Triple Block Research Articles

Kinematic stabilization after the Latarjet procedure: beyond the triple blocking effect

BackgroundThe rationale for the Latarjet procedure was described as the “triple blocking” effect. Satisfactory surgical outcomes have been reported after surgery. However, it has been reported that the “triple blocking” effect increases joint stability, but it does not fully restore it. Moreover, the procedure is nonanatomic and concerns remain regarding the effects. The study of scapulohumeral rhythm, which is a clinical parameter used for the functional evaluation of shoulder kinematics, can offer new perspectives on the rationale for the procedure. This study aimed to compare the shoulder kinematics of patients after the Latarjet procedure to the shoulders of a healthy population using magnetic and inertial measurement units (MIMUs) with a motion analysis system. MethodsA retrospective study with prospective data collection was conducted on 28 patients who underwent the open Latarjet procedure for recurrent shoulder instability. At a minimum 12-month follow-up, each patient was evaluated by assessing the range of motion (ROM), the Rowe score, and the Constant-Murley score (CMS). Patients were examined using the ShowMotion 3D kinematic tracking system (NCS Lab, Modena, Italy), which uses wireless wearable noninvasive MIMUs sensors to assess the three-dimensional kinematics of the shoulder. For each plane of elevation (i.e., flexion and abduction), the scapulohumeral rhythm (SHR) was described by three scapulothoracic rotations (i.e., protraction–retraction, mediolateral rotation and posterior–anterior tilting) as a function of humeral anteflexion or humeral abduction. ResultsThe mean time from first shoulder dislocation to surgery was 6.6 ± 3 years (range, 1-12 years). No intraoperative complications occurred, and CT performed 3 months after surgery showed graft union in all patients. After a mean follow-up time of 32.4±20 months (range, 12-96), the mean CMS and Rowe scores were 94.5±4.8 (range, 84-100) and 96.7±3.5 (range, 90–100), respectively. All patients showed no signs of glenohumeral arthritis on X-ray examination. Scapular posterior tilt and scapular internal rotation were significantly greater in the patient group than in the healthy population for the flexion–extension and abduction–adduction movements along the whole shoulder range of motion (all p < 0.05); no differences were found in upward/downward scapular rotation. ConclusionA greater scapular posterior tilt and scapular internal rotation were observed after the Latarjet procedure. The modified position of the scapula was maintained during the entire ROM, suggesting a shoulder-stabilizing kinematic effect in addition to the bony, sling and bumper effects.

Surgical Technique for the Latarjet Procedure Using Non-Cannulated Screws

Background: The Latarjet procedure is effective for patients with anterior glenohumeral instability with substantial glenoid bone loss due to its triple blocking effect. Indications: Indications include high-risk patients with recurrent anterior glenohumeral instability with any glenoid bone loss or low-risk patients with 15% to 30% glenoid bone loss. Technique Description: An incision is made lateral to the coracoid and the deltopectoral interval is established. The pectoralis minor is released medially off the coracoid and the coracoacromial (CA) ligament is released close to the acromion. The coracoid is cut with a right-angle saw and the inferior coracoid is decorticated with a burr. Two holes are pre-drilled in the coracoid. The subscapularis is split between the upper two-thirds and lower one-third with the arm in external rotation. The capsule is split vertically at the joint line and the humeral head is retracted. The anterior glenoid is decorticated with a burr, and a hole is drilled inferiorly. The depth is measured and added to the depth of the inferior bone block hole. A fully threaded 3.5-mm solid stainless steel screw is placed in the inferior hole. Care is taken to ensure that the lateral border of the bone block is flush with the articular margin. This is repeated for the superior hole. A 1.8-mm knotless suture anchor is placed between the screws. The repair stitch is passed through the capsule and loaded onto the anchor and tensioned. The CA ligament is laid over the capsule and repaired. The subscapularis split is repaired side to side and the wound is closed in layers. Results: High return-to-sport rates, including at the same level of play, have been observed among young competitive athletes with significant glenoid bone loss who underwent a Latarjet, with similarly favorable results in older patients. Ninety-day complication rates have been reported around 9%, 5% of which constituted graft or hardware failures. Discussion/Conclusion: The Latarjet procedure is an effective option for indicated patients with anterior glenohumeral instability and may be enhanced with solid screws, proper anatomic technique, and capsulolabral repair augmentation. 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.

