Blunt Needle Research Articles

Abstract: Eyebrows Elevation – a New, Easy and Cheap Trick

INTRODUCTION: Redeeming a technique published in 1967 by Dr. René Guillemain, “the Curl lift”, we find a very easy and a long-lasting result procedure to elevate the eyebrows, in a fast resolution ambulatory intervention. PURPOSE: The “Curl lifting” technique for eyebrows elevation consists in soft tissues elevation using smooth threads tied up in the level of the hairline. The threads are inserted under the skin, in two different surgical plans in order to avoid the “undermining effect” when the threads are tied up. METHODS: In all cases, local infiltrative anesthesia is used. A 15’ blade scalpel is used to stab the skin in each corner of the preliminarily marked square contour. Then, a blunt Reverdin needle is inserted through the external superior orifice in a deep plan, until it goes out across the external inferior orifice and pick up the smooth thread. Then the needle returns bringing the thread. After this the needle is inserted, again, through the internal inferior orifice, in a superficial sub-dermal plan until goes out across the external inferior orifice and pick up again the smooth thread. Then these maneuvers are repeated till the square is completed and the thread’s ends are tied up, cut and buried under the skin, using a delicate hook. The last step is a bandage with Micropore at the forehead, for three days, to immobilize the region. RESULTS: The routine operation is easy and quick to perform with a very short learning curve. The obtained outcome proves to remain for a long time. We are using the Curl-lifting technique for eyebrows elevation, above described, since May 2003, in more than 800 patients from 35 to 82 years (average of 58,5 years). CONCLUSION: The “Curl” lifting technique using smooth threads for eyebrows elevation is one more excellent tool in the therapeutic arsenal of ancillary procedures for the correction of facial aging. This is a minimal invasive ambulatory procedure which has as main advantages no visible scars and a short learning curve. This technique has the advantage of no visible scars, like the Castañares technique and the forehead lifting, easy equilibration of both sides which is difficult with Aptos threads, has a very short learning curve and is a low-cost procedure, the opposite of the endoscopic techniques.

What are we injecting with our drugs?

In preparation for a case, an anaesthetist opened a 20 ml glass vial of propofol and aspirated the propofol into a syringe via a blunt drawing-up needle. Increased resistance was felt with aspiration. On inspection, a shard of glass was found at the tip of the drawing-up needle. The shard was presumed to be from the propofol ampoule, and to have fallen into the solution upon snapping open its glass tip. This illustrative case raises the issue of contamination of drugs by particles introduced during the drawing-up process. It also highlights the possibility that during the drawing-up process, intravenous drugs may become contaminated not just with particles, but with microorganisms on the surface of the particles. In this article, we discuss relevant recent research of the implications of this type of drug contamination. We draw attention to the need for meticulous care in drawing up and administering intravenous drugs during anaesthesia, particularly propofol.

Subpial Adeno-associated Virus 9 (AAV9) Vector Delivery in Adult Mice.

The successful development of a subpial adeno-associated virus 9 (AAV9) vector delivery technique in adult rats and pigs has been reported on previously. Using subpially-placed polyethylene catheters (PE-10 or PE-5) for AAV9 delivery, potent transgene expression through the spinal parenchyma (white and gray matter) in subpially-injected spinal segments has been demonstrated. Because of the wide range of transgenic mouse models of neurodegenerative diseases, there is a strong desire for the development of a potent central nervous system (CNS)-targeted vector delivery technique in adult mice. Accordingly, the present study describes the development of a spinal subpial vector delivery device and technique to permit safe and effective spinal AAV9 delivery in adult C57BL/6J mice. In spinally immobilized and anesthetized mice, the pia mater (cervical 1 and lumbar 1-2 spinal segmental level) was incised with a sharp 34 G needle using an XYZ manipulator. A second XYZ manipulator was then used to advance a blunt 36G needle into the lumbar and/or cervical subpial space. The AAV9 vector (3-5 µL; 1.2 x 1013 genome copies (gc)) encoding green fluorescent protein (GFP) was then injected subpially. After injections, neurological function (motor and sensory) was assessed periodically, and animals were perfusion-fixed 14 days after AAV9 delivery with 4% paraformaldehyde. Analysis of horizontal or transverse spinal cord sections showed transgene expression throughout the entire spinal cord, in both gray and white matter. In addition, intense retrogradely-mediated GFP expression was seen in the descending motor axons and neurons in the motor cortex, nucleus ruber, and formatio reticularis. No neurological dysfunction was noted in any animals. These data show that the subpial vector delivery technique can successfully be used in adult mice, without causing procedure-related spinal cord injury, and is associated with highly potent transgene expression throughout the spinal neuraxis.

