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Introduction: joint replacement is a highly effective intervention that significantly improves the patient's quality of life, relieves symptoms, restores joint function, and improves mobility and independence. The optimal pain control after total hip replacement has become an important goal of postoperative management. The purpose of this paper is to compare periarticular infiltration (PAI) and lumbar plexus nerve block (LPNB) for the management of post-operative pain in primary total hip arthroplasty because we believe that LPNB provides better analgesic management and lower opioid consumption. We evaluated the opioid usage during hospitalization and the complications derived from either technique. Material and methods: we randomized 45 patients who underwent elective total hip arthroplasty between January 2019 and January 2020. Two groups were evaluated based on the association of PAI or LPNB. Both as part of a multimodal analgesic regimen. Results: a total of 45 patients were evaluated (22 PAI group, 23 LPNB group). Block group required less opioid administration (p = 0.069). Most of the patients in both groups reported mild/moderate pain. The LPNB group had lower pain scale with physiotherapy. We did not have complications derived from either technique. Conclusion: lumbar plexus nerve block (LPNB) in patients undergoing total hip arthroplasty provides better pain management and reduced opioid consumption compared to PAI. The performance of this technique does not delay the beginning of physiotherapy and there were not any issues with the patient's recovery. [ABSTRACT FROM AUTHOR]

Background: The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Total knee arthroplasty is one of the orthopedic surgeries that manifests more pain in the first 24-48 hours, needing a multimodal analgesic therapy. The objective of this work is to compare two different intravenous analgesic modes applied to patients undergoing a primary total knee arthroplasty, analyzing the quality of pain control, hospital stay and costs. Material and methods: Simple blind, comparative and prospective study comprised of 42 patients operated of total knee arthroplasty secondary to degenerative arthritis in the period between May 2016 and May 2017. Results: The distribution of pain showed significant differences (p < 0.0401) between both groups, indicating that the application of continuous pump for analgesia controls this symptom early. The hospital stay, on average, was different in the groups (p = 0.001), estimating about 15 hours less following the use of continuous pump. This strategy is globally more economic. Discussion: The continuous infusion pump of analgesia compared with intermittent formal intravenous regimen showed better control of pain, decreasing the perception of pain by the patient, bettering the tolerance to physical therapy and reducing, on average, 15 hours of hospital stay, and thus, the final costs of the surgery. [ABSTRACT FROM AUTHOR]

In recent years, progress has been made in regulating skeletal development and maintenance of bone mass of the adult by the hypothalamus-pituitary-thyroid axis. Studies have been carried out into the effect of thyroid hormones on the osteoblasts, osteoclast and the chondrocyte. This research has led to better genetic knowledge into the physiology of the cellular action of these hormones. Recently, possible D2 deodinase interventions in osteoporosis have been proposed. The link between bone mineral dignity, bone quality and the risk of fractures with thyroid hormones in normal postmenopausal women suggest a role for these hormones, even within the range of normal thyroid, in these diseases. On the other hand, the incidence of differentiated thyroid cancer, experimental in vivo thyroid hormone suppression by therapy, recurrent disease, has increased significantly. There are management guides, but it is clear that the secondary derivatives require a precise balance-adjusted indication, risk-benefit ratio of thyroid hormone dosage, prescribed long term, especially in cases of low tumor aggressiveness, advanced age and even in fragile patients. High risk patients should be referred for a bone densitometry, to consider treating future fractures. Prevention of osteoporosis, particularly in postmenopausal women, is highly desirable and should include adequate diet in calcium and vitamin D supplementation if necessary. There is still no consensus on osteoporosis treatment in the patient with thyroid cancer and suppressive treatment, but the indicated criteria for postmenopausal osteoporosis seem to be applicable in general. [ABSTRACT FROM AUTHOR]

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