Orthopedics
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Comparative Study
A comparison of epidural and non-epidural anesthesia and analgesia in total hip or knee arthroplasty patients.
This retrospective study explores a number of variables encountered with the use of either epidural or non-epidural anesthesia and analgesia. Postoperative mobility, amount of narcotic used, incidence of blood transfusion, length of stay, and presence of urinary retention, pruritus, nausea and vomiting, or respiratory depression were compared in a group of 101 consecutive patients scheduled for total hip or knee arthroplasty. ⋯ There were significantly fewer blood transfusions in the epidural group; however, epidural patients had significantly increased incidence of urinary retention and pruritus. The use of epidural anesthesia and analgesia for total hip and knee arthroplasty patients has definite merit, but is most safely administered in a monitored, skilled nursing unit.
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This report reviews the results of 36 children surgically treated for fractures of the head and neck of the radius. Indications for operation were: displacement over 2 mm and/or angulation over 45 degrees. ⋯ Eighteen children had a good result, 8 had a fair result, and 10 had a poor result. It appears that when radial head fractures are associated with severe displacement, a high rate of fair and poor results can be expected, despite treatment by open reduction and temporary internal fixation.
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Intrathecal morphine in an average dose of 0.01 mg/kg was given to 33 patients between ages 11 and 16 years who had spinal arthrodesis for idiopathic scoliosis. The morphine was administered intrathecally as a 10-cc bolus at the conclusion of the arthrodesis, but before closure. The goal was to study safety in terms of respiratory depression and pain relief. ⋯ It may be that the 10 cc bolus injected intrathecally circulates to the brain and ventricles faster than desired, or that factors relating to type of anesthesia or dose need to be considered. Low-dose intrathecal morphine does provide noticeable pain relief in younger patients undergoing spinal fusion. The side effects of nausea and respiratory depression can be managed safely with medication.