Journal Club on A novel approach to the management of a central giant cell gr...Dr Bhavik Miyani
This journal club presentation summarizes a case report on the use of denosumab to treat central giant cell granuloma (CGCG) of the mandible. CGCG is an aggressive bone lesion with high recurrence rates following surgical treatment. The case report describes a patient who did not respond to intralesional steroids or calcitonin, but did experience resolution of symptoms and ossification of the lesion within 6 months of treatment with denosumab. A biopsy 18 months later found no residual CGCG. The presentation reviews current treatments for CGCG and the mechanism of action of denosumab, and concludes denosumab may be an effective alternative or adjunct to surgery.
This study aims to evaluate the effectiveness of cervical rotatory manipulation for treating mechanical neck pain. A minimum of 30 subjects will be divided into two groups - group A will receive cervical rotatory manipulation along with other treatments, while group B will only receive other treatments. Both groups will receive 5 treatment sessions over 8 days. Pain, disability, and range of motion measurements will be taken before, during, and after treatment to analyze the impact of cervical rotatory manipulation for mechanical neck pain.
Assessment of lingual nerve injury using different surgical variables for man...DrKamini Dadsena
This document summarizes a journal presentation on a clinical study assessing lingual nerve injury from mandibular third molar surgery. The study examined 1200 patients undergoing third molar removal and found an overall 5.6% temporary lingual nerve impairment rate and 0.3% permanent rate. Factors associated with higher temporary injury rates included lingual flap retraction, tooth sectioning, and buccal guttering. The presentation reviews the study methodology, results, comparisons to other studies, and discusses techniques to reduce lingual nerve injury risk during third molar surgery.
Laryngeal massage may be an effective treatment for primary muscle tension dysphonia (MTD). MTD occurs when there is excess musculoskeletal tension in the larynx, either as a primary cause or secondary cause of voice problems. Indirect tension reduction techniques often fail to reduce stubborn laryngeal tension. Laryngeal massage aims to manually assess and reduce contracted muscle tone and abnormal laryngeal positioning during voicing through a series of cautious steps with the active participation of the patient to improve vocal quality in daily use. Raising awareness of bodily sensations may help prevent future muscle tension.
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study investigated the efficacy of pulsed electromagnetic field therapy (PEMF) in reducing delayed onset muscle soreness (DOMS) in marathon runners. A double-blind randomized controlled trial assigned 133 marathon runners to either an active PEMF device or placebo device to use for 20 minutes, 4 times per day for 5 days after a marathon. The primary outcome was thigh pain assessed using a visual analog scale during squats. Subjects using the active PEMF device had significantly lower pain scores compared to the placebo group, indicating PEMF reduced DOMS in marathon runners.
Journal Club on A novel approach to the management of a central giant cell gr...Dr Bhavik Miyani
This journal club presentation summarizes a case report on the use of denosumab to treat central giant cell granuloma (CGCG) of the mandible. CGCG is an aggressive bone lesion with high recurrence rates following surgical treatment. The case report describes a patient who did not respond to intralesional steroids or calcitonin, but did experience resolution of symptoms and ossification of the lesion within 6 months of treatment with denosumab. A biopsy 18 months later found no residual CGCG. The presentation reviews current treatments for CGCG and the mechanism of action of denosumab, and concludes denosumab may be an effective alternative or adjunct to surgery.
This study aims to evaluate the effectiveness of cervical rotatory manipulation for treating mechanical neck pain. A minimum of 30 subjects will be divided into two groups - group A will receive cervical rotatory manipulation along with other treatments, while group B will only receive other treatments. Both groups will receive 5 treatment sessions over 8 days. Pain, disability, and range of motion measurements will be taken before, during, and after treatment to analyze the impact of cervical rotatory manipulation for mechanical neck pain.
Assessment of lingual nerve injury using different surgical variables for man...DrKamini Dadsena
This document summarizes a journal presentation on a clinical study assessing lingual nerve injury from mandibular third molar surgery. The study examined 1200 patients undergoing third molar removal and found an overall 5.6% temporary lingual nerve impairment rate and 0.3% permanent rate. Factors associated with higher temporary injury rates included lingual flap retraction, tooth sectioning, and buccal guttering. The presentation reviews the study methodology, results, comparisons to other studies, and discusses techniques to reduce lingual nerve injury risk during third molar surgery.
Laryngeal massage may be an effective treatment for primary muscle tension dysphonia (MTD). MTD occurs when there is excess musculoskeletal tension in the larynx, either as a primary cause or secondary cause of voice problems. Indirect tension reduction techniques often fail to reduce stubborn laryngeal tension. Laryngeal massage aims to manually assess and reduce contracted muscle tone and abnormal laryngeal positioning during voicing through a series of cautious steps with the active participation of the patient to improve vocal quality in daily use. Raising awareness of bodily sensations may help prevent future muscle tension.
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study investigated the efficacy of pulsed electromagnetic field therapy (PEMF) in reducing delayed onset muscle soreness (DOMS) in marathon runners. A double-blind randomized controlled trial assigned 133 marathon runners to either an active PEMF device or placebo device to use for 20 minutes, 4 times per day for 5 days after a marathon. The primary outcome was thigh pain assessed using a visual analog scale during squats. Subjects using the active PEMF device had significantly lower pain scores compared to the placebo group, indicating PEMF reduced DOMS in marathon runners.
Meta analysis of clinical efficacy of pulsed radio frequencyPainezee Specialist
This meta-analysis reviewed 25 controlled clinical trials involving 1332 patients to evaluate the efficacy of pulsed radio frequency energy (PRFE) therapy for postoperative pain and edema, nonpostoperative pain and edema, and wound healing. A vote-counting method found more positive outcomes than neutral or negative outcomes for each clinical application. A statistical combination of P-values also found statistically significant improvements in pain, edema reduction, and wound healing outcomes. The analysis provides strong statistical evidence that PRFE therapy is an effective treatment for postoperative and nonpostoperative pain and edema as well as for wound healing applications.
