Patients Undergoing Knee Arthroscopy Research Articles

Should Preoperative Antibiotics Be Given in Simple Knee Arthroscopy?

Previous studies on the efficacy of preoperative antibiotics in preventing infections in patients undergoing knee arthroscopy (KA) have been either poorly designed or underpowered. The purpose of this study was to determine the association between the use of preoperative antibiotics and the risk of postoperative infection following simple KA. A health care organization's electronic medical records were used to identify patients who underwent simple KA between 2007 and 2012. Patient demographics, potential infection risk factors, and prophylactic antibiotic administration data were extracted. Simple KA included debridement, synovectomy, meniscectomy, meniscus repair, and lateral release. Complex knee arthroscopy and arthroscopy for knee sepsis were excluded. Deep infection was defined as a positive synovial fluid culture or gross pus in the knee. Superficial infection was defined as clinical signs of infection localized to the portal sites treated with an antibiotic. Of 44,112 simple knee arthroscopies, 35,518 (80.5%) received preoperative antibiotics and 8604 (19.5%) did not. The two treatment groups were similar with respect to patient demographics and infection risk factors. There were 30 deep infections in the antibiotic group (0.084%) and 11 in the non-antibiotic group (0.13%). There was no significant association between administering preoperative antibiotics and the risk of a deep infection (Risk Ratio (RR) = 0.66, 95% Confidence Interval (CI): 0.33 to 1.32, p=0.24). There were 156 superficial infections in the antibiotic group (0.44%) and 31 in the non-antibiotic group (0.36%); this difference was also not statistically significant (RR = 1.30, 95% CI: 0.88 to 1.93, p=0.23). In our large sample, there was no statistically significant association between preoperative antibiotic use and either deep or superficial infection. Any effect of preoperative antibiotic use is likely to be very small and must be balanced against the potential negative consequences, such as allergic reactions, clostridia difficile colitis, development of resistant organisms, and cost.

Effect of Celebrex on preoperative pain in patients undergoing knee arthroscopy: a prospective randomized, double-blind, placebo-controlled trial

Objective To investigate the effect of Celebrex on the preoperative pain in patients undergoing knee arthroscopy. Methods From June 2012 to May 2013, 30 patients who would receive knee arthroscopy for simple acute or sub-acute knee injury were enrolled in the study after they had been accessed by Pittsburgh Sleep Quality Index (PSQI), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale(SAS). They were 8 males and 22 females, aged from 15 to 59 years. They were evenly randomized into a Celebrex group and a vitamin C group (n= 15). The patients in Celebrex group took 200mg Celebrex twice a day from day 2 to day 4 after admission. Likewise, those in vitamin C group took vitamin C instead Visual Analogue Scale (VAS) was used to evaluate their resting and moving pain in the evenings of day 1 and day 4. At the same time, pain threshold and pain tolerance of both lower limbs were recorded by a pain-threshold machine. The 2 groups were statistically compared. Results In Celebrex group, there were statistically significant differences between pre-medication and post-medication in resting VAS (1.22±0.90 versus 1.00±0.81), moving VAS (4.23±1.38 versus 3.68±1.02), pain threshold of the normal lower limb (NL) (1.57±0.56 mA versus 1.79±0.51 mA), pain threshold of affected lower limb (AL) (1.33±0.48 mA versus 1.79±0.57 mA) (all P 0.05). In vitamin C group, the above comparisons were statistically insignificant (all P > 0.05). In Celebrex group, the variation values of moving VAS were significantly negatively correlated with those of pain threshold of the NL and AL (rNL = - 0.564, PNL = 0.028; rAL = -0.746, PAL =0.001). Conclusions Celebrex can reduce preoperative pain and increase pain threshold in patients undergoing knee arthroscopy, playing a role in preventive analgesia. There may be correlations between variations of pain and pain threshold before and after medication. Key words: Knee joints; Arthroscopy; Analgesics; Pain threshold

Diagnosis and classification of chondral knee injuries: comparison between magnetic resonance imaging and arthroscopy

