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Efficacy of intraosseous saline injection for pain management during surgical removal of impacted mandibular third molars: a randomized double-blinded clinical trial

  • Jawahar Babu. S;Naveen Kumar Jayakumar;Pearlcid Siroraj
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.23 no.3
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    • pp.163-171
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    • 2023
  • Background: Surgical extraction of impacted mandibular third molars is the most common procedure performed by oral surgeons. The procedure cannot be performed effectively without achieving profound anesthesia. During this procedure, patients may feel pain during surgical bone removal (at the cancellous level) or during splitting and luxation of the tooth, despite administration of routine nerve blocks. Administration of intraosseous (IO) lignocaine injections during third molar surgeries to provide effective anesthesia for pain alleviation has been documented. However, whether the anesthetic effect of lignocaine is the only reason for pain alleviation when administered intraosseously remains unclear. This conundrum motivated us to assess the efficacy of IO normal saline versus lignocaine injections during surgical removal of impacted mandibular third molars. The aim of this study was to assess the efficacy of IO normal saline as a viable alternative or adjunct to lignocaine for alleviation of intraoperative pain during surgical removal of impacted mandibular third molars. Methods: This randomized, double-blind, interventional study included 160 patients who underwent surgical extraction of impacted mandibular third molars and experienced pain during surgical removal of the buccal bone or sectioning and luxation of the tooth. The participants were divided into two groups: the study group, which included patients who would receive IO saline injections, and the control group, which included patients who would receive IO lignocaine injections. Patients were asked to complete a visual analog pain scale (VAPS) at baseline and after receiving the IO injections. Results: Of the 160 patients included in this study, 80 received IO lignocaine (control group), whereas 80 received IO saline (study group) following randomization. The baseline VAPS score of the patients and controls was 5.71 ± 1.33 and 5.68 ± 1.21, respectively. The difference between the baseline VAPS scores of the two groups was not statistically significant (P > 0.05). The difference between the numbers of patients who experienced pain relief following administration of IO lignocaine (n=74) versus saline (n=69) was not statistically significant (P > 0.05). The difference between VAPS scores measured after IO injection in both groups was not statistically significant (P >0.05) (1.05 ± 1.20 for the control group vs. 1.72 ± 1.56 for the study group) Conclusion: The study demonstrates that IO injection of normal saline is as effective as lignocaine in alleviating pain during surgical removal of impacted mandibular third molars and can be used as an effective adjunct to conventional lignocaine injection.

A Study on Effects of the Fall Prevention in the Rehabilitation Pilates Exercise (노인의 재활 필라테스 운동이 낙상 예방 효과에 대한 고찰)

  • Ji-Sun Kim
    • Journal of the Korean Applied Science and Technology
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    • v.40 no.2
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    • pp.290-300
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    • 2023
  • This study was understood the risk mechanism of falls in the elderly and reviewed previous research data to see if the principle of Pilates rehabilitation exercise could have a positive effect on balance ability and postural stabilization in the elderly, and the purpose of this study is to present literature-based data on the fall prevention effect of rehabilitation Pilates exercise. First, the rehabilitation Pilates exercise makes it available for strengthening the center of the body to stabilize the spine and pelvis and stimulates the nerve root, thereby having an effect on the balance and the joint stabilization. Second, a proprioceptive sensory impairment and a musculoskeletal degenerative disease due to aging increase the loss of balance ability and the instability in posture maintenance, thereby coming to raise the risk of a fall damage caused by the difficulty in performing motor functions and by the gait disturbance. Third, the rehabilitation Pilates exercise leads to improving the core muscle strength in older adults, resulting in being capable of expecting the betterment in the balance and the reaction time motor function. And there is a positive impact on the improvement in body imbalance and on the stability in movement involved in the fall prevention, resulting in being able to suggest the possibility of likely contributing to a reduction in a fall risk rate. In conclusion, the rehabilitation Pilates as the elderly exercise program showed effects on the improvement in the body's muscular strength, on the upgrade in a sense of balance, and on the stabilization of core. Thus, it was considered to diminish the risk factors for a fall damage caused by musculoskeletal degeneration and to be capable of preventing a serious disorder of activity due to a chronic senile disease.