Classic Versus Congruent-Arc Latarjet Procedures

Glenohumeral instability remains a frequent pathology, specifically in athletes and active patients. As such, several treatment options have been described. In the setting of significant glenoid bone loss (i.e., >20%), off-track Hill–Sachs lesions, and failed previous soft-tissue–based repairs, glenoid bone–augmentation techniques must be considered. These techniques restore stability by a triple blocking effect of the bony graft, the capsulolabral complex repair, and the dynamic sling effect of the conjoined tendon. The classic Latarjet procedure consists in performing a coracoid osteotomy along with the conjoined tendon attachment followed by transfer and fixation to the anterior glenoid, positioning the lateral surface of the coracoid to be flush with the articular side. Then, a modification of this technique defined as “congruent-arc Latarjet” (CAL) was described. This approach involves rotating the coracoid process 90° along its longitudinal axis using the inferior surface to recreate the native glenoid arc. Biomechanical studies have discussed advantages and disadvantages of these techniques. The CAL allows a greater glenoid surface area, which may be relevant in patients with increased glenoid bone loss. However, the bone contact area is reduced, which increases the technical difficulty of screw positioning with an increased risk of graft fragmentation. The classic Latarjet technique has a greater initial fixation strength between the graft and the glenoid and a greater potential for bone consolidation due to the broader contact bone area. Excellent clinical and sports outcomes with low recurrence rates have been observed in both techniques. Imaging findings have exhibited high bone block healing and no difference in graft placement, but CAL demonstrated a greater incidence of fibrous or nonunion rates and errors in screw fixation. Finally, while similar early complications have been reported, long-term outcomes are still needed in CAL for comparing osteoarthritis progression. These results emphasize that either technique can be considered to manage glenohumeral instability when appropriately indicated.

Опыт применения Стэнфордской нейромодулирующей терапии у пациентов с терапевтически резистентной депрессией

Stanford neuromodulation therapy (SNT) is the state-of-the-art magnetic stimulation protocol that has been developed for management of treatment-resistant depression (TRD). The study was aimed to assess the possibility of SNT implementation in clinical practice and to define the protocol safety and efficacy in patients with TRD being an episode of the recurrent depressive disorder or bipolar disorder at the independent center. The study involved six patients (among them three women aged 21–66) with TRD associated with recurrent depression and type 1 or 2 bipolar disorder. The patients received intermittent theta-burst stimulation in accordance with the SNT protocol for five days: applying 10 triple blocks of stimulation daily at intervals of 1 hr between the blocks to the selected stimulation site showing maximum negative functional connectivity with subgenual cingulate cortex within the left dorsolateral prefrontal cortex. The Montgomery–Asberg Depression Rating Scale (MADRS) was used for clinical assessment of the effects, the follow-up period was three months. The improvement of depressive symptoms to the levels characteristic of remission immediately after the SNT completion was observed in five patients (MADRS score ≤10). After three months, two patients still had remission, the condition of three patients met the criteria of mild depressive episode, and one female patient withdrew from the study due to logistical difficulties. No serious adverse events were reported. The findings confirm safety and potentially high efficacy of SNT, including in patients with type 1 and 2 bipolar disorders.

