Role of Preoperative Rehabilitation in Hip Surgeries: A Narrative Review

Hip trauma is a significant cause of morbidity and mortalityamong elderly patients. In the United States approximately30lakhs hip fractures occur each year and this number isincreasing each year along with the increased number ofelderly population. The management of hip trauma usuallydepends on the surgical management. However evidencesuggests that even with prompt surgical interventions, thepost operative complications are common and patient face agreat difficulty in post operative rehabilitation. Recently, someof the randomized trials have suggested that preoperativerehabilitation in the form of exercise or the physiotherapyis associated with improved postoperative pain score anddecreased hospital stay in elderly frail patients and in patientswith associated co morbidities such as diabetes, cardiovascular,or respiratory complications. In this present review wewill outline the importance of preoperative rehabilitationin management of different types of hip trauma based onprevious study summaries. We will also try to evaluate theimportance of such rehabilitation therapy in final outcome ofthe patients after surgery

Peripheral Nerve Blocks in Patients with Diabetic Neuropathy and other Neuropathies: A Narrative Review.

Neuropathy, arising from different etiologies, can be a majordebilitating condition that leads to pain,reduces physicalmovement and amputation. Among all known neuropathyetiologies, diabetes mellitus is one of the significant causesthat results in peripheral and other type of neuropathies thatresult in physiological discomfort and mortality. Prolongedhyperglycemia-induced oxidative stress causes damage toneuron resulting in a range of symptoms to pain and internalorgan failure. Although treatment strategies exist to alleviatethe pain symptoms, there is no existing therapy to eliminatethe root cause of neuropathy. Presently, peripheral nerveblock by several anesthetic agents shows great promise inmanaging diabetes-induced neuropathy and neuropathiesof other etiologies. This article discusses different types ofneuropathies and their classifications with special emphasison diabetic neuropathy. The following section discusses theextent of severity of the condition in terms of its epidemiologyand associated complications. The article provides an elaborateidea on different anesthetic agents used in peripheral nerveblock in diabetic neuropathy and other neuropathic conditions.Peripheral nerve block shows a potential efficiency whensingle and combination doses of anesthetics are used. Differentadjuvants are also used in combination with anesthetics toprolong and enhance the effect of analgesia. Looking at theseverity, physiological, psychosocial and economic burden ofthe neuropathic disease, more in-depth studies and discussionshould be initiated to strengthen the use of peripheral nerveblock in the management of diabetic and other neuropathies.