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The article offers the technical and therapeutic considerations of the surgical procedure called Subtotal LeFort I Osteotomy. According to the article, sub-total Le-Fort I osteotomy is attained under general anesthesia. It is stated that in few cases, it found minor resistance and none of the patients complained of more than mild discomfort during further activation of the appliance. It notes that the subtotal LeFort I osteotomy has evidently a satisfactory, rapid mechanical surgical method for maxillary expansion.

Background: Reports on any aspect of management of meniscal injuries are scarce in Nigeria, though the anecdotal experience is that occurrence of meniscal injuries is not rare. Meniscal repair is the preferred option following meniscal injury due to the long‑term harmful effects attributed to partial meniscectomies. Meniscal repair in the setting of an isolated meniscal injury is also reputed to give a satisfactory return to preinjury levels of about 91.3%. Meniscectomy has been reported to be associated with long term symptoms and functional limitations. Current treatment trend involves conserving the meniscus where and if possible. Despite this, arthroscopic partial meniscectomy is said to be one of the most common orthopaedic procedures worldwide. Indications for meniscal repairs have been well developed over the years and include factors like duration and pattern of the tear among other features. We present a study of the management of 16 patients who had surgery for meniscal injury over 1 year. Aims and Objectives: To determine the difference in short term outcome for patients who had meniscal injuries following arthroscopic treatment using the Tegner Lysholm score. Materials and Methods: Our work was a retrospective, descriptive study of all our patients who had surgery for meniscal injuries from December 1, 2018 to November 30, 2019. We recruited qualified patients into the study and extracted relevant information from their records. Data retrieved included age, sex, aetiology, presenting complaint, duration before the presentation, intra‑operative arthroscopic findings, the treatment offered and the difference in the patient’s Tegner Lysholm knee score evaluated preoperatively and at 6 months post-treatment. Results: In the study period, 16 patients had arthroscopic surgery for complaints of persistent knee pain. The majority (75%) of the patients were aged between 20 and 40 years. Most were male (88%) and had their injuries playing football (63%). The presentation was late in most cases (75%), and most of the patients had complex, irreparable tears at arthroscopy. An associated rupture of the anterior cruciate ligament was found in 25% of the patients. Majority of the patients had partial meniscectomy alone. Only two patients (12.5%) qualified for and had meniscal repairs using the outside‑in technique. Most of the patients had a poor Tegner Lysholm knee score preoperatively. Post‑operatively, at 6 months follow‑up, all the patients demonstrated a short‑term improvement in the Tegner Lysholm score. Our study indicates that the presentation of meniscal injuries is often delayed in our environment. Most of the patients who present with these injuries do not qualify for meniscal repair as they often have complex, irreparable tears. These patients have partial meniscectomies with short term relief of their complaints. Conclusion: Despite the need for meniscal conservation, partial meniscectomy is still very relevant in our environment. [ABSTRACT FROM AUTHOR]

Background: Postoperative mortality and complications after geriatric hip fracture surgery remain high despite efforts to improve perioperative care for these patients. One factor of particular interest is anesthetic technique, but prior studies on this are limited by sample selection, competing risks, and incomplete followup.Questions/purposes: (1) Among older patients undergoing surgery for hip fracture, does 90-day mortality differ depending on the type of anesthesia received? (2) Do 90-day emergency department returns and hospital readmissions differ based on anesthetic technique after geriatric hip fracture repairs? (3) Do 90-day Agency for Healthcare Research and Quality (AHRQ) outcomes differ according to anesthetic techniques used during hip fracture surgery?Methods: We conducted a retrospective study on geriatric patients (65 years or older) with hip fractures between 2009 and 2014 using the Kaiser Permanente Hip Fracture Registry. A total of 1995 (11%) of the surgically treated patients with hip fracture were excluded as a result of missing anesthesia information. The final study sample consisted of 16,695 patients. Of these, 2027 (12%) died and 98 (< 1%) terminated membership during followup, which were handled as competing events and censoring events, respectively. Ninety-day mortality, emergency department returns, hospital readmission, deep vein thrombosis (DVT) or pulmonary embolism (PE), myocardial infarction (MI), and pneumonia were evaluated using multivariable competing risk proportional subdistribution hazard regression according to type of anesthesia technique: general anesthesia, regional anesthesia, or conversion from regional to general. Of the 16,695 patients, 58% (N = 9629) received general anesthesia, 40% (N = 6597) received regional anesthesia, and 2.8% (N = 469) patients were converted from regional to general.Results: Compared with regional anesthesia, patients treated with general anesthesia had a higher likelihood of overall 90-day mortality (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.11-1.35; p < 0.001); however, when stratified by before and after hospital discharge but within 90 days of surgery, this higher risk was only observed during the inpatient stay (HR, 3.83; 95% CI, 3.18-4.61; p < 0.001); no difference was observed after hospital discharge (HR, 1.04; 95% CI, 0.94-1.16; p = 0.408). Patients undergoing conversion from regional to general also had a higher overall mortality risk compared with those undergoing regional anesthesia (HR, 1.34; 95% CI 1.04-1.74; p = 0.026), but this risk was only observed during their inpatient stay (HR, 6.84; 95% CI, 4.21-11.11; p < 0.001) when stratifying by before and after hospital discharge. Patients undergoing general anesthesia had a higher risk for all-cause readmission when compared with regional anesthesia (HR, 1.09; 95% CI, 1.01-1.19; p = 0.026). No differences according to anesthesia type were observed for risk of 90-day AHRQ outcomes, including DVT/PE, MI, and pneumonia.Conclusions: We found the use of general anesthesia and conversion from regional to general anesthesia were associated with a higher risk of mortality during the in-hospital stay compared with regional anesthetic techniques, but this higher risk did not persist after hospital discharge. We also found general anesthesia to be associated with a higher risk of all-cause readmission compared with regional, but no other differences were observed in risk for complications. Our findings suggest regional anesthetic techniques may be preferred when possible in this patient population.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Five billion people, primarily in low-income and middle-income countries, cannot access safe, affordable surgical and anesthesia care, particularly for orthopaedic trauma. The rate-limiting step for many orthopaedic surgical procedures performed in the developing world is the absence of safe anesthesia. Even surgical mission teams providing surgical care are limited by the availability of anesthesiologists. Emergency physicians, who are already knowledgeable in airway management and procedural sedation, may be able to help to fulfill the need for anesthetists in disaster relief and surgical missions.Methods: Following the 2010 earthquake in Haiti, an emergency physician was trained using the Emergency Physician's General Anesthesia Syllabus (EP GAS) to perform duties similar to those of certified registered nurse anesthetists. The emergency physician then provided anesthesia during surgical mission trips with an orthopaedic team from February 2011 to March 2017, in Milot, Haiti. This is a descriptive overview of this training program and prospectively collected data on the cohort of patients whom the surgical mission teams treated in Haiti during that time frame.Results: A single emergency physician anesthetist provided anesthesia for 71 of the 172 orthopaedic surgical cases, nearly doubling the number of cases that could be performed. This also allowed the anesthesiologists to focus on pediatric and more difficult cases. Both immediately after the surgical procedure and at 1 year, there were no serious adverse events for cases in which the emergency physician provided anesthesia.Conclusions: Given emergency physicians' baseline training in airway management and sedation, well-supervised and focused extra training under the vigilant supervision of a board-certified anesthesiologist may allow emergency physicians to be able to safely administer anesthesia. Using emergency physicians as anesthetists in this closely supervised setting could increase the number of surgical cases that can be performed in a disaster setting. [ABSTRACT FROM AUTHOR]

