Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
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Avulsion of the tibial insertion of the anterior cruiciate ligament can be managed by arthroscopic reduction and fixation. Anterograde and retrograde fixation with screws has been reported. Anterograde fixation using cannulated screws is technically less demanding and allows for stable fixation even with thin fragments. ⋯ Removal of the screw and washer is mandatory but sometimes problematic. A simple and safe technique of arthroscopic placement and removal of a screw and washer used for fixation of an avulsion fracture of the tibial insertion of the anterior cruiciate ligament is presented. The same technique can be used for placement and removal of a cannulated screw and washer used in other joints.
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We describe a new anesthetic technique of femoral and sciatic nerve blocks in knee arthroscopy. The sciatic nerve block is administered through a posterior approach, and the block of the femoral and lateral femoral cutaneous nerves in a single anterior approach. This type of regional anesthesia is safe and effective, providing excellent intraoperative and postoperative analgesia as well as minimizing postoperative complications.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intraarticular bupivacaine with the addition of morphine or fentanyl for analgesia after arthroscopic surgery.
A randomized study on 30 patients undergoing knee arthroscopy was performed. Group I (n = 15) received 50 mg of 0.25% bupivacaine and 1 mg of morphine, and group II (n = 15) received 50 mg of 0.25% bupivacaine and 100 micrograms of fentanyl. The visual analogue scale was recorded at intervals of 1, 2, 3, 4, 6, 12, 24, and 48 hours after the operation. ⋯ In group I, pain scores were lower than group II (P < .05) during the 1st, 2nd, 3rd, 12th, 24th, and 48th hours. The duration of analgesia on group I was significantly longer than group II. The combination of intraarticular morphine and bupivacaine has a longer analgesic duration and effect than a combination of fentanyl and bupivacaine.
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Anterior cruciate ligament (ACL) reconstruction is associated with significant postoperative pain, usually requiring parenteral narcotics. A prospective study of arthroscopically assisted autograft patellar tendon ACLR was initiated using Winnie's "three-in-one" femoral nerve block (FNB) as the primary means of postoperative pain control. Patient satisfaction and absence of parenteral narcotic use indicated clinical success. ⋯ The average duration of pain control was 29 hours and the majority of patients (79%) believed discharge was possible within 23 hours. There were two patients who failed to respond to FNBs (8%) and no major complications. FNB is a safe, reliable, and effective form of analgesia following ACLR, eliminating the need for parenteral narcotics.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of two regional anesthetic techniques for knee arthroscopy.
This study compares the efficacy of "3-in-1 block" versus femoral nerve block for knee arthroscopy. One-hundred patients had a 3-in-1 block; 180 patients had a femoral nerve block. The 3-in-1 block provided anesthesia in 75 patients; 20 patients needed supplementary local anesthesia. ⋯ The 3-in-1 block provided more satisfactory muscle relaxation and a longer postoperative analgesia than femoral nerve block. No side effects were recorded in either group. Our results suggest that the 3-in-1 block is the most effective technique of regional anesthesia for knee arthroscopy.