A comparison of two regional anesthetic techniques for outpatient knee arthroscopy

IMPLICATIONS: Small dose lidocaine spinal anesthesia and 3% 2-chloroprocaine epidural anesthesia provided comparable discharge times for outpatient knee arthroscopy. The incidence of transient neurologic symptoms with small-dose lidocaine spinal anesthesia was 12%.     

两种冲击波方法治疗慢性跖筋膜炎疗效的比较

[目的]比较两种冲击波方法治疗慢性跖筋膜炎的不同疗效。[方法]选取112例慢性跖筋膜炎患者为研究对象,随机分为足底组和复合组,足底组对足底区进行冲击波治疗,复合组在足底区治疗的基础上对同侧小腿三头肌进行冲击波治疗。分别于治疗前,治疗终结时,治疗后1、4、12周对两组进行视觉模拟评分(VAS)及足底部压痛阈值(PPT)比较分析。[结果]两组在治疗终结时,治疗后1、4、12周VAS评分较治疗前明显降低,差异有统计学意义,尤以复合组显著(P0.05)。复合组在治疗后各时间点VAS评分与足底组比较更低,两组间差异有统计学意义(P0.05)。两组在治疗终结时、治疗后1周PPT与治疗前无明显变化(P0.05),在治疗后4、12周PPT明显改善,与治疗前差异有统计学意义,尤以复合组显著(P0.05)。复合组在治疗后4、12周与足底组比较改善更为明显,两组间差异有统计学意义(P0.05)。[结论]足底筋膜与小腿三头肌同时冲击波治疗效果优于单纯足底筋膜治疗。     

两种不同手法强度对慢性跖筋膜炎治疗效果的研究

目的观察两种不同手法强度对慢性跖筋膜炎治疗效果的影响。方法应用强度200N/cm~2康复治疗跖筋膜炎,与强度100 N/cm~2康复治疗的跖筋膜炎作对照,以疼痛日记为疗效指标,晨起第一步时及每天最痛时的VAS评分与对照组相比较。结果经8周治疗且随访3个月,强度200 N/cm~2的手法治疗慢性跖筋膜炎优于强度100 N/cm~2,组间比较,差异有统计学意义(P0.01)。结论在治疗慢性跖筋膜炎方面,手法强度与疗效有着明显关系,大强度手法的效果较好。     

A comparison of five techniques for detecting cardiac activity in infants

BACKGROUND: The new guidelines for cardiopulmonary resuscitation recommend that laypersons should begin chest compressions without checking for a pulse because the pulse check has serious limitations in accuracy. We determined the efficacy of the most suitable method to search for cardiac activity in infants. METHODS: Twenty-eight nurses tried to detect infants' cardiac activity and determined their heart rates with five different techniques: palpation of brachial pulse, carotid pulse, femoral pulse, apical impulse and auscultation of apical impulse with the naked ear (direct auscultation technique). RESULTS: The mean time interval required to find the pulse within 30 s in the auscultation, the apical, the brachial, the carotid and the femoral were 2.4 +/- 1.2, 3.5 +/- 2.7, 4.0 +/- 2.7, 9.9 +/- 7.0 and 9.1 +/- 5.9 s, respectively. The required time was significantly shorter in the auscultation method than in the palpation of carotid and femoral pulses. The percentage and 95% confidence intervals (95% CI) of pulses identified within 10 s (= the number of the correct identified within 10 s/the number of all cases) in auscultation, apical, brachial, carotid and femoral palpations were 100.0% (95% CI 51.8, 100), 75.0% (95% CI 28.9, 89.3), 73.1% (95% CI 52.2, 88.4), 50.0% (95% CI 30.6, 69.4) and 42.9% (95% CI 24.5, 62.8), respectively. These values were greater in the auscultation method than in all the palpation methods. CONCLUSIONS: The direct auscultation technique was more rapid and accurate than any other techniques to determine cardiac activity without instruments. It is suggested that direct a auscultation technique is also superior to the palpation of brachial artery in cardiopulmonary resuscitation in infants.     

