Lower Extremity Surgery Research Articles

A Case Report: Combined Sciatic Nerve and Lumbar Plexus Nerve Block in A Patient with Acute Decompensated Heart Failure Undergoing Lower Extremity Surgical Debridement

<p><strong>Background:</strong> Peripheral nerve block for lower extremity surgeries requires a minimum of two block injections. Although the combination of the lumbar plexus block and the sciatica block is a procedure that requires large doses of local anesthetic, which may induce cardiotoxicity, a recent study suggests that change in the hemodynamic system is not clinically significant.</p><p><strong>Case Description:</strong> We report a case of a 53-year-old male presenting with a worsened shortness of breath two days before hospital admission. He also experienced a sudden high fever and pain on his right thigh. The patient had a history of Heart Failure (EF 28%) and Congestive liver disease and was diagnosed with right femur cellulitis with right phlegmon. Surgical debridement was planned to treat sepsis. Right lumbar plexus block and right sciatica block were performed as surgical anesthesia. The surgery duration was one hour, and the patient was transferred to the PACU. The patient was treated in ICU before being admitted to the general ward and was discharged on day three post-surgery.</p><p><strong>Conclusion:</strong> The combination of Sciatic nerve and lumbar plexus nerve block is an effective anesthesia and analgesia technique for lower limb surgery in individuals with a severe heart condition. </p>

Increased prevalence of lower extremity soft tissue injuries and surgeries in patients with anorexia nervosa and bulimia nervosa

ABSTRACT Purpose An abundance of literature exists linking eating disorders and fracture risk. However, no studies, to our knowledge, have investigated the impact of eating disorders on lower extremity soft tissue injury or surgery risk. The purpose of this study was to determine if anorexia nervosa and bulimia nervosa are associated with prevalence of lower extremity soft tissue injuries and surgeries. Methods Patients with anorexia nervosa or bulimia nervosa over 2010–2020 were identified through the International Classification of Diseases (ICD) codes in the PearlDiver Claims Database. Patients were matched by age, gender, comorbidities, record dates, and region to control groups without anorexia or bulimia. Soft tissue injuries were identified through ICD codes, and surgeries were identified through Current Procedural Terminology codes. Differences in relative prevalence were analyzed using chi-square analysis. Results Patients with anorexia had a significantly increased prevalence of meniscus tears (RR = 1.57, CI 1.22–2.03, p = 0.001) or deltoid ligament sprains (RR = 1.83, CI 1.10–3.03, p = 0.025), and patients with bulimia had a significantly increased prevalence of meniscus tears (RR = 1.98, CI 1.56–2.51, p < 0.001), medial collateral ligament sprains (RR = 3.07, CI 1.72–5.48, p < 0.001), any cruciate ligament tears (RR = 2.14, CI 1.29–3.53, p = 0.004), unspecified ankle sprains (RR = 1.56, CI 1.22–1.99, p < 0.001), or any ankle ligament sprains (RR = 1.27, CI 1.07–1.52, p = 0.008). Patients with anorexia had a significantly increased prevalence of anterior cruciate ligament reconstructions (RR = 2.83, CI 1.12–7.17, p = 0.037) or any meniscus surgeries (RR = 1.54, CI 1.03–2.29, p = 0.042), and patients with bulimia had a significantly increased prevalence of partial meniscectomies (RR = 1.80, CI 1.26–2.58, p = 0.002) or any meniscus surgeries (RR = 1.83, CI 1.29–2.60, p < 0.001). Conclusions Anorexia and bulimia are associated with increased prevalence of soft tissue injuries and surgeries. Orthopedic surgeons should be aware of this risk, and patients presenting to clinics should be informed of the risks associated with these diagnoses and provided with resources promoting recovery to help prevent further injury or surgery.

