Screening complications in the postoperative period of orthopedic surgeries by video arthroscopy

To analyze the prevalence and characteristics of late postoperative complications of orthopedic surgeries by video arthroscopy.This was a descriptive cross-sectional study that evaluated, through its own instrument, local and systemic postoperative complications of patients undergoing orthopedic surgeries by video arthroscopy. The study included 270 patients, who were evaluated on days 30(without prosthesis) and 90(with prosthesis placement) of the postoperative period, by telephone service. The selection of participants occurred sequentially and population-based, within the data collection period, from February to July 2020, in a large hospital for medium and high complexity surgeries. Of the 270 procedures performed in the period, 4.4% (n = 12) presented late postoperative infection. The most frequent complications were erythema (83%), edema (75%) and secretion (67%) in the surgical wound. Most used antibiotic therapy (92%) and anti-inflammatory drugs (67%). Hospital readmission was not necessary concerning the complications. Only 50% required medical evaluation before the scheduled time.The need for practices that ensure the quality of perioperative care and improve the active search to assess surgical outcomes is reinforced.

Quality of counselling for knee and shoulder arthroscopy patients during day surgery.

BACKGROUND: Counselling for day surgery patients is one of the core components for a knee or shoulder arthroscopy patient to succeed in self-care. AIM: This cross-sectional study examined the quality of counselling given to patients (n = 86) during their day surgery, using the Counselling Quality Instrument (CQI). METHODS: The data were analysed using basic and multivariate statistical methods. RESULTS: Most respondents were male and aged over 50 years. Almost all knee and shoulder arthroscopy patients were satisfied with the counselling given on follow-up and rehabilitation as well as the counselling given relating to wound and pain treatment. There was a lack of patient-centred and goal-oriented counselling, although interaction during counselling was good. Counselling was perceived as providing benefit in regard to a patient's self-care, emotions and knowledge. Respondents aged below 40 years were more dissatisfied with counselling for day surgery than those aged 40 years and over. CONCLUSION: This study identified a need to train healthcare staff in patient-centred and goal-oriented counselling. Counselling with people who are aged below 40 years should take account of patients' specific concerns.

Randomized clinical trial testing efficacy of a nurse-coached intervention in arthroscopy patients.

BACKGROUND: Emerging data suggest limited patient preparation for ambulatory surgery, decreased access to healthcare providers postoperatively, increased patient and family anxiety, and increased patient suffering. Thus, there is a need for nursing interventions to improve the postoperative experience for patients and families. OBJECTIVE: The purpose of this study was to test the hypothesis that ambulatory arthroscopic surgery patients who receive a nurse-coached telephone intervention will have significantly less symptom distress and better functional health status than a comparable group who receive usual practice. METHODS: The study sample in this randomized clinical trial with repeated measures was 102 participants (52 in the intervention group and 50 in the usual practice group) drawn from a large academic medical center in the Northeast United States. Symptom distress was measured using the Symptom Distress Scale, and functional health was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey General Health Perceptions and Mental Health subscales. RESULTS: Multivariate analysis of covariance, with three repeated measures of the Symptom Distress Scale (baseline, 72 hours postsurgery, and 1 week postsurgery) and five covariates, was used to test the hypothesis. After removal of the covariate influence, intervention participants had significantly less symptom distress at 72 hours and 1 week postsurgery and significantly better overall physical and mental health at 1 week postsurgery than those who received usual practice. DISCUSSION: The findings suggest that telephone calls from nurses during the immediate postoperative period resulted in improved patient outcomes, namely, less symptom distress and better physical and mental health states. In future research, the study sample should be expanded to older and more diverse patients.

Perioperative administration of gabapentin for shoulder arthroscopy: a prospective, randomized, double-blind, placebo-controlled study.

Recent studies suggest gabapentin has opioid-sparing effects and may reduce acute postoperative pain. However, there is limited research on the efficacy of gabapentin when combined in a multimodal approach after shoulder arthroscopy under general anesthesia with an interscalene block. We conducted prospective, double-blind study of 70 patients who were randomized to receive either 300 mg of gabapentin or placebo 1 hour before surgery, then twice a day for 2 days. The primary outcome was average pain scores. Secondary outcomes included differences in morphine equivalents, adverse effects, and sleep patterns. No significant differences in pain scores were found on day 1 (gabapentin mean [SD], 4.23 [2.61], vs placebo, 4.61 [2.57]; P = .58) or day 2 (gabapentin, 4.26 [2.39], vs placebo, 4.03 [2.34]; P = .71). Total morphine equivalents on day 1 (gabapentin, 9.75 mg [6.58 mg], vs placebo, 9.52 mg [4.75 mg]; P = .88) and day 2 (gabapentin, 9.21 mg [6.66 mg], vs placebo, 6.93 mg [5.44 mg]; P = .17) were similar. Adverse effects and sleep patterns were similar (P > .05). These results suggest this dosing regimen of gabapentin is not efficacious in improving outcomes in patients undergoing shoulder arthroscopy under general anesthesia with an interscalene block.

Postoperative telephone calls: timing is everything.

Having nurses contact same-day surgical patients by telephone early in the patients' recovery process may help guide recovery, but there are no guidelines as to the best time to make these calls. A convenience sample of 77 patients undergoing same-day knee arthroscopy surgery at a large health care center in the northeastern United States was recruited to examine the best time for telephone follow-up by a nurse. Overall patient experiences and teaching-learning needs also were investigated through open-ended questions. Findings suggest that continuous contact by nurses in the recovery period helped patients discuss and process the surgical experience. Telephone calls may be the most helpful to patients between 12 and 24 hours after surgery.