Use of Looped Monofilament Instead of Braided Suture in Orthopedic Fascial Closure

The established method of closing fascia lata is with braided continuous sutures (eg, No. 1-Vicryl). The distal extent of the fascial incision often undermines the skin incision, hindering placement of the fascial anchoring knot. An assistant may be required for forceful retraction. Looped monofilament (eg, No. 1-PDS), with a blunt needle, allows easier fascial closure. One bite is taken through both sides of the fascia before passing the needle through the preformed loop, thus completing the anchoring stitch. No assistant is needed. Monofilament is cheap, readily available, may reduce infection and tissue reaction, and maintains tensile strength for longer than braided sutures.

Stress and Insufficient Nutrition Program Abnormal Growth of the Embryo

Stress and insufficient nutrition in fetal life impose a risk of low birth weight (LBW) and increased vulnerability for chronic childhood and adult diseases. Using a unique avian embryo model, we reported previously that impaired nutrition caused LBW and, after maturation, a low number of nephrons and glomerular mesangium lesions partly resembling nephrosclerosis. In the present study, we determined in Japanese quail, Coturnix japonica, whether the stress imposed on the embryo during the early period of development induces structural defect, whereas insufficient nutrition causes impaired growth and maturation. We also examined whether α‐smooth muscle actin (α‐SMA) may serve as an injury/inflammation marker in glomerular mesangium. We found: 1) At embryonic day 8–9 (E8–9), 45.1% (n = 31) of embryos derived from eggs in which 10% of the egg‐white was withdrawn (EwW) before the start of incubation showed abnormal growth, malformation, and/or early death. At E15–16 (hatch, E17) the rate of abnormal growth/structure was lower (26.4%, n = 34). 2) The weight of the EwW embryos that showed good growth (0.74 ± 0.03 g, n = 8) was not significantly different from that of controls (CT, 0.79 ± 0.02 g, n = 14) at E8–E9, but it was lower (P < 0.01) at E16 (CT, 5.9 ± 0.2 g, n = 13; EwW, 5.2 ± 0.1 g, n = 14). 3) α‐SMA signals were present in renal arteries and arterioles, glomerular mesangium, and peritubular capillaries of embryonic kidneys. α‐SMA signals were stronger in EwW groups both in E16 embryos and in hatched quail. These results suggest that partial withdrawal of egg‐white (92% is protein) before incubation induces structural defect, possibly due to mechanical stress of egg‐white withdrawal (gentle suction via G18 blunt needle), whereas the effect of low nutrition was more obvious in the later embryonic period. α‐SMA in glomerular mesangium may serve as an injury‐inflammation marker in quail kidneys.

