Open versus arthroscopic subacromial decompressionA prospective,randomized study of 34 patients followed for 8 years

In a randomized prospective study, we selected 15 patients for arthroscopic subacromial decompression (ASD) and 19 patients for open subacromial decompression (OSD). All had impingement syndrome (Neer grade II), and had been unsuccessfully treated without surgery for more than 6 months. The UCLA Shoulder Rating Scale, Visual Analogue Scales for pain and satisfaction, isokinetic dynamometer recordings and physical testing were assessed preoperatively and at 1 (except isokinetic testing), 3, 6, and 12 months, and, finally, 8 years after surgery. We found essentially no differences in the clinical tests between the groups during this period. The use of ASD or OSD seems to be a matter of cosmesis and personal preference.     

Open versus arthroscopic subacromial decompression

In a randomized prospective study, we selected 15 patients for arthroscopic subacromial decompression (ASD) and 19 patients for open subacromial decompression (OSD). All had impingement syndrome (Neer grade II), and had been unsuccessfully treated without surgery for more than 6 months. The UCLA Shoulder Rating Scale, Visual Analogue Scales for pain and satisfaction, isokinetic dynamometer recordings and physical testing were assessed preoperatively and at 1 (except isokinetic testing), 3, 6, and 12 months, and, finally, 8 years after surgery. We found essentially no differences in the clinical tests between the groups during this period. The use of ASD or OSD seems to be a matter of cosmesis and personal preference.     

Open versus arthroscopic subacromial decompression: a prospective, randomized study of 34 patients followed for 8 years

In a randomized prospective study, we selected 15 patients for arthroscopic subacromial decompression (ASD) and 19 patients for open subacromial decompression (OSD). All had impingement syndrome (Neer grade II), and had been unsuccessfully treated without surgery for more than 6 months. The UCLA Shoulder Rating Scale, Visual Analogue Scales for pain and satisfaction, isokinetic dynamometer recordings and physical testing were assessed preoperatively and at 1 (except isokinetic testing), 3, 6, and 12 months, and, finally, 8 years after surgery. We found essentially no differences in the clinical tests between the groups during this period. The use of ASD or OSD seems to be a matter of cosmesis and personal preference.     

Mini-incision technique for total hip arthroplasty with navigation

This prospective study compares a mini-incision technique and traditional posterior approach for total hip arthroplasty (THA). Thirty-three patients who had undergone a mini-incision THA were matched by diagnosis, gender, average age, and preoperative Harris Hip Score (HHS) to 33 patients who had undergone THA using the traditional posterior approach. The average length of the incision for group 1 was 11.7 cm (range, 7.3-13.0) and for group 2 was 20.2 cm (range, 14.8-26.0). At the 3-month follow-up, patients in the mini-incision group had significant improvement in limp (P<.05) and ability to climb stairs (P <.01) compared with the traditional group. At the 6 month follow-up, the mini-incision group was significantly better in terms of limp (P <.05), distance walked (P<.001), and stairs (P < 0.001). There was no significant difference between groups for pain, function, or range of motion at the 1-year follow-up examination.     

I.v. ketoprofen for analgesia after tonsillectomy: comparison of pre- and post-operative administration

We have evaluated the safety and efficacy of ketoprofen duringtonsillectomy in 106 adults receiving standardized anaesthesia.Forty-one patients received ketoprofen 0.5 mg kg^–1 atinduction (‘pre’ ketoprofen group) and 40 patientsafter surgery (‘post’ ketoprofen group), in bothcases followed by a continuous ketoprofen infusion of 3 mg kg^–1over 24 h; 25 patients received normal saline (placebo group).Oxycodone was used for rescue analgesia. Patients in the ketoprofengroups experienced less pain than those in the placebo group.There was no difference between the study groups in the proportionof patients who were given oxycodone during the first 4 h aftersurgery. However, during the next 20 h, significantly more patientsin the placebo group (96%) received oxycodone compared withpatients in the ‘pre’ ketoprofen group (66%) andthe ‘post’ ketoprofen group (55%) (P=0.002). Patientsin the placebo group received significantly more oxycodone dosesthan patients in the two ketoprofen groups (P=0.001). Two patients(5%) in the ‘pre’ ketoprofen group and one (3%)in the ‘post’ ketoprofen group had post-operativebleeding between 4 and 14 h. All three patients required electrocautery. Br J Anaesth 2001; 86: 377–81     

