Background. Over 55,000 spinal operations are performed annually in the NHS. Effective postoperative analgesia facilitates early mobilisation and assists rehabilitation and hospital discharge, but is difficult to achieve with conventional, opioid-based, oral analgesia. The clinical and cost-effectiveness of two alternative techniques, namely intrathecal opioid and the more novel erector-spinae plane blockade, is unknown. The Pain
Background. Acute lumbar radiculopathy is a very painful condition sometimes requiring admission for strong analgesia. Purpose. To evaluate the efficacy of distal nerve root blocks as an outpatient procedure for immediate pain
Abstract. Objectives. To determine the effectiveness of LIA compared to ACB in providing pain
Abstract. Objectives. To determine the effectiveness of LIA compared to ACB in providing pain
Abstract. Introduction. Local anaesthetic injections are regularly used for perioperative pain
Purpose. Prospectively evaluate the timescale of leg pain resolution after lumbar discectomy and decompression, in the immediate post-operative period and identify possible risk factors for failure/delay in leg pain resolution. Materials and Methods. A prospective observational study of 100 consecutive patients undergoing lumbar discectomy or decompression. Patients recorded their leg and back pain in VAS and disability in ODI preoperatively. Patients rated their leg pain
Introduction and Objective. Objectives: To determine the effectiveness of LIA compared to ACB in providing pain
Purpose of the study. The aims of the study were to explore the experiences of sciatica sufferers, their perceptions of physiotherapy and healthcare service provision. Methods. This was the qualitative element of a mixed methods study investigating the feasibility of early physiotherapy for sciatica. Participants in the pilot trial consented to take part in semi-structured interviews before and after they had undertaken an individualised physiotherapy programme. Data from the interviews was examined line by line using a thematic analysis approach with key themes and sub-themes emerging. Results. Thirty-three participants were recruited and a total of 45 interviews being carried out. 7 central themes and 17 sub-themes were generated from thematic analysis. The first-line treatment administered to all participants by their G.P was a combination of analgesia. The drugs used included paracetamol, ibuprofen, nefopam, diclofenac, tramadol, morphine, diazepam and baclofen. Neuropathic pain modulating medication such as amitriptyline, gabapentin or pregabalin was widely used. Participants reported that medication simply didn't provide sufficient pain
Introduction. In rheumatoid arthritis, the forefoot is frequently affected. A variety of surgical procedures have been established in the treatment of rheumatic forefoot disorders. Postoperatively, patients are mobilized in specially designed footwear to reduce forefoot stress. Our study was conducted to investigate peak and mean plantar pressure occurring in two differently designed forefoot
Aim. The primary aim of this pilot study was to assess and evaluate the SpineCor Pain
Impact
Artificial joints have been increasingly used in the treatment of physically disabled people who suffer from joint diseases such as osteoarthritis and rheumatoid arthritis. Ultra high molecular weight polyethylene (UHMWPE) is commonly used in hard-on-polymer joints as an impact-absorbing material for artificial hip joints because of its very low friction coefficient, high wear resistance, impact strength, and biocompatibility. However, particles generated by excessive wear and fatigue can cause osteolysis, which may lead to loosening. This has led to recent interest in metal-on-metal joints, which can provide better wear properties than hard-on-polymer joints, leading to reduced osteolysis. However, during gait, metal-on-metal joints are exposed to greater impacts than hard-on-polymer joints. These impacts can cause severe pain in patients who have undergone hip replacement arthroplasty. In previous work, we proposed a double-shell metal-on-metal artificial hip joint in which a single garter spring was inserted between the inner and outer acetabular shell of an impact
The aim was to assess the effect of caudal block on patients who have had proximal femoral &/or pelvic osteotomy compared to patients who have had epidural anaesthesia with regards to pain
