Periarticular Injection Research Articles

Immunomodulatory matrix-bound nanovesicles mitigate acute and chronic pristane-induced rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and destruction of synovial joints affecting ~7.5 million people worldwide. Disease pathology is driven by an imbalance in the ratio of pro-inflammatory vs. anti-inflammatory immune cells, especially macrophages. Modulation of macrophage phenotype, specifically an M1 to M2, pro- to anti-inflammatory transition, can be induced by biologic scaffold materials composed of extracellular matrix (ECM). The ECM-based immunomodulatory effect is thought to be mediated in part through recently identified matrix-bound nanovesicles (MBV) embedded within ECM. Isolated MBV was delivered via intravenous (i.v.) or peri-articular (p.a.) injection to rats with pristane-induced arthritis (PIA). The results of MBV administration were compared to intraperitoneal (i.p.) administration of methotrexate (MTX), the clinical standard of care. Relative to the diseased animals, i.p. MTX, i.v. MBV, and p.a. MBV reduced arthritis scores in both acute and chronic pristane-induced arthritis, decreased synovial inflammation, decreased adverse joint remodeling, and reduced the ratio of synovial and splenic M1 to M2 macrophages (p < 0.05). Both p.a. and i.v. MBV reduced the serum concentration of RA and PIA biomarkers CXCL10 and MCP-3 in the acute and chronic phases of disease (p < 0.05). Flow-cytometry revealed the presence of a systemic CD43hi/His48lo/CD206+, immunoregulatory monocyte population unique to p.a. and i.v. MBV treatment associated with disease resolution. The results show that the therapeutic efficacy of MBV is equal to that of MTX for the management of acute and chronic pristane-induced arthritis and, further, this effect is associated with modulation of local synovial macrophages and systemic myeloid populations.

The effects of local infiltration anesthesia and femoral nerve block analgesia after total knee arthroplasty: a systematic review and meta-analysis.

BackgroundLocal infiltration anesthesia (LIA) and femoral nerve block (FNB) are commonly used analgesia methods after total knee arthroplasty (TKA). However, there is no definitive conclusion about which of these two analgesia modes is superior. Therefore, this study aimed to systematically evaluate the analgesic effects of LIA and FNB after TKA.MethodsWe used the terms “total knee replacement, knee replacement, total knee arthroplasty, knee arthroplasty, local infiltration analgesia, periarticular infiltration, periarticular injection, intra-articular infiltration, intra-articular injection, peripheral nerve block, femoral nerve block” to search the PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases. The search period was set from the date of establishment of the database to September 2021. The Cochrane risk of bias tool was used to evaluate the quality of the included studies, and network meta-analysis was performed using Stata14.0 and RevMan 5.30 software.ResultsNine articles were included for analysis. The results of meta-analysis showed that compared with LIA and FNB, the difference in opioid use [mean difference (MD) −4.35, 95% confidence interval (CI): −7.26 to −1.45] was statistically significant. However, there was no significant difference between the static visual analogue score at 24 hours postoperatively (MD 0.20, 95% CI: −0.91 to 1.31), the visual analogue score for exercise visual analogy at 24 hours after surgery (MD 0.10, 95% CI: −0.12 to 0.32), and the length of hospital stay (MD 0.05, 95% CI: −0.40 to 0.50).DiscussionLIA and FNB have similar effects on pain relief after TKA, but LIA can reduce the use of analgesic drugs and is easy to operate. Therefore, LIA can be used as the priority analgesic method for patients with TKA. However, multi-center, large-sample, high-quality, randomized controlled trials are still needed for further verification.

Impact of Covid-19 pandemic on injection-based practice: report from an Italian multicenter and multidisciplinary survey.

There are no papers exploring the impact of COVID-19 pandemic on the injection-based practice in patients affected by different rheumatic diseases, including osteoarthritis. The aim was to investigate the impact of COVID-19 pandemic on injection-based practice trough the Italian country. A survey-based retrospective cross-sectional study. An Italian-language questionnaire was developed by a group of senior researchers and distributed by e-mail to some Rheumatology, Orthopedic and Rehabilitation Units from different geographic areas of Italy. The survey included information about the number of injections performed during COVID-19 pandemic (stratified by injected agents and injected joint), in comparison to the pre-pandemic period, and the possible reasons behind an eventual reduction. Responses were collected and descriptive analysis calculated. Eleven centers of the National Health Service completed the survey. The activities of the injections services significantly decreased across the country with a percentage of reduction of 60% compared to the pre-pandemic period. A significant reduction of both intra-articular and peri-articular injections was registered. Among intra-articular. treatments, the most affected ones were the hyaluronic acid injections, when compared to corticosteroids. A significant decrease of the total amount of peri-articular injections was observed. The strict government restrictions and the fear of patients to become infected represented the most limiting factors. The reported decrease of the injection-based practice in our country during the COVID-19 pandemic highlights the detrimental effects of the COVID-19 pandemic on the management of chronic musculoskeletal diseases with possible negative consequences in terms of disability and quality of life.

