Local infiltration of anesthetics gives better results for pain and comfort scores then patient controlled anesthesia in total knee arthroplasty

Background : Local infiltration of anesthetics (LIA) is an upcoming alternative method for analgesia following total knee arthroplasty (TKA). It could replace patient controlled epidural anesthesia (PCEA). The advantages of LIA are faster mobilization, less risks compared to placement of an epidural catheter, and it increases patient care in a quantitative and qualitative way. On the other hand, PCEA provides prolonged analgesia postoperatively. The aim of this study was to compare the effects of LIA and PCEA on pain and comfort scores during the seven days following TKA. Methods : Two weeks after hospital dismissal, a questionnaire was sent to 116 patients who underwent TKA. Patients were asked for their pain scores on the day of surgery (=D0), two days after (=D2) and 7 days after (=D7). They were also asked about their general comfort, postoperative nausea and vomiting (PONV), vertigo and comfort urinating. The primary endpoint was pain at D7, secondary endpoints were pain on D0 and D2. and comfort scores. Results : Data of 81 patients were analyzed. 40 were provided with PCEA and 41 patients received LIA. Pain scores on D7 were significantly better in the LIA-group (18 [0-75] vs 38 [0-100] for LIA and PCEA, respectively (p=0.01)). Pain scores on D2 were also significantly better in the LIA group, whereas no difference in pain scores was seen on D0. There was less PONV on D0 and less discomfort urinating on D7 in the LIA group. Other scores showed no significant differences between the two groups. Conclusion : LIA showed in lower pain scores and improved comfort scores, compared to PCEA

A neuro-anatomically grounded scheme for LIA gives superior analgesia and comfort levels compared to epidural analgesia until seven days after total knee arthroplasty

LIA is an emerging alternative for patient-controlled epidural analgesia(PCEA) after total knee arthroplasty(TKA). LIA allows faster mobilisation, eliminates the risks of epidural catheters, and can hasten patient turnover. Conversely, PCEA provides reliable pain relief in the first days after this type of surgery. The purpose of this study was to evaluate the quality of antinociception, postoperative nausea & vomiting (PONY), and general comfort until 7 days postoperatively. 40 patients received PCEA and 41 received LIA. Patients were retrospectively asked for pain scores at the day of surgery(=D0), D2, and D7, PONV, and general comfort scores. Patients in the LIA group reported equal pain scores at DO, significantly better PONV scores and pain scores at D2 and D7. In addition to faster mobilisation and elimination of the risks and burden of an epidural catheter and PCEA, LIA delivers equal to better analgesia, and better PONY and general comfort scores

Intramedullary fixation of intertrochanteric hip fractures : a comparison of two implant designs : a prospective randomised clinical trial

We report the results of a prospective randomized clinical trial comparing the Gamma 3 nail with the ACE trochanteric nail for the treatment of pertrochanteric femoral fractures. One hundred and twelve consecutive patients were enrolled in the study : 61 patients were treated with the Gamma 3 nail, 51 with the ACE trochanteric nail. The two groups were matched for age, fracture type and preoperative Merle d'Aubigne hip score. All patients were followed up clinically and radiographically on a regular basis between 6 weeks and one year postoperatively. Twenty-six patients (23%) died within the first postoperative year. Six patients were lost to follow-up. In each group, two patients were revised due to mechanical failure. Nonunion did not occur. The mean postoperative hip scores in the Gamma 3 and the ACE group were 14.19 and 14.12 respectively, with no significant difference (p = 0.92). Walking ability was adequately restored in approximately 80% of the patients. Both implants appeared as safe and effective methods of treatment for intertrochanteric hip fractures