Effect of microneedling by dermaroller on acne scars: an observational study at tertiary care hospital

Background: Post acne facial scar is very distressing phenomenon. There are many treatment options like laser resurfacing, dermabrasion, microdermabrasion and non-ablative laser resurfacing but it may cause adverse effects and interference with the daily activities of the patient. Microneedling or dermaroller therapy is newer modality in management of acne scars with satisfactory improvement and no significant side effect. Objective of our study was to evaluate efficacy and safety of microneedling in the treatment of atrophic facial acne scars. Methods: Twenty-eight patients of Fitzpatrick skin type IV to V having atrophic facial acne scars and fulfilling inclusion criteria were treated with multiple sittings of microneedling (dermaroller) treatment at monthly interval. Goodman and Baron’s qualitative and quantitative acne scar grading system was used for assessment. Patients were evaluated clinically and by serial photography. Presence of any active infection, active acne, wounds, blisters, keloids, taking some medications like Accutane, antihypertensives, anticoagulants, systemic retinoids, topical retinoids, those undergoing cosmetic procedures, treatment with injecting fillers or ablative or non-ablative laser resurfacing, diabetes, collagen diseases and those who do not agree to participate in study were excluded. Results: Any change in the grading of scars after the end of treatment and follow-up period was noted. Efficacy and improvement of dermaroller treatment was assessed by Goodman and Baron’s global acne scarring system. Out of 18 patients (of total 28) with Goodman and Baron’s qualitative grade-4, 16 (88.90%) patients reduced to grade-1. 21 out of 28 patients achieved ‘excellent’ response. Adverse effects were limited to transient erythema and post inflammatory hyperpigmentation. Conclusions: Microneedling therapy seems to be simple, safe and efficacious for the management of atrophic facial acne scars

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely