orabase and Pain--Postoperative

The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block (SNRB) is called rebound pain.. The purpose of this study was to determine if sodium hyaluronate and carboxymethyl cellulose solution (HA-CMC sol) injection could reduce the occurrence of rebound pain at 3 days to 2 weeks after SNRB in patients with radiculopathy compared with injection with corticosteroids and local anesthetics alone.. Double blinded randomized controlled clinical trial.. A total of 44 patients (23 of 24 patients in the Guardix group and 21 of 24 patients in the control group) who finished the follow-up session were subjects of this study.. Patients were asked to write down their average VAS pain scores daily for 12 weeks. Functional outcomes were assessed by Oswestry Disability Index, Roland Morris Disability Questionnaire , and Short Form-36.. A cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of normal saline was used for the control group whereas a cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of HA-CMC solution was used for the G group. Study participants were randomized into one of two treatment regimens. They were followed up for 3 months.. VAS score at 2 weeks after the procedure was 4.19±1.32 in the control group, which was significantly (p<.05) higher than that (2.43±1.24) in the G group. VAS score at 6 weeks after the procedure was 4.00±1.23 in the control group and 3.22±1.45 in the G group, showing no significant (p=.077) difference between the two groups. There were no significant differences in functional outcomes at 6 or 12 weeks after the procedure.. Compared with conventional cocktail used for SNRB, addition of HA-CMC sol showed effective control of rebound pain at 3 days to 2 weeks after the procedure.

Topics: Adrenal Cortex Hormones; Adult; Anesthetics, Local; Bupivacaine; Carboxymethylcellulose Sodium; Double-Blind Method; Drug Combinations; Female; Humans; Hyaluronic Acid; Lidocaine; Male; Middle Aged; Nerve Block; Pain, Postoperative; Radiculopathy

Silver-containing carboxymethylcellulose fiber dressing (Aquacel®-Ag) has been used to treat burns and ulcers with a large amount of exudate. The aim of this investigation was to confirm whether Aquacel®-Ag has beneficial effects when it is used as nasal packing.. We included 44 patients who underwent bilateral endoscopic sinus surgery due to chronic rhino-sinusitis. Beschitin-F® or Aquacel®-Ag was packed postoperatively into the bilateral middle meatus. Patient's comfort was recorded using a VAS, as well as wound healing, postoperative bleeding and local infection. Postoperative-specific organisms were also evaluated from the removed packing materials located in the middle meatus when they were removed on the 4th day after surgery.. The scores for nasal obstruction and pain were not statistically different in each group. Postoperative bacteriologic studies indicated marked differences. Coagulase-negative staphylococci were predominant and potential pathogens were recovered in a few cases in the Aquacel®-Ag group. In contrast, potential pathogens, including Streptococcus pneumonia, Haemophilus influenza, and Gram-negative rods, were predominant in the Beschitin-F® group.. The results indicate that Aquacel®-Ag might contribute to hemostasis, wound healing, and patient comfort after endonasal surgery, similar to Beschitin-F®. Additionally, it may have advantages concerning the prevention of postoperative infection.

Topics: Adult; Bandages; Carboxymethylcellulose Sodium; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Pain, Postoperative; Paranasal Sinuses; Postoperative Care; Postoperative Hemorrhage; Rhinitis; Silver Compounds; Single-Blind Method; Sinusitis; Surgical Wound Infection; Treatment Outcome; Wound Healing

To evaluate the anti-adhesive and anti-inflammatory effects of sodium hyaluronate-carboxymethylcellulose (HA-CMC) in reducing postoperative pain after temporalis fascia harvest during tympanomastoid surgery.. Between January and December 2009, 27 patients underwent tympanoplasty and open cavity mastoidectomy involving the harvesting of temporalis fasciae (more than 3×4cm). At the end of surgery, patients were injected with 1.5g HA-CMC or normal saline around the fascia harvest area. Beginning immediately postoperatively and for 2 months after surgery, patients scored their pain in the temporal area on a visual analogue scale (VAS).. There were no significant postoperative complications, such as bleeding or hematoma, in either control group. VAS scores of both groups decreased over time and were negligible after 2 months. VAS scores of the HA-CMC and control groups differed significantly (p<0.001 by repeated measures ANOVA for all VAS scores).. HA-CMC can decrease immediate postoperative pain arising from tissue adhesion and inflammation, thus reducing postoperative mastication pain.

