Aims. Spinal
The aim of this study was to compare the operating
time, length of stay (LOS), adverse events and rate of re-admission
for elderly patients with a fracture of the hip treated using either
general or spinal
Introduction. Manipulation under
Hallux valgus surgery can result in moderate to severe post-operative pain requiring the use of narcotic medication. The percutaneous distal metatarsal osteotomy is a minimally invasive approach which offers many advantages including minimal scarring, immediate weight bearing and decreased post-operative pain. The goal of this study is to determine whether the use of narcotics can be eliminated using an approach combining multimodal analgesia, ankle block
Aims. Manipulation under
Purpose. The purposes of this study are as follows; 1) to compare postoperative blood loss between general anesthesia(GA) and spinal anesthesia(SA) and 2) to analyze the affecting factors of postoperative blood loss through the subgroup analysis. METHODS. A retrospective analysis was made on the clinical data of 122 patients with osteoarthritis undergoing primary TKA between January 2012 and December 2013. According to different anesthetic method, the patients were divided into the General
Background. It is unclear which form of
Total hip arthroplasty (THA) is performed under general
Aim: Supine lateral bending radiographs are the standard methods of evaluating curve flexibility before surgery in idiopathic scoliosis. Supine traction radiographs have also been used at the authors’ institution in addition to the supine lateral bending radiographs before surgery, believing that it is usually more helpful to analyze the response of the main and compensatory curves to corrective forces. The purpose of this prospective study was to use and evaluate the results of traction radiographs taken before general
Background. Digital injuries are among the most common presentations to the emergency department. In order to sufficiently examine and manage these injuries, adequate, prompt, and predictable
Radial head fractures are among the most common fractures around the elbow. Radial head arthroplasty is one of the surgical treatment options after complex radial head fractures. This surgery is usually done under general
Introduction. External fixation (EF) devices are commonly used in the management of complex skeletal trauma, as well as in elective limb reconstruction surgery for the management of congenital and acquired pathology. The subsequent removal of an EF is commonly performed under a general anaesthetic in an operating theatre. This practice is resource intensive and limits the amount of operating theatre time available for other surgical cases. We aimed to assess the use of regional
Aims. The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of ‘off-ended’ fractures in children with at least two years of potential growth remaining. Methods. A total of 34 boys and 22 girls aged 0 to ten years with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under
Aims. We hypothesized that the wide-awake local
This study was designed to compare length of hospital stay, and 30-day major and minor complications between patients undergoing total knee arthroplasty (TKA) with general
Introduction. With resumption of non-urgent surgery in May 2020, standard
Botulinum toxin A (BoNT-A) is a substance that requires repeated application due to its effectiveness being lost 12–16 weeks post application. Performing these intra-muscular injections under
The optimal timing of when to perform manipulation under
Introduction. We designed this study to compare 30-day complications and length of hospital stay between patients undergoing total knee arthroplasty (TKA) with general
Prompt mobilisation after the Fracture neck of femur surgery is one of the important key performance index (‘KPI caterpillar charts’ 2021) affecting the overall functional outcome and mortality. Better control of peri-operative blood pressure and minimal alteration of renal profile as a result of surgery and
Aims. Postoperative range of movement (ROM) is an important measure of successful and satisfying total knee arthroplasty (TKA). Reduced postoperative ROM may be evident in up to 20% of all TKAs and negatively affects satisfaction. To improve ROM, manipulation under
Background. Frozen Shoulder is a common condition which causes significant morbidity in people of working age. The 2 most popular forms of surgical treatment for this condition are Manipulation under
Introduction. While additional resources associated with direct anterior (DA) approach total hip arthroplasty (THA) such as fluoroscopy, staff, and special tables are well recognized, time consumption is not well studied. The purpose of this study was to analyze
Abstract. Introduction. Spinal local
Background – Frozen Shoulder is a common condition which causes significant morbidity in people of working age. The 2 most popular forms of surgical treatment for this condition are Manipulation under