Poster 219: Changes in Body Composition and Bone Mineral Density Following Arthroscopic Treatment of Femoral Acetabular Impingement in Collegiate Athletes: A Matched Cohort Study

Poster 219: Changes in Body Composition and Bone Mineral Density Following Arthroscopic Treatment of Femoral Acetabular Impingement in Collegiate Athletes: A Matched Cohort Study

Distance between the C2 vertical line and the femoral heads: a quasi-invariant global sagittal alignment parameter in both standing and sitting positions for asymptomatic adults.

This study aimed to investigate whether the distance between the C2 vertical line and the femoral heads (C2-FH) is quasi-invariant for the sitting position. A cross-sectional, prospective study was conducted. A cohort of 59 asymptomatic volunteers was prospectively recruited between February 1, 2020, and February 31, 2020, at Nanjing Drum Tower Hospital of Nanjing University Medical School. The following radiographical parameters were evaluated: T4-T12 thoracic kyphosis (TK), cervical lordosis (CL), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), T1-pelvic angle (TPA), and the C2-FH. The inclusion criteria were as follows: age between 18 and 35 years and no symptoms related to neck or back pain. The exclusion criteria were as follows: a history of any prior lower extremity or spine surgery; and a history of inflammatory arthritis, neuromuscular disorders, or congenital anomalies. Individuals were divided into the following 3 groups according to the percentile of ΔPT (PT difference between standing position and sitting position): group A (1-25% ΔPT, n=14), group B (25-75% ΔPT, n=30), and group C (75-100% ΔPT, n=15). Summary statistics calculated using analysis of variance (ANOVA) were used to provide 95% confidence intervals for measurement errors. The significance level of all statistical analyses was set as P < 0.05. There was no significant difference in any of the parameters among the 3 groups in the standing position. In the sitting position, for different degrees of pelvic retroversion, there were significant differences between the 3 groups in the other parameters except for C2-FH (P=0.80; 95% CI: -20.486 to -3.893), CL (P=0.47; 95% CI: -5.645 to 4.964), TK (P=0.54; 95% CI: 17.058-25.1), and PI (P=0.44; 95% CI: 40.747-49.087). Surprisingly, C2-FH changed slightly among the 3 groups in both the standing (P=0.87) and sitting (P=0.80) positions. As ΔPT gradually increased, ΔSS, ΔLL, ΔSVA, ΔL1-L4, ΔL4-S1, ΔTPA, ΔPT/PI, and ΔPI-LL showed corresponding gradual changes (all P values <0.05). However, there was no significant difference in PI (P=0.39), CL (P=0.46), C2-FH (P=0.51), or TK (P=0.51). C2-FH is a quasi-invariant parameter in both the standing and sitting positions for asymptomatic adults. The mean value of C2-FH was -11.95 mm in the standing position and -1.01 mm in the sitting position. Stable C2-FH could serve as a reference during the surgical decision-making process in adult patients with spinal deformity and sagittal malalignment.

Poster 359: Anorexia Nervosa and Bulimia Nervosa Diagnoses Are Associated with Increased Risk of Lower Extremity Soft Tissue Injury and Orthopaedic Surgery Requirements