Результати лікування хворих із нижньопоперековим больовим синдромом, де домінували прояви спондилоартрозу, із використанням радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевих анестетиків та стероїдних препараті

Актуальність. Висока поширеність дегенеративно-дистрофічного ураження хребта при малій ефективності терапії спондилоартрозу робить актуальним дослідження щодо лікування нижньопоперекового болю, зумовленого переважно спондилоартрозом, інноваційним міні-інвазивним методом високочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевих анестетиків і стероїдних препаратів. Мета дослідження: визначити ефективність впливу радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевих анестетиків і стероїдних препаратів з урахуванням ранніх та віддалених результатів лікування на ліквідацію больового синдрому у хворих із нижньопоперековим больовим синдромом, в яких переважали прояви спондилоартрозу. Матеріали та методи. Проведений аналіз ранніх та віддалених результатів лікування 78 пацієнтів (37 чоловіків та 41 жінка віком від 51 до 79 років) із нижньопоперековим больовим синдромом, в яких провідним клінічним проявом був артроз дуговідросткових суглобів, які становили основну групу, та проведена радіочастотна денервація фасеточних суглобів (за допомогою апарата RFG-1A/RFG-1B фірми Radionics) у поєднанні з періартикулярним введенням місцевого анестетика та стероїдного препарату. Оцінка больового синдрому проводилася чотири рази — у доопераційному, післяопераційному періодах (протягом тижня), через три місяці та через один рік після лікування. Використовувалася візуальна аналогова шкала болю та опитувальник індексу непрацездатності Освестрі. Контрольну групу становили 136 пацієнтів (73 чоловіки та 63 жінки віком від 44 до 81 року) із нижньопоперековим болем із домінуванням проявів спондилоартрозу, які лікувались виключно за допомогою методу радіочастотної денервації фасеточних суглобів. Результати. Як відразу ж після проведеного лікування, так і через три місяці після його здійснення отриманий вірогідний результат лікування хронічного нижньопоперекового больового синдрому, зумовленого переважно ураженням дуговідросткових суглобів, як в основній, так і контрольній групах, що свідчить про ефективність обох методів лікування. Разом із тим відмічається чітка вірогідна різниця між основною та контрольною групами як відразу після проведеного лікування, так і через три місяці після його здійснення, що свідчить про вірогідну вищу ефективність методу радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевого анестетика та стероїдного препарату в ранньому післяопераційному періоді. У віддаленому періоді (через 1 рік після лікування) отриманий вірогідний результат лікування як в основній так і в контрольній групах, але відмінність у результатах лікування між цими групами відсутня. Висновки. Отримані результати в ранньому та віддаленому періодах після лікування свідчать про ефективність та безпечність як радіочастотної денервації фасеточних суглобів, так і радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевого анестетика та стероїдного препарату у хворих із нижньопоперековим больовим синдромом, де домінують прояви спондилоартрозу. Вірогідно кращі результати в ранньому періоді отримані в групі пацієнтів, яким проводилось поєднання радіочастотної денервації фасеточних суглобів із періартикулярним введенням місцевого анестетика та стероїдного препарату. Тоді як у віддаленому періоді (через 1 рік після лікування) така відмінність між основною та контрольною групами відсутня. Періартикулярне введення місцевих анестетиків та стероїдів ефективне в короткотерміновій перспективі, а радіочастотна денервація фасеточних суглобів ефективна як у короткотерміновій, так і в довготерміновій перспективі. Обидві методики можуть бути рекомендовані до включення в алгоритм лікування фасеточного синдрому при неефективності консервативного лікування.