Journal Club on Tooth in the line of fracture its prognosis and its effects o...Dr Bhavik Miyani
This study compared outcomes of mandibular angle fracture cases where the third molar in the fracture line was either preserved or extracted. 54 patients were divided into two groups. Results showed infection was higher when the tooth was preserved, while occlusion discrepancy was higher when the tooth was extracted. Most preserved teeth showed recovery within 6-12 months, with only mild root resorption and no ankylosis. The conclusion was that despite higher complication risks, the tooth in the fracture line should generally be preserved for its benefits.
This prospective case series evaluated the effectiveness of ultrasound-guided trigeminal nerve blocks via the pterygopalatine fossa in 15 patients with unilateral facial pain refractory to medical and surgical treatments. All patients experienced complete sensory analgesia within 15 minutes and reported pain relief within 5 minutes. At follow-up over 15 months, the majority of patients maintained pain relief. No patients experienced side effects. The study concludes ultrasound-guided injections in the pterygopalatine fossa provide safe and effective long-term pain relief for refractory trigeminal neuralgia or atypical facial pain.
CARNOY’S SOLUTION AS A SURGICAL MEDICAMENT IN THETREATMENT OF KERATOCYSTIC O...DrKamini Dadsena
The term keratocyst was coined by Philipsen in 1956.
Unlike the other cystic lesion KOT, has got strong tendency for recurrence.
Treatment of these lesions remains controversial and has a number of dilemmas about the choice of treatment whether to use carnoys solution as an adjunct therapy after removal of the lesion.
This randomized, double-blind pilot study examined the effects of pulsed electromagnetic field (PEMF) therapy on pain in patients with early knee osteoarthritis. 34 patients were randomly assigned to either an active PEMF device group (n=15) or a sham device group (n=19). The PEMF signal was designed to modulate the calcium/calmodulin dependent nitric oxide signaling pathway. Results showed a 50% reduction in pain scores from baseline in the active group starting on day 1 and persisting to day 42, while no significant reduction was seen in the sham group. The overall decrease in pain was nearly threefold greater in the active group. The rapid and sustained pain relief seen with PEMF therapy suggests it may reduce inflammation
Objective: To assess the effect of a kinesitherapeutic
program of special exercises for treatment of pain intensity and
endurance of the extensor trunk muscles in patients with
chronic lumbalgy.
Methods: The study included 110 patients with chronic
lumbalgy, equally distributed in two treatment groups.
Participants in the experimental group performed the
recommended special exercises 3 times a week at home, while
those in the control group only followed the guidelines of a
physician. At the beginning of the study and 12 months later,
the pain intensity of all the participants was assessed by means
of Visual Analog Scale.
Results: In contrast to the participants in the control
group, those in the experimental group at the end of observation
were reported to experience a significant reduction in pain
intensity.
Conclusions: Treatment with specific exercises proved
more effective in terms of pain complaints in patients with
chronic lumbalgy.
Effect of Minimally Invasive Low-intensity laser therapy (MILLT) and non-ster...Nina Anigbogu
Disc hernia occurs when the soft central portion of an intervertebral disc bulges out beyond the damaged outer rings of the disc. Patients present with back pain, leg pain, or lower extremity weakness. Treatment is individualized but may include NSAIDs, narcotics, nerve medications, cortisone injections, or minimally invasive low-intensity laser therapy (MILLT). A study compared MILLT to conservative treatment using NSAIDs in 600 patients over 5 years. Results found that 76% of MILLT patients reported reduced pain within 4-5 treatments, and 85% saw decreased disc herniation on MRI after 3 months, indicating MILLT may produce longer-lasting relief than other treatments.
The document discusses varying the frequency and intensity of transcutaneous electrical nerve stimulation (TENS) for treating acute and chronic pain. It summarizes several studies that investigated:
1) The effectiveness of high vs low frequency TENS for reducing hyperalgesia and whether activation of cutaneous or deep tissue afferents is responsible for TENS analgesia.
2) The impact of varying TENS frequency, intensity, and pulse duration on primary and secondary hyperalgesia in an animal model of inflammation.
3) The short and long-term effects of high frequency TENS on motor cortex excitability in humans.
4) The effectiveness of high vs low frequency TENS for reversing hyper
1) A double-blind randomized controlled study evaluated a wearable pulsed radiofrequency electromagnetic field (PRFE) device for treating plantar fasciitis.
2) 70 subjects with plantar fasciitis were randomly assigned either an active or placebo PRFE device to wear overnight for 7 days.
3) The active PRFE device showed a progressive 40% decline in morning heel pain over 7 days, significantly greater than the 7% decline in the control group, demonstrating PRFE's potential as a drug-free noninvasive treatment for reducing plantar fasciitis pain.
The use of pulsed radiofrequency for the treatment of pudendal neuralgia a c...Jason Attaman
This study evaluated the use of pulsed radiofrequency (PRF) for treating pudendal neuralgia in 7 patients. PRF is a minimally invasive technique that uses radiofrequency energy to modulate nerves without damaging tissue. The average number of PRF treatments was 4.4, and the average duration of pain relief was 11.4 weeks. There were no complications reported. The study concludes that PRF may be an effective and safe treatment for pudendal neuralgia in patients where conservative treatments have not provided adequate relief, but larger controlled studies are still needed.
IOSRPHR(www.iosrphr.org) IOSR Journal of Pharmacyiosrphr_editor
This study investigated whether patients undergoing surgery with regional anesthesia who listened to music required less sedation than those who did not listen to music. 60 patients were randomly assigned to either listen to music of their choice (group M) or not listen to music (group C) during surgery. The dose of midazolam needed to achieve a sedation score of 3 or less was significantly lower in group M. Group M also had better sedation scores at 90 and 120 minutes after surgery began. While pain, discomfort and satisfaction scores did not differ, group C recalled more intraoperative conversations and sounds. The study concludes that music reduces the need for sedation and improves intraoperative recall during regional anesthesia.
