Advances in Orthopedics最新文献

{"title":"No Difference in Short-Term Complications following Treatment of Closed Tibial Shaft Fractures with Intramedullary Nailing versus Plate Fixation.","authors":"Conor N O'Neill,&nbsp;Nicholas Hooper,&nbsp;Jacob Wait,&nbsp;James Satalich,&nbsp;David Cinats,&nbsp;Clarence Toney,&nbsp;Paul Perdue,&nbsp;Jibanananda Satpathy","doi":"10.1155/2023/1627225","DOIUrl":"10.1155/2023/1627225","url":null,"abstract":"<p><strong>Objectives: </strong>Tibial shaft fractures are treated with both intramedullary nailing (IMN) and plate fixation (ORIF). Using a large national database, we aimed to explore the differences in thirty-day complication rates between IMN and ORIF.</p><p><strong>Methods: </strong>Patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database who had undergone either tibial IMN or ORIF for closed fractures from 2010 to 2018 were identified using current procedural terminology (CPT) codes. After excluding all patients with open fractures, the propensity score was matching. Univariate and multivariate logistic regressions were used to identify risk factors associated with the thirty-day incidence of complications in the two cohorts.</p><p><strong>Results: </strong>A total of 5,400 patients were identified with 3,902 (72.3%) undergoing IMN and 1,498 (27.7%) ORIF. After excluding any ICD-10 diagnosis codes not pertaining to closed, traumatic tibial shaft fractures, 2,136 IMN and 621 ORIF cases remained. After matching, the baseline demographics were not significantly different between the cohorts. Following matching, the rate of any adverse event (aae) did not differ significantly between the IMN (7.08% (<i>n</i> = 44)) and ORIF (8.86% (<i>n</i> = 55)) cohorts (<i>p</i>=0.13). There was also no significant difference in operative time (IMN = 98.5 min, ORIF = 100 min; <i>p</i>=0.3) or length of stay (IMN = 3.7 days, ORIF = 3.3 days; <i>p</i>=0.08) between the cohorts.</p><p><strong>Conclusion: </strong>There were no significant differences in short-term complications between cohorts. These are important data for the surgeon when considering surgical management of closed tibial shaft fractures.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2023 ","pages":"1627225"},"PeriodicalIF":1.3,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10586916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49688340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Periarticular Infiltration with Dexamethasone and Bupivacaine plus Adductor Canal Block Relative to That of Adductor Canal Block Alone for Patients Undergoing Total Knee Arthroplasty: A Retrospective Case-Matched Study.","authors":"Varah Yuenyongviwat,&nbsp;Bunyaporn Wuttiworawanit,&nbsp;Nipat Panichnantho,&nbsp;Theerawit Hongnaparak,&nbsp;Khanin Iamthanaporn","doi":"10.1155/2023/7356192","DOIUrl":"10.1155/2023/7356192","url":null,"abstract":"<p><strong>Purpose: </strong>Periarticular infiltration (PI) is a common procedure during total knee arthroplasty (TKA) for postoperative pain management. This retrospective, case-matched study aimed to evaluate the effectiveness of PI with dexamethasone and bupivacaine in combination with an adductor canal block (ACB) and compare it with that of ACB alone in reducing postoperative pain in patients with TKA.</p><p><strong>Methods: </strong>Data were collected from 66 patients who underwent TKA performed by a single surgeon. Thirty-three of them received ACB + PI, and 33 received ACB alone. However, both groups underwent identical surgical techniques and postoperative care protocols. The pain scores and fentanyl consumption of the two groups were compared.</p><p><strong>Results: </strong>The ACB + PI group had significantly lower pain scores than the ACB alone group at 8, 16, 24, and 48 hours postoperatively (<i>p</i>=0.033, 0.004, 0.038, and 0.049, respectively). The percentage of patients requiring fentanyl as a rescue medication was significantly higher for the ACB alone group (90.9%) than for the ACB + PI group (69.7%, <i>p</i>=0.03). The total fentanyl consumption was also lower for the ACB + PI group (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>The periarticular injection of the combination of dexamethasone and bupivacaine plus ACB was more effective than ACB alone in reducing postoperative pain and fentanyl consumption in patients undergoing TKA. Further studies comparing different doses of dexamethasone or other cocktail regimens may provide additional insights into this approach.