Ultrasound-guided adductor canal block using levobupivacaine versus periarticular levobupivacaine infiltration after totalknee arthroplasty: a randomized clinical trial

ABSTRACT BACKGROUND: Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING: Prospective randomized clinical trial in a university hospital. METHODS: Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated withperiarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS: VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAI-L group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAI-L group than in the ACB-L group (P < 0.05). CONCLUSION: ACB-L was superior to PAI-L regarding pain treatment after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking ability. CLINICAL TRIAL REGISTRY: ACTRN-12618000438257.

Opening of Tracheostomy in a Morbid Obese Patient With Frova Catheter.

Morbid obesity is defined as body mass index (BMI) at or over 40. Unfavorable neck anatomies of the patient are considered counter indication for percutaneous tracheostomy and they are referred for opening of surgical tracheostomy. In our case report, problems encountered in a morbid obese patient who could not be extubated due to post operative respiratory problems and the use of frova catheter (COOK, USA) in this procedure is discussed. A 42 old female patient at the weight of 246 kg. with BMI 89.4 could not be extubated due to respiratory causes post operatively and she was transferred to operating theater for surgical tracheostomy. After tracheostomy was opened, due to unsuitable anatomy associated with thick fat tissue on the neck the tracheostomy cannule couldn’t forwarded from tracheostomy hole, frova intubation catheter was sent and over it, 8 no endotracheal tube was sent in order to aerate the patient. Opening of tracheostomy in the morbidly obese is challenging operation due to specific anatomic conditions. Frova intubation guide helps in difficult intubation cases and was reported to be used for retrograde intubation in patients in whom antegrade intubation was not possible. In morbid obese patients, opening tracheostomy and then cannulating is difficult. Frova intubation guide can be used for difficult intubation in morbidly obese patients. In addition, as in the present case, it can be used in conditions in which tracheostomy cannula is too short or could not be placed during tracheostomy procedure.