67, 11.38), P < 0.000 01; MD=5.73, 95%C/(0.85, 10.60), P=0.02; MD=5.53, 95%C/(0.68, 10.38), P=0.03); MD=5.90, 95%C/(0.87, 10.93), P=0.02j. Morphine use was less in the steroid group than in the control group [MD=-7.94, 95%C/(-14.35, -1.53), P=0.02j. Hospital stay was shorter in the steroid group than in the control group [AfD=-0.98, 95%C/(-1.25, -0.71), P < 0.000 01]. Straight leg raising took less time in the steroid group than in the control group [MD=0.65, 95%C/(-0.86, 0.44), P < 0.000 01]. Postoperative C-reactive protein level was lower in the steroid group than in the control group [WMD=-4.82, 95%C/(7.41, 2.23), P=0.000 3]. Knee society score and complication rate were not significantly different between the two groups. (3) To conclude, the periarticular injection of steroid-containing cocktails after knee arthroplasty is safe and effective.
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BACKGROUND: Percutaneous curved vertebroplasty is a modified surgical method of percutaneous vertebroplasty; the most prominent feature of which is that it can make the bone cement distributed symmetrically and balance the strength on both sides of the vertebral body. In theory, it can ensure the distribution of bone cement in the vertebral body, and solve the problem that the uneven distribution of bone cement in the traditional percutaneous vertebroplasty and single injection leads to poor pain relief effect in the fracture area. OBJECTIVE: To compare the clinical efficacy of percutaneous curved vertebroplasty and percutaneous vertebroplasty bone cement injection in the treatment of osteoporotic vertebral compression fractures, and to discuss the value of percutaneous curved vertebroplasty in clinical application. METHODS: Seventy patients with single vertebral osteoporotic vertebral compression fractures from the Third Affiliated Hospital of AnHui Medical University between 2017 and 2018 were selected. The patients were randomly divided into two groups. Percutaneous curved vertebroplasty group (n=35) received treatment with percutaneous curved vertebroplasty. Percutaneous vertebroplasty group (n=35) received treatment with percutaneous vertebroplasty. Distribution and leakage of bone cement were observed in the two groups. Visual analogue scale score and Oswestry disability index were assessed preoperatively and 1 day postoperatively. Postoperative follow-up was conducted for 1 year to observe the recovery of the height of the anterior edge of the injured vertebra and the occurrence of adjacent vertebral fractures. The trial was approved by the Ethics Committee of the Third Affiliated Hospital of Anhui Medical University. RESULTS AND CONCLUSION: (1) Compared with the percutaneous vertebroplasty group, the distribution of bone cement was more uniform and satisfactory (P0.05). (4) There was no significant difference in the incidence of adjacent vertebral fractures between the two groups (P>0.05). (5) The results showed that compared with the treatment of percutaneous vertebroplasty, the treatment of osteoporotic vertebral body compression fractures by percutaneous curved vertebroplasty can reduce the rate of bone cement leakage and improve the quality of life of patients.
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BACKGROUND: Medial parapatellar approach has become the standard technique for total knee arthroplasty. However, recent studies have reported superior results in functional recovery using midvastus approach. OBJECTIVE: To evaluate the early functional outcomes of medial parapatellar and midvastus approaches. METHODS: This was a prospective, randomized, double-blind, and controlled trial. Fifty patients receiving total knee arthroplasty were randomized into two groups: medial parapatellar approach and midvastus approach. The same type of implants was used in both groups. The Visual Analogue Scale scores were recorded. The range of motion, quadriceps strength and proprioception were assessed at 3 and 6 weeks after surgery. RESULTS AND CONCLUSION: (1) The Visual Analogue Scale scores at rest and in active in the midvastus approach group were significantly lower than those in the medial parapatellar approach group. (2) The average quadriceps strength in the midvastus approach group was significantly better than that in the medial parapatellar approach group. (3) The postoperative quadriceps proprioception in the midvastus approach group was better than that in the medial parapatellar approach group. The range of motion was similar in both groups. (4) Therefore, during early rehabilitation, the midvastus approach is superior to the medial parapatellar approach, and no adverse effects associated with this method are observed.