Randomised, placebo-controlled study of the postoperative analgesic effects of ketoprofen after spinal fusion surgery

BACKGROUND: The additive effect of non-steroidal anti-inflammatory drugs administered with propacetamol after major orthopaedic surgery has not been studied. Thus, we performed a prospective, placebo-controlled study to assess the analgesic effects of ketoprofen in patients undergoing spinal fusion surgery and receiving propacetamol. METHODS: Fifty patients undergoing spinal fusion surgery received either 100 mg of ketoprofen every 8 h or a placebo, postoperatively. All patients received propacetamol and morphine (intravenous titration followed by patient-controlled analgesia (PCA) over 24 h). Pain was assessed using a visual analogue pain scale (VASpi). Data are mean+/-SD. RESULTS: During morphine titration, ketoprofen did not significantly reduce the dose of morphine (8+/-6 vs 11+/-4 mg, NS) whereas it significantly decreased VASpi (P<0.001). During PCA, ketoprofen significantly reduced morphine consumption (25+/-17 vs 38+/-20 mg, P=0.04) and VASpi (P=0.002). The total postoperative morphine consumption was significantly (33%) reduced with ketoprofen. CONCLUSION: Ketoprofen reduced morphine requirements and improved postoperative analgesia in patients undergoing major spinal surgery and receiving propacetamol.     

Intravenous Ketoprofen in Postoperative Pain Treatment after Major Abdominal Surgery

In recent years considerable attention has been paid to the treatment of postoperative pain, with regard to the favorable effect of adequate analgesia on patient outcome. Multimodal analgesia (e.g., opioids and nonsteroidal anti-inflammatory drugs [NSAIDs] or local anesthetics) is recommended for effective postoperative pain relief. There are few data on the use of NSAIDs in postoperative pain treatment after abdominal surgery. We conducted a randomized, double-blind, placebo-controlled study to assess the analgesic efficacy and safety of ketoprofen after major abdominal surgery. One and nine hours postoperatively patients received 100 mg of ketoprofen i.v. (n = 21) or placebo (n = 22) in addition to a pain-treatment protocol consisting of continuous infusion of tramadol 200 mg and metamizol 5 g over 24 hours with additional 25 mg i.v. tramadol in case of inadequate analgesia. Pain was assessed by numeric rating scale at rest and at deep breath 3, 6, 12, and 24 hours postoperatively and the total dose of tramadol used in the first 24 hours was recorded. Patients in the ketoprofen group had significantly lower pain scores both at rest and at deep breath, at 3 (p < 0.01), 6, and 12 hours (p < 0.05) postoperatively. The 24-hour use of tramadol was significantly lower in the ketoprofen group (p < 0.01), with less nausea and vomiting. There were no bleeding complications or other adverse events related to ketoprofen therapy. The study showed the value of short-term use of ketoprofen to improve the quality of analgesia after major abdominal surgery without significant adverse effects.Presented in part at the 9th Symposium on Intensive Care Medicine, June 24–27, 2002, Brijuni Islands, Croatia, and at the Euroanaesthsia 2004 Meeting, June 5–8, 2004, Lisbon, Portugal     

Comparison of the opioid-sparing efficacy of diclofenac and ketoprofen for 3 days after knee arthroplasty

