Intraoperative local infiltration anesthesia effect on post-operative pain after total knee replacement

Background: Pain following TKA renders rehabilitation difficult. Local infiltration anesthesia (LIA) could significantly decrease post-operative pain. Aim was to assess the effect of peri-articular intraoperative LIA during primary TKA on post-operative pain. Methods: This prospective, randomized and double-blind study included 150 patients, aged 65-74 years, of both sexes with stage 4 knee osteoarthritis who were assigned for primary TKA at Queen Alia Military hospital, Amman-Jordan, during the period May 2022–December 2022. Patients were divided into two groups. LIA group (GI, n=75) received a single peri-articular LIA during surgery. The cocktail comprised 75 mg diclofenac sodium, 100 mg bupivacaine, and 0.5 mg adrenaline. The cocktail was diluted in 100 ml of normal saline and split into two syringes, 50 ml each. Patients in control group (GII, n=75) received only 100 ml of normal saline. When patients had pain postoperatively, 1 mg morphine was given intravenously at 15-minute intervals. Primary outcomes were verbal analog scale (VAS) pain score from day 1 to 6 after surgery and overall morphine administration. Results: On day 1 after surgery, the average VAS was 4.19 in the LIA group vs. 6.08 in group II (p<0.002), while it was 4.01 versus 4.78 (p>0.05) on day 6. Overall morphine requirement and pain scores from day 1 to day 6 after surgery were less in the LIA group than in the other group, 13.06 mg versus 20.75 mg (p<0.004). Conclusions: Peri-articular LIA during TKA significantly improve post-operative pain and decreases morphine use.

Implementation Of Intervention Program For Controlling Glucose Level Among ICU Patients

Introduction: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes, and the risk of mortality or significant morbidity is high among those who are treated in the intensive care unit (ICU) for more than 5 days. Study objectives: To assess the effect of glucose management protocol on mortality and morbidity in a heterogeneous population of critically ill adult patients. Methods and materials: Study design: A randomized controlled trial. Study setting: Intensive care unit (ICU) for adult patients at King Hussein Medical Center, the Royal Medical Services. Study sample: A total of 50 patients were included in this study and assigned randomly into two groups, control group (N=25), and intervention group (N=25). Study protocol: The intervention group subjects were to undergo a glucose control protocol with insulin infusion titrated to maintain blood glucose level in a target range of 120-160 mg/dL; except septic patients, in whom the target was higher, 160- 180 mg/dL. Patients in the second group (control group) were treated by a conventional approach with reduction of blood glucose level only if the level was markedly elevated (>200 mg/dL) to maintain blood glucose level in a target range of 180-200 mg/dL Study findings: Although the difference in mortality between the two treatment groups was not significant at 28 days (p=0.370) and at 60 days (p=0.555), but it was to be considered for further improvements. No significant increase in hypoglycemia episodes was reported in our blood glucose level target. There was no significant difference in the development of new organ failure, new renal insufficiency, number of patients undergoing transfusion of packed red blood cells, use of antibiotics for more than 10 days, length of stay in the ICU and length of stay in the hospital. It was noticed that the rates of positive blood cultures were lower in the interventional group (8%) than in the control group (32), (p=0.068). Conclusion: The glucose management protocol resulted in significantly improved glycemic control and was not associated with increased rate of death or hypoglycemia