Continuous-flow cold therapy for outpatient anterior cruciate ligament reconstruction

This prospective, randomized study evaluated continuous-flow cold therapy for postoperative pain in outpatient arthroscopic anterior cruciate ligament (ACL) reconstructions. In group 1, cold therapy was constant for 3 days then as needed in days 4 through 7. Group 2 had no cold therapy. Evaluations and diaries were kept at 1, 2, and 8 hours after surgery, and then daily. Pain was assessed using the VAS and Likert scales. There were 51 cold and 49 noncold patients included. Continuous passive movement (CPM) use averaged 54 hours for cold and 41 hours for noncold groups (P=.003). Prone hangs were done for 192 minutes in the cold group and 151 minutes in the noncold group. Motion at 1 week averaged 5/88 for the cold group and 5/79 the noncold group. The noncold group average visual analog scale (VAS) pain and Likert pain scores were always greater than the cold group. The noncold group average Vicodin use (Knoll, Mt. Olive, NJ) was always greater than the cold group use (P=.001). Continuous-flow cold therapy lowered VAS and Likert scores, reduced Vicodin use, increased prone hangs, CPM, and knee flexion. Continuous-flow cold therapy is safe and effective for outpatient ACL reconstruction reducing pain medication requirements.Arthroscopy 1998 Mar;14(2):130-5     

Arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow in patients under fifty years of age

Degenerative arthritis of the elbow in patients aged under 50 years can cause disabling pain, severely restricted range of motion (ROM), and functional limitations. Open ulnohumeral arthroplasty has been demonstrated to produce satisfactory pain relief and ROM gains. We report the results of an all-arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow in younger patients. Eleven consecutive patients aged under 50 years with radiographically documented degenerative elbow arthritis underwent an all-arthroscopic ulnohumeral arthroplasty as described by Savoie et al. Indications for surgery were pain and limited ROM refractory to 12 months of conservative treatment. The mean age at the time of surgery was 36 years (range, 23-47 years). The minimum postoperative follow-up was 24 months, with a mean of 26 months (range, 24-29 months). Preoperatively, mean flexion was 100 degrees (range, 70 degrees-140 degrees) and mean extension (short of neutral) was 40 degrees (range, 10 degrees-60 degrees). Postoperatively, mean flexion was 140 degrees (range, 130 degrees-150 degrees; P < .01) and mean extension was 7 degrees (range, 0 degrees-20 degrees; P < .01). The total arc of motion averaged 60 degrees preoperatively and 133 degrees postoperatively (improvement of 73 degrees, P < .01). The mean subjective pain level improved from 9.2 to 1.7 (where 10 indicates worst pain and 0 indicates no pain). Mean subjective patient satisfaction improved from 1.8 to 9.0 (where 0 indicates unsatisfied and 10 indicates completely satisfied). All-arthroscopic ulnohumeral arthroplasty provides significant short-term pain relief, as well as restoration of elbow ROM and function, in patients aged under 50 years with degenerative arthritis of the elbow. The long-term durability of this procedure with regard to preservation of ROM and radiographic progression of arthritis remains unknown.     

全膝关节置换术后膝周持续冰袋加压冷敷的镇痛效果分析

目的：研究人工全膝关节置换术（ TKA）术后膝周持续冰袋加压冷敷的镇痛效果。方法2011年5月至2012年5月,将本组86例欲行单侧TKA的骨关节炎患者随机分成两组：试验组于TKA术后将毛巾包裹的10％盐水冰袋置于膝前、内、外侧冷敷,持续24 h;对照组给予同等规格的常温软包装盐水袋置于膝前、内、外侧外敷,持续48 h;两组均于术后第2天拔除引流管。术后24 h内两组患者均经静脉镇痛泵滴注吗啡行自控镇痛（PCA）,疼痛难以忍受时予以肌注吗啡5～10 mg。通过比较两组患者术后膝关节静息和活动痛视觉模拟（ VAS）评分、隐性失血量、吗啡使用情况、主动直腿抬高时间、屈膝90°时间、膝关节活动度（ ROM）以及并发症来分析膝周持续冰袋冷敷的镇痛效果。结果 TKA术后膝周持续冰袋冷敷的患者,其术后36 h内各时间段以及总的吗啡消耗量明显减少（P＜0.01）,第一次肌注吗啡的时间亦明显推迟。术后第6、12、24、36 h,试验组静息痛VAS评分显著小于对照组（ P＜0.01）,术后24、36 h活动痛VAS评分亦显著小于对照组（ P＜0.01）。术后24 h引流量间接显示,试验组隐性失血量较对照组少（P＜0.01）,患者主动直腿抬高时间、屈膝90°时间以及术后两周膝关节活动度比较,试验组均优于对照组（ P＜0.01）。两组在术后伤口愈合、感染发生率、血压、心率、皮疹、呼吸抑制和尿潴留的监测等方面进行比较,差异均无统计学意义,但试验组恶心呕吐发生率小于对照组。结论人工全膝关节置换术后膝周持续10％盐水冰袋冷敷,有助于减少术后麻醉镇痛剂消耗量,减轻术后早期疼痛,且可以有效减少隐性出血量,可促进膝关节功能恢复,且没有明显的不良反应。     