BACKGROUND: Comparative postoperative non-steroidal anti-inflammatory drug (NSAID) studies in orthopedic patients have usually been restricted in time to the first postoperative day. The opioid-sparing effect of NSAIDs may be beneficial postoperatively as long as pain otherwise restricts ambulation and rehabilitation. We therefore compared the analgesic efficacy of the maximum recommended doses of diclofenac and ketoprofen for 3 days after knee arthroplasty. METHODS: We studied 64 knee arthroplasty patients, operated on under spinal anesthesia. In a randomized, double-blind and placebo-controlled fashion, the patients received either i.v. diclofenac 75 mg (n = 24), ketoprofen 100 mg (n = 24) or saline (n = 16) in the recovery room, followed by oral diclofenac 150 mg/day, ketoprofen 300 mg/day or placebo, respectively, for 3 days, supplemented by patient-controlled analgesia (PCA) with i.v. oxycodone. RESULTS: The mean consumption of oxycodone during the first, second and third study days was 45.3, 22.3 and 15.2 mg in the diclofenac group, 43.5, 37.5 and 21.8 mg in the ketoprofen group, and 61.2, 45.9 and 36.1 mg, respectively, in the placebo group. Oxycodone consumption was significantly lower (P < 0.05) in the ketoprofen group than in the placebo group in the postoperative period 13-24 h and 61-72 h. Diclofenac was superior to placebo in the postoperative period 25-48 h (P < 0.01), 49-60 h (P < 0.05) and to ketoprofen at 49-60 h (P < 0.05). During administration of diclofenac on days 1-3 and ketoprofen on day 2, the mean pain scores (VAS) were lower than in the placebo group (P < 0.05). Six patients had difficulties in operating the PCA device. There were no differences in blood loss. CONCLUSION: We conclude that in the first day after knee arthroplasty (13-24 h), ketoprofen exerted an opioid-sparing effect. After day 1 (25-60 h), with the doses used, diclofenac proved to be better than placebo, whereas ketoprofen was not.     

Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone

STUDY OBJECTIVES: To compare the efficacy of injectable lornoxicam with diclofenac, ketoprofen, and dipyrone for acute postoperative pain. DESIGN: Prospective, randomized, placebo-controlled, double-blind study. SETTING: University hospital. PATIENTS: 200 ASA physical status I patients who were scheduled for elective septoplasty with general anesthesia. INTERVENTIONS: Patients were divided into 5 groups according to the intramuscularly administered analgesic drug: lornoxicam 8 mg (twice daily), diclofenac 75 mg (twice daily), ketoprofen 100 mg (twice daily), dipyrone 1 g (three times daily), and placebo (twice daily). MEASUREMENTS: Pain intensity was evaluated with a 0 to 100 mm Visual Analog Scale (VAS) at the 2nd, 4th, 6th, 8th, 12th, 16th, 20th, and 24th hour postoperatively. Intramuscular pethidine 1 mg/kg was administered to patients requiring additional analgesia, and treatment-related adverse effects were noted. MAIN RESULTS: Pethidine requirement was found to be significantly higher in the placebo group (1.8 mg/kg per 24 hours; 95% confidence interval, 1.5-2.2) than in the other groups (P = 0.001). No significant difference in opioid requirement was found among the treated groups (P > 0.05). Postoperative VAS scores were significantly lower at specific hours in the treatment groups when compared with placebo group (P < 0.05). No statistically significant difference in adverse effects was found among the groups studied (P > 0.05). CONCLUSIONS: Efficacy of lornoxicam in the management of acute postoperative pain was not superior to that of other nonopioid analgesics used in this study.     

Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults?

We have compared the analgesic and opioid sparing effect of three i.v. non-steroidal anti-inflammatory drugs with placebo in a randomized, double-blind, placebo-controlled study in 80 adult patients after elective tonsillectomy. A standard anaesthetic was used. After induction of anaesthesia, patients received ketoprofen 100 mg, diclofenac 75 mg or ketorolac 30 mg by i.v. infusion over 30 min. Patients in the placebo group received saline. Ketoprofen and diclofenac infusions were repeated after 12 h and ketorolac infusion at 6 h and 12 h. Oxycodone was used as rescue analgesic. Patients in the ketoprofen group requested 32% less opioid and patients in the diclofenac and ketorolac groups 42% less opioid than those in the placebo group (P < 0.05). There were one, two and six patients in the placebo, diclofenac and ketorolac groups, respectively, but none in the ketoprofen group, who did not request opioid analgesia during the study (P < 0.05, ketorolac vs placebo and ketoprofen). Visual analogue pain scores were similar in all groups. Visual analogue satisfaction scores were significantly higher in the diclofenac group compared with the placebo group. The incidence of nausea was 44-54%. There were no differences in the incidence of other adverse reactions. We conclude that all three non-steroidal anti-inflammatory drugs were superior to placebo after tonsillectomy.      

