Epidural catheter compared with local infiltration analgesia for postoperative pain relief in total knee replacement

AbstractBackground: This study compares the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty. Materials and methods: 47 females and 13 males with an average age of 65.7 years were randomly allocated into epidural (EA; n=30) and local infiltration anesthesia (LIA; n=30) groups. All patients received spinal anesthesia and were inserted epidural catheter. In LIA group, 50mL of a mixture, containing bupivacaine, ketorolac, morphine sulfate, and epinephrine was injected in to periarticular tissue and in EA group normal saline was injected. In the EA group, after surgery, an epidural catheter was attached to the patient-controlled analgesia (PCA) infusion pump with 25cc bupivacaine diluted in 75mL of normal saline but in LIA group, the PCA pump of the epidural catheter contained 100cc of normal saline, and the pump was blocked.Results: The difference in demographic data was not significant between the groups. The mean VAS score (Pain) of EA group was significantly higher than LIA group until 12 hours after surgery, At 24 hours, there was no significant difference between two groups, and Pain of EA group was significantly lower than LIA group at 48 hours after the surgery. Dranage volume and hemoglobin drops were lower in LIA group. Knee range of motion in the LIA group was not superior to that of the EA group two weeks after surgery. The patients’ ability to perform active straight leg raise had no significant difference between two groups one day after the surgery.Conclusion: local infiltration analgesia is better than epidural for postoperative pain control at first 12 hours. However, epidural analgesia can control postoperative pain more effectively at 48 hours after surgery. There was no significantly difference between two groups regard to patients ability to perform straight leg rising and Knee range of motion was similar in two groups

Frequency of Patient Complaints Before and After Legal Medicine Consultation in Orthopedic Ward

Background: Patient who complain of the health community are unpleasant and may endanger the honor of the medical community. However, patients’ complaints can improve the quality of medical services, increase the accuracy of the medical staff, and reduce diagnostic and treatment costs. The aim of this study was to investigate the prevalence of patients’ complaints before and after legal medicine consultation in the orthopedic ward of Taleghani hospital in Tehran, Iran.Methods: This retrospective cross-sectional study investigated the frequency of the complaints of 460 patients before and after legal medicine consultation from spring 2011 to winter 2017. Data were analyzed by excel.Results: The results of this study showed that the frequency of complaints was lowest in spring and highest in fall. The number of complaints and frequencies also decreased over time compared with the previous year. The lowest number of complaints was in 2011 and the highest in 2013.Conclusion: In this study, performing legal medicine consultation in Taleghani hospital in Tehran, Iran reduced the number of registered complaints

Determination of Effect of Platelet Rich Plasma Injection on Improving Pain and Function in Young Healthy Athletes with Isolated Grade 2 or 3 Knee Medial Collateral Ligament Sprains

Background: Knee medial collateral ligament (MCL) sprain is common in athletes, which keeps them away from trainings. Platelet-rich plasma (PRP) injection is used as an adjunct for treatment of musculoskeletal injuries. This study was supposed to define effect of PRP injection on high-grade MCL sprain healing, in comparison to rehabilitation alone.Materials and Methods: This study was performed on 46 healthy athletes with high-grade MCL sprains who came to sports medicine clinic of Taleghani Hospital, Tehran over a one-year period (2017-2018). In first visit injury grade, its location, baseline pain, Lysholm score and joint stability was determined. Participants randomly allocated to 2 groups (n=23), “group A” had 12-week functional rehabilitation and “group B” had the same rehabilitation plus a single PRP injection. At 4-week intervals valgus stress testing, pain and Lysholm scores was reassessed. The scores of 4th, 8th and 12th weeks was compared to the baseline scores.Results: Mean baseline pain score in control and intervention group was 5.09±0.949 and 5.26±0.810 respectively that in the fourth week of study reduced to 1.30±0.765 and 2.43±0.507 (p<0.001). In intervention group, fourth week pain was significantly reduced while stability and Lysholm scores of the groups had no significant difference.Conclusion: PRP injection had a short-term statistically significant pain reduction effect that may assist in faster rehabilitation progress, shorter return to play and less detraining which is crucial to professional athletes

