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1.
Isha Kaul Ami Amin Marta Rosenberg Laura Rosenberg Walter J. Meyer 《Burns : journal of the International Society for Burn Injuries》2018,44(2):414-422
Introduction
Pruritis after burn is one of the most common chronic complaints in burn survivors. Pruritus is often indistinguishable from neuropathic pain. There is a paucity of studies reporting the use of gabapentin and pregabalin to treat both pruritus and neuropathic pain. The purpose of this current study is to explore and document the effect of gabapentin and pregabalin in children and adolescent burn survivors.Methods
A retrospective review of charts and pharmacy records of gabapentin and pregabalin dispensed to control pruritus and/or pain was conducted for burn survivors up to 20 years of age. Data collected included medication doses, age and weight of patients, presence of neuropathic pain and pruritus, reported response to medication, and side effects of these medications. 136 individuals who received gabapentin, pregabalin, or both medications are included in the study. 112 received only gabapentin, none received only pregabalin, and 24 received both. All results are documented in mean ± standard deviation (s.d.) dose/kg/day. 104 individuals experienced pruritus exclusively, two experienced neuropathic pain exclusively, and 30 experienced both. Use of medications was considered effective if the individuals reported pruritus or pain relief from the medication. The medication was considered safe if the individuals did not experience adverse side effects warranting discontinuation of the drugs. Medications were continued with dose adjustments if an individual reported minor side effects such as sedation or hyperactivity.Results
The average effective dose mg/kg/day for gabapentin and pregabalin was calculated for each of the three age groups (≤5 years, 6–12 years, and >12 years). The average effective dose of gabapentin was 23.9 ± 10.3 mg/kg/day for children ≤5 years, 27.0 ± 15.3 mg/kg/day for children 6–12 years, and 34.1 ± 15.7 mg/kg/day for children >12 years. The average effective dose of pregabalin was 6.5 ± 3.5 mg/kg/day for children 6–12 years and 4.7 ± 1.6 mg/kg/day for children >12 years. One 5-year-old child received 3.7 mg/kg/day of pregabalin. Note that for all patients in this study, pregabalin was added after an inadequate response to gabapentin. For individuals receiving both gabapentin and pregabalin, the maximum gabapentin failure dose for pruritus was 32.8 ± 18.0 mg/kg/day and for both pain and pruritus was 28.1 ± 18.3 mg/kg/day. For individuals treated with only gabapentin, 91.4% had an adequate response for pruritus, 100% for neuropathic pain, and 43.3% for both pruritus and pain. 100% of individuals treated with both gabapentin and pregabalin had an adequate response for pruritus and 88.2% had an adequate response for both pruritus and pain. Gabapentin was associated with hyperactivity in two individuals, and sedation in one individual. One individual reported nausea, vomiting, and headaches when taking both medications; this resolved when gabapentin was discontinued. One individual reported sedation while taking both medications.Conclusion
Gabapentin and pregabalin are effective in relieving pruritus and neuropathic pain in most burn survivors. In some instances, these medications can be given together. Few individuals reported side effects. 相似文献2.
Caroline Maloney Michelle Kallis Ibrahim Abd El-Shafy Aaron M. Lipskar John Hagen Michelle Kars 《Journal of pediatric surgery》2018,53(3):431-436
Introduction
Despite its minimally invasive approach, laparoscopic surgery can cause considerable pain. Regional analgesic techniques such as the rectus sheath block (RSB) offer improved pain management following elective umbilical hernia repair in the pediatric population. This effect has not been examined in laparoscopic single-incision surgery in children. We sought to compare the efficacy of bilateral ultrasound-guided RSB versus local anesthetic infiltration (LAI) in providing postoperative pain relief in pediatric single-incision transumbilical laparoscopic assisted appendectomy (TULA) with same-day discharge.Methods
We retrospectively reviewed 275 children, ages 4 to 17 years old, who underwent TULA for uncomplicated appendicitis in a single institution from August 2014 to July 2015. We compared those that received preincision bilateral RSB (n = 136) with those who received LAI (n = 139). The primary outcome was narcotic administration. Secondary outcomes included initial and mean scores, time from anesthesia induction to release, operative time, time to rescue dose of analgesic in the PACU and time to PACU discharge.Results
Total narcotic administration was significantly reduced in patients that underwent preincision RSB compared to those that received conventional LAI, with a mean of 0.112 mg/kg of morphine versus 0.290 mg/kg morphine (p < 0.0001). Patients undergoing RSB reported lower initial (0.38 vs. 2.38; p < 0.0001) and mean pain scores (1.26 vs. 1.77; p < 0.015). Time to rescue analgesia was prolonged in patients undergoing RSB compared to LAI (58.93 min vs. 41.56 min; p = 0.047).Conclusion
Preincision RSB for TULA in uncomplicated appendicitis in children is associated with decreased opioid consumption and lower pain scores compared with LAI. As the addition of this procedure only added 6.67 min to time under anesthesia, we feel that it is a viable option for postoperative pain control in pediatric single-incision laparoscopic surgery.Retrospective comparative study
LEVEL III EVIDENCE. 相似文献3.
