This study aimed to determine the effect of the use of a bipolar coagulator on postoperative pain and complications when used during connective tissue harvesting from the palate.A randomized controlled clinical trial was conducted with 57 sequential patients requiring a connective tissue graft for periodontal or implant surgery. All samples were harvested superficially and de‐epithelized outside the mouth. The patients were randomly allocated to two groups: in one group, the bipolar coagulator was used before suturing to control bleeding, and in the other group, the coagulator was not used. The surgeon was unaware of the randomization until the end of the harvesting phase. Self‐reported maximum pain, number of painkillers used, bleeding events, emergency visits at the clinic were recorded 7 days after surgery.2 , and the mean thickness of the samples was 2.47 mm . The mean self‐reported pain value on the visual analog scale was 3.37 , and the mean number of pain medications used was 7.1 . Seven patients made an emergency visit each, and 17 delayed bleeding events were reported by 15 patients. No statistically significant differences were reported in postoperative pain, postoperative bleeding, and emergency visit to the clinic between the groups that did and did not use the bipolar coagulator. When smoking habits were taken into consideration, the number of pain medications was higher among male smokers and older smokers than among male non‐smokers and younger smokers. This study was not able to find a relationship between harvested sample dimension or thickness and postoperative discomfort.Fifty patients were randomized and treated (seven were excluded for different reasons). The mean harvested area was 75.24 mmThe bipolar coagulator can be used during connective tissue harvesting from the palate to control bleeding without influencing postoperative pain. All the procedures were approved by the institutional review board of Salzano Tirone dental Clinic and were carried out in compliance with the ethical principles for medical research involving human participants, as stated in the Declaration of Helsinki. The present study was designed as an RCT and was conducted in private practices, run by a dentist who has been practicing oral surgery for more than 15 years (FT), located in northern Italy.This trial was reported according to the Consolidated Standard of Reporting Trials Statement , immunosuppressed or immunocompromised state, those who received radiotherapy to the head and neck area, those requiring bone augmentation procedures concomitant with implant placement, allergic to some of the drugs involved in the protocol, receiving antibiotic treatment for other reasons, treated or receiving treatment with intravenous amino‐bisphosphonates, affected by untreated periodontitis, full mouth plaque score and full mouth bleeding score >15, pregnant or lactating females, and age under 18 years.All patients were informed about the surgical procedures, postoperative follow‐ups, and potential complications, and informed consent was obtained before surgery. Data on smoking habits were acquired.One hour prior to surgery, the patients took a single antibiotic dose, consisting of 2 g of oral amoxicillin (two tablets of 1 g) and 10 drops of ketorolac. The mouth was rinsed for 1 min immediately prior to implant placement with 0.2% chlorhexidine gluconate mouthwash.CT harvesting was performed following the FGG harvesting approach as previously described by Zucchelli et al. . First, The patients were randomly allocated to one of two groups using a closed envelope to be opened after CT harvesting: Group A: bipolar coagulator was not used, and bleeding was managed with x sutures  and by fixing a collagen sheet over the donor site ; Group B: bipolar coagulator  was used in the inner part of the wound boundaries (power 40 W) until hemostasis was obtained before suturing; later, the same suturing technique was performed fixing a collagen sheet in the same way. In both groups, a wet gauze was pushed against the donor site for a few minutes during extraoral de‐epithelization of the graft.The dimensions of the sample were based on the requirement for recipient site. Before de‐epithelization, the sample was measured in millimeters with a periodontal probe, and the length, height, and width were recorded. The presence or absence of adipose yellow tissue was recorded as follows: no fat tissue, less than 50% of the inner surface of the sample covered by fat tissue, and more than 50% of the inner surface of the sample covered by fat tissue.Postoperative instructions and ice packs were provided to the patient immediately after surgery. The patients were instructed to rinse with 0.12% chlorhexidine gluconate twice daily for 15 days after surgery and to refrain from brushing the area of surgery for 2 weeks and were prescribed amoxicillin 1 g, twice a day, for 6 days and ketorolac for 3 days, if needed .The patients were given a diary to record the pain medication used and the occurrence of bleeding; the diary had to be signed and delivered at suture removal, 1 week after the surgical procedure. Before suture removal, the patients were asked to fill a visual analog scale (VAS) from 0 (no pain) to 10 (worst pain) to determine the maximum pain experienced during the first healing week. The outcome data were recorded by a blinded assessor (SS).Follow‐up visits were conducted at 1 week , 2 weeks, 1 month, and 2 months after surgery.Maximum pain experienced by the patient along the first week of healing, as recoded on the VAS 7 days after surgery.Number of pain medications used, excluding the “mandatory” one before surgery.The primary outcome measures were as follows:Reported delayed bleeding events from the donor site, described as prolonged hemorrhage after discharge, recorded as “yes” or “no.”Emergency access to dental practice.The secondary outcome measures were as follows:α = 0.05. An effect size of 0.87 was obtained using Cohen's table for two independent groups. As per the G‐Power software, the number of subjects required per group was 23.The sample size was difficult to estimate because of the lack of validated data on implant patients treated with these regimens. Therefore, to perform the calculation, we hypothesized a difference of two points in the VAS score between the groups as clinically important, with a power of 0.80 and A computer‐generated randomization list comprising 50 subjects was created. Only one external investigator, not involved in the study, was aware of the sequence and had access to the file. The randomized codes were enclosed in sequentially sealed envelopes, opened at the end of the CT withdrawal before suturing.U test was used. To analyze the effect of adipose tissue on VAS and number of pain medications used, Kruskal–Wallis test was applied, followed by Dunn's post‐hoc test. Then, the sample was stratified by gender  and by age . Binomial logistic regression was used to analyze the effect of coagulation treatment, smoking, fat, area, and thickness of the sample on emergency visits and bleeding.For data analysis, the following codes were defined: treatment , adipose tissue , smoke more than 5 cigarettes for day , emergency visit , and bleeding . Considering the results of the assumptions for the parametricity of data, non‐parametric tests were performed. To analyze the effect of bipolar coagulation treatment and smoking habit on VAS and the number of pain medications used, Mann–Whitney All analyses were conducted using GraphPad Prism (Version 6.0) and SPSS (Version 22.0).3Initially, 57 patients needing CTG for either periodontal or implant surgery were screened during the recruitment period. Six of these patients were not included . One patient refused to participate in this study. Figure Finally, 50 patients were randomized and treated. The follow‐up period was the time between implant placement and 3 months after the surgical procedure. No deviations from the operative protocol occurred.The patient and treatment characteristics are described in Table The characteristics of the harvested samples are presented in Table U = 258.500; P = 0.289) or the number of pain medications  , sample area , sample thickness , and the presence of yellow adipose tissue .No statistically significant differences were found with and without the use of the bipolar coagulator, as per the 7‐day VAS outcome , sample area , sample thickness , and the presence of yellow adipose tissue .Similar results were found regarding the number of painkiller medications used, considering smoking habits   and gender , some relevant differences were found. Considering the smoking factor, male smokers took more pain medications in the first 7 days after surgery than non‐smoking males (P = 0.029)  than samples with no fat (cat. 0). Furthermore, large harvested areas were associated with significantly higher VAS scores in age class 3 than in class 1   were associated with a significantly higher quantity of pain medications  or the occurrence of postoperative bleeding  , while patients with adipose tissue covering ≥50% (cat. 2) of the inner graft surface had a 4.375 times higher probability of bleeding  than the other groups , which is similar to the values reported by other authors (namely 4.10 (Burkhardt & Hämmerle, In our study, the average graft thickness was higher than that reported by the aforementioned studies, as the main purpose of the CTGs in 60% of the cases was to compensate for ridge deficiencies in implant surgery, requiring a graft with a greater thickness than that required for other procedures (Stefanini et al., In accordance with the data reported by Burkhardt & Hämmerle, , the preTaking into consideration the socio‐demographic parameters, the only factor influencing postoperative pain that showed a tendency to significance was smoking, when the data were stratified for gender. Male smokers took more pain medications than non‐smoking males. Similarly, Burkhardt and Hämmerle  showed tThe mucosal thickness and composition of the palatal tissue vary from patient‐to‐patient and appear to be site specific and gender‐ and age‐dependent (Burkhardt & Hämmerle, Palatal coverage via different kind of hemostatic treatments has been demonstrated to be beneficial in reducing postoperative pain, (Tavelli et al., The use of a bipolar coagulator during surgery was not correlated with the self‐reported VAS score or the number of pain medications used. This means that if an oral surgeon uses this tool during CT harvesting from the palate to improve hemostasis, the healing outcome with regard to pain will not be worsened. A limitation of this study was, as mentioned above, to investigate only the FGG harvesting technique; anyway considering that recently Tavelli et al.  demonstr5Bipolar coagulator can be used during CT harvesting from the palate to control bleeding without influencing postoperative pain, bleeding, or emergency visits.The authors hereby declare that they have no conflict of interest.