Establishment of mouse endometrial injury model by curettage or coagulation

Objective: To establish mouse endometrial injury model by curettage or coagulation. Methods: Female ICR mice were randomly allocated into 2 groups: in curettage group, a blunt 20G needle was inserted in one uterine horn with 0.05 megapascals negative pressure; in coagulation group, one uterine horn was coagulated using a monopolar electric needle with 0.5 watts power. In both groups the contra-lateral uterine horn was used as control. The morphological changes and thickness of endometrium were evaluated 1 week after operation. The endometrial samples were taken on d4 of pregnancy, and the expressions of endometrial receptivity-related cytokines were examined. The number of implanted embryos on each side of uterus was calculated on d10 of pregnancy. Results: There was no difference in operation time between 2 groups. In both groups, the endometrial glands and stroma were significantly reduced, and the endometrial thickness was also significantly decreased on injury side compared to contra-lateral horn. However, local injury was more severe in coagulation group, uterine obliteration and hydrops were developed in 2 mice of coagulation group, and none in curettage group. The expressions of leukemia inhibitory factor (LIF) and oncostatin M (OSM) were significantly reduced on injured side in both groups compared to opposite side; however, the expression of LIF and OSM in curettage group was higher than that in coagulation group. The numbers of implanted embryos were decreased in both groups on injured side compared to opposite side, and fetal death was only observed in coagulation group. Conclusion: Both curettage and coagulation can make injury on mouse endometrium, impair endometrial receptivity and reduce fertility. Curettage can cause moderate injury, and coagulation may lead to more severe injury.

Needlestick Injuries, Glove Perforation and Round‐Tipped Blunt Needles

Needlestick Injuries, Glove Perforation and Round‐Tipped Blunt Needles

Occurrence of Bruise, Hematoma, and Pain in Upper Blepharoplasty Using Blunt-Needle vs Sharp-Needle Anesthetic Injection in Upper Blepharoplasty: A Randomized Clinical Trial.

Though it has been a common practice to use sharp needles to administer local anesthesia for upper blepharoplasty, the evidence for their benefit is lacking. To evaluate whether there is any benefit of using blunt-needle injection for local anesthesia when performing upper blepharoplasty to reduce postoperative bruise, hematoma, and pain. Randomized clinical trial of 44 patients who underwent bilateral upper blepharoplasty in an academic medical setting were randomized to receive local anesthesia injections (lidocaine, 2%; 27-gauge needle) with a blunt needle in one eyelid and a sharp needle in the other eyelid. Visual analog scale (VAS) score of 0 to 10 (lower score indicating lower level of pain) was used to blindly assess pain in patients receiving anesthesia injections with both needle types. After injection and skin incision, photographs of the eyelids of each patient were taken and used by 2 blinded observers to identify bruise or hematoma. In the 44 patients (88 eyelids) included in the study (all women; mean age, 31 years; age range, 18-56 years) bruise or hematoma occurred at the sharp-needle injection site in 11 women (25%) vs 0 women at the blunt-needle site (P < .001). The mean VAS scores were 5.48 and 4.64 for pain assessed at sites of sharp- and blunt-needle injections, respectively (P = .002). Use of blunt needles to administer local anesthesia when performing upper blepharoplasty is less likely to cause hemorrhage and require interventional pain procedures than use of sharp needles. Therefore, for a more accurate surgical procedure and faster recovery, a blunt needle may be a preferable choice. The use of the blunt needle presents fewer complications and allows more accurate and refined work with faster patient recovery. 1. Chinese Clinical Trial Registry identifier: ChiCTR-ONC-16007979.

Clinical efficacy of fine fat grafting of the body on facial rejuvenation

Objective To investigate how to improve the survival rate, and to avoid the serious complications in fat grafting. Methods Under comprehensive design of facial filling area, the fat was harvested by concentration in mesh; under the micro autologous fat transplantation gun with blunt needle injection technique, the fat was filled into the face to achieve the effect of improving the facial contour and the rejuvenation. From June 2014 to July 2015, 78 patients with facial contour and facial soft tissue relaxation depression were treatment by the technique. Results The follow-up of 2 months to 1 year showed that 64 patients had the soft, young, significantly enhanced facial contour; 7 patients had second times grafts and the remaining were satisfied. 7 patients gave up the second times grafts because the other reasons. The surgical complications such as facial nerve injury and infection and embolism were not seen. Conclusions This technique by comprehensive design and purification of autogenous fat granules achieves a better effect on facial rejuvenation with fewer complications. Key words: Facial contour; Fat transplantation, autologous; Facial supporting ligaments

Comparison of infracondylar versus subsartorial approach to saphenous nerve block: A randomized controlled study.

