Mean Visual Analogue Score Score Research Articles

Effect of lidocaine pumped through hepatic artery to relieve pain of hepatic artery infusion chemotherapy.

This study aims to explore the analgesic effect of lidocaine administered through the hepatic artery during hepatic artery infusion chemotherapy (HAIC) for hepatocellular carcinoma (HCC). A total of 45 HCC patients were randomly divided into a study group and a control group. Both groups received oxaliplatin (OXA) based FOLFOX protocol via electronic infusion pump. The study group was continuously infused with 100 mg of lidocaine during HAIC, while 5% glucose solution was infused in the same way as described above. Changes in vital signs, visual analogue score (VAS) and general comfort score (GCQ scale) were recorded before surgery (Time point 0), at the end of infusion (Time point 01), 1 h after HAIC (Time point 02), 3 h after HAIC (Time point 03) and 6 h after HAIC (Time point 04). At each point of time from Time point 0 through Time point 04, the differences in MAP, RR and SPO2 between the two groups were not statistically significant (P > 0.05). At each point of time from Time point 01 through Time point 04, the mean VAS scores in the study group were smaller and GCQ scores were higher than those in the control group, and the differences were both statistically significant (P < 0.05). Lidocaine infusion through the hepatic artery during HAIC effectively reduces intraoperative and postoperative pain and improves patient satisfaction with pain management, making it a valuable technique for clinical practice.

#2285 Potentially modifiable factors influencing longitudinal health-related quality of life for those with chronic kidney disease in the NURTuRE-CKD cohort

Abstract Background and Aims Factors affecting poor health-related quality of life (HRQoL) for people with chronic kidney disease (CKD) have been previously described in literature, and worse HRQoL is associated with CKD progression and death. Little emphasis has been placed on which factors may be potentially modifiable, and longitudinal HRQoL outcome analyses in non-dialysis dependent CKD cohorts are few in number. Baseline analysis of the NURTuRE-CKD cohort identified several associations between these factors and HRQoL and these associations can now be examined with longitudinal data. Method The NURTuRE-CKD cohort study recruited 2996 participants with non-dialysis dependent CKD between 2017-2019, collecting biochemical, anthropometric, sociodemographic, medical history and patient reported outcome measure (PROM) data. Face-to-face follow-up repeated these measures. Longitudinal worsening overall HRQoL was the main outcome of interest, represented by mapped EQ-5D-3L index value and visual analogue score (VAS). Multivariable linear mixed effects models were fitted in R using the lmer and lmerTest packages. Models for index value were fit separately for each independent variable of interest and collated, as well as fitting models with all variables of interest. Models were adjusted for available confounders, repeated measures and follow-up time. P-values were adjusted for multiple testing using false discovery rate correction. Results 2054/2996 (68.6%) had complete HRQoL data at follow-up, of whom most had CKD stage G3a-G4 (n = 1597, 77.8%). 1817 (88.5%) were white and 1196 (58.2%) were male. Mean age was 63.7 (SD ±14.5) years and the mean number of comorbidities was 3.7 (SD ±2.2). Median (IQR) time between baseline and follow-up was 518 (410) days. At follow-up, mean mapped EQ-5D-3L index value was 0.72 (SD ±0.3) and mean VAS score was 70.4/100 (SD ±20.6). 1595 (77.7%) reported problems in at least one EQ-5D-5L dimension, with 255 (12.4%) developing issues since baseline. 1203 (58.6%) reported worse HRQoL index values at follow up and 910 (44.3%) reported worse VAS. The dimension with the highest number of newly reported issues at follow-up was ‘usual activities’ with 301 (14.7%). Multivariable linear mixed methods models showed independent associations with worse HRQoL (Figs 1 and 2) for those on ten or more medications (β −0.118, CI −0.137 to −0.100, p &amp;lt; 0.001), current smokers (β −0.036, CI −0.067 to −0.006, p = 0.0.012), obesity (β-0.059, CI −0.080 to-0.039, p &amp;lt; 0.001), haemoglobin of &amp;lt;100g/L (β-0.044, CI −0.073 to-0.016, p = 0.014), hospital anxiety and depression scale scores of 8 or above for anxiety (β-0.146, CI −0.161 to-0.130, p &amp;lt; 0.001) and depression (β-0.202, CI-0.219 to −0.186, p &amp;lt; 0.001), worse health literacy (β −0.099, CI −0.136 to −0.063, p &amp;lt; 0.001), and pain (β −0.148, CI −0.161 to −0.135, p ≤ 0.001), weakness (β −0.106, CI −0.120 to −0.092, p &amp;lt; 0.001) and shortness of breath symptoms (β −0.074, CI −0.087 to −0.060, p &amp;lt; 0.001). Conclusion Potentially modifiable factors influencing longitudinal worsening of HRQoL for people with CKD include polypharmacy, smoking, obesity, anaemia, depression and anxiety, limited health literacy, pain, weakness and shortness of breath symptoms. This highlights the need for high quality randomised controlled trials to test interventions addressing these factors with reported HRQoL outcomes. Further work in this cohort is required, examining a third timepoint for HRQoL and linked clinical outcome data.