The primary outcome was the intraoperative remifentanil consumption. Sufentanil consumption, average patient-controlled analgesia (PCA) effective press times, the visual analog scale (VAS) scores, and incidences of postoperative nausea and vomiting (PONV) were recorded at 6 h (T1), 12 h (T2), and 24 h (T3) postoperatively.  A prospective, randomized study was conducted with 88 patients undergoing laparoscopic colorectal surgery. The experimental group . Sufentanil consumption at 6 h and 12 h postoperatively was significantly lower in the S group than that in the C group (p < 0.05); average PCA effective press times and VAS scores, at 6 h and 12 h postoperatively, were significantly lower in the S group than those in the C group (p < 0.01); differences between groups 24 h postoperatively were not significant. No significant between-group difference was noted in the incidence of nausea and vomiting.  The intraoperative remifentanil consumption was significantly lower in the S group than that in the C group ( Improving patients' sleep quality the night before surgical procedure by zolpidem can decrease the usage of intraoperative analgesics and reduce postoperative pain. Colorectal cancer, with a 5-year survival rate of 32%, is the fifth leading cause of death in the Chinese population . It is aRecent progress has been made in the study of the relationship between preoperative sleep quality and postoperative pain –19. For The aim of this prospective, randomized, single-center study was to evaluate the effect of improving preoperative sleep quality on perioperative pain by administering zolpidem. We hypothesized that administration of zolpidem the night before the procedure would improve preoperative sleep quality, reduce intraoperative anesthetic medication, and contribute to postoperative pain relief.https://www.chictr.org.cn . It was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. This randomized, single-blind study was conducted at the Department of Anesthesiology at Shengjing Hospital of China Medical University, a tertiary referral hospital.The study was approved by the Human Research Ethical Committee of Shengjing Hospital, Shenyang, Liaoning Province, China (IRB registration number: 2018PS385K) and registered at We included consecutive adult patients  classified as American Society of Anesthesiologists (ASA) physical status I or II who underwent laparoscopic colorectal surgery between March 2019 and October 2019. Exclusion criteria were patient age <40 years or >70 years; Pittsburgh Sleep Quality Index (PSQI) score ≤7 points; and history of sleep apnea, drug allergy, drug abuse, hepatorenal dysfunction, psychosis, or neuropathy. Patients with a severe hearing impairment or an inability to comprehend or complete the PSQI questionnaire were likewise excluded because of possible barriers to communicating with the anesthesiologists.An anesthesiologist, who did not participate in the surgical procedure, used the Pittsburgh Sleep Quality Index (PSQI) to assess each patient's sleep quality. The PSQI is a self-reported questionnaire used in the measurement of sleep quality over a month . The queAll patients with a global PSQI score >7 were enrolled in this study and randomly assigned to either the S (zolpidem tartrate) or C (blank control) group by an investigator, with no clinical involvement, using a head-tail binary result coin toss. The head side of the coin indicated the S group (zolpidem tartrate), and the text or tail side of the coin indicated the C group (blank control). Allocation concealment was ensured by concealing assignments into sealed opaque envelopes that were numbered sequentially and opened the night before the procedure. Zolpidem tartrate  10 mg was given to patients in the S group the night before the surgical procedure by a nurse independent of the study, while C group patients were not given medication. The patients in each group were blinded to the existence of the other group. Research personnel were maintained blinded throughout the study.On arrival in the operating room, all patients were given the Leeds Sleep Evaluation Questionnaire (LSEQ) to evaluate their sleep quality the previous night. The LSEQ is a self-rating scale comprising 10 questions, scored on a 100 mm visual analog scale, that pertain to 4 domains: the ease of getting to sleep , the quality of sleep , waking from sleep , and behavior following wakefulness  . LSEQ isIntravenous (IV) access and standard monitoring with an electrocardiogram , heart rate (HR), blood pressure (BP), and pulse oximetry were established. Peripheral arterial catheters were inserted for intraoperative monitoring of mean arterial pressure (MAP), and a multifunction combination monitor  was routinely connected to monitor the antinociceptive state and depth of anesthesia.μg/kg) and propofol (1.5 mg/kg). Orotracheal intubation was achieved using a cuffed tube and facilitated by cisatracurium (0.2 mg/kg). Following induction and intubation, ventilation  was performed at tidal volumes of 8 to 10 mL/kg, based on ideal body weight, with a 1 : 2 inspiratory-to-expiratory time ratio. Fresh gas was set to a 50% oxygen-nitrous oxide mixed flow at 2 L/min. Ventilator frequency was initially set at 12 breaths/min and was adjusted as needed to maintain an end-tidal carbon dioxide tension (ETCO2), assessed by blood gas analysis, of 35 to 45 mm Hg throughout the procedure.Once all standard monitors were connected to the patient, general anesthesia was induced by administration of IV sufentanil (0.5 μg/kg/h) and propofol (4–10 mg/kg/h), administered continuously by a syringe pump , were used for maintenance of general anesthesia. The pain threshold index (PTI) and wavelet index (WLI) were monitored with a multifunction combination monitor . According to the manufacturer's recommendations, PTI and WLI values of 40 to 60 were maintained to ensure adequate depths of anesthesia during general anesthesia. A single IV bolus of sufentanil (0.1 μg/kg) and ketorolac tromethamine (30 mg IV) was given to all patients 30 min before the end of surgery as prophylaxis against postoperative pain, along with ramosetron hydrochloride (0.3 mg IV) to curb postoperative nausea and vomiting.Remifentanil . The pump was prepared at a total volume of 100 ml by mixing 2 T) intervals: T1 (6 h), T2 (12 h), and T3 (24 h). The amount of sufentanil consumed within 24 h of the procedure was also recorded at T1, T2, and T3. Average PCA effective press times and incidence of postoperative nausea and vomiting were also recorded within 24 h of the surgical procedure.Another anesthesiologist who was blind to the research protocol was responsible for recording the amount of remifentanil consumed during the surgical procedure. A nurse who was blind to the operative details used a visual analog scale (VAS), with 0 corresponding to no pain and 10 to maximum pain, to assess each patient's pain intensity during rest and movement stages at the following postoperative time  was required. Finally, a sample size of 88 (44 in each group) was required to account for 20% dropout rate.t-test or Mann–Whitney U test; and gender, ASA status, and incidence of postoperative nausea and vomiting were analyzed using either the chi-squared or Fisher's exact test, as appropriate. All statistical analyses were performed with standard software  and statistical significance was set at p < 0.05.Descriptive statistics are reported as means with standard deviation (SD) or medians (interquartile range) for continuous variables and as frequencies or proportions for categorical variables. Age, weight, operation time, PSQI score, intraoperative remifentanil consumption, postoperative sufentanil consumption, PCA press times, and VAS scores were compared by the independent From March 2019 to October 2019, a total of 88 patients were enrolled in the study. The CONSORT diagram for patient recruitment is shown in p < 0.01) , but no between-group difference occurred at 24 h (p=0.064) (p = 0.001) and 12 h  postoperatively, but no between-group difference occurred at 24 h (p=0.159) (p < 0.01) at 6 h and 12 h postoperatively compared to the C group, both at rest and during movement . However, the between-group differences at 24 h postoperatively were not significant    . In the p=0.064) . Similarp=0.159) . In, addp=0.069) . No signp=0.738) .The results of this study showed that administering a dose of zolpidem (10 mg) can improve sleep quality preoperatively and reduce the amount of analgesics used intraoperatively and postoperatively. Moreover, lower pain intensity, both at rest and during movement, was noticed in patients given zolpidem compared to patients in the control group within the first 12 h after surgery. However, no significant difference was found in the incidence of PONV and length of hospital stay between treatment and control group patients.Sleep is a physiological phenomenon which is indispensable to an individual's physical and mental health , 44. HowIn the current study, the patients in the S group achieved higher LSEQ scores the following morning after receiving a dose of zolpidem (10 mg). This finding suggests that zolpidem can significantly increase sleep quality in patients with sleep disturbance. Zolpidem, an alternative to benzodiazepines, is a prescription sedative-hypnotic drug with a well-established safety profile . It imprRegarding the primary outcome, our study revealed that patients with better sleep quality were more likely to have lower analgesics consumption during the surgical procedure. In clinical practice, the administration of antinociceptive analgesics is usually determined by the anesthesiologist's clinical experience . TherefoFurthermore, patients with better sleep quality had significantly lower sufentanil consumption, less average PCA effective press times, and lower VAS scores at 6 h and 12 h postoperatively, compared to the C group. Our result is partially consistent with that of a systematic review showing that perioperative administration of sleep-promoting drugs can improve pain relief . SimilarHowever, there were several differences between their studies and ours. Firstly, in contrast with their studies in orthopedic patients, we mainly focused on the patients with colorectal cancer. Reportedly, nearly 40% of patients with colorectal cancer in China have preoperative insomnia . A case-Notably, our finding suggested that improved sleep quality can reduce the amount of analgesics used both intraoperatively and within the first 12 h postoperatively. A possible explanation lies in the mechanisms underlying the relationship between sleep and pain, including endogenous pain modulation, inflammation, affection, and mood as well as some roles of different endogenous substances . Endogenβ, IL-6, TNF-α, and CRP-6, which further increase pain intensity and sensitivity and increase the incidence of pain [Cytokines play critical roles in the development of inflammatory pain. Sleep disturbance can lead to increased levels of proinflammatory cytokines such as IL-1 of pain –70. Addi of pain , 72. Fur of pain . Many cl of pain –78. Slee of pain , 80. Las of pain .Anaesthesia [μg·kg−1·min−1. In our clinical trial, remifentanil infusion rate was 0.08 ± 0.02 μg·kg−1·min−1 in the C group and 0.07 ± 0.02 μg·kg−1·min−1 in the S group. Both rates were far less than 0.2 μg·kg−1·min−1. This led us to believe that the difference in postoperative analgesia was mainly due to the impact of improved sleep quality by zolpidem.Generally speaking, the intraoperative use of remifentanil has been closely linked to postoperative hyperalgesia. Thus, the lower intraoperative remifentanil consumption may contribute to the less postoperative sufentanil consumption and lower pain intensity in the S group, compared to those in the C group. Nevertheless, a study published in the journal, esthesia , confirmBased on the above research, we infer that zolpidem can improve patients' sleep quality preoperatively. This improvement contributes to the reduction in the usage of opioid analgesics intraoperatively and postoperatively (within 12 h). Further studies with objective measures  should be performed to validate our findings.Our study has some limitations. First, sleep quality was only assessed using the PSQI and LSEQ without polysomnography for evaluating sleep quality, quantity, and architecture. We did not assess patient fatigue and depression, which may also influence the measured outcomes. Second, light and noise may influence sleep quality in hospitalized patients. To minimize the effect of such disruptions, we allocated the patients randomly, thereby distributing the potential confounders equally between the groups. Additionally, as this is only a single-center single-blind trial in a relatively small population, a multicenter trial is necessary to verify its results. We acknowledge this was a single-blind study since patients were not adequately blinded. However, patients in each group were blinded to the existence of the other group. In addition, all researchers taking measurements remained blinded to the details of the study, as were also the data analysts. Blinding was also maintained by randomization and allocation concealment to minimize bias. Finally, we only administered zolpidem the night before the surgical procedure and reported the results within the first 24 h postoperatively. We did not examine the long-term duration and efficacy of pain control. Future studies should focus on the suitable dosage of zolpidem and any other medical interventions.Improving the sleep quality of patients the night before surgery by zolpidem can decrease the usage of intraoperative analgesics and reduce postoperative pain. Given the widely varying available methods, further exploration of suitable and effective ways to improve sleep quality while minimizing side effects is required. The results of this study may provide a new approach to promoting enhanced recovery after surgery.


