Search

Objectives To compare the analgesic and functional outcomes of continuous neuroablative radiofrequency (CNARF) and pulsed neuromodulative radiofrequency (PNMRF) treatment of genicular nerves up to 1 year after the intervention and to identify predictors associated with a successful outcome (defined as an at least 50% reduction in the pre-interventional visual analog scale [VAS] rating) after genicular radiofrequency treatment. Design A prospective randomized controlled trial. Setting The Pain Department of the Jerez de la Frontera University Hospital, Cadíz, Spain, from January 2018 until May 2019. Subjects Patients with grade 3–4 gonarthritis suffering from knee pain, with a VAS score ≥5 for >6 months. Methods Eligible participants were randomly assigned to receive either CNARF or PNMRF of the superior medial, superior lateral, and inferior medial genicular nerves. The VAS and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were assessed before and at 1, 6, and 12 months after treatment. Medication use was quantified before and at 6 months after the intervention. Potential characteristics associated with the efficacy of radiofrequency intervention were explored by using multivariable statistical models. Results A total of 188 participants were included. The magnitude and duration of beneficial effect and reduction in analgesic use were significantly greater in the CNARF group. Success at 6 months after radiofrequency treatment decreased with grade 4 gonarthritis; higher pre-interventional VAS score; and concomitant depression, anxiety disorder, and diabetes mellitus. Conclusions Therapeutic efficacy and reduction in analgesic consumption were superior after CNARF. Treatment success at 6 months after radiofrequency intervention decreased with more severe gonarthritis; higher pre-interventional pain intensity; and concomitant depression, anxiety disorder, and diabetes mellitus.

Resumen Introduccion La profilaxis antibiotica es una estrategia fundamental en el control de la infeccion de la herida quirurgica. Este estudio evalua la adecuacion de la profilaxis antibiotica prequirurgica en pacientes a los que se les realiza cirugia ortopedica y traumatologica. Metodos Estudio descriptivo transversal. Se incluyeron pacientes a los que se les realizaron implantes de protesis de cadera, de rodilla y cirugia de columna por inclusion consecutiva. Se hizo una estimacion muestral teniendo en cuenta un intervalo de confianza del 95%, una precision del 5%, una adecuacion global del 85% y unas perdidas del 5%. Asi, se estimaron necesarios 206 pacientes. Se evaluo la adecuacion de la indicacion, del tiempo de administracion, de la via y de la dosis de antibiotico al protocolo del Centro. Se estudio la incidencia acumulada al alta de infeccion de herida quirurgica. Resultados Se estudiaron 221 pacientes. El porcentaje de varones fue del 33,5% y 66,5% el de mujeres. La edad media fue de 61,1 anos (desviacion estandar [DE] de 14,1) y 67,1 anos (DE de 12,4), respectivamente (p 0,05). Conclusiones La adecuacion de la profilaxis antibiotica ha sido alta, pero se puede mejorar.

Antibiotic prophylaxis is an essential strategy for preventing surgical wound infection. This study assesses the adequacy of surgical antibiotic prophylaxis in trauma and orthopedic patients.Cross-sectional study including consecutive patients who underwent hip or knee replacement, or spinal surgery. Sample estimation was based on 95% confidence, 5% precision, an overall adequacy of 85%, and assuming a loss of 5%. Thus, 206 patients were required. The appropriateness of the indication, time of administration, administration route, and dose according to the hospital protocol was assessed. The cumulative incidence of surgical site infection at discharge was determined.A total of 221 patients were included, 33.5% men and 66.5% women; mean age was 61.1 (SD=14.1) for men and 67.1 (SD=12.4) for woman (P0.05). Antibiotic prophylaxis was indicated in all patients. Overall adequacy of prophylaxis according to the hospital protocol was 89.1%. Cumulative incidence of surgical wound infection at discharge was 3.2%. There was no association between the adequacy of antibiotic prophylaxis and surgical site infection (P0.05).The adequacy of postoperative antibiotic prophylaxis was high in this study, but it can be improved.