Luciano A. Favorito Kleber M. Anderson Suelen F. Costa Waldemar S. Costa Francisco JB Sampaio 《Journal of pediatric surgery》2018,53(4):780-783
Objective
To analyze the structure of the cremaster in patients with retractile testis (RT), comparing the distribution of nerves, elastic system and muscles with patients having cryptorchidism and inguinal hernia (IH).Patients and methods
We studied 31 patients, 17 with RT (mean age = 5.17years); 9 with IH (mean age = 2.6) and 5 with cryptorchidism (mean age = 3). A cremaster biopsy was performed and submitted to routine histological processing and studied using histochemistry and immunohistochemistry. The samples were photographed under an Olympus BX51 microscope. The images were processed with the Image J software and the cremaster muscle structures were quantified. Means were compared statistically using ANOVA and the unpaired t-test (p < 0.05).Results
There were no differences (p = 0.08) in diameter of muscle fiber between the groups. The muscle fiber density differed between patients with RT and IH (p = 0.02): RT (mean = 17.71%, SD = 16.67), IH (mean = 38.06%, SD = 14) and cryptorchidism (mean = 21.47%, SD = 16.18). There was no difference (p = 0.07) in the density of elastic fibers in the three groups. We observed a lower concentration of cremaster nerves of patients with RT compared with IH (p = 0.0362): RT (mean = 1.72%, SD = 0.58), IH (mean = 3.28% SD = 0.94) and cryptorchidism (mean = 2.52%, SD = 0.53).Conclusions
Retractile testis is not a normal variant, and presented a similar cremaster muscle structure as in patients with cryptorchidism.Level of evidence
II; prospective comparative study. 相似文献4.
Sevgi Buyukbese Sarsu Aydin Budeyri 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1210-1227
Introduction
Previously, the majority of wars were fought on remote battlefields between opposing armies due to conflicts preventing civilians from sustaining war-related burn injuries (WRBI). In recent years, WRBI has had a tremendous harmful impact on the pediatric population.This study aimed to investigate the demographics, causes, mechanisms of burns, surgical procedures, the major and minor risk factors affecting mortality, and outcomes of pediatric WRBI amidst the Syrian refugees and the Turkey neighborhood population, treated at our Burn Center.Methods
Out of the 852 filled records, the retrospective cohort was performed with inclusion of 707 pediatric burn patients, 469 Turkey, and 238 Syrian participants, with age 0–17 years. Included in the study were patients admitted to our institution from December 2013 to May 2016, with at least 12 months of consistent follow-up. Independent variables of each patient collected data included age, gender, weight, ethnicity, locations patients coming from, season and reason of burn, type of burn, grade of burn, burnt body regions, total body surface area (TBSA), body surface area (BSA), burnt surface area (BuSA), time delay until admission, and presence of infection at time of admission. The dependent variables were hospitalization periods, surgical procedures of escharotomy, fasciotomy, and grafting, recorded final patient status, and mortality.Results
Syrian children with WRBI (direct-blastic, indirect-unintentional) suffered from higher BSA (mean = 0.91 m2, p = 0.001) than the Turkish children with non-intentional burns (0.89 m2, p = 0.001), P = 0.001. There was a significant relationship between causes of burns, such as hot liquids, fire/flames and blastic injuries among the Syrian (52.9%, 27.3%, p = 0.000) and the Turkish (86.4%, 7.6% P = 0.000) populations, respectively. Although most of the Turkey residents suffered more from hot liquid burns than the Syrians (86.4% vs 52.9%), the majority of mortality occurred with fire/flames and blastic injuries, which was higher among the Syrians (10.10%, p = 0.001) than the Turkish (2.80% p = 0.001). Mortality corresponded with complex and third-degree burns, ranking higher in the Syrian (100%) than in the Turkish (23.3%), which, in turn, related to hospital length of stay (Syrian mean: 9.79, p = 0.001; Turkish mean: 7.83, p = 0.839).Conclusion
Our analysis showed that flame/fire and blast burns were severe and fatal in more pediatric Syrian victims than the Turkey residents due to the severity of war inflicted burned wounds, the living conditions at the refugee camps, and the tent cities. Our present study is significant as our data would alert authorities to predict pediatric WRBI risk factors, burn survivals and casualties, and thus plan strategies to promote training programs for burn management of two distinct populations to reduce risk factors of burn mortality. Burnt surface area (BuSA) is a new parameter we derived to predict mortality risk factors in WRBI. 相似文献5.