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2023 ","pages":"7356192"},"PeriodicalIF":1.3,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10586906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49688339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Postural Control in Patients Diagnosed with Unilateral Knee Osteoarthrosis and Its Relationship with the Risk of Falls.","authors":"Robson Emiliano José de Freitas,&nbsp;Jaqueline Gleice Aparecida de Freitas,&nbsp;Carolina Pereira Vieira,&nbsp;Daniela Cristina Endres,&nbsp;Fábio Martins Inacio,&nbsp;Fernanda Grazielle da Silva Azevedo Nora","doi":"10.1155/2023/5536304","DOIUrl":"10.1155/2023/5536304","url":null,"abstract":"Introduction Knee osteoarthrosis, whether subtle or marked, appears to alter the stability and performance of the knee joint in activities of daily living that prevent the maintenance of bipedal posture. However, there is still a gap in the literature as to how knee osteoarthritis can affect static balance. Objective To analyze the performance of postural control in elderly diagnosed with unilateral knee osteoarthrosis. Materials and Methods 40 elderly people of both sexes participated in this study, divided into two groups containing 20 elderly each. Group 1 (G1) consists of elderly patients who have received a diagnosis of unilateral knee osteoarthritis. Despite undergoing conservative treatment, their condition has shown insufficient improvement, leading to a clinical recommendation for total knee arthroplasty (TKA). The G2 group was made up of 20 elderly with an average age of 71.09 years, considered active, who do not have a diagnosis of osteoarthritis in the knee joint and practice physical activity. With the aid of a Baroscan pressure platform, the center of pressure (COP) displacement in the anteroposterior (COPAP) direction and mediolateral direction (COPML) and the area of center of pressure displacement were evaluated during bipedal postural control with eyes open and eyes closed. Results During postural control with eyes open and eyes closed, the G1 group showed greater displacement of the COP in the anteroposterior direction—COPAP (p = 0.007)—and mediolateral direction—COPML (p = 0.033)—when compared to the G2 group. As for the area of displacement of the COP, group G1 presented a larger area of displacement (p = 0.002) than group G2 during bipedal postural control with open eyes. For the condition with eyes closed, both groups showed similar behaviors, which resulted in no present statistically significant differences. Conclusion The results suggest that unilateral knee osteoarthritis influences bipedal postural control and activities of daily living that require this static balance, since information from the somatosensory system is reduced, resulting in stability of tasks that require body control and promoting the risk of falls. From a clinical perspective, the results suggest that the assessment of bipedal postural control can assist orthopedic physicians in assessing joint stability in patients with unilateral knee osteoarthrosis.","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2023 ","pages":"5536304"},"PeriodicalIF":1.3,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10564574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41187938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Efficacy of Local Corticosteroid Injection, Platelet-Rich Plasma, and Extracorporeal Shockwave Therapy in the Treatment of Pes Anserine Bursitis: A Prospective, Randomized, Comparative Study.","authors":"Wesam Gouda,&nbsp;Awad S Abbas,&nbsp;Tarek M Abdel-Aziz,&nbsp;Mohamed Z Shoaeir,&nbsp;Walid Ahmed,&nbsp;Abdelhfeez Moshrif,&nbsp;Ahmed Mosallam,&nbsp;Mohamed Kamal","doi":"10.1155/2023/5545520","DOIUrl":"10.1155/2023/5545520","url":null,"abstract":"<p><strong>Background: </strong>Pes anserine bursitis (PAB) is one of the most common causes of painful knee syndromes. This study aimed at examining the efficacy of local corticosteroid injection, platelet-rich plasma (PRP) injection, and extracorporeal shock wave therapy (ESWT) as different modalities to alleviate pain and enhance function in patients with pes anserine bursitis (PAB).