Patients Undergoing Knee Surgery Research Articles

Specific discrimination of pathogenic bacteria causing septic arthritis using Raman spectroscopy: In-vitro study

In this study we performed preliminary experiments using Raman spectroscopy as an evolving technology in biofluid and microbial characterization, to explore its potential for rapid diagnosis of pathogenic bacteria in an in-vitro synovial fluid infection model. Normal human synovial fluids samples were collected from patients undergoing knee surgery and the three most common pathogenic bacteria introduced in-vitro into the samples. The bacterial growth was systematically monitored using a Raman spectroscopy. Multivariate regression analysis of acquired spectra showed bacterial characteristic Raman bands related to bacterial cell membranes and DNA structures to increase continuously as the incubation period was increased. Spectra signature recorded from cultured synovial fluid samples showed a significant loss in synovial quality and protein morphology over time compared to control samples. In this study, Raman spectroscopy shows promise for rapid pathogenic bacteria identification in synovial fluid. Marker peaks distinguished inoculated bacteria, while chemical changes reveal infection dynamics.

'I've just got to take that risk and have faith . . .': The challenge of gaining and maintaining trust in patients undergoing knee surgery with a regional anaesthetic.

Traditionally, the focus of the operating theatre has been on conducting safe, efficient surgery with unconscious patients. However, the care of awake patients is now a prominent feature of modern perioperative practise as the volume of surgery performed under regional anaesthesia increases. The aim of this novel study was to understand the experience of being a conscious patient during regional anaesthesia and knee surgery in the perioperative environment. Data were gathered through observation and ethnographic interview and analysis followed a constant comparative grounded theory approach. The concepts of Trust and Faith are identified as recurrent themes highlighted in the data. This article identifies the need to understand patients' expectations regarding the clinical encounter and how subsequent treatment will develop, so that, reasons for any deviation can be discussed openly and an explanation provided. Each clinical encounter takes place within a relationship based upon an uneven distribution of power, enacted through the interaction itself, with the health care professional in a dominant role. It is the responsibility of health care staff to recognise and negate this power imbalance and reinforce trusting relationships so information and treatment options are not presented as a 'fait accompli' but negotiated through jargon free easy to understand language.

Individual Factors Modifying Postoperative Pain Management in Elective Total Hip and Total Knee Replacement Surgery.

Total hip and knee replacements are the most common orthopedic procedures performed due to osteoarthritis. Pain is an intrinsic symptom accompanying osteoarthritis, persisting long before surgery, and continuing during the preoperative and postoperative periods. Appropriate pain management after surgery determines the comfort, duration, and cost of hospitalization, as well as the effectiveness of postoperative rehabilitation. Individual differences in pain perception and tolerance in orthopedic patients remain an important research topic. Therefore, the aim of this study was to investigate the predictors of analgesic requirements (morphine, acetaminophen, and ketoprofen), including individual pain threshold and tolerance, body mass index (BMI), diabetes, and beliefs about pain control in patients undergoing elective hip or knee arthroplasty using a multilevel regression model (N = 147, 85 women, 62 men, 107 after hip replacement, and 40 after knee replacement). Results: Higher pain tolerance was associated with a lower dose of morphine per kg after surgery. Patients undergoing hip surgery received a lower dose of ketoprofen than patients undergoing knee surgery. The more the patient believed in personal pain control, the stronger the negative relationship between pain tolerance and morphine requirement. The lowest doses were given to patients with the highest pain tolerance and the greatest belief in personal control. Factors such as belief in pain control and pain tolerance should be considered in comprehensive postoperative pain management in orthopedic patients to reduce opioid doses and, thus, side effects.

Evaluating the Role and Impact of Health Literacy for Patients Undergoing Knee Surgery.