Mathieu Fontaine Jacques Latarjet Jacqueline Payre Jean-Charles Poupelin François Ravat 《Burns : journal of the International Society for Burn Injuries》2017,43(2):337-342
Introduction
The severe pain related to repeated burn dressing changes at bedside is often difficult to manage. However these dressings can be performed at bedside on spontaneously breathing non-intubated patients using powerful intravenous opioids with a quick onset and a short duration of action such as alfentanil. The purpose of this study is to demonstrate the efficacy and safety of the protocol which is used in our burn unit for pain control during burn dressing changes.Patients and methods
Cohort study began after favorable opinion from local ethic committee has been collected. Patient’s informed consent was collected. No fasting was required. Vital signs for patients were continuously monitored (non-invasive blood pressure, ECG monitoring, cutaneous oxygen saturation, respiratory rate) all over the process. Boluses of 500 (±250) mcg IV alfentanil were administered. A continuous infusion was added in case of insufficient analgesia. Adverse reactions were collected and pain intensity was measured throughout the dressing using a ten step verbal rating scale (VRS) ranging from 0 (no pain) to 10 (worst pain conceivable).Results
100 dressings (35 patients) were analyzed. Median age was 45 years and median burned area 10%. We observed 3 blood pressure drops, 5 oxygen desaturations (treated with stimulation without the necessity of ventilatory support) and one episode of nausea. Most of the patients (87%) were totally conscious during the dressing and 13% were awakened by verbal stimulation. Median total dose of alfentanil used was 2000 μg for a median duration of 35 min. Pain scores during the procedure were low or moderate (VRS mean = 2.0 and maximal VRS = 5). Median satisfaction collected 2 h after the dressing was 10 on a ten step scale.Conclusion
Pain control with intravenous alfentanil alone is efficient and appears safe for most burn bedside repeated dressings in hospitalized patients. It achieves satisfactory analgesia during and after the procedure. It is now our standard analgesic method to provide repeated bedside dressings changes for burned patients. 相似文献6.
7.
P. Ault A. Plaza J. Paratz 《Burns : journal of the International Society for Burn Injuries》2018,44(1):24-38
Background
Scar massage is used in burn units globally to improve functional and cosmetic outcomes of hypertrophic scarring following a burn, however, the evidence to support this therapy is unknown.Objective
To review the literature and assess the efficacy of scar massage in hypertrophic burn scars.Methods
MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library were searched using the key words “burn”, “burn injury”, “thermal injury” and “scar”, “hypertrophic scar” and “massage”, “manipulation”, “soft tissue mobilisation”, “soft tissue manipulation”. The articles were scored by the assessors using the Physiotherapy Evidence Database (PEDro) scale and outcome measures on range of motion (ROM), cosmesis (vascularity, pliability, height), pain scores, pruritus, and psychological measures of depression and anxiety were extracted.Results
Eight publications were included in the review with 258 human participants and 15 animal subjects who received scar massage following a thermal injury resulting in hypertrophic scarring. Outcome measures that demonstrated that scar massage was effective included scar thickness as measured with ultrasonography (p = 0.001; g = ?0.512); depression (Centre for Epidemiologic Studies — Depression [CES-D]) (p = 0.031; g = ?0.555); pain as measured with Visual Analogue Scale (VAS) (p = 0.000; g = ?1.133) and scar characteristics including vascularity (p = 0.000; g = ?1.837), pliability (p = 0.000; g = ?1.270) and scar height (p = 0.000; g = ?2.054). Outcome measures that trended towards significance included a decrease in pruritus (p = 0.095; g = ?1.157).Conclusions
It appears that there is preliminary evidence to suggest that scar massage may be effective to decrease scar height, vascularity, pliability, pain, pruritus and depression in hypertrophic burns scaring. This review reflects the poor quality of evidence and lack of consistent and valid scar assessment tools. Controlled, clinical trials are needed to develop evidence-based guidelines for scar massage in hypertrophic burns scarring. 相似文献8.