Objectives: An abundance of literature exists demonstrating the link between eating disorders and fracture risk. However, no studies to our knowledge have investigated the impact of an eating disorder diagnosis on risk for ligamentous injury or the need subsequent orthopedic surgery. The aim of this study was therefore to elucidate this link and determine if pre-existing eating disorder diagnoses are associated with increased incidence of lower extremity connective tissue-related orthopaedic injuries and surgeries. We hypothesized that eating disorders, specifically anorexia nervosa and bulimia nervosa, lead to an increased risk of ligamentous injuries and need for surgery on injured ligaments. Methods: Patients with a diagnosis of anorexia nervosa or bulimia nervosa were identified using International Classification of Diseases (ICD) -9 and -10 codes using the PearlDiver Mariner insurance claims data set. These patients were matched by age, gender, Charlson Comorbidity Index, record dates, and geographical region to respective control groups without anorexia nervosa or bulimia nervosa. Instances of ligamentous injuries were identified through ICD-9 and ICD-10 codes within the time period of 2010-2020 available within the Mariner dataset. Instances of ligamentous orthopaedic surgery procedures in these patients were identified through Current Procedural Terminology (CPT) codes. Rates of ligamentous injury and orthopaedic surgery among experimental and control cohorts were analyzed using chi-squared analysis. Results: The anorexia nervosa cohort and its matched control group contained a total of 2,475 patients each. Patients with a diagnosis of anorexia nervosa were significantly more likely to sustain a meniscus tear (RR=1.57, p=0.001) or deltoid ligament sprain (RR=1.83, p=0.025), and to undergo anterior cruciate ligament (ACL) reconstruction (RR=2.83, p=0.037). They were less likely to sustain a tibiofibular ligament sprain (RR=0.64, p=0.012). The bulimia nervosa cohort and its matched control group contained a total of 2,375 patients each. Patients with a diagnosis of bulimia nervosa were significantly more likely to sustain a meniscus tear (RR=1.98, p &lt;0.001), medial collateral ligament (MCL) sprain (RR=3.07, p&lt;0.001), any cruciate ligament tear (RR=2.14, p=0.004), unspecified ankle sprain (RR=1.56, p&lt;0.001), and any ankle ligament sprain (RR=1.27, p=0.008), and to undergo partial meniscectomy (RR=1.80, p=0.002). Conclusions: Diagnosis of an eating disorder is associated with an increased risk of certain ankle and knee ligamentous injuries and surgeries. Orthopaedic surgeons should be aware of the effects these disorders have on soft tissue injury and surgery rates. Furthermore, patients presenting to orthopaedic surgery clinics should be informed of increased risks associated with their eating disorder diagnoses and provided with information on resources promoting recovery to help prevent further injury.

The Classification Algorithms Applied to the Inpatient Stay for Lower Limb Surgery.

The revolutions of recent years in health care have involved several areas ranging from patient treatment to resource management. Therefore, several strategies have been put in place to increase patient value while trying to reduce spending. Several indicators have arisen to evaluate the performance of healthcare processes. The main one is Length of Stay (LOS). In this study, classification algorithms were used to predict the LOS of patients undergoing lower extremity surgery, an increasingly common condition given the progressive aging of the population. The context is the Evangelical Hospital "Betania" in Naples (Italy) in 2019-2020, which augments a multicenter study conducted by the same research team on several hospitals in southern Italy. All selected algorithms show an Accuracy above 90% but among them, the best is Logistic Regression with a value reaching 94%.

Continuous Epidural Analgesia Versus Continuous Peripheral Nerve Block in Unilateral Lower Extremity Pediatric Orthopedic Surgery: A Matched Case Comparison Study.

Introduction Continuous epidural analgesia (CEA) provides effective postoperative pain relief but includes a substantial side effect profile. Continuous peripheral nerve blocks (CPNBs) have fewer side effects and may quicken ambulation. The purpose of this study was to compare the morphine milligram equivalents (MMEs), need for analgesic rescue, visual analog scale (VAS) pain scores, time to ambulation, postoperative blood pressures, length of stay (LOS), and adverse event rates. Methods This was a matched case comparison study of pediatric patients (ages 8-17) undergoing unilateral lower limb surgery (41 CEA and 36 CPNB). Patients with a history of chronic pain, previous lower extremity surgery, and developmental delay were excluded. The Chi-square test and Student's t-test were used, and p-values < 0.05 were considered significant. Results There were no statistically significant differences in demographics or the American Society of Anesthesiologists (ASA) grade. There were no significant differences in postoperative MMEs, the need for analgesic rescue, or VAS scores on any postoperative day. The CEA group had a longer time to ambulation (2.56 ± 0.93 days versus 1.89 ± 0.69 days, p = 0.004). The CEA group demonstrated a higher number of days of systolic hypotension (0.61 ± 0.97 mmHg versus 0.06 ± 0.23 mmHg, p = 0.0009) and diastolic hypotension (1.90 ± 1.24 mmHg versus 1.00 ± 0.93 mmHg, p = 0.0006). There were no significant differences in the length of stay between the CEA and CPNB groups (5.08 versus 4.24, p = 0.28). There was no statistically significant difference between the rates of pruritus, light-headedness, and altered mental status. The CEA group demonstrated higher rates of nausea (51.2% versus 13.9%, p = 0.001), constipation (36.6% versus8.3%, p = 0.004), urinary retention (9.8% versus0%, p = 0.006), and average number of minor adverse events per patient (1.02 versus0.25, p = 0.002). Conclusions CPNBs and CEAs demonstrate equivalent postoperativeopioid use after unilateral lower extremity surgery in the pediatric population. In our population, a low complication rate and a decreased time to ambulation were seen in the CPNB group. There may be certain select scenarios priorly managed with a CEA that can be appropriately managed with a CPNB. A prospective multicenter study incorporating patient satisfaction data could further facilitate the incorporation of CPNB in pediatric pain management protocols after orthopedic surgery.