Health literacy is defined as "the capacity to obtain, process, and understand basic medical information and services and the competence to use such information and services to enhance health." Much of the research regarding health literacy in orthopaedic surgery has focused on readability of educational materials. However, the role of health literacy in patient-reported outcomes is somewhat unknown. The purpose of this review was to evaluate the body of literature pertaining to health literacy and knee surgery outcomes. A literature search was performed using keywords and MeSH terms in PubMed/MEDLINE, Scopus, PsycINFO, SPORTDiscus, and Cochrane. Articles written between 1990 and 2021 were evaluated for inclusion. The title and abstract of all studies returned in each database search were screened. In the case that these did not provide sufficient information, the full-text article was reviewed. The initial database search returned a total of 974 articles for review. Eight of these were duplicate results, and one article had been retracted after publication, leaving a total of 965 to be screened for inclusion. Ninety-six articles remained after screening titles and abstracts for relevance. After applying inclusion criteria, six articles remained and were included in this review. It is clear that health literacy impacts patient outcomes in health care and this review suggests that general and musculoskeletal health literacy affect patient expectations, outcomes, and satisfaction before and after knee surgery. However, the peer-reviewed literature on this topic is still deficient in terms of determining effective methods for addressing this barrier to optimal patient care. Research should focus on further elucidation of the relationships among health literacy, readability, and patient education for optimizing patient outcomes and satisfaction across orthopaedic subspecialties.

Evaluation of Postoperative Analgesia on Addition of Dexmedetomidine to Ropivacaine 0.2% in Femoral Nerve Block in Patients undergoing Open Knee Surgery-A Randomised Single Blinded Study

Introduction: Femoral Nerve Block (FNB) renders marked postoperative analgesia in patients undergoing knee surgery and use of adjuvant to Local Anaesthetic (LA) agent is more advantageous in lengthening duration of sensory effect of block. Aim: To evaluate the effect of addition of dexmedetomidine to 0.2% Ropivacaine in FNB. Materials and Methods: The randomised clinical trial was conducted at Medical College and SSG Hospital, Vadodara, Gujarat, India which included 60 patients of either sex, American Society of Anaesthesiologists (ASA) Grade-I,II,III posted for open knee surgery. Patients were randomly allocated to two groups-Group RD patients received 0.2% ropivacaine 20 milliliter (mL) with dexmedetomidine 2 mL (50 μg) and Group R received 0.2% ropivacaine 20 mL with normal saline 2 mL for FNB. Duration of postoperative analgesia, total requirement of systemic rescue analgesic in 24 hours, vital parameters and complications were observed. Statistical analysis was done with Medcalc 14.8.1 statistical software. A p<0.05 considered as significant. Result: Duration of analgesia was significantly longer in Group RD (484±26.98 min) than in Group R (338±29.40 min), p<0.0001. Mean postoperative cumulative requirement of analgesic (Tramadol) was lesser in Group RD (207±25 milligram (mg)) than in Group R (290±30 mg), p<0.0001. Conclusion: Dexmedetomidine to ropivacaine 0.2% for FNB significantly augments duration of analgesia and reduces requirement of systemic analgesic declining its unfavourable effect.

