Utility of the transversus abdominis plane and rectus sheath blocks in patients undergoing anterior lumbar interbody fusions.

BACKGROUND CONTEXT: Anterior lumbar interbody fusion (ALIF) is a well-established technique to address numerous pathological conditions of the spine and to restore sagittal spine balance. Improving patient comfort and reducing opioid consumption following lumbar fusions is a significant goal for spine surgeons. Therefore, there is a growing need to explore multimodal options for pain management post-surgery. PURPOSE: Determine the effectiveness of combined transversus abdominis plane (TAP) and rectus sheath (RS) blocks in those undergoing (ALIF) as compared to a historical control. STUDY DESIGN/SETTING: Retrospective comparative cohort performed at a tertiary referral orthopedic specialty hospital. PATIENT SAMPLE: Of the 175 patients (88 patients received a combined regional block) who underwent an ALIF between January 1, 2018 and August 1, 2021. OUTCOME MEASURES: Pain scores both during activity and at rest, opioid consumption during the first 72 hours postoperatively, total postoperative anesthesia care unit length of stay (PACU LOS), 30-day emergency department visits, 30-day readmissions, and unplanned returns to the operating room. METHODS: Charts of patients undergoing an ALIF during the open period for this study were placed into two groups: those that received combined regional anesthesia and those that did not. A t test assuming unequal variances was used to determine if there were differences in outcome variables between the two groups. RESULTS: The study group, those receiving the combine block, demonstrated a statistically significant reduction in opioid pain medicine (24.8%), reported pain (10-13%), and PACU LOS (18.7%). There were no differences in complication rates between the two groups. CONCLUSIONS: The combined use of TAP and RS blocks appears to be a well-tolerated and effective means of pain management in this patient cohort.

Intraosseous epidermoid inclusion cyst in a great toe. A case report and review of the literature.

Epidermoid inclusion cysts are benign lesions that occasionally occur in the distal phalanges of the fingers but are less frequently identified and underreported in the toes. We describe a 55-year-old man with a history of work-related trauma followed by painful expansion of his right great toe, resulting in great anxiety. Imaging studies revealed a radiolucent lesion in the distal phalanx of his right hallux. Clinical differential diagnoses included the possibility of an intramedullary inclusion cyst and other various radiolucent lesions. During surgery, a cystic lesion that contained creamy material was discovered. Frozen section diagnosis of the lesion was an intraosseous epidermoid inclusion cyst. The lesion was removed and the patient recovered uneventfully. Although it has been reported that an unduly large number of phalangeal cysts have been treated by amputation, the judicious use of intraoperative frozen sections can prevent this scenario.

Treatment of isolated type I open fractures: is emergent operative debridement necessary?

A retrospective review was done of treatment of isolated Type I open fractures. Ninety-one patients with isolated Type I open fractures were included in the study. Patients with multiple injuries, gunshot wounds, hand injuries, compartment syndromes, intraarticular fractures, or higher type open fractures were excluded. All patients received antibiotics and were followed up until fracture union. The patients' charts were reviewed for the type of fracture, mechanism of injury, type of treatment, length of hospital stay, and complications encountered, especially infections. There was a 0% incidence of infection in all patients. Only one patient received operative debridement within 12 hours. A prospective randomized study of the treatment of Type I open fractures is needed to determine whether immediate operative debridement is necessary to prevent infection. Immediate operative debridement may not be necessary in the isolated, low-energy Type I open fracture with stable fracture patterns.

Outcomes of elderly patients with nondisplaced femoral neck fractures.

Seventy patients with nondisplaced femoral neck fractures treated by cannulated screw fixation were followed up prospectively for 6 months. Preinjury Functional Independence Measure scores and comorbidities were recorded as were operative time, type of anesthesia, estimated blood loss, transfusions, and postoperative complications. Functional Independence Measure scores were reassessed at 3 and 6 months. The mean age of the patients was 78 years. The 6-month mortality was 5.7%. The mean overall Functional Independence Measure scores at 3 and 6 months were 86% and 89% of the initial score respectively. Locomotion Functional Independence Measure scores at 3 and 6 months were 73% and 89% of the initial score, respectively. Multiple regression analysis found patient age and initial overall Functional Independence Measure score to be independent predictors of overall, locomotion, and transfer Functional Independence Measure scores at 3 months. At 6 months, only initial Functional Independence Measure score predicted ultimate Functional Independence Measure scores. This suggests that patient age may affect the speed of recovery but not the ultimate functional result. Of comorbidities, only chronic obstructive pulmonary disease significantly affected functional recovery at 3 months, but not at 6 months. Operative time, estimated blood loss, type of anesthesia, and patient gender did not affect functional outcomes. Patients who sustain a nondisplaced femoral neck fracture experience predictable and lasting loss of function. Low initial functional status predicts a poorer outcome. Age and pulmonary comorbidity affect speed of recovery.