The Efficacy of Caudal Anesthesia in Pediatric Surgery

Background: Despite a long history of safety, spinal anesthesia (SA) is still seldom used outside of specialist pediatric institutions and is sometimes debated as a primary anesthetic approach for children. To lessen the risk of postoperative apnea, it is often used on previously preterm newborns who have not yet reached viability (60 weeks post- conception) (GA). There is, however, a wealth of evidence indicating its safety and effectiveness for appropriate operations in adolescents. Objective: The primary purpose of this investigation is to assess the efficacy of Caudal anesthesia pediatric surgery. Method: Tertiary care hospital was the setting for this prospective investigation. 200 children, ages 4 to 10, were included in the research because they were all given different types of anesthesia for infraumbilical or lower extremities surgery during the study's 1-year time frame. The research participants had a thorough preoperative assessment. During the study 50 patients of each were given different anesthesia including Endotracheal intubation, LMA, Caudal block and local anesthesia. Results: Majority was belonged to 4-6 years age group, 70% and 60% were male. Plus, majority of the patients were undergone circumcision, 35% and Herniorrhaphy, 28%. Followed by 20% undergone appendectomy and 5% undergone hypospadias repair. Besides, anesthesia induction and recovery on the operating room table, was lowest in the local anesthesia group (P = 0.015), whereas the results were comparable in the other groups. However, patients with caudal and local anesthesia spent significantly less time in the postoperative recovery unit (P &lt; 0.001). In fact, patients who got Caudal block had less complication where only 1% had Convulsions, Bloody puncture and vomiting. Conclusion: Caudal anesthesia as a sole method for pediatric subumbilical surgery is a relatively safe method. Patients having operation under caudal anesthesia have faster discharge times from postoperative recovery units, compared with general anesthesia. This probably reduces recovery unit expenditures.

Medical Malpractice Among Orthopedic Surgeons in Greece: An Analysis of Court Decisions.

Introduction Medical malpractice occurs when a physician, through incorrect medical action or omission, causes the patient to suffer physical harm or loss of life. Orthopedics is a high-risk medical specialty. Orthopedic surgery encompasses a wide range of procedures, including joint replacements, fracture repairs, and spinal surgeries. While orthopedic surgeons strive to provide optimal care to their patients, medical liability claims are a reality they must face. The aim of this study is to analyze the epidemiological data of judicial decisions and cases in Greece for the Specialty of Orthopedics. Material and methods Published court decisions involving medical liabilities of orthopedic surgeons and anesthesiologists, or only orthopedic surgeons were searched, in the period between 1985 and 2021. The judicial decisions were analyzed by an experienced anesthesiologist and an orthopedic surgeon based on medical knowledge and experience. Patients' age, gender, date of operationand the causes that led to the doctors' persecution were also recorded. Results Seventy court decisions of the first, second, and third degree were found. These decisions related to 34 cases: seven convictions for manslaughter, 18 convictions for bodily harm, and nine acquittals - exempting compensation. They involved 11 men and 13 women. The claims mainly related to intraoperative and postoperative complications in 20 (83.3%) of the 24 cases. Complications in elective spinal and lower extremity surgeries represent 50% (n = 12) of cases, while postoperative complications account for 16.7% of cases (n = 4). Conclusions The present study concluded that an accumulation of experience in large orthopedic centers is needed to improve the performance of orthopedic surgeons during surgery and patient monitoring. Many legal cases are due to the mismatch between patient expectations and the limitations in medicine. Thorough preoperative control and better preoperative communication with the patient are needed, in order to improve the performance of orthopedic surgeons and prevent a significant part of the claims.