Comparison of the Effects of an Adductor Canal Block and Periarticular Multimodal Drug Local Injection on Pain after a Medial Opening High Tibial Osteotomy (내측 개방 근위 경골 절골술 후 통증 조절에서 관절 주위 다중 약물 국소 주사와 내전근관 차단술의 효과 비교)

  • Kim, Ok-Gul;Kim, Do-Hun;Seo, Seung-Suk;Lee, In-Seung
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.2
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    • pp.120-126
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    • 2019
  • Purpose: The efficacy of periarticular multimodal drug injection and adductor canal block after a medial opening-wedge high tibial osteotomy was compared in terms of the postoperative pain level. Materials and Methods: From November 2016 to March 2017, 60 patients underwent a medial opening-wedge high tibial osteotomy under spinal anesthesia. Preemptive analgesic medication, intravenous patient controlled anesthesia were used for pain control in all patients. Thirty patients received a periarticular multimodal drug injection (group I), and 30 patients received an adductor canal block (group II). These two groups were compared regarding the postoperative pain level, frequency of additional tramadol injections, total amount of patient-controlled analgesia, and number of times that the patients pushed the patient-controlled analgesia button at each time interval. Results: The visual analogue scale scores over the two-week postoperative period showed no statistical significance. The frequency of additional tramadol hydrochloride injections was similar in the two groups over time. The mean number of times that patients pushed the patient-controlled analgesia button was similar in two groups over time. The total amount of patient-controlled analgesia was similar in the two groups over time. Conclusion: This study shows that intraoperative periarticular multimodal drug injections and adductor canal block may have a similar effect on postoperative pain control in patients who have undergone a medial opening-wedge high tibial osteotomy for unicompartmental osteoarthritis of the knee.

Clinical Results of Subtotal Fasciectomy for Treatment of Dupuytren Contracture (아전 근막절제술을 이용한 듀피트렌 구축의 치료 결과)

  • Lee, Yoon-Min;Song, Seok-Whan;Kim, Yong-Woo;Choi, Jae-Hoon
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.4
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    • pp.353-360
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    • 2019
  • Purpose: In the treatment of Dupuytren's contracture, the aim of optical treatment is to lower the recurrence rate and reduce complications. This paper reports the results of subtotal fasciectomy in Dupuytren's contracture, extending the excision of palmar fascial structures from the diseased to normal appearing adjacent fascial structure. Materials and Methods: From 2007 to 2017, 45 patients with Dupuytren's contracture treated by subtotal fasciectomy were reviewed retrospectively. The mean follow-up period was 45.9 months. Ninety-two digits were involved (index: 2, middle: 10, ring: 44, little: 36). The predisposing factors and affected joint were reviewed and the preoperative and postoperative contracture was measured. For clinical results, quick disabilities of the arm, shoulder, and hand (quick DASH) were used. Complications, including wound or skin problems, nerve injuries, hematoma, and complex regional pain syndrome, were assessed. Results: Preoperative flexion contracture was 43.2° in the proximal interphalangeal joint and 32.9° in the metacarpophalangeal joint. In nine cases, patients had residual contracture of 9.7° (range, 5°-20°) on average and if the total number of cases were included, the mean residual contracture was 2.3° on average. The quick DASH score at the 12 months follow-up was 12.4. The overall complication rate was 26.6%. Conclusion: Subtotal fasciectomy can be a good surgical treatment option for Dupuytren's contracture with a low recurrence and low complication rate compared to other open procedures.

Minimally Invasive Lateral Lumbar Interbody Fusion: Indications, Outcomes and Complications (최소 침습적 외측 요추간 유합술: 적응증, 결과, 합병증)

  • Soh, Jaewan;Lee, Jae Chul
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.3
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    • pp.203-210
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    • 2019
  • The aim of this review was to evaluate minimally invasive lateral lumbar interbody fusion on the latest update. Lumbar interbody fusion was introduced recently. This study performed, a literature review of the indications, clinical outcomes, fusion rate, and complications regarding recently highlighted minimally invasive lateral lumbar interbody fusion. The indications of lateral lumbar interbody fusion are similar to the conventional anterior and posterior interbody fusion in degenerative lumbar diseases. In particular, lateral lumbar interbody fusion is an effective minimally invasive surgery in spinal stenosis, degenerative spondylolisthesis, degenerative adult deformity, degenerative disc disease and adjacent segment disease. In addition, the clinical outcomes and fusion rates of lateral lumbar interbody fusion are similar compared to conventional lumbar fusion. On the other hand, non-specific complications including hip flexor weakness, nerve injury, vascular injury, visceral injury, cage subsidence and pseudohernia have been reported. Lateral lumbar interbody fusion is a very useful minimally invasive surgery because it has advantages over conventional anterior and posterior interbody fusion without many of the disadvantages. Nevertheless, nonspecific complications during lateral lumbar interbody fusion procedure remain a challenge to be improved.