Анестезиологическое обеспечение при энуклеации глазного яблока в педиатрической онкохирургии

Aiml. Optimization of anesthesia during enucleation of the eyeball in pediatric oncosurgery with an emphasis on regional methods. Material and Methods. Eight anesthesias were performed in children, whose average age was 3 years, operated on for retinoblastoma from July 2021 to January 2022. All patients underwent combined endotracheal anesthesia. A triple block was used as a regional component: palatal anesthesia, infraorbital anesthesia and van Lint block. Results. The effectiveness and adequacy of the proposed method of anesthesia using regional anesthesia was assessed in terms of hemodynamics – heart rate, systolic and diastolic blood pressure, the level of oppression of consciousness (BIS-index). The assessment was made at five stages: the beginning of anesthesia, tracheal intubation, 10 minutes after the triple block, at the traumatic stage of surgery, and at the end of anesthesia before tracheal extubation. As a result, it was noted that the studied variant of anesthetic management is characterized by a stable hemodynamic profile, and also does not provoke the development of an oculocardial reflex. There was a decrease in the level of the BIS-index below 40 c.u. at the stage of maintenance of anesthesia, which indicated the possibility of using lower concentrations of sevoflurane. Conclusions. This option of anesthetic management has sufficient efficiency and safety, and also allows to ensure the comfort of the surgeon. Key words: retinoblastoma; combined anesthesia; regional anesthesia.

Capsular repair is not an important part of the Latarjet-Walch procedure

Patte etal noted that the Latarjet procedure works by the triple blocking effect of (1) the conjoint tendon sling effect, (2) the bone block effect, and (3) the capsular repair. However, no clinical study has specifically investigated the role of capsular repair in the Latarjet procedure. The primary aim was to compare (1) the external rotation range of motion (ROM) achieved after the Latarjet procedure with and without the capsule to coracoacromial (CA-CAL) repair. The secondary aims were to compare the functional outcomes, forward elevation ROM, and internal rotation ROM after the Latarjet procedure with and without the CA-CAL repair. A prospective cohort of 30 patients who underwent the Latarjet-Walch procedure with a CA-CAL repair between October 2018 and February 2020 was compared with the preceding group of 31 patients who underwent the Latarjet-Walch procedure without any capsular repair between October 2016 and September 2018, at a minimum of 1-year of follow-up. External rotation with the elbow abducted at 90° (ER2) deficit (compared to the normal opposite side) was significantly larger after the CA-CAL repair augmentation of the Latarjet procedure (mean difference = 6°, P = .03) than that after no repair. External rotation with the elbow adducted (ER1) deficit after the CA-CAL repair augmentation was not significantly different from that after no repair. ER2 deficit of more than 15° (minimum clinically important difference) was observed in 11 patients (38%) in the CA-CAL repair group and 3 patients (10%, P = .015) in the no repair group. Walch-Duplay score, Rowe score, and Subjective Shoulder Value were not significantly different between the CA-CAL repair group and the no repair group. Covariates of hand dominance, overhead sports, and glenoid defect size did not significantly affect the ER2 deficit and ER1 deficit outcomes. This study disproved the long-held belief that capsular repair is an essential step of the Latarjet-Walch procedure. Capsular repair to the coracoacromial ligament in the Latarjet procedure leads to a clinically insignificant restriction of external rotation (with the arm abducted), no restriction of external rotation (with the arm adducted), but functional outcomes similar to those after Latarjet without a capsular repair in a nonoverhead athlete.

Synthesis and characterization of a long side-chain double-cation crosslinked anion-exchange membrane based on poly(styrene-b-(ethylene-co-butylene)-b-styrene)

By choosing a triple block polymer, poly(styrene-b-(ethylene-co-butylene)-b-styrene) (SEBS), as the backbone and adopting a long side-chain double-cation crosslinking strategy, a series of SEBS-based anion-exchange membranes (AEMs) was successively synthesized by chloromethylation, quaternization, crosslinking, solution casting, and alkalization. The 70C16-SEBS-TMHDA membrane showed high OH− conductivity (72.13 mS/cm at 80 °C) and excellent alkali stability (only 10.86% degradation in OH− conductivity after soaking in 4-M NaOH for 1700 h at 80 °C). Furthermore, the SR was only 9.3% at 80 °C and the peak power density of the H2/O2 single cell was up to 189 mW/cm2 at a current density of 350 mA/cm2 at 80 °C. By introducing long flexible side chains into a polymer SEBS backbone, the structure of the hydrophilic–hydrophobic microphase separation in the membrane was constructed to improve the ionic conductivity. Additionally, network crosslinked structure improved dimensional stability and mechanical properties.