The effect of single-injection femoral nerve block on rehabilitation and length of hospital stay after total knee replacement

BACKGROUND AND OBJECTIVES: Continuous-infusion femoral nerve block (FNB) improves analgesia and rehabilitation after total knee replacement. In this study, we investigated the efficacy of single-injection FNB to achieve similar results. METHODS: A total of 30 patients were prospectively and randomly assigned to receive 40-mL injections of either 0.25% bupivacaine (group B) or saline (group S) after total knee replacement. Blinded observers evaluated the patients for postoperative pain, morphine consumption, ambulating distances, and maximal knee flexion; pain was scored on the visual analog scale (VAS). RESULTS: Compared with group S patients, group B patients had significantly lower VAS pain scores (P <.01 in the postoperative anesthesia care unit, P <.05 on the day after surgery); group B patients also showed significantly lower total morphine use (P <.05) and a lower incidence of morphine-related side effects. Significantly more group B than group S patients could ambulate on the day after surgery (93% v 46%, P <.05), and mean ambulatory distance was significantly better for group B than group S patients at discharge (166 +/- 37 v 117 +/- 24 feet, P <.01). Knee flexion was significantly better for group B than group S patients on the second day after surgery (70 degrees v 60 degrees, P <.01), but the between-group difference was no longer statistically significant at discharge. Mean length of acute hospitalization was significantly shorter for group B (3 days; range, 3 to 5 days) than group S patients (4 days; range, 3 to 6 days, P <.05). CONCLUSIONS: Single-injection FNB provided effective analgesia, facilitated early ambulation, and reduced the length of acute hospitalization in patients undergoing total knee replacement.     

加压冷疗装置和一次性冰袋对肩关节镜检术后患者镇痛效果对比分析

目的探讨加压冷疗装置在肩关节镜检术后的镇痛效果,并与一次性冰袋的镇痛效果进行对比分析。 方法回顾性分析2016年1月至2017年4月期间在我院创伤骨科因肩关节疾病行关节镜检手术治疗的患者60例,疾病种类包括非复杂性肩袖损伤、冻结肩等。记录所有患者的手术时间,根据患者术后镇痛方式的情况,分为干预组（采用加压冷疗装置）和对照组（采用一次性冰袋）各30例,镇痛治疗的方法均为患肩周围的间断冰敷,每日3次,每次20 min,持续3 d,采用视觉模拟评分法（VAS）评估患者术后镇痛治疗期间的疼痛程度。 结果60例患者的平均手术时间为（65.5±18.47）min,干预组和对照组患者的平均手术时间分别为（62.17±15.96）min和（68.83±20.41）min,术后24、48、72 h干预组与对照组静息疼痛指数的比较差异均有统计学意义（P_24h=0.005,P_48h=0.002,P_72h=0.000）;术后24 h干预组与对照组相比,活动疼痛指数差异没有统计学意义（P_24h=0.057）,术后48 h、72 h两组患者活动疼痛指数差异有显著统计学意义（P_48h=0.015,P_72h=0.000）。 结论加压冷疗装置可有效缓解患肢术后疼痛,操作简便,有利于患者术后早期功能锻炼,促进肩关节功能康复,且便于护理操作,具有很大的临床应用价值,可作为肩关节镜检术后的有效镇痛方案。     