Introduction. Early ambulation after total hip arthroplasty (THA) predicts early discharge. Spinal
Epidural
Limited strong data exists in current literature comparing the 90-day morbidity and mortality following general or spinal anesthetic in patients who underwent total hip or knee arthroplasty, especially between matched cohorts. Because of this, there continues to be an ongoing debate regarding the risks and benefits of using general versus spinal anesthetic for patients undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) for end-stage osteoarthritis. The Alberta Bone and Joint Health Institute (ABJHI) database was searched to identify all patients who underwent either primary THA or TKA between April 2005 and December 2015. Those identified were matched 1:1 based on age, sex, type of joint replacement (THA or TKA), American Society of Anesthesiologists (ASA) score, and anesthetic type. Patients were stratified into two groups based on whether they received a general
We performed a meta-analysis to evaluate the relative efficacy of regional and general
Introduction. Arthrofibrosis remains a persistent complication following total knee arthroplasty (TKA). Although manipulation under
Objectives. The goal of this retrospective study was to compare two different processes of pain control after total knee arthroplasty (TKA): local
The purpose of this study is to determine whether the mode of
Introduction. Total knee arthroplasty is very successful although the clinical assessment and rated outcome does not always match the patients reported satisfaction. One reason for patient dissatisfaction is less than desired range of motion. Poor postoperative motion inhibits many functional activities and may create a perception of dysfunction. Early in the postoperative period when patients are having trouble regaining motion (usually 6–8 weeks), manipulation under
Aim. In our Bone Infection Unit, epidural
The purpose of this study is to determine whether the mode of
Introduction. Manipulation under
Background: Traditionally, lumbar discectomy is performed under general
Introduction: Knee arthroscopy under LA, has been shown to be reliable and safe. However, this is not a widely practiced method for knee arthroscopy in the UK. A number of studies have compared various types of
OBJECTIVE. Post TKR manipulation under
Background. Continuous epidural
Purpose: To determine if it is necessary to assess instability of the chronic anterior cruciate ligament deficient knee under general
Background: Better postoperative pain, functional outcomes and patient satisfaction have been reported using spinal
The increase in knee arthroscopy performed on an out-patient basis, along with the need for cost reduction and a safe and rapid patient discharge, has underlined the importance of adequate
Regional anaesthetic for foot surgery has been discussed as a method of post operative analgesia. Ankle block as the sole anaesthetic for foot surgery has not been extensively reviewed in the literature. We aimed to describe our experience of forefoot surgery under ankle block. Sixty-six consecutive forefoot procedures (59 patients) were carried out under ankle block. Patients were contacted post operatively and completed a standardised questionnaire including an incremental pain assessment ranging from 0-10 (0 no pain, 10 severe pain). Forty nine female and 10 male patients (age range 20-85y) were included. Procedures included 33 first metatarsal osteotomies, 15 cheilectomies, 3 first MTP joint replacements, 5 fusions, 4 excision of neuroma and 6 other procedures. 22 patients (33% of cases) reported discomfort during the block procedure (average pain score 1.5). 6 patients reported pain during their operation(s), average score 0.26. Average pain scores at 6, 12, 24 and 48 hours following surgery were 2.0, 3.2, 2.7 and 2.1 respectively. All patients were discharged home and walking on the same day. There were no readmissions. Each patient confirmed they would have surgery under regional block rather than general
Introduction and Aims: Patients with proximal femoral fracture are frail with multiple comorbidities and the
Regional anaesthetic for foot surgery has been discussed as a method of post operative analgesia. Ankle block as the sole anaesthetic for foot surgery has not been extensively reviewed in the literature. Aim. To describe our experience of forefoot surgery under ankle block. Methods. 71 consecutive forefoot procedures (65 patients) were carried out under ankle block. A mixture of 10ml 2% Lidocaine with 10ml 0.5 % Bupivacine was administered to the superficial peroneal, deep peroneal, sural and saphenous nerves. Ankle tourniquet was employed in all procedures. Patients were contacted post operatively and completed a standardised questionnaire including an incremented pain assessment ranging from 0-10 (0 no pain, 10 severe pain). Results. 61 female and 4 male patients were contacted (age range 33-67y). Procedures included 48 first metatarsal osteotomies, 15 cheilectomies, 2 first MTP joint replacements, and 6 fusions. 17 patients (26 %) reported some discomfort during the block procedure (average pain score 1.2). No patients reported any pain during their operation(s). 14 patients (22%) required supplementation of the block. Average pain score at 6, 12, 24 and 48 hours following surgery were 0.66, 2.9, 2.4 and 1.3 respectively. All patients were discharged home and walking on the same day. None complained of nausea or required parentral analgesia. There were no readmissions. Each patient confirmed they would have surgery under regional block rather than general