Serge Perrot Anne-Priscille Trouvin Virginie Rondeau Isabelle Chartier Rosine Arnaud Jean-Yves Milon Denis Pouchain 《Joint, bone, spine : revue du rhumatisme》2018,85(1):101-107
Introduction
Physical therapy (PT) represents a major approach in musculoskeletal (MSK) pain. This study aimed to assess kinesiophobia, its impact and management, in patients with MSK pain treated by PT.Methods
A national multicenter, prospective study was conducted in France in patients with MSK pain referred to PT. Kinesiophobia was scored with the Tampa Scale of Kinesiophobia (TSK). Pain, satisfaction, analgesic intake and acceptability were assessed at the initial visit, at the 5th PT session, and at the end of PT.Results
A total of 700 consecutive outpatients with MSK pain, 54.5% female, referred to PT were recruited by 186 GPs: 501 had significant levels of kinesiophobia (TSK score > 40). Patients with kinesiophobia were significantly older, with less physical activity, more pain and less acceptability. Patients from GPs presenting with kinesiophobia had both higher pain and kinesiophobia levels. After 5 PT sessions, global satisfaction was significantly higher in patients without kinesiophobia. A significant increase of PT satisfaction was observed in patients who had been given preventive analgesics before PT sessions, in 25.6% of patients. Independent predictors for specific management of PT-induced pain were: patient's kinesiophobia (OR = 2.02 [1.07–3.82]), current analgesics treatment (OR = 2.05 [1.16–3.63]), GP with postgraduate course on pain (OR = 2.65 [1.29–5.43]), GP's independent practice (OR = 1.88 [1.01–3.48]).Conclusion
Kinesiophobia is frequent in patients with MSK pain, is associated to GPs’ kinesiophobia and decreases satisfaction of physical therapy. Preventive analgesic treatment before PT sessions improves patients’ satisfaction and should be proposed to improve MSK pain management. 相似文献9.
Fardin Ajoudani Madineh Jasemi Mojgan Lotfi 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1141-1150
Introduction
Psychosocial outcomes of burn survivors in the first year of rehabilitation are not well studied. Considering the interrelationships among psychosocial processes in burn survivors, we assessed three psychosocial variables (i.e., social support, social participation, and body image) simultaneously in a longitudinal study.Aims
This study aimed at identifying the developmental trajectory of the main study variables and also discovering the causal pathways between social support, body image, and social participation of burn survivors in the first year of rehabilitation.Methods
One hundred individuals were enrolled in the study. The analysis was based on three waves of data collected at the time of discharge, 6 months after discharge, and 12 months after discharge. We used MSPSS, SWAP, and the p-scale for measuring the variables social support, body image, and social participation, respectively. A repeated-measures analysis of variance (ANOVA) was performed to identify the major differences in the mean levels of the main study variables across the three evaluation times. A structural equation modeling (SEM) approach was implemented in four hypothesized cross-lagged models (M1, M2, M3, and M4) to evaluate the bidirectional relationships among the main variables. All hypothesized models were tested, and their goodness-of-fit indexes were compared to identify the best fitting model.Results
All three main variables worsen during the first six months after burn and then do not return to their earlier level. The M4 (final model) chosen to represent the data showed the best goodness-of-fit indexes (χ2 (9) = 51.76, p < .01, RMSEA = 0.060, IFI = 0.97, and CFI = 0.98) among all hypothesized models. The effect of social participation on body image, and vice versa, seems to be relatively constant and steady. Social support at the time of discharge predicted social participation at 12 months after burn, with the relationship mediated by body image at 6 months after burn.Conclusion
Our study findings suggest that persistent care should be provided for burn survivors even after discharge. 相似文献10.
