Trousseau’s sign in orthopedic: a rare sequelae of inadequate postoperative pain management

Background: Pain management in orthopedic is very crucial matter to handle, which is many a times not managed properly and that leads to various medical complications to the patients. Trousseau sign of latent tetany is a medical sign observed in patients with low calcium. This is the first and one of a kind case series describing the development and pathogenesis of Trousseau sign in orthopedics.Methods: This is a case series of 5 patients with lower limb fractures who underwent surgery. All these patients developed Trousseau's sign in immediate postoperative period. All the patients were investigated and were diagnosed with respiratory alkalosis. They were managed with closed bag ventilation which relieved the symptoms.Results: Here we put forward a direct physiological and psychological relation between a low pain threshold and associated hyperventilation with lead to development of Trousseau's sign in our patients. So, next time in postoperative round, if we see patient hyperventilating and complaining about fixed hand’s position, do not start calcium gluconate drip immediately, it may be due to respiratory alkalosis, then closed bag ventilation would be suffice.Conclusions: Trousseau’s sign seen postoperatively in Orthopedics may be commonly due to inadequate pain management rather than altered calcium metabolism.

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population