Less time was needed to seal the root canals with Endoseal MTA, especially in group 2 (p < 0.05). Conclusions: Endoseal MTA and AH Plus had similar effects on the incidence and intensity of postoperative pain. The obturation time was shorter when using Endoseal MTA compared to AH Plus.Background: This clinical trial aimed to compare the effects of bioceramic sealer and resin-based sealer on the incidence and intensity of postoperative pain. Methods: Patients with anterior teeth or premolars requiring root canal treatment were assigned to group 1 (n = 51). Those with molars requiring treatment were assigned to group 2 (n = 57). In groups 1En and 2En, root canals were obturated with Endoseal MTA using the single-cone technique. In groups 1AH and 2AH, the sealer used was AH Plus with the continuous wave technique. On the day of canal filling, each patient was instructed to indicate their pain intensity over the 7 day postoperative period, at rest and, while biting, using a visual analog scale. Results: There was no significant difference in the incidence or intensity of postoperative pain between the Endoseal MTA and AH Plus groups during the 7 day postoperative period ( Pain of endodontic origin can be alleviated by root canal treatment. However, in one study, 17% of patients described the procedure as their most painful dental experience . The facThere are various kinds of root canal sealers; the most widely used are resin-based and bioceramic sealers, the latter of which were recently introduced. Bioceramic sealers generally contain alumina, zirconia particles, bioactive glass, calcium silicates, hydroxyapatite, and resorbable calcium phosphates . These iEndoseal MTA  is a premixed injectable bioceramic sealer that has garnered attention due to its convenience and positive outcomes. Endoseal MTA comprises calcium silicate, calcium aluminates and calcium sulfates, which has several advantages, such as high alkalinity, good flowability, and cytocompatibility ,17. In aThe purpose of this single-blind, randomized controlled clinical trial was to compare the effects of Endoseal MTA and AH Plus on the incidence and intensity of postoperative pain.A total of 108 patients from the Department of Conservative Dentistry, Ewha Womans University Hospital, were enrolled in this study between March 2019 and May 2020. The study was approved by Ewha Womans University Medical Center (EUMC) Institutional Review Board on 18 January 2018, trial registration number of IRB no. 2018-01-021. Oral and written informed consent was obtained from all patients. In addition, all methods were performed following the approved guidelines and regulations. Patients with anterior teeth or premolars requiring root canal treatment were assigned to group 1; molars were assigned to group 2. Block randomization was performed to prevent any imbalance in the number of subjects in each group. The patients in group 1 were further randomized into group 1En  and group 1AH (AH-Plus); those in group 2 were randomized to group 2En and group 2AH. The randomization table was managed by a study assistant, who delivered the allocated sealer to the practitioner just before obturation.Patients requiring root canal treatment who can follow treatment protocols as well as the criteria for postoperative pain evaluation;Patients of age between 19 to 70 years old,Patients with any uncontrolled systemic diseases;Patients who are pregnant;Patients who refused to participate;Teeth with open apex;Retreatments of root canals;Patients who initiated root canal treatment in other clinics.The root canal treatment was performed by a single practitioner. Before beginning the treatment, each patient rated their preoperative pain at rest and while biting using a visual analog scale (VAS). The treatment flow diagram is provided in The treated tooth in all patients was anesthetized with 2% lidocaine with 1:100,000 epinephrine and isolated using a rubber dam. An access cavity was formed, and the patency of each canal was confirmed using a #15 K file. The working length was established using Root ZX . Each canal was shaped with the ProTaper Next file system  and soaked in 2.5% sodium hypochlorite (NaOCl) during shaping. On the day of canal filling, the canals were irrigated with 5% NaOCl for 5 min, followed by 17% EDTA for 1 min and then irrigated with 5% NaOCl and saline. Each canal was dried with paper points. An assistant delivered the assigned sealer to the practitioner just before the obturation. The continuous-wave technique was used in the AH Plus group, and the single-cone technique was used in the Endoseal MTA group. After obturation, a postoperative radiograph was taken.On the day of obturation, each patient indicated their level of postoperative pain over 7 days, at rest and while biting, using the VAS. On day 7, each patient was asked to visit the clinic for a recall check. Their pain on that day was noted.p < 0.05. SPSS software  was used for the statistical analysis.The chi-squared test was used to compare baseline demographic characteristics between the groups. Pain incidence and intensity were analyzed by multivariate logistic regression analysis and repeated analysis of variance (ANOVA), respectively. The Mann–Whitney U test was used to analyze the obturation time data. Differences were considered significant at A total of 108 patients were enrolled in this 14 month study. According to the study criteria, 20 patients were excluded, and 21 were lost to follow-up. Thus, 32 patients in group 1 and 35 in group 2 were analyzed, with a response rate of 76.13%. The average patient age was 49.04 ± 16.62 years. There were no significant differences in the effects of Endoseal MTA and AH Plus on postoperative pain (pain intensity or incidence). The postoperative VAS pain scale scores were classified as follows: no pain, 0; slight pain, 1–39; moderate pain, 40–69; and severe pain, 70–100. Most patients had no pain or slight pain. The proportions of patients with pain at rest and while biting were similar, but there was a trend toward a higher incidence of biting pain.p > 0.05) Repeated-measures ANOVA was conducted to determine the relationships of time and sealer with VAS pain score. The VAS scores over the 7 day postoperative period are shown in Multiple logistic regression analysis was then conducted to determine the effects of the following potential confounding factors on pain incidence: sex, pulp vitality, and sealer. None of the preoperative factors significantly influenced the incidence of pain at any time during the 7 day postoperative period (p = 0.004).Obturation time was compared between the sealers . In grouOnly a few studies have compared the effects of resin-based sealers, such as AH Plus, with those of other bioceramic sealers on postoperative pain; to the best of our knowledge, there have been no such studies on Endoseal MTA. Endoseal MTA is known for its high alkalinity  and goodp > 0.05). Similarly, a previous study reported no difference in postoperative pain between AH Plus  and Total Fill , although confounding variables, such as tooth location, may have affected the results [No statistically significant difference was found in pain incidence or severity between the sealers at any time point during the 7 days after obturation ( results . It is d results . A randoIn this clinical trial, the patients were divided into anterior/premolar and molar groups because postoperative pain varies significantly by tooth type . A previPopular filling techniques, such as lateral condensation and warm vertical compaction, have drawbacks, including apical extrusion of the gutta-percha cone and insufficient gutta-percha homogeneity . The sinBioceramic sealers are very promising but were introduced more recently than conventional resin-based sealers. Thus, further studies are required to definitively compare the clinical performance of various bioceramic sealers and postoperative pain with longer follow-ups and radiographical assessments.This study showed that Endoseal MTA and AH Plus had equivalent effects on postoperative pain incidence and intensity. In addition, less time was needed for obturation in the Endoseal MTA group compared to the AH Plus group.Thus, Endoseal MTA used in conjunction with the single-cone technique is a fast and less painful option for obturation.