Sinem Sari Betul Kozanhan Ayse Ilksen Egilmez Aykut Soyder Osman Nuri Aydin Fabrizio Galimberti Daniel Sessler Alparslan Turan 《Brazilian Journal of Anesthesiology》2018,68(3):231-237
Background and objectives
Fluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively.Methods
127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post‐anesthesia care unit and every 4 h in the first 24 h. Adverse effects were questioned every 4 h. Time to oral intake and ambulation were recorded. Post‐surgical pain, hospital anxiety, depression scale, SF‐12 questionnaire were evaluated at 1 and 3 month visits.Results
There was no difference in acute pain scores and analgesic consumption through the 24 h period, Visual Analog Scale at 24 h was 1.5 ± 1.5 cm for follicular group 1.4 ± 1.7 cm for luteal group (p = 0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6 ± 0.7 cm and 1.8 ± 0.8 cm for follicular group and 2.7 ± 1.3 cm and 2.9 ± 1.7 cm in the luteal group (p = 0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF‐12 scores at either time. Nausea was more common in follicular‐phase group (p = 0.01) and oral feeding time was shorter in follicular phase (5.9 ± 0.9 h) than in luteal phase (6.8 ± 1.9 h, p = 0.02).Conclusions
Although persistent postoperative pain was significantly more common one and three months after surgery the magnitude of the pain was low. Our results do not support scheduling operations to target particular phases of the menstrual cycle. 相似文献11.
Clifford C. Sheckter Harriet Kiwanuka Zeshaan Maan Elizabeth Pirrotta Catherine Curtin Nancy E. Wang 《Burns : journal of the International Society for Burn Injuries》2019,45(1):165-172
Introduction
Innovations in topical burn treatment along with a drive toward value-based care are steering burn care to the outpatient setting. Little is known regarding what characteristics predict outpatient treatment of pediatric minor burns and whether there is a temporal trend toward this treatment paradigm.Methods
A retrospective cohort study was performed using California’s Office of Statewide Health Planning and Development linked emergency department and inpatient database (2005–2013). All patients under 18 years of age with a primary burn diagnosis were extracted. Using patient and facility level variables, we used regression modeling to evaluate predictors of outpatient burn treatment and temporal trends.Results
There were 16,480 pediatric minor burn encounters during the period. 56.4% were male, 85.3% had <10% total body surface area (TBSA), 76.3% were scald or contact, and 77.3% were at deepest depth 2nd degree. Multiple variables predicted an increased likelihood of discharge home including older age(p < 0.001), smaller TBSA(p < 0.001), and superficial/partial thickness burns(<?0.001). Children of Hispanic and Black race were less likely to be discharged home compared to White and Asian peers(p = <0.001). On Poisson modeling, the incidence rate ratio over the 9-year period for home discharge was 1.004 (95% CI 1.001–1.008, p = 0.032).Conclusion
Older patients and those with more superficial burns were more likely to be treated as outpatients. Black and non-white Hispanic race was associated with inpatient admission. There is a growing trend toward ambulatory treatment of minor burns in the pediatric population. Further research is needed to assess whether outpatient treatment of pediatric minor burns results in greater readmissions. 相似文献12.
Michael Scheffler Susan Koranyi Winfried Meissner Bernhard Strauß Jenny Rosendahl 《Burns : journal of the International Society for Burn Injuries》2018,44(7)
The aim of the present meta-analysis was to investigate the efficacy of non-pharmacological interventions for procedural pain relief in adults undergoing burn wound care compared to standard care alone or an attention control.Through a comprehensive literature search in various electronic databases 21 eligible randomized controlled trials (RCTs) were included, comprising a total of 660 patients. Random effects meta-analyses revealed significant positive treatment effects on pain outcomes, Hedges’ g = 0.58, 95% CI [0.33; 0.84]. Heterogeneity of study effects was substantial, I2 = 72%. Effects were significantly larger for comparisons against treatment as usual (TAU), g = 0.69, CI 95% [0.40; 0.98] than for comparisons against attention control groups, g = 0.21 [?0.11; 0.54], p < 0.001. Distraction interventions, particularly those using virtual reality, and hypnosis revealed the largest effects on pain relief. Non-pharmacological interventions further resulted in a significant small, homogeneous effect on anxiety reduction, g = 0.36 [0.20; 0.52].In summary, benefits of non-pharmacological interventions on procedural pain relief and reduction of mental distress were demonstrated. Results have been proven to be free of publication bias. However, further high quality trials are needed to strengthen the promising evidence. 相似文献
13.