Percutaneous Fifth Metatarsal Osteotomy for Bunionette Deformity Without Fixation or Strapping: A Retrospective Study.

Bunionette deformity (BD) is a painful condition of the fifth metatarsal characterized by an osseous prominence and fifth toe varus deformity. The purpose of this study is to assess the clinical, functional, and radiographic outcomes of percutaneous distal metatarsal metaphyseal osteotomy (DMMO) without fixation or postoperative strapping of the foot. A retrospective case series was performed on 111 patients (132 feet) with symptomatic BD who underwent percutaneous DMMO of the fifth metatarsal from September 2020 to January 2022 by an experienced minimally invasive surgeon. According to the Shimobayashi classification, we treated 1 type I deformity, 37 type II deformities, 52 type III deformities, 42 feet with type IV deformity, and no patient with a type V deformity. Ninety patients (81%) underwent unilateral osteotomy, and 21 (19%) had bilateral osteotomies. Most cases included other procedures including treatment of 114 associated deformities of the same feet: 68 bunions, 12 lesser metatarsal osteotomies (2-3-4 metatarsals), and 34 hammertoes (20 second hammertoes, 10 third hammertoes, 1 fourth hammertoes, 2 fifth hammertoes). Patient-reported clinical outcome measures, including the Foot Function Index (FFI) questionnaire, the visual analog score (VAS), and overall satisfaction were collected. Fourth-to-fifth intermetatarsal angle (IMA) correction, time to bone union, and complication rates were assessed in all patients. Mean follow-up was 24.1 months (range, 14-39 months). Both radiographic parameters and patient-reported outcome measures significantly improved after DMMO procedure. The average fourth-to-fifth IMA improved from 12.2 degrees, preoperatively, to 4.4 degrees, postoperatively (P < .001). Patient outcomes reflect the overall outcomes of the combined surgeries on a per-patient basis. Preoperatively, patients had a mean VAS score of 7.6, which improved to 0.6 at the last follow-up (P < .001). Furthermore, the average FFI significantly decreased from pre- to postoperation from 19.2 to 4.4, respectively (P < .001). Overall, 108 of 111 patients reported being satisfied with the outcomes of the procedure. Average bone union was achieved at 12.6 weeks postoperation, with a minimum of 12 and a maximum of 25 weeks. The complication rate was 1.5%, including 1 case of an asymptomatic cock-up deformity and 1 case of lateral fifth metatarsal shaft bone overhang pain, which resolved with an exostectomy. The results of this study of patients who had minimally invasive surgery from an experienced surgeon suggest that percutaneous DMMO of the fifth metatarsal without internal fixation or postoperative immobilization or strapping can be effective at improving radiographic alignment, pain, function, and overall satisfaction with minimal rates of complication. Level IV, case series.

TO STUDY THE EFFICACY OF TROPICAL APPLICATION OF CANNABIS IN CHRONIC KNEE JOINT PAIN PATIENTS

Introduction: Tropical application of Cannabis oil is effective in patients suffering from chronic knee pain. Objectives: The objective of this study was to study the decrease in pain at specified time intervals after tropical application of cannabis oil in chronic joint pain patients and to study the change in the visual analog score (VAS) and numeric rating scale (NRS) scoring of patient’s pain before and after the application. Methods: Patients were pre-informed about the process. VAS and NRS scores were noted before tropical application of the Cannabis oil. Cannabis oil was applied tropically on patients with chronic joint pain on the specified site, that is, B/L knee joints. Then, the decrease in the severity of pain at specific time interval was recorded on the pre-set pro forma. The VAS score and NRS score were recorded 30 min after the application. The final data were represented in the form of tables and graphs. Results: The mean improvement values at 0–5 min, 5–10 min, 15–20 min, and 20–30 min were 35.90%, 41.80%, 47.90%, and 56.50%, respectively. The mean VAS score before application 7.00 reduced significantly to 2.32 after 30 min of application (p&lt;0.05). Similarly, the mean NRS score also reduced significantly to 2.52 from mean value 7.08 at before application (p&lt;0.05), that is, pain is significantly reduced. Conclusion: From the data analysis, we reach to the conclusion that tropical application of Cannabis oil is effective in B/L knee joint osteoarthritis chronic pain.