To compare the magnetic resonance imaging (MRI) findings of patients undergoing knee arthroscopy for chondral lesions. The hypothesis was that MRI displays low sensitivity in the diagnosis and classification of chondral injuries. A total of 83 knees were evaluated. The MRIs were performed using the same machine (GE SIGNA HDX 1.45T). The MRI results were compared with the arthroscopy findings, and an agreement analysis was performed. Thirty-eight of the 83 MRI exams were evaluated by another radiologist for inter-observer agreement analysis. These analyses were performed using the kappa (κ) coefficient. The highest incidence of chondral injury was in the patella (14.4%). The κ coefficient was 0.31 for the patellar surface; 0.38 for the trochlea; 0.46 for the medial femoral condyle; 0.51 for the lateral femoral condyle; and 0.19 for the lateral plateau. After dividing the injuries into two groups (ICRS Grades 0-II and Grades III and IV), the following κ coefficients were obtained as follows: 0.49 (patella); 0.53 (trochlea); 0.46 (medial femoral condyle); 0.43 (medial plateau); 0.67 (lateral femoral condyle); and 0.51 (lateral plateau). The MRI sensitivity was 76.4% (patella), 88.2% (trochlea), 69.7% (medial femoral condyle), 85.7% (medial plateau), 81.8% (lateral femoral condyle) and 75% (lateral plateau). Comparing the radiologists' evaluations, the following κ coefficients were obtained as follows: 0.73 (patella); 0.63 (trochlea); 0.84 (medial femoral condyle); 0.72 (medial plateau); 0.77 (lateral femoral condyle); and 0.91 (lateral plateau). Compared with arthroscopy, MRI displays moderate sensitivity for detecting and classifying chondral knee injuries. It is an important image method, but we must be careful in the assessment of patients with suspected chondral lesions. III.

Utilizing heart rate variability: Midazolam prevents the sympathovagal imbalance caused by fentanyl/propofol induction

Context Heart rate variability (HRV) can monitor cardiac autonomic control. Sympathovagal imbalance is expected after fentanyl/propofol induction. Aim The aim of the study was to investigate the effects of intravenous midazolam on HRV and whether it prevents the sympathovagal imbalance caused by fentanyl/propofol induction. Settings and design This is a controlled, randomized, double-blinded study. Patients and methods The study included 50 patients undergoing knee arthroscopies under general anesthesia. Powers of low-frequency (LF: 0.04-0.15 Hz) and high-frequency (HF: 0.15-0.4 Hz) components of HRV, total power (TP), and LF/HF ratio were recorded using MemCalc software. Patients received midazolam 0.05 mg/kg (midazolam group) or an equivalent volume of normal saline (control group), followed by fentanyl 1 mcg/kg and then propofol 2 mg/kg intravenously. Statistical analysis The Mann-Whitney U-test and two-way repeated analysis of variance, followed by Bonferroni correction as a post-hoc test, were used to analyze the data. Results Midazolam induced significant decrease in TP and HF powers, with unchanged LF power and LF/HF ratio. Fentanyl induced significant decrease in TP and LF powers with unchanged HF power and LF/HF ratio in both groups. Propofol induced a significant decrease in TP, HF, and LF powers in both groups. Propofol decreased the LF/HF ratio significantly in the control group but not in the midazolam group. Conclusion Midazolam premedication induced significant decrease in TP and HF powers without changes in LF power or LF/HF ratio. When fentanyl and propofol were given, midazolam was capable of modulating the net effects of both drugs on the HRV by minimizing the decrease in LF power to keep the LF/HF ratio unchanged. This modulatory effect of midazolam works in favor of maintaining the sympathovagal balance.

