Adductor canal blocks offer an alternative to femoral nerve block for postoperative pain relief in knee arthroplasty. They may reduce the risk of quadriceps weakness, allowing earlier mobilisation of patients postoperatively. However, little is known about the effect of a tourniquet on the distribution of local anaesthetic in the limb. Ultrasound-guided adductor canal blocks were performed on both thighs of five human cadavers. Left and right thighs of each cadaver were randomised to tourniquet or no tourniquet for one hour. Iohexol radio-opaque contrast (Omnipaque 350) was substituted for the local anaesthetic for X-Ray imaging. All limbs underwent periodic flexion and extension during this hour to simulate positioning during surgery. The cadavers were refrozen. Fiducial markers were inserted into the frozen tissue. X-rays were obtained in 4 planes (AP, lateral 45° oblique/medial oblique, lateral). University Research Ethics Approval was obtained and cadavers were all pre-consented for research, imaging and photography according to the Anatomy Act (1984). Analysis of radiographs showed contrast distribution in all thighs to be predominantly on the medial aspect of the thighs. The contrast margins were entire and well circumscribed, strongly suggesting it was largely contained within the aponeurosis of the adductor canal. Tourniquets appeared to push the contrast into a narrower and more distal spread along the length of the thigh compared to a more diffuse spread for those without. Proximal spread towards the femoral triangle was reduced in limbs without tourniquets. The results suggest that contrast material may remain within the adductor canal structures during adductor canal blocks. Tourniquets may cause greater distribution of contrast proximally and distally in the thigh, but this does not appear to be clinically significant. Further studies might include radio-stereo photometric analysis using the fiducial markers in the limbs and in vivo studies to show the effect of haemodynamics on distribution.
Surgical complications are common and frequently preventable. The introduction of the WHO Surgical Safety Checklist has improved surgical outcomes. WHO guidelines reduce, but do not prevent errors. Successful arthroplasty surgery requires strict infection control measures. We observed a single surgical team to see if errors caused by operating room personnel were covered by the WHO Checklist. Two independent observers studied compliance of WHO Checklists and operating room etiquette, for one surgical team. All operating room personnel were observed during thirteen arthroplasties (hips and knees) from induction to recovery. All Personnel were blinded to the purpose of this study. Data was categorised into errors with WHO checklists and operating room etiquette.Purpose
Method
Students attend operating room sessions throughout their medical school training and are often given the opportunity to scrub and assist during the surgery. Many students have no or very little formal teaching in operating room etiquette, which leads to last minute on the job training from operating room staff. This study aimed to identify if there was any difference between the students knowledge, technique and competency in operating room etiquette skills between two groups of students who received different methods of teaching. Thirty three 2nd year medical students, that had no previous exposure to operating room etiquette, were recruited for this study. There was variation in their age 18 to 27 years (mean SD years; 19.7 1.9). All students were initially observed scrubbing, gowning and gloving using their baseline knowledge. Their technique was scored using the Dundee University Assessment Sheet and each students knowledge was tested using a spot the mistake quiz. The students were ranked on initial competency then using randomised stratification, separated into two groups. Group One received traditional teaching by operating room staff. Group Two was taught using the new operating room etiquette course, which includes a power point presentation, a video and a practical session. Both groups knowledge and practical skills were reassessed following their teaching. The assessment was repeated at 3 months using the same method, to measure longer-term learning.Purpose
Method
Method: Six TKRs in young, active patients with excellent Oxford Knee Scores and Knee Society Scores, mean 76 months post knee replacement and 5 control patients, 2 weeks post TKR, were selected. Each patient had weight bearing stereo radiographs of at 0, 15, 30, 45 and 60 degrees of flexion while standing in a calibration grid. These x-rays were analysed using our Radio Stereometric Analysis (RSA) system. The three-dimensional shape of the TKR (manufacturer’s computer aided design model) was matched to the TKR silhouette on the calibrated stereo radiographs for each angle of flexion. The relative positions of the femoral and tibial components in space were then determined and the linear and volumetric penetration was calculated using Matlab software.
*Oxford Hip and Knee Group: P McLardy-Smith, C Dodd, D Murray &
R Gundle