We selected 20 matched pairs of patients who had had total hip arthroplasty by the same surgeon using the same cemented technique. Matching was by age, sex, height, weight and diagnosis. One of each pair had received hypotensive epidural
Aim: Our aim was to record our experience with a fine needle 27G with any possible difficulties and side-effects. Methods: 38 patients (26 men, 12 women) were selected for our study, aged 18–33 years. The underwent orthopedic surgery (femoral fractures, ankle surgery, patella, tibia and fibula fractures). The patients were preloaded with 500–700 ml crystalloid fluids.Lignocaine 2% (2–4ml) was injected for skin infiltration. The spinal was performed in lateral positioning in O3–O4 or O4–O5 spaces. Bupivacaine (Marcaine 0.5%) was injected and clonidine (Catapresan) was added in 8 cases for prolonged
Introduction: There are a number of publications in the literature on managing post-operative pain and early rehabilitation after primary total hip replacement (THR). However, there has been very little work in the literature to study the influence of the anaesthetic technique used on the post-operative length of hospital stay following primary THR. We, therefore, wished to particularly study the influence of anaesthetic technique and the anaesthetist concerned on the length of hospital stay, as well as the effect of age and body mass index (BMI). Methods: We studied 121 consecutive THRs in 109 patients. All procedures in our study were performed by the same surgeon using the same posterolateral approach, the same prosthetic design and the same physiotherapy protocol for all patients. Patients received either general
Using a computer-based quality assurance program, we analysed peri-operative data on 160 patients undergoing one-stage bilateral hip or knee arthroplasties under regional
The effect of hypobaric spinal
Background. Pain control following knee replacement (TKR) surgery is often poor. Moderate to severe pain is often reported in the first 48 hours following surgery requiring opiate analgesia. The Local Infiltration Anaesthetic (LIA) technique has been described as a method to reduce post operative pain. In this study we report on our experience using LIA in addition to the PainKwell system (Peak Medical) of continuous infusion intra-articularly, of 0.25% bupivacaine at 4–5 mls/hour for 48 hours post surgery. The PainKwell catheter is placed in the knee joint during surgery. Methods. Between the June 2012 and Sep 2012, 62 patients undergoing primary TKR were prospectively followed up. All patients studied had spinal
Purpose. The pros and cons of general
Introduction: Although there are a number of publications in the literature on managing post-operative pain and early rehabilitation after surgery in general, there has been little work on the influence of anaesthetic technique on the post-operative length of hospital stay following primary total hip replacement (THR). We wished to particularly study the influence of anaesthetic technique and the anaesthetist concerned on the length of hospital stay, as well as the effect of age and body mass index (BMI). Methods: We studied 121 consecutive THRs in 109 patients. All procedures were performed by the same surgeon using the same posterolateral approach, prosthetic design and the same physiotherapy protocol. Patients received either general
Objective. Compare the safety and effectiveness of different anesthetic technique used in the simultaneous bilateral total knee arthroplasty (BTKA). Methods. Medical records of patients admitted for simultaneous BTKA between January 1, 2014 and September 1, 2015 in ‘The safety and effect evaluation of joint arthroplasty’ database were analyzed. The general
Hip fracture is associated with highest mortality following trauma in the elderly. The objective of this study is to evaluate the association between duration of
Enoxaparin, a low-molecular-weight heparin, has been used together with spinal or general
The use of regional
Introduction. Stiffness after total knee arthroplasty is a common occurrence. Despite its prevalence, little is known as to which patients are at risk for poor range of motion after total knee arthroplasty. The purpose of this study was to determine the risk factors for manipulation under