A comparison of two sedation techniques for neuroradiology

Two groups of 25 patients were sedated during neuroradiological investigation. The first group was sedated with fentanyl and midazolam while the other was given fentanyl and a two-stage infusion of propofol in a subanaesthetic dose. Both techniques resulted in satisfactory sedation and recovery, although those who received propofol were more likely to recall their journey from the X-ray department back to the ward. Sedation in both groups resulted in unacceptable PaO2 values in some patients which could subsequently be corrected by administration of supplementary oxygen.     

A comparison of two osteotomy techniques for tibial lengthening

Introduction There are various methods of long bone lengthening. The quality of the regenerated bone depends on stable external fixation, low energy corticotomy, latency period, optimum lengthening rate and rhythm, and functional use of the limb. Percutaneous corticotomy and ostetomy with multiple drill holes yield the best results for the quality of the regenerated bone. An alternative low energy osteotomy, which respects the periosteum, is the Afghan percutaneous osteotomy. The purpose of the current study was to compare a percutaneous multiple drill hole osteotomy with a Gigli saw osteotomy in terms of the healing index (HI).Materials and methods Forty-four tibias of 41 patients were lengthened at our institution between 1995 and 2000. All patients underwent limb lengthening without any deformity correction by the Ilizarov device. The etiology of the limb length discrepancy was sequelae to poliomyelitis in 16 tibias, idiopathic hypoplasia in 17 tibias, posttraumatic discrepancy in 5 tibias, bilateral tibial lengthening in achondroplastic dwarfism in 3 patients. Patients with metabolic bone diseases were not included in this series.Results The mean amount of length discrepancy was 5.7 cm (range 2–12 cm). The mean HI of the whole group was 1.65 month/cm (range 1.1–2.4 month/cm). When comparing the osteotomy methods without taking the etiology into consideration, the percutaneous, multiple drill hole group yielded a mean HI of 1.98 month/cm (range 1.4–2.4 month/cm), while the Gigli saw group yielded a mean HI of 1.37 month/cm (range 1.1–1.8 month/cm). There was a statistically significant difference between the two groups (p=0.022). The Gigli saw patients with poliomyelitis had a significantly better HI compared with patients who underwent lengthening by the other form of osteotomy (1.1 vs 1.9 month/cm; p=0.027).Conclusion Our results confirm the biologic superiority of the Gigli saw technique.     

A comparison of two anaesthetic techniques for daycase arthroscopy

A randomised, double-blind study of 100 patients admitted for daycase arthroscopy was undertaken. Fifty patients received alfentanil 500 micrograms and midazolam 5 mg, and 50 received alfentanil 500 micrograms alone, in each case 2 minutes before induction of anaesthesia with methohexitone. Anaesthesia was maintained in both groups with nitrous oxide, oxygen and enflurane. Recovery was assessed quantitatively by measuring time to when they awoke and by a comparison of pre- and postoperative performance of p-deletion and postbox tests. Qualitative assessment of recovery and of postoperative pain was also undertaken. Patients completed a questionnaire to record the incidence of any anaesthetic-related symptoms on the first and second postoperative days. Patients who received midazolam required a reduced dose of methohexitone but their initial recovery time was prolonged significantly. The incidences of anaesthetic-related side effects and postoperative pain were similar in the two groups and while the questionnaires did not reveal any statistically significant differences in symptoms on the first 2 postoperative days, the results indicated that patients who received a larger induction dose of methohexitone were subjectively drowsier on the first day after operation.     

