Efficacy of intraarticular hyaluronic acid injection through a lateral approach under fluoroscopic control for advanced hip osteoarthritis.

OBJECTIVES: Hyaluronic acid (HA) is used for intraarticular treatment of hip osteoarthritis (OA). The objective of this study was to determine the efficacy of intraarticular injection of HA through a lateral approach under fluoroscopic control for advanced hip OA. METHODS: The study included 21 patients with advanced hip OA. All patients received 2.5 ml HA injection once a week for 3 weeks by lateral approach under fluoroscopic control. Disability (Lequesne index), pain scores (visual analog scale-VAS) and analgesic use of patients were assessed before treatment and 1, 3 and 6 months after the treatment. RESULTS: Lequesne index and VAS pain scores measured 1, 3 and 6 months after treatment were significantly lower compared to baseline scores (p<0.001). Although analgesic use was significantly reduced 1 and 3 months after treatment compared to baseline (p<0.05), no difference was determined in analgesic use at the 6th month (p>0.05). No side effect was observed. CONCLUSION: In conclusion, intraarticular HA injection through a lateral approach under fluoroscopic control was shown to be a safe and effective method for patients with advanced hip OA.

Effects of ropivacaine on pain after laparoscopic cholecystectomy: a prospective, randomized study.

Postoperative pain after laparoscopic cholecystectomy is an ongoing problem. To relieve this pain, practitioners have used many anesthetic and analgesic drugs. This study was undertaken to assess the effects of incisional and intraperitoneal administration of ropivacaine on postoperative pain and stress response in patients undergoing laparoscopic cholecystectomy. In this prospective, single-blinded, randomized study, 45 patients with ASA (American Society of Anesthesiologists) scores I and II who were about to undergo laparoscopic cholecystectomy were divided into 3 groups. After cholecystectomy, a total of 40 mL of 3.75% ropivacaine was administered pre-incisionally and intraperitoneally to patients in group 1 (n=14); pre-incisionally and intraperitoneally to patients in group 2 (n=17); and intraperitoneally and locally at incision sites to patients in group 3 (n=14). Blood levels of epinephrine and norepinephrine were examined preoperatively, 15 min after insufflation, and at the end of the operation. Visual analog pain scale scores and analgesic requirements were used for 24-h postoperative follow-up of pain levels reported by patients. No statistically significant difference was found among the 3 groups with respect to visual analog pain scale scores, total analgesic requirements, and accompanying pain, nausea, and vomiting. The earliest analgesic requirements were seen in group 2 (P<.005), and less shoulder pain was noted in group 3 (P<.005). Norepinephrine and epinephrine levels showed no statistically significant differences between the 3 groups. Administration of ropivacaine preoperatively and postoperatively for laparoscopic cholecystectomy has similar effects on postoperative pain and the stress response of patients.

[Addition of ketamine infusion to patient controlled analgesia with intravenous morphine after abdominal hysterectomy]. / Abdominal histerektomilerde postoperatif analjezide intravenöz hasta kontrollü analjezi ile morfin uygulamasina ketamin infüzyonunun eklenmesi.

In our study we aimed to reduce postoperative morphine consumption, prevent adverse effects of morphine, and improve analgesic quality via adding analgesic doses of ketamine infusion to intravenous morphine-patient controlled analgesia (PCA). After local ethics committee approval, 45 patients scheduled for total abdominal hysterectomy were included in the study. In the postoperative period the patients were separated into two groups randomly. After starting morphine-PCA in both groups, one group received ketamine infusion (Group K: n= 22), while the other group received saline infusion (Group S: n= 23) for 24 hours. There was no significant difference between the postoperative systolic and diastolic arterial pressures, heart rate and respiratory rate values. Visual Analogue Scale and Verbal Rating Scale measures was significantly lower in Group K (p<0.01). Total morphine consumption was higher in Group S (p<0.05). Sedation scores were significantly lower in Group K (p<0.05). When adverse effects were evaluated we found that nausea was higher in Group S (p<0.05), while there was no difference in the other side effects (p>0.05). Patient satisfaction was better in the 24th and 48th hours in Group K and was found to be statistically significant (p<0.05). Our results suggest that ketamine infusion added to opioids for postoperative analgesia, reduces total opioid requirement and prevents side effects.