RESUMO
Pain is one of the greatest concerns of patients undergoing total knee arthroplasty [TKA]; which is severe and intolerable within 72 hours post-surgery. Appropriate pain management is a key factor in patient's early mobilization, launching physiotherapy, less hospital length of stay and more importantly, patient's satisfaction. New studies with the infiltration of combined analgesic agents peri and intra-articularly has shown encouraging results in pain reduction, good clinical outcome and patient's satisfaction. The purpose of this study was to compare the analgesic effect of locally infiltrated analgesia [I] compared with single injection femoral nerve block [F] and its impact on pain relief, patient's satisfaction, morphine consumption and clinical outcome. This research was a double-blind randomized clinical trial on 36 consecutive patients undergone TKA divided into group [F] in which the ipsilateral femoral nerve in the inguinal area was blocked by a single injection of 20 ml ropivacaine [10 mg/ml] and group [I] which a combination of ketorolac, ropivacaine and epinephrine was injected peri and intra-articularly on the knee during TKA. Pain intensity measured by visual analog scale [VAS], clinical outcome [based on range of motion], morphine consumption and patient's satisfaction of pain management after TKA were compared between the two groups. Pain intensity score [VAS] and Morphine consumption were statistically less in group I than group F during the first 6 hours and 24 hours post surgery respectively [P< 0.05]; however, group F had 12-hour VAS score of 5 which was less than group [I] by 1 grade in pain scale [VAS] [P< 0.05]. Other parameters were not statistically different in the two groups and patients' response to our pain management protocols proved to be satisfactory in both groups. Lower level of pain and morphine consumption in group [I] during the first 24 hours post-surgery in contrast to group [F] and its ease of use by a surgeon intra-operatively, introduce local infiltration analgesia as an effective method to decrease the patient's pain and improve patient's satisfaction in early post-surgery period after total knee arthroplasty
RESUMO
Ischemia reperfusion injury [IR injury] is a common problem in clinical conditions. Researches have frequently revealed that ATP- sensitive potassium [K[ATP]] channels and nitric oxide plays a role in protection against ischemic injury in skeletal muscle. The present study aimed at evaluating the possible link between this two pathways. Sixty-eight male wistar rats, were pretreated with saline, diazoxide [K[ATP] opener; 45 mg/Kg, IP], glibenclamide [K[ATP] inhibitor; 5 mg/Kg], or L-NAME [iNOS inhibitor; 20 mg/Kg, IP] before 3 h ischemia and 2 h reperfusion. Activities of antioxidant enzymes superoxide dismutase [SOD] and catalase [CAT], and the level of malondialdehyde [MDA] and expression of iNOS were measured in muscle tissue. Tissue MDA content was significantly increased by IR [p < 0.001]. Diazoxide significantly decreased the IR-induced elevation of tissue MDA level [p < 0.05] and Glibenclamide increased MDA [p < 0.05 vs. IR group]. L-NAME inhibited the effect of diazoxide on decreasing MDA [p < 0.01 vs., diazoxide+IR group] and IR decreased the activity of SOD and CAT [p < 0.01], while pretreatment with diazoxide increased activity of SOD and CAT [p < 0.01]. Glibenclamide decreased SOD and CAT activity after IR [p < 0.05]. L-NAME pretreatment in diazoxide-treated rats abolished the effect of diazoxide on increasing the activity of SOD and CAT [p < 0.05 vs. Diaz+IR]. Expression of iNOS was increased by IR [p < 0.01 vs. Sham group]. Diazoxide significantly decreased iNOS expression after IR [p < 0.05 vs. IR]. L-NAME significantly decreased iNOS expression after IR [p < 0.01] in diazoxide-treated rats [p < 0.01 vs. Diaz+IR]
RESUMO
A cross-sectional non-experimental study.To collectively detect the reliability and feasibility of the five types of clinical tests that have been used to measure endurance of the trunk muscles in subjects with and without low back pain [LBP] and identify the sensitivity of each test to predict the probability of the occurrence of LBP.Testing spinal muscle endurance seems to be very important in prediction, prevention and rehabilitation of LBP. Several types of methods of static endurance testing such as: Sorensen test, prone isometric chest raise test, prone double straight-leg raise test, supine isometric chest raise test and supine double straight-leg raise test regarding their utilization have been reported in the literature. However, identification of the tests that have more dominant sensitivity on assessment of LBP has not yet been determined. Information regarding the sensitivity of each test is needed for effective prevention and appropriate treatment strategies.A total of 200 subjects participated in this study. Subjects were categorized into four groups: asymptomatic males [N= 50, mean age= 38+12 years], asymptomatic females [N= 50, mean age= 43+11 years], males with LBP [N= 50, mean age= 39+12 years], and females with LBP [N= 50, mean age= 43+12 years]. Five clinical tests were measured in each group and the relative association of each test on LBP was assessed.Among all the performed tests, the prone double straight-leg raise test had the highest association with LBP. Other tests such as the prone isometric chest raise test, Supine isometric chest raise test and Supine double straight-leg raise test had low association with LBP in comparison with the prone double straight-leg raise test.It seems that the prone double straight-leg raise test has more association with LBP than other tests and could be used as a useful method for testing spinal muscle endurance, prediction of the probability of the occurrence of LBP, and prevention and rehabilitation of LBP