Background: A previous PAIN OUT study found that American orthopaedic-surgical patients rated 'worst pain' higher than did similar European patients. This study aims to confirm these findings in a larger, international patient sample, explore whether risk factors for greater postoperative pain exist disproportionately in the American population, and confirm the findings for one procedure.Methods: Surveyors collected patient reported outcomes (PROs) and perioperative pain management practices using PAIN OUT methodology. Most PROs used 11-point numerical rating scales (0=null, 10=worst possible). Risk factors included: female gender, younger age, high BMI, chronic pain, and opioid use before surgery. Initial analysis used a mixed patient cohort. A secondary analysis used only patients undergoing total knee replacement (TKR). Inference was based primarily on effect size using Cohen's d.Results: 13,770 patients in 13 European and non-European countries (international ) and 564 patients from the United States (US) contributed data on the 1st postoperative day. Three of 11 PROs differed between the cohorts: 'worst pain' {US 7.5 (2.5) vs international 5.6 (2.8); d=0.66 [confidence interval (CI) 0.58-0.75]}; proportion 'receiving information about treatment options' [US 0.86 vs international 0.66; d=0.53 (CI 0.39-0.66)]; reporting adverse effects and their severity [US 0.87 vs international 0.73; d=0.52 (CI 0.38-0.66)]. Risk factors did not differ between the two cohorts. PROs and management patterns in TKR patients were similar to the mixed cohort.Conclusions: Three PROs differed between international and US patients, with higher 'worst pain' for US patients. Neither risk factors, nor patient mix accounted for the observed differences for 'worst pain'.Clinical Trial Registration: NCT 02083835. [ABSTRACT FROM AUTHOR]

Background: Postoperative nausea and vomiting (PONV) is one of the major concerns after anesthesia and surgery, and it may be more frequent in orthopedic patients receiving patient-controlled epidural analgesia (PCEA). The purpose of this study was to compare the effect of palonosetron and dexamethasone on the prevention of PONV in patients undergoing total joint arthroplasty and receiving PCEA. Methods: Patients scheduled for total hip or knee arthroplasty under spinal anesthesia/PCEA were randomly allocated to receive either intravenous palonosetron (0.075 mg, n = 50) or dexamethasone (5 mg, n = 50). Treatments were administered intravenously to the patients 30 min before the beginning of surgery. The total incidence of PONV and incidence in each time period, severity of nausea, need for rescue anti-emetics, pain score, and adverse effects during the first 48 h postoperatively were evaluated. Results: The total incidence of PONV was lower in the palonosetron group compared with the dexamethasone group (18.4% vs. 36.7%, P = 0.042), but there were no statistically significant differences in incidence between the groups at all time points. No significant intergroup differences were observed in the severity of nausea, use of rescue anti-emetics, pain score, and adverse effects. Conclusions: Although there were no significant differences in the incidence of PONV between the treatment groups at all time points, intravenous palonosetron reduced the total incidence of PONV in orthopedic patients receiving PCEA compared with dexamethasone. [ABSTRACT FROM AUTHOR]

Study Design: A prospective cohort study.Objective: The purpose of this study was to compare surgical outcomes between non-elderly and elderly patients with cervical spondylotic myelopathy (CSM) who underwent laminoplasty.Summary Of Background Data: Since age at the time of surgery influences the surgical outcome, we designed a large-scale cohort study to examine the surgical outcome for CSM from a single operative procedure used exclusively in elderly patients.Methods: A total of 505 consecutive patients with CSM (311 men; 194 women) were prospectively enrolled. The mean age was 66.6 years (range, 41-91), and the average postoperative follow-up period was 26.5 ± 12.5 months. Patients were divided into three groups according to age: non-elderly (<65 yr, n = 201), young-old (65-74 yr, n = 186), and old-old (≥75 yr, n = 118). Pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association scoring system for cervical myelopathy (JOA score) and quantifiable tests-the 10-s grip and release test (10-s G&R test) and the 10-s step test.Results: Mean achieved JOA scores in non-elderly, young-old, and old-old groups were 3.1, 3.2, and 3.0, respectively, with no significant difference among three groups (P = 0.5735). Mean preoperative 10-s G&R test results were 17.3, 14.4, and 13.0, respectively, indicating a significant decrease with increasing age, whereas postoperative results significantly improved in all groups (21.0, 17.9, and 16.3, respectively). Similarly, the 10-s step test significantly decreased with age, with preoperative scores of 14.3, 11.5, and 8.6, respectively, whereas postoperative scores improved to 17.3, 14.9, and 12.5, respectively. The three groups showed no significant difference in the rate of postoperative complications.Conclusion: Elderly patients adequately recovered from laminoplasty in terms of achieved JOA score, the 10-s G&R test, and the 10-s step test. Therefore, laminoplasty for CSM is beneficial in elderly patients.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

