Suture-method versus Through-the-needle Catheters for Continuous Popliteal-sciatic Nerve Blocks: A Randomized Clinical Trial.

BACKGROUND:The basic perineural catheter design has changed minimally since inception, with the catheter introduced through or over a straight needle. The U.S. Food and Drug Administration recently cleared a novel perineural catheter design comprising a catheter attached to the back of a suture-shaped needle that is inserted, advanced along the arc of its curvature pulling the catheter past the target nerve, and then exited through the skin in a second location. The authors hypothesized that analgesia would be noninferior using the new versus traditional catheter design in the first two days after painful foot/ankle surgery with a primary outcome of average pain measured with the Numeric Rating Scale. METHODS:Subjects undergoing painful foot or ankle surgery with a continuous supraparaneural popliteal-sciatic nerve block 5 cm proximal to the bifurcation were randomized to either a suture-type or through-the-needle catheter and subsequent 3-day 0.2% ropivacaine infusion (basal 6 ml/h, bolus 4 ml, lockout 30 min). Subjects received daily follow-up for the first four days after surgery, including assessment for evidence of malfunction or dislodgement of the catheters. RESULTS:During the first two postoperative days the mean ± SD average pain scores were lower in subjects with the suture-catheter (n = 35) compared with the through-the-needle (n = 35) group (2.7 ± 2.4 vs. 3.4 ± 2.4) and found to be statistically noninferior (95% CI, -1.9 to 0.6; P < 0.001). No suture-style catheter was completely dislodged (0%), whereas the tips of three (9%) traditional catheters were found outside of the skin before purposeful removal on postoperative day 3 (P = 0.239). CONCLUSIONS:Suture-type perineural catheters provided noninferior analgesia compared with traditional catheters for continuous popliteal-sciatic blocks after painful foot and ankle surgery. The new catheter design appears to be a viable alternative to traditional designs used for the past seven decades

Mechanical Evaluation of Fourth-Generation Composite Femur Hybrid Locking Plate Constructs

Locking compression plates are routinely used for open reduction and internal fixation of fractures. Such plates allow for locking or non-locking screw placement in each hole. A combined use of both types of screw application for stabilization of a fracture is commonly applied and referred to as hybrid internal fixation. Locking screws improve the stability of the fixation construct but at the expense of significant additional cost. This study experimentally analyzes various combinations of locking and non-locking screws under simultaneous axial and torsional loading to determine the optimal hybrid locking plate—screw construct in a fourth generation composite femur. Clinically it is necessary to ensure adequate fixation stability in a worse case fracture-bone quality scenario. A locking screw near the fracture gap increased the axial and torsional strength of the locked plate system. Greater removal torque remained in non-locked screws adjacent to locked screws compared to an all non-locking screws control group

Mechanical Evaluation of Fourth-Generation Composite Femur Hybrid Locking Plate Constructs

Locking compression plates are routinely used for open reduction and internal fixation of fractures. Such plates allow for locking or non-locking screw placement in each hole. A combined use of both types of screw application for stabilization of a fracture is commonly applied and referred to as hybrid internal fixation. Locking screws improve the stability of the fixation construct but at the expense of significant additional cost. This study experimentally analyzes various combinations of locking and non-locking screws under simultaneous axial and torsional loading to determine the optimal hybrid locking plate—screw construct in a fourth generation composite femur. Clinically it is necessary to ensure adequate fixation stability in a worse case fracture-bone quality scenario. A locking screw near the fracture gap increased the axial and torsional strength of the locked plate system. Greater removal torque remained in non-locked screws adjacent to locked screws compared to an all non-locking screws control group

Percutaneous auricular nerve stimulation (neuromodulation) for the treatment of pain following outpatient surgery: a proof-of-concept case series.

BackgroundFollowing outpatient surgery, it is often difficult to provide adequate analgesia while concurrently minimizing opioid requirements. Ultrasound-guided percutaneous peripheral nerve stimulation has been proposed as an analgesic, but requires physician-level skills, advanced equipment, up to an hour to administer, and is frequently cost prohibitive. In contrast, percutaneous auricular neuromodulation may be placed by nursing staff in a few minutes without additional equipment, theoretically provides analgesia for nearly any anatomic location, lacks systemic side effects, and has no significant risks. We now present a case report to demonstrate proof of concept for the off-label use of an auricular neuromodulation device-originally developed to treat symptoms associated with opioid withdrawal-to instead provide analgesia following outpatient surgery.Case presentationFollowing moderately painful ambulatory orthopedic and breast surgery, seven patients had an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) affixed within the recovery room in approximately 5 min and discharged home. Average resting and dynamic pain scores measured on the 0-10 Numeric Rating Scale were a median of 1 over the first 2 days, subsequently falling to 0. Five patients avoided opioid use entirely, while the remaining two each consumed 5 mg of oxycodone during the first 1-2 postoperative days. After 5 days, the devices were removed at home and discarded.ConclusionsThese cases demonstrate that ambulatory percutaneous auricular neuromodulation is feasible and may be an effective analgesic and decreasing or even negating opioid requirements following outpatient surgery. Considering the lack of systemic side effects, serious adverse events, and misuse/dependence/diversion potential, further study with a randomized, controlled trial appears warranted