Effectiveness of an Educational Booklet for the Management of Patients with Chronic Low Back Pain

Introduction: The aim of the present study was to assess the effectiveness of provision of an educational booklet for the management of patients with chronic low back pain. Material and Methods: A Randomized controlled clinical trial was conducted from January 2018 to June 2018 among 80 patients attending at Physical Medicine and Rehabilitation outpatient department of the Shaheed Suhrawardy Medical College and Hospital after obtaining requisite consent from the patients. 80 Patients were divided into two groups (Group A and Group B). Group A contains Patients educational booklet group + exercises + analgesics (Case group). Group B contains Physicians advice only group + exercises + analgesics (control group). Data were collected through interviewing and examining of the patients. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the effectiveness of provision of an educational booklet for the management of patients with chronic low back pain. The study was approved by the institutional ethical committee. Results: In a pool of 80 patients, the range of age was 18-55 years in case group and control group. There was no significant difference found in age between case and control group (p value is 0.383). Among the patients of case group 28 (70.0%) were male and 12 (30.0%) were female. Among the patients of control group 17 (42.5%) were male and 23 (57.5%) were female. Visual analogue score (VAS) score of group A patient was 5.4±1.0 and group B was 5.7±1.1 (p=0.143). At the first follow up the mean VAS score of group A was 4.5±1.0 and group B was 4.8±0.9 (p=0.111). At the second follow up the mean VAS score of group A was 3.1±0.9 and group B was 3.5±0.8 (p=0.077). And at the final (third) follow up the mean VAS score of group A was1.9±0.8 and group B was 2.4±0.6 (p=0.002). Conclusion: There was significant improvement of pain of case group than control group. At the end of study we can tell that, educational booklet is effective for the management of patients with chronic low back pain. Medicine Today 2023 Vol.35(2): 87-90

SURVIVAL OF CEMENT-LINKED CUSTOM IMPLANTS AND THEIR MEDIUM-TERM OUTCOMES SUPPORT THEIR USE IN COMPLEX AND SALVAGE ARTHROPLASTY

AbstractIntroductionPatients presenting with loosening or a fracture between ipsilateral hip and knee replacements provide a unique reconstructive challenge. We present mid-term results of the cement-over megaprosthesis (COM) when managing these complex cases. A COM is cement-linked to the stem of a well-fixed existing implant. We report the largest series to date and show that this may be preferable to total femoral replacement in a cohort of patients who often have significant co-morbidities.MethodologyA retrospective analysis of patients undergoing COM between 2002–2022 was performed. Primary outcomes were defined as implant survival, displayed with survival analysis. Secondary outcomes included mortality and surgical complications. Functional outcomes included Visual Analogue Score (VAS), EuroQol-5D-3L and Musculoskeletal Tumour Society (MSTS) score at one year post operatively.Results34 patients underwent reconstructive cement-over technique. There were 20 custom distal femur replacements and 10 custom proximal femoral replacements. Two patients were revised, with a ten year implant survival of 94%. Fifteen patients died during the study period with an mean time to death of 66 months (25–109). The mean follow up was 75 months. 11 patients (32%) developed surgical complications. Mean VAS score was 4.9 (1–10), EuroQol-5D-3L index 0.45 (−0.59 – 0.88) and MSTS score was 16.8 (2–27) in 29 patients.ConclusionThe COM technique provides good implant survivorship in complex cases with compromised bone stock and this series confirms this as an established alternative to total femoral replacement in these cases.

FUNCTIONAL OUTCOME OF PATIENTS WITH CHRONIC PLANTAR FASCIITIS TREATED BY LOCAL INJECTION OF AUTOLOGOUS PLATELET-RICH PLASMA

