Effects of general anesthesia with and without thoracic epidural block on length of stay after open spine surgery: a single-blinded randomized controlled trial.

BACKGROUND CONTEXT: Length of hospital stay (LOS) is an important concern in all types of surgery, and the enhanced recovery after surgery (ERAS) protocol has been developed to improve perioperative management and outcomes, which require multidisciplinary management. In terms of pain control, intraoperative regional anesthesia and postoperative opioid-sparing analgesia are recommended. For open spine surgery, we aimed to combine thoracic epidural analgesia to reduce pain and opioid-related side effects, thereby hastening recovery. PURPOSE: This study aimed to compare the length of hospital stay after open complete laminectomy with fusion between general anesthesia and combined general anesthesia involving a single thoracic epidural injection. DESIGN: A randomized single-blinded controlled study. PATIENT SAMPLE: Thirty-eight patients scheduled for elective open laminectomy with fusion between I and III levels were selected. OUTCOME MEASURES: LOS, postoperative pain, patient-controlled morphine consumption at 24 hours, patient satisfaction score, and other opioid-related side effects were recorded. METHODS: Patients were randomly selected to receive standard general anesthesia (GA) or GA combined with a single-shot thoracic epidural at T11-T12 or T12-L1, a block with 10 mL of 0.25% bupivacaine, and 4 mg of morphine. RESULTS: There were no significant differences in the demographic variables between groups. LOS was significantly lower in the combined epidural and/or GA than in the control group (3.78±0.81 [mean±standard deviation] and 4.79±1.51 days, respectively; p=.017). Numeric rating score (at rest) at the post-anesthesia care unit, 24 hours postoperative morphine consumption (mg), operating time, and blood loss were significantly lower in the epidural group. Patients who received combined epidural and/or GA were more likely to report higher patient satisfaction (p=.008). However, the incidence of intraoperative hypotension was significantly higher in the epidural group (72.2% vs. 21.1%, p=.003). The incidences of adverse events and surgical field rating scores did not differ between the 2 patient groups. CONCLUSIONS: Combined lower thoracic epidural and/or GA in patients undergoing elective lumbar spine surgery was associated with decreased LOS.

A prospective analytical study of the effects and adverse events of alendronate (Aldren70) treatment in Thai postmenopausal women.

OBJECTIVE: To elucidate the efficacy and adverse events of alendronate (Aldren70) after 12 months of treatment in 50 to 70 years old postmenopausal women. MATERIAL AND METHOD: The authors observed 50 postmenopausal women who had clinical conditions of osteopenia or osteoporosis and had never been treated with alendronate acid. Bone mineral density (BMD) of L1-L4, the left hip, and the left forearm were performed at the initial assessment and after 12 months of treatment. The serum levels of osteocalcin (OC), procollagen type 1 N-terminal propeptide (PINP) and beta-crosslaps (beta-CTx) were performed at the baseline and then after 3 months, 6 months and 12 months of treatment. The data were analyzed using the SPSS software. Paired t-test was used to compare lumbar spine, hip and forearm before and after treatment. RESULTS: Treated by using Aldren70 once weekly for one year the BMD of the lumbar spine increased highly up to 11.26% (g/cm2) and 25.82% (T-score) from the base line (p < 0.001 and p < 0.001, respectively). On the other hand, the change in BMD of the left hip increased 17.54% (g/cm2), 8.2% (T-score), at the left forearm increased 3.96% (g/cm2), 7.62% (T-score) after 12 months respectively. There was significant increase of BMD between before and after 12 months. The mean values of bone markers at the 0.05 level before treatment, three months, six months, and 12 months of treatment in osteocalcin were 0.2813, 0.1242, 0.896, and 0.0889 ng/ml respectively. The PINP were 36.1762, 19.3894, 14.3084, and 15.1260 ng/ml respectively. Beta-crosslaps were 0.2813, 0.1242, 0.0896, and 0.0889 ng/ml respectively. Adverse events found in five patients were the symptoms of stomachache (2.4%), constipation/diarrhea (1.2%), palpitation (1.2%), and muscle/bone pain (1.2%). CONCLUSION: The generic alendronate (Aldren 70) in our clinical trial was found to be highly effective at the spine concerning the bone mass improvement and less at the hip and wrist joints in comparison. All the result figures met the standard efficacy after 12 months follow-up by increasing bone mass and reducing serum bone markers.

A prospective study comparing mobile-bearing versus fixed-bearing type in total knee arthroplasty using the free-hand-cutting technique.

BACKGROUND: The mobile-bearing knee prosthesis was claimed to get more flexion in the laboratory testing and may provide better functional outcome than the conventional fixed-bearing prosthesis in patients. To prove this hypothesis in the patients between those two type prosthesis about flexion and functional out come was our study goal. MATERIAL AND METHOD: The prospective randomized control trial. The Free-Hand-Cutting technique underwent TKR (100 mobile bearing and 100 fixed bearing). Post operative clinical outcomes were compared in range of movement, Knee Society Score, Function Knee Score and Oxford Knee Score at 2 months, 6 months, 1 year and 2 years. RESULTS: The mobile-bearing type prosthesis provided more flexion than the fixed-bearing knee prosthesis. But the same clinical out come was observed. CONCLUSION: The mobile-bearing type prosthesis gave more functional out come but not significant in daily patient activity compare to the fixed bearing knee prosthesis.