Total hip arthroplasty (THA) is associated with high intraoperative and postoperative blood loss. Antifibrinolytic drugs have been used to minimize the potential risks of bleeding and blood transfusion. Studies on the effect of tranexamic acid on decreasing blood loss in THA have revealed interesting results, but most have focused on cemented THA. Yet its benefits in THA, especially in cementless THA, have not been proved. We conducted a prospective double-blind randomized controlled study on 64 patients who were candidates for cementless THA under epidural
Introduction. Arthrofibrosis following total knee arthroplasty (TKA) is a complex and multifactorial complication that may require manipulation under
Aims. We performed a retrospective, comparative study of elderly patients
with an increased risk from
Our aim in this prospective radiological study was to determine whether the flexibility rate calculated from radiographs obtained during forced traction under general
Our aim was to assess the value of external fixation in pathological fractures in selected patients. During 2003–2008 we treated 35 patients with multiple myeloma or disseminated cancer, visceral metastases and pathological fractures with external fixation under sedation and local anaesthetic, because they were not fit for general
Background Adhesive capsulitis of the shoulder is a painful condition that results in gradual loss of joint movement. Numerous treatment modalities have been utilised with variable benefits. Because of the risk of brachial plexus injury and fracture, manipulation under
To determine the effect of experience of the operator and the effect of type of
BACKGROUND. The need for post-operative manipulation under
Various techniques have been used for the fixation of the posterior pelvis, each with disadvantages specific to the technique. In this study, a new protocol involving the placement of posterior pelvic screws in the CT suite is described and evaluated. A total of 66 patients with unstable pelvic ring injuries was stabilised under local
Aim. This study was performed to evaluate the efficacy of a balanced interscalene and general anaesthetic and its potential for use in increasing the provision of day case shoulder surgery. Patients and Methods. 104 patients undergoing shoulder surgery were audited using a questionnaire immediately postoperatively, and at 6, 12 and 48 hours. Pain scores were recorded using a visual analogue scale. Operative details including operation time, postoperative stay and complications have also been recorded. At 48 hours patients were asked about having their operation as a day case and their pain control was assessed. Results. 52 males and 52 females mean age 49 years (range 18–85) completed the questionnaire. 90 responded to a 48-hour interview. 75 arthroscopic decompressions, 15 arthroscopically assisted mini open cuff repairs, 9 open glenohumeral stabilisations and 5 open Mumford procedures were performed. Mean operation time was 47 minutes (range 25–90) and 101 patients were discharged after one (86 patients) or two (15 patients) postoperative nights. 97 patients had no pain immediately postoperatively, 76 were pain free at 6 hours and 39 were pain free at 12 hours. Mean pain scores at 6 and 12 hours were 3 and 4. 101 patients said that their pain was well controlled throughout the first 48 hours with simple oral analgesics. 83% of patients expressing an opinion on day case treatment (69 out of 83) could have been managed as day cases provided that they were adequately counseled about the procedure. 6 patients showed signs of Horner’s syndrome that resolved fully by 12 hours. No other complications related to the inter-scalene block occurred. Conclusion. This study has shown that interscalene
Aim:. To review the use of traction x-rays under
We studied the effectiveness of a local injection of 1 ml of 2% mepivacaine into the sheath of the flexor tendon in 64 fingers and found it to be a safe procedure giving satisfactory
Aims: To evaluate the inßuence of simultaneous local
A reduced range of movement post total knee replacement (TKR) surgery is a well recognised problem. Manipulation under
Many factors have been demonstrated to influence the range of knee movement that an individual can achieve. The purpose of this study was to objectively demonstrate how range of knee movement is affected when the influence of pain is abolished. Sixty-eight patients with degenerative joint disease presenting for primary total knee arthroplasty were recruited. Using a digital camera, images were taken before and after the induction of
The last decade has seen a rise in the use of the gamma nail for managing inter-trochanteric and subtrochanteric hip fractures. Patients with multiple co-morbidities are under high anaesthetic risk of mortality and are usually not suitable for general or regional
In this study we aimed to identify infection rates in arhroplasty patients which were operated bilaterally with single
One hundred and seventy-four consecutive patients with symptoms of derangement of the knee were examined with an arthroscope under local