Synthesis of monodisperse polymer suspensions with a narrow particle size distribution in the presence of water-insoluble triple block copolymers of polypropylene oxide and polyethylene oxide (pluronics)

Synthesis of monodisperse polymer suspensions with a narrow particle size distribution in the presence of water-insoluble triple block copolymers of polypropylene oxide and polyethylene oxide (pluronics)

Functional Outcome of Open Latarjet Procedure in Non-Athletic Middle-Aged Patients.

Introduction:The movement and steadiness of the shoulder joint is due to both the dynamic and static stabilisers. Recurrent anterior shoulder instability is common due to the Bankart lesion or the Hill Sachs lesion. The bone loss and soft tissue failure due to these lesions causing instability is well compensated by Latarjet procedure which acts by triple blocking effect of the bone graft, the sling effect of the conjoint tendon of subscapularis and the ligament of the coracoacromial ligament stump.Materials and methods:Middle-aged patients with recurrent anterior shoulder dislocation and a mid-range instability on clinical assessment with an isolated glenoid bone loss of 20% or Bankart lesion with engaging Hill Sachs lesion were selected for the study. The surgical procedure included a subscapularis split to expose the glenoid. The coracoid graft harvested was prefixed with Kirschner wires and placed flush over the glenoid ensuring no medial or lateral overhang and fixed with 4.0mm cancellous screws with the washer. The functional outcome was measured with the ROWE score and ASES score and the movements were evaluated.Results:A total of 24 patients fulfilled the inclusion criteria. Post-operatively at final follow-up, the mean ROWE score was 97.08 ±8.45 and the mean ASES score was 94.4±9.10. One patient had screw breakage as a complication and another had restriction of movement which was managed with physiotherapy.Conclusion:Open Latarjet is an effective procedure for recurrent anterior shoulder instability in non-athletic middle-aged patients as a excellent functional outcome was achieved with this technique. We therefore recommend open Latarjet as an alternative to arthroscopic treatment in developing countries where patient affordability and the availability of the resources are the issues.

In vitro comparison of two photostimulable phosphor plate systems for early detection of occlusal dentin caries with and without a sharpening filter.

Background. Dental caries is the most important reason for tooth loss. Clinical examination is the most commonly used technique for occlusal caries diagnosis. The diagnostic power of digital systems is a matter of controversy in this field. The present study aimed to determine the diagnostic accuracy of two photostimulable phosphor plate (PSP) systems for early occlusal dentin caries in vitro. Methods. Sixty-nine extracted molar and premolar teeth were used in this study. The teeth were mounted in triple blocks, and standard radiographs were taken by the Digora and Acteon digital radiographic systems. The original and filter 1-enhanced radiographs were evaluated by two experienced observers twice at an interval of two weeks, and dentin caries was recorded in Tables prepared for the study. The teeth were then sectioned in a buccolingual direction and evaluated under a stereomicroscope. The observers’ reports were compared with microscopic findings as the gold standard. SPSS 23 was used to calculate the kappa coefficient, sensitivity, specificity, and area under the ROC curve (AUC). Statistical significance was set at P<0.05. Results. The internal and the external agreements in both imaging systems were good to excellent. The means of sensitivity, specificity, and AUC in the Acteon system were 34.1, 92.9, and 0.674, with 30.8, 94.8, and 0.659, respectively, in the Digora system. Conclusion. The accuracy of early occlusal caries diagnosis was poor on both systems, and no significant difference was observed between the two systems at a 95% confidence interval. Although the AUC was slightly higher in the original images, there was no significant difference between them; however, due to their high specificity, they can prevent unnecessary treatments in the clinic.