Background and Objectives:Only a few different approaches are currently utilized for saphenous nerve block. Our study aimed to compare two different ultrasound (US)-guided saphenous nerve blocks and designed this study to test the hypothesis that the medial infracondylar approach has more success rate than the subsartorial approach applied in saphenous nerve blockage.Methods:The study included 76 patients (18–65 years old) with the American Society of Anesthesiologists physical status of I–III, who were scheduled for below-knee surgery by the orthopedics clinic. The patients who underwent US-guided saphenous nerve blockade were randomly divided into two groups: Group S (subsartorial approach) and Group M (medial infracondylar approach). For all patients who had a block procedure, the pinprick test was performed using a blunt needle on the saphenous nerve dermatome. Success rate, time of block performance (TBP), onset time of block (OTB), and duration of sensory blockade (DSB) were recorded using a patient follow-up form.Results:The US-guided saphenous nerve block success rate was similar (88% vs. 91%) or both techniques. The DSB values were 415.2 ± 65.3 min (95% confidence interval [CI]: 286.3–539.8) for Group S and 369.7 ± 52.2 min (95% CI: 265.6–467.8) for Group M (P = 0.04), and no significant differences in the TBP and OTB were observed between the groups.Conclusion:Both of the different anatomical approaches have equally high success rates. Although the DSB was found to be significantly longer in the subsartorial approach, this is clinically unimportant, and the medial infracondylar approach is still a viable alternative technique during saphenous nerve blockage.

Reduction of needlestick injuries in obstetrics and gynecology trainees and attendings through introduction of blunt needles on labor and delivery unit

Reduction of needlestick injuries in obstetrics and gynecology trainees and attendings through introduction of blunt needles on labor and delivery unit

Stellate block using blunted needle as an OPD procedure in the symptomatic management of cervicobrachial neuralgia

Background: Cervicobrachial neuralgia is a very common symptom of patients attending orthopaedics OPD. There are multitude of causes and some of them are life threatening. These patients are usually treated by Tricyclic ante depressants and similar drugs. Stellate ganglion block is a proven technique for the management of sympathetic mediated pain as is the case with most of these cervicobrachial neuralgias Materials & Methods: The study was done in Govt. TD Medical College, Alleppey, Kerala, India between a period of 2015 July and 2016 august for Adults with cervicobrachial neuralgia both acute and chronic evaluated clinically and radiologically to rule out malignancies and mechanical severe root compression. Total number of patients included in the study were 35 of which 10 were males and 25 were females. Three sessions of stellate block is performed in patients at biweekly intervals using 10ml 1% lignocaine with adrenaline. They were followed up at 1month 3 months 6 months and 1 year using VISUAL ANALOUGE SCALE. Results: All petients were followed up for 1 year after 3 sessions of biweekly stellate block using blunted needle at 1 month 3 months 6 months and 1 year intervals. The outcomes were measured using Visual Analouge scale. At I year follow up 32 out of 35 patients had good results (VAS 0). 3 patients had fair results (VAS 1) Conclusions: Among the options for the management of Cervicobrachial neuralgia stellate ganglion block is very effective and well documented method. When compared to stallate block, medical management using tricyclic antidepressants and similar drugs cause significant adverse reactions at therapeutic dosage. Stellate block using a blunted needle is a very safe method and nullifies the complications

Effect of Cassave leaf flavonoid extract on TNF-&amp;#945; expressions in rat models suffering from periodontitis