Achondroplasia natural history study (CLARITY): 60-year experience in orthopedic surgery from four skeletal dysplasia centers

BackgroundThe purpose of this study was to describe the frequency and risk factors for orthopedic surgery in patients with achondroplasia. CLARITY (The Achondroplasia Natural History Study) includes clinical data from achondroplasia patients receiving treatment at four skeletal dysplasia centers in the United States from 1957 to 2018. Data were entered and stored in a Research Electronic Data Capture (REDCap) database.ResultsInformation from one thousand three hundred and seventy-four patients with achondroplasia were included in this study. Four hundred and eight (29.7%) patients had at least one orthopedic surgery during their lifetime and 299 (21.8%) patients underwent multiple procedures. 12.7% (n = 175) of patients underwent spine surgery at a mean age at first surgery of 22.4 ± 15.3 years old. The median age was 16.7 years old (0.1–67.4). 21.2% (n = 291) of patients underwent lower extremity surgery at a mean age at first surgery of 9.9 ± 8.3 years old with a median age of 8.2 years (0.2–57.8). The most common spinal procedure was decompression (152 patients underwent 271 laminectomy procedures), while the most common lower extremity procedure was osteotomy (200 patients underwent 434 procedures). Fifty-eight (4.2%) patients had both a spine and lower extremity surgery. Specific risk factors increasing the likelihood of orthopedic surgery included: patients with hydrocephalus requiring shunt placement having higher odds of undergoing spine surgery (OR 1.97, 95% CI 1.14–3.26); patients having a cervicomedullary decompression also had higher odds of undergoing spine surgery (OR 1.85, 95% CI 1.30–2.63); and having lower extremity surgery increased the odds of spine surgery (OR 2.05, 95% CI 1.45–2.90).ConclusionsOrthopedic surgery was a common occurrence in achondroplasia with 29.7% of patients undergoing at least one orthopedic procedure. Spine surgery (12.7%) was less common and occurred at a later age than lower extremity surgery (21.2%). Cervicomedullary decompression and hydrocephalus with shunt placement were associated with an increased risk for spine surgery. The results from CLARITY, the largest natural history study of achondroplasia, should aid clinicians in counseling patients and families about orthopedic surgery.

Comparison of remimazolam and dexmedetomidine for intraoperative sedation in patients undergoing lower extremity surgery under spinal anesthesia: a randomized clinical trial

BackgroundDexmedetomidine sedation has advantages, such as low incidence of respiratory depression and prolonged block duration, but also significant disadvantages, such as slow onset, high rate of sedation failure, and a...

Joint Injury, Osteoarthritis, and Cardiovascular Disease Risk Factors in Former National Football League Athletes: An NFL-LONG Study.