Objectives: The objectives of the study are as follows: To assess functional outcome of patients with chronic plantar fasciitis (PF) treated by autologous injection of platelet-rich plasma (PRP). (1) To know the side effects, if any, in these patients. Methods: This was a prospective study conducted in the Department of orthopedics of a tertiary care medical college. Forty patients having chronic PF were included in this study on the basis of a predefined inclusion and exclusion criteria. Autologous PRP was injected in plantar fascia at the point of maximum tenderness. Patients were followed up for 3 months. Intensity of pain and functional outcome was assessed using the visual analog score (VAS) score and American Orthopedic Foot and Ankle Score (AOFAS) score. For statistical purposes, p&lt;0.05 was taken as significant. Results: There were 14 (35.00%) males and 26 (65.00%) females with a M: F ratio of 1:1.85. The mean age of male and female patients was found to be 43.82±9.98 years and 41.68±10.12 years, respectively. Majority of the patients (65%) were overweight whereas 6 (15%) patients were obese and 8 (20%) patients were having a normal healthy body mass index. The mean duration of symptoms was found to be 10.67±3.89 months. The mean VAS score at the time of final follow-up was significantly less (0.96±0.46) as compared to pre-injection VAS score (7.20±1.38) whereas the AOFAS score at the time of final follow-up (91.9±6.68) significantly improved as compared to pre-injection AOFAS score (38.96±8.78). There were no major side effects in any of the studied cases. Conclusion: Local injection of autologous PRP appears to be an effective treatment for chronic PF in terms of reduction of pain and functional improvement with no significant side effects.

Outcome of ganglion impar block in chronic coccydynia

Background: Chronic coccydynia is an annoying condition and is characterized by pain in the tail bone. Most cases are treated conservatively initially but failed conservative management calls for interventions of various type. One of the interventions in the armamentarium of the orthopaedic surgeon is a ganglion impar block. The present study aimed at assessing the outcome of ganglion impar block in chronic coccydynia. Methods: This prospective study of five years duration included 27 patients with chronic coccydynia with failed conservative treatment. Visual analogue score (VAS) and Oswestry disability index (ODI) were used to quantify pain and the improvement in symptoms. Minimum final follow-up was two years. Results: The mean VAS and ODI scores pre-injection were 5.98±1.86 and 52.13±2.13, respectively. The mean VAS and ODI scores at final follow-up were 2.47±1.65 and 23.59±2.34, respectively. The improvement in the above objective scores was found to be statistically significant with a p=0.00257 for VAS score and 0.00425 for ODI score. One patient developed syncope post-injection and one patient complained of superficial injection site pain which persisted for three weeks. No significant or major complication was encountered. Conclusions: Ganglion impar block appears to be a very impressive modality of treatment for chronic coccydynia in view of the simplicity, ease and reproducibility of the technique along with minimal complication rates. However, randomized control trials with large sample size are recommended.

Effect of oral pregabalin on post operative analgesia in patients undergoing lumbar spine fusion surgeries under general anesthesia

Pregabalin has been used successfully as a component of multimodal analgesia regimen in a variety of surgical procedures. However, side effects such as dizziness and somnolence have been reported especially with doses ≥300mg. We hypothesized that using a lower cumulative dose of oral pregabalin in a divided dosing regimen would lower the incidence of side effects while providing adequate postoperative analgesia in patients undergoing lumbar spine fusion surgery. Seventy adult patients of either sex of ASA 1-3, undergoing lumbar spine fusion surgery under general anesthesia were randomly divided into two equal groups. Group B received oral pregabalin 150mg one hour before induction and 75mg 2 hours after surgery. Group A received oral placebo at the corresponding time points. Pain was assessed using Visual Analogue Score (VAS) at extubation, 2, 4, 6, 12, 18 and 24 hours after surgery. In the first 24 hours after surgery, the mean VAS scores were significantly lower in Group B (P0.001) at all time points while tramadol consumption for rescue analgesia (P0.001) and postoperative nausea (P0.013) and vomiting (P0.011) were significantly higher in Group A. Preoperative anxiety and sedation scores and postoperative incidence of dizziness and somnolence were comparable between the two groups. Low dose oral pregabalin preoperatively and postoperatively using a divided dose regimen can be safely used to provide adequate postoperative analgesia with low incidence of side effects after lumbar spine fusion surgeries.

Outcome of Transforaminal Endoscopic Discectomy in Rural India in a Single-Level Lumbar Disc Prolapse Under Local Anesthesia.

