BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there w...BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there was a significant difference in pain scores in patients treated with femoral nerve blocks(FNB)compared with patients treated with the standard analgesia protocol.The secondary objective was to find if there was a significant difference in morbidity between the two groups.AIM To evaluate the effectiveness of ultrasound(US)-guided FNB in managing preoperative pain and reducing morbidity in patients with neck femur fractures compared to the standard analgesia protocol.The study seeks to determine whether FNB offers superior outcomes in terms of pain control,rehospitalization rates,and mortality.METHODS This retrospective cohort study included 1577 patients suffering from neck femur fractures.387 patients were treated with a FNB for pain management upon arrival at the emergency department,the rest were treated with standard analgesia.Pain was assessed from electronic medical records using the visual analogue scale(VAS)pre surgery,12-and 24-hour post-surgery.To determine morbidity and mortality during hospitalizations and 6 months after,it was collected from electronic medical records.RESULTS In a cohort of 1577 patients,those receiving US-guided FNB had significantly lower preoperative VAS pain scores(1.46±2.49 vs 1.82±2.59,P=0.001),reduced rehospitalization rates(0.99±1.96 vs 1.46±2.34,P<0.001),and lower mortality(16%vs 32%,P<0.001)compared to standard analgesia.CONCLUSION US guided FNB is more effective for pain management compared with standard analgesia.This method was also found to significantly reduce the risk of morbidity in those patients.展开更多
<b>Introduction:</b> Regional anaesthesia techniques have been used for perioperative analgesia for hip fractures. The supra-inguinal approach to fascia iliaca block (FIB) can potentially provide superior ...<b>Introduction:</b> Regional anaesthesia techniques have been used for perioperative analgesia for hip fractures. The supra-inguinal approach to fascia iliaca block (FIB) can potentially provide superior analgesia compared to femoral nerve block (FNB) by blocking the obturator and lateral femoral cutaneous nerves. We aimed to evaluate the analgesic effect of single shot FIB and FNB for surgical fixation of hip fractures. <b>Methods:</b> After obtaining ethics approval and written, informed consent, 30 patients undergoing surgical fixation of hip fractures were recruited and randomized into 2 groups. Patients received either a single shot FIB or FNB with 0.5% Ropivacaine 30 mls, and a subarachnoid block. Pain scores were assessed pre-operatively, post-block, in recovery and at 24 hours post-operatively. Time to first analgesic, oxynorm consumption, opioid related side effects and block related complications were assessed at 24 hours. <b>Results:</b> There were no statistically significant difference in post-block pain scores, median (IQR) of 0 (0 - 0) versus 0 (0 - 0) at rest and 3 (2 - 6) versus 5 (2 - 6) on positioning for spinal;and 24 hour pain scores were 0 (0 - 0) versus 0 (0 - 0) at rest and 4 (2 - 5) versus 5 (2 - 6) on movement for FIB and FNB groups respectively. 5 patients from each group required post-operative opioids, post-operative opioids requirement were similar. <b>Conclusions:</b> Though ultrasound guided supra-inguinal FIB was more consistent in blocking the lateral femoral cutaneous nerve then a femoral nerve block, this did not translate to any difference in terms of pain scores, opioid consumption and side effects.展开更多
Objective:To evaluate the effect of ketoprofenphonophoresis and femoral nerve block in knee osteoarthritis.Methods:One hundred and fourteen patients with knee osteoarthritis were randomly divided into two groups.The c...Objective:To evaluate the effect of ketoprofenphonophoresis and femoral nerve block in knee osteoarthritis.Methods:One hundred and fourteen patients with knee osteoarthritis were randomly divided into two groups.The control group consisted of 57 patients who were treated with only ketoprofenphonophoresis.The experimental group consisted of patients were treated with ketoprofenphonophoresis and femoral nerve block.The patients were followed for more than one month.The treatment effect assessed by observing their WOMAC index before and after therapy.Results:All the patients finished the follow-up.Their WOMAC indexes were reduced after therapy and one month after treatment,especially in the experimental group(P<0.05).The effective efficiency of ketoprofenphonophoresis and femoral nerve block were higher than that in the control group after treatment and after one month of follow-up(P<0.05).Conclusion:Compared with only ketoprofenphonophoresis,the combined treatment of ketoprofenphonophoresis and femoral nerve block was more appropriate in knee osteoarthritis.展开更多
BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiqu...BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiquated PSH elements and introduction of new practices.AIM To investigate the transition from femoral nerve blocks(FNB)to adductor canal nerve blocks(ACB)during TKA.METHODS Our 13-month study from June 2016 to 2017 was divided into four periods:a three-month baseline(103 patients),a one-month pilot(47 patients),a three-month implementation and hardwiring period(100 patients),and a six-month evaluation period(185 patients).In total,435 subjects were reviewed.Data within 30 postoperative days were extracted from electronic medical records,such as physical therapy results and administration of oral morphine equivalents(OME).RESULTS Our institution reduced FNB application(64% to 3%)and increased ACB utilization(36% to 97%)at 10 mo.Patients in the ACB group were found to have increased ambulation on the day of surgery(4.1 vs 2.0 m)and lower incidence of falls(0 vs 1%)and buckling(5% vs 27%)compared with FNB patients(P<0.05).While ACB patients(13.9)reported lower OME than FNB patients(15.9),the difference(P=0.087)did not fall below our designated statistical threshold of P value<0.05.CONCLUSION By demonstrating closure of the“knowledge to action gap”within 6 mo,our institution’s findings demonstrate evidence in the value of implementation science.Physician education,technical support,and performance monitoring were deemed key facilitators of our program’s success.Expanded patient populations and additional orthopedic procedures are recommended for future study.展开更多