Postoperative pain is a major concern for patients and doctors. This preliminary study investigated the use of a wearable pulsed radiofrequency energy (PRFE) device to control postoperative pain in 18 women undergoing breast augmentation surgery. Patients were randomly assigned to receive either an active or placebo PRFE device. Those receiving the active device experienced significantly lower pain scores over 7 days as measured by a visual analog scale. They also took fewer narcotic pain medications than those receiving the placebo. The findings suggest PRFE therapy is an effective non-drug method for controlling postoperative pain.
This document summarizes and discusses several articles on physical medicine and rehabilitation (PMR) topics that were published in recent issues of various journals. The articles cover a range of topics including the treatment of 12th rib syndrome, the use of the tourniquet ischemia test to diagnose complex regional pain syndrome, physiotherapy interventions for treating spasticity, a telehealth intervention to increase fitness for those with spinal cord injuries, spinal cord involvement in COVID-19, the use of local anesthetic injections in athletes, and a comparison of video-based and text-based physical activity interventions. The document also provides an introduction and welcome from the editor as well as information about new contributors.
This study evaluated the effectiveness of a Global Postural Reeducation (GPR) program compared to a Stabilization Exercise (SE) program for patients with persistent low back pain. 100 patients were assigned to either the GPR group or SE group. Outcome measures including disability questionnaires and pain/mobility scales were measured at baseline and 3 and 6 month follow-ups. Results showed significantly greater improvements in all outcome measures in the GPR group compared to the SE group at both short-term and mid-term follow-ups. The GPR intervention was found to be more effective for reducing pain and disability in patients with persistent low back pain.
Relief of urinary urgency, hesitancy, and male pelvic pain with pulsed radiof...Jason Attaman
This document summarizes a case report of a 86-year-old man who underwent pulsed radiofrequency ablation (RFA) of the pudendal nerve to treat urinary urgency, hesitancy, and pelvic pain. The patient had a 30-year history of urinary symptoms and had tried various medications and procedures without success. After undergoing pulsed RFA of the pudendal nerve, the patient reported marked improvement in his pelvic pain and a significant reduction in his urinary symptoms. The summary concludes that pudendal nerve block with pulsed RFA may be an effective treatment for pelvic pain and urinary symptoms.
This article reviews recent literature on the application of transcutaneous electrical nerve stimulation (TENS) for pain management. Several studies have found TENS to be effective for acute postoperative pain, reducing medication needs and facilitating earlier recovery. TENS placed near surgical incisions reduced pain and medication requirements after procedures like laparotomy, cholecystectomy, and laminectomy. TENS may also benefit rehabilitation after knee surgery by reducing pain and narcotic use, allowing for earlier quadriceps strengthening and range of motion. While specific stimulation settings do not seem to impact outcomes, proper electrode placement is important. Overall, TENS is an effective non-pharmacological option for acute pain that facilitates recovery after surgery and injury.
The article discusses the impacts of the COVID-19 pandemic on physiatry and rehabilitation medicine. It highlights how physiatrists played a vital role in the front lines during the pandemic by converting rehabilitation units and innovating care delivery. However, the pandemic has also caused significant disruptions and stress for medical practices through reduced patient volumes, higher costs, and threats of reimbursement cuts from insurers and governments. Moving forward, physicians are questioning the level of support they will receive from their employers and the government given the sacrifices many have made during the pandemic.
This randomized controlled trial evaluated the efficacy and safety of buccal buprenorphine film for chronic low back pain in opioid-experienced patients. Patients underwent an opioid taper and then open-label titration with buccal buprenorphine before being randomly assigned to continued buprenorphine or placebo. Patients receiving buprenorphine had significantly greater reductions in pain scores compared to placebo over 12 weeks. The most common adverse event with buprenorphine was vomiting. This study demonstrates the efficacy and tolerability of buccal buprenorphine for chronic low back pain in patients taking around-the-clock opioids.
rakshat syn presentation.pptx for learniRakshatNayak1
This document presents a research proposal that aims to compare the analgesic effect of two different doses of intrathecal nalbuphine hydrochloride with 0.5% hyperbaric bupivacaine for lower abdominal surgeries. The study will involve 150 patients randomized into three groups receiving different combinations of intrathecal bupivacaine and nalbuphine. Outcome measures will include onset of sensory and motor blockade, duration of analgesia, and hemodynamic parameters. A literature review found that intrathecal nalbuphine prolongs postoperative analgesia without increasing side effects when used as an adjuvant to bupivacaine. The results of this study may provide insights into
This document outlines a proposed study on the efficacy of intravenous lidocaine in preventing fentanyl-induced cough before induction of anesthesia. The study aims to determine if lidocaine reduces the incidence of cough caused by fentanyl injection before anesthesia by 30% compared to placebo. It will involve 96 patients randomized to receive either lidocaine or saline before fentanyl injection. The primary outcome is reduction in cough incidence and secondary outcomes include hemodynamic stability and adverse effects. The proposed methodology describes patient selection criteria, interventions, data collection and analysis in detail.
Meta analysis of clinical efficacy of pulsed radio frequencyPainezee Specialist
This meta-analysis reviewed 25 controlled clinical trials involving 1332 patients to evaluate the efficacy of pulsed radio frequency energy (PRFE) therapy for postoperative pain and edema, nonpostoperative pain and edema, and wound healing. A vote-counting method found more positive outcomes than neutral or negative outcomes for each clinical application. A statistical combination of P-values also found statistically significant improvements in pain, edema reduction, and wound healing outcomes. The analysis provides strong statistical evidence that PRFE therapy is an effective treatment for postoperative and nonpostoperative pain and edema as well as for wound healing applications.