Norepinephrine versus ephedrine for the prevention of spinal anesthesia-induced hypotension in coronary artery disease patients undergoing knee arthroscopy

Background Spinal anesthesia, a popular technique used for lower limb surgery in coronary artery disease patients, could be associated with hypotension, which could be managed with colloids, vasopressor, ephedrine, or norepinephrine (NE). Aim The aim of this study was to assess the efficacy and safety of bolus administration of NE versus ephedrine for the maintenance of systolic blood pressure during spinal anesthesia in coronary artery disease patients undergoing knee arthroscopy. Patients and methods A randomized, controlled, double-blinded study was carried out on 100 ASA II or III coronary artery disease patients undergoing knee arthroscopy. The patients were divided into two groups of 50 patients each: the ephedrine group (group EPH) and the norepinephrine group (group NE). When hypotension occurred, group EPH received 5 mg of ephedrine and group NE received 5 μg of NE. Systolic blood pressure and heart rate were recorded at 0, 5, 10, 15, 30, and 60 min, and side effects of both drugs were also recorded. Results Efficacy was found in 20 (40%) patients of group EPH and in 40 (80%) patients of group NE. The results were highly significant ( P P Conclusion NE is more effective compared with ephedrine in the maintenance of systolic blood pressure with reduction in heart rate, which is useful in coronary artery disease patients undergoing knee arthroscopy under spinal anesthesia in whom tachycardia is undesirable.

ED50 and ED90 of intrathecal hyperbaric 2% prilocaine in ambulatory knee arthroscopy.

Hyperbaric 2% prilocaine (HP) is increasingly used for spinal anesthesia in day-case surgery. The aim of this prospective double-blind study was to determine the effective dose (ED)50 and the ED90 of HP for patients undergoing knee arthroscopy. Doses of HP were determined using an up-and-down sequential allocation technique. Sequences were analyzed by isotonic regression analysis. A subsequent observational study was performed with the calculated ED90 in 50 patients to confirm the initial result and to describe the induced blockade effects and side effects. Times corresponding to onset and duration of sensory and motor block, surgical data, and side effects were recorded. The ED50 was estimated at 28.9 mg (95% confidence interval [CI]: 26.5 to 35.3) and the ED90 was estimated to be 38.5 mg (95% CI: 35.7 to 39.5). A 40 mg dose of HP provided efficient anesthesia in 46 patients (92%, 95% CI: 82 to 98). The average (SD) time to effective anesthesia was 14.5 (3.9) min. Complete sensory block at level T12 was obtained after ten minutes in 44 of 50 patients. The average (SD) duration of the sensory block was 205 (36.1) min. Maximal level of sensory block was obtained at the T8-T11 levels in 41 of 50 patients without hemodynamic instability. A Bromage 3 score was obtained in 40 of the 46 patients who achieved successful anesthesia after 30 min. Patients did not experience urinary retention, nor were any signs of transient neurologic symptoms observed. This study determined the ED50 of HP is 28.9 mg and suggests that a 40-mg dose of HP is adequate to provide successful spinal anesthesia for outpatient knee arthroscopy.

Routine Examination of Pathology Specimens Following Knee Arthroscopy: A Cost-Effectiveness Analysis.

While the clinical value of routine pathologic examination of tissues removed during orthopaedic procedures has not been determined, limited cost-effectiveness and a low prevalence of findings that alter patient management have been previously demonstrated with arthroscopy. The purpose of this study was to examine the clinical value and cost-effectiveness of routine histological examination of knee arthroscopy specimens. Retrospective chart analysis of 3797 consecutive knee arthroscopies by two surgeons from 2004 to 2013 at three affiliated hospitals within one health-care system was undertaken. Pathology reports regarding tissue removed during partial meniscectomies and anterior cruciate ligament reconstructions were reviewed to determine if the results altered patient care. The total costs of histological examination were estimated in 2012-adjusted U.S. dollars. The cost per health effect was determined by calculating the cost per discrepant and discordant diagnosis. The prevalence of concordant diagnoses was 99.3% (3769 of 3797), the prevalence of discrepant diagnoses was 0.7% (twenty-seven of 3797), and the prevalence of discordant diagnoses was 0.026% (one of 3797). The total cost of histological examinations was estimated to be $371,810. The total cost of the pathology cost per discrepant diagnosis was $13,771, and the cost per discordant diagnosis was $371,810. Routine pathological examination of surgical specimens from patients undergoing knee arthroscopy had limited cost-effectiveness because of the low prevalence of findings that altered patient management. Histological examination of surgical specimens from arthroscopic knee surgery did not alter patient care and increased costs. We suggest that gross and histological examination of tissue removed during knee arthroscopy should be done at the discretion of the orthopaedic surgeon rather than being mandatory.

