Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3

Pain Related Publications

3 Thiopental-Fentanyl versus Midazolam-Fentanyl for Emergency Department Procedural Sedation and Analgesia in Patients with Shoulder Dislocation and Distal Radial Fracture-Dislocation: A Randomized Double-Blind Controlled Trial

Authors: D. Farsi, Gh. Dokhtvasi, S. Abbasi, S. Shafiee Ardestani, E. Payani

Abstract:

Background and aim: It has not been well studied whether fentanyl-thiopental (FT) is effective and safe for PSA in orthopedic procedures in Emergency Department (ED). The aim of this trial was to evaluate the effectiveness of intravenous FT versus fentanyl-midazolam (FM) in patients who suffered from shoulder dislocation or distal radial fracture-dislocation. Methods: In this randomized double-blinded study, Seventy-six eligible patients were entered the study and randomly received intravenous FT or FM. The success rate, onset of action and recovery time, pain score, physicians’ satisfaction and adverse events were assessed and recorded by treating emergency physicians. The statistical analysis was intention to treat. Results: The success rate after administrating loading dose in FT group was significantly higher than FM group (71.7% vs. 48.9%, p=0.04); however, the ultimate unsuccessful rate after 3 doses of drugs in the FT group was higher than the FM group (3 to 1) but it did not reach to significant level (p=0.61). Despite near equal onset of action time in two study group (P=0.464), the recovery period in patients receiving FT was markedly shorter than FM group (P<0.001). The occurrence of adverse effects was low in both groups (p=0.31). Conclusion: PSA using FT is effective and appears to be safe for orthopedic procedures in the ED. Therefore, regarding the prompt onset of action, short recovery period of thiopental, it seems that this combination can be considered more for performing PSA in orthopedic procedures in ED.

Keywords: Pain, procedural sedation and analgesia, thiopental, fentanyl, midazolam, orthopedic procedure, Emergency Department

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2 Dynamic Balance, Pain and Functional Performance in Cruciate Retaining, Posterior Stabilized and Uni-Compartmental Knee Arthroplasty

Authors: Ahmed R. Z. Baghdadi, Amira A. A. Abdallah

Abstract:

Background: With the perceived pain and poor function experienced following knee arthroplasty, patients usually feel un-satisfied. Yet, a controversy still persists on the appropriate operative technique that doesn’t affect proprioception much.

Purpose: This study compared the effects of Cruciate Retaining (CR) and Posterior Stabilized (PS) total knee arthroplasty (TKA) and uni-compartmental knee arthroplasty (UKA) on dynamic balance, pain and functional performance following rehabilitation.

Methods: Fifteen patients with CRTKA (group I), fifteen with PSTKA (group II), fifteen with UKA (group III) and fifteen indicated for arthroplasty but weren’t operated on yet (group IV) participated in the study. The mean age was 54.53±3.44, 55.13±3.48, 52.8±1.93 and 55.33±2.32 years and BMI 35.7±3.03, 35.7±1.99, 35.6±1.88 and 35.73±1.03 kg/m2 for group I, II, III and IV respectively. The Berg Balance Scale (BBS), WOMAC pain subscale and Timed Up-and-Go (TUG) and Stair-Climbing (SC) tests were used for assessment. Assessments were conducted four and eight weeks pre- and post-operatively with the control group being assessed at the same time intervals. The post-operative rehabilitation involved hospitalization (1st week), home-based (2nd-4th weeks), and outpatient clinic (5th-8th weeks) programs.

Results: The Mixed design MANOVA revealed that group III had significantly higher BBS scores, and lower pain scores and TUG and SC time than groups I and II four and eight weeks post-operatively. In addition, group I had significantly lower pain scores and SC time compared with group II eight weeks post-operatively. Moreover, the BBS scores increased significantly and the pain scores and TUG and SC time decreased significantly eight weeks post-operatively compared with the three other assessments in group I, II and III with the opposite being true four weeks post-operatively.

Interpretation/Conclusion: CRTKA is preferable to PSTKA with UKA being generally superior to TKA, possibly due to the preserved human proprioceptors in the un-excised compartmental articular surface.

Keywords: Pain, dynamic balance, functional performance, knee arthroplasty

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1 Understanding Grip Choice and Comfort Whilst Hoovering

Authors: S.R.Kamat, A.Yoxall, C.Craig, M.J.Carré, J.Rowson

Abstract:

The hand is one of the essential parts of the body for carrying out Activities of Daily Living (ADLs). Individuals use their hands and fingers in everyday activities in the both the workplace and home. Hand-intensive tasks require diverse and sometimes extreme levels of exertion, depending on the action, movement or manipulation involved. The authors have undertaken several studies looking at grip choice and comfort. It is hoped that in providing improved understanding of discomfort during ADLs this will aid in the design of consumer products. Previous work by the authors outlined a methodology for calculating pain frequency and pain level for a range of tasks. From an online survey undertaken by the authors with regards manipulating objects during everyday tasks, tasks involving gripping were seen to produce the highest levels of pain and discomfort. Questioning of the participants showed that cleaning tasks were seen to be ADL's that produced the highest levels of discomfort, with women feeling higher levels of discomfort than men. This paper looks at the methodology for calculating pain frequency and pain level with particular regards to gripping activities. This methodology shows that activities such as mopping, sweeping and hoovering shows the highest numbers of pain frequency and pain level at 3112.5 frequency per month while the pain level per person doing this action was 0.78.The study then uses thin-film force sensors to analyze the force distribution in the hand whilst hoovering and compares this for differing grip styles and genders. Women were seen to have more of their hand under a higher pressure than men when undertaking hoovering. This suggests that women may feel greater discomfort than men since their hand is at a higher pressure more of the time.

Keywords: Pain, hovering, grip

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