Aims: Primary aim of this study was to evaluate the inßuence of simultaneous local
Introduction: Patients presenting with fracture of the femoral neck are usually elderly, and often have extensive co-morbidity. Patients who are considered too unwell for surgery are often keep being delayed until assumed optimised or treated non-operatively. These patients have a high morbidity and mortality and present significant nursing difficulties. Materials and Methods: We describe a technique of fixation of fracture of the femoral neck under direct infiltration local
Purpose: To assess the effect of regional versus general
Introduction: There has been controversy in recent publications for/against the value of intraoperative traction views under
Aims: Evaluation of the potential of blood salvage in osteotomy of the pelvis after T…NNIS, using a special anaesthetic technique (Adrenalin Augmented Hypotensive Epidural
Context: Published data on extracorporeal shock wave therapy (ESWT) for heel pain provide controversial evidence about the clinical effectiveness. In previous studies, three interventions of ESWT without local
Aim: The aim of the study is to present our experience in the treatment of intertrochanteric fractures in high-risk elderly patients, using regional
The aim was to compare the efficacy and outcomes of reduction of closed forearm fractures in a paediatric population using Ketamine in the Emergency Department (ED) setting versus reduction under general
Paravertebral
Aims. In-hospital length of stay (LOS) and discharge dispositions following arthroplasty could act as surrogate measures for improvement in patient pathways, and have major cost saving implications for healthcare providers. With the ever-growing adoption of robotic technology in arthroplasty, it is imperative to evaluate its impact on LOS. The objectives of this study were to compare LOS and discharge dispositions following robotic arm-assisted total knee arthroplasty (RO TKA) and unicompartmental arthroplasty (RO UKA) versus conventional technique (CO TKA and UKA). Methods. This large-scale, single-institution study included patients of any age undergoing primary TKA (n = 1,375) or UKA (n = 337) for any cause between May 2019 and January 2023. Data extracted included patient demographics, LOS, need for post
Aim: To assess the efficiency of pre-emptive analgesia in a clinical setting as opposed to closely controlled animal models, looking at postoperative pain scores, total analgesia requirement and amount of general anaesthetic agent required during surgery. Methods and Results. Subject to exclusions, 40 patients undergoing day-case arthroscopy of the knee (mean age 44 years, ASA grade 1–2) were randomized into two treatment groups. All patients had general
To determine the effectiveness of LIA compared to ACB in providing pain relief and reducing opiates usage in hamstring graft ACL reconstructions. In a consecutive series of hamstring graft ACL reconstructions, patients received three different regional and/or anaesthetic techniques for pain relief. Three groups were studied: group 1: general anaesthetic (GA)+ ACB (n=38); group 2: GA + ACB + LIA (n=31) and group 3: GA+LIA (n=36). ACB was given under ultrasound guidance. LIA involved infiltration at skin incision site, capsule, periosteum and in the hamstring harvest tunnel. Analgesic medications were similar between the three groups as per standard multimodal analgesia (MMA). Patients were similar in demographics distribution and surgical technique. The postoperative pain and total morphine requirements were evaluated and recorded. The postoperative pain was assessed using the visual analogue scores (VAS) at 0hrs, 2hrs, 4hrs, weight bearing (WB) and discharge (DC).Abstract
Objectives
Materials and Methods
To determine the effectiveness of LIA compared to ACB in providing pain relief and reducing opiates usage in hamstring graft ACL reconstructions. In a consecutive series of hamstring graft ACL reconstructions, patients received three different regional and/or anaesthetic techniques for pain relief. Three groups were studied: group 1: general anaesthetic (GA)+ ACB (n=38); group 2: GA + ACB + LIA (n=31) and group 3: GA+LIA (n=36). ACB was given under ultrasound guidance. LIA involved infiltration at skin incision site, capsule, periosteum and in the hamstring harvest tunnel. Analgesic medications were similar between the three groups as per standard multimodal analgesia (MMA). Patients were similar in demographics distribution and surgical technique. The postoperative pain and total morphine requirements were evaluated and recorded. The postoperative pain was assessed using the visual analogue scores (VAS) at 0hrs, 2hrs, 4hrs, weight bearing (WB) and discharge (DC).Abstract
Objectives
Materials and Methods