Identification of Synovial Fluid Biomarkers for Cartilage Pathology and Associated Outcomes in Knee Arthroscopy

Identification of Synovial Fluid Biomarkers for Cartilage Pathology and Associated Outcomes in Knee Arthroscopy

Prevention of Venous Thromboembolic Events With Low-Molecular-Weight Heparin in the Non-Major Orthopaedic Setting: Meta-Analysis of Randomized Controlled Trials

To assess the efficacy of low-molecular-weight heparin (LMWH) venous thromboprophylaxis in patients with transient reduced mobility in the non-major orthopaedic setting. A meta-analysis was conducted using data from all available randomized trials comparing LMWH with placebo or no prophylactic treatment in patients with leg immobilization for fracture or soft-tissue injury of the lower limb or in patients undergoing knee arthroscopy. The primary endpoint was the incidence of major venous thromboembolic events (VTEs), including asymptomatic proximal deep-vein thrombosis, symptomatic VTEs, and VTE-related death. The Mantel-Haenszel method was used to generate the summary statistics for the overall effect of LMWH. Fourteen studies were included (4,726 patients). The weighted rate of major VTEs was estimated to be 2.9% (95% confidence interval [CI], 2.2% to 3.7%) without LMWH prophylaxis. Overall, a significant 68% reduction in the risk of major VTEs was observed with LMWH prophylaxis (relative risk [RR], 0.32; 95% CI, 0.20 to 0.51; P < .001). The treatment effect was not modified by the clinical setting, that is, distal lower limb injury (7 studies; 1,711 patients; RR, 0.42; 95% CI, 0.20 to 0.86) or knee arthroscopy (6 studies; 2,428 patients; RR, 0.27; 95% CI, 0.15 to 0.49). A nonsignificant 35% increase in the risk of major bleeding was observed in the LMWH prophylaxis group (RR, 1.35; 95% CI, 0.53 to 3.47). This meta-analysis indicates potential efficacy of LMWH in preventing thromboembolic events in patients with reduced mobility in the non-major orthopaedic setting compared with placebo or no treatment. However, the decision of whether to implement LMWH prophylaxis in each specific setting should also take into account the risk of VTEs in the absence of prophylaxis, the potential adverse effects of LMWH, and the cost. Level II, meta-analysis of Level II studies or Level I studies with inconsistent results.

Arthroscopic posteromedial drive-through test in posterior cruciate ligament insufficiency: a new diagnostic test

The study investigated the prevalence of the posteromedial drive-through sign in patients undergoing knee arthroscopy and determined its relationship to posterior cruciate ligament (PCL) insufficiency. A retrospective review was performed on 1,015 patients undergoing knee arthroscopy from 2009 to 2012 at two institutions. During knee arthroscopy, the ability to pass the arthroscope easily between the medial femoral condyle and the PCL is considered a positive posteromedial drive-through sign. We calculated the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of posteromedial drive-through sign for diagnosis of PCL ruptures. The posterior laxity measured by Telos stress radiograph was compared between the posteromedial drive-through sign (+) and (-) patients with PCL ruptures. Of the 1,015 patients, 73 (7%) had a positive posteromedial drive-through sign. For the diagnosis of PCL rupture, a posteromedial drive-through sign had an overall accuracy of 97.6%, sensitivity of 78.8%, specificity of 99.3%, positive predictive value of 91.7% and negative predictive value of 98.1%. For the ligament laxity examination using stress radiographs, the mean posterior tibia translation was 13.8±2.2mm, while the mean posterior translation was 10.6±2.4mm in those with a negative posteromedial drive-through sign (p<0.05). There was no relationship between a positive posteromedial drive-through sign and age and combined injuries (n.s.). A positive posteromedial drive-through sign strongly indicates the presence of PCL injuries and this arthroscopic sign is highly associated with grade III posterior knee instability. III.