Blood Flow Restriction Following ACL Reconstruction

Background: Blood flow restriction (BFR) therapy is a technique that uses partial occlusion of arterial blood flow in tandem with low-load resistance training to promote an environment of metabolic stress within muscle tissue. It is hypothesized that such therapy can facilitate protein synthesis and muscle hypertrophy even in the setting of age, injury, or postoperative rehabilitation—conditions which are marred by muscle atrophy and progressive loss of function. Therefore, BFR may be a successful option to facilitate strength gains even in patients unable to perform traditional high-load resistance training. Indications: BFR therapy has been shown to be efficacious when used in healthy athletes, the elderly, or in postoperative patients undergoing rehabilitation after upper or lower extremity procedures. More specifically, BFR application in patients undergoing knee surgery has been shown to reduce muscle atrophy post operatively. Technique Description: BFR involves application of a tourniquet or occlusion cuff at 70% of the determined arterial occlusion pressure (commonly 150-180 mm Hg). The arterial occlusion pressure is calculated by observing the loss of Doppler ultrasonography signal at the pedal pulses with sequential inflation of a blood pressure cuff. This cuff should be applied as proximal as possible at the affected extremity. The patient subsequently performs 5 exercises, including 3 sets of 15 repetitions of each exercise, with 30 seconds of rest in between sets. The cuff remains inflated for all 5 exercises. Results: BFR in tandem with low-load resistance training has been shown to be effective in improving lower extremity muscle torque and mass of the quadriceps and hamstring muscles when used after knee surgery, specifically anterior cruciate ligament (ACL) reconstruction. The most commonly reported adverse outcomes after BFR include muscle soreness and sensory paresthesias; however, BFR is generally believed to be safe and acceptable for use in a broad spectrum of patients. Discussion/Conclusion: Muscle atrophy and loss of strength are hallmarks of aging, injured, and postoperative patients. Traditional means of high-intensity strength training is not feasible in these patient populations, and the use of BFR in tandem with lower intensity strength training shows promise in its ability to promote improvements in muscle strength and hypertrophy. However, more high-level research into the long-term effects, complications, and optimal BFR training regimen is warranted. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Comparison of the Efficacy between Femoral Nerve Block and Fascia Iliaca Compartment Block for Postoperative Analgesia in Patients after Knee Surgery

Background: Moderate to severe pain develop after knee surgery results prolong hospital stay and delay return to normal daily activities. Various analgesic modalities have been used for postoperative analgesia in patients undergoing knee surgery. Both femoral nerve block (FNB) block and fascia iliaca compartment block (FIB) are used routinely for postoperative pain relief in patients undergoing knee surgery. Objectives: To compare the efficacy of postoperative analgesia of FNB & FIB in postoperative period among patients undergoing knee surgery under sub- arachnoid block. Methods: This Randomized Clinical Trial was performed in Combined Military Hospital (CMH), Dhaka from July 2020 to December 2020. Forty patients scheduled for routine knee surgery under sub-arachnoid block belonging to ASA class I, II and III were included in the study and randomly divided into two groups with 20 patients in each group. At the end of surgery, In Group A (n= 20) femoral nerve block was employed & in Group B (n=20) fascia iliaca compartment block was employed. Results: Significant relief of pain occurred in recovery room in group B than group A (3.67±0.802 vs 4.3±0.877; p<0.05). This improvement was noticed in group B at 6 and 24 hours follow up (p<0.05 in all follow up). Post-operative analgesic consumptions was also lower in group B at 1, 12 & 24 hours follow up (p<0.05 in all follow up). Demographic characteristics were similar across the two groups in terms of age, sex, BMI and ASA grading (p>0.05 in all cases). No significant difference was noted in both pre-operative, post-operative and recovery room heart rate (p>0.05) and mean arterial pressure (p>0.05). Complication was similar in both groups. Conclusion: Fascia iliaca compartment block (FIB) for management of post-operative analgesia in knee surgery is more effective than femoral nerve block (FNB).

Mitochondrial Dysfunction Affects the Synovium of Patients with Rheumatoid Arthritis and Osteoarthritis Differently.

There is growing evidence regarding the role of mitochondrial dysfunction in osteoarthritis (OA) and rheumatoid arthritis (RA). However, quantitative comparison of synovial mitochondrial derangements in these main arthritis forms is missing. A prospective clinical study was conducted on adult patients undergoing knee surgery. Patients were allocated into RA and OA groups based on disease-specific clinical scores, while patients without arthritis served as controls. Synovial samples were subjected to high-resolution respirometry to analyze mitochondrial functions. From the total of 814 patients, 109 cases were enrolled into the study (24 RA, 47 OA, and 38 control patients) between 1 September 2019 and 31 December 2021. The decrease in complex I-linked respiration and dyscoupling of mitochondria were characteristics of RA patients, while both arthritis groups displayed reduced OxPhos activity compared to the control group. However, no significant difference was found in complex II-related activity between the OA and RA groups. The cytochrome C release and H2O2 formation were increased in both arthritis groups. Mitochondrial dysfunction was present in both arthritis groups; however, to a different extent. Consequently, mitochondrial protective agents may have major benefits for arthritis patients. Based on our current study, we recommend focusing on respiratory complex I in rheumatoid arthritis research.

