Dihydroergotamine and mobilization after major orthopedic surgery

The effects of dihydroergotamine (DHE) on the degree of mobilization and response to orthostatic stress after total hip arthroplasty were studied. In the mobilization study, 78 patients received DHE, 0.5 mg im, twice a day from the day of surgery until full mobilization was achieved. Eighty-four patients who received placebo served as controls. There was no significant difference in the time until the first day of mobilization or the degree of mobilization. In the orthostatic test condition, subgroups of 61 patients receiving placebo and 55 patients receiving DHE were subjected to orthostatic testing. There were no differences in cardiovascular response to bed rest or in orthostatic stress. We conclude that DHE does not stabilize the cardiovascular reaction to orthostatic stress, nor does it enhance mobilization in patients after total hip arthroplasty.     

Medical hypnosis and orthopedic hand surgery: pain perception, postoperative recovery, and therapeutic comfort

Orthopedic hand-surgery patients experience severe pain postoperatively, yet they must engage in painful exercises and wound care shortly after surgery; poor patient involvement may result in loss of function and disfigurement. This study tested a hypnosis intervention designed to reduce pain perception, enhance postsurgical recovery, and facilitate rehabilitation. Using a quasi-experimental research design, 60 hand-surgery patients received either usual treatment or usual treatment plus hypnosis. After controlling for gender, race, and pretreatment scores, the hypnosis group showed significant decreases in measures of perceived pain intensity (PPI), perceived pain affect (PPA), and state anxiety. In addition, physician's ratings of progress were significantly higher for experimental subjects than for controls, and the experimental group had significantly fewer medical complications. These results suggest that a brief hypnosis intervention may reduce orthopedic hand-surgery patients' postsurgical PPI, PPA, and anxiety; decrease comorbidity; and enhance postsurgical recovery and rehabilitation. However, true experimental research designs with other types of controls must be employed to determine more fully the contribution of hypnosis to improved outcome.     

成年脊柱侧弯矫形后的断棒现象

背景:脊柱矫形内固定疗效的好坏与植骨融合技术以及内固定材料的疲劳特性疲劳寿命直接相关。目的:分析成人脊柱侧弯矫形后发生断棒的相关因素及临床意义。方法:对9例成人脊柱侧弯矫形后断棒并进行手术治疗的患者出现断棒时间、活动度、植入物位置、植骨融合率、术中矫形率进行相关性分析。结果与结论:9例患者中6例存在椎板间植骨融合不充分现象,有明显的植骨融合空白区和假性骨岛生成。经相关分析表明,金属疲劳寿命与植骨融合率、矫形率间呈正相关(P<0.01)。提示成年脊柱侧弯患者矫形手术中良好的植骨融合条件可以保证在治疗过程中所应用的金属内固定器材处于相对稳定的抗疲劳强度状态,满足内固定治疗过程所需的条件;保证内固定棒获得低于金属固有疲劳阈值点的疲劳状态,达到有效的弹性固定和持续的矫形的目的,并避免断棒现象的发生。     

骨科手术后感染病人的心理护理

骨科感染病人病程长,易反复,病人背负极大的经济压力及精神压力。在长期治疗过程中,病人常常自责给家人带来经济负担,担心周围人群或亲人的指责或慢待,存在一定的不良情绪,这些不良情绪会在一定程度上影响治疗效果。心理护理作为一种重要的护理方法在临床上越来越受到重视,它能较好地解决病人的负性心理。现报告如下。     

莱菔子热敷配合腹部按摩对骨科术后肠蠕动恢复的影响

[目的]探讨莱菔子热敷配合腹部按摩对骨科术后肠蠕动恢复的作用.[方法]选择骨折手术后病人120例,随机分为观察组60例和对照组60例.观察组除常规护理外,于术后开始实施莱菔子热敷脐部配合腹部按摩,每天2次,连续3 d ～5 d;对照组则接受骨科手术后常规护理.比较两组术后肠蠕动恢复情况、腹胀发生率.[结果]观察组术后肠鸣音恢复时间、首次排气、排便时间、腹胀发生率与对照组比较,差异均有统计学意义(P<0.01),观察组的效果优于对照组.[结论]采用莱菔子热敷配合腹部按摩能有效地促进术后肠蠕动的恢复,预防术后腹胀的发生.     