The multimodal management of canal stenosis is increasing, and inhibitors of central sensitization are playing a crucial role in central sensitization processes. Pregabalin and gabapentin are antiepileptic drugs that reduce presynaptic excitability. The objective of this study was to investigate whether the use of pregabalin and gabapentin is effective in the symptomatic management of canal stenosis. A literature search was conducted in four databases. The inclusion criteria were studies that compared pregabalin or gabapentin with a control group in lumbar canal stenosis. Randomized clinical trials and a comparative retrospective cohort study were included. The main clinical endpoints were VAS/NRS, ODI, and RDQ (Roland Morris Disability Questionnaire) at 2, 4, 8 weeks, and 3 months, adverse events, and walking distance were also collected. Data were combined using Review Manager 5.4 software. Six studies and 392 patients were included. The mean age was 60.25. No significant differences were observed in VAS at 2, 4, and 8 weeks: (MD: 0.23; 95% CI: −0.63-1.09), (MD: −0.04; 95% CI: −0.64 to −0.57), and (MD: −0.6; 95% CI: −1.22 to 0.02). Significant differences were observed in favor of pregabalin with respect to VAS at three months: (MD: −2.97; 95% CI: −3.43 to −2.51). No significant differences were observed in ODI (MD: −3.47; 95% CI: −7.15 to −0.21). Adverse events were significantly higher in the pregabalin/gabapentin group (OR 5.88, 95%CI 1.28-27.05). Walking distance and RDQ could not be compared, although the results were controversial. Gabapentinoids have not been shown to be superior to other drugs used in the treatment of LSS or to placebo. However, they have shown a higher incidence of adverse effects, improved results in VAS at 3 months, and a slight improvement in ambulation at 4 months in combination with NSAIDs compared to NSAIDs in monotherapy.
Aims. The aim of this study was to compare the effectiveness of a femoral
nerve block and a periarticular infiltration in the management of
early post-operative pain after total knee arthroplasty (TKA). Patients and Methods. A pragmatic, single centre, two arm parallel group, patient blinded,
randomised controlled trial was undertaken. All patients due for
TKA were eligible. Exclusion criteria included contraindications
to the medications involved in the study and patients with a neurological
abnormality of the lower limb. Patients received either a femoral
nerve block with 75 mg of 0.25% levobupivacaine hydrochloride around
the nerve, or periarticular infiltration with 150 mg of 0.25% levobupivacaine
hydrochloride, 10 mg morphine sulphate, 30 mg ketorolac trometamol
and 0.25 mg of adrenaline all diluted with 0.9% saline to make a
volume of 150 ml. Results. A total of 264 patients were recruited and data from 230 (88%)
were available for the primary analysis. Intention-to-treat analysis
of the primary outcome measure of a visual analogue score for pain
on the first post-operative day, prior to physiotherapy, was similar
in both groups. The mean difference was -0.7 (95% confidence interval
(CI) -5.9 to 4.5; p = 0.834). The periarticular group used less
morphine in the first post-operative day compared with the femoral nerve
block group (74%, 95% CI 55 to 99). The femoral nerve block group
reported 39 adverse events, of which 27 were serious, in 31 patients
and the periarticular group reported 51 adverse events, of which
38 were serious, in 42 patients up to six weeks post-operatively.
None of the adverse events were directly attributed to either of
the interventions under investigation. Conclusion . Periarticular infiltration is a viable and safe alternative to
femoral nerve block for the early post-operative
Between 1998 and 2007, fifteen patients with haemophilia A underwent 21 ankle arthrosco-pies+/− arthroscopic cheilectomy in order to attempt symptomatic
Introduction: We present the results of a controlled randomized trial of the use of a popliteal block for pain
Introduction. We hereby present results of controlled randomized trial of use of popliteal block for pain
Introduction. Large diameter femoral heads provide increased range-of-motion and reduced dislocation rates compared to smaller diameter femoral heads. However, several recent studies have reported that contemporary large head prostheses can directly impinge against the local soft tissues leading to anterior hip pain. To address this we developed a novel Anatomically Contoured large diameter femoral Head (ACH) that maintains the profile of a large diameter femoral head over a hemispherical portion and then contours inward the distal profile of the head for soft-tissue
Introduction. Dual mobility (DM) implants provide increased stability and range-of-motion through the use of a large diameter mobile liner articulating against an acetabular shell. However, recent studies have reported that such contemporary large head prostheses can directly impinge against the local soft tissues leading to anterior hip pain. To address this drawback, a novel Anatomically Contoured Dual Mobility (ACDM) liner was developed that maintains the outer spherical geometry over an approximately hemispherical portion and then contours inward the distal profile of the DM liner for soft-tissue