The effect of intravenous ketoprofen on postoperative epidural sufentanil analgesia in children.

We compared the effect of IV ketoprofen and placebo as an adjuvant to epidural sufentanil analgesia after major surgery. We used a prospective, randomized, double-blinded, placebo-controlled, parallel-group study design in 54 children aged 1-15 yr who received a standardized anesthetic. Either IV ketoprofen or saline was administered in addition to an epidural sufentanil infusion, which was adjusted as required clinically. The study drug infusions were discontinued when pain scores were <3 on 0-10 scale for 6 h at a sufentanil infusion rate of 0.03 microg x kg(-1) x h(-1). Children in the ketoprofen group had a better analgesic effect, as shown by decreased need for sufentanil (mean [10th-90th percentiles] 8.3 [3.1-15.1] microg/kg vs 12.5 [6.2-18.9] microg/kg; P = 0.002) and earlier possibility to discontinuation of the epidural sufentanil (11 [46%] vs 3 [13%]; P = 0.014) before the end of the 72-h study period. In the ketoprofen group, median (range) pain scores were lower during activity at 24 h (2 [0-5] vs 5 [0-7]; P = 0.01) and at 72 h (0 [0-3] vs 2 [0-6]; P = 0.033), and fewer children had inadequate pain relief during activity at 24 h (0 vs 5; P = 0.037). Children who received ketoprofen required fewer infusion rate adjustments (12 [4-20] vs 17 [6-42]; P = 0.016). In the ketoprofen group, the incidence of desaturation (1 [4%] vs 6 [26%]; P = 0.035) and fever (3 [12%] vs 11 [48%]; P = 0.008) was less than that in the placebo group. We conclude that ketoprofen improved postoperative pain in children. IMPLICATIONS: We compared the effect of the IV nonsteroidal antiinflammatory drug ketoprofen versus placebo as adjuvants to epidural opioid analgesia with sufentanil. The continuous IV nonsteroidal antiinflammatory drug improved pain after major surgery in children receiving an epidural opioid. Although ketoprofen reduced epidural sufentanil requirements, the incidence of opioid-related adverse effects was not changed.     

Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: preliminary results

Shoulder surgery is often associated with severe postoperative pain. Previous results in which single or continuous subacromial infiltration of local anesthetics was used as a method of postoperative pain relief have been contradictory. This study was initiated to evaluate the postoperative analgesic effect of a subacromial continuous 0.25% bupivacaine infusion at a rate of 6 mL/h after elective open shoulder surgery. We hypothesized that this procedure would improve postoperative analgesia while reducing morphine requirements. By use of a prospective, double-blind, randomized study design, 50 consecutive patients undergoing acromioplasty and rotator cuff repair surgery received a multiorifice catheter placed in the subacromial space. Twenty patients received 0.25% bupivacaine (group 1), and twenty-two patients received saline solution (group 2). The primary endpoints in the two groups were total morphine consumption administered by patient-controlled analgesia and the patient's subjective pain level evaluated by a visual analog scale during the first 48 postoperative hours. No major technical or pharmacologic side effects were noticed, and the indwelling pain catheter was well tolerated by all patients. There was no statistically significant difference (P < .05) either in total cumulative morphine consumption microg/48 h (73.2 +/- 43.1 vs 60.9 +/- 35.9) or in subjective pain perception 10-point visual analog scale (3.2 +/- 1.4 vs 3.1 +/- 1.5) between the two study groups. The continuous subacromial infiltration of 0.25% bupivacaine at a rate of 6 mL/h is concluded to be ineffective in providing pain relief supplementary to patient-controlled analgesia after open rotator cuff repair and acromioplasty surgery.     

Arthroscopic subacromial decompression.