</p><p><strong>Methods: </strong>A prospective, randomized, comparative study was conducted on 180 patients diagnosed with chronic PAB. They were equally divided into three groups as follows: Group I received a local corticosteroid injection of 40 mg of methylprednisolone acetate/1 ml; Group II received a PRP injection; and in Group III, ESWT was used. Outcome measures included the visual analog scale (VAS), Western Ontario and McMaster Universities (WOMAC) pain score, WOMAC physical function score, and Ritchie articular index (RAI) for tenderness, which were recorded at the baseline, after 1 week, and after 8 weeks.</p><p><strong>Results: </strong>Before the application of procedures, there was a statistically significant increase in the WOMAC pain score in the local corticosteroid group compared to the PRP group and the ESWT group (<i>P</i> < 0.001). After the application of procedures, there was a statistically significant improvement in the 1-week and 8-week WOMAC pain score, WOMAC physical function score, and VAS in the local corticosteroid group in comparison to the PRP group and the ESWT group. (<i>P</i> < 0.001). Moreover, RAI for tenderness shows statistically significant improvement at 8 weeks in the local corticosteroid groups compared to the PRP groups (<i>P</i> < 0.001) and ESWT groups (<i>P</i> < 0.001). Similarly, a statistically significant difference was found between the PRP and ESWT groups (<i>P</i>=0.023).</p><p><strong>Conclusion: </strong>Our data suggest that in patients with PAB, local corticosteroid injection is more efficient than PRP injection and ESWT for reducing pain and enhancing function.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2023 ","pages":"5545520"},"PeriodicalIF":1.3,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10560108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41107096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagined MPFL Reconstruction: Retinacular Fixation of the Doubled Hamstring Graft at the Patella and Suture Anchor-Based Femoral Fixation.","authors":"Muhammed Ehsan Nazeer,&nbsp;Sagar Goel,&nbsp;Muhammed Nazeer,&nbsp;Gowrishankar Sreenivasan,&nbsp;Mohsin Nazeer Muhammed,&nbsp;Suzaan Shajil","doi":"10.1155/2023/6647760","DOIUrl":"https://doi.org/10.1155/2023/6647760","url":null,"abstract":"<p><strong>Background: </strong>Lateral patellar dislocation is frequently observed among teenagers and young adults. There is no consensus on the best type of graft or fixation strategy for the femur and patella, and complications such as iatrogenic patella fracture, tunnel malposition, and grafting failure are common. The objective of our research is to find out the functional outcome of a new method of medial patellofemoral ligament (MPFL) reconstruction, which involves two key components: (1) patellar fixation is accomplished by suturing the two limbs of the looped doubled hamstring graft in a divergent fashion to the retinaculum at the medial border of the upper half of patella and (2) the placement of a suture anchor tied to the graft at the isometric point on the medial femur condyle.</p><p><strong>Methods: </strong>This study is a retrospective assessment of patients who underwent MPFL reconstruction at our hospital between September 2018 and August 2020. Patients were monitored for at least 2 years after the initial procedure until August 2022.</p><p><strong>Results: </strong>A total of 29 patients were recruited for the study, with 22 being females and the average age being 30.38 years. During the postoperative period, none of the participants experienced instability, redislocation, patellar/femoral fractures, or abnormal distal femur growth. The Tegner-Lysholm knee score was good to excellent for 17 (58.6%) participants, fair for 10 (34.5%) participants, and poor for 2 (6.9%) participants. The Kujala anterior knee pain score was more than 80 for 19 (65.5%) participants.</p><p><strong>Conclusion: </strong>This research presents a significant achievement rate of the surgical procedure, accompanied by the mean Tegner-Lysholm knee score of 82.68 and the mean Kujala anterior knee pain score of 82.71. Notably, there were no complications observed in the postoperative period.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2023 ","pages":"6647760"},"PeriodicalIF":1.3,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10513867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41099510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Orthopaedic Shoulder and Elbow Surgeons on a Biostatistical Knowledge Examination.","authors":"Andrew P Collins,&nbsp;Max McCall,&nbsp;Joshua Cassinat,&nbsp;Alison Grise,&nbsp;Jonathan Schwartzman,&nbsp;John Kelly,&nbsp;Benjamin C Service","doi":"10.1155/2023/8840263","DOIUrl":"https://doi.org/10.1155/2023/8840263","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study is to evaluate the biostatistical interpretation abilities of fellowship trained orthopaedic surgeons.</p><p><strong>Methods: </strong>A cross-sectional survey was administered to orthopaedic surgeon members of the American Shoulder and Elbow Surgeons (ASES), assessing orthopaedic surgeon attitudes towards biostatistics, confidence in understanding biostatistics, and ability to interpret biostatistical measures on a multiple-choice test.</p><p><strong>Results: </strong>A 4.5% response rate was achieved with 55 complete survey responses. The mean percent correct was 55.2%. Higher knowledge test scores were associated with younger age and fewer years since board exam completion (<i>p</i> ≤ 0.001). Greater average number of publications per year correlated with superior statistical interpretation (<i>p</i>=0.009). Respondents with higher self-reported confidence were more likely to accurately interpret results (<i>p</i> ≤ 0.017). Of the respondents, 93% reported frequently using statistics to form medical opinions, 98% answered that statistical competency is important in the practice of orthopaedic surgery, and 80% were eager to continue learning biostatistics.</p><p><strong>Conclusions: </strong>It is concerning that fellowship-trained shoulder and elbow surgeons, many of whom frequently publish or are reviewing scientific literature for publication, are scoring 55.2% correctly on average on this biostatistical knowledge examination. Surgeons that are further from formal statistical knowledge training are more likely to have lower biostatistical knowledge test scores. Respondents who published at the highest rate were associated with higher scores. Continuing medical education in biostatistics may be beneficial for maintaining statistical knowledge utilised in the current literature.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2023 ","pages":"8840263"},"PeriodicalIF":1.3,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10506879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes and Practices Surrounding Opioid Prescriptions following Open Reduction Internal Fixation of Distal Radius and Ankle Fractures: A Survey of the Canadian Orthopaedic Association Membership.","authors":"Jihad A Abouali,&nbsp;Evan D Curd,&nbsp;Xin Y Mei,&nbsp;Ujash Sheth,&nbsp;Moin Khan,&nbsp;Darren de Sa,&nbsp;Vehniah K Tjong,&nbsp;Jesleen Rana","doi":"10.1155/2023/9968219","DOIUrl":"10.1155/2023/9968219","url":null,"abstract":"Background The past two decades have seen a significant increase in consequences associated with nonmedical misuse of prescription opioids, such as addiction and unintentional overdose deaths. This study aimed to use an electronic survey to assess attitudes and opioid-prescribing practices of Canadian orthopaedic surgeons and trainees following open reduction internal fixation (ORIF) of distal radius and ankle fractures. This study was the first to assess these factors following ORIF of distal radius and ankle fractures using a survey design. Methods A 40-item survey was developed focusing on four themes: respondent demographics, opioid-prescribing practice, patients with substance use disorders, and drug diversion. The survey was distributed among members of the Canadian Orthopaedic Association. Descriptive statistics were used to summarize respondent demographics and outcomes of interest. A Chi-square test was used to determine if proportion of opioid prescriptions between attending surgeons and surgeons in training was equal. Results 191 surveys were completed. Most respondents prescribed 10–40 tabs of immediate-release opioids, though this number varied considerably. While most respondents believed patients consumed only 40–80% of the prescribed opioids (73.6%), only 28.7% of respondents counselled patients on safe storage/disposal of leftover opioids. 