Comparison of intra articular NSAID (ketorolac) injection versus hyaluronic acid injection for the mean decrease of pain score (according to UCLA shoulder rating scale) in the management of adhesive capsulitis.

Adhesive capsulitis is painful condition, associated with gradual loss of active and passive shoulder motion that has a disabling capability. In this study we compared the short term outcome by measuring the mean decrease of pain in adhesive capsulitis using University of California Los-Angeles (UCLA) shoulder rating scale after intra-articular Non-Steroidal Anti Inflammatory Drug (NSAID) Ketorolac and Hyaluronic acid injection. This Randomized controlled trial was carried out using non probability consecutive sampling technique from 1st November 2015 to 30th April 2016. Total 160 patients with adhesive capsulitis for six months' age between 18 to 70 years were taken and randomly divided into two equal groups by computer allocation method. The 80 patients in Group A received Intra-articular (NSAID) Ketorolac injection while patients in Group B were given Intra-articular Hyaluronic acid. Pain score for both the groups were recorded using UCLA shoulder rating scale before treatment and then at follow up after a period of 4 weeks. Out of total 160 cases, 47.5% (n=38) in Group A and 45% (n=36) in Group B were male whereas 52.5% (n=42) in Group A and 55% (n=44) in Group B were females. Most commonly affected age group with 40% (n=32) participants was aged between 51 - 60 years. Mean age of Group A was 37.87±1.027 and in Group B was 45.37±5.743. Interestingly 60% (n=48) of Group A and 55% (n=44) of Group B had involvement of the right shoulder. Pre-treatment UCLA pain score was calculated to be 14.90±4.969 in Group-A and 15.16±5.578 in Group-B. Final post treatment UCLA score was 26.67±2.331 in Group A and 21.72±3.838 in Group B. The mean decrease of pain in Adhesive capsulitis using UCLA rating scale was significantly better in NSAID group as compared to Hyaluronic acid group.

Antibiotic prophylaxis in hip surgery: A comparision of two vs. three doses of cefuroxime.

OBJECTIVE: To compare the efficacy of two-dose regime with a three-dose regime of cefuroxime in the prevention of post-operative wound infection in hip surgery patients and to determine the most effective regime of antibiotic prophylaxis for such patients. METHODS: The prospective, comparative, multi-centre cohort study was conducted from January 1998 to June 1998 at Dundee Royal Infirmary and attached district hospitals (Stirling Royal Infirmary and Falkirk Royal Infirmary). It comprised patients who had hip surgery i.e. fracture fixation, hemiarthroplasty or total hip replacement. Patients were assigned to two groups. Group A patients received cefuroxime 750mg at induction of anaesthesia and 750mg at the end of the procedure, while Group B patients received 1.5gm of cefuroxime at the induction of anaesthesia, followed by 750mg 8 and 16 hours after the operation. Patients were assessed post-operatively daily according to the ASEPSIS wound scoring system during the hospital stay. RESULTS: There were 280 patients in the study, with 140(50%) in each of the two groups. In Group A 60(43%) patients required fracture fixation, the rate of wound infection was 2(3.3%), 40(28.5%) required hemiarthroplasty and the rate of wound infection was 1(2.5%) and 40(28.5%) required total hip replacement and the rate of wound infection was zero. In Group B, the corresponding numbers were 1/60 (1.6%), 1/40 (2.5%) and zero. No evidence of minor, moderate or severe wound infection was observed in 272(97%) patients regardless of the group. The most frequent pathogens were Staphylococcus aureus in 3(1%) patients and Staphylococcus epidermidis in 2(0.7%). CONCLUSIONS: There was no significant difference in the prevalence of wound infection between the patients who had received two or three doses of cefuroxime.