Rejected

The role of topical non-steroidal anti-inflammatory drugs (NSAIDs) in routine cataract surgery has been established since decades. Topical NSAIDs have been shown to reduce postoperative ocular inflammation and pain, preserve intraoperative mydriasis, and reduce the risk of postoperative cystoid macular oedema, whilst carrying a very low side-effect profile. Nepafenac is one of the currently available topical NSAIDs. The studies have shown that is has a high ocular penetration, allowing for potentially better results than other NSAIDs. This review gathers the current literature on the role of nepafenac in cataract surgery aiming to help surgeons maximise the benefits of its use to achieve improved surgical outcomes.

Carbon monoxide is a colorless, odorless, highly toxic gas primarily produced through the incomplete combustion of organic material. Carbon monoxide binds to hemoglobin and other heme molecules, causing tissue hypoxia and oxidative stress. Symptoms of carbon monoxide poisoning can vary from a mild headache to critical illness, which can make diagnosis difficult. When there is concern for possible carbon monoxide poisoning, the diagnosis can be made via blood co-oximetry. The primary treatment for patients with carbon monoxide poisoning is supplemental oxygen, usually delivered via a nonrebreather mask. Hyperbaric oxygen can also be used, but the exact indications are controversial.

Extracorporeal Shock Wave Lithotripsy (ESWL) is one of the treatment options for patients with renal and ureteral calculi. Even though the procedure is less invasive compared to others, pain caused by the procedure is a major concern. Several studies recommended the use of either local or systemic analgesia with varying results. We aimed to compare the use of local anesthetics and systemic analgesics from randomized controlled trials evaluating pain management during ESWL. A systematic search adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol was performed in theMedline, ScienceDirect, and Cochrane library databases. The bias was evaluated using the Cochrane risk of bias tool. Mean difference (MD) was used to analyze continuous outcomes. A total of seven studies were obtained. The topical anesthesia used was eutectic mixture of local anesthetic cream and xylocaine gel. In contrast, the local injection anesthesia used was subcutaneous prilocaine and intracutaneous sterile water injection. The systemic analgesics used were intramuscular and oral forms of sodium diclofenac. There is no significant difference between the visual analogue scale results between the local and systemic groups (P> .05). The differences in ESWL frequency were also insignificant (P > .05). Additional analgesics supplementation (MD 8.44, 95% CI 2.28-14.61, P¼ .007) and the duration of the procedure (MD 1.39, 95% CI 0.21-2.56, P¼ .02) were significantly lower in the local group. Local anesthesia in ESWL shows a similar degree of pain and frequency but has a shorter duration and fewer analgesics supplementation than systemic analgesics.

Pharmacologic management of acute pain should be tailored for each patient, including a review of treatment expectations and a plan for the time course of prescriptions. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain. Topical NSAIDs are recommended for non-low back, musculoskeletal injuries. Acetaminophen is well tolerated; however, lower doses should be used in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder. Nonselective NSAIDs are effective but should be used with caution in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease. Selective cyclooxygenase-2 NSAIDs are a more expensive treatment alternative and are used to avoid the gastrointestinal adverse effects of nonselective NSAIDs. Adjunctive medications may be added as appropriate for specific conditions if the recommended dose and schedule of first-line agents are inadequate (e.g., muscle relaxants may be useful for acute low back pain). For severe or refractory acute pain, treatment can be briefly escalated with the use of medications that work on opioid and monoamine receptors (e.g., tramadol, tapentadol) or with the use of acetaminophen/opioid or NSAID/opioid combinations. The opioid epidemic has increased physician and community awareness of the harms of opioid medications; however, severe acute pain may necessitate short-term use of opioids with attention to minimizing risk, including in patients on medication-assisted therapy for opioid use disorder.

Despite being invasive, with serious complications, epidural blood patch (EBP) is still considered the gold standard therapy for Post Dural Puncture Headache (PDPH). The use of Peripheral nerve blocks for PDPH are studied here.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of a variety of musculoskeletal conditions, injuries and after surgery for postoperative pain management. Their use has been associated with impaired bone healing, possibly due to a multifactorial function, which may include inhibition of osteoblast recruitment and differentiation. However, up to date, there is no consensus regarding the impact of NSAIDs on bone-healing. The aim of the current study was to investigate the effects of five NSAIDs on the cellular functions of mouse MC3T3-E1 pre-osteoblasts. Cells were treated with the non-selective COX inhibitors lornoxicam and diclofenac, the COX-2 selective inhibitors parecoxib, meloxicam and paracetamol, as well as steroidal prednisolone at different doses and exposure times. The PrestoBlue™ technique was used to measure cell viability, an enzymatic assay was employed for alkaline phosphatase (ALP) activity and alizarin red S mineral staining was used to determine osteogenic differentiation. All drugs had a negative impact on pre-osteoblast cell growth, with the exception of paracetamol. Lornoxicam, diclofenac and meloxicam reduced ALP activity, while the other NSAIDs had no effect and prednisolone strongly increased ALP activity. In contrast, calcium deposits were either unaffected or increased by NSAID treatments but were significantly decreased by prednisolone. These results provide evidence that NSAIDs may adversely affect the viability of mouse pre-osteoblast cells but their actions on the osteogenic differentiation are drug-specific. The direct comparison of the effects of different NSAIDs and prednisolone on pre-osteoblasts may serve to place some NSAIDs in a preferential position for analgesic and anti-inflammatory therapy during bone repair.

Percutaneous radiofrequency ablation (RFA) of the trigeminal Gasserian ganglion via the foramen ovale is still one of the classic treatments for primary trigeminal neuralgia. However, the Gasserian ganglion is deep in the middle cranial fossa. Although it is a structure outside the brain tissue, the puncture needle must enter the encephalic to reach the Gasserian ganglion and so it is difficult to completely avoid the risk of intracranial hemorrhage and infection caused by puncture damage to intracranial blood vessels. It is not clear whether if it is possible for RFA at the extracranial non-gasserian-ganglion site via the exit of the cranial channel (foramen ovale) for patients with V3 trigeminal neuralgia (TN).