Identification of sarcopenic obesity in adults undergoing orthopaedic surgery: Relationship between "a body shape index" (ABSI) and fat-free mass. A cross -sectional study.

BackgroundSarcopenic obesity is a condition characterised by the coexistence of low muscle mass and function (sarcopenia) and excessive fat mass (obesity). The aim of this study was to determine the prevalence of this condition in patients undergoing orthopaedic surgery by gender and type of orthopaedic surgery. In addition, this study investigated the suitability of a waist circumference-based anthropometric measure, body shape index (ABSI), for predicting sarcopenic obesity and the predictive power of ABSI for fat-free mass index (FFMI), a surrogate marker of lean body mass.Methods and findingsA cross-sectional study of overweight and obese orthopaedic patients undergoing knee or hip and spine surgery was conducted between October 2019 and March 2020 in Orthopaedic Hospital Valdoltra, Slovenia. General anthropometric parameters body mass index (BMI) and ABSI = (WC/(BMI2/3x height½) as well as body composition data (fat mass FM, fat-free mass FFM, FFMI, and the ratio FM/FFM as an index of sarcopenic obesity) were determined in 120 women (aged 66.5 ± 9.6 years) and 89 men (aged 65.5 ± 7.8 years) with overweight (25 kg/m2 ≤ BMI < 30 kg/m2) and obesity (BMI ≥ 30 kg/m2) by bioelectrical impedance analysis (BIA). Sarcopenic obesity phenotypes based on FM/FFM ratio > 0.80 was present in 15.3% of patients, mainly in female patients undergoing knee surgery. ABSI was significantly associated with age in all women and obese men and with waist circumference (WC) in all patients. ABSI did not correlate with BMI in women and men; however, multiple linear regression analysis showed that BMI independently predicted FFMI (R = 0.83 and 0.70, respectively, p < 0.001) in women and men (β-coefficients: 0.801 and 0.686, respectively) and ABSI in women only (β-coefficient: -0.104). Women with a lower ABSI had a significantly higher FFMI than the group with a higher ABSI.ConclusionsSarcopenic obesity was most prevalent in obese women scheduled for knee surgery. In addition, ABSI, independently predicted FFMI in women and represents a significant predictor of sarcopenic obesity.

Femur Length is Correlated with Isometric Quadriceps Strength in Post-Operative Patients.

BACKGROUNDFew existing studies have examined the relationship between lower extremity bone length and quadriceps strength.PURPOSE/HYPOTHESISTo evaluate the relationship between lower extremity, tibia and femur lengths, and isometric quadriceps strength in patients undergoing knee surgery. The null hypothesis was that there would be no correlation between lower extremity length and isometric quadriceps strength.STUDY DESIGNCross-sectional studyMETHODSPatients with full-length weightbearing radiographs that underwent isometric quadriceps strength testing after knee surgery were included. Using full-length weightbearing radiographs, limb length was measured from the ASIS to the medial malleolus; femur length was measured from the center of the femoral head to the joint line; tibia length was measured from the center of the plateau to the center of the plafond. Isometric quadriceps strength was measured using an isokinetic dynamometer. Pearson’s correlation coefficient was used to report the correlation between radiographic limb length measurements. A Bonferroni correction was utilized to reduce the probability of a Type 1 error.RESULTSForty patients (26 males, 14 females) with an average age of 25.8 years were included. The average limb, femur, and tibia lengths were not significantly different between operative and non-operative limbs (p>0.05). At an average of 5.8±2.5 months postoperatively, the peak torque (156.6 vs. 225.1 Nm), average peak torque (151.6 vs. 216.7 Nm), and peak torque to bodyweight (2.01 vs 2.89 Nm/Kg) were significantly greater in the non-surgical limb (p<0.01). Among ligament reconstructions there was a significant negative correlation between both limb length and strength deficit (r= -0.47, p=0.03) and femur length and strength deficit (r= -0.51, p=0.02). The average strength deficit was 29.6% among the entire study population; the average strength deficit was 37.7% among knee ligament reconstructions. For the non-surgical limb, femur length was significantly correlated with peak torque (r = 0.43, p = 0.048).CONCLUSIONFemur length was significantly correlated with the isometric quadriceps peak torque for non-surgical limbs. Additionally, femur length and limb length were found to be negatively correlated with quadriceps strength deficit among ligament reconstruction patients. A combination of morphological features and objective performance metrics should be considered when developing individualized rehabilitation and strength programs.