Elderly Sarcopenia and Vitamin B Deficiency: A Relationship? (비타민 B 결핍에 의한 노인성 근감소증)

  • Kisang Kwon;Hye-Jeong Jang;Sun-Nyoung Yu;Soon-Cheol Ahn;O-Yu Kwon
    • Journal of Life Science
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    • v.33 no.7
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    • pp.574-585
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    • 2023
  • Sarcopenia is a leading cause of increased medical and nursing care costs among the elderly. In Korea, preventive measures for sarcopenia are mostly targeted toward the general elderly population without specific diseases. However, it is also necessary to implement measures for elderly individuals living in nursing homes and hospitals, where the prevalence of sarcopenia is high. Currently, computed tomography and/or magnetic resonance imaging are considered standard diagnostic tools. However, their complexity and time-consuming nature make them unsuitable for clinical use. The exact pathophysiological mechanisms of sarcopenia are unclear, as they involve various molecular biological pathways, including decreased exercise, protein and nutrient intake, changes in testosterone and growth hormone, and inflammation. Sarcopenia symptoms can lead to several diseases, such as osteoporosis, fractures, dementia, diabetes, and cardiovascular disease. Vitamin B deficiency is a significant factor in sarcopenia induction, with B vitamins being directly involved in energy and protein metabolism and nerve function. Vitamin B deficiency can lead to neuromuscular and neurogenic disorders, which often overlap with sarcopenia. Suboptimal intake of B vitamins, malabsorption, and anorexia are common among the elderly. This study aims to provide information on the role of water-soluble B vitamins in preventing and controlling muscle mass loss and deterioration among the elderly with sarcopenia. In addition, we discuss the potential of myokines from the B vitamin family in modulating sarcopenia.

Comparative evaluation of photobiomodulation therapy at 660 and 810 nm wavelengths on the soft tissue local anesthesia reversal in pediatric dentistry: an in-vivo study

  • Ankita Annu;Sujatha Paranna;Anil T. Patil;Sandhyarani B.;Adhithi Prakash;Renuka Rajesh Bhurke
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.23 no.4
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    • pp.229-236
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    • 2023
  • Background: Local anesthesia has been reliably used to control pain during dental procedures and is important in pediatric dentistry. However, children occasionally complain of prolonged numbness after dental treatment, leading to several problems. Studies conducted to reverse the effect of local anesthesia using phentolamine mesylate and photobiomodulation therapy (PBM) are encouraging but limited. PBM is a type of light therapy that utilizes visible and near-infrared non-ionizing electromagnetic spectral light sources. Hence, this study used this modality to compare the reversal of local anesthesia at two different wavelengths. This study compared the effect of PBM at 660 and 810 nm wavelengths on the reversal of soft tissue local anesthesia using a diode LASER in pediatric dentistry. Method: Informed consent and assent were obtained, and the participants were then divided randomly into three groups of 20 children each: control group-without LASER irradiation, LASER irradiation at 660 nm, and LASER irradiation at 810 nm. Sixty children aged 4-8 years with deciduous mandibular molars indicated for pulp therapy were administered an inferior alveolar nerve block. After 45 min of injection, a duration that was similar to the approximate duration of treatment, they were exposed to 660- and 810-nm LASER irradiation according to their groups until reversal of local anesthesia was achieved. The control group did not undergo LASER irradiation. The reversal of the soft tissue local anesthetic effect was evaluated using palpation and pin prick tests every 15 min, and the LASER irradiation cycle continued until reversal of the soft tissue local anesthesia was achieved. Results: A significant reduction of 55.5 min (27.6%) in the mean soft tissue local anesthesia reversal time was observed after the application of 810 nm wavelength PBM and 69 min (34.7%) after 660 nm wavelength LASER irradiation. Conclusion: PBM with a 660 nm wavelength was more effective in reducing the mean soft tissue local anesthesia reversal duration, and thus can be used as a reversal agent for soft tissue local anesthesia in pediatric dentistry.

