ABSTRACT
BACKGROUND: Recently, high-volume local infiltration analgesia (LIA) in total knee arthroplasty (TKA) has been introduced, but dosage, timing, and effects of adjuvants are still debated. METHODS: We randomized 102 patients undergoing TKA to receive either epidural analgesia (EDA group) or LIA (ropivacaine 150 mg and epinephrine 0.5 mg) combined with ketorolac 30 mg and morphine 5 mg given either locally (LIA group) or i.v. (LIAiv group). Epidural analgesia was maintained for 48 h. Intra-articular re-injection via a catheter with ropivacaine 142.5 mg and either intra-articular or i.v. ketorolac 30 mg was given 24 h after surgery. Pain scores, morphine consumption, side-effects, and readiness for hospital discharge were studied. RESULTS: At discharge from the postoperative anaesthetic care unit, verbal pain scores were lower in the EDA group (P=0.004), but discharge was delayed [difference 101 min, 95% CI: (23, 178), P=0.007]. Group LIA reported lower pain scores at rest beyond 24 h after surgery [mean VAS (sd) at 24/48/72 h: LIA group 16/12/10 (14)/(13)/(11); LIAiv group 22/18/15 (17)/(15)/(12); EDA group 27/30/21 (21)/(29)/(19)]. Both the LIA and the LIAiv groups were mobilized faster and were earlier ready for hospital discharge [3.5 days (LIA group) vs 4 days (LIAiv group) vs 5.5 days (EDA group); P<0.001]. Cumulated morphine consumption (72 h) was lowest for the LIA group [80 vs 101 mg (EDA group) vs 118 mg (LIAiv group), P=0.007]. CONCLUSIONS: LIA with local adjuvants compared with epidural analgesia results in reduced opioid consumption, faster mobilization, and earlier readiness for hospital discharge. Ketorolac and morphine are more efficient when given locally than systemically. The study has been registered at clinicaltrials.gov (NCT00562627) before onset of participant enrolment: http://clinicaltrials.gov/ct2/show/NCT00562627?term=spreng&rank=2 (April 21, 2010).
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Arthroplasty, Replacement, Knee , Ketorolac/administration & dosage , Morphine/administration & dosage , Pain, Postoperative/prevention & control , Aged , Amides/administration & dosage , Analgesia, Epidural/methods , Analgesics, Opioid/administration & dosage , Anesthetics, Local/administration & dosage , Arthroplasty, Replacement, Knee/rehabilitation , Drug Administration Schedule , Drug Combinations , Epinephrine/administration & dosage , Female , Humans , Injections, Intra-Articular , Injections, Intravenous , Male , Middle Aged , Pain Measurement/methods , RopivacaineABSTRACT
Various radiographic factors have been suggested as predictively important when dealing with an unstable distal radius fracture. Accordingly, many classification systems have been established in order to give an accurate description of a fracture and to grade the seriousness of the injury. In this paper, we use the classification of Colles fractures introduced by Frykman to investigate the predictive value of a concomitant fracture of the ulnar styloid. We found styloid affection to be a better predictor of a poor outcome than intra-articularity, but the combination carries the worst prognosis. We therefore suggest that a fracture of the distal radius associated with those two types of injuries should be considered for surgical treatment.
Subject(s)
Colles' Fracture/complications , Ulna Fractures/complications , Adult , Aged , Colles' Fracture/diagnostic imaging , Female , Fracture Healing , Humans , Male , Middle Aged , Prognosis , Radiography , Ulna/diagnostic imaging , Ulna Fractures/diagnostic imagingABSTRACT
Supervision by physiotherapists, starting 4-6 weeks after cast removal, was compared with self-training in 110 patients treated for Colles' fracture. The patients guided by physiotherapists were all satisfied with the treatment, but no functional advantages could be discerned when compared with self-training.