Photosensitizing Activity of Steroid Derivatives of Pyropheophorbide in the Oxidation of Tryptophan in the Aqueous Phase

Solubilization with pluronic F-127 gave water-soluble forms of hydrophobic photosensitizers—steroid derivatives of pyropheophorbide a. Solubilization was performed by evaporating the chloroform co-solutions of photosensitizer and pluronic (triple block copolymer of ethylene and propylene oxide) and subsequently dissolving the resulting dry residue in water. The concentration ratios of modified pyropheophorbide–pluronic at which the photosensitizer completely passed into the aqueous phase were determined. Among the starting hydrophobic photosensitizers, pyropheophorbide–dihydrotestosterone possessed the highest activity in photosensitized oxidation of anthracene with singlet oxygen in chloroform, while after solubilization, pyropheophorbide–testosterone was most active in the test (for photodynamic therapy) oxidation of tryptophan in aqueous solutions.

Determination of Cohesion values of Rock Materials using Double Shear Jaws

In this study, experimental and numerical analyses were carried out for determination of cohesion values of different types of rock materials using double shear jaws (DSJ) which can be practically used with the conventional compressive test equipment, to make shear planes in the rock core specimens. Effects of various parameters like jaw dimensions, gaps between triple blocks of the DSJ and contact conditions of the jaw on the results and validity of the cohesion test were investigated considering failure mechanisms of rock core specimens. Instead of a failure induced due to the shear stresses, tensile failures are mostly seen from conventional shear testing conditions. For a valid failure under the control of shear stresses, a DSJ design was suggested to be used in cohesion determination tests according to the results obtained from this study.

Open Latarjet: tried, tested and true

The open Latarjet procedure has proven to be an effective procedure in the treatment of anterior shoulder instability, particularly in patients with glenoid bone loss and/or an engaging Hill-Sachs lesion. The transfer of the coracoid bone block to the anterior glenoid provides stability via the “triple blocking effect”. We describe our indications and surgical technique for the open Latarjet procedure.

Triple Block Nanocarrier Platform for Synergistic Cancer Therapy of Antagonistic Drugs.

A unique biodegradable triple block nanocarrier (TBN) is designed and developed for synergistic combination therapy of antagonistic drugs for cancer treatment. The TBN was built with hydrophilic polyethylene glycol (PEG) outer shell; a middle hydrophobic and biodegradable polycaprolactone (PCL) block for encapsulating anthracycline anticancer drug like doxorubicin (DOX), and an inner carboxylic-functionalized polycaprolactone (CPCL) core for cisplatin (CP) drug conjugation. TBN-cisplatin drug conjugate self-assembled as stable nanoparticles in saline (also in PBS) wherein the hydrophobic PCL block functions as a shield for Pt-drug stability against GSH detoxification. Enzymatic-biodegradation of TBN exclusively occurred at the intracellular environment to deliver both cisplatin (CP) and doxorubicin (DOX) simultaneously to the nucleus. As a result, the TBN-cisplatin conjugate and its DOX-loaded nanoparticles accomplished 100% cell growth inhibition in GSH overexpressed breast cancer cells. Combination therapy revealed that free drugs were antagonistic to each other, whereas the dual drug-loaded TBN exhibited excellent synergistic cell killing at much lower drug concentrations in breast cancer cells. Confocal microscopic analysis confirmed the localization of drugs in the cytoplasm and at peri-nuclear site. Flow cytometry analysis revealed that the drugs were taken up 4-fold better while delivering them from TBN platform compared to free form. The TBNs approach is a perfect platform to overcome the GSH detoxification in Pt-drugs and enable the codelivery of antagonistic drugs like cisplatin and DOX from single polymer dose to accomplish synergistic killing in breast cancer cells.