Continuous neuraxial or deep peripheral nerve blockade used to provide postoperative analgesia after major orthopaedic surgery is associated with a risk of spinal or perineural haematoma, especially in patients concomitantly receiving anticoagulants. Limited data on the use of fondaparinux in surgical patients in whom this procedure is performed are available. The EXPERT trial was an observational international study in patients undergoing major orthopaedic surgery designed to evaluate the overall efficacy and safety of once-daily 2.5 mg fondaparinux initiated 6 to 12 hours post-operatively and administered for 4±1 weeks after surgery. A 48-hour “therapeutic window” was applied in patients in whom a neuraxial/deep peripheral indwelling catheter was placed: one of the planned doses of fondaparinux was omitted, the catheter was removed 36 hours after the previous fondaparinux dose, and the next fondaparinux dose administered 12 hours after catheter removal. The primary endpoints were symptomatic venous thromboembolism (VTE) and major bleeding 5±1 weeks after surgery. These events were validated by an independent adjudication committee. Overall, 5704 patients (mean age ± SD: 66 ± 12 years) were recruited between July 2003 and October 2004. They underwent surgery for total hip replacement (52%, n=2941), knee replacement (40%, n=2263), hip fracture (6%, n=353), or other indications (3%, n=148). Fondaparinux was given for a median of 35 (range: 1–105) days. Many operations (62%) were performed under regional
This study aims to determine the incidence of surgical site infection leading to reoperation for sepsis following minor hand procedures performed outside the main operating room using field sterility in the South African setting. The investigators retrospectively reviewed the records of 485 patients who had WALANT-assisted minor hand surgery outside a main operating theatre, a field sterility setting between March 2019 and April 2023. The primary outcome was the presence or absence of deep surgical site infection that required reoperation within four weeks. Cases included where elective WALANT minor hand procedures, a minimum age of 18 with complete clinical records. The patients were mostly female (54.8%), with a mean age of 56.35 years. The majority of cases were trigger finger and carpal tunnel release. An overall 485 cases were reviewed, the deep surgical site infection rate resulting in reoperation within 4 weeks post-operatively was 1.24% ((95% Confidence Interval (CI) 0.0034 to 0.0237); p = 0.009). Minor hand procedures performed under field sterility using WALANT have a low surgical site infection rate. The current study's infection rates are comparable to international surgical site infection rates for similar surgeries performed in main operating rooms using standard sterilisation procedures. Field sterility is a safe and acceptable clinical practice that may improve work efficiency in public sector.
Aims. To identify variables independently associated with same-day discharge (SDD) of patients following revision total knee arthroplasty (rTKA) and to develop machine learning algorithms to predict suitable candidates for outpatient rTKA. Methods. Data were obtained from the American College of Surgeons National Quality Improvement Programme (ACS-NSQIP) database from the years 2018 to 2020. Patients with elective, unilateral rTKA procedures and a total hospital length of stay between zero and four days were included. Demographic, preoperative, and intraoperative variables were analyzed. A multivariable logistic regression (MLR) model and various machine learning techniques were compared using area under the curve (AUC), calibration, and decision curve analysis. Important and significant variables were identified from the models. Results. Of the 5,600 patients included in this study, 342 (6.1%) underwent SDD. The random forest (RF) model performed the best overall, with an internally validated AUC of 0.810. The ten crucial factors favoring SDD in the RF model include operating time,
Although periarticular injection plays an important role in multimodal pain management following total hip arthroplasty (THA), there is no consensus on the optimal composition of the injection. In particular, it is not clear whether the addition of a corticosteroid improves the pain relief achieved nor whether it is associated with more complications than are observed without corticosteroid. The aim of this study was to quantify the safety and effectiveness of cortocosteroid use in periarticular injection during THA. We conducted a prospective, two-arm, parallel-group, randomized controlled trial involving patients scheduled for unilateral THA. A total of 187 patients were randomly assigned to receive periarticular injection containing either a corticosteroid (CS group) or without corticosteroid (no-CS group). Other perioperative interventions were identical for all patients. The primary outcome was postoperative pain at rest during the initial 24 hours after surgery. Pain score was recorded every three hours until 24 hours using a 100 mm visual analogue scale (VAS). The primary outcome was assessed based on the area under the curve (AUC).Aims
Methods