Étude prospective randomisée comparant l’infiltration périarticulaire multidrogue au cathéter épidural chez 55 patients subissant une arthroplastie totale de la hanche

IntroductionEpidural catheter (EC) and periarticular multidrug injection (PMDI) are widely performed for reducing total hip arthroplasty (THA) postoperative pain. However, the more effective analgesic technique between the two is unclear. Thus, we aimed to answer the following questions: (1) does PMDI contribute to less postoperative pain than EC? (2) is there any difference in side-effect occurrence between the methods? (3) does PMDI provide better functional recovery than EC? (4) is there any difference in inflammatory parameters between the methods? HypothesisPMDI would reduce postoperative pain and side effects, provide better functional recovery, and contribute to lower inflammation compared with EC. Materials and MethodsThis single-center, randomized controlled trial was conducted from 2017 to 2019 and enrolled 55 patients randomly allocated into two groups (28 patients: PMDI, 27 patients: EC). The primary outcome was evaluated using the pain visual analogue scale (VAS). The secondary outcomes were narcotic consumption, side effects, hip range of motion (ROM), ratio of patients performing the straight leg raise (SLR) on postoperative day (POD) 1, the day the patient started using a walker and cane, and inflammatory parameters (white blood cell [WBC], and C-reactive protein [CRP]). Paired t-tests and Fisher's exact test were used for comparisons. ResultsThere were no significant differences in the pain VAS scores between groups. The EC group experienced significantly more side effects than the PMDI group (p<0.01). ROM of the PMDI group on POD 3 was significantly better than the EC group (p<0.05). Furthermore, more patients in the PMDI group could perform SLR than those in the EC group on POD 1 (p=0.01). On POD 1, the WBC count was significantly higher (p<0.01) in the PMDI group, whereas CRP levels were significantly lower in the PMDI group (p<0.05) and remained lower than the EC group on POD 3 (p<0.01). DiscussionThe patients in the PMDI and EC groups had comparable postoperative pain. Those in the PMDI group had lower side effects. Functional recovery was comparable between the patients in the PMDI and EC groups. Compared to the EC group, the PMDI group had higher WBC count and lower CRP levels. Level of evidenceI; Prospective randomized controlled trial.

Effectiveness of Periarticular Cocktail Injection in Pain Management of Patients Undergoing Total Knee Arthroplasty

Introduction: Total knee arthroplasty is a procedure that can improve quality of life, and it is performed in increasing numbers every year because of the increase in the elderly population due to improved medical technology. However, the problem is that patients avoid this operation because of postoperative pain, which affects patient satisfaction and delays recovery and rehabilitation. There are many modalities to improve operative pain control, such as femoral nerve blocks, epidural anaesthesia, and periarticular injections. These modalities have been shown to reduce post-operative pain and increase patient satisfaction. Periarticular injection was reported to have good efficacy in controlling pain, cost-effectiveness, a few side effects, and ease of use. This method can be used by every surgeon without further training, unlike techniques like epidural anaesthesia or femoral nerve blocks, which require experience and further training. Material and Methods: The study was conducted in the Department of Orthopaedics at SCB Medical College &amp; Hospital, Cuttack, Odisha. All the IPD patients who got admitted to the Dept. of Orthopaedics were taken as the study subject total of 30 cases were selected during study period out of which 15 were cases and 15 controls. Observation and Discussion: In Group A, R/L TKA was done in 3/12 patients and in Group B, R/L TKA was done in 8/7. All the Group A patients experienced less pain than the baseline parameters(p&lt;0.05) following TKA. Post-operative evaluation of Range of motion in between 2 Groups there was significant difference in between the two Groups A and B as it was comparatively more in POD1, POD2, POD3, POD7, DOD AND 3 months after follow up in Cocktail Group A. Knee Society Score in POD3 was found to be 100 and 90 in Group A and Group B respectively. Conclusion: This study has several strengths. First, it is a well powered, randomized study. Second, we included follow-up beyond the initial hospitalization. Third, the injection medications we used are available through any hospital pharmacy and are easily administered during the surgical procedure, so our findings could be generalized for any joint reconstruction surgeon. Keywords: Total knee replacement, Periarticular injection, Pain management

Additional Peripheral Nerve Block to Periarticular Injection Has No Benefit for Patients Undergoing TKA: A Factorial Propensity Score-Matched Analysis Comparing Four Multimodal Analgesic Techniques.