In this study, we analyzed the results of two series of patients treated for impingement syndrome by undergoing arthroscopic subacromial decompression (ASD). Patients had not responded to nonoperative treatment. Group 1 included 112 consecutive patients (average age, 41 years) with 96 (77%) patients available for 2-year follow-up. Group 2 (28 patients, 29 shoulders; average age, 43 years; range, 22 to 72) had ASD and the subacromial space digitally palpated to determine if adequate decompression was performed. Twenty-two (85%) of 26 shoulders were available for follow-up. At follow-up, pain, function, range of motion, strength, impingement signs, and patient satisfaction were assessed. In group 1, according to the Neer criteria, 48% of the patients were graded as satisfactory and 52% unsatisfactory. Workers' Compensation patients had a satisfactory rate of 32%, whereas non-Workers' Compensation patients had a satisfactory rate of 59%. Twenty patients had open acromioplasty after ASD. Inadequate decompression was noted in 14 of 20 failed patients. In group 2, 86% of the patients were graded as satisfactory according to the Neer criteria, with 14% unsatisfactory, which included the 2 failures. The 2 (9%) of 22 shoulders that failed the ASD went on to further surgical treatment. Average follow-up was 56 months (range, 13 to 78 months). The average American Shoulder and Elbow Society score at follow-up was 90.4. No difference between Workers' Compensation cases and the other cases was seen (P <.7). Finger palpation can help to improve outcomes by allowing the surgeon to assess the adequacy of decompression.     

Patient-controlled ropivacaine analgesia after arthroscopic subacromial decompression

Purpose: To evaluate the efficacy of a subacromial patient-controlled analgesia (PCA) infusion of 0.2% ropivacaine versus saline for postoperative pain control following arthroscopic shoulder surgery. Type of Study: Double-blind prospective randomized study. Methods: A prospective, randomized double-blind study was performed on a consecutive group of 24 patients. All patients had arthroscopic subacromial decompression. Ropivacaine was chosen as the study drug due to the association of cardiac toxicity with the use of bupivacaine. The surgeon, anesthesiologist, and the operating room staff were blinded to the randomization. Immediately before surgery, the pharmacy staff randomized the type of drug infusion. Patients were asked to record their pain score using a visual analog scale (VAS) along with the amount of hydrocodone consumption for the first 2 days after surgery. Results: Nineteen patients completed the study. Ten patients received a subacromial infusion of 0.2% ropivacaine at 5 mL per hour with a bolus dose of 2 mL at a 15-minute lockout period via a microjet PCA pump (group I). Nine patients received saline in the same experimental conditions (group II). The use of a PCA ropivacaine infusion (group I) resulted in a significant reduction of postoperative pain by 34% as measured by VAS scale (P < .05), but no changes in the amount of hydrocodone consumption. Conclusions: The use of subacromial 0.2% ropivacaine PCA infusion provided effective postoperative pain control. Level of Evidence: Level I.     

Parenteral ketoprofen for pain management after adenoidectomy: comparison of intravenous and intramuscular routes of administration

BACKGROUND: Different parenteral routes of administration of NSAIDs such as ketoprofen have not been properly compared in children. This study was designed to compare the analgesic efficacy of intravenous and intramuscular ketoprofen for pain management in children after day-case adenoidectomy. METHODS: A total of 120 children, aged 1-9 years, who were scheduled to undergo adenoidectomy, were randomized to receive ketoprofen 2 mg/kg either intravenously with intramuscular placebo (n = 40) or ketoprofen 2 mg/kg intramuscularly with intravenous placebo (n = 40), or both intravenous and intramuscular placebo (n = 40) at induction of anesthesia. The study design was prospective and double-blind with parallel groups. Pain was assessed at rest and during swallowing using the Maunuksela pain scale during 3 h after surgery, and fentanyl i.v. was given for rescue analgesia. RESULTS: Children in the Placebo group needed significantly more doses of fentanyl (72 doses) than either children in the intravenous group (47 doses) or children in the intramuscular group (51 doses) (P = 0.021). In addition, a higher proportion of children in the Placebo group than in the two ketoprofen groups (P = 0.03) demanded rescue analgesic. No difference in the need for rescue analgesia or in pain scores was found between the two ketoprofen groups. Children in the intravenous group had less pain than children in the Placebo group. The difference was significant during swallowing at 1 h after surgery (P = 0.046) and for the worst pain observed during swallowing for 3 h after surgery (P = 0.022). There were no differences between the three groups with respect to operation times, amount of perioperative bleeding, or rate or extent of adverse events. CONCLUSION: The efficacy of intravenous and intramuscular ketoprofen was similar, and they both differed from placebo.     

Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up

The effectiveness of arthroscopic surgery, supervised exercises, and placebo was compared in 125 patients with rotator cuff disease (impingement syndrome stage II) in a randomized clinical trial. The median age was 48 years, and the median duration of complications was 1 to 2 years. The treatments were arthroscopic subacromial decompression performed by 2 experienced surgeons, an exercise regimen supervised for 3 to 6 months by 1 experienced physiotherapist, or 12 sessions of detuned soft laser (placebo) for 6 weeks. The criterion for success was a Neer shoulder score > 80. Fifteen (50%) and 11 (22%) of the patients randomized to placebo and exercises, respectively, had surgery during the 2 1/2-year follow-up period and were classified as having failure with the treatments. The success rate was higher (P < .01) for patients randomized to surgery (26 of 38) and exercises (27 of 44) compared with the placebo group (7 of 28). The odds ratio for success after surgery compared with exercises was 1.5 (95% confidence interval 0.6 to 3.7; P = .49). Including all patients who underwent operation, the success rate in those not on sick leave (19 of 21) before surgery was higher compared with those on sick leave (18 of 36) (adjusted odds ratio 5.6 [1.2 to 29.2]). Similar results were observed for patients not receiving versus those receiving regular pain medication before surgery (adjusted odds ratio 4.2 [1.2 to 15.8]).     

Étude comparative de la buprénorphine et de son association au kétoprofène et au propacétamol pour l'analgésie postopératoire en chirurgie urologique

ObjectiveTo compare the analgesic effect of subcutaneous buprenorphine alone and in combination with propacetamol and ketoprofen following urologic surgery.Study designOpen randomized clinical trial.PatientsSixty ASA II/III patients undergoing urologic surgery.MethodsThe patients were randomized into three groups to receive either buprenorphine (0.3 mg subcutaneous) on demand (group 1, n = 20), or a combination of buprenorphine (0.3 mg)- propacetamol (2 g)-ketoprofen (100 mg) by intravenous route over 2 hours followed by an infusion of propacetamol (2 g) and ketoprofen (100 mg) at a constant rate over. The remaining 22 hours (group 2, n = 20), or the same loading dose as in group 2 prolonged by a continuous infusion of buprenorphine (0.3 mg), propacetamol (2 g) and ketoprofen (100 mg) over the same period (group 3, n= 20). Visual analogue scale pain scores (0–10) were assessed every hour during the 24 hours of the study. When the VAS score exceeded 5, an additional dose of 0.3 mg of buprenorphine was administered.ResultsGroups were similar for age, surgery, anaesthesia and initial pain levels. Compared to group 1, the onset of analgesia was earlier in groups 2 and 3 at the 1 st hour (P < 0.05); the level of analgesia was lower at the 3rd hour (P < 0.05). The maintenance of this analgesia level required constant buprenorphine administration. Buprenorphine requirements were decreased to 56% and 37% in groups 2 and 3 respectively, compared to group 1 (P < 0.05). Incidence of nausea and vomiting was lowered to 15% in group 3 (P < 0.05).ConclusionA combination of buprenorphine, propacetamol and ketoprofen provides effective postoperative analgesia with a low incidence of nausea and vomiting and decreased requirements of buprenorphine     

The effect on leg strength of tourniquet use during anterior cruciate ligament reconstruction: A prospective randomized study