Measuring "pain load" during general anesthesia.

IntroductionFunctional near-infrared spectroscopy (fNIRS) allows for ongoing measures of brain functions during surgery. The ability to evaluate cumulative effects of painful/nociceptive events under general anesthesia remains a challenge. Through observing signal differences and setting boundaries for when observed events are known to produce pain/nociception, a program can trigger when the concentration of oxygenated hemoglobin goes beyond ±0.3 mM from 25 s after standardization.MethodfNIRS signals were retrieved from patients undergoing knee surgery for anterior cruciate ligament repair under general anesthesia. Continuous fNIRS measures were measured from the primary somatosensory cortex (S1), which is known to be involved in evaluation of nociception, and the medial polar frontal cortex (mPFC), which are both involved in higher cortical functions (viz. cognition and emotion).ResultsA ±0.3 mM threshold for painful/nociceptive events was observed during surgical incisions at least twice, forming a basis for a potential near-real-time recording of pain/nociceptive events. Evidence through observed true positives in S1 and true negatives in mPFC are linked through statistically significant correlations and this threshold.ConclusionOur results show that standardizing and observing concentrations over 25 s using the ±0.3 mM threshold can be an arbiter of the continuous number of incisions performed on a patient, contributing to a potential intraoperative pain load index that correlates with post-operative levels of pain and potential pain chronification.

"Effectiveness of Blood Flow Restriction Training in Patients Undergoing Knee Surgery"

"Effectiveness of Blood Flow Restriction Training in Patients Undergoing Knee Surgery"

Very Low Risk for In-hospital Adverse Outcome Such as ST-elevation or Non-ST-elevation Myocardial Infarction in Patients Undergoing Knee Surgery.

Knee surgery is a very common surgery. The risk of cardiac events is thought to be low. The goal of this study was to evaluate inpatients adverse outcomes such as ST-elevation myocardial infarction (STEMI) or Non-ST-elevation myocardial infarction in patients undergoing knee surgery. Using the nation inpatient sample database, we evaluated the occurrence of STEMI and Non-STEMI in a very large population. Using 2 random samples from 2005 to 2014, 10 years apart involving 7444 knee surgeries, the occurrence of STEMI and Non-STEMI were very low. In 2005, only 1 STEMI (0.0%) and 4 non-STEMI (0.1%) events occurred in inpatient knee-surgery patients. In the 2014 group, 0 STEMI (0.0%) and 5 non-STEMI (0.16%) events occurred in inpatient knee-surgery patients. Overall, STEMI or non-STEMI events occurred in 0.13% of inpatient knee-surgery procedures. Inpatients' adverse outcome of patients undergoing knee surgery is very low suggesting that extensive cardiac workup for knee surgery may not be warranted.

FNIRS brain measures of ongoing nociception during surgical incisions under anesthesia.

