Adductor canal block performed 20 hours after total knee arthroplasty to improve postoperative analgesia and functional recovery: a double-blind randomized controlled clinical trial.

BACKGROUND: The goal of postoperative pain protocols in total knee arthroplasty (TKA) is to get pain free patients throughout severe pain period without impairing walking ability. The aim of the study was to investigate if an adductor canal block performed 20 hours after TKA, in patients treated with systemic analgesia and intraoperative local infiltration anesthesia (LIA), improves postoperative pain and functional outcomes. METHODS: A prospective randomized, double-blinded controlled study was conducted. One hundred eighty-three patients undergoing primary TKA were randomized to receive either a sham block or an adductor canal block with 20 mL of ropivacaine 0.5%. The primary outcome was resting and dynamic pain scores using the Numerical Pain Rating Scale (NPRS). Secondary outcomes included opioid rescue requirements, quadriceps and adductor muscle strength, patient ability for ambulation and complications. RESULTS: Two hours after the block, in adductor canal block group NPRS was significantly lower at rest (1 [0-2] vs. 3 [2-5], P<0.001) and with mobilization (5 [3-6] vs. 6 [5-8], P<0.001), and quadriceps strength was significantly higher (3.7 [2.7-6] vs. 3 (1.7-4.9), P=0.023). The differences were not maintained beyond 24 hours post-block. In the first 24 hours the percentage of patients with tramadol requirements was lower in the adductor canal block group (36 [38.3] vs. 52 [58.4], P=0.006). Other secondary outcomes were similar between groups. There were no patient falls. CONCLUSIONS: An adductor canal block done 20 hours after total knee arthroplasty reduces pain and opioid requirements without increasing the risk of falls. An optimal pain control, especially at movement was not achieved.

¿Puede tener un papel la mascarilla laríngea en la práctica de la terapia electroconvulsiva? Un estudio piloto / Can the laryngeal mask play a role in electroconvulsive treatment? A pilot study

Introducción. Optimizar el control de la ventilación en el proceso anestésico de la terapia electroconvulsiva (TEC) puede ser una forma de mejorar la efectividad y la seguridad del tratamiento. Existen varios métodos para inducir una convulsión terapéutica adecuada en pacientes con enfermedad médica comórbida o en aquellos con elevado umbral convulsivo, aunque todos presentan alguna limitación. Un nuevo abordaje es la hiperventilación con mascarilla laríngea, que produce una mayor oxigenación e hipocapnia, disminuyendo el umbral convulsivo. Este hecho puede, hipotéticamente, servir para disminuir la energía necesaria para obtener una convulsión terapéutica adecuada. Material y métodos. Se ha realizado un estudio piloto aleatorizado y cruzado con 14 pacientes en TEC de mantenimiento, utilizando mascarilla laríngea versus mascarilla facial. Las sesiones de TEC con mascarilla facial se realizaron con la energía estándar, mientras que en las sesiones de TEC con mascarilla laríngea se disminuyó la energía en un 45%. Resultados. A pesar de la reducción del 45% en la energía aplicada con el uso de mascarilla laríngea, no se han encontrado diferencias significativas en la duración de la convulsión en ambos grupos. Conclusiones. Con estos resultados se podría proponer la ventilación con mascarilla laríngea como una alternativa para disminuir la energía aplicada sin repercutir en la duración de la crisis. Este es un estudio preliminar con una muestra pequeña, aunque abre nuevas líneas de investigación. Sería necesario aumentar la muestra y valorar otras medidas de calidad de las convulsiones en futuros estudios con el fin de estudiar sus efectos no solo en la dosis de energía necesaria, sino también en una posible mejora de la ventilación y una posible minimización de los potenciales efectos secundarios de la TEC, algo que sería relevante sobre todo en pacientes con comorbilidad médica (AU)