Introduction: Scientific studies on injury characteristics are rather common in professional football but not in amateur football despite the thousands of amateur football tournaments taking place worldwide each year. The purpose of this study was to evaluate the preparation and injury patterns of players of two different football skill levels who participated in an international amateur football tournament.Methods: In a prospective cohort study, an international amateur football tournament of medical doctors in 2011 was analysed with regard to training and warm-up preparation, the level of football played before the tournament and injury data during the tournament by means of standardised injury definitions and data samples for football.Results: Amateur players of registered football clubs had higher training exposure before the tournament (p < 0.001) than recreational players and had more frequently performed warm-up programmes (p < 0.001). Recreational football players showed a significantly higher overall injury incidence (p < 0.002), particularly of overuse injuries (p < 0.001), during the tournament than amateur players. In almost 75% of players in both groups, the body region most affected by injuries and complaints was the lower extremities. Orthopaedic and trauma surgeons had the lowest overall injury incidence and anaesthetists the highest (p = 0.049) during the tournament.Conclusion: For the first time, this study presents detailed information on the injury incidence and injury patterns of an amateur football tournament. Less-trained recreational players sustained significantly more injuries than better-trained amateur players, probably due to the lack of sufficient preparation before the tournament. Preventive strategies against overuse and traumatic injuries of recreational football players should start with regular training and warm-up programmes in preparation for a tournament. [ABSTRACT FROM AUTHOR]

Background: The challenging task of postoperative pain relief comes within the realm of the anesthesiologist. Combined spinal epidural (CSE) anesthesia can be used as the sole technique for carrying out surgical procedures and managing postoperative pain using various drug regimes. Epidural administration of opioids in combination with local anesthetic agents in low dose offers new dimensions in the management of postoperative pain. Aims: Comparative evaluation of bupivacaine hydrochloride with nalbuphine versus bupivacaine with tramadol for postoperative analgesia in lower limb orthopedic surgeries under CSE anesthesia to know the quality of analgesia, incidence of side effects, surgical outcome and level of patient satisfaction. Settings and Design: A prospective, randomized and double-blind study was conducted involving 80 patients of American Society of Anesthesiologists physical status I and II coming for elective lower limb orthopedic surgeries carried under spinal anesthesia. Materials and Methods: Anesthesia was given with 0.5% of 2.5 ml bupivacaine intrathecally in both the groups. Epidurally 0.25% bupivacaine along with 10 mg nalbuphine (group A) or tramadol 100 mg (group B) diluted to 2 ml to make a total volume of 10 ml was administered at sensory regression to T10. Statistical Analysis: The data were collected, compiled and statistically analyzed with the help of MS Excel, EPI Info 6 and SPSS to draw the relative conclusions. Results and Conclusions: The mean duration of analgesia in group A was 380 ± 11.49 min and in group B was 380 ± 9.8 min. The mean sedation score was found to be more in group B than group A. The mean patient satisfaction score in group A was 4.40 ± 0.871 and in group B was 3.90 ± 1.150 which was found to be statistically significant (P < 0.05). We concluded that the addition of nalbuphine with bupivacaine was effective for postoperative analgesia in terms of quality of analgesia and patient satisfaction score as compared to tramadol. [ABSTRACT FROM AUTHOR]

INTRODUCTION How many orthopods does it take to change a light bulb? One - to refer to the medics for 'Darkness ?Cause'. Additionally, anaesthetists and surgeons often disagree on the estimated blood loss during surgery and the estimated procedure duration. We designed this study to compare the ability of orthopaedic surgeons and anaesthetists in: (a) estimating fluid volumes; (b) estimating procedure durations; and (c) changing light bulbs. METHODS Participants had to either be a specialist in anaesthesia or orthopaedic surgery, or a trainee in that specialty for at least two years. Three different fluid specimens were used for volume estimation (44 mL, 88 mL and 144 mL). Two videos of different lengths (140 seconds and 170 seconds), showing the suturing of a banana skin, were used for procedure duration estimation. To determine the ability at changing light bulbs, the participants had to match eight different light sockets to their respective bulbs. RESULTS 30 male anaesthetists and trainees and 31 male orthopaedic surgeons and trainees participated in this study. Orthopaedic surgeons underestimated the three fluid volumes by 3.9% and anaesthetists overestimated by 5.1% (p = 0.925). Anaesthetists and orthopaedic surgeons overestimated the duration of the two procedures by 21.2% and 43.1%, respectively (p = 0.006). Anaesthetists had a faster mean time in changing light bulbs (70.1 seconds vs. 74.1 seconds, p = 0.319). CONCLUSION In an experimental environment, male orthopaedic surgeons are as good as male anaesthetists in estimating fluid volumes (in commonly seen surgical specimens) and in changing light bulbs. Both groups are poor at estimating procedure durations. [ABSTRACT FROM AUTHOR]

A four-month old, 4.5kg weight infant with normal mentation was posted for Achilles tendon lengthening for bilateral club foot. Anaesthesia was provided with intrathecal administration of 0.4ml of 0.5% bupivacaine and popliteal sciatic nerve block with 0.2 % bupivacaine 1.5ml to each side. The sciatic nerve was looking hypoechoic than the classical honeycomb possibly due to lesser development of connective tissue. The infant had satisfactory analgesia for 12hrs post-surgery and there was no analgesic requirement. Routine follow up for three months was uneventful. We conclude that intrathecal bupivacaine supplemented with ultrasound guided peripheral nerve blocks can be administered even in infants. As case reports like this are rare to find in literature, we report this case for its uniqueness. [ABSTRACT FROM AUTHOR]