An unusual case of early dislocation of a mobile bearing posterior stabilized total knee arthroplasty in a 48-year-old Caucasian woman is described. Dislocation occurred one day postoperatively, attributed to a gap mi...An unusual case of early dislocation of a mobile bearing posterior stabilized total knee arthroplasty in a 48-year-old Caucasian woman is described. Dislocation occurred one day postoperatively, attributed to a gap mismatch. Revision surgery reduced posterior dislocation, increased bearing plate thickness and rebalanced ligaments. A second dislocation occurred after revision surgery. The patient’s history was retaken and a hamstring spasm disease identified. A new revision utilized a more constrained design, without perioperative local nerve block. Two years following surgery, no further dislocation had occurred. A numerical musculoskeletal model of the case and implant configuration identified no trend to mobile bearing dislocation when regular muscle forces were applied. Muscle spasm is a risk factor for mobile bearing total knee arthroplasty dislocation, especially with femoral nerve block.展开更多
Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate t...Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group.Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group.Operations were performed under combined spinal and epidural anesthesia.After the operations,0.2％ ropivacaine was given at a speed of 5 ml/h through catheters in all patients.Visual analogue scale （VAS） pain scores at rest and while moving were noted at 4,24,and 48 hours after the operation,and quadriceps strength was also assessed at these time-points.Secondary parameters such as doses of complementary analgesics and side effects were also recorded.Results There were no significant differences between the groups in VAS pain scores at rest or while moving,at 4,24,or 48 hours after the operation （P ＞0.05）.At these time-points,mean quadriceps strengths in the adductor group were 3.0 （2.75-3.0）,3.0 （3.0-4.0）,and 4.0 （3.0-4.0）,respectively,all of which were significantly stronger than the corresponding means in the femoral group,which were 2.0 （2.0-3.0）,2.0 （2.0-3.0）,and 3.0 （2.0-4.0）,respectively （P ＜0.05）.There were no significant differences between the groups in doses of complementary analgesics or side effects （P ＞0.05）.X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.Conclusions Continuous adductor canal block with 0.2％ ropivacaine could be used effectively for analgesia after total knee replacement.Compared with continuous femoral nerve block,this analgesic method has similar analgesic effects and is associated with less weakness of quadriceps muscle.展开更多
文摘BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there was a significant difference in pain scores in patients treated with femoral nerve blocks(FNB)compared with patients treated with the standard analgesia protocol.The secondary objective was to find if there was a significant difference in morbidity between the two groups.AIM To evaluate the effectiveness of ultrasound(US)-guided FNB in managing preoperative pain and reducing morbidity in patients with neck femur fractures compared to the standard analgesia protocol.The study seeks to determine whether FNB offers superior outcomes in terms of pain control,rehospitalization rates,and mortality.METHODS This retrospective cohort study included 1577 patients suffering from neck femur fractures.387 patients were treated with a FNB for pain management upon arrival at the emergency department,the rest were treated with standard analgesia.Pain was assessed from electronic medical records using the visual analogue scale(VAS)pre surgery,12-and 24-hour post-surgery.To determine morbidity and mortality during hospitalizations and 6 months after,it was collected from electronic medical records.RESULTS In a cohort of 1577 patients,those receiving US-guided FNB had significantly lower preoperative VAS pain scores(1.46±2.49 vs 1.82±2.59,P=0.001),reduced rehospitalization rates(0.99±1.96 vs 1.46±2.34,P<0.001),and lower mortality(16%vs 32%,P<0.001)compared to standard analgesia.CONCLUSION US guided FNB is more effective for pain management compared with standard analgesia.This method was also found to significantly reduce the risk of morbidity in those patients.
文摘<b>Introduction:</b> Regional anaesthesia techniques have been used for perioperative analgesia for hip fractures. The supra-inguinal approach to fascia iliaca block (FIB) can potentially provide superior analgesia compared to femoral nerve block (FNB) by blocking the obturator and lateral femoral cutaneous nerves. We aimed to evaluate the analgesic effect of single shot FIB and FNB for surgical fixation of hip fractures. <b>Methods:</b> After obtaining ethics approval and written, informed consent, 30 patients undergoing surgical fixation of hip fractures were recruited and randomized into 2 groups. Patients received either a single shot FIB or FNB with 0.5% Ropivacaine 30 mls, and a subarachnoid block. Pain scores were assessed pre-operatively, post-block, in recovery and at 24 hours post-operatively. Time to first analgesic, oxynorm consumption, opioid related side effects and block related complications were assessed at 24 hours. <b>Results:</b> There were no statistically significant difference in post-block pain scores, median (IQR) of 0 (0 - 0) versus 0 (0 - 0) at rest and 3 (2 - 6) versus 5 (2 - 6) on positioning for spinal;and 24 hour pain scores were 0 (0 - 0) versus 0 (0 - 0) at rest and 4 (2 - 5) versus 5 (2 - 6) on movement for FIB and FNB groups respectively. 5 patients from each group required post-operative opioids, post-operative opioids requirement were similar. <b>Conclusions:</b> Though ultrasound guided supra-inguinal FIB was more consistent in blocking the lateral femoral cutaneous nerve then a femoral nerve block, this did not translate to any difference in terms of pain scores, opioid consumption and side effects.
