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Introduction: Anesthetic strategies to improve postoperative pain management after Total Knee Arthroplasty (TKA) include multimodal pain management to minimize opiate requirements. Postoperatively, subcutaneous standard bupivacaine HCl is often used. Recent studies have suggested that high dose liposomal bupivacaine may result in improved outcomes. Objectives: This study aims to compare periarticular injection of 399mg (high dose) Liposomal Bupivacaine to Standard Bupivacaine in patients undergoing Total Knee Arthroplasty. Methods: We propose a phase II, single-institution, randomized, controlled, double-blinded, superiority trial with two parallel arms with a 1:1 allocation ratio. The two arms of the study will be standard bupivacaine and liposomal bupivacaine at 399mg dose. We will include patients with age >50 years, with primary knee osteoarthritis requiring TKA, ASA status 1 and 2, without opioid consumption in the last 3 months, and with signed informed consent. Exclusion criteria are history of substance abuse, uncontrolled psychiatric disorder, hepatic cirrhosis, renal failure, rheumatoid arthritis, immune arthritis, post-traumatic osteoarthritis, active malignancy or oncologic disease, pregnancy, synchronic surgical intervention, and morbid obesity with Body Mass Index (BMI) equal or greater than 40kg/m2. The primary outcome is time to first opioid rescue. Secondary outcomes include total opioid consumption, VAS scale, adverse events, GROC score, arc of motion, bupivacaine serum levels, length of stay, and mobilization. Discussion: Improving total knee arthroplasty postoperative pain without opioids decreases opioid-related side effects, reduces costs, and improves outcomes. By decreasing opiate use and complications related to them, Liposomal Bupivacaine may improve patient satisfaction as well as functional outcomes.

Introduction: One of the most common diseases with high mortality is acute pancreatitis, which is caused by gallstone disease or excess alcohol ingestion. Elevation in serum amylase and lipase levels supports the diagnosis of acute pancreatitis. Potential valuable tests in evaluation of acute pancreatitis are ultrasound and magnetic resonance cholangiopancreatography, additionally, they’re useful in identifying stones in the common bile duct and directly evaluating the pancreatic parenchyma. Aim of work: In this article, we highlight the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis. Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1985, through February 2017. The following search terms were used: acute pancreatitis, causes of pancreatitis, diagnosis of pancreatitis, management of pancreatitis Conclusions: Acute pancreatitis remains a common reason of hospital admission necessitating a multipronged approach for the diagnosis and treatment. Management is predominantly focused toward supportive care with advanced endoscopic adjuncts (in the setting of choledocholithiasis, symptomatic pseudocysts, or walled-off pancreatic necrosis) and early surgical mediation (i.e., cholecystectomy in the setting of an index admission for gallstone pancreatitis) used when clinically needed, although its antecedents remain multifactorial, as are the number of scoring systems that define severity. Key words: pancreatitis, gastroenteritis, acute care.