Analgesic efficacy and safety of two oral controlled-release morphine preparations in orthopedic postoperative pain.

This single-dose, double-blind, randomized, parallel-group study compared the analgesic efficacy and safety of MS Contin (MSC) and Oramorph SR (OSR), two controlled-release preparations of oral morphine sulfate, in patients following orthopedic surgery. One hundred patients received MSC 30 mg, MSC 60 mg, or OSR 60 mg (two 30-mg tablets) when postoperative pain became moderate or severe. Patients self-rated pain intensity and relief on categorical (CAT) and visual analogue scales (VAS) hourly for up to 12 hours. MSC 60 mg produced the greatest peak analgesic effect and was more efficacious than OSR 60 mg through the sixth hour, with statistical significance achieved at 1, 2, and 3 hours postdosage. Compared with OSR 60 mg, both MSC dosages provided significantly more rapid times to peak effect by CAT and VAS ratings. The OSR group experienced almost twice as many adverse events as did the two MSC groups and also reported somnolence and dizziness more frequently. MSC 60 mg provided more rapid and greater peak analgesia with fewer adverse effects than did OSR 60 mg.

The surgical treatment of tendinitis. Clinical rationale and biologic basis.

The rationale for surgical treatment of tendinitis is to induce a modulation of the tendon cell-matrix environment by either promoting a renewed wound repair cycle or by the removal of aberrant tissue. The adequacy of healing as a result of surgical tendon treatment has been poorly documented histologically; what evidence exists suggests normal tissue is not achieved. The clinical experience of the authors as well as preliminary analysis of wound healing patterns in a longitudinal internal tenotomy rabbit tendo-Achilles model are discussed.

Holmium:YAG laser arthroscopy of the temporomandibular joint.

A new pulsed midinfrared laser has become available for use in arthroscopic surgery of the temporomandibular joint (TMJ). This article reviews holmium:YAG (yttrium-aluminum-garnet) laser physics, its tissue effects, and reports initial experience with its use in TMJ arthroscopy. Because the Ho:YAG laser can precisely and rapidly resect cartilaginous tissues with only moderate necrosis, can function in a saline environment, and can be transmitted through conventional optical fibers, it has the potential of becoming a useful and adaptable system for TMJ arthroscopic surgery.

Accurate compartment pressure measurement using the Intervenous Alarm Control (IVAC) Pump. Report of a technique.

This study demonstrates the accuracy of a common, readily available pressure transducer system (IVAC pump) for the measurement of compartment syndromes. An in vitro assay was used to compare the accuracy of the IVAC pump manometer with the Hewlett-Packard monometer (HP78532B) and a miniaturized digital fluid pressure manometer (Stryker). The IVAC pump was accurate within 2.4 mm Hg difference of the HP78532B and Stryker manometers. Twenty-five patients suspected of having compartment syndrome posttibial fracture had compartment pressures measured using the IVAC pump. In all the patients, compartment syndrome was accurately assessed (positive in one case and negative in the remainder). The IVAC pump is readily available in most hospitals. It is easy to use and provides accurate measurements of compartment pressures.

Contamination of operating room personnel during total arthroplasty.

The authors prospectively evaluated the degree of contamination to the operating room team during 60 consecutive total joint arthroplasties. Each member of the team was required to wear a hood, mask, protective eyewear, and shoecovers. At the conclusion of each procedure, all members were assessed in terms of degree and location of contamination. One hundred percent of the surgeons and first assistants were exposed. The face and eyewear were noted to be the area of greatest contamination. The authors found orthopedic surgeons to be at significant risk of contamination with blood and body fluids during total joint arthroplasty.

Treatment of tumors of the cervical spine.

In 34 patients with primary or metastatic tumors of the cervical spine over a ten-year period, the presenting symptom was neck pain. Eleven patients demonstrated evidence of radiculopathy, one a myelopathy, and three a combined myeloradiculopathy. Surgical stabilization, combined in eight cases with cord decompression, successfully relieved pain and prevented further neurologic deterioration in 17 of 18 patients with radioresistant tumors. Complications included two patients who were treated with short posterior fusions displacing as a result of tumors progressing above and below the fusion, and one patient in whom an anterior methacrylate mass became dislodged and appeared to jeopardize the esophagus. Methacrylate was used to augment the grafts posteriorly to facilitate early mobilization without the need for a halo splint. Mean patient survival was not significantly increased by surgical intervention (26 weeks vs. 20 weeks). While most lesions of the cervical spine can best be managed by nonoperative methods, in selected patients long posterior fusion with wires and methacrylate appears successful in relieving pain, halting progress of neurologic deficits, and facilitating early mobilization.

Radionuclide imaging in internal derangements of the knee.

The clinical specificity and sensitivity of imaging with 99mTc was evaluated prospectively in 104 consecutive patients admitted to the hospital for diagnostic/surgical arthroscopy. Four distinct patterns of radionuclide activity were seen that correlated with observed arthroscopic findings. These patterns of activity were seen with degenerative joint disease (DJD) or severe rotational instability, meniscal pathology, fracture of the subchondral plate or full thickness cartilaginous ulceration, and synovitis. Radionuclide imaging was seen to be extremely sensitive and highly specific for all four patterns of activity. The observed association of subchondral plate injury with meniscal pathology may present an explanation for the observed poor outcome in a limited number of patients following meniscectomy.

Analysis of ground-foot reaction forces in patients with myelomeningocele.

This paper describes a system for evaluation of ground-foot reaction forces in which multiple 1 centimeter diameter metal coated points transmit pressure to a photoelastic sheet. The pressure generates circular interference patterns, the diameters of which are linearly related to the pressure applied. The system permits the computerized construction of a three-dimensional contour map which can be compared to a pedobarograph. The qualitative/quantitative assessment system can identify areas on the plantar aspect of the foot at risk for skin breakdown. This information will permit treatment to proceed on a more rational basis than has been possible heretofore.