The influence of timing of systemic ketamine administration on postoperative morphine consumption

STUDY OBJECTIVE: To determine the influence of timing of systemic ketamine administration on postoperative morphine consumption. DESIGN: Prospective randomized study. SETTING: Operating rooms, postanesthesia care unit, and gynecology service of a university hospital. PATIENTS: Forty-five patients undergoing laparotomy for benign gynecologic pathologies were randomized into 3 groups. INTERVENTIONS: In Group 1, before surgical incision, patients received 0.5 mg/kg ketamine IV, followed by normal saline infusion and normal saline IV at wound closure in group 1 (n = 15). In group 2 (n = 15), patients received 0.5 mg/kg ketamine IV before surgery, followed by ketamine infusion 600 mug . kg(-1) . h(-1), until wound closure and normal saline IV at that time. In the other group (group 3, n = 15), patients received normal saline IV before surgery, followed by saline infusion and then 0.5 mg/kg ketamine IV at wound closure. In the postoperative period, patient-controlled analgesia IV morphine was used for postoperative pain relief. First requested analgesic medication time was recorded. Postoperative pain was assessed by measuring morphine consumption at 0 to 2, 0 to 4, and 0 to 24 hours and visual analog scale (VAS) pain scores in response to cough at 2nd, 4th, and 24th hours and during rest at 0 to 2, 0 to 4, and 0 to 24 hours after surgery. MEASUREMENT AND MAIN RESULTS: First requested analgesia was shorter in group 1 than the others (P < .01). Mean VAS pain scores in response to cough at 24th hour in groups 2 and 3 were significantly lower than in group 1 (P < .001 and P < .01, respectively). Mean VAS pain scores during rest at 0 to 24 hours in groups 2 and 3 were significantly lower than in group 1 (P < .01 and P < .05, respectively). Morphine consumption was lower in groups 2 and 3 at 0 to 2 hours (P < .001 and P < .01). Moreover, morphine consumption at 0 to 4 hours in group 2 was significantly lower (P < .01). CONCLUSIONS: Lower pain scores and morphine consumption in groups 2 and 3 may be related to higher plasma ketamine concentrations caused by the higher doses and later administration. Our findings suggest that a single preoperative dose of ketamine provided less analgesia compared with other dosing regimens that included intraoperative infusions or postoperative administration.     

The Oxiplex/SP gel-morphine compound after lumbar microdiscectomy in the management of postoperative pain. Report of 20 cases

OBJECT: Morphine-based compounds are used epidurally after lumbar microdiscectomy to minimize postoperative pain. After the withdrawal of ADCON-L we started to use Oxiplex (Oxiplex/SP Gel) as a barrier against epidural fibrosis and as a vehicle for morphine delivery. METHODS: We administered epidurally morphine (1 mg) dissolved in Oxiplex gel to 20 consecutive patients after lumbar microdiscectomy, evaluating safety and analgesic effectiveness. Outcome measures adopted were (1) visual analog scale (VAS) of back and radicular pain, (2) straight leg raising (SLR) maneuver to assess evoked pain, (3) postoperative time to comfortable ambulation, (4) postoperative hospitalization, (5) postoperative request of analgesics, and (6) postoperative work time loss. RESULTS: No complications, such as urinary retention, respiratory disturbances, or wound infections, were observed. During the first 24 hours the mean VAS was lower than the preoperative one (12.5 vs 77.3 mm, respectively; P < .01). The mean postoperative SLR was 62.25 degrees vs 38.74 degrees of preoperative period (P < .05). After a mean of 29.8 hours, patients were discharged. Twelve patients (60%) had low back and radicular pain relapse 36 to 72 hours after operation, requiring assumption of analgesics. At that time, 2 patients reported a level of pain higher than the preoperative one. At 1- and 2-week follow-up visits, mean VAS scores were 33.5 and 12.0 mm, respectively. The 2-week overall treatment satisfaction rating was excellent for 60% and good for 40%. Finally, the mean postoperative work time loss was 27 days. CONCLUSIONS: The epidural application of Oxiplex-morphine compound after lumbar microdiscectomy was found to be safe. Regarding postoperative pain control, it was found to be effective only during the first 36 hours.     

