The American journal of sports medicine
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Randomized Controlled Trial Clinical Trial
The effect of intraarticular injection of morphine and bupivacaine on postarthroscopic pain control.
This study sought to compare the effects of morphine, bupivacaine, and saline injected into the knee after arthroscopic surgery. In a double-blind, randomized trial, 124 patients received either bupivacaine, morphine, bupivacaine and morphine, or saline at the completion of surgery. Postoperative pain was assessed with a 100-mm visual analog pain scale. ⋯ Therefore, our results failed to show any beneficial effect of morphine used for postoperative analgesia, either alone or in combination with bupivacaine. The overall pattern in all patients demonstrated decreased pain scores, decreased analgesic use, and increased weightbearing status as the observation period progressed. Finally, preoperative pain was correlated with pain at discharge, indicating that the most significant predictor of postoperative pain was preoperative level of discomfort.
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Randomized Controlled Trial Clinical Trial
Intraarticular lidocaine versus intravenous analgesic for reduction of acute anterior shoulder dislocations. A prospective randomized study.
We performed a prospective, randomized study to evaluate the use of injected lidocaine as an anesthetic for closed reduction of acute anterior shoulder dislocations. Thirty consecutive patients who presented at the emergency department with acute anterior shoulder dislocations were randomly placed in one of two groups. One group received an intraarticular injection of 20 ml of 1% lidocaine and the other group, intravenous injections of morphine sulfate and midazolam. ⋯ The lidocaine group had no complications and had a statistically significant shorter emergency department visit when compared with the intravenous sedation group (mean, 78 minutes versus 186 minutes; P = 0.004). Lidocaine provides excellent anesthesia for patients with uncomplicated anterior shoulder dislocations and can be very beneficial when sedation is contraindicated. Lidocaine injections also proved to be cost effective in our institution, reducing total costs by as much as 62%.
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Eight cadaveric lower extremities were examined by three experienced knee surgeons in blinded fashion. The knees were examined with intact anterior cruciate ligaments, sectioned anteromedial bundles, and completely sectioned anterior cruciate ligaments to evaluate detectable laxity changes. Lachman, anterior drawer, lateral pivot shift, and KT-1000 arthrometer testing were performed. ⋯ Clinically diagnosed "partial tear" is likely to be complete rupture of the anterior cruciate ligament. Historically, clinically diagnosed partial tears of the anterior cruciate ligament have tended to "progress" to symptomatic instability. Our data imply these patients may have had functionally incompetent ligaments from time of injury and, in fact, were demonstrating the expected natural history of an anterior cruciate ligament-deficient knee.