SignificanceFunctional near-infrared spectroscopy (fNIRS) has evaluated pain in awake and anesthetized states.AimWe evaluated fNIRS signals under general anesthesia in patients undergoing knee surgery for anterior cruciate ligament repair.ApproachPatients were split into groups: those with regional nerve block (NB) and those without (non-NB). Continuous fNIRS measures came from three regions: the primary somatosensory cortex (S1), known to be involved in evaluation of nociception, the lateral prefrontal cortex (BA9), and the polar frontal cortex (BA10), both involved in higher cortical functions (such as cognition and emotion).ResultsOur results show three significant differences in fNIRS signals to incision procedures between groups: (1) NB compared with non-NB was associated with a greater net positive hemodynamic response to pain procedures in S1; (2) dynamic correlation between the prefrontal cortex (PreFC) and S1 within 1 min of painful procedures are anticorrelated in NB while positively correlated in non-NB; and (3) hemodynamic measures of activation were similar at two separate time points during surgery (i.e., first and last incisions) in PreFC and S1 but showed significant differences in their overlap. Comparing pain levels immediately after surgery and during discharge from postoperative care revealed no significant differences in the pain levels between NB and non-NB.ConclusionOur data suggest multiple pain events that occur during surgery using devised algorithms could potentially give a measure of “pain load.” This may allow for evaluation of central sensitization (i.e., a heightened state of the nervous system where noxious and non-noxious stimuli is perceived as painful) to postoperative pain levels and the resulting analgesic consumption. This evaluation could potentially predict postsurgical chronic neuropathic pain.

This Month in Anesthesiology

This Month in Anesthesiology

A High-Sensitivity International Knee Documentation Committee Survey Index From the PROMIS System: The Next-Generation Patient-Reported Outcome for a Knee Injury Population

Background: Patient-reported outcomes (PROs) measure progression and quality of care. While legacy PROs such as the International Knee Documentation Committee (IKDC) survey are well-validated, a lengthy PRO creates a time burden on patients, decreasing adherence. In recent years, PROs such as the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function and Pain Interference surveys were developed as computer adaptive tests, reducing time to completion. Previous studies have examined correlation between legacy PROs and PROMIS; however, no studies have developed effective prediction models utilizing PROMIS to create an IKDC index. While the IKDC is the standard knee PRO, computer adaptive PROs offer numerous practical advantages. Purpose: To develop a nonlinear predictive model utilizing PROMIS Physical Function and Pain Interference to estimate IKDC survey scores and examine algorithm sensitivity and validity. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The MOTION (Military Orthopaedics Tracking Injuries and Outcomes Network) database is a prospectively collected repository of PROs and intraoperative variables. Patients undergoing knee surgery completed the IKDC and PROMIS surveys at varying time points. Nonlinear multivariable predictive models using Gaussian and beta distributions were created to establish an IKDC index score, which was then validated using leave-one-out techniques and minimal clinically important difference analysis. Results: A total of 1011 patients completed the IKDC and PROMIS Physical Function and Pain Interference, providing 1618 complete observations. The algorithms for the Gaussian and beta distribution were validated to predict the IKDC (Pearson = 0.84-0.86; R2 = 0.71-0.74; root mean square error = 9.3-10.0). Conclusion: The publicly available predictive models can approximate the IKDC score. The results can be used to compare PROMIS Physical Function and Pain Interference against historical IKDC scores by creating an IKDC index score. Serial use of the IKDC index allows for a lower minimal clinically important difference than the conventional IKDC. PROMIS can be substituted to reduce patient burden, increase completion rates, and produce orthopaedic-specific survey analogs.

Comparing the minimum local anesthetic dose of ropivacaine in real-time ultrasound-guided spinal anesthesia and traditional landmark-guided spinal anesthesia: a randomized controlled trial of knee surgery patients.