Journal Club on Tooth in the line of fracture its prognosis and its effects o...Dr Bhavik Miyani
This study compared outcomes of mandibular angle fracture cases where the third molar in the fracture line was either preserved or extracted. 54 patients were divided into two groups. Results showed infection was higher when the tooth was preserved, while occlusion discrepancy was higher when the tooth was extracted. Most preserved teeth showed recovery within 6-12 months, with only mild root resorption and no ankylosis. The conclusion was that despite higher complication risks, the tooth in the fracture line should generally be preserved for its benefits.
This prospective case series evaluated the effectiveness of ultrasound-guided trigeminal nerve blocks via the pterygopalatine fossa in 15 patients with unilateral facial pain refractory to medical and surgical treatments. All patients experienced complete sensory analgesia within 15 minutes and reported pain relief within 5 minutes. At follow-up over 15 months, the majority of patients maintained pain relief. No patients experienced side effects. The study concludes ultrasound-guided injections in the pterygopalatine fossa provide safe and effective long-term pain relief for refractory trigeminal neuralgia or atypical facial pain.
CARNOY’S SOLUTION AS A SURGICAL MEDICAMENT IN THETREATMENT OF KERATOCYSTIC O...DrKamini Dadsena
The term keratocyst was coined by Philipsen in 1956.
Unlike the other cystic lesion KOT, has got strong tendency for recurrence.
Treatment of these lesions remains controversial and has a number of dilemmas about the choice of treatment whether to use carnoys solution as an adjunct therapy after removal of the lesion.
This randomized, double-blind pilot study examined the effects of pulsed electromagnetic field (PEMF) therapy on pain in patients with early knee osteoarthritis. 34 patients were randomly assigned to either an active PEMF device group (n=15) or a sham device group (n=19). The PEMF signal was designed to modulate the calcium/calmodulin dependent nitric oxide signaling pathway. Results showed a 50% reduction in pain scores from baseline in the active group starting on day 1 and persisting to day 42, while no significant reduction was seen in the sham group. The overall decrease in pain was nearly threefold greater in the active group. The rapid and sustained pain relief seen with PEMF therapy suggests it may reduce inflammation
Objective: To assess the effect of a kinesitherapeutic
program of special exercises for treatment of pain intensity and
endurance of the extensor trunk muscles in patients with
chronic lumbalgy.
Methods: The study included 110 patients with chronic
lumbalgy, equally distributed in two treatment groups.
Participants in the experimental group performed the
recommended special exercises 3 times a week at home, while
those in the control group only followed the guidelines of a
physician. At the beginning of the study and 12 months later,
the pain intensity of all the participants was assessed by means
of Visual Analog Scale.
Results: In contrast to the participants in the control
group, those in the experimental group at the end of observation
were reported to experience a significant reduction in pain
intensity.
Conclusions: Treatment with specific exercises proved
more effective in terms of pain complaints in patients with
chronic lumbalgy.
Effect of Minimally Invasive Low-intensity laser therapy (MILLT) and non-ster...Nina Anigbogu
Disc hernia occurs when the soft central portion of an intervertebral disc bulges out beyond the damaged outer rings of the disc. Patients present with back pain, leg pain, or lower extremity weakness. Treatment is individualized but may include NSAIDs, narcotics, nerve medications, cortisone injections, or minimally invasive low-intensity laser therapy (MILLT). A study compared MILLT to conservative treatment using NSAIDs in 600 patients over 5 years. Results found that 76% of MILLT patients reported reduced pain within 4-5 treatments, and 85% saw decreased disc herniation on MRI after 3 months, indicating MILLT may produce longer-lasting relief than other treatments.
The document discusses varying the frequency and intensity of transcutaneous electrical nerve stimulation (TENS) for treating acute and chronic pain. It summarizes several studies that investigated:
1) The effectiveness of high vs low frequency TENS for reducing hyperalgesia and whether activation of cutaneous or deep tissue afferents is responsible for TENS analgesia.
2) The impact of varying TENS frequency, intensity, and pulse duration on primary and secondary hyperalgesia in an animal model of inflammation.
3) The short and long-term effects of high frequency TENS on motor cortex excitability in humans.
4) The effectiveness of high vs low frequency TENS for reversing hyper
1) A double-blind randomized controlled study evaluated a wearable pulsed radiofrequency electromagnetic field (PRFE) device for treating plantar fasciitis.
2) 70 subjects with plantar fasciitis were randomly assigned either an active or placebo PRFE device to wear overnight for 7 days.
3) The active PRFE device showed a progressive 40% decline in morning heel pain over 7 days, significantly greater than the 7% decline in the control group, demonstrating PRFE's potential as a drug-free noninvasive treatment for reducing plantar fasciitis pain.
The use of pulsed radiofrequency for the treatment of pudendal neuralgia a c...Jason Attaman
This study evaluated the use of pulsed radiofrequency (PRF) for treating pudendal neuralgia in 7 patients. PRF is a minimally invasive technique that uses radiofrequency energy to modulate nerves without damaging tissue. The average number of PRF treatments was 4.4, and the average duration of pain relief was 11.4 weeks. There were no complications reported. The study concludes that PRF may be an effective and safe treatment for pudendal neuralgia in patients where conservative treatments have not provided adequate relief, but larger controlled studies are still needed.
IOSRPHR(www.iosrphr.org) IOSR Journal of Pharmacyiosrphr_editor
This study investigated whether patients undergoing surgery with regional anesthesia who listened to music required less sedation than those who did not listen to music. 60 patients were randomly assigned to either listen to music of their choice (group M) or not listen to music (group C) during surgery. The dose of midazolam needed to achieve a sedation score of 3 or less was significantly lower in group M. Group M also had better sedation scores at 90 and 120 minutes after surgery began. While pain, discomfort and satisfaction scores did not differ, group C recalled more intraoperative conversations and sounds. The study concludes that music reduces the need for sedation and improves intraoperative recall during regional anesthesia.