The Efficiency of Locking Compression Plates versus Dynamic Compression Plates in the Treatment of Low Distal Fibula Fracture: A Randomized Clinical Trial

Background: Uncertainties remain as to which type of plate [locking compression plate (LCP) or dynamic compression plate (DCP)] is more efficient and cost-effective in fixing and stabilizing the fractures. We aimed to compare the clinical utility of the two types of plates including LCPs and 3.5-mm DCPs in the treatment of low distal fibula fracture (distal lateral malleolus fractures).   Methods: This randomized single-blinded clinical trial was performed on 54 patients with distal fibula fractures who were candidates for surgical treatment using compression plate fixation. The patients were randomly assigned into two groups scheduled for treatment with fixation of LCPs or with 3.5-mm T-plates (DCPs). The patients were finally followed-up for two years to assess the clinical outcome of the procedures.   Results: No difference was revealed between the two groups in the prevalence of postoperative infection, nonunion, wound dehiscence, skin reactions, and local surgical pain. The mean functional score [Olerud-Molander Ankle Score (OMAS)] in the DCP and LCP groups was 85.33 ± 4.92 and 84.85 ± 5.12, respectively, indicating no difference between the groups (P = 0.726).   Conclusion: In the treatment of low distal fibula fractures, the use of LCPs and 3.5mm DCPs can similarly result in improving functional status with minimal postoperative complications. Due to the similarity of the consequences of using both plates and the fact that the DCP type is more cost-effective and available in remote and deprived areas, this type seems to be preferred.

Distal radius volar T plate versus distal clavicle pre-contoured locking plate in Neer 2b distal clavicle fracture; a randomized control trial study

Purpose The purpose of current study was to compare the clinical and radiographic outcomes of distal radius volar T plate and pre-contoured locking plate in distal clavicle fracture. Materials and methods A total of 60 patients with Neer 2b distal clavicle fracture included in this study and undergone open reduction and internal fixation between March 2019 and November 2020 via two different plates; distal radius volar T plate and distal clavicle pre-contoured locking plate. All patients were followed at least two years post-operative. Union rate, time to union, need to device removal, and Constant-Murley score were assessed among them. ResultsIn all patients, bony union was achieved without wound related complication. The mean time to union in distal radius volar T plate group was 3.3 0.6 and 3.6 0.7 in pre-contoured locking plate (p value=0.14). The mean Constant-Murley score was 93.1 2.2 and 92.1 2.5 in T plate group and pre-contoured plate group, respectively (p value=0.09). Five cases with T plate and eight cases with pre-contoured plated were candidate for device removal (p value=0.53) ConclusionDistal radius volar T plate could be a reasonable choice to manage Neer 2b distal clavicle fracture as it restores functional range of motion with excellent bone union and without the necessity of device removal; beside its economical price

Intravenous injection of tranexamic acid in patients with pelvis or acetabulum fractures to reduce blood loss: a randomized double-blinded controlled trial