The incidence is increasing in elderly, diabetic or immunocompromised patients and can be fatal without ‘appropriate’ antibiotic therapy.3 This novel study evaluated the use of erythrocyte sedimentation rate (ESR) and pain scores as measures of response to determine the dose and duration of antibiotic therapy in patients diagnosed with NOE over a 4 year period from November 2015.CT, MRI, and technetium 99 bone scans are often performed but poorly correlate to the clinical response to empirical treatment.Patients diagnosed with NOE were evaluated using pain scores (0–10/10 where 0 = no pain and 10 = worst pain) and ESR at presentation and then at subsequent outpatient visits. Patients received 6 weeks of IV antibiotics  followed by oral ciprofloxacin. Initially ciprofloxacin was prescribed at 750 to 500 mg twice daily and the dose and duration of treatment was personalized according to pain scores and ESR. No ethical approval was required since this was an observational study of standard management of this condition at the Trust.Pseudomonas aeruginosa which in four patients was resistant to gentamicin and in two of these patients also to ciprofloxacin. At presentation pain score was 10/10 in all but three patients (5/10 in one patient and 8/10 in two patients) and ESR values ranged from 31 to 82 (median 66). Both values fell within 1–2 weeks of commencing IV antibiotics and after 6 weeks pain scores were 0/10 in eight patients, 3/10 in the others. ESR at this stage fell to 10–33 (median 15). One patient developed diarrhoea and stopped ciprofloxacin after only 2 weeks remaining well at 6 months follow-up. Eight patients required 3 to 12 months ciprofloxacin. Four patients required restarting or increasing ciprofloxacin dose to control rising pain scores which reflected an increase in their ESR values but in one of these patients having grown Pseudomonas resistant to ciprofloxacin, two further 6 week courses of piperacillin/tazobactam were required. Three patients currently remain on ciprofloxacin at the lowest dose to keep their pain scores and ESR under controlTwelve patients  aged 49 to 91 years (median 74.5 years) were treated. Five had diabetes mellitus and three had been treated for a malignancy. The time of first symptoms to diagnosis ranged from 3 weeks to 32 months (median 3 months). Six had developed facial nerve palsies; three of whom had additional cranial nerve involvement. All had swabs positive for Pain scores with ESR values are invaluable in determining the activity of NOE thereby personalizing the antibiotic dose and duration in patients with this life-threatening infection.


Hip osteoarthritis (OA) is characterized by chronic pain, but there remains a mismatch between symptoms and radiological findings. Recently, brain connectivity has been implicated in the modulation of chronic peripheral pain, however its association with perceived pain in hip OA is not understood. We used resting-state functional magnetic resonance imaging (fMRI) to examine functional connectivity associated with pain in hip OA patients. Thirty participants with hip OA and 10 non-OA controls were recruited. Using the visual analogue scale (VAS), pain scores were obtained before and after performing a painful hip activity. All participants underwent 3.0 T resting-state fMRI, and functional connectivity of brain regions associated with pain was determined and compared between participants, and before and after hip activity. Relative to controls, functional connectivity between the secondary somatosensory cortex and left posterior insula was increased, and functional connectivity between the bilateral posterior insula and motor cortices was significantly decreased in hip OA participants. In response to painful hip activity, functional connectivity increased between the thalamus, periaqueductal grey matter and brainstem. Functional connections between brain regions associated with pain are altered in hip OA patients, and several connections are modulated by performing painful activity. Unique lateralization of left posterior insula and linked brain functional connectivity patterns allows assessment of pain perception in hip OA providing an unbiased method to evaluate pain perception and pain modulation strategies. This places limits on how we effectively treat the perceived pain associated with chronic hip OA. Whereas the hallmark signs of joint pathology—degradation and inflammation—are in the periphery, it is unclear why joint pain progresses from local, sharp and episodic, to widespread, dull and persistent. Several studies suggest that pathological changes, evident within the joint afferent neurons6, spinal cord7, and brain circuits9, are distinct features of long-standing OA. Thus, there is increasing recognition that mechanisms within the central nervous system (CNS) play a significant role in the modulation and perception of pain10. Indeed, central sensitization (typified by CNS neuroinflammation and neuroplasticity) characterizes neuropathic-like pain in OA patients16. In one study, pain was reduced and recovery was improved after total knee arthroplasty when patients were treated with the CNS-acting drug, duloxetine, a serotonin–norepinephrine reuptake inhibitor17. Hence, there is a need to better understand the impact of OA on the CNS such that patient-specific therapy can be tailored.The lack of association between radiological indicators of hip osteoarthritis (OA) and self-reported pain by individual patients18.These studies using fMRI report increased activity within the thalamus, posterior and anterior insula, secondary somatosensory cortex, anterior cingulate cortex and periacqueductal grey matter. Wager called this a pain signature within the brain19. Other investigations using fMRI in patients with chronic pain have shown multiple changes, i.e., distinct signatures, in a number of brain regions20. In patients with hand OA, increased activation of the thalamus, anterior cingulate, frontal and somatosensory cortices was observed, relative to controls, when subjects were asked to perform a hand movement task21. Specific changes within the brain circuitry of knee OA patients have been reported to involve the periaqueductal grey matter, ventral tegmental area, and bilateral medial orbital prefrontal cortex22. Most recently, a resting-state fMRI study of knee OA patients following arthroplasty demonstrated changes in the temporal synchrony between the rostal anterior cingulate cortex and rostral ventromedial medulla23 .Functional magnetic resonance imaging (fMRI) has demonstrated changes within brain circuits involved in the perception of pain11. Interestingly, a volumetric brain MRI study of hip OA patients demonstrated evidence of reversal of thalamic atrophy following total joint arthroplasty24, suggesting that CNS changes may be reversible following the removal of the  stimulus of chronic joint pain.With regards to hip OA patients, alterations in periacqeductal gray matter activity in response to skin stimulation have been reportedCollectively, these studies demonstrate a clear involvement of the CNS in OA; however, the pain signatures vary depending on the condition and joint itself. Hence, there is a need to investigate the association between hip OA pain and CNS brain circuity, to determine the potential of CNS-targeted therapies to improve the quality of life of hip OA patients. The present study used resting-state fMRI to explore differences in functional connectivity between hip OA patients and control subjects. Further, changes in connectivity were examined in hip OA patients following an acute painful hip activity.This study was approved by the Conjoint Health Research Ethics Board of the University of Calgary (REB14-2375), and written Informed consent was obtained from all participants. All methods were performed in accordance with the relevant guidelines and regulations. Thirty patients with hip OA requiring total hip replacement were recruited from the Alberta Hip and Knee Clinic, in Calgary, Alberta . As determined by SF-36 questionnaire, collection of a Harris Hip Score and interview, patients were recruited for the study if they had no history of other chronic pain issues , diabetes, neurological or psychiatric disorders, or were using antidepressants or marijuna. None of the patients used regularly prescribed medications for analgesia. Many had intermittently tried nonsteroidal anti-inflammatory agents and acetaminophen with no sustained benefit. The patients were symptomatic for greater than 1 year, many for multiple years before qualifying for total joint arthroplasty.Ten healthy participants  were also recruited and similarly assessed.29 ranging from 0 to 10, where 0 indicates no pain and 10 indicates severe pain. All participants underwent MRI using a 3.0 T GE Discovery MR750 scanner equipped with a 12-channel receive-only phased array head coil . The MRI session consisted of resting-state fMRI using a gradient-recalled echo, echo planar imaging sequence , during which participants were instructed to keep their eyes open and focussed on a fixation cross at the center of a projection screen inside the MRI scanner bore. Anatomical images for registration of the resting-state data were collected using a three-dimensional magnetization-prepared rapid gradient echo sequence . Hip OA participants and controls were removed from the MRI scanner and completed 10 min of physical activity engaging the hip  and were re-assessed for pain using the VAS and for blood pressure, heart rate and oxygen saturation levels. The participants were immediately placed back inside the MRI scanner and underwent a repeated resting-state fMRI scan. VAS scores were compared between baseline and post painful activity by a Wilcoxon Signed-Rank test.For both OA patients and controls, blood pressure, heart rate and oxygen saturation levels were acquired prior to the MRI session. Baseline levels of perceived pain was assessed for hip OA patients using a visual analogue scale (VAS) for painhttp://www.fmrib.ox.ac.uk/fsl/). Using MELODIC (part of the FSL software library), Independent component analysis (ICA) was used to identify time-varying signals arising from artifact due to non-physiological noise, residual non-corrected head motion, and cardiac and respiratory pulsatility, which were subsequently removed by linear regression30. The total number of ICA components reviewed were automatically estimated using MELODIC  of which 4-6 components are identified as artifact. To permit group comparisons, resting-state fMRI images were registered to anatomical images and subsequently to the Montreal Neurological Institute’s (MNI) standard brain template, using a 12 DOF linear registration model. All images were visually inspected to ensure alignment with the brain template was successful using well-established anatomical landmarks .Resting-state fMRI images underwent pre-processing, including skull stripping, motion correction using a six degrees-of-freedom (DOF) rigid body trasnsformation, intensity normalization of the entire 4D volume, slice-timing correction using sinc interpolatiom to account for timing difference of each slice within the TR, high-pass temporal filtering using a 0.001 Hz cutoff, and 6-mm Gaussian kernel spatial smoothing. These steps were performed using FSL image analysis software . Comparisons of functional connectivity of each ROI between hip OA and control subjects as well as between baseline and after painful hip activity were determined using a mixed-effects analysis in FEAT. Results were presented as brain maps of the Z-score of the difference in connectivity, corrected for multiple comparisons using a false-discovery rate (FDR) threshold of 0.05, corresponding to a cluster volume of greater than 322 voxels, as determined by AlphaSim 31, which uses simulations of a null distribution of Z-scores given the spatial smoothness of the images. Other than the MR data, all results are presented as mean ± SD. Comparison between groups was performed using Student’s t-test, with significance level set at p < 0.05.A region-of-interest (ROI) approach was used to analyse the resting-state fMRI data. Specific ROIs were chosen as ‘seed’ regions, to determine their functional connectivity with the rest of the brain and how connectivity differed between subject groups and after physical activity involving the hip. The ROIs included the secondary somatosensory cortex (S2), anterior/posterior insulae and thalamus, as these regions have been shown to be associated with acute onset of painp < 0.001), confirming that the painful hip activity intervention