Comparison of the Effects on Balance Abilities in the Women Elderly with Application TENS versus Balance Training (TENS 적용과 균형운동이 여성노인의 균형능력에 미치는 효과 비교)

  • Lee, Seung Won;Lee, Wan Hee
    • 한국노년학
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    • v.30 no.3
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    • pp.993-1003
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    • 2010
  • his study was to investigate effects of improvement of balance abilities through 8-weeks Transcutaneous Electrical Nerve Stimulation (TENS) and balance training in the women elderly. 42 women elders who were participated in silver college. Randomized study design of two groups was used: TENS group (21 women, 84.53 years old) and balance training group(21 women, 79.93 years old). Each group had a application of TENS, balance training by a researcher three times per week for 8 weeks. Measurements of static postural sway velocity on the floor and foam, timed get up and go test (TUG), functional reach test (FRT), and lateral functional reach test (LFRT) were evaluated at initial presentation (pretest) and after completion of the each intervention program (posttest). The results showed that the TUG was significantly decreased in all groups (p<.05) and the postural sway velocity using force plate in all conditions was significantly decreased in all groups (p<.05). FRT and LFRT were significantly increased in all groups (p<.05). There were significantly differences in TUG and postural sway velocity on the eye closed condition between two groups (p<.05). In conclusion, the application of TENS to older adults whose somatosensory were deteriorated was effective for improvement balance ability.

Voice therapy for pitch problems following thyroidectomy without laryngeal nerve injury (신경학적 손상이 없는 갑상선 술 후 음도문제의 음성치료)

  • Ji-sung Kim;Mi-jin Kim
    • Phonetics and Speech Sciences
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    • v.15 no.3
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    • pp.53-58
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    • 2023
  • After thyroidectomy, some patients who show normal vocal cord movement still complain of subjective voice problems, which could lead to a decrease in quality of life related to communication. This study aims to investigate the effectiveness of a newly designed voice therapy applying neck exercise and semi-occluded vocal tract exercise (SOVTE) to improve voice problems after thyroidectomy without neurological injury. For this purpose, voice therapy was randomly assigned to 10 women who received thyroidectomy. Acoustic analysis [fundamental frequency, jitter, shimmer, noise-to-harmonics ratio, min Voice Range Profile (VRP), max VRP, VRP] was performed before and after surgery and immediately after voice therapy to compare voice changes. The study showed a statistically significant increase in max VRP and VRP after voice therapy compared to before surgery. These results suggest that the voice therapy methods in this study effectively improve a major symptom of voice problems after thyroidectomy, specifically the reduction in the high-frequency range. However, this study was limited in the number of s participants and did not control for the type of surgery. Therefore, further research utilizing larger sample sizes and controlled variables is needed to investigate the long-term effects of voice therapy.

Thermal Comfort and the Physiological and Psychological Effects of Spending Time in Broad-Leaved Forests in Summers (여름철 활엽수림에서의 휴식이 온열환경 쾌적성 및 인체의 생리ᐧ심리적 반응에 미치는 영향)

  • Juhyeon Kim;Injoon Song;Choyun Kim;Dawou Joung;Yunjeong Yi;Bum-Jin Park;Chorong Song
    • Journal of Korean Society of Forest Science
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    • v.112 no.4
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    • pp.544-553
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    • 2023
  • The purpose of this study was to reveal the thermal comfort and physiological and psychological effects of spending time in broad-leaved forests in suumer. Thirty-one university students (with an average age of 21.4 ± 2.1 years) participated in the study, and a within-subjects experimental design methodology was used. The participants moved to an experimental site (with a crown closure of 76.6%) or a control site (25.9%), sat on a chair to eliminate the impact of movement, and rested for 5 minutes with closed eyes. At this time, thermal comfort, heart rate variability, heart rate, and forehead temperature were continuously measured. After that, blood pressure and pulse rate were measured, and a subjective evaluation was conducted. As a result, spending time at an experimental site showed a statistically significant decrease in the predicted mean vote and the percentage of dissatisfied values, enhancement of parasympathetic nerve activity, decrease of forehead temperature, diastolic blood pressure, heart rate, pulse rate, and improvement of personal thermal sensation (thermal sensation vote and comfort sensation vote). In conclusion, it was found that a forest with high crown closure reduces thermal stress and induces physiological and psychological relaxation.