Clinical outcome and radiographic results after operative treatment of Scheuermann's disease

The aim of this prospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome, and to report complications and instrumentation failure after operative treatment of Scheuermann's disease using a combined anterior and posterior spondylodesis. The loss of sagittal plane correction after removal of the posterior instrumentation was analysed. The indication for surgery was a thoracic kyphosis greater than 60 degrees in adolescents and adults with persistent back pain, which failed to respond to conservative treatment. Thoracic kyphosis and lumbar lordosis angles were measured by the Cobb method at preselected time points and at final follow-up. Sagittal plane alignment was measured as translation. The validated Scoliosis Research Society Instrument (SRSI) questionnaire was sent to all patients at follow-up. P-values were calculated using the Wilcoxon signed rank test (P<0.05 is significant). Between October 1987 and August 1999, 23 consecutive patients underwent operative treatment. The median follow-up was 75 months (range 25-126 months). Median preoperative thoracic kyphosis was 70 degrees (range 62 degrees-78 degrees) and median preoperative lumbar lordosis was 68 degrees (range 54 degrees-84 degrees). Immediate postoperative median thoracic kyphosis was 39 degrees (range 28 degrees-54 degrees) (P<0.05) and immediate postoperative median lumbar lordosis was 49 degrees (range 35 degrees-63 degrees) (P<0.05). These significant corrections were maintained at early follow-ups conducted 1 year and 2 years postoperatively. At final follow-up, the median thoracic kyphosis had significantly increased, to 55 degrees (range 36 degrees-65 degrees) (P<0.05 relative to immediate postoperative value), and the median lumbar lordosis had increased to 57 degrees (range 44 degrees-70 degrees) (P<0.05). The late deterioration of correction in the sagittal plane was mainly caused by removal of the posterior instrumentation, and occurred despite radiographs, bone scans and thorough intra-operative explorations demonstrating solid fusions. The median SRSI score was 83 points (range 55-106). There was no significant correlation between the radiographic outcome and the SRSI score (P>0.05). Our series showed relatively fair outcome after operative treatment in Scheuermann's disease. Therefore, the indication for surgery in patients with Scheuermann's disease can be questioned.     

局部冰敷对腹股沟疝修补术后伤口疼痛及渗出的影响

目的探讨局部冰敷对腹股沟疝修补术后伤口疼痛及渗出的影响。 方法选取2017年12月至2018年3月四川大学华西医院收治的单侧原发性腹股沟疝患者60例,随机分为冰敷组和对照组,每组患者30例,均采用局部麻醉下腹股沟疝无张力修补术。冰敷组在术后常规治疗的基础上局部加用挤压后医用冰袋冰敷,对照组在术后常规治疗的基础上局部加用非挤压医用冰袋压迫。观察2组术后24 h内患者静息状态的疼痛视觉模拟评分（VAS）,术后需要追加止痛药物数量及术后切口敷料的渗出例数及面积。 结果冰敷组在术后6、12、24 h的VAS评分明显低于对照组,差异有统计学意义（P<0.05）;冰敷组术后镇痛药使用数量6例（20.0%）低于对照组21例（70.0%）,差异有统计学意义（P<0.001）;冰敷组术后切口敷料渗出2例（6.7%）,低于对照组6例（20%）,但差异无统计学意义（P>0.05）。切口敷料渗出患者中,冰敷组平均渗出面积（0.30±0.71）cm²低于对照组（4.18±2.54）cm²,但差异无统计学意义（P>0.05）。2组术后的切口均顺利愈合。 结论局部冰敷为腹股沟疝修补术的患者提供了一种安全、有效且副作用少的止痛方式,但其对伤口渗出的影响有待更进一步研究。     

Comparison of a continuous temperature-controlled cryotherapy device to a simple icing regimen following outpatient knee arthroscopy