Controversy remains over what and how many analgesic techniques are required as the most effective multimodal pain regimen in total knee arthroplasty (TKA). This study aimed to evaluate the effect of additional analgesic methods combined with periarticular injection (PAI) analgesia for TKA. Using retrospective cohort data, patients undergoing TKA with spinal anesthesia and PAI were divided into 4 groups. Group A (control) comprised 66 patients; group B (73 patients) had additional adductor canal block; group C (70 patients) obtained additional femoral nerve block, and group D (73 patients) received additional adductor canal block and intrathecal morphine. Propensity score matching was applied to compare visual analog scale (VAS) for pain intensity, cumulative morphine use (CMU), knee flexion angle, straight leg raise, length of hospital stay, and postoperative nausea and vomiting. There was no significant difference regarding VAS and morphine use, when either group B or C was compared with group A. Group D had significantly lower VAS than groups A, B, and C during the first 24hours after surgery and required significantly less CMU than groups A and B. However, the pain score of group D increased afterward, with significantly longer length of hospital stay than groups A and B. There was no difference in straight leg raise among the groups. Additional peripheral nerve block to PAI provides no benefit for patients undergoing TKA. Adjuvant intrathecal morphine could significantly reduce the VAS and CMU in the acute postoperative period; however, rebound pain with prolonged hospital stays was observed.

Adductor Canal Block Combined with Interspace between the Popliteal Artery and Capsule of the Knee (iPACK) versus Periarticular Injection for Total Knee Arthroplasty.

The combination of the adductor canal block (ACB) and the infiltration of anesthetic solution into the interspace between the popliteal artery and capsule of the knee (iPACK) has become increasingly used to augment rapid recovery protocols in total knee arthroplasty (TKA). However, its efficacy in comparison with periarticular anesthetic injection (PAI) alone has yet to be evaluated. Hence, we conducted a retrospective study to compare PAI and ACB + iPACK for controlling pain after TKA. Propensity scores, incorporating American Society of Anesthesiologists scores, body mass index, age, and sex, were used to match the ACB + iPACK group with the PAI group. All patients received the identical surgical technique and postoperative care. Outcome measures were visual analog scale (VAS) for pain, morphine consumption, knee flexion angle, straight leg raising (SLR), postoperative nausea vomiting (PONV), and length of stay (LOS) after the surgery. After matching by propensity score, there were 49 patients with comparable demographic data in each group. The VAS and morphine requirements of the PAI and ACB + iPACK groups were not different during the first 48 hours after TKA. At 72 hours postoperatively, the VAS of the ACB + iPACK was 0.97 higher than that of the PAI group (p = 0.020). Knee flexion angle, SLR, PONV, and LOS were not significantly different between groups. No procedure-related complications were identified in either group. The anesthesiologist-administered ACB + iPACK was as effective as surgeon-administered PAI in controlling pain in the first 48 hours after TKA. However, the ACB + iPACK group had higher intensity of pain than did the PAI group at 72 hours after TKA.

A multimodal opioid-sparing pain management following total knee replacement.

The purpose of this study is to compare the pain scores, opioid consumption, and range of motion of the operated knee after total knee replacement (TKR) in the 10-day follow-up period between a traditional opioid-containing pain management protocol and a multimodal opioid-sparing treatment protocol. This prospective, randomized, single-center study included 90 patients (24 men and 66 women; mean age 69.7±7.2 years) undergoing TKR for osteoarthritis between October 2019 and October 2020. Patients were randomized into 3 cohorts for comparison: traditional opioid-containing pain management protocol (n=30), multimodal opioid-sparing pain management protocol (n=30), and traditional opioid-containing pain management protocol with additional local infiltration analgesia (LIA). Changes in visual analog scale for pain (VAS), range of motion (ROM), and opioid consumption were compared between groups. A lower mean postoperative VAS score was observed in the opioid-sparing cohort, which was statistically significant at all time points compared with the traditional cohorts. Mean total morphine consumption was significantly lower in the opioid-sparing cohort (2.7±5.8 MMEs) compared to the traditional (14.0±14.8 MMEs) and traditional with LIA cohorts (8.3±9.5 MMEs; p<0.05). The mean degree of flexion of the operated knee of patients was significantly greater in patients in the opioid-sparing group than in the other groups on the postoperative day 3 (opioid-sparing: 87.0±11.2°; traditional: 74.1±11.6°; traditional with LIA: 84.7±8.9°; p<0.05), as well as on day 10 (opioid-sparing: 99.3±10.8°; traditional: 87.3±12.4°; traditional with LIA: 92.5±9.7°; p<0.05). The rate of adverse events after TKR did not differ between the groups. The results of this study suggest that a multimodal opioid-sparing pain protocol after TKR, which includes oral non-opioid medications and periarticular injection with bupivacaine, provides better pain relief and early functional gains with fewer rescue opioids compared to traditional opioid-based protocols (Tab. 4, Fig. 2, Ref. 22).

