Intravenous Lidocaine for Postoperative Analgesia in 90 patients After Total Knee Arthroplasty and Limb Fractures.

BACKGROUND The aim of this research was to investigate the analgesic effects of intravenous lidocaine on postoperative pain management in orthopedic patients after total joint arthroplasty and fractures of the limbs and to compare lidocaine efficacy between these orthopedic surgical procedures. MATERIAL AND METHODS Ninety patients scheduled for elective orthopedic surgery were recruited: 46 patients with total knee arthroplasty, and 35 patients with femoral fractures. Patients in the lidocaine group received lidocaine during the induction phase of anesthesia as a bolus injection of 1.5·kg⁻¹·mg over 10 min, followed by intravenous infusion of 1.5 mg·kg⁻¹·h⁻¹ for 24 postoperative hours. Patients in the control group received an equal volume of saline as placebo administered at the same rate. Pain scores were assesed at intervals of 0, 15, 30, 60 min, and 6, 12, and 24 h postoperatively. The reduction rate of additional analgesics, total analgesic use, incidence of nausea and vomiting, mobilization, length of hospital stay, adverse effects, and hemodynamic parameters were secondary outcomes. RESULTS Pain scores at rest and during movement were significantly lower in the lidocaine group compared to those in controls starting at 30 min (P=0.03), the first postoperative hour, and also at 6, 12, and 24 h (P<0.001). Additional analgesics were administered at a significantly lower rate in the lidocaine group (P<0.05). Total analgesic use in the postoperative period was significantly higher in the control group (P<0.001). CONCLUSIONS This study showed that intravenous lidocaine provided adequate postoperative analgesia for orthopedic patients undergoing elective total joint arthroplasty and limb fracture repair.

Single Atrium and Miscarriages.

Background A single atrium is a very rare heart condition, in which the inter atrial septum is missing. These congenital heart defects usually are surgically corrected after birth. Case Presentation We present a successful surgical repair of a single atrium (SA) in a 27-year-old woman, who has a complete missing of the atrial septum, without coexisting valvular pathology. The SA diameter was 9.97 × 6.18 cm and the Systemic blood flow/pulmonary blood flow (Qp/Qs) was 4.1 due to the single atrium. Surgical correction consisted of creating a new atrial septum, using a double-velor patch. At first- and second-year follow up, the patient was in a very good condition and without any symptoms present. We consider that the diagnoses of single atrium, especially in child bearing women, should be done in appropriate time, to avoid miscarriages, preterm births and other complications associated. Conclusion There are many case reports that show good surgical repair of single atrium and without late complications. In our case, we have obtained a very good surgical repair, without AV bundle damage and no residual shunt demonstrated on intraoperative transesophageal echocardiography.