Knee surgery recovery: Post‐operative Quality of Recovery Scale comparison of age and complexity of surgery

Initial validation and feasibility for the Post-operative Quality of Recovery Scale (PQRS) was published in 2010. Ongoing validation includes studies to determine whether this scale can discriminate differences in recovery between cohorts. A prospective cohort study included 61 patients, 18-40 years, and 61 patients, aged ≥ 65 years, undergoing knee arthroscopy under general anaesthesia; and 13 patients, aged ≥ 65 years, undergoing total knee replacement under general anaesthesia. Patients were assessed using the PQRS. Assessments were performed pre-surgery, at 15 and 40 min, 1 and 3 days, and 3 months after surgery. The effect of age was assessed by comparing young versus older arthroscopy patients. There were minimal differences in recovery profiles, other than for the nociceptive domain, where pain recovery was significantly better in the older arthroscopy patients (P < 0.001). The effect of surgery was assessed by comparing older patients undergoing knee arthroscopy with knee replacement patients. Recovery was significantly worse for the knee replacement group for cognition (P = 0.015), nociception (pain and nausea, P < 0.001), activities of daily living (P < 0.001), emotive recovery (P = 0.029), and all-domains recovery (P < 0.001). Despite differences in quality of recovery, satisfaction was high in all cohorts. Knee replacement had a large effect on recovery compared with knee arthroscopy. Age had minimal effect on recovery after knee arthroscopy. The study showed the ability of the PQRS to discriminate recovery in different domains.

Relationship of distal femoral morphometrics with anterior cruciate ligament injury using MRI

Objective The aim of the study was to compare the distal femoral morphology in anterior cruciate ligament (ACL) noninjured and injured patients and to explore differences between men and women. Patients and methods Retrospective study of MRI measurements of the distal femur of 159 patients was conducted; notch width (NW), bicondylar width (BCW), and notch index (NI) were measured in 72 patients with ACL injury and in 87 patients without ACL injury. All patients underwent knee arthroscopy. The measured values in both ACL-injured and non-ACL-injured male and female individuals were analyzed; P value less than 0.05 was considered to be statistically significant. Results There were significant differences in NW and BCW between male and female individuals with non-ACL injury ( P = 0.000), whereas no statistically significant difference was noted regarding NI ( P = 0.789). There was statistically significant difference in the male group with ACL injury regarding NW and NI ( P = 0.000), with no significant statistical difference regarding BCW. In the female group, there were significant differences ( P = 0.000) in the bone morphology between ACL-injured and non-ACL-injured individuals, including NW, BCW, and NI. Conclusion There was difference between male and female distal femur morphologies. In both sexes, patients with small NI and NW are at high risk for ACL injuries.

Analysis of Low-Field Magnetic Resonance Imaging Scanners for Evaluation of Knee Pathology Based on Arthroscopy.

Background:In recent years, few studies have evaluated low-field magnetic resonance imaging (MRI) diagnoses compared with intraoperative findings of the knee.Purpose:To determine the accuracy and sensitivity of low-field MRI scanners in diagnosing pathology of the menisci, cruciate ligaments, and osteochondral surfaces.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:MRI examinations without intra-articular contrast were performed on 379 patients for knee pathologies over a 4-year period. The MRI examinations were done using a 0.2-tesla scanner utilizing a dedicated knee coil and read by 1 of 3 board-certified, musculoskeletal fellowship–trained radiologists. Within a mean time of 50 days after MRI, all patients underwent knee arthroscopy performed by 1 of 2 sports fellowship–trained orthopaedic surgeons. Operative notes from the knee arthroscopies were then reviewed by a single independent observer, and the intraoperative findings were compared with the MRI reports.Results:For medial meniscus tears, the sensitivity, specificity, positive predictive value, and negative predictive value were 83%, 81%, 89%, and 71%, respectively. For lateral meniscus tears, the values were 51%, 93%, 84%, and 73%, respectively. For anterior cruciate ligament (ACL) tears, the values were 85%, 94%, 69%, and 97%, respectively. For osteochondral lesions, the values were 8%, 99%, 29%, and 94%, respectively. For posterior cruciate ligament (PCL) tears, the specificity and negative predictive value were 99% and 100%, respectively.Conclusion:Low-field MRI was an accurate tool for evaluation of medial meniscus and ACL tears. However, within the study population, it is not as effective in diagnosing lateral meniscus tears and showed a poor ability to detect osteochondral lesions. More information is needed to properly assess its ability to diagnose PCL tears.