ЭФФЕКТИВНОСТЬ ПЕРИАРТИКУЛЯРНЫХ ИНЪЕКЦИЙ ТРАНЕКСАМОВОЙ КИСЛОТЫ ПРИ ТОТАЛЬНОМ ЭНДОПРОТЕЗИРОВАНИИ КОЛЕННОГО СУСТАВА

The article presents a comparative analysis of laboratory results of total knee arthroplasty and postoperative blood loss in 120 patients (24 men and 96 women) suffering from gonarthrosis, aged 42 to 86 years (average 68.8 years), operated on with the introduction of tranexamic acid periarticularly (n=60) or without it (n=60) observed for 3 days. from the time of surgery. Periarticular injection of tranexamic acid (TXA) made it possible to reduce postoperative blood loss. Assessing the data obtained, we determined a significantly lower proportion of cases in the main group (Hb=118.3) compared to the control group (Hb=103.3) (p&lt;0.05). In addition, it was not possible to identify a significant difference in relation to comorbidities or other side effects caused by tranexamic acid.

Perioperative Concerns and Complaints of Patients Undergoing Total Hip Arthroplasty.

Preoperative concerns of patients undergoing total hip arthroplasty (THA) and their complaints during the initial postoperative period are not well investigated. We evaluated preoperative concerns of patients and patient-perceived problems during the operation and initial 5 days after the operation. One hundred and thirty-two patients, who underwent primary THA at a tertiary referral hospital, were surveyed using a questionnaire and a face-to-face interview 1 day before the operation, operation day, and postoperative days 1, 2, 3, and 4. The severity of pain was assessed daily using a visual analog scale. The most common preoperative concern was the severity of pain after the surgery (65.2%), followed by the need of transfusion (34.8%) and postoperative rehabilitation (32.6%). Among 29 patients who could recall the experience during the operation, 12 (41.4%) suffered from shoulder pain on the contralateral side, and 6 (20.7%) answered that hammering sound had been annoying. After returning to the ward, 29 patients (22.0%) suffered from nausea, 8 (6.1%) complained of back pain, and 7 (5.3%) had ipsilateral knee pain. On postoperative day 1, 7 patients (5.3%) had persistent back pain, 8 (6.1%) had headache, and 5 (3.8%) suffered from nausea. On postoperative day 2, nine patients (6.8%) complained of radiating pain due to aggravation of pre-existing spinal stenosis, 7 (5.3%) complained of weakness of the hip flexor due to periarticular injection of ropivacaine during the operation, and 5 (3.8%) had dressing-related skin problem at the wound. On postoperative days 3 and 4, patients had no problem other than hip pain. The mean pain score was the highest (3.1 ± 1.0) on postoperative day 1. The results of this study might provide information needed to solve problems and improve satisfaction of patients undergoing THA.

Periarticular liposomal bupivacaine mixture injection vs. single-shot interscalene block for postoperative pain in arthroscopic rotator cuff repair: a prospective randomized controlled trial.

The pain control efficacy, postoperative opioid requirements, and costs among patients undergoing major shoulder surgery using different perioperative analgesia modalities have been topics of active debate. Several studies have compared periarticular injection (PAI) to interscalene block (ISB) in shoulder arthroplasty, but there is a paucity of data comparing them in arthroscopic rotator cuff repair. Patients aged 18-80 years with full-thickness rotator cuff tears and undergoing primary arthroscopic rotator cuff repair at 2 different shoulder centers were screened and subsequently randomized to receive either periarticular injection (PAI) of liposomal bupivacaine mixed with 0.25% bupivacaine (n = 41) or single-shot interscalene nerve block (ISB) (n = 36). Visual analog scale (VAS) pain scores, oral morphine equivalent (OME) use, Single Assessment Numerical Evaluation (SANE) scores, and costs were collected. Differences with P <.05 were considered statistically significant. Day of surgery VAS score and OME usage were significantly reduced with ISB vs. PAI (0.69 vs. 4.65, P < .001, and 18.66 vs. 34.39, P < .001, respectively). There were no significant differences between groups regarding VAS score on postoperative days (PODs) 1-3; however, OME usage on PODs 1 (50.5 vs. 38.8, P = .03) and 2 (48.1 vs. 37.8, P = .04) was significantly more in the ISB group. At POD 3, VAS score (4.13 vs. 3.97, P = .60) and OME use (28.60 vs. 31.16, P = .51) were similar. At 6 and 12 weeks, there were also no significant differences between groups regarding VAS and OME use. There was no difference in SANE score at 12 weeks following surgery between groups and no difference between average 12-week cumulative OME use between groups. The average charge for the PAI was $455, and the average charge for ISB was $745. Both ISB and PAI provide acceptable pain control following arthroscopic rotator cuff repair. Patients have less pain on the day of surgery with ISB, but rebound pain is significant after the block wears off, resulting in substantially increased opioid use in the first 2 PODs. However, cumulative opioid use between groups was similar. There were also no significant differences at the end of the12-week episode of care in any of the other variables studied. The charge per patient for PAI is approximately $300 less than ISB. Thus, PAI may offer surgeons and patients an effective postoperative analgesic modality as an alternative to ISB.