Aim The aim of this study was to undertake a clinical study to evaluate the outcomes of transforaminal endoscopic discectomy under local anesthesia and to study the complication rate. Study Design It is a prospective study. Methods We prospectively analyzed outcomes of 60 patients with a single-level lumbar disc prolapse in rural India from December 2018 to April 2020 who underwent endoscopic discectomy under local anesthesia. Follow-up was done using the visual analogue score (VAS) and Oswestry Disability Index (ODI) scoring systems with a minimum follow-up up to 1 year postoperatively. Results In our study of 60 patients, there was 38 cases of L4-L5 disc pathology, 13 L5-S1 discs, and 9 L3-L4 discs. Our study showed a significant clinical reduction in mean VAS score that was 7.07/10 preoperatively and reduced to 3.88/10 at the third month and 3.64/10 at 1 year of follow-up ( p -value < 0.05) showing clinical significance. The ODI scoring done preoperatively was an average mean of 57.37% pointing to how crippled the patients were with lumbar disc prolapse and showed a significant reduction to 29.32% postoperatively at 1 year ( p -value < 0.05) showing clinical significance. This reduction in ODI directly corelates to how almost all patients returned to normal life coping to all activities and were completely pain free at 1 year of follow-up. Conclusion Endoscopic spine surgery in lumbar disc prolapse is highly effective and can deliver a good functional outcome if done with correct preoperative planning and approach.

REFRACTORY PLANTAR FASCIITIS- PRP OR LOCAL CORTICOSTEROID?

Background/Purpose: Plantar Fasciitis is often a nuisance to treat because of its intractable nature. Corticosteroid injections have been conventionally used to treat such cases.One emerging therapeutic modality is the use of PlateletRich-Plasma.We compare the efficacy of the two modalities.Methods: 60 patients with intractable plantar fasciitis were randomised to receive either autologous PRP or Corticosteroid injection. All patients were assessed with the Visual Analogue Score (VAS) for pain and the Foot &amp; Ankle Disability Index (FADI) Score.Data was collected prospectively on the cohort,pre-treatment,and at 1st,2nd,6th and 12th week post injection and the results were compared. Results:Both treatment cohorts had 30 patients, with the PRP injection group having an average age of 42.0 ± 12.98 years and Corticosteroid injection had an average age of 39.4 ± 10.09 years.PRP injection group had male to female ratio of 0.875 while corticosteroid injection group had a ratio of 0.67.Mean FADI scores and VAS scores on 2nd and 6th week of study were significantly higher in corticosteroid injection group as compared to the PRP injection group,while the mean of two scores had no significant difference between the two groups when measured on 1st and 12th week.Conclusion: Although both techniques have similar immediate and long term results,corticosteroid injection has better pain relief in short term

The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures, a randomized clinical trial

BackgroundHip fractures are common in elderly patients. The surgery is usually delayed due to underlying conditions, and pain control is crucial while the patient is cleared for surgery. In this randomized controlled trial (RCT) study, we hypothesized that the application of skin traction in patients with intertrochanteric fracture does not significantly change the Visual Analogue Score (VAS) of pain.MethodsThis is a prospective, single institution, parallel randomized controlled trial. Two hundred and twenty-nine patients with isolated intertrochanteric fractures were enrolled in the study. Patients with neurologic issues, drug addiction, scars or swelling, or vascular issues at the site of skin traction application were excluded from the study. Patients were divided into two groups: group A included 97 patients, and group B included 95 patients. Skin traction was applied for group A, while only a soft pillow was put beneath the patients’ knees in the other group. The VAS score was measured after the diagnosis, two hours before the operation, and 24 h after the surgery. The morphine dosage administered per day was documented for both groups.ResultsAfter excluding patients with postoperative delirium, 154 patients (55 males and 99 females) with isolated intertrochanteric fractures (69 right-sided and 85 left-sided), and a mean age of 70 ± 10 remained in the study. There were no significant differences between the two groups regarding age, gender, and mean time from injury to admission (P > .05). The mean VAS score measures and morphine dosage administered per day were not significantly different between the two groups (P > .05). Both groups experienced significant pain relief 24 h postoperatively (P < .001).ConclusionPre-operative skin traction application affected neither the patients' VAS scores nor the mean morphine dosage per day in patients with isolated intertrochanteric fractures. Our data does not support the routine application of pre-operative skin traction in patients with intertrochanteric fractures.Trial registrationThe project was registered in the Iranian Registry of Clinical Trials (registration reference: IRCT20180729040636N3, registration date: 01/07/2020).Level of evidence1.

A Randomized Double-Blind Prospective Study Comparing the Efficacy of Subperiosteal and Periarticular Injections of a Local Anesthetic for Postoperative Pain Management after Total Knee Arthroplasty.