Topics: Adult; Aged; Analysis of Variance; Carboxymethylcellulose Sodium; Drug Carriers; Fascia; Female; Humans; Hyaluronic Acid; Male; Mastication; Mastoid; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies; Single-Blind Method; Tissue Adhesions; Transplant Donor Site; Tympanoplasty; Viscosupplements

A mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HA/CMC) has been shown to be effective for decreasing postoperative adhesions in various kinds of surgeries. We evaluated the clinical efficacy and safety of HA/CMC gel on the early postoperative range of motion and pain relief after total knee arthroplasty (TKA). Thirty one patients who underwent bilateral TKA as a single-stage procedure for primary osteoarthritis were included in the study. At the completion of surgery, among both knees, the HA/CMC gel was applied to one knee (the HA/CMC group) and HA/CMC gel was not applied to the other knee (the control group). The primary outcome measure was the early assessment of range of motion and the secondary outcome measures were the VAS pain scores and the number of complications in each group. Periarticular application of HA/CMC gel was safe without causing any wound problems or infection. However, local application of HA/CMC gel neither increased the range of motion nor reduced the pain during the early postoperative period of TKA.

Topics: Administration, Topical; Aged; Arthroplasty, Replacement, Knee; Carboxymethylcellulose Sodium; Drug Combinations; Female; Gels; Humans; Hyaluronic Acid; Knee Joint; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies; Range of Motion, Articular; Tissue Adhesions; Treatment Outcome

This randomized, open-label study evaluated Aquacel Ag Hydrofiber dressing with silver (HDS; ConvaTec, Skillman, NJ, USA) with an adherent or gelled protocol in the management of split-thickness donor sites.. HDS was the primary dressing in the adherent group (gauze as secondary covering) and gelled group (transparent film as secondary covering). Dressings were changed on study day 1 or 2 and study days 5 (optional), 10 (optional), and 14. The primary outcome was healing (>or=90% re-epithelialization) at study day 14.. Seventy subjects were treated (36 adherent, 34 gelled). By study day 14, 77% of donor sites had healed (67% adherent, 88% gelled). Pain scores decreased over time in both treatment groups. Investigators were "very satisfied" or "satisfied" with (adherent, gelled) time required to manage dressing change (89%, 79% of subjects), minimization of donor-site pain (64%, 82%), ease of application (97%, 94%), management of drainage (92%, 82%), ease of removal (77%, 85%), and ability of dressing to remain in place (69%, 76%). Thirty-nine (56%) subjects had adverse events, most commonly non-donor-site infection (11%) and gastrointestinal events (11%).. In this randomized, open-label study, HDS was well-tolerated, versatile, and effective in the management of split-thickness donor sites.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bandages; Carboxymethylcellulose Sodium; Child; Child, Preschool; Drug Carriers; Epithelium; Female; Humans; Male; Middle Aged; Pain, Postoperative; Silver Compounds; Skin Transplantation; Wound Healing; Wounds and Injuries; Young Adult

Functional endoscopic sinus surgery (FESS) has become the treatment of choice for patients with medically resistant chronic rhinosinusitis (CRS and nasal polyposis). Nasal packing is usually placed after the surgery to minimize mucosal bleeding and support the wound healing process. Both the packing itself and its removal are often associated with pain and discomfort.. To evaluate the effect of carboxymethylcellulose (CMC) nasal packing on patient comfort following FESS.. Forty consecutive patients underwent bilateral FESS. One side of the nasal cavity was packed with CMC (mesh or gel) and the opposite side was not packed, the sides having been randomly selected. Postoperatively, patients were given visual analog scales to rate nasal airway obstruction and headache/pressure separately for the right and left sides. They also rated sleep disturbance and general well-being.. No significant differences were found between the CMC-packed side and the unpacked side with regard to patient comfort. No significant differences were found between CMC mesh and CMC gel.. Based on the presented data concerning patient comfort, CMC appears to be an ideal packing material following FESS. However, there is no other study revealing an identical study design focusing on other resorbable packing material. As a consequence, other available resorbable packing material should be investigated to find the ideal packing material following FESS, if packing is required.

Topics: Adult; Aged; Biocompatible Materials; Carboxymethylcellulose Sodium; Double-Blind Method; Endoscopy; Female; Gels; Humans; Male; Middle Aged; Nasal Polyps; Pain, Postoperative; Postoperative Hemorrhage; Rhinitis; Sinusitis; Surgical Mesh

Our study compared Rapid Rhino (RR; Applied Therapeutic Ltd, Leicestershire, UK) and Merocel (Medtronic Xomed, Jacksonville, FL) nasal packing materials in endonasal septoplasty surgery in terms of postoperative patient comfort and reactionary bleeding.. Fifty-one patients underwent endonasal septoplasty. One nasal cavity was packed with Merocel packs and the RR pack was used for the other side. The pain and nasal fullness levels on each side were studied at 1 and 6 hours postoperatively. Pain level was also studied during the removal of the nasal packs on the second day. These levels were scored on the basis of a visual analogue scale (VAS) between 0 and 10. Reactionary bleeding after nasal pack removal was also recorded. The Wilcoxon test was used for statistical analysis of the VAS scores, and the McNemar test was used for comparison of bleeding levels after pack removal. A p value<.05 was considered to be statistically significant.. Minimal bleeding was noted in 15 patients following Merocel pack removal; however, no bleeding was seen following RR pack removal. Comparison of the VAS scores of pain and nasal fullness of each nasal pack at 1 and 6 hours postoperatively showed a statistically significant difference (p<.05). Similarly, comparison of the pain level for pack removal and bleeding after removal on the second postoperative day demonstrated a statistically significant difference (p<.05 and p=.001, respectively).. RR is more tolerable by patients than Merocel after septoplasty surgery. RR also has some advantages, namely, easy pack removal and less reactionary bleeding.

