The Journal of arthroplasty
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Randomized Controlled Trial Clinical Trial
Femoral nerve block for total knee arthroplasty patients: a method to control postoperative pain.
This study was designed to determine the effects of a single-injection femoral nerve block (FNB) using 30 mL of 0.5% bupivacaine with epinephrine 1:200,000, on pain control following total knee arthroplasty (TKA). Forty patients were randomly distributed into 2 groups: Group A received general anesthesia plus a FNB (n = 19), whereas Group B received general anesthesia plus a FNB with 30 mL of preservative-free saline (n = 21). The amount of morphine used, sedation, and average pain perception were measured for the first 24 hours and daily postoperatively. ⋯ The average pain perception was significantly different (P =.002). Postoperative management of pain following TKA can be improved through a preoperative single-injection FNB with 0.5% bupivacaine plus epinephrine 1:200,000. The cost is minimal, risks appear acceptable, and the procedure is efficacious.
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Randomized Controlled Trial Clinical Trial
Bone bleeding during total hip arthroplasty after administration of tranexamic acid.
Numerous methods of controlling bleeding during total hip arthroplasty have been used. Thromboplastic agents have been used with some success, but the resultant fibrin layer interposed between the bone and cement weakens the interface. Topical freezing saline and hypotensive anesthesia have proved to be the most effective to date. ⋯ No significant difference was found between the groups in terms of blood loss from the femoral canal, the perioperative bleeding, and postoperative hemoglobin. In the group that received tranexamic acid, a greater number of patients required transfusion than in the placebo group. The results of this study do not support the routine use of tranexamic acid in primary total hip arthroplasty.
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Randomized Controlled Trial Clinical Trial
Functional comparison of posterior cruciate-retaining versus posterior stabilized total knee arthroplasty.
A prospective, randomized comparison of posterior cruciate-retaining (PCR) and posterior stabilized (PS) total knee arthroplasties (TKAs) was conducted in 20 patients who underwent bilateral TKAs for osteoarthritis. All procedures were performed by a single surgeon. One knee was implanted with a PCR TKA, and a contralateral knee with a PS TKA. ⋯ Patients had a clinical and radiographic evaluation at a mean of 31.7 months for PCR TKAs and 30.6 months for PS TKAs postoperatively. There were no significant differences between the PCR and PS TKAs in postoperative knee scores. However, postoperative improvement in range of motion was significantly superior in the PS group.
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Randomized Controlled Trial Clinical Trial
Bupivacaine bolus injection versus placebo for pain management following total knee arthroplasty.
Following surgery, total knee arthroplasty (TKA) patients experience considerable pain. All available effective analgesia agents produce some unwanted side effects. Sixty consenting elective TKA patients were randomized to receive bupivacaine 20 mL 0.5% (100 mg) or 20 mL normal saline injected into the joint space after capsule closure. ⋯ Narcotic usage was recorded. The bupivacaine group had lower pain scores and reduced narcotics during the 24-hour period, with a 23-minute shorter time to discharge from the postanesthesia care unit than the placebo group (P =.02). Although a bupivacaine bolus injected at capsule closure results in decreased pain levels (P =.07) and narcotic consumption (P =.09), it is not statistically significantly better than placebo.