Local Infiltration Analgesia Versus Femoral Nerve Block for Pain Control in Anterior Cruciate Ligament Reconstruction: A Systematic Review With Meta-analysis.

Background:Anterior cruciate ligament reconstruction (ACLR) is often performed on an outpatient basis; thus, effective pain management is essential to improving patient satisfaction and function. Local infiltration analgesia (LIA) and femoral nerve block (FNB) have been commonly used for pain management in ACLR. However, the comparative efficacy and safety between the 2 techniques remains a topic of controversy.Purpose:To compare pain reduction, opioid consumption, and side effects of LIA and FNB after ACLR.Study Design:Systematic review; Level of evidence, 3.Methods:A systematic search of MEDLINE, Embase, and Cochrane Library databases was performed to identify studies comparing pain on the visual analog scale (a 100-mm scale), total morphine-equivalent consumption, and side effects between the 2 techniques after ACLR at the early postoperative period. The LIA was categorized into intra-articular injection and periarticular injection, and subgroup analyses were performed comparing either intra-articular injection or periarticular injection with FNB. Two reviewers performed study selection, risk-of-bias assessment, and data extraction.Results:A total of 10 studies were included in this systematic review and meta-analysis. In terms of VAS pain scores, our pooled analysis indicated that FNB was significantly more effective at 2 hours postoperatively compared with LIA (mean difference, 8.19 [95% confidence interval (CI), 0.75 to 15.63]; P = .03), with no significant difference between the 2 techniques at 4, 8, and 12 hours postoperatively; however, LIA was significantly more effective at 24 hours postoperatively compared with FNB (mean difference, 5.61 [95% CI, −10.43 to −0.79]; P = .02). Moreover, periarticular injection showed a significant improved VAS pain score compared with FNB at 24 hours postoperatively (mean difference, 11.44 [95% CI, −20.08 to −2.80]; P = .009), and the improvement reached the threshold of minimal clinically important difference of 9.9. Total morphine-equivalent consumption showed no difference between the 2 techniques, and side effects were unable to be quantified for the meta-analysis because of a lack of data.Conclusion:Compared with FNB, LIA was not as effective at 2 hours, comparable within 12 hours, and significantly more effective at 24 hours postoperatively for reducing pain after ACLR. Total morphine-equivalent consumption showed no significant differences between the 2 techniques.

Value of imaging to guide interventional procedures in rheumatic and musculoskeletal diseases: a systematic literature review informing EULAR points to consider

ObjectivesTo summarise current data on the value of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal disease (RMDs) informing an European Alliance of Associations for Rheumatology taskforce.MethodsA...

Intra-operative peri-articular cocktail injection in inflammatory arthritis patients undergoing total knee arthroplasty

&lt;p class="abstract"&gt;&lt;span lang="EN-US"&gt;Pain following TKA is often severe in most patients. The purpose of this case series was to assess the efficiency of intra-operative peri-articular cocktail injection in management of pain following total knee arthroplasty. This case series involves 16 patients with inflammatory arthritis of knee undergoing total knee arthroplasty (TKA). All patients had received peri-articular cocktail of drugs before the implantation of prosthesis with cement. In our study, there was significant improvement of Knee Clinical Score and Knee Functional Score following TKA. The mean KSS score was 37.5 (range: 31-44) improved to 92.5 (range, 86-99) and the functional score improved from 25.5 (range, 18-33) to 76 (range, 72- 80) at 6 months and 93 (range: 90-96) at 12 months. Intraoperative peri-articular injection with 20 ml of 0.5% ropivacaine, 1 ml of ketorolac, 1ml of clonidine and 0.5ml noradrenaline diluted in 20 ml of saline is effective in reducing immediate post-operative pain and thereby improving the overall functional outcome.&lt;/span&gt;&lt;/p&gt;