Postoperative pain is a major concern for patients and doctors. This preliminary study investigated the use of a wearable pulsed radiofrequency energy (PRFE) device to control postoperative pain in 18 women undergoing breast augmentation surgery. Patients were randomly assigned to receive either an active or placebo PRFE device. Those receiving the active device experienced significantly lower pain scores over 7 days as measured by a visual analog scale. They also took fewer narcotic pain medications than those receiving the placebo. The findings suggest PRFE therapy is an effective non-drug method for controlling postoperative pain.
This document summarizes and discusses several articles on physical medicine and rehabilitation (PMR) topics that were published in recent issues of various journals. The articles cover a range of topics including the treatment of 12th rib syndrome, the use of the tourniquet ischemia test to diagnose complex regional pain syndrome, physiotherapy interventions for treating spasticity, a telehealth intervention to increase fitness for those with spinal cord injuries, spinal cord involvement in COVID-19, the use of local anesthetic injections in athletes, and a comparison of video-based and text-based physical activity interventions. The document also provides an introduction and welcome from the editor as well as information about new contributors.
This study evaluated the effectiveness of a Global Postural Reeducation (GPR) program compared to a Stabilization Exercise (SE) program for patients with persistent low back pain. 100 patients were assigned to either the GPR group or SE group. Outcome measures including disability questionnaires and pain/mobility scales were measured at baseline and 3 and 6 month follow-ups. Results showed significantly greater improvements in all outcome measures in the GPR group compared to the SE group at both short-term and mid-term follow-ups. The GPR intervention was found to be more effective for reducing pain and disability in patients with persistent low back pain.
Relief of urinary urgency, hesitancy, and male pelvic pain with pulsed radiof...Jason Attaman
This document summarizes a case report of a 86-year-old man who underwent pulsed radiofrequency ablation (RFA) of the pudendal nerve to treat urinary urgency, hesitancy, and pelvic pain. The patient had a 30-year history of urinary symptoms and had tried various medications and procedures without success. After undergoing pulsed RFA of the pudendal nerve, the patient reported marked improvement in his pelvic pain and a significant reduction in his urinary symptoms. The summary concludes that pudendal nerve block with pulsed RFA may be an effective treatment for pelvic pain and urinary symptoms.
This article reviews recent literature on the application of transcutaneous electrical nerve stimulation (TENS) for pain management. Several studies have found TENS to be effective for acute postoperative pain, reducing medication needs and facilitating earlier recovery. TENS placed near surgical incisions reduced pain and medication requirements after procedures like laparotomy, cholecystectomy, and laminectomy. TENS may also benefit rehabilitation after knee surgery by reducing pain and narcotic use, allowing for earlier quadriceps strengthening and range of motion. While specific stimulation settings do not seem to impact outcomes, proper electrode placement is important. Overall, TENS is an effective non-pharmacological option for acute pain that facilitates recovery after surgery and injury.
The article discusses the impacts of the COVID-19 pandemic on physiatry and rehabilitation medicine. It highlights how physiatrists played a vital role in the front lines during the pandemic by converting rehabilitation units and innovating care delivery. However, the pandemic has also caused significant disruptions and stress for medical practices through reduced patient volumes, higher costs, and threats of reimbursement cuts from insurers and governments. Moving forward, physicians are questioning the level of support they will receive from their employers and the government given the sacrifices many have made during the pandemic.
This randomized controlled trial evaluated the efficacy and safety of buccal buprenorphine film for chronic low back pain in opioid-experienced patients. Patients underwent an opioid taper and then open-label titration with buccal buprenorphine before being randomly assigned to continued buprenorphine or placebo. Patients receiving buprenorphine had significantly greater reductions in pain scores compared to placebo over 12 weeks. The most common adverse event with buprenorphine was vomiting. This study demonstrates the efficacy and tolerability of buccal buprenorphine for chronic low back pain in patients taking around-the-clock opioids.
rakshat syn presentation.pptx for learniRakshatNayak1
This document presents a research proposal that aims to compare the analgesic effect of two different doses of intrathecal nalbuphine hydrochloride with 0.5% hyperbaric bupivacaine for lower abdominal surgeries. The study will involve 150 patients randomized into three groups receiving different combinations of intrathecal bupivacaine and nalbuphine. Outcome measures will include onset of sensory and motor blockade, duration of analgesia, and hemodynamic parameters. A literature review found that intrathecal nalbuphine prolongs postoperative analgesia without increasing side effects when used as an adjuvant to bupivacaine. The results of this study may provide insights into
This document outlines a proposed study on the efficacy of intravenous lidocaine in preventing fentanyl-induced cough before induction of anesthesia. The study aims to determine if lidocaine reduces the incidence of cough caused by fentanyl injection before anesthesia by 30% compared to placebo. It will involve 96 patients randomized to receive either lidocaine or saline before fentanyl injection. The primary outcome is reduction in cough incidence and secondary outcomes include hemodynamic stability and adverse effects. The proposed methodology describes patient selection criteria, interventions, data collection and analysis in detail.
This document provides information on pain management for internal medicine housestaff. It begins with definitions of pain from the International Association for the Study of Pain. It then covers the basic approach to pain management, including assessing the etiology, classifying pain types, clinically assessing pain, and treating pain. It discusses treating cancer pain specifically and provides guidelines on the WHO analgesic ladder for treating mild, moderate, and severe pain. It also covers adjuvant analgesics, opioid selection, routes of administration, and equianalgesic dosing of common opioids like morphine, oxycodone, fentanyl, hydromorphone, and methadone.
1) 95 chronic pain patients who had failed long-term opiate analgesic therapy were given sublingual buprenorphine for pain treatment.
2) 86% experienced moderate to substantial relief of pain along with improved mood and functioning.