BackgroundThrough previous studies and clinical practice, we have found that real-time ultrasound-guided (UG) spinal anesthesia (SA) and traditional landmark-guided (LG) SA each require a different minimum local anesthetic dose (MLAD) of ropivacaine. For this study, we used Dixon’s up-and-down sequential method to analyze and compare the MLAD of different ropivacaine concentrations required for the UG and LG SA methods.MethodsA total of 120 patients undergoing knee surgery were consecutively recruited and randomly divided into four groups (30 patients per group). These groups were categorized as follows: Group I: high ropivacaine ultrasound-guided (HRUG), Group II: low ropivacaine ultrasound-guided (LRUG), Group III: high ropivacaine landmark-guided (HRLG), and Group IV: low ropivacaine landmark-guided (LRLG). SA was established by a bolus administration of up-and-down doses of 0.75% or 0.5% plain ropivacaine. Initial doses of 16, 18, 12, and 14 mg were administered to groups I–IV, and after that, increased or decreased by 1.5 mg according to dose effectiveness. Upon identifying the intervertebral puncture level, a lumbar X-ray was performed with metal markers, and actual radiographic findings were identified and compared to the initial markings.ResultsFor UG groups, the MLAD in the LRUG group was significantly higher than in the HRUG group [20.192 mg (95% CI, 19.256–21.174) versus 17.176 mg (95% CI, 16.276–18.124), respectively; P<0.001]. For LG groups, the MLAD in the LRLG group was significantly higher than in the HLRG group [14.478 mg (95% CI, 13.364–15.500) versus 13.201 mg (95% CI, 11.959–14.571), respectively; P=0.047]. When comparing both high ropivacaine groups (HRGs: I/III) to the low ropivacaine groups (LRGs: II/IV), we found that both UG subgroups (I/II) had a significantly higher MLAD than LG subgroups (III/IV) (P<0.001). US identified L4–5 in up to 90% of cases. Comparatively, palpation was successful in only 33.3% of patients. The rates of cephalad localization by US and palpation were 6.67% vs. 66.67%, respectively (P=0.002).ConclusionsWe found a higher MLAD of ropivacaine was required for UG SA at the L4–5 level due to the method providing a more accurate (less cephalad) localization than traditional LG SA.Trial RegistrationChinese Clinical Trial Registry ChiCTR2000033158.

Ultrasound-Guided Sciatic and Femoral Block in Patient with Recent Embolism Stroke Undergo Amputation Above the Knee

Background: Patients undergoing amputation of the lower extremities usually have poor circulation and other comorbidities and, therefore, present a challenge to the anesthesiologist. The combination of sciatic and femoral nerve block is reported to be an effective anesthetic technique for patients undergoing knee surgery, and it is known to be an effective method of postoperative analgesia in patients undergoing major surgery on the subject's lower extremities. Case: A 70-year-old man with a recent embolism stroke, death of his limb on the right cruris region, and underwent an amputation above the knee. Preoperative physical examination showed GCS E4 V, motor aphasia M6, blood pressure 131/82 mmHg, pulse 114 bpm, RR 20 times/minute with bodyweight 70 kg, height 160 cm, SpO2 97%. There was cyanosis in the right cruric region with motor power of 1/5 1/5. The value of leukocytes 18,600/ul, platelets 309,000/ul, Prothrombin Time (PT) 15.8 seconds, Activated partial thromboplastin time (APTT) 25.9 seconds, International normalized ratio (INR) 1,330, neutrophils 81.7%, lymphocytes 12.6%, creatinine 1.8 mg/dl, urea 137 mg /dl, blood sugar at the time 258 mg/dl, Cl 95 mmol/l. This case report suggests that ultrasound-guided peripheral nerve blocks may be useful for major lower extremity surgery in patients with severe hemodynamic impairment. Conclusion: Perioperative management of embolism stroke patients undergoing above-knee amputation requires special attention in selecting anesthetics. Ultrasound-guided peripheral nerve blocks minimize patient hemodynamic changes and provide better postoperative pain control.