Frozen shoulder is a very common condition with a prevalence of 2%-5% in the general population. Decrease in joint volume as a result of fibrosis and hyperplasia of the joint capsule leads to painful and restricted glenohumeral motion. Frozen shoulder is a self-limiting disease with a chronic character, and is mostly treated in a primary care setting. In this review, we set out to address the current evidence-based literature on management of this disabling disease using a PubMed search. Many non-surgical and surgical therapeutic options are described, including supervised neglect, intra-articular corticosteroid injections, physical therapy, manipulation under anesthesia, capsular distension, and arthroscopic capsular release. In the literature, the long-term outcome shows a significant decrease in pain and improvement of shoulder function for all treatment modalities without clear evidence of superiority of one over the other. This possibly indicates that a self-limiting character is the most important factor in the course of the disease. Management of frozen shoulder is primarily conservative. Supervised neglect is combined with analgesia and stretching exercises as the pain subsides. In the early painful phase, intra-articular corticosteroid injections are recommended for pain relief. When the patient has persistent pain and glenohumeral stiffness after adequate conservative treatment, invasive options can be considered, like arthroscopic capsular release, manipulation under anesthesia, or capsular distension. [ABSTRACT FROM AUTHOR]

Background: Various adjuvant are being used with local anesthetics for prolongation of intra operative and postoperative analgesia in epidural block for lower limb surgeries. Dexmedetomidine, the highly selective α2 adrenergic agonist is a new neuroaxial adjuvant gaining popularity. The aim of the present study was to compare the hemodynamic, sedative and analgesia potentiating effects of epidurally administered dexmedetomidine when combined with ropivacaine. Materials and Methods: The study was conducted in prospective, randomized double-blind manner in which 100 patients of American Society of Anesthesiologist Grade I and II in the age group of 20-65 years of either sex under going lower limb surgeries were included after taking informed consent. The patients were randomly allocated into two groups of 50 each. Epidural anesthesia was given with 150 mg of 0.75% ropivacaine in Group A (n = 50) and 150 mg of 0.75% ropivacaine with dexmedetomidine (1 μg/kg) in Group B (n = 50). Two groups were compared with respect to hemodynamic changes, block characteristics which included time to onset of analgesia at T10, maximum sensory analgesic level, time to maximum sensory and motor block, time to regression at S1 dermatome and time to the first dose of rescue analgesia for 24 h. At the end of study, data was compiled and analyzed statistically using Chi-square test, Fisher's exact test and Student t-test. P < 0.05 was considered to be significant and P < 0.001 as highly significant. Results: Significant difference was observed in relation to the duration of sensory block (375.20 ±15.97 min in Group A and 535.18 ±19.85 min in Group B [P - 0.000]), duration of motor block (259.80 ±15.48 min in Group A and 385.92 ±17.71 min in Group B [P - 0.000]), duration of post-operative analgesia (312.64 ±16.21 min in Group A and 496.56 ±16.08 min in Group B [P < 0.001]) and consequently low doses of rescue analgesia in Group B (1.44 ± 0.501) as compared to Group A (2.56 ±0.67). Sedation score was significantly more in Group B in the post-operative period. Conclusion: Epidural Dexmedetomidine as an adjuvant to Ropivacaine is associated with prolonged sensory and motor block, hemodynamic stability, prolonged postoperative analgesia and reduced demand for rescue analgesics when compared to plain Ropivacaine. [ABSTRACT FROM AUTHOR]

In modern veterinary medicine, like in human medicine all major surgery procedures must be performed under balanced anaesthesia. This protocol contained substances that insure: neurovegetativ protection, analgesia, miorelaxation, hypnosis. Rocuronium represent a nondepolarizing agent, intermediate acting ( 60-120 seconds), with relative long effects ( 40-90 minutes), and with the posibility of effect reversal ( agents-Sugammadex). The aim of this study was monitorization of clinical, haematological and biochemical parameters perioperative in dogs scheduled for orthopedic procedures. This study was performed on five canine patients (different breed, with age between 4 months to 11 years), scheduled for femoral had resection procedure. In this dogs balanced anaesthesia was performed: induction with propofol to effect, maintained with sevoflurane 2.5%; analgesic component: fentanyl 3μg/kg b.w.-bolus followed by CRI 5 μg/kg b.w./min, the neuromuscular blocking agent was represented by rocuronium 0.4 mg/kg b.w. Haematological analysis were performed with Abacus Junior Vet 3 diff analyzer, biochemical parameters with UV-VIS Screen Master Touch Hospitex Diagnostic spectrophotometer, and electrolytes with GEM Premier 2000 analyzer. The majority of biochemical and mineral parameters suffered only small changes, without statistical importance. After the surgery we determined only a slight reduction of erythrocyte number, haemoglobin and PCV, a mild increase of γ-globulin. Regarding the clinical parameters only internal temperatures was modified. We recommend the use of rocuronium in orthopedic procedures for the advantages offered in the surgical act (profound miorelaxation) without any major biochemical, haematological, electrolytes alteration. [ABSTRACT FROM AUTHOR]

Background: Several virtual reality simulators have been developed to assist orthopaedic surgeons in acquiring the skills necessary to perform arthroscopic surgery. The purpose of this study was to assess the construct validity of the ArthroSim virtual reality arthroscopy simulator by evaluating whether skills acquired through increased experience in the operating room lead to improved performance on the simulator. Methods: Using the simulator, six postgraduate year-1 orthopaedic residents were compared with six postgraduate year-5 residents and with six community-based orthopaedic surgeons when performing diagnostic arthroscopy. The time to perform the procedure was recorded. To ensure that subjects did not sacrifice the quality of the procedure to complete the task in a shorter time, the simulator was programmed to provide a completeness score that indicated whether the surgeon accurately performed all of the steps of diagnostic arthroscopy in the correct sequence. Results: The mean time to perform the procedure by each group was 610 seconds for community-based orthopaedic surgeons, 745 seconds for postgraduate year-5 residents, and 1028 seconds for postgraduate year-1 residents. Both the postgraduate year-5 residents and the community-based orthopaedic surgeons performed the procedure in significantly less time (p = 0.006) than the postgraduate year-1 residents. There was a trend toward significance (p = 0.055) in time to complete the procedure when the postgraduate year-5 residents were compared with the community-based orthopaedic surgeons. The mean level of completeness as assigned by the simulator for each group was 85% for the community-based orthopaedic surgeons, 79% for the postgraduate year-5 residents, and 71% for the postgraduate year-1 residents. As expected, these differences were not significant, indicating that the three groups had achieved an acceptable level of consistency in their performance of the procedure. Conclusions: Higher levels of surgeon experience resulted in improved efficiency when performing diagnostic knee arthroscopy on the simulator. Further validation studies utilizing the simulator are currently under way and the additional simulated tasks of arthroscopic meniscectomy, meniscal repair, microfracture, and loose body removal are being developed. [ABSTRACT FROM AUTHOR]