Intra-operative peri-articular cocktail injection in inflammatory arthritis patients undergoing total knee arthroplasty

&lt;p class="abstract"&gt;Surgical treatment of scaphoid fractures has evolved over the years to include variety of procedures and techniques. However scaphoid middle and distal third fractures fixation with Herbert screw by means of volar approach is a safe and effective method with good functional outcome and union rates. Our study concluded that management of middle and distal third scaphoid fractures with Herbert screw by volar approach gives excellent results in terms of union and recovery to daily activities. The wrist function improvement is more satisfactory, and the incidence of complications is low with this modality of treatment.&lt;/p&gt;

Would high-dose corticosteroid addition to multimodal cocktail periarticular injection contribute to prolonged pain control and better recovery following total knee arthroplasty?: study protocol for a randomized controlled trial

BackgroundEnhanced recovery following total knee arthroplasty (TKA) has been advocated to enhance postoperative recovery. Multimodal cocktail periarticular injection (MCPI) use for pain control in TKA has gained wide acceptance. MCPI-containing corticosteroids are believed to be an effective solution owing to their local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence regarding its benefits. This trial aims to compare MCPI with a high dose of corticosteroid, normal dose of corticosteroid, and non-corticosteroid during TKA, to assess the effectiveness of MCPI containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects and provide evidence that high-dose corticosteroids result in prolonged pain control and better recovery following TKA.MethodsThis is a double-blinded, randomized, placebo-controlled study. A total of 234 patients scheduled for TKA will be recruited. During surgery, before wound closure, 80 ml of the cocktail analgesic will be injected into the muscle and joint capsule for local infiltration analgesia; the participants will be randomly assigned to three groups to receive a high dose of betamethasone MCPI (group H), normal dose of betamethasone MCPI (group N), and non-betamethasone MCPI (group C). The following indices will be recorded and analyzed: the strongest knee pain experienced during 90° flexion at 6 h, 24 h, 48 h, 72 h, 5 days, 14 days, and 30 days after surgery; 1 min walking ability; and circumference around the patella at 2, 5, 14, and 30 days after surgery; Knee Society knee score at 14 days and 30 days after surgery; C-reactive protein and blood sedimentation; blood sugar 2, 5, 14, and 30 days following surgery; rescue analgesic consumption; and adverse events. If any participant withdraws from the trial, an intention-to-treat analysis will be performed.DiscussionThe results of this study will provide clinical evidence on the effectiveness of MCPI-containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and adverse events, as well as provide evidence on the efficacy of high-dose corticosteroids in prolonged pain control and better recovery following TKA.Trial registrationChinese Clinical Trial Registry, ChiCTR2000038671. Registered on September 27, 2020.

Comparison of periarticular multidrug injection versus epidural catheter in 55 patients undergoing total hip arthroplasty: A prospective randomized controlled trial

IntroductionEpidural catheter (EC) and periarticular multidrug injection (PMDI) are widely performed for reducing total hip arthroplasty (THA) postoperative pain. However, the more effective analgesic technique between the two is unclear. Thus, we aimed to answer the following questions: (1) does PMDI contribute to less postoperative pain than EC? (2) is there any difference in side-effect occurrence between the methods? (3) does PMDI provide better functional recovery than EC? (4) is there any difference in inflammatory parameters between the methods? HypothesisPMDI would reduce postoperative pain and side effects, provide better functional recovery, and contribute to lower inflammation compared with EC. Materials and methodsThis single-center, randomized controlled trial was conducted from 2017 to 2019 and enrolled 55 patients randomly allocated into two groups (28 patients: PMDI, 27 patients: EC). The primary outcome was evaluated using the pain visual analogue scale (VAS). The secondary outcomes were narcotic consumption, side effects, hip range of motion (ROM), ratio of patients performing the straight leg raise (SLR) on postoperative day (POD) 1, the day the patient started using a walker and cane, and inflammatory parameters (white blood cell [WBC], and C-reactive protein [CRP]). Paired t-tests and Fisher's exact test were used for comparisons. ResultsThere were no significant differences in the pain VAS scores between groups. The EC group experienced significantly more side effects than the PMDI group (p<0.01). ROM of the PMDI group on POD 3 was significantly better than the EC group (p<0.05). Furthermore, more patients in the PMDI group could perform SLR than those in the EC group on POD 1 (p=0.01). On POD 1, the WBC count was significantly higher (p<0.01) in the PMDI group, whereas CRP levels were significantly lower in the PMDI group (p<0.05) and remained lower than the EC group on POD 3 (p<0.01). DiscussionThe patients in the PMDI and EC groups had comparable postoperative pain. Those in the PMDI group had lower side effects. Functional recovery was comparable between the patients in the PMDI and EC groups. Compared to the EC group, the PMDI group had higher WBC count and lower CRP levels. Level of evidenceI; Prospective randomized controlled trial.