was successful in reproducing the hip pain. Participants’ vital signs were monitored and the changes in the vital sign post exercise are noted in Table The VAS scores of pain for hip OA patients at baseline and after physical activity are shown in Fig. Functional connectivity based on seed regions and their activation comparing OA patients and controls is summarized in Table The connectivity changes in the study patients before and after activity are shown in Table Functional connectivity between the secondary somatosensory cortex S2) and the left posterior insula was significantly greater in hip OA patients than in control subjects . The majority, 88% of right handed people are left hemispheric dominant and 78% of left handed people are also left hemisphere dominant. It would be interesting to speculate if localization of pain to the left posterior insula would hold true for patients who are right hemisphere dominant, i.e. only ~ 7% of left handed people41.The present study demonstrates a difference in functional connectivity of controls and patients with severe osteoarthritis. We observed a unique signature of increased connectivity between the secondary somatosensory cortex and the left posterior insula. The posterior insula and its relationship to nociception has been well describedPost-surgical fMRI studies could also lead to a fuller understanding of the potential reversibility of the observed imaging characteristics, particularly the circuitry involved in central sensitization associated with OA disease. Despite the cost related to MRI studies, the fMRI could be a worthwhile consideration as a tool for patients with chronic OA pain, including persistent post-surgical pain. The present study revealed that resting-state fMRI defines an unusual signature of brain connectivity characteristic of chronic OA hip pain at baseline.42. Our findings are similar to what has been reported for brain activation following acute pain and include nociceptive, emotional and motivational circuitry59. When pain is acute and severe, brain regions involved in emotion, cognition and motivation are predominantly activated60.Following acute pain brought on by painful hip activities, we observed patterns of altered interconnectivity of multiple brain regions sometimes referred to as the pain matrix49. As the same VAS was used repeatedly on each patient, before and after painful hip activities, each patient served as their own comparator for this measure of clinical hip pain. The documentation of brain connectivity afforded by the resting state fMRI analyses used here is based on an unbiased statistical methodology. The choice of predetermined ROIs permitted an hypothesis-based analysis; however, there may be other brain regions involved that are not revealed using our approach.The connectivity results presented here need to be considered in two phases: (a) connectivity differences between OA and control patients, and (b) connectivity differences in OA patients before and after provocative hip tests. Presumably, connectivity differences at baseline between OA and controls reflect neuroplastic changes that occur in response to chronic OA hip pain, which typically takes months or years to develop, conceivably in a timeframe that corresponds in some way with development of hip OA pathology. In contrast, changes from baseline connectivity detected in OA patients after provocative hip tests infers activation of pre-existing neural connections in the brain rather than structural neuroplastic changes. This later type of brain activation is analogous (but not homologous) to brain activation in BOLD fMRI images in response to a noxious stimulus . While these two connectivity signals are not mechanistically congruent nor directly comparable, they represent valid and intriguing brain signals corresponding to hip OA pain. As such, this resting-state fMRI approach would seem to be advantageous for evaluating both spontaneous (baseline) and evoked pain that in turn assess two important aspects of pain-circuit connectivity: development and activation.While we present novel observation, the study does rely on a few assumptions and limitations. An important limitation is that all but one patients were right handed. In addition, the VAS methodology is based on subjective self-reporting by patients. While known to be variable, this methodology is widely used and has been shown to have validity for studies of OA pain61. Future work should examine this component of change as well.One final limitation that can be recognized is that this assessment is only measuring functional connectivity and has not assessed structural changes in the brain. Baliki and coauthors have shown that different clinical conditions have different patterns of structural change in the brain, for example Chronic low back pain showed reduced whole-brain gray matter volume, whereas 2 other chronic pain conditions did not, Chronic Regional Pain Syndrome and Knee OAIn summary, the resting-state fMRI of patients with hip OA relative to controls demonstrated greater connectivity between secondary somatosensory cortex and the left posterior insula. Connectivity was reduced between the posterior insula and the hip area of the primary motor and sensory cortices. We believe that this is a resting-state fMRI signature for OA of the hip with chronic pain, and indeed may hold an important clue in understanding pain pathways in patients with chronic OA of the hip. Similar to other reports, we also demonstrated connectivity changes after painful hip activity.


Existing literature supports bromelain enzymatic debridement as an early tool for selective escharectomy, resulting in fewer skin grafts after burn injury. Enzyme application is painful, so many centers use continuous infusions of narcotics, ketamine, and sedatives in the intensive care unit. The authors utilize oral ketamine in burn practice- as it is safe, can decrease the need for higher level of care, and be used without fasting. The purpose of this study is to evaluate whether oral ketamine can safely be utilized as an alternative to continuous infusions of medications for bromelain treatment.This was a retrospective study of patients who received oral ketamine  and oral lorazepam (for anxiolysis and prevention of dysphoria) for bromelain-based selective enzymatic debridement application over a 6-month period. Data collected included patient demographics, burn characteristics, sedatives and analgesics administered, pain scores, adjunct medications, and vital signs. Presence of respiratory insufficiency , hypertensive urgency , dysphoric reactions, and uncontrolled pain were recorded. Oral ketamine (2-4 mg/kg) was given 30 minutes prior to the procedure. Patients were monitored per sedation guidelines and had capnography plus supplemental oxygen. Small PRN IV boluses of narcotics were given during the procedure, along with their baseline oral multimodals and narcotics. Pain was measured with the 1-10 verbal rating scale with minimal pain defined as < 4 or the patient clinically observed as sleeping. Patients were not made NPO for the procedure.Ten patients were included. Four patients (40%) had minimal pain during enzyme application, 3 (30%) patients slept through their procedure, and 3 (30%) patients reported 10/10 pain during treatment (2 had 10/10 pain before treatment). Five patients were treated on the floor, 7 were treated in the ICU. The median ketamine dose was 225 mg , or 3mg/kg . Additional oral and IV opioids received during the 8–14-hour interval was 21 morphine milligram equivalents (MEs). The median benzodiazepine dosing before and during enzymatic debridement was 1.4 lorazepam MEs. Three patients (30%) had hypertensive urgency, 2 (20%) of whom reported 10/10 pain, and all 3 received 10mg IV labetalol. No one had dysphoric reactions or respiratory insufficiency.This preliminary study reveals oral ketamine administration is safe and effective for pain control during bromelain-based enzymatic debridement. Most patients required small to moderate amounts of PRN IV opioids, had acceptable pain control, and there were no significant adverse effects. Future large, prospective studies should evaluate dosing and timing for optimal patient outcomes.


Aims: There has been a paradigm shift in diagnosis of cardiac transthyretin amyloidosis (ATTR) with non-invasive techniques including technetium-99m 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) bone scintigraphy. We evaluated structural and functional biventricular alterations by transthoracic echocardiography (TTE) and determined the correlation with 99mTc-DPD tracer uptake in ATTR.Materials and Methods: ATTR patients  with 99mTc-DPD and TTE were selected; 99mTc-DPD uptake was analyzed quantitatively. TTE assessment of left ventricle (LV) and right ventricle (RV) parameters was performed.Results: Forty ATTR patients  were included. TTE parameters displaying good correlation with 99mTc-DPD tracer uptake included LV average wall thickness (r = 0.837), LV indexed mass , RV wall thickness (r = 0.610), average e' (r = −0.830), E/e' ratio (r = 0.786), LV global longitudinal strain  and RV GLS . Hereditary ATTR and TTR variant carriers without cardiac tracer uptake had normal echocardiographic parameters. Receiver operating characteristic curves demonstrated strong diagnostic accuracies for structural  of 0.96 for all) and functional  parameters.Conclusion: Good correlations between TTE biventricular structural and functional parameters were demonstrated with quantitative 99mTc-DPD uptake. Echocardiography may potentially assume a significant role in longitudinal follow-up for monitoring disease progression and for evaluating treatment response. Systemic amyloidosis is a multiorgan disease resulting from extracellular deposition of insoluble amyloid fibrils, formed from aggregated, misfolded proteins , 2. CardATTR subtypes include wild-type and hereditary, both displaying heterogeneity in clinical symptoms and organ involvement , 2. Card99mTc-DPD) scintigraphy emerged as an important diagnostic modality with strong tracer avidity for the transthyretin protein, with high sensitivity and specificity  variant carriers who attended the Westmead Hospital Amyloidosis Clinic, a statewide referral service for amyloidosis patient evaluation in New South Wales, Australia. Ethics was submitted and approved by the Western Sydney Local Health District (WSLHD) Research Ethics and Governance Committee in keeping with the Declaration of Helsinki. Two patients were excluded as 99mTc-DPD reference imaging was not available for quantitative analysis.We retrospectively reviewed 42 consecutive patients with wild-type, hereditary ATTR and asymptomatic transthyretin  were included for analysis after screening to ensure absence of a monoclonal gammopathy. All had undergone TTE and 99mTc-DPD scintigraphy within a 12-month period. 