Topics: Adolescent; Adult; Carboxymethylcellulose Sodium; Epistaxis; Female; Formaldehyde; Hemostatics; Humans; Male; Middle Aged; Nasal Septum; Pain, Postoperative; Polyvinyl Alcohol; Polyvinyls; Postoperative Hemorrhage; Tampons, Surgical; Young Adult

Aim is to determine the efficacy and pain level associated with the use of dissolvable carboxymethyl cellulose (CMC) foam dressing in functional endoscopic sinus surgery (FESS) in adult patients. In the present prospective study, 60 patients with bilateral chronic rhinosinusitis were included. All patients underwent bilateral FESS. Thirty patients had both nasal cavities packed with dissolvable CMC foam (CMCF) and another 30 patients had their nasal cavities packed with routine nasal packing (RNP) in latex glove fingers. The haemostatic effect of the CMCF was assessed during the recovery period, and pain levels were recorded by the patients on a visual analogue scale 24 h after surgery. The prevalence of postoperative middle meatal synechia formation was assessed 1, 2, 4 and 8 weeks after the operation. Four (13.3%) of the patients packed with CMCF had primary postoperative bleeding during the recovery period and required additional dressing. Bleeding appeared in two (6.7%) patients packed with RNP. The mean level of pain was 0.962 (range 0-4) for patients packed with CMCF but was 5.5 (range 3-9) for patients packed with RNP. Four (6.7%) of 26 CMCF patients and 10 (35.7%) of 28 RNP patients developed a synechia in the middle meatus. We found that dissolvable CMC foam dressing is associated with very low levels of localised pain and with low levels of postoperative bleeding and synechia formation.

Topics: Administration, Intranasal; Adult; Aged; Bandages; Carboxymethylcellulose Sodium; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Pain, Postoperative; Prospective Studies; Rhinitis; Sinusitis; Young Adult

A consecutive, case series comparison.. To compare safety, long-term pain, and disability scores with and without use of carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel after microdiscectomy with interlaminectomy.. Patient outcomes after microdiscectomy for lumbar disc herniation are frequently complicated by adhesions and fibrotic scars. Present management is controlled by good surgical technique as adhesion-reduction agents to date, have either proved ineffective or toxic. In 2002 a 100% synthetic combination of CMC/PEO, which reduces adhesions and fibrosis, became available across Europe as a gel application, (OXIPLEX/SP adhesion barrier gel FzioMed, Inc., San Luis Obispo, CA) and distributed under the trade names OXIPLEX/SP adhesion barrier gel (DePuy International, Ltd., Leeds, United Kingdom) and MEDISHIELD adhesion barrier gel (Medtronic International Trading SARL, Tolochenaz, Switzerland).. A consecutive series of 70 patients with lumbar disc herniation undergoing microdiscectomy with interlaminectomy by the same surgeon were treated at the end of surgery with either CMC/PEO gel (N = 35) or no gel (N = 35). Treatments were allocated by an independent investigator. At presurgery and regular intervals over 3 years postsurgery, Oswestry disability index (ODI) and leg and back pain scores determined by visual analog scales (VAS), were assessed by a member of the surgical team blinded to the initial treatment allocation.. Three years postsurgery reduction in disability as measured by the decrease in ODI compared with presurgery (mean +/- SD) was significantly (P < 0.05) greater with CMC/PEO than controls (-49.4 +/- 12.7 vs. -41 +/- 17.8). CMC/PEO treatment also resulted in significantly more patients having no disability as measured by reaching 0% ODI scores (15 CMC/PEO [43%] vs. 0 control group [0%]) (P < 0.01). Leg and back pain as measured by the decrease in VAS scores 3 years postsurgery were reduced with CMC/PEO compared with controls(leg -6.8 +/- 1.7 vs. -5.6 +/- 1.6, back -0.4 +/- 1.5 vs. -0.1 +/- 2.0), P < 0.05 for leg pain. Importantly there were no safety issues and no differences in complications between the 2 treatment groups during the 30 day postoperative period.. CMC/PEO gel after microdiscectomy with interlaminectomy appears safe to use and in a 3-year follow-up significantly reduces disability and leg pain scores compared with our conventional treatment.

Topics: Adult; Aged; Carboxymethylcellulose Sodium; Disability Evaluation; Diskectomy; Female; Follow-Up Studies; Gels; Humans; Intervertebral Disc Displacement; Laminectomy; Lumbar Vertebrae; Male; Microsurgery; Middle Aged; Pain, Postoperative; Polyethylene Glycols; Research Design; Time