Evidence supports the concept that patients undergoing major orthopedic surgery benefit from either thromboprophylaxis or peripheral nerve blocks, especially continuous techniques. A group of anesthesiologists with significant experience in orthopedic anesthesia and peripheral nerve blocks reviewed the literature related to thromboprophylaxis and peripheral nerve blocks and their combination in orthopedics. Major bleeding, including retroperitoneal hematoma, is an established complication of thromboprophylaxis. Major bleeding, including retroperitoneal hematoma, is also an established complication of peripheral nerve blocks. Between 1997 and 2012, only 4 case reports of major bleeding were reported in patients receiving thromboprophylaxis and peripheral nerve blocks. Evidence supports the safety of the combination of thromboprophylaxis and peripheral nerve blocks. This group of experts concluded that currently there is no evidence that the combination of thromboprophylaxis and peripheral nerve block increases the risk of major bleeding compared to either of the treatments alone. [ABSTRACT FROM AUTHOR]

Background: Various options are available for the provision of analgesia following major surgical procedures including systemic opioids and regional anesthetic techniques. Regional anesthetic techniques offer the advantage of providing analgesia while avoiding the deleterious adverse effects associated with opioids including nausea, vomiting, sedation and respiratory depression. Although used commonly in infants and children, there is a paucity of experience with the use of caudal epidural blockade in adolescents. Methods: We retrospectively reviewed the perioperative care of adolescents undergoing major urologic or orthopedic surgical procedures for whom a caudal epidural block was placed for postoperative analgesia. Results: The cohort for the study included 5 adolescents, ranging in age from 13 to 18 years and in weight from 42 to 71 kilograms. Caudal epidural analgesia was accomplished after the induction of anesthesia and prior to the start of the surgical procedure using 20-25 mL of either 0.25% bupivacaine or 0.2% ropivacaine with clonidine (1 μg/kg). The patients denied pain the recovery room. The time to first request for analgesia varied from 12 to 18 hours with the patients requiring 1-3 doses of analgesic agents during the initial 24 postoperative hours. Conclusions: Our preliminary experience demonstrates the efficacy of caudal epidural block in providing analgesia following major urologic and orthopedic surgical procedures. The applications of this technique as a means of providing postoperative analgesia are discussed. [ABSTRACT FROM AUTHOR]

Background: Ultrasound guidance improves the localization of anesthetic placement during regional anesthesia, but a decreased rate of adverse events has not been demonstrated in the current literature. In this large prospective study, we evaluated the safety, efficacy, and patient satisfaction associated with ultrasound-guided interscalene block. Methods: A cohort of 1319 patients undergoing arthroscopic shoulder surgery at an outpatient surgery center was prospectively evaluated. Interscalene blocks were performed by experienced anesthesiologists and trainees with use of ultrasound guidance. Patients were queried by a physician twenty-four hours postoperatively regarding their satisfaction with the interscalene block and were screened for a comprehensive register of minor and major adverse events. Individuals with adverse events were followed until symptoms resolved. Results: Interscalene block was ultimately successful in 99.6% of the cases. A total of thirty-eight adverse events (prevalence, 2.88%) were noted. At the time of the latest follow-up, permanent sequelae were present in three patients (0.23%), all of whom had relevant comorbidities. With regard to patient satisfaction, 99.06% of the respondents were "satisfied" or "very satisfied" with the interscalene block, whereas 0.94% of respondents were unsatisfied. In addition, 97.8% of the patients stated that they would elect to have an interscalene block again in the future. Conclusions: The present study supports the use of ultrasound-guided interscalene block by trained anesthesiologists for well-screened patients undergoing shoulder arthroscopy, given the high rate of patient satisfaction and the low rate of adverse events. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to determine the optimal target-controlled concentration of remifentanil combined with desflurane, by using a more widely and decreasing end-tidal concentration of desflurane. Methods: Ninety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries, were registered and randomly allocated to receive either a target-controlled concentration of 1 ng/ml (group R1), 2 ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D). Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5-min intervals from after a 10-15 min period of surgical incision to before a 10-min period prior to the end of an operation. End-tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR. If the value of bispectral index (BIS) was from 60-62 for more than 2 min or systolic blood pressure would fall below 90 mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock. Results: The end-tidal desflurane concentration was lower in the group receiving 1 ng/ml (5.2 ± 0.5 vol%; P < 0.001) and 2 ng/ml remifenanil (4.4 ± 0.5 vol%; P < 0.001) compared to patients in group D (7.9 ± 0.5 vol%). Conclusions: We recommend the use of 2 ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia. [ABSTRACT FROM AUTHOR]

The article presents abstracts on orthopedic anesthesiology which include "The influence of anaesthetic technique on the outcome of 226 patients with aortic murmurs undergoing hip fracture repair," by R. Monteiro and S. White, "Fractured neck of femur pathway: the Torbay experience," by J. Kosy and colleagues, and "The effect of the Sernbo score on mortality after intracapsular hip fracture," by E. J. Dawe and colleagues.