Aims. The volume of ambulatory total hip arthroplasty (THA) procedures is increasing due to the emphasis on value-based care. The purpose of the study is to identify the causes for failed same-day discharge (SDD) and perioperative factors leading to failed SDD. Methods. This retrospective cohort study followed pre-selected patients for SDD THA from 1 August 2018 to 31 December 2020. Inclusion criteria were patients undergoing unilateral THA with appropriate social support, age 18 to 75 years, and BMI < 37 kg/m. 2. Patients with opioid dependence, coronary artery disease, and valvular heart disease were excluded. Demographics, comorbidities, and perioperative data were collected from the electronic medical records. Possible risk factors for failed SDD were identified using multivariate logistic regression. Results. In all, 278 patients were identified with a mean age of 57.1 years (SD 8.1) and a mean BMI of 27.3 kg/m. 2. (SD 4.5). A total of 96 patients failed SDD, with the most common reasons being failure to clear physical therapy (26%), dizziness (22%), and postoperative nausea and vomiting (11%). Risk factors associated with failed SDD included smokers (odds ratio (OR) 6.24; p = 0.009), a maximum postoperative pain score > 8 (OR 4.76; p = 0.004), and procedures starting after 11 am (OR 2.28; p = 0.015). A higher postoperative tolerable pain goal (numerical rating scale 4 to 10) was found to be associated with successful SDD (OR 2.7; p = 0.001). Age, BMI, surgical approach, American Society of Anesthesiologists grade, and
Objectives: To determine the effectiveness of LIA compared to ACB in providing pain relief and reducing opiates usage in hamstring graft ACL reconstructions. In a consecutive series of hamstring graft ACL reconstructions, patients received three different regional and/or anaesthetic techniques for pain relief. Three groups were studied: group 1: general anaesthetic (GA)+ ACB (n=38); group 2: GA + ACB + LIA (n=31) and group 3: GA+LIA (n=36). ACB was given under ultrasound guidance. LIA involved infiltration at skin incision site, capsule, periosteum and in the hamstring harvest tunnel. Analgesic medications were similar between the three groups as per standard multimodal analgesia (MMA). Patients were similar in demographics distribution and surgical technique. The postoperative pain and total morphine requirements were evaluated and recorded. The postoperative pain was assessed using the visual analogue scores (VAS) at 0hrs, 2hrs, 4hrs, weight bearing (WB) and discharge (DC).Introduction and Objective
Materials and Methods
Methoxyflurane can cause hepatotoxicity and nephrotoxicity at anaesthetic doses but has excellent analgesic properties and no nephrotoxic effects in patients without preexisting disease. Approved for use in the UK and Ireland in 2015, it is currently being used in emergency departments for analgesia during fracture reduction. During the Covid emergency, with theatre access severely restricted and many patients unwilling to use inhaled Nitrous oxide, Penthrox had the potential to provide adequate pain relief to aid frame removals and minor procedures in the clinic. Patients presenting to the Limb Reconstruction Unit Elective clinic and requiring frame removal or minor procedures were included in the study. Patients with renal, cardiac or hepatic disease, history of sensitivity to fluorinated anaesthetic agents and those on any nephrotoxic or enzyme inducing drugs were excluded. Verbal consent was obtained, the risks and benefits explained and the procedure was done in a side room in the clinic. Besides patient and procedure details, the Visual Analog Score and Richmond Agitation Scale was noted and patient's satisfaction documented. The results were presented as numbers, means and averages.Introduction
Materials and Methods
Aims. As the world continues to fight successive waves of COVID-19 variants, we have seen worldwide infections surpass 100 million. London, UK, has been severely affected throughout the pandemic, and the resulting impact on the NHS has been profound. The aim of this study is to evaluate the impact of COVID-19 on theatre productivity across London’s four major trauma centres (MTCs), and to assess how the changes to normal protocols and working patterns impacted trauma theatre efficiency. Methods. This was a collaborative study across London’s MTCs. A two-month period was selected from 5 March to 5 May 2020. The same two-month period in 2019 was used to provide baseline data for comparison. Demographic information was collected, as well as surgical speciality, procedure, time to surgery, type of
We present a case of delayed presentation of a subdural haematoma causing cauda equina syndrome which occurred 96 hours after a spinal anaesthetic had been administered for an elective total hip replacement in an 86-year-old man. The patient had received low-molecular-weight heparin anticoagulation which had been delayed until 12 hours postoperatively. No other cause of the haemorrhage could be identified.