Ultrasonographic measurements of plantar fascia thickness and echogenicity in individuals with and without plantar fasciitis: Reliability and group differences

ObjectiveImaging techniques such as ultrasonography are beneficial for diagnosis of plantar fasciitis. The purpose of this study was to investigate intra-rater reliability of plantar fascia thickness and echogenicity in subjects with and without plantar fasciitis and to compare the measurements between the two groups.DesignSonographic evaluation of the plantar fascia was performed in prone position in 20 subjects without plantar fasciitis and 20 subjects with plantar fasciitis. The outcome measures extracted from the ultrasound images included plantar fascia thickness at the insertion, 1 cm and 3 cm distal from the insertion and plantar fascia echogenicity. The reliability of outcome measures was estimated for both groups using absolute and relative reliability variables. The two groups were compared using analysis of variance (ANOVA).ResultsICCs _{(3, 3)} for intra-rater reliability of plantar fascia thickness and echogenicity were, respectively, ≥0.89 and ≥0.89 in the healthy controls and 0.87≥ and 0.90≥ in the plantar fasciitis group. The subjects with plantar fasciitis showed a thicker plantar fascia with lower echogenicity in all of measurement stations of plantar fascia compared to the healthy controls.ConclusionThe results of the present study indicated that ultrasonography is a reliable method to measure plantar fascia thickness and echogenicity. Furthermore, the findings showed that plantar fascia is affected not only at its insertion but also in other points remote from the insertion in patients with plantar fasciitis. These findings support the diagnostic value of ultrasonography in therapy and research of the patients with plantar fasciitis.     

A retrospective comparison of costs for regional and general anesthesia techniques

In this retrospective study, we compared the costs for three different regional anesthesia techniques with the costs of general anesthesia (GA). A total of 1587 anesthesia cases which were performed for orthopedic and trauma patients over a 1-yr period in a tertiary level, university hospital setting were analyzed. The anesthesia technique-related costs were determined calculating case-specific costs for personnel, supplies, and drugs. The techniques were compared on the basis of anesthesia costs and surgical procedure duration. As a result, we found that the costs per surgical minute largely depend on the surgical procedure duration. Based on the regression function, the cost advantage of spinal anesthesia over GA can be estimated to be 13% for a 50-min case, 9% for a 100-min case, and 5% for a 200-min case. The cost disadvantage of brachial plexus anesthesia over GA can be estimated to be 19% for a 50-min case, 8% in a 100-min case, and 1% for a 200-min case. We found no difference in costs between epidural and GA. We concluded that cost comparisons of anesthesia techniques largely depend on the surgical duration of the cases studied. Even in a teaching hospital setting, spinal anesthesia has economic advantages over GA. Especially for short cases, brachial plexus block is more expensive in this setting.     

A comparison of three regional anaesthesia techniques for outpatient knee arthroscopy

Purpose

The purpose of this study was to compare intraoperative conditions and postoperative pain control of three penpheral regional anaesthesia techniques for outpatient knee arthroscopic procedures.

Methods

Sixty patients were randomized to one of three groups. Group IA received portal injections (10 ml lidocaine 1%), intraarticular lidocaine (20 ml CO₂ lidocaine 2% with 1/200.000 adrenaline) and a placebo femoral nerve block (20 ml saline). Group FNB received a femoral 3-in-1 nerve block (20 ml chloroprocaine 2% with 1/200.000 adrenaline), placebo portal injections (10 ml saline) and placebo intraarticular saline (20 ml saline with 1/200.000 adrenaline). Group FNB + IA received a femoral 3-m-1 nerve block, intraarticular hdocaine and placebo portal injections. The following were assessed: intraoperative pain (10 cm VAS: 0 = no pain. 10 = extreme pain), surgical operating conditions (1 = excellent. 4 = unacceptable), intraoperative use of sedation and analgesia, time to discharge, patient satisfaction score (1= very satisfied, 5 very unsatisfied) and postoperative analgesia. Data were analyzed using ANOVA, Kruskal-Wallis, and Chi-square tests as appropriate. P< 0.05 was considered significant.

Results

There were no differences among the groups regarding any of the vanables tested. Considerable postoperative pain (VAS> 5) was expenenced by 20/54 (37%) patients.

Conclusion

Any of the three anaesthetic techniques tested provide reliable intraoperative patient and surgical conditions for outpatient knee arthroscopy. Patient discomfort postoperatively was considerable in all groups and requires further investigation.     