99mTc-DPD scintigraphy; the remaining six patients had hereditary ATTR or were asymptomatic TTR variant carriers confirmed by ATTR genotyping, without cardiac involvement. Both TTR variant carriers and hereditary ATTR patients had positive family histories and were identified to have an amyloidogenic mutation, with hereditary ATTR patients additionally having clinical symptoms or proven amyloid deposition . One patient identified to have cardiac involvement had mild aortic stenosis. All patients had serum creatinine , troponin I, N-terminal-pro hormone brain natriuretic peptide (NT-proBNP) and electrocardiography. Demographic and clinical information were collected for all patients. Sixteen patients had mild hypertension (14/34 in those with cardiac amyloidosis and 2/6 in those without).In total, 40 patients ; examinations included 2-dimensional, color and Doppler echocardiography, performed in accordance with the American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations . DedicatLV interventricular septum and posterior wall thickness were measured from the parasternal long axis view in end-diastole . Average2 for males and 95 g/m2 for females  . LV wall females .For LV diastolic function, peak E and A wave velocities were obtained using pulsed wave Doppler, with the sample volume placed at the mitral leaflet tips . Tissue The RV focused view was used to obtain end-diastolic and end-systolic areas to calculate fractional area change . TricuspBiventricular 2-dimensional speckle tracking strain analysis was performed using specialized computer software .LV strain analysis was performed from the 3 apical views  by tracing the endocardium . A regioRV strain analysis was performed by tracing the endocardium in the RV focused view . A regio99mTc-DPD scintigraphy was performed using Siemens Symbia single-photon emission computed tomography-computerized tomography (SPECT-CT) machine  with injection of 900MBq 99mTC-DPD, which was followed 1 h later by SPECT of the thorax and upper abdomen including heart, lungs and liver in the field of view. A SPECT-CT of this region and whole-body sweep were acquired 3 h after injection. The SPECT-CT examination was utilized for quantification with attenuation correction, scatter correction and resolution recovery options applied to the data set. Reference standard for uptake was the aortic arch blood pool  and MedCalc software version 14.8 .Normality of data was tested using the Shapiro–Wilk test. Continuous data has been expressed as either the mean and standard deviation or as a median with interquartile range. Categorical variables have been expressed as percentages. TTE parameter measurements were compared to quantitative ferences . Bland–ATTR variant with one having peripheral neuropathy. TTE and 99mTc-DPD scintigraphy were performed with a median time of 7 days between scans (inter-quartile range 99.8 days); 88% of patients had scans within 4 months of each other. Six patients with pacemakers were excluded from the electrocardiogram analysis. Demographic, biochemical, electrocardiogram and TTE data for the group are presented in Forty patients comprised the study cohort  with 34 patients with cardiac involvement. The remaining 6 patients were genotyped as carrying an amyloidogenic Echocardiographic LV parameters were obtained for all patients. Due to limited image quality, RV fractional area change, RV FWS and RV GLS could not be obtained in two patients and RV wall thickness and RV s' velocity could not be performed in one patient.99mTc-DPD scintigraphy signal obtained for each ventricle demonstrated a median LV value of 272% (interquartile range 462%) and median RV value of 203% (interquartile range 265%). There was a significant correlation of NT-proBNP levels with LV and RV 99mTc-DPD tracer uptake   , while o< 0.001) .99mTc-DPD scintigraphic evidence of cardiac involvement, all demonstrated normal biventricular wall thickness and function ; there was moderate sensitivity (77%) and high specificity (100%) for a cutoff of 12.2 mm for wall thickness, whereas LVMI had lower sensitivity (71%), but similar specificity (100%) for a cutoff value of 110 g/m2  and specificity (100%) using a cutoff value of 5.5 mm . RV GLS 99mTC-DPD scintigraphy analysis in all regions demonstrated a coefficient of correlation >0.93  demonstrated stronger correlation with hickness . Our grohickness . SixteenIt has previously been demonstrated that patients with atrial fibrillation may have impaired LV GLS compared to those in sinus rhythm independent of sex, age, heart rate, LVEF and LV mass . A varia99mTc-DPD scintigraphy, initially utilized for bone scintigraphy, was found incidentally to demonstrate avidity for cardiac amyloid (99mTc-DPD binding to ATTR fibrils is yet to be identified (99mTc-DPD tracer uptake, the absence of monoclonal protein in serum and urine affords diagnostic sensitivity >99% and specificity 100% ( amyloid . A large amyloid . The mecentified . Althougity 100% .99mTc-DPD scintigraphy image acquisitions vary, with methods using either thorax targeted or whole body planar images; more recently, SPECT-CT imaging has been employed (99mTc-DPD image assessment has been performed by qualitative visual grading using the Perugini method or semi-quantitative assessment with heart-to-body region ratios (99mTc-DPD SPECT-CT imaging has allowed exploration of quantitative methods to evaluate cardiac amyloid burden (99mTc-DPD tracer uptake and NT-proBNP levels suggest that quantitative 99mTc-DPD scintigraphy could potentially provide prognostic information; however, this requires validation.employed . 99mTc-Dn ratios , 34. Incd burden , 17. Thed burden . NT-proBd burden . The corEchocardiography plays an important role in screening and longitudinal follow-up of cardiac ATTR patients , 35. Cha99mTc-DPD tracer uptake employed a combination of qualitative visual grading, semi-quantitative analysis and planar imaging to quantify 99mTc-DPD tracer uptake (99mTc-DPD tracer uptake correlates with LV wall thickness, mitral annular systolic velocity, tricuspid annular plane systolic excursion, E/e' and LV GLS (99mTc-DPD tracer uptake in ventricular chambers and correlate this with biventricular structural and functional echocardiographic parameters. Additionally, prior studies focused primarily on LV parameters, with limited RV assessment, and only one previous study evaluated LV GLS (Only few studies evaluating echocardiographic changes in ATTR patients with r uptake –41. In cd LV GLS –41. To od LV GLS –41.99mTc-DPD scintigraphy for monitoring both disease progression and response to emerging therapeutic agents. Echocardiography could be particularly useful in regional centers, where availability of quantitative 99mTc-DPD scintigraphy is limited.Given the good correlation, we demonstrate the potential utility of TTE for longitudinal patient follow-up alongside quantitative 99mTc-DPD scintigraphy data available; however, these are data from a single site and are comparable to other ATTR patient studies (TTR variant carriers was small, but previous studies have also demonstrated no tracer uptake or evidence of echocardiographic abnormalities in such individuals (99mTc-DPD tracer uptake corresponding to traditional echocardiographic parameters. Further prospective studies with contemporaneous echocardiograms and 99mTc-DPD scintigraphy would be required for validation. Our cohort included 16 patients with a history of mild hypertension with 14 in the cardiac involvement group, which may have contributed to some of the alterations in GLS. In our patients used to assess our reproducibility, seven of the 20 patients randomly selected had a history of mild hypertension, but still demonstrated an overall low variability. To determine the independent effects of comorbidities such as hypertension and diabetes mellitus, future studies with larger patient groups would be required for adequate subgroup analysis. Longitudinal studies are required to confirm whether abnormalities in these imaging parameters correlate with disease progression demonstrate response to specific treatment modalities and afford prognostic value.Our sample size was limited to 40 patients with echocardiographic and  studies –41. The ividuals . Larger 99mTc-DPD scintigraphy uptake. Additionally, we demonstrated that absence of 99mTc-DPD tracer uptake is associated with normal structural and functional echocardiographic measurements, suggesting absence of cardiac ATTR deposition. Thus, in addition to their diagnostic utility for cardiac ATTR 99mTc-DPD scintigraphy and echocardiography may both play significant roles in longitudinal follow-up of ATTR patients for monitoring disease progression and evaluating response to therapy.We have demonstrated an association between echocardiographic structural and functional biventricular parameters with quantitative The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by WSLHD HREC. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.All authors have contributed to the design, data collection, analysis, and manuscript preparation.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Every subject was treated with three regimens and followed up for 15 days. Results showed that FSN has an immediate effect on VAS, PPT, TH, and PFG. Moreover, sustained effects on pain relief were followed up to 15 days. Pain remission was consistent with long-term PRTEE results. Overall, FSN is a safe and efficient therapy option for LE, significantly improving pain relief and activity difficulty with immediate, short-term, and long-term effectiveness. This trial is registered with ClinicalTrials.gov NCT03605563.Lateral epicondylalgia (LE), a common overuse syndrome of the extensor muscle and tendons on the lateral epicondyle, causes persistent severe musculoskeletal pain on the outer part of the elbow. Fu's subcutaneous needling (FSN), a newly invented subtype of acupuncture and dry needling, is a new trend and potential treatment of LE by targeting the myofascial trigger points (MTrPs). However, no scientific evidence is available to support this method. This study aims to evaluate the distal FSN treatment on the LE by measuring pain-related scales, such as visual analog scale (VAS), pressure pain threshold (PPT), muscle tissue hardness (TH), pain-free grip (PFG), and the functional outcome by a patient-rated tennis elbow evaluation (PRTEE) questionnaire study. A total of 60 LE patients were randomly divided into FSN ( Lateral epicondylalgia (LE), also known as tennis elbow, is one of the musculoskeletal disorders and is the most common cause of elbow pain due to overuse of the extensor muscle and tendons . The preAlthough most patients recover within one year, some patients have a long disease course up to two years . ConventFu's subcutaneous needling (FSN) is a new technique originated from Chinese acupuncture, which utilizes the dual structure trocar and chooses the site away from the lesion, targeting the myofascial trigger points (MTrPs) in the taut band with needling insertion and sway movement in the superficial fascia. FSN has the advantages of few needle requirements and no need to penetrate to the deep layers of the derma and muscle generally. FSN has an immediate and long-lasting effect on pain control of musculoskeletal diseases through the swaying and reperfusion approach , 18. ForThis study utilized subjective and objective outcome measurements, such as visual analog scale (VAS), pressure pain threshold (PPT), muscle tissue hardness (TH), pain-free grip (PFG), and patient-rated tennis elbow evaluation (PRTEE) questionnaire, to assess the efficacy of the FSN treatment compared with TENS on the LE patients.A total of 60 participants were recruited in accordance with a randomized, controlled, open-label experiment. This study was approved by the Institutional Review Board of the China Medical University Hospital. All patients gave their written informed consent to participate in this study, and the research was conducted in accordance with the principles of the Declaration of Helsinki.The inclusion criteria are as follows: (1) age over 20; (2) diagnosed with LE for more than one month and subjective VAS >5; and (3) local tenderness on lateral epicondyle with exacerbating pain under isometric resistant test for supination of the forearm. Meanwhile, the exclusion criteria include the following: (1) patients who previously received operations for the neck, upper back, or four limbs; (2) currently undergoing different therapies for LE; and (3) equipped with a pacemaker, diagnosed with epilepsy, or other conditions, such as skin injury, contributing to the inapplicability of electric patch.Every subject was randomly allocated into two groups: an experimental group who will undergo FSN treatment, and a placebo group who will undergo TENS treatment . The entThe forearm of the experimental group relied on using a disposable Fu's subcutaneous needle  to treat the radial aspect of the forearm extensor muscle . The punReceding the core needle and then fixing the protuberance of the soft tube seat in the slot of the core seat prevent the exposure of the needle tip outside followed by starting a swaying movement. The tip of the needle should be maintained at the same horizontal level in swaying by using the thumb and the middle finger holding the core base, and the index and ring fingers are separated on the left and right side of the middle finger to sway in a seesaw-like sector one after the other . The timWaiguan) and LI11 (Quchi), according to the guidance of the WHO  generated by LE patients upon the onset of pain . The tesTH assessment of the forearm muscle revealed the capability of muscles against deformation during activities.  PatientsThe PRTEE questionnaire was regularly used to measure perceived pain and disability . A totalP < 0.05) among the results were revealed by using Statistical Package for Social Science (SPSS 18.0) for Windows. Data were expressed as mean ± standard deviation. The analysis of baseline characteristics of age, sex, VAS, PTT, TH, PFG, and PRTEE was conducted by analysis of variance (ANOVA). The within-group analysis of all variables was conducted by paired sample t-test for inferential statistics, while the between-group analysis of the variables was performed by independent two-sample t-test.Statistically significant differences , PPT , and PFG  were significantly improved in the FSN group in day 1  and PFG  were significantly improved for TENS  and 1.82 ± 1.52 in day 15  compared with day 1 pretreatment. Except for TH, PPT and PFG revealed significant improvements on days 8 and 15 (P < 0.01) compared with day 1 pretreatment in both groups . These results indicated the sustained effect of FSN on pain relief.To further understand the superiority of FSN to TENS on LE treatment. The improved VAS of patients in FSN on days 8 and 15 was significantly higher than that in TENS  and to 15.23 ± 12.16 in day 15  and to 26.27 ± 15.77 on day 15  revealed the etiological mechanism of taut band induced by MTrPs , and theThe mechanical pain is due to microwound accumulation from an imbalance in global muscle recruitment or local muscle overuse . The musThis study provides evidence to support the effectiveness of FSN as a therapy for LE with immediate and sustained effects to relieve pain. Furthermore, the data from the questionnaire study suggest a significant and positive effect of FSN for LE treatment. Thus, FSN is a good treatment option for LE.


