Efficacy of epinephrine in local infiltration analgesia on pain relief and opioid consumption following total knee arthroplasty: a randomized controlled trial.

BACKGROUND AND PURPOSE: Local infiltration analgesia (LIA) is one of the effective regimens to reduce pain after total knee arthroplasty (TKA). Epinephrine is a commonly used sympathetic adjunct in LIA. It is expected to enhance the intensity and extend the duration of LIA. The primary aim of the study was to evaluate the efficacy of epinephrine on postoperative pain control after primary TKA. PATIENTS AND METHODS: A total of 80 patients who underwent primary TKA were randomized into an epinephrine (EN) and a control (C) group. Postoperative visual analogue pain score (VAPS) and morphine consumption were recorded every 6 hours until 48 hours after operation. The VAPS 6-48 hours were compared using repeated measure statistics. The range of motion (ROM) on discharge and complications were also compared between these 2 groups. RESULTS: The study showed that although VAPS differed statistically between the 2 groups at 12 hours (C higher) and 48 hours (C lower) postoperatively (p = 0.04 and 0.02, respectively), repeated measures analysis revealed that there were no significant differences in 6-48 hours VAPS (p = 0.6). Total morphine consumption in the EN and C groups was 3.4 (SD 3.7) and 4.2 (SD 4.4) mg, respectively (p = 0.4). ROM on discharge was also similar between the groups. No complications were detected in this study. CONCLUSION: Our study showed that additional epinephrine in LIA had a statistically significant reduction in VAPS at 12 hours and morphine usage during 6-12 hours when compared with the control group. However, the magnitude of difference did not reach minimal clinically importance difference (MCID) value for TKA.

Recovery of Hip Abductor Muscle Strength after Total Hip Arthroplasty in Patients with Leg Length Discrepancy.

Background: Total hip arthroplasty (THA) is an effective treatment to reduce pain and improve function outcomes for osteoarthritis patients. To our knowledge, there were scant of information about effect of preoperative leg length discrepancy (LLD) on recovery of hip abductor muscle strength and functional outcomes. Objective: To evaluate the recovery of hip abductor muscle strength after THA in osteoarthritis patients with LLD and to study the correlation among LLD, recovery of hip abductor muscle strength and functional outcomes. Material and Method: Between January 2014 and December 2015, 30 osteoarthritis patients who underwent THA at least six months were divided into two groups, Group 1 (LLD less than 2 cm), and Group 2 (LLD greater than 2 cm). Four parameters were measured on anteroposterior both hip radiographs in the supine position before and after operation: LLD, abductor length, abductor lever arm, and femoral offset (FO). Abductor muscle strength was calculated quantitatively by an isokinetic/isometric dynamometer [Con-Trex MJ]. Hip abductor strengths were calculated as the ratio of operated hip to contralateral healthy hip which used as controls. Functional outcomes were evaluated by two-minute walk test (2MWT) and timed up and go test (TUG). Results: The mean of hip abductor muscle strength ratio in all patients was 89.50% (standard deviation (SD) 29.94). Patients showed 83.10% (SD 34.58) of mean abductor muscle strength ratio at 6 to 12 months after operation, 88.50% (SD 25.36) at 12 to 24 months after operation, and 112.20% (SD 25.27) after 24 months after operation. Patients in Group 1 had 94.74% (SD 33.54) of mean hip abductor muscle strength ratio. It was greater than 79.02% (SD 18.18) in Group 2, however, there were no statistically significant differences between the two groups (p = 0.18). There were no significant differences of 2MWT and TUG between the two groups either. A weak correlation between preoperative LLD and hip abductor muscle strength ratio (rs = 0.163, p = 0.39), and between preoperative LLD and 2MWT (rs = 0.030, p = 0.874), TUG (rs = -0.067, p = 0.73) were found. Conclusion: The hip abductor muscle strength showed good to excellent recovery after THA. The results from this study showed no correlation among preoperative LLD, the recovery of hip abductor muscle strength, and functional outcomes.

Results of surgical release in pediatric trigger thumb.

OBJECTIVE: To observe and evaluate the treatment outcome of pediatric trigger thumb in patients who had undergone surgical release of the annular ligament with the oblique pulley partially released in patients who did not achieve full IP joint extension. MATERIAL AND METHOD: From 2003 to 2010, 21 surgically operated thumbs in 17 patients were reviewed. Bowstringing, range of motion (ROM) of thumb interphalangeal joint, Notta's node resolution and assessment of patient/parent satisfaction were used as outcome parameters. The pulley pathology system was observed intra-operatively. The annular ligament was completely released, and in patients who were notfully corrected, a further procedure in which 50% of the oblique pulley was released was undertaken. RESULTS: One thumb had recurrent triggering after 60 months of follow-up. No infection, neurovascular injury, excessive scarring, or bowstringing were detected. Notta's node was fully resolved in all operated thumbs. Mean follow-up was 64 months. Improved IP joint motion without flexion contracture was observed in all patients. The procedure was well tolerated by patients and both the patients and parents of patients expressed satisfaction with the results of the procedure. CONCLUSION: Surgical release is recommended for children aged more than one year that are afflicted with trigger thumb. This procedure delivers satisfactory results with minimal complications. To achieve full FPL excursion, some patients need to release 50% of the oblique pulley after the first procedure.