Perioperative fluid management.

Technological advances have changed how traditional surgical procedures are performed. New knowledge and surgical skills are required to effectively monitor the patient and manage fluids administered perioperatively. Today, selective fluids are used in a variety of surgical specialties. Complications of fluid therapy can occur that are intrinsic to each procedure within a specialty. This article provides perioperative nurses with the information needed to evaluate different fluid media and their applications and identify patient care considerations. Possible complications and important postanesthesia care concerns also are discussed.

Discoid lateral meniscus in children.

The discoid lateral meniscus is the most common abnormal meniscal variant in children. It affects the shape and mobility of the menisci, altering the normal mechanical relationships between the articulating surfaces of the knee and predisposing it to injury. The incidence of discoid lateral meniscus is estimated to be 1%-3% in the pediatric population and the condition is bilateral in 10%-20% of patients (Stanitski, 2002). An otherwise asymptomatic knee with an incidentally detected discoid meniscus does not require surgical intervention. However, a discoid lateral meniscus is much more likely to tear, and many children develop pain as well as mechanical symptoms (popping, snapping, locking, or giving way of the knee). Recent improvements in arthroscopic technique have led to greater attempts to stabilize, sculpt, and repair the torn discoid lateral meniscus. This article will review the classification, clinical presentation, diagnostic/imaging studies, and treatment options for a discoid lateral meniscus in children.

Wrist arthroscopy.

Arthroscopic surgery, a minimally invasive, outpatient procedure, is a valuable tool in the diagnosis and treatment of most disorders of the wrist. It offers direct visualization of the structures of the joint anatomy and existing disease processes while causing minimal damage to surrounding soft tissue. Other benefits of arthroscopic treatment compared to traditional open procedures include less postoperative pain, shorter recovery times, and fewer surgical complications.

Knee block anesthesia for arthroscopic procedures.

Knee block anesthesia frequently is used for arthroscopic knee procedures by orthopedic surgeons and anesthesia care providers at Bronson Methodist Hospital, Kalamazoo, Mich. This type of regional anesthesia using local anesthetic medications provides excellent surgical conditions and prolonged postoperative analgesia. Use of this anesthetic technique avoids many of the side effects of general, spinal, and epidural anesthesia and saves time and money for patients and facilities.

Arthroscopic hip surgery.

Many pathological entities that previously could be accessed only through large, open incisions now can be treated arthroscopically. Furthermore, arthroscopy has allowed certain conditions to be diagnosed that previously were unrecognized. Arthroscopic hip surgery has become an accepted surgical procedure with well-defined indications and expected outcomes, primarily because of recent advances in surgical instrumentation and techniques. Hip arthroscopy is performed as a same-day procedure using a fracture table to apply distraction to the hip joint. Coordination among surgeons and perioperative nursing staff members is essential for achieving consistent results and minimizing complications during this technically demanding procedure.

Plan estandarizado de cuidados para el pacienteintervenido de artroscopia de rodilla / Standardized nursing care plan for patients undergoing knee arthroscopy

El desarrollo de las técnicas de la artroscopia ha potenciado su finalidad terapéutica. Gracias a ello es posible efectuar reparaciones articulares ocasionando pocas complicaciones a los pacientes. En este artículo se comentan brevemente los puntos más relevantes de la cirugía artroscópica llevada a cabo en la articulación de la rodilla; posteriormente se desarrolla el plan de cuidados estandarizados, en el que se identifican los diagnósticos de enfermería y los problemas interdependientes referidos a una paciente que ha sido sometido a una artroscopia de rodilla. Basándonos en el modelo conceptual de Virginia Henderson y en la metodología del proceso de atención de enfermería, se identifican los diagnósticos de enfermería (taxonomía NANDA), en cuyo desarrollo se indican las manifestaciones de dependencia, los objetivos y las actividades indicadas para solventar la necesidad del paciente. Finalmente, se incluyen los criterios de evaluación, necesarios para valorar la consecución de los objetivos. Posteriormente, se detallan los problemas interdependientes derivados de esta intervención quirúrgica, donde se especifican los controles de enfermería para detectar las posibles complicaciones potenciales, así como las actividades a realizar cuando se instaura el problema (AU)

A water-infusion system with two reservoirs at different levels.

To provide a continuous supply of fluid during arthroscopic surgery, we suggest an infusion system with 2 reservoirs placed at different heights. The lower bag serves as a water reservoir, which allows more time for the circulating nurse to complete the task of exchanging the emptied water bag.

Anterior cruciate ligament reconstruction.

The anterior cruciate ligament (ACL) is the most commonly reconstructed knee ligament. It is estimated that more than 100,000 new ACL injuries occur annually. This article discusses preoperative education, perioperative nursing care, surgical technique, and postoperative management of patients undergoing ACL reconstruction procedures.

Thermal capsulorrhaphy for acute or chronic shoulder instability.

During the past two decades, arthroscopic procedures have been replacing traditional, more invasive orthopedic surgical procedures. As technology becomes more advanced, the opportunity to provide a greater number of minimally invasive surgical interventions continues to improve. Thermal modification of joint capsule and ligamentus tissues, a recent introduction to medical science, has been investigated extensively during the past six years. Arthroscopic thermal capsulorrhaphy is one such procedure, and it is performed on individuals with a history of joint instability. These patients now can be treated surgically without large incisions and significant shoulder joint trauma. The thermal unit in both monopolar and bipolar models has similar properties to those of the basic electrosurgical unit. Relatively low-temperature heat is directed to the supportive structures of the shoulder joint causing the tissues to expand. This tightens a previously stretched and attenuated shoulder capsule.