To study patients who enroll in treatment at a specialized pain management clinic at a tertiary referral center following ulnar nerve decompression.Data from medical charts and postoperative questionnaires were collected for all patients after surgery for ulnar nerve compression at the elbow from 2011 to 2014 (n = 173) at a tertiary referral center. Differences in characteristics between patients who enrolled in treatment at the pain management clinic  and the rest of the patients  were analyzed. The study group was further evaluated using questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP) and regarding outcome of pain treatment.The study group was characterized by prior pain conditions, earlier contact with a pain management clinic, and high degrees of kinesiophobia, depression/anxiety, low quality of life, and low life satisfaction. These patients had significantly higher postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, were significantly younger, and had bilateral surgery significantly more often than the reference group. For patients with unilateral surgery, simple decompression was significantly more common in the reference group. The most common treatments at the clinic were antidepressants and anticonvulsants for neurogenic pain. In 5 of 26 patients, pain relief, or pain reduction was the documented reason for discharge.Pain is a relevant outcome measure for ulnar nerve decompression among complicated cases at a referral center. Severe postoperative pain is connected to higher disability, reduced life satisfaction, and overall low health status. This study maps out characteristics of patients who postoperatively enroll in treatment at a specialized pain management clinic following ulnar nerve decompression. Further studies are needed to define predictive factors for such pain.Prognostic III. The outcome often focuses on objective measures, and disability is evaluated using validated questionnaires.Depression, anxiety, and psychological vulnerability before surgery are associated with poor results, increased disability, greater pain intensity, and a higher risk of developing chronic or persistent postsurgical pain in the chest, head, neck, extremities, and abdomen.The presence of neurogenic pain, ie, pain caused by a lesion or disease of the somatosensory nervous system, including peripheral fibers, is often associated with sensory and motor deficits.,Surgeons tend to overprescribe opioids after upper extremity surgery.In our system, enrollment in treatment at a specialized pain management clinic indicates that surgery failed to relieve the preoperative pain or resulted in severe pain. Pain is defined, by the International Association for the Study of Pain, as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Pain is a subjective experience that varies among patients and is influenced by biopsychosocial factors.A retrospective study included patients postoperatively enrolled in treatment at the Pain and Rehabilitation Center, Linköping University Hospital, Linköping, Sweden, from January 1, 2011, to December 31, 2014, following surgery for ulnar nerve compression at the elbow at the Department of Hand Surgery, Plastic Surgery, and Burns, Linköping University Hospital, Linköping, Sweden, a tertiary referral center. The surgical techniques employed were simple decompression or subcutaneous transposition as index surgery (n = 150) and subcutaneous transposition (n = 31) as revision surgery after simple decompression. Patients who postoperatively enrolled in treatment at the pain management clinic due to pain arising or worsening after the surgery were the study group, while the reference group referred to the rest of the patients having surgery for ulnar nerve compression at the same referral center during the same period. Patients already preoperatively enrolled at the pain management clinic due to ulnar nerve condition or another pain condition were excluded, as well as those postoperatively enrolled due to other pain conditions (n = 8). These patients were found in the reference group, as this study focused on postoperative pain after surgery for ulnar nerve compression at the elbow.,Data from medical charts  and a poThe SQRP was a national registry based on several surveys postoperatively completed by the patient in conjunction with the first visit to a pain management clinic. Hence, no data of this kind or preoperative data were available for the reference group.,TSK inquires about the patient’s fear of movement-related to pain, and it was used extensively both in trials and clinical services.HADS was a widely used valid scale for measuring anxiety and depression in somatic hospital care.EQ-5D-3L consisted of 5 dimensions regarding health-related well-being with 3 different severity levels and a visual analog scale (VAS) for current health status . The answers from the 5 questions were summarized as an index number from −1 to 1, where −1 was very low health-related well-being and 1 was excellent health-related well-being.,LiSat-11 measured life satisfaction through 11 different questions about social life, family, relationships, physical and psychological health, economy, and life in general. Each item was scored 1 to 6, where 1 was very unsatisfied and 6 was very satisfied.th-75th percentiles).The study group was compared to the reference group regarding patient characteristics, preoperative McGowan grade, comorbidity, surgical method, and postoperative DASH scores. Chi-square test was used when analyzing dichotomized qualitative data; if assumptions were violated, Fisher exact test was applied. The t test was used for continuous normally-distributed data. If conditions were violated, a nonparametric test was used. Parametric data were presented as mean ± standard deviation and nonparametric as median  and the reference group (n = 147) are presented in Twenty-six (15%) of 173 patients surgically treated for ulnar nerve compression at the elbow were subsequently enrolled in treatment at the pain management clinic due to severe postoperative pain. Of these, 18 patients had previously been treated for a pain condition at some medical institution before surgery. Ten of these 18 patients had been treated at a pain management clinic but had since been dischargedP =.037, Mann-Whitney U test).In the SQRP surveys for the study group, scores from the TSK were calculated for 9 patients and found to be 40.3 ± 9.9. Six of 9 patients had a high degree of kinesiophobia (cut-off at 37 points). Fifteen HADS scores were calculated for each subscale . PatientEQ-5D-3L index and VAS current health status values were obtained for 13 patients. EQ-5D-3L index value and mean EQ-5D-VAS were 0.25 (SD 0.32) and 42.5 ± 22, respectively . AnswersP =.001 and 7.3 [3.3–8.6] vs. 3.5 [1.5–5.7], P =.025, respectively, see Postoperative DASH scores and estimated pain VAS during postoperative activity were statistically higher for the study group than for the reference group . Treatment provided at the pain management clinic is shown in This study illustrates that postoperative pain can be a major concern for patients having surgery for ulnar nerve compression at the elbow at a tertiary referral center. We found that the study group, comprised of patients who enrolled postoperatively in treatment at a specialized pain management clinic, differed significantly in many ways from a reference group without severe postoperative pain.,,The study group was significantly younger than the reference group. In other studies of surgery for ulnar nerve compression, young age has, in contrast, been associated with a more favorable surgical outcome.QuickDASH score and a higher rate of dissatisfaction after surgery for carpal tunnel syndrome.Higher BMI may reduce subjective well-being and increase depressive symptoms.The TSK yielded high values with a degree of kinesiophobia comparable to patients with chronic back pain.The high frequency of severe postoperative pain and low rate of pain relief observed in our study, compared to the literature, might be explained by our broad inclusion criteria or that the department is a tertiary center where severe cases are treated. More than half of the study group suffered from another ipsilateral neuropathy; a condition that is often an exclusion criterion in other studies. Another reason for this discrepancy could be the insufficient consideration of pain as a separate variable in other studies. Of the present group, 21 of 26 patients did not have a documented pain relief after treatment at the pain management clinic, indicating that such a population needed special care, a different treatment approach before surgery, or even treatment options other than surgery. The low observed rate of pain relief at the pain management clinic may not, however, show the full picture. Five patients continued treatment at another clinic, indicating that the pain management clinic had found a therapy that relieved the pain, but that it did not necessarily need to be administrated by a pain specialist. Failure to attend appointments (2 patients) might also suggest that the severity of symptoms declined.The postoperative DASH scores differed significantly between the study and reference groups. However, there was great variation within the 2 groups, and some patients in the reference group scored higher than patients in the study group. All low postoperative DASH scores (<40), except for 1 outlier in the study group, were found in the reference group, indicating that pain greatly affected disability.,Recommendation of opioids for the treatment of neurogenic pain is very infrequent or nonexistent.There are several weaknesses in this study. The major ones include the retrospective design, the lack of preoperative and reference group SQRP-questionnaires, a low rate of questionnaire completion, and the absence of preoperative and repeated responses for questionnaires (including DASH) and pain scales. The strengths of the study include the broad inclusion criteria that are representative of clinical practice and the use of several patient-reported outcome measures. It is important to emphasize that even though the characteristics of patients with severe postoperative pain may represent predictive factors for the development of pain, no such conclusion can be drawn from this study. Further studies are needed to explore causality.We provide a perspective that is seldom highlighted, ie, the consideration of severe postoperative pain in patients with surgery for ulnar nerve compression at the elbow. We conclude that previous pain conditions are common among patients who postoperatively enroll in treatment at a pain management clinic, and patients who enrolled are younger, more often have bilateral surgery, and have higher postoperative DASH scores than a reference group. Pain is a major concern for affected patients, and it negatively impacts disability, fear of movement, levels of anxiety and depression, overall health status, and life satisfaction. Of patients treated at the pain management clinic, 20% achieve pain relief or pain reduction, while almost 40% are discharged due to the exhaustion of treatment options. A qualitative study acquiring information on how this affects a patient’s everyday life would be helpful in further designing strategies to address this patient population. Furthermore, future studies are needed to predict the potential risk factors for the development of severe postoperative pain.