Tessa Garside Fiona M. Wood Ann-Maree Vallence 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1195-1202
Objective
The study aimed to investigate intracortical inhibition following a burn injury, and to establish transcranial magnetic stimulation (TMS) as a useful and sensitive tool to investigate the cortical response to a burn injury.Methods
Thirteen burn injured patients and 12 uninjured subjects underwent TMS to measure the cortical silent period (cSP), a marker of intracortical inhibition.Results
In burn injury patients, cSP was similar in the burn-injured and less-injured arm (133 and 132 ms respectively; p = 0.96). cSP was numerically shorter in burns patients than control subjects, however, these differences were not statistically significant (133 vs 148 ms, p = 0.24). Subgroup analysis revealed cSP was shorter in the burn arm of patients compared to the uninjured control subjects in patients with upper-limb burn (cSP 120 ms vs 148 ms, p = 0.03), those with <10% TBSA (cSP 120 ms vs 148 ms, p = 0.01), those <2 years’ post-burn (cSP 110 ms vs 148 ms, p = 0.01), and patients with partial thickness burns (cSP 120 ms vs 148 ms, p = 0.02).Conclusions
These results demonstrate significantly shorter cSP in the burned arm in patients with upper limb burn sustained <2 years ago, those with partial thickness burns, those with upper limb burns only, and those with burns of less than 10% TBSA. The results are consistent with the existing literature, which demonstrates a reduction in cSP duration in patients with a range of peripheral nerve injuries. There is a strong suggestion that cortical inhibition is altered following burn injury, and that TMS is a useful and sensitive method for investigating changes in cortical inhibition in burn patients. 相似文献14.
Background and objectives
Gabapentin is an antiepileptic drug. Widely used for the management of neuropathic pain. Although it is known to be well tolerated, somnolence and dizziness are the most frequent adverse effects. In this study, we aimed to evaluate the effect of melatonin on daytime sleepiness side effect of gabapentin, sleep quality and pain intensity of patients with neuropathic pain.Methods
Patients suffering from “neuropathic pain” and planed to receive gabapentin therapy were randomly divided into two groups. Group 1 received melatonin 3 mg and gabapentin 900 mg orally, group 2 received matching placebo capsule and gabapentin 900 mg. The Epworth Sleepiness Scale, the Pittsburgh sleep quality index for assessment of sleep quality and Verbal Rating Scale were completed at the 0 th, 10th and 30th days of treatment. Additive analgesic drug requirements were recorded.Results
Eighty patients were enrolled to the study; age, gender, ratio of additive analgesic consumption, baseline Epworth Sleepiness Scale, Pittsburg Sleep Quality index and Verbal Rating Scale scores were similar between the groups. Epworth Sleepiness Scale scores, Pittsburgh sleep quality index scores and Verbal Rating Scale scores in Group 1 were significantly lower than group 2 at the 10th day of treatment (p = 0.002, p = 0.003, p = 0.002 respectively). At the 30th day of treatment, Epworth Sleepiness Scale scores and Verbal Rating Scale scores were significantly lower in Group 1 (p = 0.002, p = 0.008 respectively). However, Pittsburgh sleep quality index scores did not significantly differ between the groups (p = 0.0566).Conclusions
Melatonin supplementation rapidly and significantly improved daytime sleepiness side‐effect of gabapentin, however sleep quality of the patients with neuropathic pain was similar between groups. 相似文献15.