A comparison of two techniques for ultrasound guided infraclavicular block

Background. There is some debate about the proper site and armposition and the direction of the needle for the performanceof ultrasound guided infraclavicular block. Methods. Using ultrasound, we compared the ease and successrate of a medial or a lateral approach to the brachial plexusfor performing infraclavicular block in two groups of patients(n=202). The proximity of the needle to the lung in each groupwas also measured with and without the arm abducted from theside. Results. The medial approach was quicker to perform comparedwith the lateral approach (9 min vs 13 min). The medial approachalso had a faster onset. On average, the three cords were morereadily imaged with the medial technique (92%) compared withthe lateral technique (82%) and the medial technique preventedtourniquet pain more reliably (97%) vs the lateral technique(83%). In the medial technique, the plexus was also closer tothe skin (3.7 cm) compared with the lateral technique (4.5 cm).The lateral approach more frequently avoided the chest wall(49%) compared with the medial technique (35%) but resultedin more frequent vascular puncture. Both approaches providedgood anesthesia at the surgical site. Abducting the arm 110°and externally rotating the shoulder moves the plexus away fromthe thorax and closer to the surface of the skin. Conclusion. For infraclavicular block using ultrasound guidancethe medial approach is faster and easier to perform, has lowerincidence of tourniquet pain and vascular puncture, and bringsthe plexus closer to the skin. We recommend abducting the arm110° to minimize the risk of pneumothorax. Externally rotatingthe shoulder also brings the plexus closer to the skin.     

Biomechanical evaluation of two clinical tests for plantar heel pain: the dorsiflexion-eversion test for tarsal tunnel syndrome and the windlass test for plantar fasciitis

BACKGROUND: Plantar heel pain may result from several conditions such as tarsal tunnel syndrome (TTS) and plantar fasciitis. The dorsiflexion-eversion test is used to diagnose TTS, whereas the windlass test is used for plantar fasciitis. Given the similarity between both tests, the purpose of this study was to evaluate whether these tests are able to selectively load the structures which they aim to examine. METHODS: Both tests were evaluated in six cadavers by measuring strain in the plantar fascia, tibial nerve, lateral plantar nerve (LPN), and medial plantar nerve (MPN) using miniature displacement transducers. Longitudinal excursion of the nerves was measured with a digital caliper. RESULTS: With the dorsiflexion-eversion test, dorsiflexion and eversion of the ankle in combination with extension of the metatarsophalangeal (MTP) joints significantly increased strain in the tibial nerve (+1.1%), LPN (+2.2%), and MPN (+3.3%) but also in the plantar fascia (+1.2%) (all: p=0.016). Both components (dorsiflexion-eversion and MTP extension) resulted in significant increases. With the windlass test, extension of all MTP joints significantly increased strain in the plantar fascia (+0.4%, p=0.016), but also in the tibial nerve (+0.4%, p=0.016), LPN (+0.8%, p=0.032) and MPN (+2.0%, p=0.016). Excursion of the nerves was always in the distal direction but only reached significance for the tibial nerve (6.9 mm, p=0.016) and LPN (2.2 mm, p=0.032) during the dorsiflexion-eversion test. CONCLUSIONS: Both tests mechanically challenge various structures that have been associated with plantar heel pain. This questions the usefulness of the tests in the differential diagnosis of plantar heel pain.     

Comparison of two regional anesthetic techniques for knee arthroscopy

This study compares the efficacy of “3-in-1 block” versus femoral nerve block for knee arthroscopy. One-hundred patients had a 3-in-1 block; 180 patients had a femoral nerve block. The 3-in-1 block provided anesthesia in 75 patients; 20 patients needed supplementary local anesthesia. Five patients required a general anesthesia to complete the operation. The femoral nerve block was effective in 88 patients; 90 patients needed intravenous flunitrazepam and/or fentanyl; 2 patients needed general anesthesia. The 3-in-1 block provided more satisfactory muscle relaxation and a longer postoperative analgesia than femoral nerve block. No side effects were recorded in either group. Our results suggest that the 3-in-1 block is the most effective technique of regional anesthesia for knee arthroscopy.     