USE OF AN AQUEOUS SOLUTION «PHOTODITAZIN», COMPLEXED WITH A VARIETY OF POLYMERS FORTHE TREATMENT OF PURULENT WOUNDS OF SOFT TISSUE EXPERIMENT

The article presents the results of a study of water-soluble polymers effects on the “Photoditazin” activity and the course of wound process under photodynamic therapy of purulent wounds in rats. The data of macroscopic and histological study of wounds status before and after photodynamic therapy, and assessed the quality and degree of intensity of reparative processes under influence of photodynamic therapy with the drug “Photoditazin” and its complexes with water-soluble polymers of natural poly- saccharide chitosan and a triple block copolymer of ethylene- and propylene oxide (pluronic F127).It was given the rationale for Pluronic F127 joining to the drug “Photoditazine” for reducing the cytotoxic effects of the drug.

Functionally integrated liquid crystalline photochromic triple block copolymer with locally light‐ and thermal‐controllable sub‐blocks

ABSTRACTPhotoorientation and reorientation processes induced by illumination of the samples with oppositely directed polarized light and by the thermal treatment were studied for the films of triblock copolymer pAzo10‐b‐pPhM80‐b‐pAzo10 consisting of a nematic phenyl benzoate сentral sub‐block (PhM, DP = 80) with two terminal smectic azobenzene sub‐blocks (Azo, DP = 10). For amorphized films of triblock copolymer, illumination with polarized light (λ = 546 nm) is shown to be by orientation of only Azo‐containing groups, but upon following annealing of the film, PhM groups are adjusted to the orientation of Azo fragments. It was found, that the subsequent illumination of the block copolymer sample with oppositely directed polarized light changes the orientation of azobenzene groups, while the orientation of phenyl benzoate groups is remained unchanged. Thus, the cyclic illumination of the triblock copolymer samples by the linear polarized light and subsequent thermal treatment make it possible to control and fix orientation of azobenzene and phenyl benzoate groups located in different sub‐blocks in the desired and independent manner. The comparison of these results with the data on random p(Azo7‐ran‐PhM30) copolymer of the similar composition revealed, that in the random copolymer, both Azo and PhM mesogenic groups are involved in the orientational cooperative process regardless of films process treatment. © 2016 Wiley Periodicals, Inc. J. Polym. Sci., Part B: Polym. Phys. 2016, 54, 1602–1611

Acupressure and anxiety in cancer patients.

Background:Anxiety has negative effects on mental and physical performance, quality of life, duration of hospitalization, and even on the treatment of patients with cancer.Objectives:Today acupressure is widely used to treat anxiety. Thus, the present study aimed to investigate the effects of acupressure on anxiety in patients with cancer.Patients and Methods:A double-blind randomized clinical trial was conducted on 85 patients hospitalized with 3 groups including acupressure group (n = 27), sham group (n = 28), and control group (n = 30) in the hematologic ward of Shahid Beheshti Hospital of Hamadan, Iran, in 2013. The sampling permuted-block randomization with triple block was used. The anxiety of the patients in the experimental, sham, and control groups were measured with Spielberger’s State-Trait Anxiety Inventory (STAI). Then, real acupressure was performed in the experimental group and fake acupressure in the sham group, and only routine care was provided for the control group. Anxiety of the patients was also assessed at 5 and 10 days after the intervention. Statistical analysis of the data was performed by SPSS software using repeated measures analysis of variance (ANOVA) and post hoc least significant difference (LSD) test.Results:According to the findings, the mean level of anxiety before the intervention between groups were matched (P > 0.05). Acupressure had a significant influence on the anxiety in the experimental group at 5 (45.30 ± 7.14) and 10 days (43.48 ± 6.82) after the intervention (P < 0.05). However, it did not have a significant impact on their covert anxiety (45.48 ± 7.92 at 5th day vs 45.63 ± 8.08 at 10th day, P > 0.05). No significant differences were observed in the fake points regarding overt and covert anxiety of patients in the sham group (overt anxiety; 47.57 ± 7.85 at 5th day vs. 46.71 ± 7.32 at 10th day, P > 0.05) (covert anxiety; 47.96 ± 6.33 at 5th day vs. 46.89 ± 6.94 at 10th day, P > 0.05). Moreover, the routine care provided for the control group did not have any effect on the overt and covert anxiety of the patients (P > 0.05).Conclusions:Acupressure is recommended as a complementary therapy to reduce anxiety in patients with cancer because of its low cost, safety, and simplicity.