Practical management of anticoagulants in family medicine after orthopedic surgery

In order to prevent postoperative venous thromboembolism, prophylactic anticoagulant therapy is routinely administered to hospitalized patients after total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, after hospital discharge, anticoagulant therapy is primarily managed by a primary care physician (PCP). The agents traditionally used for this purpose are associated with certain limitations that affect anticoagulation management. The new, fixed-dose oral anticoagulants have predictable pharmacokinetic and pharmacodynamic profiles, no requirement for coagulation monitoring, and a low propensity for food and drug interactions. As a result, they have the potential to simplify and improve postoperative outcomes in patients who have undergone THA or TKA and allow for simpler management of anticoagulation in these patients. This article examines the clinical evidence for benefits of the new oral anticoagulants, discusses caveats regarding their appropriate use, and provides some guidance regarding bleeding management with these agents.     

Low-dose warfarin for prevention of symptomatic thromboembolism after orthopedic surgery

BACKGROUND: Warfarin dosing with a target international normalized ratio (INR) range of 1.5-2.5 has not been reported as adequate for venous thromboembolism (VTE) prophylaxis after total knee (TKR) and total hip replacement (THR) surgery. OBJECTIVE: To evaluate the rate of symptomatic VTE after TKR and THR surgery using a low-dose (INR 1.5-2.5) warfarin protocol started the evening before surgery compared with a literature cohort treated with enoxaparin. METHODS: TKR/THR patients treated with a 21-day low-dose warfarin protocol were followed via a consecutive observational design. Main outcome measures were symptomatic VTE and pulmonary embolism (PE), with major bleeds and death as secondary outcomes. Low-dose warfarin was compared with a literature cohort of patients treated with enoxaparin who received enoxaparin for a similar length of time and was evaluated for the same outcomes. Cohort event rates were derived as a weighted average using the DerSimonian model. RESULTS: VTE, PE, bleeds, and deaths in the low-dose warfarin group were 8 (1.04%), 4 (0.52%), 8 (1.04%), and 4 (0.52%), respectively. The cohort weighted average values were 35 (1.33%), 19 (0.72%), 65 (2.46%), and 18 (0.67%), respectively. Odds ratios for low-dose warfarin for VTE, PE, and VTE plus PE were 0.778 (95% CI 0.36 to 1.68), 0.717 (0.24 to 2.11), and 0.754 (0.41 to 1.42), respectively, all nonsignificant. Odds ratios for bleeds and death were 0.420 (0.20 to 0.87; p = 0.02) and 0.756 (0.26 to 2.24; NS), respectively. CONCLUSIONS: For this evaluation, low-dose warfarin was comparable to the enoxaparin cohort for development of VTE, PE, and VTE+PE. Incidences of bleeds in the enoxaparin cohort were significantly higher than in patients receiving low-dose warfarin.     

Evidence-based impact of cryotherapy on postoperative pain, swelling, drainage and tolerance after orthopedic surgery

Cryotherapy is often used in postoperative nursing after orthopedic surgery in order to support healing. A comprehensive literature search was executed in the databases of Medline, Cinahl and The Cochrane Library to identify meta analysis and randomised controlled trials of the application of local cooling after knee, hip, shoulder and spine surgery. The focus was on effects on pain-relief swelling, drainage, and the patients' tolerance. The findings of the 17 included articles were of variable methodological quality and in several points contradictory. Generally, solely an analgesic effect was demonstrated by the use of continuous cooling. The application of cold above 4 degrees C was considered comfortable by the patients, whereas reducing effects on swelling and drainage could not been found. Crashed ice, cold packs and electric-powered cooling devices differ in handling, effect and efficiency. Therefore, exact recommendations on application time and temperature can not be given. Furthermore, the effect of local cooling is influenced by compression and wound dressing techniques and must be considered with the application.     

自控硬膜外镇痛在骨科患者术后中的应用效果观察

目的观察自控硬膜外镇痛(patient-controlled epidural analgesics,PCEA)对骨科患者术后镇痛和镇静的效果。方法选择280例手术后采用PCEA方法的骨科患者,采用视觉模拟评分法(visual analogue scales,VAS)和Ramsay评分法观察并记录患者术后4、8、12、24、48h疼痛及镇静情况和不良反应发生情况。结果 280例患者疼痛评分为(1.5±0.5)分;镇静程度为(2.5±0.5)分。44例患者发生恶心和呕吐,142例患者出现尿潴留,无1例发生呼吸抑制等严重不良反应。结论对骨科术后的患者采用PCEA,镇痛和镇静效果满意,术后12h后无不良反应的发生,值得临床推广应用。     

