The Journal of arthroplasty
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Randomized Controlled Trial
Surgeon delivered psoas compartment block in total hip arthroplasty.
Total hip arthroplasty is associated with significant postoperative pain. A psoas compartment block is superior to other regional techniques in analgesia post THA. However, traditional methods of delivery are associated with serious complications. ⋯ There were no adverse effects. We have demonstrated the analgesic efficacy of Psoas Compartment Block performed during surgical access for total hip arthroplasty. This technique should be considered in the analgesic regimen for total hip arthroplasty.
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Randomized Controlled Trial Comparative Study
Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty.
Benefits of a direct anterior approach (DAA) versus a posterior-lateral (PA) approach to THA were assessed in a single-surgeon, IRB-approved, prospective, randomized clinical study. Subjects (43 DAA and 44 PA) were evaluated at 6 weeks, and 3, 6 and 12 months. The primary end point was ability to climb stairs normally and walk unlimited at each time point. ⋯ DAA subjects performed better during the immediate post-operative period; they had lower VAS pain scores on the first post-operative day, more subjects climbing stairs normally and walking unlimited at 6 weeks, and higher HOOS Symptoms scores at 3 months. There were no significant differences between groups at later time points. Findings confirm previous reports of benefits of DAA versus PA in early post-operative phases.
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Randomized Controlled Trial
Dexamethasone reduces length of hospitalization and improves postoperative pain and nausea after total joint arthroplasty: a prospective, randomized controlled trial.
Controlling postoperative pain and nausea after total joint arthroplasty remains an important challenge. We conducted a prospective, randomized controlled trial with 120 patients to determine if the addition of perioperative dexamethasone to a multimodal regimen improves antiemetic and analgesic control, enhances mobility, and shortens hospital length of stay after total hip and knee arthroplasty. ⋯ A second, 24-hour postoperative dose of 10mg intravenous dexamethasone provided significant additional pain and nausea control and further reduced length of stay (P<0.05). No adverse events were detected with the administration of the intraoperative and/or postoperative dexamethasone.
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Randomized Controlled Trial
Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection in total knee arthroplasty: a randomized, double-blinded study.
Pain control is necessary for successful rehabilitation and outcome after total knee arthroplasty. Our goal was to compare the clinical efficacy of periarticular injections consisting of a long-acting local anesthetic (ropivacaine) and epinephrine with and without combinations of an α2-adrenergic agonist (clonidine) and/or a nonsteroidal anti-inflammatory agent (ketorolac). ⋯ Compared with Group D, Group A and B patients had significantly lower postoperative visual analog pain scores and nurse pain assessment and Group C patients had a significantly greater reduction in physical therapist pain assessment. We found no differences in other parameters analyzed.
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Randomized Controlled Trial
Use of bovine thrombin to reduce blood loss in primary total knee arthroplasty: a controlled randomized trial.
Reducing blood loss during primary total knee arthroplasty (TKA) can improve outcomes by reducing transfusion requirements and wound complications. We examined the use of bovine thrombin to augment hemostasis during primary TKA. A double-blinded randomized trial was performed with 80 primary TKA patients. ⋯ Hemoglobin levels in the study group did decline less than the control group, but no statistically significant difference was found in rates of transfusion, drain outputs, length of stay, or Knee Society scores. This agent does appear to slightly reduce blood loss, but routine use is not cost effective. Thrombin may be considered for patients who would benefit more from greater blood conservation.