Total knee arthroplasty (TKA) serves as an effective surgical treatment method for advanced osteoarthritis (OA). Nonetheless, it is associated with postoperative pain that can influence patients' functional outcome. This study aimed to compare the analgesic effect of subperiosteal and periarticular injection methods of a special local anesthetic in patients who underwent TKA. This double-blind prospective clinical study was conducted on patients with advanced knee OA who underwent TKA. Patients were randomly divided into two groups, with a local anesthetic (21 ml) administered either in periarticular (P group) or subperiosteal (S group) forms prior to wound closure. The local anesthetic consisted of lidocaine 2% (15 cc), dexmedetomidine (1 cc), and marcaine 0.5% (5 cc). A study-blinded orthopedic resident recorded postoperative pain levels using a 10-point visual analogue score (VAS) (0 indicating no pain, 10 indicating worst pain) at 6, 12, 24, and 48 hours after surgery. A total of 40 patients (P and S group; n=20 each), consisting of 10 males (mean age=67.4 years old), were included in this study. The intensity of pain in the S group was significantly lower than in the P group 24 hours after surgery (mean VAS scores in the P group: 4±1 vs. the S group: 3.3±0.7, P=0.024). Furthermore, VAS scores at 6, 12, and 48 hours post-surgery were lower in the S group compared to the P group; however, the difference was not statistically significant (P>0.05). Our study indicated that subperiosteal injection of lidocaine, dexmedetomidine, and marcaine is more effective than periarticular injection, providing effective postoperative pain management after TKA.

FUNCTIONAL OUTCOME OF FLEXOR HALLUCIS LONGUS TRANSFER AUGMENTED WITH GASTROCNEMIOUS TURNDOWN FLAP IN THE RECONSTRUCTION OF CHRONIC ACHILLES TENDON RUPTURE

Introduction Chronic spontaneus rupture of Achilles tendon commonly occurs in middle aged and elderly person, which often goes undiagnosed or untreated for long duration, resulting in large gap in between two ruptured ends. Disrupted Tendo Achilles causes weakness in plantar exion of foot and abnormal gait. Surgical repair of the chronic rupture have poor result due to large gap in between ends. Different surgical procedures are described in the literature for Reconstruction of chronic Tendo Achilles injuries without any clear superior technique. Purpose of this study is assessment of functional outcome of Flexor Hallucis Longus transfer augmented by turn down Gastrocnemius ap in chronic Tendo achilles rupture. Methods This study Assessed functional outcome of Chronic achilles tendon rupture, reconstructed by Flexor Hallucis Longus transfer augmented by turndown gastrocnemius ap done at orthopaedics department, Bankura Sammilani medical college between november 2020 to october 2021. Patients were followed up for 12 months and then assessed clinically for range of movement , return to normal mobility , persistance of pain and complications . Functional outcome were assesed by American Orthopaedic Foot and Ankle Society(AOFAS) ankle and hindfoot score and Visual analogue Score (VAS). Observations Out of 8 patients, 6 had Excellent AOFAS score of 90 to 100, while 2 patient had a good score of 80 to 89. None had fair or poor score.None of the patients had wound breakdown, ankle stiffness, persistant nerve palsy or rerupture of the reconstructed tendon. Mean VAS score for pain at 12 month follow for 8 patients was 0, as none had any pain complain. None of the patient had any loss of ankle joint movement or stability, All patient resumed there normal day to day activity but none could restart recreational or sporting activity. Conclusions. Flexor Hallucis Longus transfer with turndown ap augmentation gives good to excellent outcome with minimal complication, if meticulous soft tissue handling and proper wound closure are done.

Arthroscopic anatomical reconstruction of lateral collateral ligaments with ligament advanced reinforcement system artificial ligament for chronic ankle instability.

BACKGROUNDRecently, the use of ligament advanced reinforcement system (LARS) artificial ligament, a new graft which has several unique advantages such as no donor-site morbidity, early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction. Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing. However, the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.AIMTo evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.METHODSTwenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament. The visual analogue score (VAS), American Orthopaedic Foot and Ankle Society score (AOFAS score) and Karlsson score were used to evaluate the clinical results before and after surgery.RESULTSA total of 22 patients (22 ankles) were followed up for a mean of 12 mo. All patients reported significant improvement compared to their preoperative status. The mean AOFAS score improved from 42.3 ± 4.9 preoperatively to 90.4 ± 6.7 postoperatively. The mean Karlsson score improved from 38.5 ± 3.2 preoperatively to 90.1 ± 7.8 postoperatively. The mean VAS score improved from 1.9 ± 2.5 preoperatively to 0.8 ± 1.7 postoperatively.CONCLUSIONAll-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.