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BACKGROUND: Both thunder-fire moxibustion and electroacupuncture can effectively improve the related symptoms of knee osteoarthritis. At the same time, the two treatments have the advantages of simple operation, low cost, strong practicability and so on. OBJECTIVE: To observe the difference in curative effect between thunder-fire moxibustion combined with electro-acupuncture and celecoxib capsule in the treatment of cold-wet knee osteoarthritis. METHODS: Seventy-two patients with cold-wet knee osteoarthritis, including 35 males and 37 females, who were treated in Ruikang Hospital affiliated to Guangxi University of Chinese Medicine from June 2017 to December 2018, were randomly divided into two groups: observation group (n=35) received thunder-fire moxibustion (once a day) combined with electroacupuncture treatment (once a d); and control group (n=37) was given oral celecoxib capsule (once a day). Treatment in each group lasted for two sessions of 14 days each with a 2-day break. Visual analogue scale score, Western Ontario and McMaster Universities (WOMAC) score, and joint fluid related inflammatory index were detected before and after treatment. The effective rate of TCM syndrome was evaluated. A 1-month follow-up was carried out after treatment. The experimental protocol was approved by the Ethics Committee of Ruikang Hospital affiliated to Guangxi University of Chinese Medicine (KY2017-005). RESULTS AND CONCLUSION: There were no adverse reactions in the two groups. The visual analogue scale scores and WOMAC scores (pain, stiffness and function) in the observation group were significantly reduced after treatment and during the follow-up (P < 0.05). The visual analogue scale scores and WOMAC scores (pain and stiffness) in the control group were significantly reduced after treatment and at the end of the follow-up (P < 0.05). Compared with the control group, the visual analogue scale scores and WOMAC scores (pain, stiffness and function) were significantly lower in the observation group after treatment and during the follow-up (P < 0.05). The levels of interleukin-6 and tumor necrosis factor-α in the two groups were significantly lowered after treatment, and a more significant reduction was observed in the observation group (P < 0.05). The total effective rate of treatment in the observation group was higher than that in the control group (97.1% vs. 81.1%, P < 0.05). Therefore, electroacupuncture combined with thunder-fire moxibustion has favorable outcomes in the treatment of cold-wet knee osteoarthritis accompanied by less adverse reactions. Moreover, electroacupuncture combined with thunder-fire moxibustion is superior to celecoxib capsule in terms of curative effect persistence.
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BACKGROUND: Percutaneous kyphoplasty (PKP) has become an effective method for the treatment of osteoporotic vertebral compression fractures, but the distribution of bone cement in the vertebral body can cause certain differences in postoperative clinical symptoms. OBJECTIVE: To investigate the clinical effect of bone cement distribution on the treatment of vertebral compression fractures in different sites after percutaneous kyphoplasty. METHODS: A retrospective analysis of eligible 339 patients with vertebral compression fractures at different sites who received treatment at the Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University from January 2017 to January 2019 were included in this study. These patients were aged 60-85 years. They were divided into a thoracic fracture group (n=144) and a lumbar fracture group (n=195). All patients received bone cement injection after percutaneous kyphoplasty. After surgery, the diffusion distribution of bone cement in the vertebral body was divided into I-V types in each group. Visual Analogue Scale score and Oswestry Disability Index were evaluated before surgery, and 3 days and 6 months after surgery. This study was approved by the Medical Ethics Committee, Affiliated Zhongshan Hospital of Dalian University, China. RESULTS AND CONCLUSION: (1) At 3 days and 6 months after surgery, Visual Analogue Scale score and Oswestry Disability Index were significantly decreased compared with before surgery (P 0.05). (3) At 6 months after surgery, there was no significant difference in Oswestry Disability Index between different distribution types of bone cement in the thoracic fracture group (P > 0.05). At 6 months after surgery, Visual Analogue Scale score in patients with types I, II and III bone cement distribution was significantly lower than in those with types IV and V bone cement distribution (P 0.05). At 6 months after surgery, Visual Analogue Scale score in patients with types I, II and III bone cement distribution was significantly lower than in that in patients undergoing types IV and V bone cement distribution (P < 0.05). (5) These results suggest that after percutaneous kyphoplasty, bone cement distributed in types I-III can lead to better pain relief than that distributed in other types.
