Postoperative pain control in total joint arthroplasty: a prospective, randomized study of a fixed-dose, around-the-clock, oral regimen.

This randomized, prospective study assessed postoperative pain control in 119 patients undergoing total joint arthroplasty. Group 1 (59 patients) received scheduled, around-the-clock, oral opioids and group 2 (60 patients) received oral opioids on an as-needed basis. Both groups had parenteral opioids available for breakthrough pain. The average scores for group 1 were lower than group 2. Differences were significant in sensory scores (AM day 1; AM and PM day 2), affective scores (PM day 2), total pain (PM day 2), visual analog scale (PM day 2), and present pain intensity index (AM day 1; PM day 2). Group 1 averaged 2.05 breakthrough pain doses and group 2 averaged 3.47 doses (P=.003), an average savings of 17.2% of the cost of pain medications during the first 2 postoperative days. The results indicate that scheduled, around-the-clock, oral opioids are an effective treatment regimen for postoperative pain control in total joint arthroplasty patients.

Intraoperative radiographic assessment of ankle fractures.

This retrospective study was performed to determine whether three or two radiographic views are necessary for intraoperative evaluation of low energy, rotational ankle fracture reduction and fixation. Four orthopaedic surgeons independently reviewed two sets of radiographs of 93 low energy, rotational ankle fractures treated by open reduction and internal fixation. The reviewers judged reduction and fixation, without measurement, as if they had been the operating surgeons. Set 1 consisted of mortise and lateral views and Set 2 consisted of anteroposterior, mortise, and lateral views. There was a 2-month interval between the review of Set 1 and Set 2. Intraobserver consistency for Sets 1 and 2 for reduction ranged from 92% to 98% and consistency for fixation ranged from 85% to 94%. These results underwent statistical testing by calculation of the kappa value. With a 95% confidence interval, the kappa value for reduction ranged from 0.376 to 0.701; the kappa value for fixation ranged from 0.598 to 0.781. The interobserver consistency for Sets 1 and 2 also was calculated. The authors conclude that fracture reduction and fixation can be assessed adequately with lateral and mortise views. The anteroposterior view can be eliminated from the standard radiographic protocol, potentially resulting in cost savings.