The role of local anaesthesia in knee arthroscopy

IntroductionIn current times, knee arthroscopy is the most common orthopaedic procedure. Over the years, the preferential method of anaesthesia has been general or spinal anaesthesia. The use of local anaesthesia (LA) in knee arthroscopies has been mentioned in surprisingly few orthopaedic publications over the past few decades. This reflects the very moderate role of LA in general compared to other forms of anaesthesia, even though the majority of operations in orthopaedic practice can be regarded as minor procedures. The aim of this study is to assess the efficacy of LA in knee arthroscopies. MethodsWe performed a retrospective analysis of the efficacy of local anaesthesia in patients undergoing knee arthroscopy under LA over a period of 5 years. The anaesthetic routinely used is Xylocaine 2% with adrenaline. We evaluated pain during procedure and after the procedure by recording a Visual Analogue Score (VAS). ResultsOver a 5 year period (07/2005–06/2010), 433 knee arthroscopies have been performed under LA. The male:female ratio was 52:48%, mean age 48 years (range 14–84). The mean VAS during injection was 1.8 (SD 2) and during the procedure 0.9 (SD 1.7). There has been no complication reported related to LA. We have not encountered any type 1 allergic reactions. ConclusionOur experience demonstrates that LA in arthroscopies is a convincing alternative to other forms of anaesthesia and should further be considered as gold standard anaesthesia in knee arthroscopy.

Venous Thromboembolism Following Arthroscopic Knee Surgery: A Current Concepts Review of Incidence, Prophylaxis, and Preoperative Risk Assessment

The purpose of this review was to compile existing knowledge regarding venous thromboembolism (VTE) after arthroscopic knee surgery (AKS). We reviewed the reported incidence, published prophylaxis guidelines, randomized controlled trials (RCT) of prophylaxis, and current prophylaxis practice patterns. In this context we then considered the most appropriate VTE risk assessment model for patients undergoing knee arthroscopy. The existing body of literature regarding VTE and AKS reports a wide range of incidence, often utilizing primary outcome measures with unclear clinical significance: asymptomatic and distal deep vein thrombosis (DVT). Published prophylaxis guidelines provide limited practical guidance and it is unclear how to translate the results of RCTs to clinical practice, as many of the VTE prevented by routine prophylaxis are asymptomatic or distal DVT. Literature regarding actual implementation of pharmacologic prophylaxis following AKS suggests that no consensus exists. Patients undergoing knee arthroscopy would be best managed with the individual model of VTE risk assessment rather than the group model that is applied to hip and knee arthroplasty patients.

Diz manyetik rezonans görüntüleme bulguları ve fizik muayene bulgularının artroskopik bulgular ile karşılaştırılması

Comparison of magnetic resonance imaging and pysical examination of knee with arthroscopic findings Objective: To determine the effects of physical examination findings with the results of manyetik rezonans imaging (MRI) on the decision for arthroscopic surgery. Methods: Preoperative physical examination findings and MRI results of the patients undergoing knee arthroscopy in our clinic were evaluated statistically by reference of arthroscopy retrospectively. Results: The mean age of patients in the study is 47.2 (22.73), respectively. 25 of the patients were female, 20 of them were male. Arthroscopic surgery was performed for 27 left knee and 18 right knee. Mc Murray test sensitivity in patients with medial meniscus tear is 69.8%. The medial joint line tenderness sensitivity is 97.7% in the patients with medial meniscus tear. Sensitivity of MRI is determined as 93% in the group with medial meniscus tear. Mc Murray test sensitivity in patients with lateral meniscal tear is 71.4%. The lateral joint line tenderness sensitivity is 100% in the patients with lateral meniscus tear. Sensitivity of MRI is determined as 85.7% in the group with lateral meniscus tear. Mc Murray test sensitivity is 68.9%, joint line tenderness sensitivity is 97.8% and sensitivity of MRI is determined as 93.3% without discrimination on the medial and lateral meniscal tear. Conclusion: A careful physical examination is the most effective diagnostic method to determine meniscal pathologies. We think that careful physical examination could reduce the rates of

