ABSTRACT
CONTEXT: Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mobilization and shorter hospital stay. AIM: To compare adductor canal block (ACB) versus local infiltration analgesia (LIA) for postoperative pain relief in patients undergoing TKA. SETTINGS AND DESIGN: This prospective, single-blind, randomized controlled trial was undertaken at a tertiary care university hospital. MATERIALS AND METHODS: Sixty patients of American Society of Anesthesiologists physical status Classes I, II, and III, who received spinal anesthesia for TKA were randomly allocated to two groups. Group A patients had LIA of the knee joint using a mixture of 50 mL of 0.25% bupivacaine, 10 mg morphine (1 mL) and 99 mL of normal saline. Group B patients received ACB using 25 mL of 0.5% bupivacaine under ultrasound guidance. All patients received multimodal analgesia comprising of paracetamol, diclofenac, and patient controlled analgesia with morphine in the first 24 h' postoperative period. The primary outcome measures were first 24 h' morphine consumption and pain scores at 4, 6, 8, 12, and 24 h. The secondary outcome measures were nausea/vomiting, sedation, and patient satisfaction scores. STATISTICAL ANALYSIS: Statistical analysis was performed using the Student's t-test, Mann-Whitney test, and Chi-square test. RESULTS: The 24 h morphine consumption was 11.97 ± 7.97 and 10.83 ± 6.41 mg in the LIA group and ACB group, respectively (P = 0.54). No significant differences were noted either in the pain scores at rest and flexion or secondary outcome measures between both groups in the first 24 h. CONCLUSION: Single-shot ACB is equally effective as LIA as postoperative analgesia for TKA.
ABSTRACT
Twenty-nine multiparous cows of each of the Jersey and Friesian breeds, all kappa-casein AB phenotype, were grazed together and managed identically. On three occasions during 10 d in spring (early lactation), milk was collected from all cows at four consecutive milkings and bulked according to breed. On a separate occasion, milk samples were also collected from each cow at consecutive a.m. and p.m. milkings to form one daily sample per cow. The bulked milks (800-1000 l per breed on each occasion) were standardized to a protein:fat (P:F) ratio of 0.80, and 350 l from each breed was made into Cheddar cheese. The solids content of the remaining Friesian milk was then increased by ultrafiltration to a solids concentration equal to that of the Jersey milk. This solids-standardized Friesian milk and a replicate batch of P:F standardized Jersey milk were made into two further batches of Cheddar cheese in 350-l vats. Compared with Friesian milk, Jersey milk had higher concentrations of most milk components measured, including protein, casein and fat. There were few difference in milk protein composition between breeds, but there were differences in fat composition. Friesian milk fat had more conjugated linoleic acid (CLA) than Jersey milk fat. Jersey milk coagulated faster and formed firmer curd than Friesian milk. Concentrations of some milk components were correlated with coagulation parameters, but relationships did not allow prediction of cheesemaking potential. Jersey milk yielded 10% more cheese per kg than Friesian milk using P:F standardized milk, but for milks with the same solids concentration there were no differences in cheese yield. No differences in cheese composition between breeds were detected. Differences in cheesemaking properties of milk from Jerseys and Friesians were entirely related to the concentrations of solids in the original milk.