A prospective randomised trial comparing the analgesic efficacy of postoperative infusion of epidural bupivacaine and ropivacaine in orthopaedic surgeries

Background: Epidural administration of local anaesthetic provides effective pain relief. Commonly used epidural local anaesthetics are bupivacaine and ropivacaine. Most studies compared these drugs along with an opioid or any other adjuvants like clonidine, dexmedetomidine etc. Our aim was to compare the analgesic efficacy and safety of continuous infusion of epidural ropivacaine and bupivacaine without any adjuvants in postoperative patients. Materials and methods: A prospective randomized clinical study was conducted in a tertiary care hospital in 60 patients between the age groups of 20-years and 60-years undergoing elective lower limb orthopaedic procedures. Total patients were divided into two groups (A and B) of 30 each. Continuous epidural infusion was started with 6ml per hour of 0.125% bupivacaine in Group A and 6ml per hour of 0.2% ropivacaine in Group B postoperatively. After the commencement of epidural infusions, heart rate, blood pressure, Visual Analogue Score (VAS) and supplementary analgesic requirement were monitored postoperatively for 48 hrs. Results: Our observations showed no significant difference in haemodynamic parameters like heart rate and blood pressure. VAS showed a statistically significant difference with higher mean VAS score in Group B patients at one hour (p value = 0.0126), 12 hrs (p value = 0.031) and 24 hrs (p value = 0.0421) as compared to Group A. Add on analgesic requirement was also higher for Group B patients. Conclusions: Both bupivacaine and ropivacaine can be used effectively for postoperative analgesia but bupivacaine has a superior analgesic efficacy than ropivacaine with similar safety profile.

A Comparative Study between Thoracic Epidural and Conventional Methods of Pain Management in Post Thoracotomy Patients

Background: Postoperative discomfort has a negative impact on the outcome of thoracic surgical procedures, which are among the most painful operations. Controlling pain after a thoracotomy enhances patient satisfaction while lowering postoperative morbidity. Aim of the study: The aim of the study was to evaluate the effects of thoracic epidural and conventional pain management methods in post-thoracotomy patients.Material &amp; Methods:A randomized cross-sectional comparative study was conducted among 260 patients of post thoracotomy between January 2018 and December 2020 in a single tertiary-care hospital of Dhaka, Bangladesh. Outcomes of surgery were evaluated using the visual analogue score (VAS) at resting and coughing time.Results:We divided all 260 patients into two groups (group A: thoracic epidural 130; group B: conventional/control 130). The mean age of the patients was 49.74±23.46 years in group A and 50.48±56.23 in group B. There were 61% male patients and 39% female patients, and the male: female ratio was 81:48 in group A, and 78:53 in group B. Mean duration of surgeries was 2.95± 67.92 hours and 2.84± 57.31 hours in group A and B respectively and mean follow up was 1.9 years and 1.4 years in group A and B respectively. The maximum number (36.9%%) of patients were in the age group of 50 to 54 years, and the minimum number (4.61%) of patients were in the age group of 35 to 39 years. In group A, the maximum number (31) of patients had gone through open window formation, and a minimum number of patients (4) had gone through segmentectomy. And in group B, the maximum number (33) of patients had gone through open window formation, and a minimum number (4) had gone through hydatid cyst removal surgery. The change between comparative values of postoperative mean VAS scores at resting time and coughing time of both groups of patients was significant in this study.Conclusions:In thoracotomy surgery, the efficacy of thoracic epidural anesthesia is more evident than in other types of surgery. Although managing thoracotomy pain might be challenging, the advantages of proper pain management are substantial.

Clinical Outcomes of Surgical Correction and Fusion for Postlaminectomy Kyphosis Following Spinal Tumor Resection in Adolescent Patients.

Progressive spinal deformity following laminectomy and resection surgery of spinal tumor has been well-documented. However, the postlaminectomy deformity in adolescent patients often bring challenge to clinical treatment, which may be subjected to rapid progression of kyphosis during the growth spurt. The aim of this study is to investigate the clinical outcome of long fusion correction surgery for thoracic or thoracolumbar kyphotic deformity secondary to laminectomy and tumor resection in adolescent patients. Records of 12 cases underwent correction surgery of postlaminectomy thoracic (n=6) or thoracolumbar (n=6) kyphotic deformity were reviewed. The Cobb angle of sagittal and coronal curve before surgery, immediately after surgery, and at the final follow-up were measured to evaluate the correction of deformity and loss of correction. Neurological function was evaluated using the Frankel grading system. Back pain was assessed by using the visual analog score (VAS). Disability status was evaluated by the Oswestry Disability Index (ODI). Patients' satisfaction to surgery was assessed by the patient satisfactory index. The mean kyphosis angle reduced from 76±20 degrees before surgery to 34±18 degrees immediately after surgery and remained at 39±17 degrees at the final follow-up with the average correction rate of 58.6% and 51.0%, respectively. For 7 patients with concomitant scoliosis, the Cobb angle of major curve reduced from 52±21 degrees before surgery to 16±9 degrees immediately after surgery and 20±9 degrees at the final follow-up. The average corrective rate was 69.5% and 62.4%, respectively. The mean ODI score improved from 19.9±7.5 to 10.8±8.0, whereas the mean VAS score improved from 5.3±2.0 to 1.5±1.4. The sagittal and coronal balance of the spine, Frankel grading, ODI, and VAS were improved, and the patient satisfactory index was 100%. One patient had inferior paraplegia recovered to Frankel grade E after treatment. Satisfactory clinical outcomes can be achieved after long fusion surgery for thoracic or thoracolumbar kyphotic deformity secondary to laminectomy for spinal tumor. Due to the high risk of secondary kyphotic deformity in adolescent patients, internal fixation should be performed simultaneously with the resection of spinal tumor, especially for the cases in the thoracic or thoracolumbar region. Level III.