Introduction. Optimising ventilation control in the anaesthetic process of electroconvulsive therapy (ECT) can be a method for improving the effectiveness and safety of some treatments. There are several approaches for inducing adequate therapeutic seizures in patients with medical co-morbidity or in those with high seizure thresholds, although all of them present limitations. A new approach is hyperventilation with laryngeal mask, a method that improves oxygenation, achieves hypocapnia, and lowers seizure threshold. Thus, hyperventilation with laryngeal mask could, hypothetically, be useful to decrease the energy needed to obtain adequate therapeutic seizures. Material and methods. A randomized crossover study was conducted on 14 patients on maintenance ECT, using a laryngeal mask versus a facemask. When laryngeal masks were applied, the energy was reduced by 45% compared with the energy required when ventilated with facemasks (performed with standard dose). Results. The results of the study revealed that, despite a 45% energy reduction with laryngeal mask, there were no significant differences in seizure length in either group. Conclusions. These results prompt us to propose ventilation with laryngeal mask as an alternative to decrease energy applied without lowering seizure times. This is a preliminary study with a small sample, which opens new lines of research. Larger samples and other measurements of seizure adequacy are needed in future studies, in order to study possible improvements in ventilation and minimising adverse effects of ECT, especially in patients with medical co-morbidities (AU)

Can the laryngeal mask play a role in electroconvulsive treatment? A pilot study. / ¿Puede tener un papel la mascarilla laríngea en la práctica de la terapia electroconvulsiva? Un estudio piloto.

INTRODUCTION: Optimising ventilation control in the anaesthetic process of electroconvulsive therapy (ECT) can be a method for improving the effectiveness and safety of some treatments. There are several approaches for inducing adequate therapeutic seizures in patients with medical co-morbidity or in those with high seizure thresholds, although all of them present limitations. A new approach is hyperventilation with laryngeal mask, a method that improves oxygenation, achieves hypocapnia, and lowers seizure threshold. Thus, hyperventilation with laryngeal mask could, hypothetically, be useful to decrease the energy needed to obtain adequate therapeutic seizures. MATERIAL AND METHODS: A randomized crossover study was conducted on 14 patients on maintenance ECT, using a laryngeal mask versus a facemask. When laryngeal masks were applied, the energy was reduced by 45% compared with the energy required when ventilated with facemasks (performed with standard dose). RESULTS: The results of the study revealed that, despite a 45% energy reduction with laryngeal mask, there were no significant differences in seizure length in either group. CONCLUSIONS: These results prompt us to propose ventilation with laryngeal mask as an alternative to decrease energy applied without lowering seizure times. This is a preliminary study with a small sample, which opens new lines of research. Larger samples and other measurements of seizure adequacy are needed in future studies, in order to study possible improvements in ventilation and minimising adverse effects of ECT, especially in patients with medical co-morbidities.

[The concept of Health Literacy and its importance for nursing]. / Il concetto di Health Literacy e la sua importanza per la professione infermieristica.

INTRODUCTION: Individuals and population's health is influenced by environmental, social economical and cultural aspects which in turn connect individuals to society. In order to decide autonomously, independently and consciously individuals should have several competences. The aim of this study is to identify, analyse and emphasise health literacy concept relevance per se,its relationship with nursing through a narrative revision focused on: Health literacy definition recognition and analysis; evaluation of connection between nursing and health literacy. METHODS: A narrative review was carried out through PUBMED and CINHAL, using 'health literacy' and nursing related terms, in English or Italian between 2010 and 2015. RESULTS: Results show that 'health literacy' is fully appraised, while attention paid by nurses on the topic is poor due both to a lack of awareness of its relevance on individuals' health and of appraisal. Twenty-height definition emerged from the revision; concepts expressed by scholars are mainly focused on very few individuals' abilities and competences applied to the health context (reading, writing, calculation, comprehension, listening and so on). CONCLUSIONS: According to the results it is difficult to define health literacy due to its multidimensional nature. Notwithstanding the above an attempt to develop a unique new definition of health literacy has been carried out although its multidimensional nature and its strong connection to several variables constantly under development. Nevertheless it is imperative that educational modules would be developed and stably integrated in health care education, at the same time a strong effort is due from professional and policy makers to provide population of the necessary tools in order to improve their health.