A comparison of two limited open techniques for carpal tunnel release

Review of the literature shows the effectiveness of limited open carpal tunnel release to be comparable to that of endoscopic carpal tunnel release in respect of recovery of grip strength, time of return to work and complication rate. A randomised, controlled study was designed to compare the effectiveness of a single versus a double limited open technique of carpal tunnel release. Sixty-five patients (73 hands) with a mean age of 48 years were operated on, 40 hands by the single incision and 33 by the double incision method. Grip and pinch strengths, digital sensibility (Filament and 2PD tests) and Levine scores were evaluated throughout 12 months of follow-up. We found that the single incision method offers better results in respect of grip and pinch strengths: less weakness at 1 month after surgery and a faster improvement relative to pre-operative values which is statistically significant. This, however, did not translate directly into Levine functional and symptom scores which, at each assessment, did not differ significantly between the two methods.     

A comparison of two techniques for digital distraction lengthening in skeletally immature patients

Since 1987, 16 skeletally immature patients aged 2 to 16 years (mean, 7.9 years) underwent 27 digital lengthening procedures of terminal bones, 20 metacarpals and 7 phalanges, using the distraction callotasis technique. Seven digits were lengthened with 2 fixator half-pins on either side of the osteotomy site (dual half-pin group). Twenty digits, which were too small to accommodate 4 half-pins, were lengthened over a longitudinal intramedullary guidewire with 1 fixator half-pin on either side of the osteotomy site (single half-pin/K-wire group). No bone grafts were needed. The mean preoperative bone length in the dual half-pin group was 30 mm (range, 23-40 mm) and that of the single half-pin/K-wire group was 18 mm (10-30 mm). The mean total length gained was 14 mm (9-23 mm) in the dual half-pin group and 12 mm (6-19 mm) in the single half-pin/K-wire group. The mean percent lengthened was 49% (22% to 96%) in the dual half-pin group and 70% (27% to 136%) in the single half-pin/K-wire group. Eighteen complications occurred: 15 in the 20 cases using the central guidewire (75%) and 3 in the 7 cases without the central guidewire (43%). Only 7 complications required repeat surgery. We conclude that the use of the single half-pin/K-wire technique allows successful and substantial lengthening for bones shorter than 23 mm, making correction surgery possible for younger children. This technique, however, has a greater risk for complications.     

A comparison of two continent catheterizable vesicocutaneous techniques.

In a rabbit model we describe and compare two continent catheterizable diversion techniques for which the bladder is intact and the stoma is situated in the lower abdomen. Both mechanisms are formed from a short segment of ileum; one utilizes the principles of the encircling loop technique as described by Koff and the second, the Kock principle (intravesical nipple). Both models were evaluated for the following parameters: ease of catheterization (87%, 79% respectively), continence (91%, 86% respectively), and ease of construction. We present evidence that both techniques are applicable to the clinical setting.     

Intraoperative carotid arteriography. A comparison of two techniques

Routine intraoperative completion carotid arteriography was performed in 225 patients from January 1980 to December 1985 to detect technical problems. In the first 100 patients, standard common carotid artery puncture was used. In the last 125 patients, catheter technique through the superior thyroid artery was compared with the needle technique to evaluate quality of images, completeness of the study, number of exposures required, and complications from these two techniques. The needle technique resulted in complete visualization of the extracranial and intracranial circulations in 94 patients (94 percent). The catheter technique was similarly successful in 123 of 125 patients (98 percent). The proportions of complete visualization were not statistically different in the two groups (p = 0.16). Six patients (6 percent) in the needle technique group and three patients (2 percent) in the catheter technique group required multiple exposures. When the complications incurred by the two techniques were compared, there was no statistical difference between the two techniques (p = 0.39). Two complications occurred in the needle technique group (2 percent), one resulting in dissection and the other, extravasation. There were no complications in the catheter technique group. Due to technical ease of performance, the catheter technique is preferred, although statistical data did not reveal superiority of one technique over the other.