The American journal of orthopedics
-
Randomized Controlled Trial
Effects of a preoperative femoral nerve block on pain management and rehabilitation after total knee arthroplasty.
The objective of this prospective, randomized, double-blind study was to determine if preoperative administration of a femoral nerve block reduces the amount of morphine needed for postoperative analgesia after total knee arthroplasty (TKA). Forty-two patients undergoing TKA were randomly assigned to receive either a femoral nerve block (0.50% bupivacaine hydrochloride with epinephrine 1:200,000) or matching placebo. Results showed postoperative morphine use was significantly lower in patients who received the nerve block (25.5 vs 37.5 mg, P = .016); however, the 2 groups had similar pain scores and rehabilitative outcomes. In general, a preoperative femoral nerve block is a safe and effective adjunct for decreasing morphine use for post-TKA analgesia.
-
The most appropriate prophylactic regimen for thromboembolic disease has not been determined. There appear to be several good alternatives, all of which yield similar results as determined by the incidence of symptomatic pulmonary embolism, but all are associated with various bleeding-related risks. Results from past research of almost 3500 total knee arthroplasties demonstrated a low risk for pulmonary emboli (0.1%) and a reduced risk for postoperative bleeding with use of aspirin and foot pumps as prophylaxis against thromboembolic disease. We continue to remain comfortable recommending this regimen for our patients.
-
Without prophylaxis, rates of deep vein thrombosis (DVT) after major orthopedic surgery range from 40% to 60%. Randomized clinical trials over the past 30 years have provided evidence that primary thromboprophylaxis reduces DVT, pulmonary embolism (PE), and fatal PE, and prophylaxis to prevent venous thromboembolism (VTE) in patients at risk has been ranked as the highest safety practice for hospitalized patients. Since 1986, some type of prophylaxis has been recommended for total knee arthroplasty (TKA), total hip arthroplasty (THA), and hip fracture surgery. ⋯ In addition to following these recommendations for routine prophylaxis, surgeons should assess patients for additional VTE risk. Patients at higher risk may need more intense prophylaxis. Data from meta-analyses and placebo-controlled, blinded, randomized clinical trials have demonstrated little or no increase in rates of clinically important bleeding with prophylaxis.
-
Exchange femoral nailing is the preferred method for treating femoral nonunions. When the index femoral nail is broken, the difficulty of exchange nailing increases dramatically. In this article, we describe a new technique for removing a broken retrograde nail--advancing it out of the proximal end of the femur.