Background: Bacteria playing a role in periodontitis are Gram-negative anaerobic bacteria that can release endotoxin or lipopolysaccharide (LPS). LPS acts as a stimulus to a variety of host cells that can stimulate expression of pro-inflammatory cytokines in periodontal disease, such as IL-1α, IL-1β, and TNF-α. Increased TNF-α then can lead to periodontal tissue destruction. Furthermore, cassava leaves have many health benefits due to flavonoid organic compound contained, known to possess anti-inflammatory activity are used as a medicine. Purpose: This study aimed to determine the effect of cassava leaf flavonoid extract as a basic ingredient of anti-inflammatory gel on TNF-α expression in Wistar rats suffering from periodontitis induced with Escherichia coli (E. coli) LPS. Method: This study used 24 male Wistar rats. Those rats were divided into six groups. Group 1 consisted of four rats induced with E. coli LPS for 2 weeks, and then decapitation was performed on day 3. Group 2 consisted of four rats induced with E. coli LPS for 2 weeks, and then decapitation was conducted on day 7. Group 3 consisted of four rats induced with E. coli LPS for 2 weeks, treated with the topical cassava leaf flavonoid extract gel (Manihot esculenta) at a concentration of 25%, and then decapitation was performed on day 3. Group 4 consisted of four rats induced with E. coli LPS for 2 weeks, treated with the topical cassava leaf flavonoid extract gel (Manihot esculenta) at a concentration of 25%, and then decapitation was conducted on day 7. Group 5 consisted of four rats induced with E. coli LPS for 2 weeks, treated with the topical cassava leaf flavonoid extract gel (Manihot esculenta) at a concentration of 50%, and then decapitation was performed on day 3. And, group 6 consisted of four rats induced with E. coli LPS for 2 weeks, treated with the topical Cassava leaf flavonoid extract gel (Manihot esculenta) at a concentration of 50%, and then decapitation was conducted on day 7. The topical Cassava leaf flavonoid extract gel was inserted into gingival sulcus on the first right molar of their lower jaw by using a blunted syringe needle. The gel was given two times a day for 7 days. Result: The expression of TNF-α in the control group was more than that in the treatment groups given the Cassava leaf flavonoid extract gel at the concentrations of 25% and 50%. The expression of TNF-α in the treatment groups given the cassava leaf flavonoid extract gel at the concentration of 50% was lower than that in the treatment groups given the cassava leaf flavonoid extract gel at the concentration of 25%. Conclusion: Cassava leaf flavonoid extract gel could be used as an anti-inflammatory gel characterized by a decrease in TNF-α expression in rat models suffering from periodontitis.

A Modified Technique with a New Device of Laparoscopic Percutaneous Extraperitoneal Closure for Pediatric Inguinal Hernia.

Laparoscopic percutaneous extraperitoneal closure (LPEC) in boys is more complex than in girls, because the vas deferens and testicular vessels must be separated from the peritoneum. We therefore developed a needle-shaped surgical instrument that enables blunt separation. Here, we report the effectiveness of this new device. The new device is a ligature carrier consisting of (1) an inner tube (19-G blunt needle) through which slides a rod with a loop wire at its tip that can catch and release suture materials and (2) an outer tube (17-G needle) with a cutting edge. The blunt-structured inner tube enables blunt separation. All actions (stabbing, separation, and catching) in the LPEC procedure that are required to close the hernia orifice using a thread are facilitated through a simple small incision by switching between the inner and outer tubes. From January 2013 to September 2015, 73 boys with inguinal hernia or hydrocele underwent LPEC, and the new device was used in 45 of these cases. We compared surgical results between cases wherein the new (group A) and conventional devices (LPEC needle; group B) were used. The mean surgery duration was 33.4 and 34.8 min for groups A and B, respectively. Neither group experienced complications during or after surgery. Our findings suggest that the newly developed needle device may improve the safety of the LPEC procedure for boys, although further investigation involving more cases and long-term follow-up is needed in the future.