This prospective, randomized study compared postoperative pain control with use of a continuous temperature-controlled cryotherapy system versus a traditional ice therapy regimen following outpatient knee arthroscopy. Patients with unilateral knee pathology scheduled for outpatient arthroscopic surgery were included. Patients with major ligament reconstructions were excluded. A specific cold therapy regimen was begun postoperatively and continued for 2 weeks as adjunctive management of postoperative pain. Preoperative and postoperative pain intensity, pain type, functionality, and sleep quality were assessed. Patients were randomly assigned to either an ice or a continuous cryotherapy group. Follow-up questionnaires were completed on 5 postoperative days. Data were analyzed using a chi-square test with a level of significance at P < 0.05. Fifty-three patients completed the study. Pain intensity was similar between groups throughout the course of the study. Among patients who reported experiencing night pain, 36% of those in the continuous cryotherapy group were able to sleep soundly with minimal awakening through postoperative day 2 versus 5.9% among the ice therapy group (P = 0.04). No significant differences existed between groups regarding functional ability, and no differences were noted on other follow-up days. These findings support use of continuous temperature-controlled cold therapy devices for nighttime pain control and improved quality of life in the early period following routine knee arthroscopy.     

Short-Term Effects of Early Postoperative Celecoxib Administration for Pain,Sleep Quality,and Range of Motion After Total Knee Arthroplasty: A Randomized Controlled Trial

BackgroundWe hypothesized that early postoperative administration of celecoxib would reduce pain scores and improve sleep quality and active range of motion after total knee arthroplasty (TKA) under general anesthesia.MethodsPatients in the celecoxib group received 400 mg of celecoxib 2 hours after TKA, followed 6 hours later by 200 mg of celecoxib. Patients in the control group received 400 mg of celecoxib the second day after surgery. Patients in both group had access to patient-controlled analgesia fentanyl. The primary outcome measure was the patient-reported visual analog scale (VAS) pain score the second day after TKA. The secondary outcome measure was sleep quality (days 1, 2, and 7 postoperatively). Active knee joint range of motion was assessed on days 2 and 7 postoperatively, and VAS pain scores were evaluated on postoperative days 1 to 7. Total fentanyl consumption was also assessed.ResultsCompared to the control group, the celecoxib group had significantly lower median VAS pain scores on postoperative days 1 and 2, significantly less nocturnal awakening (in minutes) and frequency of body motion, and better sleep efficacy on postoperative day 1. The celecoxib group also had a significantly better median flexion angle (°) on postoperative days 2 and 7, and lower cumulative fentanyl consumption.ConclusionEarly administration of celecoxib after TKA was associated with significantly reduced early VAS pain scores and improved sleep quality and active knee flexion angles. Thus, the early administration of celecoxib after TKA under general anesthesia may reduce pain and improve sleep quality and functional recovery.Levels of EvidenceLevel II, therapeutic study.Trial RegistrationUMIN-CTR 000014624 (July 23, 2014).     

围手术期地塞米松对全膝关节置换术后恶心呕吐和疼痛的影响

目的:探讨围手术期应用地塞米松对于单侧全膝关节置换术后恶心呕吐和疼痛的影响及安全性评估。方法:2014年2月至2016年6月采用全膝关节置换治疗的单侧晚期骨性关节炎患者100例,分为2组,每组50例:其中地塞米松组,男27例,女23例,年龄(72.30±7.02)岁,术前给予地塞米松10 mg静脉滴注;生理盐水组,男26例,女24例,年龄(71.30±6.08)岁,相应时间给予等量生理盐水静滴。观察记录术后2、4、6、8、12、24、36、48 h时休息时和屈膝45°时疼痛VAS评分,记录术后0～24 h和24～48 h发生呕吐情况、使用止吐药及阿片类药情况。并记录术后患者药物副作用及并发症。结果:100例患者均获得随访,平均随访时间14.5个月。休息时疼痛VAS评分地塞米松组术后8、24、48 h时低于生理盐水组(P0.05);屈膝45°时VAS评分地塞米松组术后8、48 h时低于生理盐水组(P0.05);地塞米松组休息时和屈膝45°时VAS评分总体低于生理盐水组(P0.05)。术后0～24 h、24～48 h阿片类药用量及总阿片类药用量地塞米松组均低于生理盐水组(P0.05)。两组患者术后0～24 h和24～48 h发生恶心呕吐比例,术后0～24 h要求使用止吐药比例差异均有统计学意义(P0.05)。总止吐药用量地塞米松组少于生理盐水组(P0.05)。截止末次随访,两组患者未出现术后感染、消化道溃疡、出血等并发症。结论:术前全身应用地塞米松可有效减少TKA术后疼痛和恶心呕吐,且并不增加术后并发症。     