Lymphatic treatments after orthopedic surgery or injury: A systematic review

BackgroundOrthopedic injuries in conjunction with extensive damage to tissues, bones and blood vessels, usually require a long recovery. Associated consequences are pain, movement limitations, decreased function and occasionally, prolonged edema, which can delay or interfere with the healing process. Lymphatic and compression therapy have become increasingly common, intending to reduce edema and pain, thus, promoting the recovery process.AimsTo examine the efficacy of methods commonly used to reduce edema after orthopedic injury or surgery, i.e. decongestive therapy, manual lymphatic drainage, and compression bandaging.MethodsEnglish literature search was undertaken in January 2019, in the following databases: Cochrane Library, MEDLINE, PEDro. Inclusion criteria: randomized controlled or quasi-controlled trials in adults who have edema or pain after recent limb trauma or surgery. Two independent assessors rated study quality and risk of bias using the PRISMA recommendations and PEDro score.ResultsWe evaluated 71 papers. After excluding duplicated and irrelevant papers, 15 met the eligibility criteria (6 on lymphatic treatment and 9 on compression). Quality of papers ranged from 3 to 7 on PEDro score; of them, 13 were 1b Level of Evidence and two were 1c.ConclusionAfter elective surgeries, when the significant edema appears or persists beyond recovery time, complex decongestive therapy and manual edema mobilization should be recommended in addition to conventional physical therapy. In acute injuries such as ankle or distal radius fractures, lymphatic treatments and compression bandaging should be considered as part of the therapeutic protocol. Nine studies evaluated different compression modalities found that only multilayer and long stretch compression significantly reduce edema.     

加速康复外科对腹腔镜卵巢囊肿患者术后恢复的影响效果

目的 观察以循证医学证据为基础的快速康复外科(ERAS)在腹腔镜卵巢囊肿手术护理中的应用效果.方法 以接受腹腔镜卵巢囊肿手术治疗的86例患者作为研究对象,根据患者住院号单双数分为对照组(单数者)44例和ERAS组(双数者)42例.对照组采用常规围术期护理,ERAS组采用ERAS护理干预,比较2组患者尿管拔除时间、初次下...     

Ethical challenges in orthopedic surgery

Despite our recent attention to ethical issues in orthopedics, we are still faced with multiple conflicts of interest that continue to pose ethical dilemmas to the practicing physician. Using four case scenarios, we review the potential conflicts of interest and the dilemmas posed by these frequently encountered situations. The ethical conflicts confronted in resident training, the introduction of new technology, physician advertising, and the obligations of the sports team physician are reviewed and discussed. The basic principles of medical ethics, including acting for the good of the patients and doing no harm, are discussed in the context of the four case scenarios.     

Intravenous acetaminophen for pain after major orthopedic surgery: an expanded analysis

Background and Methods: From the time that Sinatra et al. (Anesthesiology. 2005; 102 :822) was published to FDA apaproval of intravenous (IV) acetaminophen, an expanded analysis of the original raw study data became necessary for the regulatory submission. The following analyses were conducted: (1) sum of pain intensity differences over 24 hours (SPID24) using currently accepted imputation methods to account for both missing data and the effects of rescue; (2) efficacy results after the first 6 hours; (3) effects of gender, race/ethnicity, age, weight, surgical site, ASA Class, and serotonin antagonists; and (4) a stepwise regression analysis of why adverse events of nausea and vomiting were numerically (although not statistically) higher in the IV acetaminophen group compared with placebo. Results: Sum of pain intensity differences over 24 hours using a 0‐ to 100‐mm visual analog scale was statistically significantly (P < 0.001) in favor of IV acetaminophen (n = 49) compared with placebo (n = 52). Time to rescue was found to be 3.9 and 2.1 hours, respectively, for total hip and knee arthroplasty compared with 0.8 hours for the placebo group. Rescue medication consumption, requests, and actual administration were all significantly lower in the IV acetaminophen group compared with placebo for each dosing interval, except in the 6‐ to 12‐hours interval where a numerical trend was observed. Analysis of various subset variables demonstrated similar efficacy for each variable. A stepwise regression analysis demonstrated that AE reports of nausea and vomiting were most likely due to prerandomization events, particularly opioid consumption and presence of nausea prior to randomization. Conclusion: Repeated‐dose 24‐hours end points were found to be as robust as previously published results. IV acetaminophen efficacy and safety appeared to be unaffected by specific subset variables.?