Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · May 2014
Randomized Controlled Trial Comparative StudyIntraarticular analgesia versus epidural plus femoral nerve block after TKA: a randomized, double-blind trial.
Pain management after TKA remains challenging and the efficacy of continuously infused intraarticular anesthetics remains a controversial topic. ⋯ Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
-
Clin. Orthop. Relat. Res. · May 2014
Randomized Controlled Trial Comparative StudySingle-injection or continuous femoral nerve block for total knee arthroplasty?
The ideal local anesthetic regime for femoral nerve block that balances analgesia with mobility after total knee arthroplasty (TKA) remains undefined. ⋯ Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
-
Clin. Orthop. Relat. Res. · May 2014
Randomized Controlled Trial Comparative StudyIs L2 paravertebral block comparable to lumbar plexus block for postoperative analgesia after total hip arthroplasty?
Continuous lumbar plexus block (LPB) is a well-accepted technique for regional analgesia after THA. However, many patients experience considerable quadriceps motor weakness with this technique, thus impairing their ability to achieve their physical therapy goals. ⋯ Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
-
Clin. Orthop. Relat. Res. · May 2014
ReviewThe influence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty: a systematic review.
Despite the overall success of total joint arthroplasty, patients undergoing this procedure remain susceptible to cognitive decline and/or delirium, collectively termed postoperative cognitive dysfunction. However, no consensus exists as to whether general or regional anesthesia results in a lower likelihood that a patient may experience this complication, and controversy surrounds the role of pain management strategies to minimize the incidence of postoperative cognitive dysfunction. ⋯ Both anesthetic and pain management strategies appear to influence the risk of early cognitive dysfunction after elective joint arthroplasty, although only one study identified differences that persisted beyond 1 week after surgery. Investigators should strive to use accepted, validated tools for the assessment of postoperative cognitive dysfunction and to carefully report details of the anesthetic and analgesic techniques used in future studies.
-
Clin. Orthop. Relat. Res. · May 2014
Review Case ReportsPulmonary cement embolization after vertebroplasty requiring pulmonary wedge resection.
Pulmonary cement embolization after vertebroplasty is a well-known complication but typically presents with minimal respiratory symptoms. Although this rare complication has been reported, the current literature does not address the need for awareness of symptoms of potentially devastating respiratory compromise. ⋯ Pulmonary cement embolism is a potentially serious complication of vertebroplasty. If a patient has chest pain or respiratory difficulty after the procedure, chest radiography and possibly advanced chest imaging studies should be performed immediately.