3) Only 6 patients discontinued treatment due to side effects or exacerbated pain, showing sublingual buprenorphine was well tolerated and effective for treating chronic pain in patients who did not respond to opiate analgesics.
local anesthesia seminar in oral and maxillofacial surgeryRishiKodali2
This document discusses local anesthesia, including its definition, history, classification, pharmacokinetics, pharmacodynamics, and mechanisms of action. It describes how local anesthetics work by blocking sodium channels in nerves to disrupt nerve conduction and outlines factors that influence their onset, duration, and potency such as ionization, lipid solubility, and protein binding. The document also categorizes local anesthetics based on their chemical structure, biological site and mode of action, duration of action, potency, and more.
This randomized controlled trial assessed the efficacy of paravertebral block (PVB) for perioperative analgesia in patients undergoing laparoscopic cholecystectomy. It found that patients receiving PVB before general anesthesia required significantly less intraoperative fentanyl and postoperative PCA morphine compared to those receiving only general anesthesia. PVB also resulted in lower pain scores in the immediate postoperative period and fewer opioid-related side effects. The study demonstrates that PVB can provide effective analgesia and reduce opioid consumption for laparoscopic cholecystectomy.
Novel drug delivery system (herbal) -:To acknowledge patient and doctor tu used widely herbal drug to greater therapeutic effect
To find out Niosomes in neem...
Laparoscopic administration of bupivacaine at the uterosacral ligaments during benign laparoscopic androbotic hysterectomy: a randomized controlled trial
This document describes a research study protocol to evaluate the efficacy of intrathecal dexmedetomidine as an adjuvant to levobupivacaine spinal anesthesia for abdominal hysterectomy. The study will randomly assign 104 patients to receive either levobupivacaine with normal saline or levobupivacaine with 10 μg dexmedetomidine intrathecally. The primary outcomes will be postoperative analgesia duration measured by VAS scores and time to first rescue analgesic. Secondary outcomes include sensory and motor block durations and any intraoperative hemodynamic changes or side effects. Standard protocols will be followed for preoperative, intraoperative and postoperative care.
Current Update in the Management of Post-operative Neuraxial Opioid-induced P...asclepiuspdfs
This document summarizes the current pharmacological treatments available for managing opioid-induced pruritus caused by spinal opioids in postoperative patients. It discusses the mechanisms by which opioids induce pruritus, including activation of the itch center in the central nervous system and sensitization of peripheral nociceptors. The most useful drugs for treating or preventing pruritus are mu opioid receptor antagonists like naloxone, and mixed kappa opioid agonists/mu antagonists like nalbuphine and butorphanol. Other treatments with some efficacy include 5-HT3 serotonin receptor antagonists, D2 dopamine receptor antagonists, sub-anesthetic doses of propofol, and prophylaxis with mirtazapine
This document summarizes a study on the use of sublingual buprenorphine to treat chronic pain syndrome. 95 patients with chronic pain who had failed long-term opiate analgesic therapy were given low doses of sublingual buprenorphine or buprenorphine/naloxone. 86% experienced moderate to substantial relief of pain along with improved mood and functioning. Side effects led to discontinuation for 6 patients. The study suggests sublingual buprenorphine is well tolerated, safe, and effective for treating chronic pain patients who have not responded to opiate analgesics.
Aspirin is a nonselective COX inhibitor that is rapidly converted to salicylic acid, which is responsible for its analgesic, antipyretic, and anti-inflammatory actions. At analgesic doses, its main adverse effects include nausea, vomiting, and gastric mucosal damage. At higher anti-inflammatory doses, it can cause salicylism, a syndrome with symptoms like dizziness, tinnitus, and electrolyte imbalance. Acute salicylate poisoning is more common in children and can manifest as vomiting, dehydration, breathing issues, and potentially death from respiratory or cardiovascular failure without treatment.
Subarachnoid Block With Low Dose Bupivacaine And Fentanyl In Elderly Hyperten...lgmitra01
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Thoracic(N):Lobectomy/Pneumonectomy
14/8 (64/36%) 15/8 (65/35%) 0.88
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Drug History: NSAIDs/Steroids N (%)
4/2 (18/9%) 5/1 (22/4%) 0.72
Data are presented as mean ± SD or number (percentage).
ASA: American Society of Anesthesiologists physical status classification.
DM: Diabetes Mell
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Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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2. PRESENTED BY,
DR. BHAVIK MIYANI
IIND YEAR M.D.S.
GUIDED BY,
DEPARTMENT OF
OMFS,
NPDCH, VISNAGAR.
#2nd JOURNAL CLUB PRESENTATION
3. TITLE OF ARTICLE
USE OF 0.5% BUPIVACAINE WITH
BUPRENORPHINE IN MINOR ORAL
SURGICAL PROCEDURES
4. CONTENTS
1. About the Journal
2. About the Author
3. Abstract
4. Introduction
5. Material and Method
6. Results
7. Discussion
8. Conclusion
9. Review of Literature
10. Critical Evaluation
11. References
5. ABOUT THE JOURNAL
National Journal of Maxillofacial Surgery
Open access PubMed Indexed Journal
Published By- Wolters Kluwer - Medknow
Issue 2
Year of Publication- July-December 2017
Volume 8
Page No.- 117 to 124
6. ABOUT THE AUTHORS
• Varun Nagpal1
• Tejinder Kaur2
• Sarika Kapila2
• Ramandeep Singh Bhullar2
• Amit Dhawan2
• Yashmeet Kaur2
1. Department of Oral Surgery, Maharaja Ganga Singh Dental College, Sri
Ganganagar, Rajasthan.
2. Department of Oral Surgery, Sri Guru Ram Das Institute of Dental Sciences
and Research, Amritsar, Punjab, India.
7.
8. INTRODUCTION
• Local anesthetic agents are the mainstay of perioperative
pain control for most office-based oral surgical procedures.
