Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · May 2014
Observational StudyLateralizing epidural catheter placement as evidenced by electrical stimulation.
Epidural steroids are more effective if administered in the anterolateral epidural space. It follows that the ability to administer local anesthetics in the ipsilateral anterolateral epidural space should likewise improve their efficacy for postoperative epidural analgesia. ⋯ Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
-
Clin. Orthop. Relat. Res. · May 2014
Does chondrocalcinosis affect Knee Society scores and range of motion after TKA?
Chondrocalcinosis is manifested by crystalline deposits of calcium commonly found during primary TKA for osteoarthritis. Its frequency among patients undergoing TKA is poorly defined, as is its influence on pain or function after TKA. ⋯ Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
-
Clin. Orthop. Relat. Res. · May 2014
ReviewCan regional anesthesia and analgesia prolong cancer survival after orthopaedic oncologic surgery?
The perioperative period of major oncologic surgery is characterized by immunosuppression, angiogenesis, and an increased load of circulating malignant cells. It is a window period in which cancer cells may seed, invade, and proliferate. Thus, it has been hypothesized that the use of regional anesthesia with the goal of reducing surgical stress and opioid and volatile anesthetic consumption would avoid perioperative immune suppression and angiogenesis and ultimately cancer recurrence. ⋯ Although basic science studies suggest a potential benefit of regional anesthesia and stress response reduction in cancer formation, we found little clinical evidence to support the theory that regional anesthesia and analgesia improve overall patient survival after oncologic surgery.
-
Clin. Orthop. Relat. Res. · May 2014
Randomized Controlled TrialDoes limb preconditioning reduce pain after total knee arthroplasty? A randomized, double-blind study.
Total knee arthroplasty (TKA) can be associated with considerable postoperative pain. Ischemic preconditioning of tissue before inducing procedure-related underperfusion may reduce the postoperative inflammatory response, which further may reduce associated pain. ⋯ Given the ease of this intervention, ischemic preconditioning may be considered as part of a multimodal analgesic strategy. However, more study into the impact of different preconditioning strategies, elucidation of mechanisms, safety profiles, and cost-effectiveness of this maneuver is needed.