Blood transfusion incidence in primary Total Knee Arthroplasty of Unilateral vs Bilateral group with a high prevalence of low hemoglobin concentration: A Retrospective Observational Study

Background: Blood transfusion is one of the major concerns following Total Knee Arthroplasty. We assessed the incidence rate of blood transfusion (packed red cells) in our geographical group based on age, gender, preoperative Haemoglobin and following both unilateral and bilateral primary TKA done either in single-stage or sequentially after a week. Materials and Methods: This was a retrospective observational study that included 200 patients who underwent primary TKA unilateral, bilateral done in single-stage and sequential from June 2015 to May 2016. Two doses of parenteral Tranexamic acid and periarticular cocktail injection was given. Transfusion was indicated with postoperative Hgb below 8 g/dl associated with or without clinical signs of tissue hypoperfusion. Results: The study group was 200 patients with the age group of 50-81 years, of which 154 (77%) were female and 46 (23%) were male and had a mean preoperative Hgb level of 12.6 g/dl. 88 (44%) unilateral, 40 (20%) bilateral and 72 (36%) sequential TKA were performed and 7 (7.95%), 12 (30%) and 26 (36%) patients received blood transfusion respectively. Among the transfused 45 patients, 38 patients were bilateral group, of which 30 (66.6%) patients had a preoperative Hgb level of 10–12 g/dl, indicating a high incidence of transfusion in bilateral cases compared to unilateral and with preoperative Hgb levels of 10–12g/dl which was statistically significant with p-value &lt;0.05. Conclusion: In our study, age and gender were not the major factors for blood transfusion, but low preoperative Hgb levels and bilateral single stage and sequential TKA showed a significantly higher incidence of blood transfusion. Keywords: total knee arthroplasty, blood transfusion, preoperative Hgb

Landmark-guided Injections for Treatment of Sacroiliac Joint Pain

<h3>Research Objectives</h3> To investigate patients' degree and duration of pain relief from landmark-guided injections without fluoroscopy or image-guidance for the treatment of sacroiliac joint (SIJ) pain. <h3>Design</h3> A retrospective cohort study was conducted to examine patients' degree and duration of SIJ pain relief from landmark-guided injections. Patients' self-reported measures to the provider's common follow-up questions were assessed in the electronic medical record from their follow-up visits. <h3>Setting</h3> An out-patient orthopedic spine surgery clinic. <h3>Participants</h3> 311 patients identified as having SIJ pain that received at least one landmark-guided injection were reviewed. Four patients with a history of image-guided or fluoroscopy-guided SIJ injections were excluded. <h3>Interventions</h3> The SIJ was palpated and a landmark-guided, periarticular injection consisting of an anesthetic agent and corticosteroid was administered with a 22-gauge needle without image or fluoroscopy guidance. The patient was prepped using an aseptic technique and ethyl chloride. <h3>Main Outcome Measures</h3> The primary outcomes included the duration of relief recorded in weeks and the degree of relief recorded as a percentage. Secondary outcomes included reported adverse side effects. Covariates of interest including age, smoking status, BMI, reason for pain onset, and sex were collected for further comparative analysis. <h3>Results</h3> Of these 311 patients included in this review, 191 patients returned for follow-ups with reports of duration and degree of pain relief. The average length of relief reported was 8.88 weeks. The average percent relief reported was 53.55%. Reported adverse side effects included: increased low back pain, an irregular menstrual cycle, and vaginal bleeding unrelated to menstruation. No other adverse side effects were reported. No comparisons between outcomes and covariates were statistically significant. <h3>Conclusions</h3> Landmark-guided SIJ injections are a reasonable and safe treatment option for SIJ pain, as our patient population had on average greater than 50% sustained relief for over 2 months. This treatment option is a more affordable and accessible option that can be done quickly in the clinic as compared to the gold-standard approach of fluoroscopically-guided SIJ Injections. A prospective, controlled study of the efficacy of these injections is underway at our institution. Other future research should investigate patients' degree and length of relief from subsequent landmark-guided injections. <h3>Author(s) Disclosures</h3> No conflicts to report.