Orthopedics
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Randomized Controlled Trial
Intra-articular morphine enhances analgesic efficacy of ropivacaine for knee arthroscopy in ambulatory patients.
The aim of this double-blind, randomized control trial was to compare the effectiveness of intra-articular ropivacaine alone or with morphine or ketoprofen for controlling pain after arthroscopic knee surgery. One hundred fifty-six patients scheduled for elective knee arthroscopy were recruited. All patients received general anesthesia and were randomly assigned to 4 groups to receive intra-articular ropivacaine 40 mg (group R), ropivacaine 24 mg plus morphine 8 mg (group R+M), ropivacaine 36 mg plus ketoprofen 100 mg (group R+K), or normal saline (group N/S). ⋯ Patients who received ropivacaine and morphine or normal saline had a higher incidence of nausea and vomiting vs the other groups (P=.001 and P=.036, respectively). The combination of intra-articular ropivacaine and morphine is associated with less pain after knee arthroscopy during early recovery but with a higher incidence of nausea and vomiting. However, the addition of ketoprofen to ropivacaine provides relatively satisfactory pain relief, but with fewer side effects compared to morphine.
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Randomized Controlled Trial Historical Article
The dynamics of proximal femoral nails: a clinical comparison between PFNA and Targon PF.
The objective of this study comparing the proximal femoral nails Targon PF (Aesculap, Tuttlingen, Germany) and Proximal Femoral Nail Antirotation (PFNA; Synthes. Oberdorf, Switzerland) was to observe the complications and postoperative results following pertrochanteric femoral fracture fixation, with special attention devoted to the dynamic properties of both implants under physiological load in vivo. The survey was designed as a randomized, prospective study of 80 patients who had sustained a pertrochanteric femoral fracture (AO type 31. ⋯ Both implants are suited to treat pertrochanteric femoral fractures and display comparable clinical results. The Targon PF demonstrates better dynamic properties than the PFNA under physiological load in vivo. A disadvantage of the Targon PF, however, is the more complicated surgical technique and the longer operative time.
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Randomized Controlled Trial Comparative Study
Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotation and gamma nail 3.
The goal of this study was to compare the results of proximal femoral nail antirotation (PFNA; Synthes, Oberdorf, Switzerland) fixation with those of Gamma nail 3 (GN-3; Stryker, Mahwah, New Jersey) fixation for unstable proximal femoral fractures. A total of 136 unstable trochanteric fractures were divided into 2 treatment groups: 66 patients were treated with the PFNA and 70 were treated with the GN-3. The 2 groups were comparable with regard to demographic variables. ⋯ Shortening of the femoral shaft was 5.30+/-0.36 mm in PFNA group and 5.49+/-0.39 mm in GN-3 group (P=.73). There was no difference in clinical outcome between the PFNA and GN-3 groups, although the PFNA shows some advantages over the GN-3. We consider these 2 methods to be useful in the treatment of unstable proximal femoral fractures.
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Randomized Controlled Trial Comparative Study
Pulmonary gas exchange impairment following tourniquet deflation: a prospective, single-blind clinical trial.
The tourniquet has been considered as a recognized cause of limb ischemia/reperfusion injury in orthopedic surgery resulting in a transient neutrophil, monocyte activation, and enhanced neutrophil transendothelial migration with potential remote tissue injury. This study investigated the effect of unilateral tourniquet application within a safe time limit on pulmonary function and the roles of lipid peroxidation and systemic inflammatory response. Thirty patients undergoing unilateral lower extremity surgery with or without tourniquet were equally divided into a control group with no tourniquet (Group C) and a tourniquet (Group T). ⋯ The results represented no significant changes in Group C with regard to either blood gas variables or levels of circulating mediators, while blood gas variable changes of greater A-aDO(2) and respiratory index and lower PaO2 and a/A ratio were shown at 6 hours following tourniquet deflation. The levels of malondialdehyde, IL-6, and IL-8 were increased over baseline values from 2 to 24 hours following tourniquet deflation in Group T. We concluded that tourniquet application within a safe time limit may cause pulmonary gas exchange impairment several hours after tourniquet deflation, where lipid peroxidation and systemic inflammatory response may be involved.
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Randomized Controlled Trial
The effectiveness of ultrasonography-guided suprascapular nerve block for perishoulder pain.
This study analyzed the effectiveness of suprascapular nerve block under ultrasonographic guidance in patients with perishoulder pain. Patients with perishoulder pain were enrolled in the study and were randomly divided into 2 groups. In the first group of 25 patients (12 men and 13 women), nerve block was applied under ultrasonographic guidance. ⋯ No complications occurred in the study group. In the control group, there were 2 cases of arterial punctures and 3 cases of direct nerve injury with neurological deficit for 2 months. Ultrasonography-guided suprascapular nerve injection is a safe, accurate, and useful procedure compared to the blind technique.