Orthopedics
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Upper-extremity deep venous thrombosis (DVT) is considered an uncommon clinical event with considerable potential for morbidity. This article presents a case of upper-extremity DVT following a clavicular fracture. A 25-year-old man presented with pain and distortion of the left midclavicular area after falling on his left shoulder during martial arts practice. ⋯ The patient was placed in a sling instead of a figure-of-8 bandage to immobilize the arm, while anticoagulation therapy with enoxaparin was started (1 mg/kg every 12 hours, 80 mg subcutaneous daily for 3 months). The swelling was reduced after 5 days. At 2-week follow-up, the patient had no pain and the swelling had completely disappeared.
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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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Upper-extremity deep venous thrombosis (DVT), although not as common as its lower-extremity counterpart, is a clinical entity with potentially devastating complications. Approximately 1% to 4% of all DVT cases involve the upper extremity, with 9% to 14% of these cases complicated by pulmonary embolism. Prompt diagnosis with duplex ultrasonography and subsequent anticoagulation are the gold standards for identification and treatment. ⋯ After hematology consultation and a short hospitalization, the patient was discharged home on a 3-month course of Warfarin. The goal of treatment of upper-extremity venous thrombosis is to improve the patient's acute symptoms and prevent both pulmonary embolism and post-thrombotic syndrome. Post-thrombotic syndrome is a chronic, potentially debilitating condition that occurs in approximately 15% of upper-extremity DVT cases with symptoms consisting of pain, swelling, paresthesias, and functional limitation.