Individuals with lower extremity osteoarthritis (OA) have a 25% greater risk of cardiovascular disease (CVD) than those without OA. The prevalence of traumatic joint injuries among National Football League (NFL) players exposes these athletes to an elevated risk for OA and potentially a greater risk of cardiovascular risk factors (CRFs) and CVD. To examine the associations between a history of lower extremity joint injury, lower extremity OA, and the prevalence of CRFs and CVD among former NFL athletes. Cross-sectional study. Former NFL players completed a comprehensive health questionnaire that was used in an ongoing study, the Neurologic Function Across the Lifespan: A Prospective, Longitudinal, and Translational Study for Former NFL Players (NFL-LONG). A subsample of 1738 former players reported lifetime medical diagnoses including CVD or CRFs. Crude and adjusted prevalence ratios (PRsadj) characterized the associations between CVD or CRFs and injury, OA diagnosis, or both among athletes who reported (1) no history of lower extremity joint injury or surgery and no diagnosed OA, (2) a history of lower extremity joint injury or surgery and no diagnosed OA, and (3) a history of lower extremity joint injury or surgery and diagnosed OA. Neither a history of lower extremity joint injury (PRadj = 1.34; 95% CI = 0.86, 2.07) nor a history of lower extremity joint injury and diagnosed OA (PRadj = 1.41; 95% CI = 0.89, 2.25) was significantly associated with CVD. However, CRFs were 30% and 53% more prevalent in former players with lower extremity joint injury and no diagnosed OA (PRadj = 1.30; 95% CI = 1.12, 1.50) and those with lower extremity joint injury and diagnosed OA (PRadj = 1.53; 95% CI = 1.31, 1.78), respectively, versus athletes with no history of either condition. The prevalence of CRFs was highest among former NFL athletes with a history of lower extremity joint injury and diagnosed OA. These findings provide insight regarding the potential pathways to chronic diseases that may be initiated by joint injury early in life.

Use of Patient-Reported Outcome Measures in Lower Extremity Research.

A large number of patient reported outcome measures (PROMs) have been developed for specific lower extremity orthopaedic pathologies. However, a consensus as to which PROMs are recommended for use in evaluating treatment outcomes for patients with hip, knee, ankle and/or foot pathology based on the strength of their psychometric properties is lacking. To identify PROMs that are recommended in systematic reviews (SRs) for those with orthopaedic hip, knee, foot, and ankle pathologies or surgeries and identify if these PROMs are used in the literature. Umbrella Review. PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for SRs through May 2022. A second search was done to count the use of PROMs in seven representative journals from January 2011 through May 2022.SRs that recommended the use of PROMs based on their psychometric properties were included in the first search. SRs or PROMs not available in the English were excluded. The second search included clinical research articles that utilized a PROM. Case reports, reviews, and basic science articles were excluded. Nineteen SRs recommended 20 PROMs for 15 lower extremity orthopaedic pathologies or surgeries. These results identified consistency between recommended PROMs and utilization in clinical research for only two of the 15 lower extremity pathologies or surgeries. This included the use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Copenhagen Hip and Groin Outcome Score to assess outcomes (HAGOS) for those with knee osteoarthritis and groin pain, respectively. A discrepancy was found between the PROMs that were recommended by SRs and those used to assess clinical outcomes in published research. The results of this study will help to produce more uniformity with the use of PROMs that have the most appropriate psychometric properties when the reporting treatment outcomes for those with extremity pathologies. 3a.

Cross-Culturally Adapted Versions of Patient Reported Outcome Measures for the Lower Extremity.

A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown. The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization. Literature Review. PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data. Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use. Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use. 3a.

Examining the motivation and the implementation of early mobilization in post-lower extremity operations

Background: Early mobilization is an effective approach for the healing process following lower extremity surgery. However, its successful implementation requires self-encouragement and motivation from patients. Objective: This study aimed to investigate the relationship between motivation and the implementation of early mobilization in patients undergoing lower extremity surgery. Methods: A cross-sectional analytic descriptive study was conducted involving 41 respondents who were selected using a purposive sampling technique. Data were collected through motivation questionnaires and early mobilization observation sheets. The collected data were analyzed using the Spearman Rho test with a significance level of ? = 0.05. Results: Out of the 41 respondents, 21 (51.2%) showed moderate levels of motivation for early mobilization, while 20 (48.8%) demonstrated sufficient to good implementation of early mobilization. The statistical test revealed a significant relationship between motivation and early mobilization (p=0.035 or p&lt;0.05), with an r-value of 0.329. Conclusions: The results highlight a significant correlation between motivation and early mobilization, which is closely associated with psychological mechanisms. The need for quick recovery serves as an encouragement for optimal early mobilization. Higher motivation levels contribute to better implementation of early mobilization. Considering the importance of motivational variables, it is suggested that nurses increase educational exposure and involve the patient’s family in order to enhance motivation for early mobilization.

