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The purpose of this study was to determine whether the use of a periarticular injection using liposomal bupivacaine could decrease pain and improve outcomes after total knee arthroplasty. Fifty consecutive patients received no periarticular injections (group A). Another 50 consecutive patients received a periarticular injection of liposomal bupivacaine (group B). There were no differences in the groups with respect to gender, age, body mass index (BMI), or comorbidities. There was a significant reduction in the amount of narcotics used in the liposomal bupivacaine group (60.97-mg oral morphine equivalent vs 89.74 mg, P  = 0.009). Patients in group B with a BMI <40 and a Charlson comorbidity index of 0-3 had decreased length of stay (2.64 vs 3.06 days, P  = .004), narcotic use over 24-48 hours (110.66 vs 182.47 mg, P  = .013), and narcotic use over 48-72 hours (49.61 vs. 112.65 mg, P  = .004). In patients with a BMI <40 and comorbidity index of ≤3, periarticular injection using liposomal bupivacaine leads to earlier discharge along with decreased use of narcotics.

Background: The performance of dual-energy CT (DECT) for the detection of myocardial blood volume deficits has not systematically been compared with single-energy CT (SCT) spectra., Objective: We evaluated the accuracy for detection of myocardial blood volume deficits in DECT and SCT compared with 99m-Tc-Sestamibi-SPECT (single-photon emission CT) during rest and stress., Methods: 47 patients underwent rest/stress SPECT myocardial perfusion imaging and cardiac DECT on a dual-source CT scanner. The A- and B-tubes were operated with 140 kV and 80 kV/100 kV, respectively. DECT raw data were reconstructed by (1) only using high-energy (140 kV) CT spectra, (2) only using low-energy (80 kV/100 kV) CT spectra, (3) merging data (30% low- and 70% high-energy CT spectra), and (4) DECT-based iodine maps. Two independent, blinded observers analyzed all CT data according to each of the 4 reconstruction strategies for myocardial blood volume deficits., Results: Specificity and positive predictive values were relatively similar between the 4 reconstruction strategies, with highest specificity (98%) of SCT datasets based on 140 kV for mixed perfusion deficits seen on SPECT. DECT iodine maps showed highest sensitivity, negative predictive value, and accuracy of 91%, 97%, and 93%, respectively, for mixed perfusion deficits. Analysis with receiver operating characteristics showed highest area under the curve values (0.84-0.93) with the use of DECT iodine maps in the detection of purely fixed and mixed perfusion deficits., Conclusion: DECT iodine maps show superior performance for the detection of fixed and mixed perfusion deficits compared with SCT spectra., (Copyright © 2011 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Background: Intracoronary aqueous oxygen (AO) hyperoxemic perfusion, initiated shortly (15-30 min) after the onset of postinfarction reperfusion, reduces infarct size and improves left ventricular function. Whether such therapy provides similar benefits when administered many hours after the onset of reperfusion is unknown. Accordingly, the hypothesis was tested that AO hyperbaric perfusion, performed 24 h after the onset of postinfarction reperfusion, reduces infarct size and improves left ventricular ejection fraction (LVEF) in swine., Methods: Following a 1-h balloon occlusion of the left anterior descending coronary artery in air-ventilated juvenile domestic swine, reperfusion was allowed to proceed without adjunctive therapy overnight in all animals. The following day, half of the reanesthetized, air-ventilated swine were randomized to treatment with intracoronary AO hyperbaric perfusion for 90 min (n=6, mean arterial perfusate PO(2)=899+/-78 mm Hg), while the remainder served as controls (n=6)., Results: Infarct size by triphenyl tetrazolium chloride was reduced by 48% and the [area of necrosis]/[area at risk] ratio was reduced by 44% in the AO group compared to the control group (p<0.05). By serial ventriculography, mean LVEF improved by 21% during AO perfusion, relative to baseline and control group values (p<0.05), with no significant change 1 h after completion of treatment (p>0.05)., Conclusion: AO hyperbaric perfusion, delayed 24 h after the onset of postinfarction reperfusion, reduces infarct size and improves LVEF in an experimental animal model.