ABSTRACT
OBJECTIVE: To assess the effect of bilateral ultrasound-guided transversus abdominis plane block with ropivacaine compared with placebo as part of a multimodal analgesic regimen. DESIGN: A randomized, double-blind, placebo-controlled trial following the CONSORT criteria. SETTING: Hvidovre University Hospital. PATIENTS: Forty-six women scheduled for total abdominal hysterectomy. INTERVENTION: Women received either ropivacaine 0.75%, 20 mL (n = 24) or 0.9% saline, 20 mL (n = 24) in the transversus abdominis plane on each side. MAIN OUTCOME MEASURES: Primary outcome was the 24-h postoperative morphine consumption. Secondary outcomes were pain scores at rest and during coughing, postoperative nausea and vomiting at 1, 2, 4, 6, 8, and 24 h, and time to first mobilization. RESULTS: There was no difference in the mean 24-h postoperative morphine consumption between the two groups (p = 0.733). The ropivacaine group had significantly lower median pain scores at 1 h (p = 0.008) and 2 h (p = 0.027) postoperatively at rest and at 8 h (p = 0.028) during coughing. There was no significant difference in other secondary outcomes. CONCLUSION: There was no reduction in 24-h morphine consumption when using an ultrasound-guided transversus abdominis plane block in women undergoing total abdominal hysterectomy. As part of a multimodal regimen the transversus abdominis plane block showed some effect on pain scores at rest only in the early postoperative period.
Subject(s)
Abdominal Muscles/diagnostic imaging , Amides/administration & dosage , Anesthetics, Local/administration & dosage , Morphine/administration & dosage , Pain, Postoperative/prevention & control , Ultrasonography, Interventional/methods , Abdominal Muscles/innervation , Adult , Analgesia, Patient-Controlled/methods , Analgesics, Opioid/administration & dosage , Double-Blind Method , Female , Humans , Hysterectomy , Middle Aged , Ropivacaine , Treatment Outcome , Women's HealthABSTRACT
Hydroxyappatite-ß-tricalciumphosphate (HA/ß-TCP) was reinforced with poly(D,L)-lactic acid (PDLLA) to overcome its weak mechanical properties. Two substitutes with porosities of 77% and 81% HA/ß-TCP reinforced with 12 wt % PDLLA were tested in compression. The effects of allograft, substitute (HA/ß-TCP-PDLLA), Colloss®E, and combination of substitute with Colloss®E on bone formation in vivo were evaluated. Cylindrical critical size defects were created at distal femoral condyles bilaterally in sheep. Titanium implant with concentric gap filling with one of the four materials was inserted. After 9 weeks, the sheep were sacrificed. Implants with surrounding bone were harvested and sectioned into two parts: one for microcomputed tomography scanning and push-out test, and one for histomorphometry. The 77% HA/ß-TCP reinforced with PDLLA had similar mechanical properties to human cancellous bone and was significantly stronger than the HA/ß-TCP without PDLLA. Microarchitecture of gap mass was significantly changed after implantation for all groups. Allograft had stronger shear mechanical properties than the other three groups, whereas there were no significant differences between the other three groups. Significant new bone formation could be seen in vivo in all four groups and there were no significant differences between them. The PDLLA-reinforced substitute seems to be good alternative substitute material for bone healing in sheep. Further investigations should be performed to validate this novel substitute material.
Subject(s)
Bone Morphogenetic Proteins/pharmacology , Bone Substitutes/pharmacology , Calcium Phosphates/pharmacology , Collagen/pharmacology , Durapatite/pharmacology , Femur/injuries , Fracture Healing/drug effects , Lactic Acid/pharmacology , Polymers/pharmacology , Animals , Bone Morphogenetic Proteins/chemistry , Bone Substitutes/chemistry , Bone Transplantation , Calcium Phosphates/chemistry , Collagen/chemistry , Durapatite/chemistry , Femur/transplantation , Humans , Lactic Acid/chemistry , Materials Testing , Polyesters , Polymers/chemistry , Sheep , Transplantation, HomologousABSTRACT
The tourniquet is often used during orthopaedic surgery in order to optimize the view of the surgical field. The recommended guidelines for the use of tourniquet are not well known even though complications following tourniquet use are well documented. We have made a short review of the literature and found that the evidence for using tourniquet is very limited and that the use even might prolong the length of stay.