• Amide types of local anesthetics (bupivacaine, etidocaine,
lidocaine, mepivacaine, prilocaine, and articaine) with a
moderate-to-long duration of action are commonly used
for these surgical procedures.
Maimon WN, Schuller DE. Lidocaine vs. bupivacaine in facial plastic surgery. A clinical trial. Arch
Otolaryngol 1984;110:525-8.
• Bupivacaine hydrochloride, introduced in 1963, is a long-
acting amide type of local anesthetic. It is a powerful
anesthetic with an intermediate onset of action (2–5 min),
allowing a slow return to normal sensation (180–600 min).
9. • It provides additional analgesia time, known as residual analgesia, and
minimizes the duration of postoperative pain, facilitating postoperative
care, and maintenance of proper oral hygiene.
• Infection if present alters the ability of local anesthetic to achieve
adequate pain control during surgery as the low pH of the inflamed
tissue leads to quick dissociation of local anesthetic to cation form,
which is not able to penetrate the phospholipid membrane of the
neuronal cells. Locally injected opioids may act synergistically with local
anesthetics in inflamed tissues and increase the perioperative analgesic
effect.
Rattan V, Arora S, Grover VK. Assessment of the effectiveness of peripheral administration of fentanyl with
lidocaine in inflamed dentoalveolar tissues. Int J Oral Maxillofac Surg 2007;36:128-31.
• Buprenorphine is a semi-synthetic, oripavine alkaloid derived from
thebaine. It is a long-acting, lipid-soluble, mixed agonist-antagonist
opioid analgesic which was first synthesized in 1966.
10. • The low abuse liability of the drug in humans soon turned it into a
widely used therapeutic agent in patients with opioid dependence. The
principal clinical application of buprenorphine is as an analgesic for
moderate-to-severe pain in perioperative setting.
Johnson RE, Fudala PJ, Payne R. Buprenorphine: Considerations for pain management. J Pain Symptom
Manage 2005;29:297-326.
• The analgesic effect of buprenorphine appears to depend on the
integrity of descending fibers from the rostral ventromedial medulla.
Residual analgesic effects of opioids after inactivation of descending
fibers may be caused by peripheral effects in the presence of
inflammation.
Vadivelu N, Hines RL. Buprenorphine pharmacology and clinical applications. Semin Anesth Perioper Med
Pain 2004;23:281-90.
11. • Buprenorphine is shown to be fully efficacious with
an antinociceptive potency 20-70 times higher than
morphine. It binds to mu, kappa, and delta opioid
receptors and dissociates slowly from these
receptors. Buprenorphine acts as a partial mu opioid
agonist and a kappa opioid antagonist.
• The parenteral formulation of buprenorphine has an
onset time of 5-15 min, and duration of action is
about 8 h after administration. It is metabolized by
the gut and liver.
12. • The various advantages associated with the use of
buprenorphine are that it has a longer duration of analgesic
action, low addiction propensity, and a high therapeutic
index. The adverse effects associated with it include
sedation, nausea, itching, constipation, addiction in higher
doses, confusion, hallucinations, dry mouth, blurred vision,
and respiratory depression with the overdose of drug.
• The purpose of the study was to compare the efficacy of
0.5% bupivacaine versus 0.5% bupivacaine with
buprenorphine in providing prolonged postoperative
analgesia during various minor oral surgical procedures.
13. PATIENTS AND METHODS
• Fifty healthy adult patients who reported to the department of
oral and maxillofacial surgery requiring minor oral surgical
procedures were included in this study.
• Various minor surgical procedures included incision and
drainage of abscess, removal of impacted third molars,
apicoectomy, neurectomy, surgical extraction of teeth, cyst
enucleation, and fracture reduction and fixation under local
anesthesia.
• Informed consent was obtained from each patient.
14. EXCLUSION CRITERIA
• Patients with a history of uncontrolled medical illness,
• Sensitivity to local anesthesia,
• Tolerance or addiction to analgesic drugs,
• Pregnancy,
• Bleeding disorders,
• Chronic obstructive pulmonary disease,
• Neurologic, psychiatric illness,
• Positive drug abuse history.
15. TREATMENT GROUPS
2 Equal Treatment group by randomization method.
GROUP 1- (25 PATIENTS)- Intraoral nerve blocks with 0.5%
bupivacaine with 1:200000 epinephrine.
GROUP 2- (25 PATIENTS)- same blocks using the mixture of 39
ml of 0.5% bupivacaine with 1:200,000 epinephrine and 1 ml of
300 microgram buprenorphine (3 μg/kg).
Analgesics were prescribed postoperatively only when the
patient began to complaint of pain.
The prescribed analgesic was tablet ketorol 10 mg.
16. ASSESMENT
1. Total volume of anesthetic solution used during the
surgery (in ml)
2. Onset of action of anesthetic agent: The onset of
anesthesia was determined by evaluating the subjective
and objective symptoms of anesthesia of the respective
nerve block used
3. Duration of surgery after anesthetic administration (in
minutes): The duration of surgery corresponded to the
period between the first incision and the last suture
4. Duration of anesthesia (in minutes): The duration of
anesthesia was determined as the time from onset of
anesthesia to the time when symptoms of anesthesia
17. 5. Duration of postoperative analgesia (in minutes): The
duration of postoperative analgesia was taken as the time
from the end of surgery to the time for the need of first
analgesic medication.
6. Patients were observed for side effects such as sedation,
pruritus, nausea, vomiting, and respiratory depression.
7. Efficacy of postoperative analgesia: The efficacy of
analgesia was recorded with the aid of a 100 mm-length
visual analog scale (VAS) with the markings between:
a. 1–25: Mild pain
b. 26–50: Moderate pain
c. 51–75: Intense pain
d. 76–100: Unbearable pain
18. STATISTICAL ANALYSIS
The data obtained were subjected to statistical analysis and
expressed as mean ± standard deviation.