Comparison of Efficacy of Adductor Canal Block, Local Infiltration Analgesia and Both Combined in Postoperative Pain Management After Total Knee Arthroplasty: A Randomized Controlled Trial.

The aim of our study is to compare the efficacy of adductor canal block (ACB), periarticular local infiltration (PLI) and both combined (ACB + PLI) in multimodal pain management after TKA. This is a prospective, randomized controlled double-blinded study undergoing primary unilateral TKA. They were randomized into three groups with fifty patients in each group: ACB alone (30ml of 0.2% ropivacaine), PLI alone (30ml 0.5% ropivacaine in 20ml of normal saline), and both combined (ACB + PLI). The primary outcome studied was pain using visual analog score (VAS) in postoperative days (POD) 1 and 2. The secondary outcomes estimated were the ambulation capacity, the knee range of motion, need for rescue analgesia and length of hospital stay. The mean VAS score was significantly lower at rest and after mobilization in the combined group (3.51 at POD 1, 2.04 at POD 2), compared with either alone group (ACB = 4.70, 2.86 versus PLI = 4.39, 3.41 at POD 1 and 2 respectively after mobilization, p < 0.001). The ambulation capacity (combined = 103.3 steps versus ACB = 98.1 and PLI = 95.2 steps, p = 0.04) and the knee range of motion (arc of motion 106.7 degrees versus ACB = 104.9 and PLI = 102.2 degrees, p = 0.004) were significantly higher in the combined group compared to the other groups. There was no significant difference in the length of stay between the groups (p = 0.12). Adductor canal block combined with periarticular local infiltration provides better pain relief, good range of motion, quicker rehabilitation, and reduced opioid consumption.

Proximal fibular osteotomy in medial OA knee

Background: Osteoarthritis (OA) of the knee is an emerging cause of morbidity and indirect mortality encountered by the clinician. Failure to respond to conservative management is common and surgery is the usual outcome. Total Knee arthroplasty (TKA) and Unicondylar knee arthroplasty (UKA) have displayed dependable results but are demanding surgeries with a limited lifespan. High tibial osteotomy (HTO) corrects the alignment of the limb and improve knee function but is associated with a series of complications and difficult conversion. Recent studies on Proximal Femoral Osteotomy (PFO) in medial OA of the knee proclaim much relief in pain and correction of limb alignment. We conducted a prospective interventional study to evaluate the functional and radiological outcome of PFO in medial OA knee. Materials and Methods: 18 patients (30 knees) of medial OA knee with Kellgren Lawrence (KL) grade 2 and 3 disease underwent PFO after written informed consent and institutional review board clearance. The patients were followed up at 3 months, 6 months and 1 year and Femoro-Tibial angle (FTA), Visual Analogue Score (VAS), Knee injury and Osteoarthritis Outcome score (KOOS) and Oxford Knee Score (OKS) were documented pre-operatively and at each follow up. Result: The mean age in our study was 64 years. The mean VAS score was 6.86 pre-operatively while 3-month VAS was 6.96 and its 12 month value was 7.26 The mean pre-operative OKS was 34.26 which decreased to 33.36 at 3 months and 32.26 at 12 months. The mean pre-operative KOOS was 52.99 while it was 51.88 at 3 months and worsened to 50.98 at the final follow up. The mean FTA pre operatively was 182.96 degree and at 1 year follow up it deteriorated to 183.26 degree. 3 patients (10%) informed paresthesias and weakness in the foot which resolved on medical management. Conclusion: We did not observe relief in pain and function after PFO. The limb alignment did not improve at 1 year follow up. The authors conclude that more evi