文摘Objective:To evaluate the effect of ketoprofenphonophoresis and femoral nerve block in knee osteoarthritis.Methods:One hundred and fourteen patients with knee osteoarthritis were randomly divided into two groups.The control group consisted of 57 patients who were treated with only ketoprofenphonophoresis.The experimental group consisted of patients were treated with ketoprofenphonophoresis and femoral nerve block.The patients were followed for more than one month.The treatment effect assessed by observing their WOMAC index before and after therapy.Results:All the patients finished the follow-up.Their WOMAC indexes were reduced after therapy and one month after treatment,especially in the experimental group(P<0.05).The effective efficiency of ketoprofenphonophoresis and femoral nerve block were higher than that in the control group after treatment and after one month of follow-up(P<0.05).Conclusion:Compared with only ketoprofenphonophoresis,the combined treatment of ketoprofenphonophoresis and femoral nerve block was more appropriate in knee osteoarthritis.
文摘BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiquated PSH elements and introduction of new practices.AIM To investigate the transition from femoral nerve blocks(FNB)to adductor canal nerve blocks(ACB)during TKA.METHODS Our 13-month study from June 2016 to 2017 was divided into four periods:a three-month baseline(103 patients),a one-month pilot(47 patients),a three-month implementation and hardwiring period(100 patients),and a six-month evaluation period(185 patients).In total,435 subjects were reviewed.Data within 30 postoperative days were extracted from electronic medical records,such as physical therapy results and administration of oral morphine equivalents(OME).RESULTS Our institution reduced FNB application(64% to 3%)and increased ACB utilization(36% to 97%)at 10 mo.Patients in the ACB group were found to have increased ambulation on the day of surgery(4.1 vs 2.0 m)and lower incidence of falls(0 vs 1%)and buckling(5% vs 27%)compared with FNB patients(P<0.05).While ACB patients(13.9)reported lower OME than FNB patients(15.9),the difference(P=0.087)did not fall below our designated statistical threshold of P value<0.05.CONCLUSION By demonstrating closure of the“knowledge to action gap”within 6 mo,our institution’s findings demonstrate evidence in the value of implementation science.Physician education,technical support,and performance monitoring were deemed key facilitators of our program’s success.Expanded patient populations and additional orthopedic procedures are recommended for future study.
文摘An unusual case of early dislocation of a mobile bearing posterior stabilized total knee arthroplasty in a 48-year-old Caucasian woman is described. Dislocation occurred one day postoperatively, attributed to a gap mismatch. Revision surgery reduced posterior dislocation, increased bearing plate thickness and rebalanced ligaments. A second dislocation occurred after revision surgery. The patient’s history was retaken and a hamstring spasm disease identified. A new revision utilized a more constrained design, without perioperative local nerve block. Two years following surgery, no further dislocation had occurred. A numerical musculoskeletal model of the case and implant configuration identified no trend to mobile bearing dislocation when regular muscle forces were applied. Muscle spasm is a risk factor for mobile bearing total knee arthroplasty dislocation, especially with femoral nerve block.
文摘Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group.Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group.Operations were performed under combined spinal and epidural anesthesia.After the operations,0.2％ ropivacaine was given at a speed of 5 ml/h through catheters in all patients.Visual analogue scale （VAS） pain scores at rest and while moving were noted at 4,24,and 48 hours after the operation,and quadriceps strength was also assessed at these time-points.Secondary parameters such as doses of complementary analgesics and side effects were also recorded.Results There were no significant differences between the groups in VAS pain scores at rest or while moving,at 4,24,or 48 hours after the operation （P ＞0.05）.At these time-points,mean quadriceps strengths in the adductor group were 3.0 （2.75-3.0）,3.0 （3.0-4.0）,and 4.0 （3.0-4.0）,respectively,all of which were significantly stronger than the corresponding means in the femoral group,which were 2.0 （2.0-3.0）,2.0 （2.0-3.0）,and 3.0 （2.0-4.0）,respectively （P ＜0.05）.There were no significant differences between the groups in doses of complementary analgesics or side effects （P ＞0.05）.X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.Conclusions Continuous adductor canal block with 0.2％ ropivacaine could be used effectively for analgesia after total knee replacement.Compared with continuous femoral nerve block,this analgesic method has similar analgesic effects and is associated with less weakness of quadriceps muscle.