English

AIMS AND OBJECTIVES: 1. To assess the site of obstruction of lacrimal passage. 2. To aid in the diagnosis and management of lacrimal passage pathology. 3. To reveal the anatomy of passage and the changes due to disease. 4. To aid in the diagnosis of diverticula, fistulae and filling defects caused by stones or tumours. STUDY DESIGN: Prospective Observational Study.This study is to be conducted among 40 patients with Chronic Dacryocystitis attending our department as outpatient as well as inpatient the wards of our Govt. Rajaji Hospital, Madurai. A total of 40 patients attending as outpatient and in the wards of the Department of Ophthalmology, Govt. Rajaji Hospital, Madurai who satisfy the inclusion criteria. STUDY PERIOD: 6 Months (April 2014 to September 2014). INCLUSION CRITERIA: 1. Patients diagnosed with chronic dacryocystitis. 2. Recurrence of disease after surgery (Dacryocystectomy) 3. Age > 12 years & < 70 years. EXCLUSION CRITERIA: 1. Pregnant Patients. 2. Patients not consenting for the study. 3. Hypertensive with BP > than 140 / 90 mm of Hg. 4. Age 70 5. Immunocompromised patients. 6. History of anaphylaxis. 7. Allergy to contrast drugs. Preliminary ocular examination done to detect swelling in lacrimal sac area/ fistula, With Slit-lamp careful examination of patient’s eyelids and then the lacrimal puncta are noticed. Then syringing performed with a 5-mL syringe and an irrigating cannula / 26-gauge blunt needle to flush saline via lower punctum which reveals complete/partial block involving the nasolacrimal duct / the lacrimal sac / atonic sac/fistula/residual sac. After verbal consent from the patient, using standardized techniques dacryocystogram performed under topical anesthesia. Initial dacryocystogram was more reliable in demonstrating the anatomy of lacrimal passage and identifying the level, type of block, morphology of lacrimal sac ,associated findings and also etiological factor for epiphora can be diagnosed based on it. Hence enabling us to meticulously plan the treatment for chronic dacryocystitis, there by better outcome following surgery can be achieved without recurrence.

Modified Rhytidectomythat Produces a More Natural Look: Experience with 110 Cases.

Recognition of the effects of aging on the ear and the mechanisms leading to ear deformity associated with facelift procedures aid in achieving improved aesthetic results. In 2009, the author developed a novel rhytidectomy technique to provide more natural-looking results than those achieved through other facelift procedures, which often result in facial and ear distortion/deformity. This technique is designed to optimize aesthetic outcomes by employing incisions hidden within the ear, autologous fat transfer to restore normally lost facial volume, and absorbable bidirectional sutures, all of which allow less skin removal and shorter, more concealable scars within the inside perimeter of the ear, and thus less-distorted facial contours. In this retrospective study, the author added one important modification to this previously described approach for preventing ear deformity. The author will show that this modified rhytidectomy technique has many benefits over a traditional rhytidectomy, and it results in a natural-looking facelift. The author modified the original technique to secure the ears in a way that prevents inferior drifting. The modified technique involves the placement of two parallel strands of 3-0 Monocryl sutures under the scalp and over the skull and running from one side of the head to the other side using a 6-inch blunt needle. The absorbable strands are passed from the inferior part of each earlobe-one in front of the ear and the other in back of the ear. The strands are tied with knots under moderate tension under each earlobe, securing the ear back in the anatomical preoperative position. This secures the bottom of the ears and prevents caudal drifting. The use of 360° round-block, inside-the-ear incisions is advantageous. These incisions have much less lymphatic derangement of the skin, because the overall cut is shorter and the skin is not cut as extensively as in other methods that use longer incisions to get rid of more excess skin in facelifts. This modified rhytidectomy technique has many benefits over a traditional rhytidectomy: the incisions are hidden inside the ears, so there are almost no visible external incisions, and there is no deformity of the ears and earlobes, because the ears do not drift downward. The ear canal is not distorted, there is no hairline distortion, and most importantly, it results in a natural-looking facelift without the commonly seen deformity of any noticeable pulling. This modified approach to rhytidectomy achieves natural looking, aesthetically pleasing results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Transitioning to Blunt Suture Needles in Obstetric Operating Rooms