Ashish Nagpal Melissa-Moore Clingenpeel Rajan K. Thakkar Renata Fabia Jeffrey Lutmer 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1308-1316
Objective
To determine the association between fluid resuscitation volume following pediatric burn injury and impact on outcomes.Methods
A retrospective chart review of pediatric patients (0–18 years) sustaining ≥15% TBSA burn, admitted to an American Burn Association verified pediatric burn center from 2010 to 2015.Results
Twenty-seven patients met inclusion criteria and had complete data available for analysis. Fifteen (56%) patients received greater than 6 ml/kg/total body surface area burn in first 24 h and twelve (44%) patients received less than 6 ml/kg/percent total body surface area burn in first 24 h. There were no differences between groups in median number of mechanical ventilator days (4 vs 8, p = 0.96), intensive care unit length of stay (10 vs 13.5, p = 0.75), or hospital length of stay (37 vs 37.5, p = 0.56). Secondary analysis revealed that patients with a higher mean cumulative fluid overload (>253 ml/kg, n = 16) had larger burn size, higher injury severity scores, and were more likely to receive mechanical ventilation and invasive support devices. Controlling for burn size, odds of longer PICU length of stay and duration of mechanical ventilation were 20.33 [95% CI (1.7–235.6) p = 0.02] and 27.9 [95% CI (2.1–364.7) p = 0.01], respectively, among patients with a high cumulative fluid overload on day 3 compared to low cumulative fluid overload.Conclusions
Resuscitation volume in the first 24 h was not associated with adverse outcomes. Persistent cumulative fluid overload at day 3 and beyond was independently associated with adverse outcomes. 相似文献16.
Muhammad Mustehsan Bashir Muhammad Sohail Ahmad Wahab Umar Iqbal Rehan Qayyum Saadia Nosheen Jan 《Burns : journal of the International Society for Burn Injuries》2018,44(3):678-682
Objective
To compare the clinical outcomes of release of flexion contractures after burn of the hand in children using tourniquet or tumescent technique in terms of operative time, postoperative pain score, and percentage of graft take.Methods
Patients aged 3 to 12 years who required release of post-burn flexion contractures involving volar aspect of palm and fingers were enrolled from outpatient clinic. Patients were randomized in 1:1 ratio to the use of either tumescent technique or tourniquet during contracture release. Duration of procedure, postoperative pain score, percentage of graft take, and any complications were assessed and analyzed in both groups by a blinded observer.Results
Of the 160 patients randomized in the study (80 in each group), 84 (52.5%) were males. The mean ± SD age of participants was 7.84 ± 3.49 years, with no statistically significant difference in gender and age distribution between the groups. Similarly, there was no statistically significant difference in duration of surgery in both groups. However, there was a statistically significant difference in percentage of graft take at the 14th postoperative day; significantly more graft take was noted in the tumescent group (8.97 ± 3.7 cm vs. 7.26 ± 2.6 cm; P = 0.001). Mean analgesia consumed in the tumescent group was significantly less than that of the tourniquet group (6.26 ± 1.9 mg vs. 9.41 ± 2.2 mg; P ≤ 0.001). Similarly, statistically significant difference in the mean FLACC pain score was noted, with remarkably low pain score in the tumescent group.Conclusion
We found that the use of the tumescent technique for the release of flexion contracture resulted in better graft take, lower pain scores, and lesser consumption of analgesic than the use of tourniquet. 相似文献17.
《Journal of Clinical Orthopaedics and Trauma》2019,10(1):81-86
Continuous femoral nerve block (CFNB) has been used to prevent the breakthrough pain after total knee arthroplasty (TKA). Multimodal drug injection (PMDI) has also been shown to decrease opioid consumption and pain. We investigated whether the use of PMDI further improves analgesic and rehabilitation outcomes when used in conjunction with CFNB. This is a prospective randomized controlled study of 44 patients undergoing primary TKA. The treatment group (n = 23) received a PMDI of combined ropivacaine, epinephrine, ketorolac and morphine, and the controlled group (n = 21) received saline at wound closure. Total opioid consumption, pain scores, knee range of motion (ROM) outcomes, length of stay, and patient satisfaction were measured and compared. The total consumption of morphine is similar between the two groups (52.6 ± 40.6 vs. 41.5 ± 32.9, p = 0.325). The mean morphine consumption of the treatment group was significantly lower than the control at 4 h after surgery (4.2 ± 5.5 vs. 11.3 ± 8.1, p = 0.002) but comparable on POD1, POD2, and POD3. The mean pain scores were significantly higher in the treatment group than the control group at POD2 (at rest: 47.3 ± 29.1 vs. 23.8 ± 20.6, p = 0.004; after PT: 57.7 ± 25.4 vs. 35.2 ± 26.8, p = 0.007) and POD3 (at rest: 30.9 ± 30.3 vs. 14.8 ± 20.9, p = 0.045; after PT: 50.2 ± 30.6 vs. 29.0 ± 32.1, p = 0.035), and not significantly different at 4 h after surgery or at POD1. Mean maximal knee flexion ROM in degrees during active and active assisted mobilization showed no significant difference between the control and the treatment groups on POD2 and POD3. The mean length of stay of the treatment group is significantly longer than the control group (5.1 ± 2.1 vs. 3.8 ± 1.6, p = 0.032). At discharge, no significant difference exists between the two groups for mean patient satisfaction. The addition of PMDI led to a decrease in opioid consumption in the immediate postoperative period but with no significant difference in the total consumption within the first three days postoperatively. This finding provides an opportunity for appropriate preoperative treatment and education for both patients and caregivers. 相似文献
18.