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OBJECTIVE@#To observe the effect of electroacupuncture (EA) on the rehabilitation of knee joint function after anterior cruciate ligament (ACL) reconstruction.@*METHODS@#A total of 140 patients with ACL reconstruction were randomly divided into an observation group (58 cases recruited, 12 cases dropped out) and a control group (65 cases recruited, 5 cases dropped out). The patients in the control group were treated with routine rehabilitation treatment. The patients in the observation group, on the basis of the treatment in the control group, were treated with EA at Fengshi (GB 31), Futu (ST 32), Zusanli (ST 36), Shangjuxu (ST 37), Fenglong (ST 40), Xuanzhong (GB 39), Diji (SP 8) and Sanyinjiao (SP 6) on the affected side (2 Hz/100 Hz of dilatational wave, 2-5 mA). Each EA treatment lasted 20-30 min, twice a day for 7 days. The swelling degree (d), pain visual analogue scale (VAS), knee joint range of motion (ROM), scores of International Knee Documentation Committee (IKDC) subjective short form and scores of Lysholm were observed in the two groups 1 day, 1 month, 3 months, 6 months and 1 year after operation.@*RESULTS@#One month and 3 months after operation, the swelling degree (d) and VAS scores in the observation group were lower than those in the control group (0.05). One month, 3 months, 6 months and 1 year after operation, the ROM of the knee joint in the observation group was higher than that in the control group (<0.05), the IKDC score and Lysholm score were higher than those in the control group (<0.05). Within one year, there were no relaxations, fractures and other related complications in the two groups. The pivot shift test, anterior drawer test and the Lachman test were all negative.@*CONCLUSION@#EA combined with routine rehabilitation training could obviously reduce the pain of knee joint, improve the swelling degree, increase the ROM of knee joint, promote the functional recovery in patients with ACL reconstruction, which are superior to rehabilitation training alone.
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Objective To observe the therapeutic efficacy of Tian Yuan acupuncture method in treating liver cancer pain and its effect on quality of life (QOL) and adverse reactions. Method A total of 108 patients with liver cancer were randomized into an observation group and a control group, with 54 cases in each group. The observation group was intervened by Tian Yuan acupuncture method, while the control group was intervened by the three-step analgesic ladder recommended by the World Health Organization (WHO). The clinical efficacies, changes in Visual Analogue Scale (VAS) and QOL, and the occurrence of adverse reactions in the two groups were observed. Result The total effective rate in the observation group was significantly higher than that in the control group (P<0.05); the VAS and QOL scores showed improvement after treatment in both groups and the improvements in the observation group were more significant than those in the control group (P<0.05); adverse reactions occurred in both groups, and the occurrence rate was 25.9％ in the observation group, significantly lower than 53.7％ in the control group (P<0.05).Conclusion Tian Yuan acupuncture method can produce significant clinical efficacy in treating liver cancer pain. It can effectively improve the symptoms of cancer pain and enhance the QOL.
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BACKGROUND:Knee society score of Peking Union Medical Col ege has been promoted and used in the 306th Hospital of PLA for 2 years and we have accumulated some clinical data. OBJECTIVE:To analyze the stability and feasibility for suitable clinical medical practice of knee society score of Peking Union Medical Col ege. METHODS:Fifty-five patients with osteoarthritis of the knee were included, and the patients were divided into three groups:the preoperative group;3 months postoperative fol ow-up group;6 months postoperative fol ow-up group. The measurement results obtained by the application of the scale were compared to those of the Western Ontario and McMaster Universityies Ostroarthritis Index, visual analog scale, and hospital for special surgery score, and then knee society score goodness-of-fit analysis was performed based on the structural equation model. RESULTS AND CONCLUSION:Knee society score performance assessment of the signs and symptoms of osteoarthritis of the knee patients was positively correlated with the pain severity of visual analog scale score;the overal knee society score of the patients after 6-month fol ow-up was significantly improved compared with that before treatment. The knee society score after 3-and 6-month fol ow-up was significantly higher than that before treatment, and the score was quite with the hospital for special surgery score. The overal assessment of the knee society score after treated for 3 and 6 months was improved for more than grade Ⅰ, the visual analog scale score was decreased for more than 30%. The pain assessment items and physiological functional assessment items of Western Ontario and McMaster Universityies Ostroarthritis Index after 6-month fol ow-up were significantly better than those before treatment (Pgoodness-of-fit analysis showed that the scale had good goodness which had scientific nature and application value.