Purpose: The purpose of this study was to prospectively evaluate the effect of tourniquet use during endoscopic anterior cruciate ligament (ACL) reconstruction surgery on dorsiflexion strength, plantarflexion strength, quadriceps strength, and calf and thigh girth. Type of Study: The study was a prospective, double-blind, randomized clinical trial. Methods: Forty-eight patients were prospectively randomized into 2 groups: (1) tourniquet use during surgery (T) and, (2) no tourniquet use during surgery (NT). Within 1 week before ACL reconstruction, all patients were evaluated for isometric plantarflexion and dorsiflexion strength, thigh strength, and thigh and calf girth. These same measurements were repeated 3 weeks postoperatively. At 6 months, isokinetic quadriceps strength was evaluated at 60° per second. All patients underwent ACL reconstruction using a patella-tendon autograft and a tourniquet was placed on the affected extremity. In all 25 T patients, the tourniquet was inflated to 300 mm Hg. The average tourniquet time was 85 ± 7 minutes (range, 51 to 114 minutes). Results: ACL reconstruction resulted in a significant decrease in thigh girth (P <.01), calf girth (P <.01), dorsiflexion strength (P <.01), and plantarflexion strength (P <.05) at 3 weeks postoperatively in both groups. The T group had a greater decrease in thigh girth than the NT group (P <.05). Tourniquet use did not have an effect on calf girth (P =.53), dorsiflexion strength (P =.17), or plantarflexion strength (P =.32) at 3 weeks postoperatively. Tourniquet use also had no effect on quadriceps strength at 6 months postoperatively (P =.78). Conclusions: Tourniquet use of less than 114 minutes during ACL reconstruction had no effect on the strength of the lower extremity after surgery.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 603–607     

Cellular immune response to 3 anesthetic techniques for simple abdominal hysterectomy

BACKGROUND AND OBJECTIVE: The effect of surgery and anesthesia on the immune response may have a significant effect on perioperative tumor surveillance. The aim of this study was to characterize the cellular immune response of patients undergoing simple abdominal hysterectomy under 3 types of anesthesia. PATIENTS AND METHODS: ASA 1-2 patients undergoing simple abdominal hysterectomy were enrolled prospectively after they gave informed consent; the patients were randomized to 3 groups of 20 each to receive balanced anesthesia (group A), remifentanil-based anesthesia and analgesia (group B), or combined general-epidural anesthesia (group C). Postoperative analgesia was provided in accordance with group assignment. Four and 24 hours after surgery, 20 mL of blood was drawn from each patient for analysis of leukocyte populations and lymphocyte subpopulations. Statistics were calculated with the SPSS software package, version 12.0. RESULTS: All groups had elevated neutrophil counts after surgery; the lowest levels were in group C (P<.05). Patients in all 3 groups developed lymphopenia, which was still evident 24 hours after surgery (P<.05). CD3 cell counts at 4 hours were lowest in patients who had received combined anesthesia (group C), CD19 cell counts were highest in group A, and CD16 cell counts were lowest in group C; this last difference was maintained at 24 hours (P<.05 for all these comparisons). CONCLUSION: Combined general-epidural anesthesia seems to lower the counts of natural killer cells that are involved in tumor surveillance and destruction.     

Self-training versus physiotherapist-supervised rehabilitation of the shoulder in patients treated with arthroscopic subacromial decompression: a clinical randomized study

In a controlled clinical prospective study, 43 consecutive patients (43 shoulders) with subacromial impingement resistant to conservative therapy and without full-thickness rotator cuff tears underwent arthroscopic subacromial decompression. The patients were randomized to either self-training or physiotherapist-guided rehabilitation for immediate postoperative rehabilitation. Postoperative follow-up was performed by an independent observer after 3, 6, and 12 months. With the use of the Constant score for evaluation of functional outcome, patients training themselves improved from a mean 53 points (range 26 to 81 points) to a mean 79 points (range 45 to 100) points after 12 months. Physiotherapist-supervised patients improved from a mean 54 points (range 20 to 90 points) to a mean 80 points (range 40 to 100 points). The self-training patients returned to work after a mean 8.5 weeks (range 1 to 14 weeks), whereas the physiotherapist-supervised patients returned to work after a mean 8 weeks (range 3 to 13 weeks). No statistical difference was found between the 2 rehabilitation methods. This study was unable to show any beneficial effect of physiotherapist-supervised rehabilitation after arthroscopic subacromial decompression of the shoulder.