Stability of the forearm after resection of the distal ulna and proximal radius in rheumatoid arthritis: report of 11 cases

Combined resection of radial head and distal ulna could jeopardize the stability and kinematics of the forearm bones. The goals of this retrospective study was to investigate these data after resection of distal ulna and proximal radius in rheumatoid arthritis. Between 1990 and 1998, eleven patients had these bone resections combined with implantation of elbow prostheses (eight Kudo and three GSB III). Wrist surgery consisted in five wrist arthrodeses combined with Darrach procedure, four Sauvé-Kapandji procedures and two isolated Darrach procedures. Mean age at surgery was 58 years and the average follow-up was 40 months. We assessed at follow-up: 1) wrist and elbow pain according to Gschwend; 2) stability of the forearm bones (cubitus valgus angle, impingement of the proximal radial stump with humerus, giving away accident of the ulnar distal stump); 3) wrist and elbow mobility. At follow-up six patients had no pain at the elbow and five had slight occasional pain. At the wrist, five patients had no pain and six slight occasional pain. Elbow motion was increased (from mean 83 degrees [50 degrees-100 degrees] to mean 110 degrees [85 degrees-135 degrees]) excepted in supination which slightly decreased (from mean 3 degrees [40 degrees-90 degrees] to mean 75 degrees [85 degrees-90 degrees]). Mean wrist mobility was impaired because of the five combined radiocarpal arthrodeses. If these five wrist arthrodeses were excluded, the mean ranges of motion were: 10 degrees in flexion, 16 degrees in extension, 2 degrees in radial deviation, 14 degrees in ulnar deviation. At follow-up, no patient had giving away accident of the ulnar distal stump nor impingement between radial stump and humerus in full flexion. Average cubitus valgus was 10 degrees. This study pointed out the predominant effect of the interosseous membrane in stability of the forearm bones.     

The effect of meperidine-impregnated autogenous free fat grafts on postoperative pain management in lumbar disc surgery

STUDY DESIGN: Prospective, randomized, double-blind clinical study. OBJECTIVE: To examine the effect of meperidine-impregnated autogenous free fat grafts (AFFGs) on postoperative pain management after 1-level, first-time lumbar disc surgery. SUMMARY OF BACKGROUND DATA: Uncontrolled postoperative pain impedes patient recovery. Insufficient control of postoperative pain makes it difficult to convince new patients to undergo the lumbar disc surgery. METHODS: Twenty-seven patients scheduled to undergo lumbar microdiscectomy for the first time were divided into 2 groups by a randomized double-blind method. Group 1 patients received a meperidine-impregnated AFFG in the epidural area. Group 2 received the graft without meperidine impregnation. Both groups were asked to use a Patient Controlled Analgesia device to deliver tramadol, and at 1, 4, 12, and 24 hours postoperatively, the amounts of tramadol used and pain severity on the 10-cm Visual Analog Scale (VAS) were recorded. RESULTS: The VAS scores and total tramadol use were both lower in group 1 compared with the control group (P<0.05). The first hour of VAS scores were significantly lower in group 1 than in the control group (P<0.05). CONCLUSIONS: In this study, we helped patients, who underwent 1-level, first-time lumbar microdiscectomy have a postoperative pain-free and comfortable period by using epidural meperidine-impregnated AFFGs.     

Efficacy of Systemic Steroid Use Given One Day After Total Knee Arthroplasty for Pain and Nausea: A Randomized Controlled Study