Peripheral nerve blocks give greater hemodynamic stability than general anesthesia for ASA III patients undergoing outpatient knee arthroscopy

Abstract

Satisfaction of Patients undergoing Knee Arthroscopy for Meniscal Trimming in the Outpatient Arthroscopy Clinic at Assiut University Hospital

Patient satisfaction is a health care recipient's reaction to salient aspects of the context, process and result of theirservice experience. Meniscal injuries affects 60 to 70 cases per 100,000 people, In the USA, surgical procedures forthe meniscus are performed on approximately 850,000 patients each year. The aim of the present study was to assesssatisfaction of patients who will undergo arthroscopic knee surgery for meniscal trimming with medical carereceived in the out-patient arthroscopy clinic. Subjects and methods: A convenient sample of sixty adult patients(male and female) undergoing arthroscopic knee surgery for meniscal trimming were included in this study. Thestudy was conducted at the arthroscopic out-patient clinic at Assiut University Hospital. One tool was utilized tofulfill the aim of this study; Patient Satisfaction Questionnaire PSQ18. Results showed that patients were highlysatisfied with technical quality (65.42 %, high satisfaction), followed by satisfaction with communication with themedical team (63.83 %, moderate satisfaction). While they were least satisfied with financial aspects (36.17 %, mildsatisfaction). Conclusion: patients were highly satisfied with the technical quality and least satisfied with thefinancial aspect.

COMPARISON OF INTRATHECAL BUPIVACAINE (17.5mg) WITH PRESERVATIVE FREE MIDAZOLAM (1mg) VERSUS INTRATHECAL BUPIVACAINE (17.5mg) FOR POSTOPERATIVE PAIN RELIEF IN LOWER LIMB SURGERIES.

Background: Spinal anaesthesia is a common anaesthetic technique for lower limb surgery. Many adjutants have been tried to prolong the duration of analgesia provided by local anaesthetics when administered intrathecally. Midazolam has been shown to prolong the duration of analgesia when used as an adjuvant, providing the added advantages of mild sedation and amnesia, while being devoid of neurotoxicity, and the adverse effects of opioids. This study was designed to evaluate the effect of 1 mg preservative-free intrathecal midazolam added to spinal bupivacaine during postoperative analgesia, and the incidence of adverse effects, if any, in patients undergoing knee arthroscopies. Method: 60 consenting American Society of Anesthesiologists (ASA) physical status I or II patients of either gender (men = 48, women = 12), aged between 20-60 years, were randomly allocated to two groups (30 each). Group B received 0.5% hyperbaric bupivacaine with saline intrathecally, and Group BM received 0.5% hyperbaric bupivacaine with preservative-free midazolam 1 mg intrathecally. Peak sensory level, total duration of analgesia, duration of motor blockade, pain score using the Visual Analogue Scale, and sedation score using the Observer Assessment Score of Sedation were assessed, along with vital parameters, namely heart rate and systolic, diastolic and mean blood pressure. Results: The total duration of analgesia observed was significantly higher in Group BM (336.2 ± 37.50minutes) vs. Group B (151.17 ± 15.41 minutes), and the pain score was lower in Group BM (33.6 ± 4.68 mm) vs. Group B (56.6 ± 8.64 mm). Conclusion: The addition of preservative-free midazolam 1 mg to intrathecal 0.5% hyperbaric bupivacaine prolongs the duration of analgesia without any observed adverse effects in patients undergoing lower limb surgeries.

Prevention of VTE in Orthopedic Surgery Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

BackgroundVTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT.MethodsThe methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement.ResultsIn patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava filter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lower-extremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B).ConclusionsOptimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches. VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava filter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lower-extremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B). Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches.