Postoperative analgesia in total knee arthroplasty

Total knee arthroplasty is commonly performed in patients with end-stage osteoarthritis or rheumatic knee arthritis to relieve joint pain, increase mobility, and improve quality of life. Despite advances in surgical techniques, postoperative pain management in these types of patients is still deficient. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to total knee replacement and pain management. Pain after total knee arthroplasty has been shown to involve both peripheral and central pain pathways, which is why various postoperative pain management strategies are currently applied, including patient-controlled analgesia, continuous peripheral nerve blocks, or single injection or local infiltration analgesia. Today local techniques such as periarticular injections are becoming more common in total knee replacement due to their effectiveness in controlling pain without causing muscle weakness. The development of minimally invasive techniques associated with multimodal and preventive analgesia improves recovery rates and early rehabilitation in patients undergoing total knee arthroplasty, reducing in-hospital costs, risk of complications, and improving patient satisfaction with chronic osteoarthropathy.

Inferior vena cava filters: a review

Venous thromboembolism is an entity that ranges from deep vein thrombosis to pulmonary embolism, both are highly prevalent diseases in our environment and potentially fatal. The intention of this review is to compile information regarding the indications, contraindications, complications and comparison of different therapeutic methods in order to create an algorithm. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to inferior vena cava filters. Venous thrombosis manifested as deep vein thrombosis or pulmonary embolism is a highly prevalent disease in our setting with high morbidity and mortality. Currently, different therapeutic options have been presented to address this pathology, in this review we focus on the developments regarding the use of vena cava filters. Reviewing the indications for the placement of a vena cava filter, we find absolute indications such as a contraindication to anticoagulation and high risk of massive pulmonary embolism. Pulmonary thromboembolism is a disease with high prevalence and mortality, we have highly effective and novel treatments such as the vena cava filter, patients should be selected carefully always taking into account the absolute and relative indications

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease