A new improvement: subperiosteal cocktail application to effectively reduce pain and blood loss after total knee arthroplasty

Observational study of ropivacaine and compound betamethasone mixture for analgesia after triangular fibrocartilage complex repair under wrist arthroscopy: A single-center randomized double-blind controlled trial

BACKGROUND

The purpose of this study was to investigate the clinical effect of an intra-articular and local infiltration injection of a compound analgesic mixture of ropivacaine and compound betamethasone on the repair of the triangular fibrocartilage complex under wrist arthroscopy.

METHODS

This prospective, double-blind, randomized study involved 20 patients with Atzei type 2 or 3 injuries of the triangular fibrocartilage complex who underwent repair under wrist arthroscopy. Patients were divided into two groups (n = 10) according to the systematic random sampling method. The test group was injected with a "cocktail" mixture for pain relief. The control group was injected with normal saline. The visual analog scale (VAS) pain score, pinch force, wrist joint mobility, wrist joint function score (PRWE score), occurrence of adverse reactions and dosage of analgesic drugs were evaluated before and after the operation in the two groups.

RESULTS

The resting pain of the patients in the test group was less severe than that of the control group at 12 h, 24 h and 48 h after the operation (P < 0.05), and the pinch force of the patients in the test group was significantly greater than that of the control group at 1 d, 2 d and 3 d after the operation (P < 0.01). The amount of postoperative analgesics used in the test group was significantly lower than that in the control group (P < 0.01), and the patient satisfaction rate in the test group was higher than that in the control group (P < 0.05). There were no postoperative adverse effects in either group.

CONCLUSION

An intra-articular and local infiltration injection of a "cocktail" analgesic mixture in the repair of triangular fibrocartilage complex under wrist arthroscopy can provide good pain control in the early postoperative period and reduce the amount of postoperative analgesic drugs administered, thus improving clinical safety.

LEVEL OF EVIDENCE

Level II; Randomized Controlled Trial; Treatment Study.

Perioperative multimodal analgesic injection for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion surgery

PURPOSE

This retrospective cohort study compared postoperative as-needed (PRN) opioid consumption pre and postimplementation of a perioperative multimodal analgesic injection composed of ropivacaine, epinephrine, ketorolac, and morphine in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Secondary outcomes include pain score measurements, time to ambulation, length of stay, blood loss, 90-day complication rate, operating room time, nonopioid medication usage, and total inpatient medication cost before and after the initiation of this practice.

METHODS

Consecutive patients weighing ≥ 20 kg who underwent PSF for a primary diagnosis of AIS between January 2017 and December 2020 were included. Data from 2018 were excluded to account for standardization of the practice. Patients treated in 2017 only received PCA. Patients treated in 2019 and 2020 only received the injection. Excluded were patients who had any diagnoses other than AIS, allergies to any of the experimental medications, or who were nonambulatory. Data were analyzed utilizing the two-sample t-test or Chi-squared test as appropriate.

RESULTS

Results of this study show that compared with 47 patients treated postoperatively with patient-controlled analgesia (PCA), 55 patients treated with a multimodal perioperative injection have significantly less consumption of PRN morphine equivalents (0.3 mEq/kg vs. 0.5 mEq/kg; p = 0.02). Furthermore, patients treated with a perioperative injection have significantly higher rates of ambulation on postoperative day 1 compared with those treated with PCA (70.9 vs. 40.4%; p = 0.0023).

CONCLUSION

Administration of a perioperative injection is effective and should be considered in the perioperative protocol in patients undergoing PSF for AIS.

LEVEL OF EVIDENCE

Therapeutic Level III.

Comparison of Blood Loss between Open-Box Prosthesis and Closed-Box Prosthesis after Primary Total Knee Arthroplasty

Objective

To compare the blood loss after procedures of primary unilateral or one‐stage bilateral total knee arthroplasty (TKA) caused by open‐box prosthesis and closed‐box prosthesis.

Methods

This was a retrospective study. Patients undergoing procedures of primary TKA between January 2017 and July 2020 in our institution were assessed for eligibility for this study. Those who were diagnosed with knee osteoarthritis and underwent primary unilateral or one‐stage bilateral TKA by using PFC Sigma PS150 (closed‐box prosthesis) or Vanguard (open‐box prosthesis) knee systems and had complete data of laboratory indexes on postoperative day (POD) 1, POD 3, and POD 5 were the interested population. At last 243 patients were enrolled, among which 88 patients were classified into the unilateral closed‐box group, 66 patients into the unilateral open‐box group, 47 patients into the one‐stage bilateral closed‐box group, and 42 patients into the one‐stage bilateral open‐box group. The perioperative management and operative techniques were almost the same for each patient, except the selection of prosthesis, which was decided according to surgeon's preference. The baseline information, postoperative laboratory indexes tested on POD 1, POD 3, and POD 5 including hemoglobin, hematocrit, platelet, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR), the primary outcome measurements including the maximum decreased value of hemoglobin and the volume of total blood loss, and the secondary outcome measurements including the transfusion rate and the average transfused red blood cell (RBC) units were well compared between the open‐box group and the closed‐box group.

Results

The baseline was comparable between groups, except higher preoperative levels of hemoglobin (134.43 g/L vs 126.51 g/L, P = 0.003) and hematocrit (39.92% vs 37.37%, P = 0.000) observed in the one‐stage bilateral open‐box group. The differences of postoperative coagulation function monitored by TT, PT, APTT, and INR were clinically irrelevant between groups. For patients receiving unilateral TKA, significantly higher value of decreased hemoglobin (26.06 g/L vs 21.05 g/L, P = 0.025) and significantly larger amount of total blood loss (920.34 mL vs 723.19 mL, P = 0.013) were observed in the open‐box group. For patients receiving one‐stage bilateral TKA, the open‐box prosthesis was observed to cause more hemoglobin drop (37.81 g/L vs 32.02 g/L, P = 0.071) and total blood loss (1327.26 mL vs 1177.42 mL, P = 0.247) compared to the closed‐box prosthesis, though the differences were not significant. The transfusion rate and the average transfused RBC units were not significantly different between the open‐box group and the closed‐box group no matte whether the patients were from the unilateral TKA group or from one‐stage bilateral TKA group.

Conclusion

The use of open‐box prosthesis caused more hemoglobin drop and total blood loss than closed‐box prosthesis after primary unilateral or one‐stage bilateral TKA, resulting in comparable transfusion rate and average transfused RBC units between groups.