BackgroundSystemic steroid has been used to control pain and nausea in total knee arthroplasty (TKA), but most studies recommend a single dose administration prior to, or during, surgery. This study aimed to determine the efficacy of administration on 1 day postoperatively.MethodsPatients who were scheduled to undergo TKA were randomly assigned to the following groups: control group, receiving normal saline injection; group 1, receiving 10 mg dexamethasone intravenously (IV) 1 hour before surgery; group 2, receiving 0.1 mg/kg dexamethasone (IV) 24 hours after surgery; or group 3, receiving 0.2 mg/kg dexamethasone (IV) 24 hours after surgery (n = 44-46 per group). Primary outcomes were pain and nausea visual analogue scale (VAS). Secondary outcomes were analgesic administration, rescue antiemetic administration, C-reactive protein, range of motion, and complications.ResultsPostoperative pain and nausea remained high for 48 hours post-TKA. Group 1 had lower pain and nausea VAS scores than did the control group (P < .01) for only 24 hours post-TKA. Groups 2 and 3 had lower pain and nausea VAS scores than did the control group and group 1 (P < .01) 48 hours post-TKA. Analgesic and antiemetic administration were significantly lower in groups 2 and 3 than in the control group during 48 hours after TKA. There were no differences in C-reactive protein level and range of motion, and complications were not detected.ConclusionThe effect of preoperative and postoperative administration of dexamethasone for controlling pain and nausea was observed only for 24 hours. Considering that severe pain and nausea persisted for more than 48 hours after TKA, additional administration of dexamethasone at 1 day postoperatively is suggested.Level of EvidenceLevel I.     

The effectiveness of an anesthetic continuous-infusion device on postoperative pain control

Purpose: To evaluate the effectiveness of an anesthetic continuous-infusion device on postoperative pain after outpatient shoulder surgery. Type of Study: Double-blinded randomized trial. Methods: A prospective, double-blinded, randomized study of 50 consecutive patients undergoing outpatient arthroscopic shoulder surgery was performed. Patients were assigned by computer-generated randomized permuted block of four to 2 groups (25 each) receiving either a saline or 0.5% bupivacaine solution via an infusion pump after surgery. All patients gave informed consent and were randomized immediately before surgery. The surgical team, patient, clinic staff, and data collector were blinded to the randomization. Procedures performed included arthroscopic rotator cuff repairs, SLAP lesion repairs, subacromial decompressions, and capsular reefings. The infusion pump that was tested was used continuously for 48 hours and administered 2 mL each hour. For subacromial and rotator cuff surgery, the catheter was placed in the subacromial space. For glenohumeral surgery, the catheter was placed in the glenohumeral joint. Routine pain-control efforts were continued. Interviews were conducted at 1, 2, and 8 hours after surgery, followed by daily telephone interviews for 1 week. Visual analog scale (VAS), categorical pain scale (Likert) data, and oral medication use data were recorded. Results: Complete data sets were collected from 25 bupivacaine and 24 saline patients because 1 pump malfunctioned and was removed early. The average age of the bupivacaine group patients was 47.4 ± 16.3 years (range, 16 to 84); patients in the saline group had an average age of 46.0 ± 15.5 years (range, 19 to 73). There were 17 men and 8 women in the bupivacaine group and 16 men and 8 women in the saline group. The Likert and VAS mean values showed lower pain scores for the patients using the pump containing bupivacaine than for the saline group at all recorded times (P < .05) throughout the 7 days of data collection. The interval of greatest pain was on day 2. Postoperative oral medication use was always greater for the saline group than for those receiving bupivacaine. Conclusions: Postoperative pain control after arthroscopic shoulder surgery is essential so that these procedures can be successfully carried out in an outpatient setting. The first 2 postoperative days is the period of greatest pain. Continuous postoperative bupivacaine infusion is effective during this critical period, and the effect lingers even after the infusion is discontinued. The administration of bupivacaine via a continuous-infusion anesthetic pump statistically reduced postoperative pain after outpatient arthroscopic rotator cuff repairs, SLAP lesion repairs, subacromial decompressions, and capsular reefings.     

自制新型冷敷袋在膝关节镜术后患者中的应用

目的 探讨更有效的减轻膝关节镜术后关节肿痛的冷敷方法.方法 将296例膝关节镜术后患者随机分为对照组(144例)和观察组(152例).对照组采用毛巾包裹清水冰袋进行冷敷,观察组采用自制新型冷敷袋进行冷敷,术后当天冰敷2h,术后第1～5天每天冰敷2次,每次2小时.结果 两组术后第3天舒适度,术后6h、24 h、48 h疼...     