Intervertebral Disc Protrusion in a Ferret with Triple Thoracic Block Vertebrae

Hind limb paresis or plegia in ferrets is a common sign of illness, which can be produced by intervertebral disc (IVD) extrusion or protrusion along with many other systemic diseases. This case report describes a ferret (Mustela putorius furo) with chronic onset paraplegia in which T7-T8, T8-T9, and T10-T11 IVD herniations and T9-T10 block vertebrae were diagnosed with the assistance of myelography. It is believed that the excessive stress on the adjacent annulus fibrosus and vertebral endplates resulting from block vertebrae could have been the cause of IVD disease in the atypical location described in this case.

The Latarjet Procedure for Recurrent Anterior Shoulder Instability: Rationale and Technique

The Latarjet coracoid transfer procedure provides a triple blocking effect in the treatment of anterior shoulder instability. First, the coracoid bone block increases the anterior posterior diameter of the inferior portion of the glenoid fossa, making it more difficult for the humeral head to subluxate or dislocate. Second, the conjoined tendon acts as a sling reinforcing the inferior capsular ligamentous complex and the inferior portion of the subscapularis. Finally, repair of the inferior capsular ligamentous complex to the stump of the coracoacromial ligament reconstructs the capsulolabral anatomy. We describe our preferred technique for this procedure. With proper patient selection and systematic surgical technique, instability can be eliminated without loss of external rotation in more than 98% of cases.

Tribloc (fémoral, sciatique, obturateur) pour la chirurgie ambulatoire arthroscopique de genou : étude prospective de faisabilité et d’efficacité

Background The purpose of this study was to evaluate intra- and postoperative conditions of the triple nerve block technique (femoral, obturator, sciatic block) for outpatient knee arthrsopic procedures. Methods After written informed consent, ASA I-III patients received a combined triple nerve block with 30–40 ml lidocaine or mepivacaine (1,5%). Blocks were performed using a nerve stimulation technique. Onset time, block failure, supplemental general anesthesia (GA) or analgesia and pain score were recorded intraoperatively. After surgery, side effects (at days 0, 1, 3, 7 and after 4 weeks), patient and surgeon satisfactions were noted. Results Three hundred and twelve patients were screened and 115 triple blocks were performed (157 choosed GA, 19 spinal anaesthesia, 21 exclusion for regional anaesthesia). Failed blocks occurred for 12 (10%) patients. These 12 patients received GA before surgery incision. Time to complete block was 40 (10–60) min. Supplemental GA was required for 12 patients (12%) due to surgical ( n = 7, 7%) or tourniquet ( n = 5, 5%) pain. Intraoperative surgeon satisfaction was 90 (60–100). After surgery, time to discharge the postoperative care unit was 15 (5–60) min. Pain score at rest (Visual Analog Scale) until six hours was less than 30 /100, without any additionnal morphine. Two patients (< 2%) failed for ambulatory discharge criteria (no relation with triple block). At day 0, 3, 5% patients suffered PONV (8% at D1), paresthesia was noted in 1.7% at D0 (0,8% D3). No other secondary effects were observed after seven days and 91% patients “would like same anaesthesia” for next surgery. Conclusion We conclude that triple nerve block provided reliable intraoperative patient and surgical conditions for outpatient knee arthroscopy. Failed block (10%) was the major reason of supplemental anaesthesia. To increase surgical turn over under triple nerve block, a preoperative room may be required (block onset time).