Local infiltration analgesia following total hip replacement: a review of current literature / 中华创伤杂志(英文版)

Controlling postoperative pain after total hip replacement is important and controversy remains regarding different regimens. By reviewing 18 studies, we attempt to find whether local infiltration analgesia after total hip replacement has any effect on postoperative pain, length of hospital stay and opioid consumption. We conclude that local infiltration analgesia is an effective method for decreasing postoperative pain.

GlideScope: a rescuer in difficult pediatric airway

Effective airway management includes anticipating and planning for problems. Difficulties frequently occur as the result of patient characteristics that interfere with spontaneous breathing, bag mask ventilation, laryngoscopy or intubation of the trachea. We are presenting here a case report of a 5 year old child with large sublingual dermoid with bilateral adenoid hypertrophy where successful intubation was done with the use of GlideScope

Methylprednisolone in hair dye poisoning

Poisoning due to hair dye consumption is relatively rare in India. Compound responsible for hair dye toxicity is paraphenylenediamine [PPD]. Hair dye [PPD] poisoning has high morbidity and mortality and its incidence has increased dramatically in the past 4 years. Prompt recognition and effective management lead to complete recovery. Diagnosis is made solely on the basis of the history given by the attendants and symptoms of cervicofacial edema, black colored urine and muscular pain. The key to successful management is detection and avoidance of triggers, early recognition of attacks, and aggressive airway management when warranted. Initial treatment in a patient presenting with most forms of angioedema includes antihistamines and glucocorticoids if required. Epinephrine should be administered if there is a concern for laryngeal edema.We present here a case report of hair dye poisoning where patient presented as cervicofacial edema not responding to conventional treatment, but responded to metyhlprednisolone intravenously

Failed ventilation with LMA Proseal [registered sign] in a patient with sleep apnea syndrome

Patients with sleep apnea syndrome [SAS] have excessive adipose tissue in oropharynx which can obstruct the airway. A high prevalence of difficult intubation has been reported in these patients and an association between the severity of SAS and difficult intubation has been suggested. LMA Proseal[registered sign] [LMA Company, USA] has been launched as a better alternative to LMA classic, as it provides good airway seal due to its modified cuff. The improved seal of LMA Proseal[registered sign] [PLMA[registered sign]] has an advantage in obese patients where higher airway pressures are required for positive pressure ventilation. We found that LMA Classic[registered sign] provided better airway management than PLMA[registered sign] in one of our obese patients with SAS

Evaluation of interadductor approach in neurolytic blockade of obturator nerve in spastic patients

Spasticity is a syndrome associated with a persistent increase in involuntary reflex activity of a muscle in response to stretch. Adductor muscle spasticity is a common complication of spinal cord and brain injury. It needs to be treated if it interferes with activities of daily living and self-care. Obturator neurolytic blockade is one of the cost-effective therapeutic possibilities to treat spasticity of adductor group of muscles. In this study, we assessed the efficacy of interadductor approach in alleviating the spasticity. Obturator neurolysis using 8-10 ml 6% phenol was given with the guidance of a peripheral nerve stimulator in 20 spastic patients. Technical evaluation included number of attempted needle insertions, time to accurate location of the nerve, depth of needle insertion, and success rate. Pain, spasticity, hip abduction range of motion [ROM], number of spasms, gait, and hygiene were evaluated at 1[st] hour, 24[th] hour, end of the 1[st] week, and in the 1[st], 2[nd], and 3[rd] months following the intervention. The success rate was 100% with mean time to accurate nerve location 4.9 +/- 2.06 min. Average depth of needle insertion was 2.91 +/- 0.32 cm. Compared with the scores measured immediately before the block, all studied parameters improved significantly. An increase in the Modified Ashworth Scale values was observed in the 2[nd] and 3[rd] months, but they did not reach their initial values. The interadductor approach proved to be accurate and fast, with a high success rate. Phenol blockade is an efficient and cost-effective technique in patients with adductor spasticity. It led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene, with an efficacy lasting for about 3 months

Spasticity - pathogenesis, prevention and treatment strategies

This review of the long-term management of spasticity addresses some of the clinical dilemmas in the management of patients with chronic disability. It is important for clinicians to have clear objectives in patient treatment and the available treatment strategies. The review reiterates the role of physical treatment in the management, and thereafter the maintenance of patients with spasticity. Spasticity is a physiological consequence of an injury to the nervous system. It is a complex problem which can cause profound disability, alone or in combination with the other features of an upper motor neuron syndrome, and can give rise to significant difficulties in the process of rehabilitation. This can be associated with profound restriction to activity and participation due to pain, weakness, and contractures. Optimum management is dependent on an understanding of its underlying physiology, an awareness of its natural history, an appreciation of the impact on the patient, and a comprehensive approach to minimizing that impact. The aim of this article is to highlight the importance, basic approach, and management options available to the general practitioner in such a complex condition

Obturator neurolysis using 65% alcohol for adductor muscle spasticity

Spasticity is motor alteration characterized by muscle hypertonia and hyperreflexia. It is an important complication of spinal cord injury, traumatic brain injury, cerebral palsy, and multiple sclerosis. If uncorrected, fibrosis and eventually bony deformity lock the joint into a fixed contracture. Chemical neurolysis using various agents is one of the therapeutic possibilities to alleviate spasticity. We are, hereby, reporting 3 patients in whom 65% alcohol was used as neurolytic agent for the treatment of hip adductor spasticity, and the effect lasted for a variable period