Unpaired t-test was used to analyze the data for the mean
volume of anesthetic solution, onset and duration of
anesthesia, postoperative analgesia, and duration of surgery
for both the groups.
Data for the percentage of patients taking postoperative
analgesics were analyzed using nonparametric Chi-square
test.
Mann–Whitney test was used for the evaluation of pain with
VAS because the data were not normally distributed, P <
19. RESULTS
29 (58%) male and
21 (42%) female
Mean age of patients was 27.60 years in
bupivacaine group and 27.50 years in
buprenorphine combination with bupivacaine
group
20.
21. RESULTS
Patients who had taken analgesic medication Evaluation of pain using visual analog scale
22.
23.
24. DISCUSSION
Pain may be described as an unpleasant sensory and
emotional experience associated with actual or potential
tissue damage.
Buprenorphine has been used for the treatment of acute
and chronic pain as a supplement to anesthesia for
behavior and psychiatric disorders and as a maintenance
medication for heroin dependence.
The postoperative analgesic effects of buprenorphine
25. Being a partial mu opioid agonist, buprenorphine has a
wider safety profile as compared to full mu agonists.
Further, the slow dissociation of buprenorphine from the
receptor may result in fewer signs and symptoms of opioid
withdrawal upon termination of buprenorphine therapy than
those which occur with full mu opioid agonists such as
morphine, heroin, and methadone.
Antagonist effects at the kappa receptors are associated
with limited spinal analgesia, dysphoria, and psychomimetic
effects.
Buprenorphine can be used by various routes in human
26. The pH of the tissue and pKa of drug are the most
important factors which affect the time of onset of
anesthesia.
The pKa defines the pH at which the ionized and
nonionized forms of a drug are in complete equilibrium,
that is, half of the drug is ionized.
Only the nonionized form of the local anesthetic can
diffuse across lipid nerve sheath and cell membrane.
pKa also reflects the proportion of local anesthetic that is
in a diffusible nonionized state and therefore contributes
greatly to the rate of onset of anesthesia.
The pKa values of commonly used local anesthetics are
greater than the normal tissue pH (approximately 7.4)
27. At normal tissue pH, the proportion of nonionized form
of bupivacaine is 20%; this contributes in part to slightly
slower onset of anesthesia with bupivacaine, particularly
for nerve block anesthesia.
In the present study, the mean value for time of onset as
referred to lip and tongue numbness and also on pinprick
test in bupivacaine group was 3.00 ± 1.08 and 7.28 ±
1.59 min, respectively, as compared to 2.92 ± 1.03 min
and 7.40 ± 1.93 min, respectively, in buprenorphine
combination group.
28. CONCLUSION
Buprenorphine in combination with 0.5%
bupivacaine group in comparison to 0.5%
bupivacaine group alone provided a longer duration
of postoperative analgesia and markedly decreased
the need for analgesic medication in postoperative
period.
Overall, buprenorphine is a highly effective
analgesic for the treatment of moderate-to-severe
pain. It has a unique pharmacological and
physiochemical profile allowing for relatively safe
29. Thus, buprenorphine can be used in
combination with bupivacaine for patients
undergoing minor oral surgical procedures to
provide postoperative analgesia for a longer
duration, but it should be used cautiously in
individuals with a past or current history of
substance abuse or dependence, as it produces
opioid-like subjective and physiologic effects
dependent on the dose and the route of
administration.
30. Effect of buprenorphine as an adjunct with plain local
anesthetic solution in supraclavicular brachial plexus block
on quality and duration of postoperative analgesia
Surekha Patil, Debasis Debata, and Sapna Sinha
Supraclavicular brachial plexus block is ideal for upper
limb surgical procedures. Buprenorphine, an agonist
antagonist opioid has been used as an adjunct to prolong
analgesia. We aimed to evaluate the quality and duration of
postoperative analgesia by addition of buprenorphine to
local anesthetic solution.
REVIEW OF LITERATURE
31. REVIEW OF LITERATURE
Lidocaine v bupivacaine in facial plastic surgery. A
clinical trial.
Maimon WN, Schuller DE.
The ideal local anesthetic agent for facial plastic surgery should have
rapid onset, good surgical anesthesia, and reasonably long duration.
The purpose of this prospective, randomized, double-blind study
was to compare 1% lidocaine hydrochloride with 1:200,000
epinephrine with 0.5% bupivacaine hydrochloride with 1:200,000
epinephrine, a newer, longer-acting local anesthetic, in different
facial operations. The results suggest that bupivacaine is an effective
and safe agent for these procedures.
32. CRITICAL EVALUATION
TITLE:-
Title is appropriate.
ABSRACT:-
Abstract is well structured.
INTRODUCTION:-
It describes aim of the study.
Null hypothesis is not mentioned.
It follows seminarist approach.
33. MATERIAL AND METHOD:-
Sample size is enough for come to an exact conclusion.
Duration of study is also sufficient to overcome a result.
Exclusion Criteria is also mentioned.
Informed consent was also taken.
RESULTS:-
Results in text match with the table.
Testing Methodology is mentioned.
Author has not mentioned about ADRs and toxicity of
drug.
DISCUSSION:-
• The points mentioned in material & method and results
are justified by discussion.
34. REFERENCES:-
References are well quoted in article.
Author followed Vancouver method for quoting
references.
Author has referred enough references for his study.
35. REFERENCES
1. Maimon WN, Schuller DE. Lidocaine vs. bupivacaine in facial plastic
surgery. A clinical trial. Arch Otolaryngol 1984;110:525-8.
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Editor's Notes
SD means quantity expressing by how much the members of group differ from mean value.
Unpaired t test means two different group. Chi-square test means to determine significant difference b/w expected n observed frequency.
Mann-whitney means non parametric test that is qualitative. P value reject or accept null hypothesis.
Null hypothesis by HO. It means no difference. It says that difference b/w group is purely by sampling error for eg by chance.