Background: Where surgery has been preferred, the torn Achilles tendon (AT) has most commonly been repaired under general or spinal anaesthetic (GA). Repair using local anaesthetic (LA) has been reported, but does not appear to be widely used. Methods: We retrospectively reviewed 87 patients, following open repair using either GA or LA at Nelson Hospital, 2001-2005. Calf strength and ankle range of motion (ROM) were assessed. Subjective pain and function were assessed using the American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire. Complications, time off work and sport, time in theatre, and hospital were recorded. Results: Fifty-nine tendons were repaired under GA (68%) and 28 under LA (32%). Outcomes were similar for each group. There was no significant difference in strength and ROM. Foot and Ankle Questionnaire scores were similar. Total theatre time averaged 57 min for GA and 37 min for LA ( P = 0.01). LA repairs (82%) were performed as a day case compared with 10% of the GA repairs ( P = 0.01). LA patients had a quicker return to work. GA complications included two deep vein thromboses and two pulmonary emboli. One patient from each group had a re-rupture. Conclusion: A repair of the acutely ruptured AT under LA is at least as effective as repair under GA with regard to function, long-term pain and patient satisfaction. LA repair results in significant cost savings due to less theatre time, fewer anaesthetic costs, and a shorter hospital stay. [ABSTRACT FROM AUTHOR]

Background: A pulse oximeter is one of the most important monitors to save patients undergoing anesthesia and monitored sedation. The authors report a case of orthopedic surgery, in which interference of pulse oximetry occurred when using a Stealth Station™ navigation system (Medtronic Sofamor Danek, Memphis, TN). Applying a black plastic shield (Masimo Ambient Shield: Masimo Corporation, Irvine, CA) completely eliminated the interference. Case presentation: A 37-year-old male patient with a giant cell tumor of the left femur was scheduled to undergo curettage of the femur using an intraoperative CT three-dimensional imaging system (O-arm™) and Stealth Station™ navigation system. During the surgery, the SpO value, which was maintained between 97 and 99% until the time, disappeared suddenly with abnormal pulse wave. Because a distortion in the SpO value was reproduced by repeated movement of cameras on the head of the Stealth Station™ navigation system, we recognized that the interference signal was coming from the navigation system. To eliminate the infrared light, the pulse oximetry probe was covered with a black plastic shield and the interference was completely eliminated. Conclusions: The Stealth Station™ navigation system was found to interfere with the SpO value, and a black plastic shield was useful for eliminating the interfering signal. Anesthesiologists should understand the risk of interference by the neuro-navigation system and know how to solve the problem. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To compare the femoral nerve block with the fascia iliaca block for postoperative analgesia in adolescents undergoing reconstructive knee surgery. Design: Randomized, single-blinded study. Setting: Full-service pediatric medical center. Patients: 23 ASA physical status I and II patients, aged 8 to 16 years, undergoing anterior cruciate ligament (ACL) repair. Interventions: Patients received either fascia iliaca or femoral nerve block prior to reconstructive surgery. Measurements: Pain scores by visual analog scale (VAS; 0-10) and morphine use were routinely recorded through to discharge from the hospital. Pain scores were assessed on days 1 and 2 at home post-discharge. Main results: There was no difference between the femoral nerve block and the fascia iliaca nerve block in VAS pain scores or postoperative morphine consumption. Conclusion: Either the femoral nerve block or the fascia iliaca block, followed by patient-controlled analgesia with morphine, provides efficacious analgesia for adolescents undergoing ACL reconstruction. [Copyright &y& Elsevier]

Objective--To determine fluid retention, glomerular filtration rate, and urine output in dogs anesthetized for a surgical orthopedic procedure. Animals--23 dogs treated with a tibial plateau leveling osteotomy Procedures--12 dogs were used as a control group. Cardiac output was measured in 5 dogs, and 6 dogs received carprofen for at least 14 days. Dogs received oxymorphone, atropine, propofol, and isoflurane for anesthesia (duration, 4 hours). Urine and blood samples were obtained for analysis every 30 minutes. Lactated Ringer's solution was administered at 10 mL/kg/h. Urine output was measured and glomerular filtration rate was estimated Fluid retention was measured by use of body weight, fluid balance, and bioimpedance spectroscopy Results--No difference was found among control, cardiac output, or carprofen groups, so data were combined. Median urine output and glomerular filtration rate were 0.46 mL/kg/h and 1.84 mL/kg/min. Dogs retained a large amount of fluids during anesthesia, as indicated by increased body weight, positive fluid balance, increased total body water volume, and increased extracellular fluid volume. The PCV, total protein concentration, and esophageal temperature decreased in a linear manner Conclusions and Clinical Relevance--Dogs anesthetized for a tibial plateau leveling osteotomy retained a large amount of fluids, had low urinary output, and had decreased PCV, total protein concentration, and esophageal temperature Evaluation of urine output alone in anesthetized dogs may not be an adequate indicator of fluid balance. [ABSTRACT FROM AUTHOR]

The article discusses a study on the impact of Entropy Module and Bispectral Index (BIS) monitoring on drug consumption and recovery times compared with standard clinical practice in patients undergoing orthopaedic surgery using a combination of regional and general anaesthesia. An experienced anaesthesiologist performed the anaesthesia. The study involved 90 adult patients who received a propofol-remifentanil anaesthesia at the University of Bonn in Germany. Results show Entropy and BIS-monitoring were not superior over standard practice.

Summary: Arterial tourniquets are commonly used in orthopaedic anaesthesia to provide a bloodless field for better operating conditions. It is also used in intravenous regional blocks both for upper and lower limbs. Complications can be either local to the affected limb or systemic. Systemic effects can occur during inflation and deflation of the tourniquet. General guidelines should be followed in order to minimize such complications. [Copyright &y& Elsevier]

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Abstract: The 23rd Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society (AOFAS) was held 13–15 July 2007 at the Westin Harbour Castle Hotel in Toronto, Ontario, Canada. There were 538 registrants in attendance, including 182 individuals from 29 countries outside the United States. [Copyright &y& Elsevier]

Purpose: We aimed the investigate of the effect of iv paracetamol on hemodynamic indices, liver functions in the patients underwent major orthopaedic surgery. Material and Methods: This study was performed on 120 patients with ASA I-II risk group underwent major ortopaedic surgery. The patients are randomly divided into there groups: Group I (only iv meperidine), Group II (Parasetamol in doses 1g is intravenously given by infusion during the 30 mins ago end of the operation, and this dose is repeated in every 6 hours.) and Group III: Parasetamol iv 1gr is given by infusion during the 30 mins ago from the anesthesia induction, and this dose is repeated in every 6 hours. Patient Control Anaestesia (PCA) method; meperidin was administered via PCA as loading dose 0.5mg/kg, set bolus dose 0.1mg/kg and standing locked term 10 mins. Blood for ALT and AST taken on preoperative and postoperative 24th hour is examined. Results: In control group, compared with parasetamol and preemptive groups, SAP in postop 60th, DAP in postop 30. and 60th mins, HR in postop 15th mins were recorded higher. The preop and postop examined ALT and AST were similar. Conclusion: We concluded that iv paracetamol administration to the patients underwent to major ortopaedic surgery did not cause negative hemodynamic results and liver functions. [ABSTRACT FROM AUTHOR]

