Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
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Comparative Study
Comparison of ketorolac and opioid analgesics in postoperative ACL reconstruction outpatient pain control.
Pain control is an important postoperative consideration with any surgical procedure. Technological and procedural improvements have contributed to the reduction in both the degree of surgical difficulty and the postsurgical complications associated with intricate surgeries. As a result, certain surgeries have potential for being performed on an outpatient basis, dependent upon appropriate pain-management regimens and the degree of potential for postoperative complications. ⋯ The purpose of this study was to determine the efficacy of a ketorolac tromethamine used for the management of the postoperative pain produced as a result of outpatient ACL reconstruction. When the ketorolac pain management regimen is compared in this setting with meperidine or morphine, pain control is as good as, or in some cases better than, either of the opioid drugs. Additionally, the adverse side effects associated with opioid drugs are significantly reduced at a substantially lower direct cost to the patient.
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Irreducible knee dislocation is a rare effection of the knee joint; only 23 cases have been reported in the literature. This is a case report of a 35-year-old man who injured his left knee in a motorcycle accident. Dislocation was documented on radiograph. ⋯ Eventually, the patient had open reduction of the dislocation. An arthroscopy view of the dislocation showed that the medial femoral condyle was buttonholed through the anteromedial capsule and retinaculum. Arthroscopy was an excellent tool for partial lateral meniscectomy and planning the open surgical procedure.
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Sixty-five patients underwent magnetic resonance (MR) shoulder arthrography. Forty-eight of these patients underwent examination under anesthesia (EUA). MR images were retrospectively evaluated for signs felt to be imaging indicators of shoulder instability, including evaluation of various capsular measurements and the presence of glenoid labral tears, as well as Hill-Sachs fractures. ⋯ However, there was a statistically significant correlation between the presence of a Bankart cartilaginous deformity (p = 0.000) and Hill-Sachs fractures (p = 0.022) with EUA-documented instability. Sensitivity to labral tears was 89% and specificity was 98%, whereas Hill-Sachs fracture detection was 69% and 87%, respectively. We believe that MR saline arthrography is of benefit in the evaluation of the anterior labrum when unenhanced MR imaging is inconclusive, and we speculate on the role of MR arthrography as a primary investigative tool.
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Comparative Study
A comparison of patient-controlled analgesia and continuous lumbar plexus block after anterior cruciate ligament reconstruction.
Anterior cruciate ligament (ACL) reconstruction is often a painful operation. Fifty-eight patients who underwent ACL reconstruction using patellar tendon autograft received either a lumbar plexus block (LPB) or patient-controlled analgesia (PCA) for pain relief during the first 24 h after surgery. ⋯ The common narcotic analgesic side effects of nausea, pruritus, sedation, and urinary retention were significantly less in the LPB group. The LPB is a safe and effective alternative analgesia after ACL reconstruction.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain relief after arthroscopic surgery of the knee: a prospective, randomized, and blinded assessment of bupivacaine and bupivacaine with adrenaline.
A prospective, randomized, and double-blind study was conducted to compare the influence on postoperative pain of equal volumes of saline, bupivacaine, or bupivacaine with adrenaline, injected both intraarticularly and into the wound puncture site, for 118 day case patients undergoing elective knee arthroscopy. Marginal analyses of postoperative visual analogue pain scores and postoperative fentanyl doses showed that the group given bupivacaine with adrenaline had less postoperative pain when compared with the saline group. However, when multifactor analyses were performed, preoperative visual analogue pain scores, operation type and length, and the sex of the patient were all shown to be significant predictors of postoperative pain, but the use of bupivacaine was not. We conclude that the observed differences in postoperative pain were due to differences between the groups in these predictive factors, especially preoperative pain scores, and that the use of bupivacaine was less important and not statistically significant in influencing postoperative pain.