Graded dosage of local anesthetic for spinal anesthesia during orthopedic and trauma surgeries on the lower extremities

Background. The development of a clear algorithm of a local anesthetic dosage for spinal anesthesia during surgeries on the lower extremities is an urgent issue, even after a century of using this method of analgesia. The aim of our study is to improve the efficiency and safety of spinal anesthesia during lower extremity surgery in orthopedic and trauma patients by developing a local anesthetic dosage algorithm. Materials and methods. The conducted study is based on the analysis of the bilateral spinal anesthesia methods in 75 patients with degree I–II ASA operational risk during orthopedic and trauma surgeries on the lower extremities who were divided into 3 study groups. Spinal anesthesia was performed using 0.5% bupivacaine, with the anesthetic dosage algorithm developed according to the patients’ height (group III) and the standard recommended dosage (group I, patients of short height, and group II, patients’ height &gt; 180 cm). Results. When studying the hemodynamic indicators, the heart rate before surgery was as follows: in the first group, 73 ± 8 bpm, in the second group, 78 ± 6 bpm, in the third group, 79.32 ± 14.47 bpm. Thirty minutes after the injection of the anesthetic, the heart rate in the group 1 was 68 ± 5 bpm, and three hours after, it was 71 ± 9 bpm. In the group 2, the heart rate of patients 30 minutes after the injection of the anesthetic was 79 ± 7 bpm, three hours after, it was 84 ± 9 bpm. In the group 3, the heart rate of patients 30 minutes after the administration of the anesthetic was 71.56 ± 14.14 bpm, three hours after the injection, it was 71.280 ± 9.002 bpm. Data on systolic blood pressure before surgery was started were as follows: in the first group, 139.6 ± 12.3 mmHg, in the second group, 136.0 ± 9.6 mmHg, in the third group, 138.40 ± 16.18 mmHg. During the surgical intervention, blood pressure indicators in the group 1 were: 30 minutes after the introduction of the anesthetic — 113.0 ± 7.1 mmHg, 3 hours after — 122 ± 14 mmHg; in the second group: 30 minutes after the injection of the anesthetic — 138.0 ± 10.2 mmHg, 3 hours after — 141.0 ± 12.5 mmHg; in the third group: 30 minutes after the administration of the anesthetic — 102.48 ± 13.47 mmHg, 3 hours after the introduction — 118.2 ± 10.0 mmHg. The average duration of the sensory block in the group 1 was 182.5 ± 17.2 min, of the motor block — 130.0 ± 24.8 min; in patients of the group 2, the sensory block lasted 70.6 ± 13.1 min, and the motor block 23.3 ± 6.7 min; in the group 3, the duration of sensory block was 252.20 ± 74.32 min and of the motor block — 198.2 ± 59.0 min. Conclusions. 1. The use of small doses of hyperbaric bupivacaine does not affect hemodynamic parameters but reduces the quality and duration of anesthesia in tall patients. 2. The frequency of complications during spinal anesthesia does not increase with an increase in the volume of local anesthetic in tall patients. 3. Selection of graded dose allows for more predictable and qualitative application of spinal anesthesia during orthopedic and trauma surgeries.

Comparison of the effectiveness of the WALANT method in soft tissue and bone tissue surgeries in lower extremities.

This study aims to investigate the effectiveness of wide-awake local anesthesia with no tourniquet (WALANT) technique in both bony and soft tissue procedures in lower extremities. Between January 2021 and December 2022, a total of 29 patients (20 males, 9 females; mean age: 34.6±20.2 years; range, 14 to 82 years) who were operated for lower extremity pathologies with the WALANT technique in our clinic were included. The patients were divided into two groups: lower extremity soft tissue surgeries in Group A (n=10) and bone tissue surgeries in Group B (n=19). Postoperative pain onset time, pain score, the amount of intraoperative bleeding, need for additional solution, use of cautery, and the amount of bleeding in the surgical field were compared within groups. The Visual Analog Scale (VAS) was used to evaluate pain. There was no significant difference between the two groups in terms of age (p=0.265), sex (p=0.107), and surgical side (p=0.700). There was no significant difference between the two groups in terms of intraoperative bleeding at the discretion of the surgeon (p=0.701). There was no significant difference in the use of additional solution (p=0.105), cautery usage (p=0.522), pain onset time (p=0.636), and VAS scores (p=0.735) between the two groups. Our study results suggest that the WALANT technique is an effective and safe method in selected lower extremity surgeries. It is of utmost importance to apply the technique correctly to prevent complications that may occur.

Effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets

Introduction: The use of a tourniquet in lower extremity surgery can help surgeons optimize the surgical field. However, tourniquet inflation may create ischemic conditions in the extremity, and tourniquet deflation may pose a risk of ischemic reperfusion injury (IRI). Ischemic conditions can increase the production of reactive oxidative stress (ROS), which, if it occurs simultaneously with IRI, will produce malondialdehyde (MDA), a toxic metabolite. The prolonged use of tourniquets can cause damage to the local skin tissue at the tourniquet inflation and poses a risk of IRI to other organs. This study aims to observe the effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets. Methods: This study is an observational study with a prospective cohort design to measure malondialdehyde levels in lower extremity surgery using tourniquets. When the data were normally distributed, a statistical test was performed using an independent sample t-test to compare the demographic data of the two groups. To compare the results of the observation after the induction, 15 and 120 minutes after the release of the tourniquets, a repeated measures ANOVA was performed when the data were normally distributed. Then, to examine the correlation between variables, Spearman's correlation test was applied when the data were not normally distributed. Results: In this study, almost all the subjects in the isoflurane and dex-iso groups had no significantly different characteristics, and also showed no effect of tourniquet pressure on malondialdehyde levels. Conclusion: Based on statistical analysis and discussion of the effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets, it can be concluded that there was no statistically significant effect of dexmedetomidine administration on malondialdehyde levels in lower extremity surgery using tourniquets.

D9. Gait Impairments Seen in Diabetic Neuropathy Patients after Surgical Intervention for Open Wounds

PURPOSE: Identifying gait impairments at different levels of neuropathy guides clinicians to prophylactically treat neuropathy symptoms. This is the first large-scale study to quantify gait parameters based by degree of neuropathy. METHODS: Adults who could safely ambulate without pain, open wounds, and lower extremity surgery in the previous three months were offered participation. Participants completed a standardized 120-second walk test with wearable sensors at a self-selected pace. Levels of neuropathy in diabetic patients were defined as “0 = no neuropathy; 1 = neuropathy but no deformity; 2 = neuropathy with deformity (hammertoes, bunion, equinus, etc); 3 = neuropathy with history of an open wound that led to lower extremity surgical intervention. Data were collected and analyzed with Motility Lab software and STATA VSN 17.0 with significance defined as p < 0.05. RESULTS: Of the 135 patients included (56.79 + 16.55 years of age, BMI 28.78 kg/m2), 70 had neuropathy and 65 non-diabetic patients served as control. Linear regression modeling revealed patients with open wounds that led to surgery (Level 3) neuropathy were associated with poorer gait function in all parameters compared to non-diabetic controls (p<0.0001). Level 1 correlated with poorer gait speed, and single and double limb support (p<0.05). CONCLUSION: Neuropathic patients with chronic wounds requiring surgical intervention demonstrated gait dysfunction. Patients at risk of severe diabetic neuropathy should be counseled and supported to avoid further ambulatory impairment.

Ultrasound Guided Combined Peripheral Nerve Blocks in a High-Risk Patient: A Case Report

The use of ultrasound in peripheral nerve blocks has become increasingly more frequent. Lower–extremity surgeries are mainly performed under general or central neuraxial anesthesia, ultrasound-guided combined peripheral nerve block (PNB) can be a good alternative anesthetic technique, especially for high-risk patients who require continuous anticoagulation treatment and present with poor cardiovascular conditions.