Background: Shoulder arthroplasty procedures are seldom performed on an ambulatory basis. Our objective was to examine postoperative analgesia, nausea and vomiting, patient satisfaction and complications of ambulatory shoulder arthroplasty performed using interscalene brachial plexus block (ISB). Materials and Methods: We prospectively examined 82 consecutive patients undergoing total and hemi-shoulder arthroplasty under ISB. Eighty-nine per cent (n=73) of patients received a continuous ISB; 11% (n=9) received a single-injection ISB. The blocks were performed using a nerve stimulator technique. Thirty to 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine was injected perineurally after appropriate muscle twitches were elicited at a current of less than 0.5% mA. Data were collected in the preoperative holding area, intraoperatively and postoperatively including the postanesthesia care unit (PACU), at 24h and at seven days. Results: Mean postoperative pain scores at rest were 0.8 ± 2.3 in PACU (with movement, 0.9 ± 2.5), 2.5 ± 3.1 at 24h and 2.8 ± 2.1 at seven days. Mean postoperative nausea and vomiting (PONV) scores were 0.2 ± 1.2 in the PACU and 0.4 ± 1.4 at 24h. Satisfaction scores were 4.8 ± 0.6 and 4.8 ± 0.7, respectively, at 24h and seven days. Minimal complications were noted postoperatively at 30 days. Conclusions: Regional anesthesia offers sufficient analgesia during the hospital stay for shoulder arthroplasty procedures while adhering to high patient comfort and satisfaction, with low complications. [ABSTRACT FROM AUTHOR]

Abstract: Orthopaedic surgery is an expanding surgical specialty with a potentially difficult patient population. Regional anaesthesia is becoming increasingly popular as it offers several advantages over general anaesthesia. Consider the following when deciding if a patient is suitable for regional anaesthesia: possible contradictions should be excluded and full consent obtained after an explanation of the intended procedure; the patient''s comfort in a noisy theatre environment for a prolonged period of time; a combination of a regional technique with sedation or a general anaesthetic is possibly indicated; the surgeon''s preference; the patient''s health; the duration of the intended procedure; the practice pattern of the hospital; and the expertise of the anaesthetist. Regional anaesthesia is best done by anaesthetists who are knowledgeable in the anatomy and nerve distribution, and have the dexterity to perform the necessary techniques. For upper limb surgery, interscalene blocks are ideally suited for shoulder and upper arm surgery, suprascapular nerve blocks for upper arm, elbow and radial side of forearm, and the infraclavicular and axillary block for hand, wrist and forearm surgery. Individual nerve blocks are best suited to a localized surgery of the hand, but do not cover tourniquet sites. Lower extremity surgery can be blocked centrally. However, it is associated with significant complications and possible bowel and bladder disturbance and bilateral limb immobility. For hip surgery a lumber plexus block offers many advantages. The three-in-one block is usually ineffective because it does not reliably block the lateral cutaneous nerve or the obturator nerve. For knee replacement surgery both femoral and sciatic nerve blockades are indicated, and the insertion of catheters is becoming more common. This offers much improved analgesia and earlier mobilization. Increased knowledge and practice in regional techniques has the benefit of improving analgesia and mobilization, shortens hospital stay and therefore has many advantageous cost implications as well as improving overall quality of care. [Copyright &y& Elsevier]

Background: The purpose of this systematic review was to critically appraise the literature on the accuracy of orthopaedic tests for the spine. Methods: Multiple orthopaedic texts were reviewed to produce a comprehensive list of spine orthopaedic test names and synonyms. A search was conducted in MEDLINE, MANTIS, CINAHL, AMED and the Cochrane Library for relevant articles from inception up to December 2005. The studies were evaluated using the tool for quality assessment for diagnostic accuracy studies (QUADAS). Results: Twenty-one papers met the inclusion criteria. The QUADAS scores ranged from 4 to 12 of a possible 14. Twenty-nine percent of the studies achieved a score of 10 or more. The papers covered a wide range of tests for spine conditions. Conclusion: There was a lack of quantity and quality of orthopaedic tests for the spine found in the literature. There is a lack of high quality research regarding the accuracy of spinal orthopaedic tests. Due to this lack of evidence it is suggested that over-reliance on single orthopaedic tests is not appropriate. [ABSTRACT FROM AUTHOR]

The aim of this study is to identify the effect of time and pressure of tourniquet in blood pressure and pulse rate immediately after the releasing of tourniquet in the upper and lower extremity of the orthopedic surgeries. This retrospective study examined 206 consecutive patients. Comparisons of the systolic and diastolic pressure and heart rate were made before the induction of anesthesia and tourniquet inflation, and immediately after the deflation. In general, there was no significant difference in hemodynamic changes between the upper- and lower-limb with regard to the type of anesthesia. There was no significant correlation between systolic blood pressure and tourniquet pressure, while by increasing the tourniquet time significantly, the systolic blood pressure decreases immediately after the deflation. Interestingly, the considerable increase in age paralleled with a significant decrease in the systolic blood pressure. The effect of tourniquet time is more than the age. There was no significant correlation between the tourniquet pressure and tourniquet time with diastolic blood pressure. Simply the increase in age significantly paralleled with the mild decrease in diastolic blood pressure Orthopedic surgeons are recommended not to rely on the benefits of tourniquet to raise blood pressure due to hypotensive conditions after the deflation especially in the old. [ABSTRACT FROM AUTHOR]