Peter D. Drummond Linda F. Dawson Fiona M. Wood Mark W. Fear 《Burns : journal of the International Society for Burn Injuries》2018,44(3):582-588
Stimulation of α1-adrenoceptors evokes inflammatory cytokine production, boosts neurogenic inflammation and pain, and influences cellular migration and proliferation. Hence, these receptors may play a role both in normal and abnormal wound healing. To investigate this, the distribution of α1-adrenoceptors in skin biopsies of burn scars (N = 17), keloid scars (N = 12) and unscarred skin (N = 17) was assessed using immunohistochemistry. Staining intensity was greater on vascular smooth muscle in burn scars than in unscarred tissue, consistent with heightened expression of α1-adrenoceptors. In addition, expression of α1-adrenoceptors was greater on dermal nerve fibres, blood vessels and fibroblasts in keloid scars than in either burn scars or unscarred skin. These findings suggest that increased vascular expression of α1-adrenoceptors could alter circulatory dynamics both in burn and keloid scars. In addition, the augmented expression of α1-adrenoceptors in keloid tissue may contribute to processes that produce or maintain keloid scars, and might be a source of the uncomfortable sensations often associated with these scars. 相似文献
19.
Vetrichevvel Palanivelu Siaavash Maghami Hilary J. Wallace Dulharie Wijeratne Fiona M. Wood Mark W. Fear 《Burns : journal of the International Society for Burn Injuries》2018,44(7)
Burn scars can be associated with significant loss of cutaneous sensation, paresthesia and chronic pain. Long-term systemic changes in cutaneous innervation may contribute to these symptoms and dorsal root ganglia have been implicated in the development of chronic neuropathic pain. Therefore we hypothesized that changes in cutaneous innervation after burn injury may be mediated at the level of the dorsal root ganglia. Burn group rats (n = 20) were subjected to a unilateral burn injury while 12 control rats underwent sham procedure. The DRGs dermatomally related to the site of burn (Thoracic 13, lumbar 1 and lumbar 2), ipsilateral and contralateral to the injury, were compared for Type A, Type B and total cell number with sham control DRGs, at 4 and 6 weeks after injury. There was a significant decrease in Type A cell count (cell bodies of nerve fibres mediating touch-pressure-vibration sensation) in the 4 week time-point group (p = 0.0124) ipsilateral to the burn injury. Total DRG cell count and Type B DRG cell count (cell bodies of fibres mediating pain and itch) on the ipsilateral side was not significantly altered. On the side contralateral to the burn injury, there was no statistically significant change in the total cell count, Type A cell count or Type B cell count. This data showed a decrease in Type A cell number in DRGs after a burn injury, suggesting cell death may mediate some changes observed in cutaneous innervation after a burn. Type B cells constituted a greater proportion of the viable cell population in the ipsilateral DRG after a burn injury. This change may be important in the induction of signalling related to pain and itch and has important implications for the restoration of normal cutaneous innervation after burn injury. Investigating whether neuro-protective or neuro-restorative approaches can ameliorate damage to the DRG will be important to improve sensory outcomes for burn patients. 相似文献
20.
Jane E. Ashbrook Carol Shacklady Sue Johnson Gillian Yeowell Peter Charles Goodwin 《Journal of cystic fibrosis》2018,17(1):78-82