INTRODUCTION: Our objective was to identify impact of transition to blunt-tip suture needles in obstetric procedures on incidence of needlestick injuries (NSI) in obstetric residents and attendings. METHODS: All OBGYN residents and attending physicians in a tertiary care hospital were surveyed regarding NSI. Following this, suture needles in obstetric operating rooms were changed to blunt needles. A one-year follow-up survey was then sent. RESULTS: Prior to introduction of blunt needles, 28% of attendings had at least one NSI in previous year. Eight needlesticks were sustained in the year preceding transition to blunt needles versus 1 in the year following transition (P=.05) in attendings. Prior to their introduction, greater than 70% of attendings believed blunt needles would reduce NSI; following introduction, only 29% still felt this to be true, despite the actual reduction in NSI occurrence among attendings (P less than .01 for change). Of the responding residents, 61% had sustained at least 1 NSI in the preceding year in the initial query; 50% sustained at least 1 NSI following the introduction to blunt suture needles. At the 1-year follow-up survey, a total of 10 NSI were recalled, with a reporting rate of 50%. CONCLUSION: The introduction of blunt suture needles was associated with a decrease in total recalled needlestick injuries sustained by residents and attendings. The decrease was most notable among the attending physicians, despite their perception that blunt needles were not safer. Blunt needles are an acceptable alternative to the sharp suture needles and thus should be utilized wherever feasible.

Con: Buttonhole cannulation of arteriovenous fistulae.

Successful cannulation of arteriovenous fistulas (AVFs) using a safe and effective technique that minimizes patient harm is a crucial aspect of haemodialysis treatment. Although the current standard of care for many years has been the rope-ladder technique (using sharp needles to cannulate rotating sites across the entire AVF), a number of enthusiasts have recently advocated for the alternative method of buttonhole cannulation (using blunt needles to repeatedly cannulate the same site via a healed track) on the basis of putative, as yet unproven benefits. In this article, we review all available observational studies, randomized controlled trials, and systematic reviews and meta-analyses that have compared the clinical outcomes of buttonhole and rope-ladder cannulation of AVFs. These studies clearly and consistently demonstrated that buttonhole cannulation causes significant and serious infectious harm to haemodialysis patients, especially in the home setting. No strategies or treatments have been proven to effectively mitigate this hazard of buttonhole cannulation. Moreover, buttonhole cannulation is associated with a higher rate of abandonment and has not been shown to have any proven benefit compared with the rope-ladder method. Specifically, buttonhole cannulation has not been shown to reduce cannulation-related pain, improve vascular access survival, reduce vascular access interventions, reduce haematoma formation, improve haemostasis or reduce aneurysm formation. Consequently, rope-ladder cannulation should remain the standard of care and buttonhole cannulation should only be used in rare circumstances (e.g. short segment AVFs where the only alternative is a haemodialysis catheter).

Intraoperative Adductor Canal Block for Augmentation of Periarticular Injection in Total Knee Arthroplasty: A Cadaveric Study

BackgroundFunction is often sacrificed for pain control after total knee arthroplasty. Motor-sparing blocks, including adductor canal block (ACB) and periarticular injection (PAI), have gained interest to address this compromise. Our study evaluates the anatomic feasibility, accuracy, and safety of intraoperative ACB as an adjunct to PAI by analyzing 3 different injection orientations and needle configurations. MethodsEleven cadaveric knees underwent a standard medial parapatellar arthrotomy. Blunt dissection through the suprapatellar recess was performed. Using a 10-mL syringe, various colors of dyed liquid gelatin were injected toward the proximal and distal adductor canal (AC) using 3 needle configurations. Medial dissection of the knee for each specimen was performed. The position of each needle and location of injected dye was identified and described relative to the AC. ResultsAccuracy of each injection orientation and/or needle configuration was different: 86% for a blunt needle in the distal AC, 57% for blunt needle in the proximal AC, and 14% for a spinal needle in the proximal AC. Puncture of the femoral artery was observed with the spinal needle 43% of the time and had the closest average proximity to the femoral artery with a distance of 5.9 mm. There were no vascular punctures using blunt needles, and the average distance from the femoral artery with proximal and distal orientation was 10.2 mm and 15.4 mm, respectively. ConclusionIntraoperative ACB augmentation of PAI appears to be anatomically feasible and safe. There was decreased accuracy and increased risk of vascular puncture using a 3.5-inch spinal needle. A blunt 1.5-inch needle directed toward the distal AC had the highest accuracy while minimizing vascular injury.

Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO119)

Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO119)