30.5% of respondents felt confident in their knowledge of opioid use and mechanisms of addiction. Most respondents desired further education on topics such as procedure-based opioid-prescribing protocols (74.2%), alternative pain management strategies (69.7%), and mechanisms of opioid addiction (49.0%). Conclusions The principle finding of this study is the lack of a standardized approach to postoperative prescribing in distal radius and ankle fractures, illustrated by the wide range in number of opioids prescribed by Canadian orthopaedic surgeons. Our data suggest a trend towards overprescription among respondents following distal radius and ankle ORIF. Future studies should aim to rationalize interventions targeted at reducing postoperative opioid prescribing for common orthopaedic trauma procedures.","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2023 ","pages":"9968219"},"PeriodicalIF":1.3,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10501842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10339576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the Combination of Platelet-Rich Plasma and Hyaluronic Acid the Best Injective Treatment for Grade II-III Knee Osteoarthritis? A Prospective Study.","authors":"Gianluca Ciapini, Matteo Simonettii, Michele Giuntoli, Giorgio Varchetta, Silvia De Franco, Edoardo Ipponi, Michelangelo Scaglione, Paolo Domenico Parchi","doi":"10.1155/2023/1868943","DOIUrl":"10.1155/2023/1868943","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis is a common disease with increasing incidence and prevalence in western countries. It can cause severe pain and functional limitations, thereby representing a threat for patients' quality of life and a burden for national health systems. Intra-articular injections with hyaluronic acid (HA) and platelet-rich plasma (PRP) have been used for decades in order to reduce the symptoms caused by osteoarthritis. In recent years, a combination of HA and PRP has been introduced in clinical practice with the aim to minimize the clinical presentation of osteoarthritis and potentially delay articular degeneration.</p><p><strong>Materials and methods: </strong>Sixty cases with grade II-III knee osteoarthritis according to the Kellgren-Lawrence classification were included in a prospective study, focused on the evaluation of clinical and functional outcomes after intra-articular knee injections. Cases were randomly divided into three groups. Twenty cases (Group <i>A</i>) were injected with HA, 20 (Group <i>B</i>) had PRP, and the remaining 20 (Group <i>C</i>) received a combination of HA and PRP. Basal WOMAC score and VAS score were recorded before the treatment and repeated within 3 and 6 months after the treatment.</p><p><strong>Results: </strong>At 6-month follow-up, Group <i>C</i> (PRP + HA) was the one with the lowest WOMAC and VAS mean values. It was also the only group that reported a reduction in the two values both in the first three months and in the following three months. No major complication was recorded.</p><p><strong>Conclusion: </strong>The combination of platelet-rich plasma and hyaluronic acid can be effective in the treatment of grade II-III knee osteoarthritis in a short-to-mid-term scenario. It represents an innovative and valuable alternative to the administration of its two components alone.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2023 ","pages":"1868943"},"PeriodicalIF":1.2,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10023227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9146263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Intrathecal Bupivacaine Plus Dextrose 5% and Fentanyl Compared with Bupivacaine Alone on the Onset and Duration of Analgesia in Patients Undergoing Lower-Limb Orthopedic Surgery.","authors":"Amir Sabertanha,&nbsp;Gholam Reza Makhmalbaf,&nbsp;Maryam Bayati,&nbsp;Aram Meshkini","doi":"10.1155/2023/2496557","DOIUrl":"https://doi.org/10.1155/2023/2496557","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare the effect of intrathecal bupivacaine plus dextrose 5% and fentanyl with bupivacaine alone on the onset and duration of analgesia in patients undergoing lower-limb orthopedic surgery.</p><p><strong>Materials and methods: </strong>A total of 40 patients eligible for lower-limb surgery were divided into two groups by simple randomization: the control group which received only bupivacaine and the intervention group which received bupivacaine plus dextrose 5% and fentanyl. Anesthesia was induced by the spinal method. The visual analog scale (VAS) was used to assess the patients' pain; hemodynamic status (systolic and diastolic blood pressure and the heart rate) and oxygen saturation were also monitored.</p><p><strong>Results: </strong>There was a significant difference between groups in the type of lower-limb movement at the L1 anesthesia level, the sensory block level at time zero after surgery, the type of backward movement at time zero after surgery, and the analgesic dose received (<i>p</i> < 0.05). Fifteen and 30 minutes after the start of surgery, mean systolic blood pressure, and 45 and 60 minutes after the start of surgery, systolic and diastolic blood pressure and the heart rate were significantly lower in the control group than in the intervention group (<i>p</i> < 0.05). The VAS score was significantly lower in the intervention group than in the control group at 6 and 24 hours after surgery (<i>p</i> < 0.05). Systolic and diastolic blood pressure at time zero, systolic blood pressure at hour 6, and diastolic blood pressure at hour 24 after surgery were significantly lower in the control group than in the intervention group (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>The mean duration of anesthesia and analgesia was significantly longer in patients receiving bupivacaine plus fentanyl than in those receiving bupivacaine alone. However, concerning hemodynamic parameters, it cannot be concluded that the bupivacaine plus fentanyl receiving group was generally superior to the bupivacaine receiving group.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2023 ","pages":"2496557"},"PeriodicalIF":1.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9943617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9321544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Preoperative Antianxiety Medications on Blood Pressure and Blood Loss in Total Knee Arthroplasty: A Case-Control Study.","authors":"Zuhdi O Elifranji,&nbsp;Jihad M Al-Ajlouni,&nbsp;Munther G Al-Saber,&nbsp;Yazan S Hammad,&nbsp;Basel A Baniatta,&nbsp;Sara N Alshoubaki,&nbsp;Mohammad S Jabaiti,&nbsp;Ahmad M Alkhatib,&nbsp;Abdelrahman M Abu Awad,&nbsp;Abdelrahman E Altarazi,&nbsp;Aseel N Abdin,&nbsp;Abdallah Al-Ani,&nbsp;Mohammad Ali Alshrouf","doi":"10.1155/2023/6355849","DOIUrl":"https://doi.org/10.1155/2023/6355849","url":null,"abstract":"<p><strong>Background: </strong>The increasing number of canceled operations in patients undergoing total knee arthroplasty (TKA) due to high blood pressure readings has put a considerable burden on surgeons. In this study, we aim to assess the effect of giving antianxiety drugs preoperatively on maintaining blood pressure (BP) and blood loss for patients undergoing TKA surgery.</p><p><strong>Methods: </strong>This retrospective case-control study included patients who underwent total knee arthroplasty and divided them into two main groups: those who had taken a 3 mg bromazepam oral tablet at the night preoperatively and the control group. The blood pressure of patients was then measured preoperatively (baseline), in the morning of surgery, in the operating room before anesthesia, and during the surgery. The percentage of measured BP was calculated by dividing the measured BP by the baseline, then multiplying by 100.</p><p><strong>Results: </strong>301 patients were included in our study: 137 received bromazepam and 164 as a control group. The ratio of systolic BP (SBP) in the morning of surgery to the baseline (percentage of morning SBP) decreased significantly in the bromazepam group compared with the controls. The ratio of SBP, in the operating room before anesthesia (percentage of preanesthesia SBP) also decreased significantly in the bromazepam group. However, the percentage of SBP in the middle of surgery did not change significantly. In addition, there was a significant difference change from the baseline in diastolic BP and mean arterial BP between the two groups in the morning of surgery, inside the theatre, and in the middle of the operation. The bromazepam group also showed a significant decrease in blood loss.</p><p><strong>Conclusion: </strong>Preoperative oral antianxiety drugs (bromazepam) helps in controlling hemodynamic changes associated with anxiety, including maintaining BP in well-controlled hypertensive and healthy patients undergoing TKA, and it plays a role in decreasing the total blood loss.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2023 ","pages":"6355849"},"PeriodicalIF":1.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10349676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9825142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}