The objective of this study was to compare the analgesic potency of oxycodone versus morphine after laparoscopic deep infiltrating endometriosis resection.Fifty patients undergoing laparoscopic deep infiltrating endometriosis resection were randomized to receive oxycodone or morphine intravenous-PCA after surgery. The primary outcome was opioid consumption during the 24 h after surgery. Secondary outcomes included time to first request for analgesia, the number of bolus, pain, sedation, nausea, vomiting, respiratory depression, and bradycardia. The prominent pain that caused patients to press the analgesic device was also recorded.vs 123) was less and the average time to first request for analgesia (97.27 ± 59.79 vs 142.17 ± 51) was longer in the oxycodone group. The incidence of nausea was higher in the morphine group than in the oxycodone group at 0–2 h (45.45% vs 17.19%), 2–4 h (50% vs 17.19%),12–24 h (40.91% vs 13.04%) and 0–24 h (39.17% vs 19.13%). The overall incidence of vomiting was higher in the morphine group (27.27% vs 13.92%). There was no difference in visual analogue scale score, the incidence of respiratory depression, and bradycardia between groups. Of the three types of pain that prompted patients to request analgesia, the incidence of visceral pain was highest .Oxycodone consumption (14.42 ± 2.83) was less than morphine consumption (20.14 ± 3.83). Compared with the morphine group, the total number of bolus (78 Oxycodone was more potent than morphine for analgesia after laparoscopic endometriosis resection, and oxycodone has fewer side effects than morphine.Name of the registry: Chinese Clinical Trial RegistryTrial registration number: ChiCTR1900021870URL of trial registry record:http://www.chictr.org.cn/edit.aspx?pid=35799&htm=4Date of registration: 2019/3/13 0:00:00 Deep infiltrating endometriosis (DIE) is a specific form of endometriosis characterized by endometriosis implants that penetrate for more than 5 mm in the affected tissue, which includs bladder, ureter, vagina, rectum, uterosacral ligaments, etc. Medical treatment for DIE is usually limited, complete excision of the lesions under the laparoscopy is the preferred method . Pain isIncisional pain, shoulder pain, and visceral pain are three main types of pain after laparoscopic surgery . The proOxycodone, which is a semisynthetic μ- and κ-opioid receptor agonist, can provide better analgesia than pure μ-opioid receptor agonists after some surgeries due to the critical role of κ-opioid receptors in the reduction of visceral pain –8. HowevSince DIE resection involved one or more abdominal internal organs, we speculated that visceral pain was an important component of the pain after laparoscopic DIE resection. Given that oxycodone had both μ-and κ-opioid receptor agonist, we hypothesized that oxycodone was more potent than morphine for analgesia after laparoscopic DIE resection. This present study aimed to confirm visceral pain was an important component of the pain after laparoscopic DIE resection and compare the analgesic potency and side effects of oxycodone versus morphine, in order to provide a better choice for good analgesia after laparoscopic DIE resection.This prospective randomized double-blinded clinical trial, which adhered to CONSORT guidelines and included a completed CONSORT checklist as an additional file, was approved and was performed from April 2019 to August 2019, in accordance with the Helsinki Declaration of the World Medical Association. This study has been registered in the Chinese Clinical Trial Registry (registration No. ChiCTR1900021870).2 or < 18 kg/m2; postoperative recovery in the intensive care unit; prolongation of operation time; and surgical complications during operation (such as bleeding…etc.).After obtaining the patients’ written informed consent, 50 adults (20–55 years of age), presenting with American Society of Anesthesiologists (ASA) physical status I and II, and scheduled for laparoscopic DIE resection under general anesthesia, were included in the trial. Patients were excluded in case of drug or alcohol addiction; known allergy to any drug used in the study; chronic opioid therapy in the 3 months before surgery; chronic therapy with antidepressants or clonidine; a history of abdominal surgery; bilirubin level > 3.0 mg/dL; aspartate aminotransferase and/or alanine aminotransferase > 250 IU; body mass index (BMI) > 30 kg/mThe day before the operation, the patients were instructed carefully to use a visual analogue scale  to measure the degree of pain. If VAS > 3, patients received analgesia by pressing intravenous patient-controlled analgesia (IV-PCA) device until VAS ≤ 3. Meanwhile, the three main pain components after laparoscopic surgery were explained in detail as described below to the patients . Incision = 25) group, and oxycodone  group by using a computer-generated random number table. Patients received morphine or oxycodone IV-PCA  for 24 h postoperatively. At the end of the operation, a 0.1 mg/kg dose of morphine or oxycodone was given. Allocation concealment was performed using a sealed envelope approach because randomly generated treatment allocations were placed in sealed opaque envelopes. The envelopes were opened by a nurse who was not involved in this study just before the induction of anaesthesia. The anaesthesiologists who were responsible for the anaesthesia and analgesia during the operation were blinded to the group allocation. The nurses who prepared the analgesic device were not involved in the observation, pain scoring of patients, and treatment of the patients during the operating room. The surgeons and observers were also blinded to the group allocation  and analysed using the Mann–Whitney U test. The Bonferroni correction was used for multiple measures. Categorical data were described as numbers or percentages and analysed with the chi-square or Fisher’s exact tests, as appropriate. The difference in continuous variables over time was tested by the repeated-measures analysis of variance. Statistical significance was defined as p < 0.05. SPSS Statistics version 26.0 for Windows was used to perform all analyses .Out of 50 patients assessed for eligibility, 48 were enrolled and randomly assigned to each of the two groups, and 45 (90%) completed the study Fig. .Fig. 1Cop < 0.05, Fig. p < 0.01, Fig. Total opioid consumption was higher in group M  than in group O . More specifically, morphine consumption was higher than oxycodone consumption at all postoperative time intervals except at 8–12 h  are common adverse effects in PCA with opioids. It is known the use of opioids is a risk factor of PONV. Opioids cause nausea and vomiting by stimulating the chemoreceptor trigger zone in the medulla via μ-receptor . AlthougThere was no difference in the incidence of respiratory depression, or bradycardia between groups, and no clinically significant postoperative respiratory depression or bradycardia was observed. The possible reasons might be that most patients did not use the PCA device to completely eliminate their pain, or PCA technology could effectively reduce respiratory depression and bradycardia.There were some limitations in the present study. First, we only explored the main type of pain after laparoscopic DIE resection, but did not evaluate the frequency and intensity of the three types of pain. Further research was to characterize the early pain characteristics. Second, we did not follow up the patients to evaluate whether chronic pain was reduced with the oxycodone in the study. Future research should also focus on the long-term effects. The third limitation was that the patients’ pain thresholds were not tested before conducting the study.In conclusion, oxycodone and morphine could provide effective and safe analgesia after laparoscopic DIE resection. The consumption of oxycodone was less than morphine, and the incidence of nausea and vomiting with oxycodone was lower than that with morphine. Therefore, oxycodone was more potent than morphine for postoperative pain relief after laparoscopic DIE resection.