The Effects of Blood Flow Restriction in Patients Undergoing Knee Surgery: A Systematic Review and Meta-analysis

Background: Blood flow restriction (BFR) training has been shown to have beneficial effects in reducing quadriceps muscle atrophy and improving strength in patients with various knee pathologies. Furthermore, the effectiveness of BFR training in patients undergoing knee surgery has been investigated to determine if its use can improve clinical outcomes. Purpose/Hypothesis: The purpose of this study was to conduct a systematic review and meta-analysis to examine the effectiveness of BFR training in patients undergoing knee surgery. We hypothesized that BFR, before or after surgery, would improve clinical outcomes as well as muscle strength and volume. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: This systematic review and meta-analysis of peer-reviewed literature was conducted using PubMed, Embase, and Cochrane databases from 1980 to present. Search results were limited to those assessing BFR training in patients undergoing knee surgery published in a scientific peer-reviewed journal in English. Selected studies subsequently underwent data extraction, methodological quality assessment, and data analysis. Results: Eleven studies were eligible, including anterior cruciate ligament reconstruction (n = 10) and knee arthroscopy (n = 1). Two studies specifically assessed BFR use in the preoperative time frame. For the meta-analysis, including 4 studies, the primary outcome variables included the cross-sectional area of the quadratus femoris muscle group assessed with magnetic resonance imaging or ultrasonography, and patient-reported outcome measure scores. The results demonstrated that BFR use in the postoperative time period can lead to a significant improvement in the cross-sectional area when quantifying muscle atrophy. However, there were no significant differences found for patient-reported outcome measures between the included studies. It should be noted that 4 of the included papers in this review reported increases in clinical strength when using BFR in the postoperative setting. Last, preoperative BFR training did not show any significant clinical benefit between the 2 studies. Conclusion: This is the first systematic review and meta-analysis to study the effects of BFR in patients undergoing knee surgery. The results of this analysis show that BFR in the postoperative period after knee surgery can improve quadriceps muscle bulk compared with a control group. However, future research should examine the effects of preconditioning with BFR before surgery. Lastly, BFR protocols need to be further investigated to determine which provide the best patient outcomes. This will help standardize this type of treatment modality for future studies.

Patients Undergoing Hip or Knee Arthroplasty in Poland Based on National Data-Challenge for Healthcare in Aging Society.

Arthroplasty procedures are more frequently performed due to their impact on the quality of life. The aim of this study was to evaluate and analyze the Polish national datasets and registries for hip and knee arthroplasty across Poland in order to describe and understand the challenges for healthcare in an aging society. The study included national data on 83,525 hip or knee arthroplasties performed in 2017. Of those, 78,388 (93.8%, 63.0% females) were primary operations: 66.6% underwent hip replacement surgery (HPRO, mean age 68.43 years, SD 11.9), and 5137 were secondary operations (females: 62.9%), with 75.2% of those being HPRO (mean age 69.0 years, SD 12.0). The mean age of the patients undergoing knee surgery (KPRO) was 68.50 years (SD 8.2). The majority (79.9%) were scheduled. The main reason for hospitalization was arthrosis (84.2% in total, HPRO—76.5%, and KPRO—99.5%), then trauma (15.1%; p < 0.001). In 5137 cases (6.2%, 62.9% females) in revision surgery group, 75.2% underwent HPRO (mean age 69.0 years; SD12.0), and 24.8% KPRO (mean age 68.0 years; SD 10.5). Similarly, 71.1% were scheduled. The main reason for hospitalization was complications (total—90.9%, HPRO—91.4%, and KPRO—89.4%) (p < 0.001). Comorbidities were present (over 80%) with the level of influenza, hepatitis B vaccination, and pre-hospital rehabilitation not exceeding 8% each in both groups. Due to the increasing age of patients, implicating comorbidities, there is a need for better preparation prior to surgery.