Skin cooling, pain and chronic wound healing progression

Effect of intracanal cryotherapy on the fracture resistance of endodontically treated teeth

OBJECTIVE

The aim of this study is to evaluate the effect of intracanal cryotherapy on the fracture resistance of endodontically treated teeth.

MATERIALS AND METHODS

Sixty single-rooted maxillary lateral incisor teeth with single root canals were selected and randomly divided into two groups (n = 30). The specimens were immersed in distilled water, which was heated to 37 °C during the procedures. The root canals were chemomechanically prepared up to the apical size of 50 and assigned to either the control group or the cryotherapy group. The specimens in the cryotherapy group were irrigated with 20 mL sterile cold (2.5 °C) saline solution, which was delivered with an EndoVac system for 5 min, whereas the specimens in the control group received a sterile saline solution at room temperature. The fracture resistance of the specimens was then tested with a universal testing machine. The data was analyzed using the independent sample t test with a 5% significance threshold.

RESULTS

The fracture strength of the specimens in the intracanal cryotherapy group was significantly lower than that of the control group (p< .05).

CONCLUSIONS

Application of intracanal cryotherapy as a final irrigant reduced the vertical fracture resistance of prepared roots when compared to the control group.

Pain Management Strategies in Shoulder Arthroplasty

Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain. Patients with anxiety and depression, preoperative narcotic use, and medical comorbidities are at an increased risk for suboptimal pain control. Minimizing narcotic use decreases opioid-related adverse effects and facilitates productive rehabilitation efforts.

Does cryotherapy improve skin circulation compared with compression and elevation in preventing venous leg ulcers?

This trial compared skin blood flow, temperature and incidence of venous leg ulcers in patients with chronic venous disease using compression wraps and elevation pillows. Patients with CEAP C4 skin damage and C5 history of ulcers were randomly assigned to a cryotherapy intervention (n = 138) or placebo cuff control (n = 138) applied to the lower legs over 9 months. The time the ulcers healed prior to enrollment in the study for the cryotherapy group ranged from 1 to 2218 days (n = 8, median = 32 days); for the control group, the range was 24 to 489 days (n = 6, median = 390 days). There were no statistically significant blood flow changes measured in perfusion units with a laser Doppler flowmetre within or between the groups; mean difference between the groups was 0·62, P = 0·619. No differences were noted in skin temperature measured with an infrared thermometer within and between the groups; mean difference between the groups was -0·17°C, P = 0·540. Cryotherapy did not improve skin blood flow or temperature and did not show efficacy in preventing ulcers. However, at least 30% of intervention and 50% of control participants were anticipated to develop an ulcer during the study; only ∼7% occurred. These findings suggest that strict adherence to standard of care decreases the incidence of leg ulcers and remains a best practice for leg ulcer prevention.

Ice Reduces Needle-Stick Pain Associated With Local Anesthetic Injection

BACKGROUND

Local anesthetic injections are widely used in the emergency department for different purposes. Pain management for such injections is of great importance to both patients and the healthcare system.

OBJECTIVES

Our study aimed to determine the effectiveness and safety of cryotherapy in patients receiving local anesthetic injections.

METHODS

Subjects who presented with superficial lacerations were randomly assigned to 2 groups, the first group received ice packing prior to injection and the second did not. The pain severity, length and depth of the laceration, and the other necessary information before and after the pain-reducing intervention were measured, documented, and compared at the end of the study. Pain scores were measured using a numerical rating scale before and after the procedure, and the differences were compared using a t-test.

RESULTS

Ninety subjects were enrolled in the study, 45 in each group. There were no statistical differences between the 2 groups in terms of baseline preoperative and operative characteristics (P > 0.05). The pain scores in the cryotherapy group were significantly lower before and after the procedure (P < 0.001). There was no statistically significant difference between the 2 groups for wound infection (P = 0.783).

CONCLUSIONS

Cooling the injection site prior to local anesthetic injection is an effective and inexpensive method to reduce the pain and discomfort caused by the injection.

Hydrogel sheet dressings and short-stretch cohesive bandaging: case study

Hard-to-heal wounds such as leg ulcers are associated with long duration and a high incidence of complications such as pain, often resulting in considerable financial burden (European Wound Management Association (EWMA), 2008). The financial burden is not just one for the NHS but for the patients as well in lost days from work, taxi fares, prescription charges and even having to take early retirement. The prevalence of venous leg ulcers is approximately 1% in the whole population and this increases with age. Where appropriate research-based treatment protocols and guidelines are in place, about 50% of leg ulcers heal within 4months (EWMA, 2008). The following case study demonstrates that using protocols, national and local guidelines can have a positive effect on the patients wound care journey and promote optimal wound care (Wounds UK, 2008).