The Journal of arthroplasty
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Randomized Controlled Trial
Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty.
This prospective randomized trial compared preoperative autologous blood donation (PAD) with epoetin alfa in patients undergoing primary total knee reconstruction. Fifty adult patients with pretreatment hemoglobin level of 100 to 130 g/L were randomized to either epoetin alfa 40,000 U at preoperative days 14 and 7 or to a standard PAD protocol. Patient characteristics and operative blood loss were similar between groups. ⋯ There was no significant difference in the incidence of allogeneic transfusions between groups (28% for epoetin alfa vs 8% for PAD; P = .1383). Both treatments were generally well tolerated. Epoetin alfa appears to be a safe alternative to PAD in patients who are at risk for transfusion in the perioperative period following total knee arthroplasty.
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Randomized Controlled Trial Comparative Study
Blood rheology in PCA and PCEA after total knee arthroplasty.
The rheological events in 2 groups of patients undergoing total knee arthroplasty were compared--15 patients were given general anesthesia and controlled their postoperative pain applying intravenous patient-controlled analgesia; 17 individuals received combined spinal-epidural anesthesia and controlled their postoperative pain by patient-controlled epidural analgesia (PCEA). Twenty-four and 48 hours after surgery, the patient-controlled analgesia group showed a significant increase in whole-blood viscosity at the 3 shear rates (P < .01), as well as in relative viscosity at both periods (P < .001 and .01, respectively). ⋯ These values were less expressed in the PCEA group, particularly 48 hours after surgery (P < .01), and the patients showed lower scores on the visual analog pain scale. The better results observed in the PCEA group favor the application of epidural anesthesia and PCEA analgesia in patients undergoing total knee arthroplasty.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cryo/Cuff compared to epidural anesthesia after knee unicompartmental arthroplasty: a prospective, randomized and controlled study of 60 patients with a 6-week follow-up.
The aim of this prospective, randomized, and controlled study was to evaluate the efficacy of cold compressive dressings (Cryo/Cuff) and epidural anesthesia (EDA) in the postoperative management of primary unicondylar knee arthroplasty. Sixty patients (61 knees) were randomized into 3 groups. ⋯ There was no significant difference in morphine consumption between the 2 treatment groups. Based on the results of this study, Cryo/Cuff seems to be a rational, effective, risk-free, and well-tolerated alternative to EDA to reduce pain and morphine after unicondylar knee arthroplasty.
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Randomized Controlled Trial Clinical Trial
Reliability of common knee injection sites with low-volume injections.
This study's purpose was to evaluate the reliability of knee injection sites with low-volume (2-3 cc) injection typical of viscosupplementation. This was a prospective study of 131 knees randomly assigned to 3 injection groups before to knee arthroscopy: SM-superomedial, superolateral, and lateral joint line (LJL). ⋯ Injections then were graded at the time of arthroscopy as good, fair, or poor, depending on the intra-articular staining of MB. We conclude that a lateral joint line injection site may not be reliable for routine injections of low volumes into knees, because it results in good intra- articular delivery less than half of the time, with a high incidence of soft-tissue infiltration.
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Randomized Controlled Trial Clinical Trial
Femoral nerve block for total knee arthroplasty patients: a method to control postoperative pain.
This study was designed to determine the effects of a single-injection femoral nerve block (FNB) using 30 mL of 0.5% bupivacaine with epinephrine 1:200,000, on pain control following total knee arthroplasty (TKA). Forty patients were randomly distributed into 2 groups: Group A received general anesthesia plus a FNB (n = 19), whereas Group B received general anesthesia plus a FNB with 30 mL of preservative-free saline (n = 21). The amount of morphine used, sedation, and average pain perception were measured for the first 24 hours and daily postoperatively. ⋯ The average pain perception was significantly different (P =.002). Postoperative management of pain following TKA can be improved through a preoperative single-injection FNB with 0.5% bupivacaine plus epinephrine 1:200,000. The cost is minimal, risks appear acceptable, and the procedure is efficacious.