Background: Despite their low incidence, pelvis and acetabular fractures have a high mortality rate due to extensive hemorrhage. Tranexamic acid (TXA) is an antifibrinolytic drug that inhibits the production of plasminogen. This study aimed to evaluate the safety and efficacy of TXA use to reduce blood loss and the need for blood transfusion in patients with pelvis or acetabulum fractures. Methods: 108 patients were recruited from two tertiary care hospitals, and assigned evenly either to the intervention (TXA) or the control (CTL) group. TXA group received 15mg/kg TXA 30 minutes before the fracture reduction and fixation surgery. The number of transfused blood units before, during, and after the surgery was registered. Blood loss was assessed by calculation of estimated blood loss (EBL), collected blood with drain, collected blood with suction and weight of the used gauzes during the surgery. The time between fracture occurrence and the surgery, the duration of the surgery, and the days of admission were assessed. Results: The mean age was 39.49 ±15.81, 69.4% were female. 6 patients had pelvic and 102 patients had acetabulum fractures. The duration of the surgery was not significantly different. The time gap between fracture occurrence and the surgery was significantly higher in the TXA group (P value=0.032). The mean postoperative hospitalization time was significantly lower among TXA group patients (P value=0.037). The mean hemoglobin was significantly higher in TXA group postoperatively (P value =0.028). The mean EBL, the amount of collected blood volume by suction or drain, the weight of the used gauzes during the surgery and the number of transfused units were significantly lower in the TXA group patients. The transfusion rate was significantly lower in patients with a shorter time gap between fracture occurrence and reduction surgery (P value=0.021) Conclusion: Tranexamic acid can reduce blood loss, the number of transfused blood units during and after the surgery, and hospital admission duration. Moreover, it did not increase the chance of PTE or DVT in the patients receiving tranexamic acid; thus, it can be assumed as a safe and efficient drug in patients with acetabulum or pelvis fractures

Comparison of Early Versus Delayed Weight-bearing Outcomes after Ankle Fractures Surgical Treatment; A Retrospective Analytical Study: Rehabilitation after Ankle Fracture

Introduction: This study aimed to evaluate the early and delayed weight-bearing outcomes in patients with ankle fractures who underwent surgical treatment. Materials and Methods: This retrospective analytical study was conducted on 38 patients with bimalleolar ortrimalleolar fractures referred to Taleghani Hospital, Tehran, Iran. Patients who underwent ankle fracture surgical treatment were divided into the early weight-bearing group (study group) and the delayed weight-bearing group (comparison group). The outcomes were functional factors including pain, bulging, running, support, daycare, and stiffness were assessed and compared between the groups. Data were analyzed by IBM SPSS Statistics ver.23 at significant level of P-values <0.05. The Kolmogorov-Smirnov test approved the normality of data. Chi-squared test and independent T-Test were used to compare the outcomes between the groups. Results: Out of 38 patients, 30 were men (79%), and 8 were female (21%), with a mean age of 32.12 ±1.22 years old (range: 17 to 58 years). Contrary to the comparison group (delayed weight-bearing), pain (P=0.006), running (P=0.035), support (P=0.003), daycare (P=0.001), and total scores (P=0.001) were significantly higher in the intervention group (early weight-bearing) two weeks after the surgery. The other variables (bulging, stiffness, staring up, jumping, sitting/standing) did not significantly differ between the groups (P>0.05). Conclusions: Based on the results, early weight-bearing compared to delayed weight-bearing, has better outcomes in patients with ankle fractures who underwent surgical management

Comparison of Two Methods of Bolus and Infusion of Tranexamic Acid in Reduction of Blood Loss in Total Knee Arthroplasty

AbstractBackground: So far, many studies have been performed to determine the optimal dose and regimen of tranexamic acid to reduce preoperative and postoperative blood loss in primary total knee arthroplasty. In the present study, two different methods of administration (bolus and infusion), were compared.Materials and Methods: Forty patients were randomized in the two groups (A and B) of 20 patients each. All patients received 500 mg tranexamic acid before inflation of tourniquet. Group A (mean age, 64± 6.1 years) received 500 mg tranexamic acid 10 minutes before loosening of tourniquet and group B (mean age, 63.5 ± 7.7 years) received 500 mg tranexamic acid through IV infusion during 6 hours from the time of tourniquet loosening (total dose of TA, 1 g in both groups). Intraoperative blood loss,postoperative drainage (in 6 and 12 hours), blood transfusion (in 48 hours), and decrease in hematocrit and hemoglobin (6 and 12 hours later), were compared between the two groups.Results: The patients in group B had lower intra- and postoperative blood loss in 6 and 12 hours and also had lower decrease in hemoglobin, and their packed cell transfusion rate was significantly lower compared to the group A.Conclusion: The findings of this study indicated that infusion administration of tranexamic acid in primary total knee arthroplasty, was more effective in the reduction of perioperative blood loss as well as need for blood transfusion in 48 hours