Background: Despite a trend toward the use of regional anesthesia for orthopaedic procedures, there has been resistance to the use of interscalene regional block for shoulder surgery because of concerns about failed blocks and potential complications. Methods: We retrospectively reviewed the cases of 568 consecutive patients who had shoulder surgery under interscalene regional block in a tertiary-care, university-based practice with an anesthesiology residency program. The blocks were performed by a group of anesthesiologists who were dedicated to the concept of regional anesthesia in their practice. Complete anesthetic and orthopaedic records were available for 547 patients. The surgical procedure, planned type of anesthesia, occurrence of block failure, and the presence of complications were noted. Results: Of the 547 patients, 295 underwent an arthroscopic procedure and 252 (including eighty who had an arthroplasty) underwent an open procedure. General anesthesia was the initial planned choice for sixty-nine patients because of the complexity or duration of the procedure, the anatomic location, or patient insistence. Thirty-four of the sixty-nine patients also received an interscalene regional block. Interscalene regional block alone was planned for 478 patients. A total of 462 patients (97%) had a successful block whereas sixteen required general anesthesia because the block was inadequate. The success of the block was independent of the type or length of the surgery. No patient had a seizure, pneumothorax, cardiac event, or other major complication. Twelve (2.3%) of the 512 patients who had a block had minor complications, which included sensory neuropathy in eleven patients and a complex regional pain syndrome that resolved at three months in one patient. For ten of the eleven patients, the neuropathy had resolved by six months. Conclusions: Interscalene regional block provides effective anesthesia for most types of shoulder surgery, including arthroplasty and fracture fixation. When administered by an anesthesiologist committed to and skilled in the technique, the block has an excellent rate of success and is associated with a relatively low complication rate. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Presents a calendar of events related to pain and palliative care from February to November 2005. V European Congress of Orthopaedic Anesthesia and Pain in Spain; International Symposium: Places of death: Agenda of the 21st Century in Switzerland; International Forum on Pain Medicine in Bulgaria.

Copyright of Implantodontie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Looks at developments in the field of orthopedic anesthesia in the ten years prior to 2003. Changing nature of surgery; Pre-operative assessment clinic; High dependency care; Anesthetics.

Summary The effects of intra-operative magnesium sulphate on pain relief after major lumbar surgery were investigated in 24 patients. Patients were randomly allocated to receive either an infusion of 50 mg.kg-1 magnesium sulphate or an equivalent volume of saline at induction of anaesthesia. Anaesthesia was induced with propofol and remifentanil. Tracheal intubation was facilitated using rocuronium. Maintenance was achieved with remifentanil and sevoflurane in nitrous oxide/ oxygen. Intra-operative monitoring included standard equipment and neuromuscular transmission. During surgery, neuromuscular block recovery was longer in the magnesium group. Postoperative opioid consumption and pain scores were lower in the magnesium group. The first night's sleep and the global satisfaction scores were better in the magnesium group. The results of the study support magnesium sulphate as a useful adjuvant for postoperative analgesia after major lumbar surgery. [ABSTRACT FROM AUTHOR]

Examines the effectiveness of continuous bupivacaine infiltration for pain management following orthopedic knee surgery in the U.S. Safety of the bupivacaine infiltration, a anesthetic method; Usefulness of the study for nurses and physicians; Aim of postoperative pain management.

SummaryBoth continuous spinal anaesthesia and continuous epidural anaesthesia are supposed to provide adequate post-operative pain relief. The purpose of this randomized, prospective study was to compare the quality of analgesia, occurence of side effects and patient satisfaction between spinal and epidural administration of bupivacaine during the first post-Íoperative 72 h. One hundred and two patients scheduled for hip arthroplasty were randomly assigned to one of two groups: Group 1 received continuous spinal anaesthesia for intra-operative and post-operative management, Group 2 received continuous epidural anaesthesia. Immediately after surgery, the continuous spinal anaesthesia-group received a 1-mL bolus (bupivacaine 0.25%), followed by a continuous infusion of 10 mL over 24 h. The continuous epidural anaesthesia-group received a 10-mL bolus (bupivacaine 0.25%), followed by 2 mL h-1. The level of pain was gauged from a verbal rating score and from a visual analogue scale; the degree of motor blockade was recorded using the Bromage score. In the continuous spinal anaesthesia-group 90.2% reported complete analgesia on the verbal rating scale, but only 21.6% of the continous epidural anaesthesia-group did. The visual analogue scale scores given by the continuous spinal anaesthesia-group were significantly lower than those of the continuous epidural anaesthesia-group. The percentage of patients with a motor block was significantly higher in the continuous spinal anaesthesia-group on the day of surgery and at the first post-operative day. During the first 24 h, nausea and vomiting occured more often in the continuous epidural anaesthesia-group. The satisfaction was considered excellent in 92.2% of the continuous spinal anaesthesia-group and in 70.6% of the continuous epidural anaesthesia-group. It is concluded that continuous spinal anaesthesia and continuous epidural anaesthesia are effective and safe for post-operative pain relief after hip... [ABSTRACT FROM AUTHOR]

This article discusses the substantial impact of obesity for hospitals, orthopedic practices, and individual patient outcomes, as well as measures to address these challenges. Special issues include anesthesia management pre- and intra-operatively, adapting surgical techniques, infection control, pain management, and hospital equipment. [ABSTRACT FROM PUBLISHER]

To determine the rate of manipulation under anaesthesia (MUA) following distension arthrogram for adhesive capsulitis of the shoulder. Thirty-nine patients (42 shoulders) between 1998 and 2004 were treated with distension arthrogram for adhesive capsulitis diagnosed by the clinical picture of progressive pain and stiffness. Capsular disruption into the subscapular bursa was demonstrated in 40 of the 42 shoulders (95%). Thirty-seven of 42 (88%) shoulders were painfree following distension arthrogram. 15 of 42 (36%) shoulders underwent MUA following distension arthrogram for stiffness although 10 of these (67%) were painfree. Prior to distension arthrogram, the range of external rotation (ER) was no different between those that had MUA and those that did not ( P = 0.36). The improvement in ER was 33% ( P = 0.28) in those that had MUA and 50% ( P = 0.001) in those that did not. The only complication was a vasovagal episode during the procedure. Distension arthrogram can be used as a therapeutic procedure for achieving symptomatic pain relief in the majority of adhesive capsulitis and decrease the rate of MUA of the shoulder. [ABSTRACT FROM AUTHOR]