Efficacy of low-dose intrathecal morphine for postoperative analgesia after abdominal aortic surgery: a double-blind randomized study

BACKGROUND AND OBJECTIVES: Several studies suggest that intrathecal morphine (ITM) improves analgesia after aortic surgery. We tested the hypothesis that in combination with multimodal postoperative pain management, low-dose ITM associated with general anesthesia would decrease postoperative analgesic requirements in patients undergoing abdominal aortic surgery. METHODS: Thirty patients were randomized to receive either general anesthesia alone or preceded by low-dose ITM (0.2 mg) administration. Patients and providers were blinded to treatment. Postsurgical multimodal pain management was similar in both groups, including parenteral paracetamol, followed by intravenous nefopam and then morphine if not sufficient. Intravenous analgesic requirements, visual analog scale (VAS) scores, and the incidence and severity of side effects were recorded for 48 hours after surgery. RESULTS: Intraoperative data were comparable between the 2 groups, except sufentanil consumption, which was significantly lower in the ITM group when compared with the control group (P = .023). ITM decreased postoperative total-morphine requirements with respect to both the number of patients who received morphine (4 v 12 patients, P = .003) and the cumulative dose of morphine administered (0 [0-12.4] v 23 [13.9-45.6] mg, P = .006). VAS scores at rest were higher in the control group than in the ITM group at awakening (P < .01), at 4 hours (P < .01) after surgery, and at 8 hours (P < .05) after surgery but did not differ between groups after this period. Whereas VAS scores on coughing were higher in the control group at awakening (P < .01) and 4 hours after surgery (P < .05), no differences were found between groups from 8 hours after surgery. CONCLUSION: In patients undergoing abdominal aortic surgery, intrathecal morphine (0.2 mg) improves postoperative analgesia and decreases the need in intraoperative and postoperative analgesics. Further studies are indicated to evaluate the role of ITM in postoperative recovery.     

How Does Preoperative Central Sensitization Affect Quality of Life Following Total Knee Arthroplasty?

BackgroundCentral sensitization (CS) has been recently identified as a significant risk factor for persistent pain and patient dissatisfaction following total knee arthroplasty (TKA). However, it remains unclear as to whether the preoperative CS persists after the elimination of a nociceptive pain source by TKA, or how CS affects the quality of life after TKA.MethodsA total of 222 consecutive patients undergoing primary TKA were enrolled in the study. All patients were preoperatively screened for CS using the Central Sensitization Inventory (CSI) and categorized into either a CS (n = 55; CSI ≥ 40) or non-CS group (n = 167; CSI < 40). CSI, pain visual analog scale (VAS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index score, and satisfaction were recorded at postoperative 2 years.ResultsTwo years after TKA, preoperative CS remained unchanged; there was no difference between preoperative and postoperative CSI scores, and both preoperative and postoperative CSI severity levels were similar (P > .1). The CS group showed worse pain VAS, KSS, and Western Ontario and McMaster Universities Osteoarthritis Index scores than did the non-CS group (P < .01) and more patients in the CS group were dissatisfied with all activities (P < .01). However, a similar percentage of the CS group achieved the previously documented minimal clinically important difference in pain VAS and KSS, compared with the non-CS group. Multivariate regression analysis revealed that preoperative CSI scores were associated with dissatisfaction at postoperative 2 years.ConclusionPreoperative CS was persistent at 2 years after TKA. Although CS patients achieved comparable clinical improvement following TKA, CS patients had worse quality of life, functional disability, and dissatisfaction than non-CS patients.     

全膝关节置换术患者应用加压持续冷疗袋的效果观察

目的观察全膝关节置换术后患者应用加压持续冷疗袋的镇痛效果。 方法选取100例广州医科大学附属第一医院骨科全膝关节置换术后患者，等距随机抽样分为观察组和对照组各50例，观察组术后采用自制的加压冷疗袋给予持续加压冷疗，对照组采用传统清水冰块冷疗。采用视觉模拟评分法(VAS)，通过方差分析、双侧t检验比较两组患者冷疗前和冷疗后6、12、24、48、72 h伤口疼痛评分及两组患者使用止痛药情况。 结果术后6、12、24、48、72 h的疼痛评分，观察组均低于对照组，差异有统计学意义(F＝22.0、22.6、20.5、19.5、18.6，均为P<0.01)；观察组术后72 h给予镇痛药物的频次低于对照组，差异有统计学意义(t＝9.61, P<0.001)。 结论全膝关节置换术后患者应用自制加压持续冷疗袋的镇痛效果优于传统冰块冰敷的镇痛效果，减少了止痛药物的使用。