Scand J Plast Recons
-
Scand J Plast Recons · Jan 2009
Randomized Controlled Trial Comparative StudyModification of the forearm tourniquet techniques of intravenous regional anaesthesia for operations on the distal forearm and hand.
Our aim was to find out if a modified intravenous regional anaesthetic block technique, used for invasive surgical procedures on the distal forearm and hand, results in a drier operative field than traditional methods. Twenty consenting adult (age > 18) patients who were to have an operation on the distal forearm or hand were randomised into two groups (n=10 in each). The first group was using a traditional bier block, with a double upper arm tourniquet. ⋯ This benefit was not sustained postoperatively (p=0.57). Plasma lignocaine concentrations were higher in the conventional group (p=0.004). The modified technique was as safe as the conventional technique but has the benefits of a drier surgical field and improved intraoperative comfort for patients.
-
Scand J Plast Recons · Jan 2009
Evaluation of a Swedish version of the patient-rated wrist evaluation outcome questionnaire: good responsiveness, validity, and reliability, in 99 patients recovering from a fracture of the distal radius.
The patient-rated wrist evaluation (PRWE) form is an established outcome questionnaire designed to measure wrist pain and disabilities in activities of daily living. We translated and validated this score for use in Sweden. The original PRWE score was translated forwards and backwards, and then the responsiveness, validity, and reliability of the Swedish version were tested in 99 patients who were recovering from a fracture of the distal radius. ⋯ The PRWE showed a strong correlation with DASH score (Spearman's rank coefficient = 0.86). Intraobserver reliability of the test-retest and internal consistency was good (Kendall W coefficient = 0.79, Spearman's rank coefficient = 0.99, Cronbach's alpha = 0.94-0.97). We found this Swedish version of the PRWE to be responsive, valid, and reliable for evaluating the patient-rated outcome after a fracture of the distal radius.
-
To investigate the safety and efficacy of interpleural analgesia for postoperative pain control in patients having breast reconstruction we did a retrospective audit of 114 women who had had their breasts reconstructed by the same team. A group of 22 women given morphine postoperatively acted as a historical control. Ninety-two women were given continuous postoperative interpleural bupivacaine with free access to morphine. ⋯ Pain scores were similar in all groups (p=0.11). Nausea and vomiting scores were significantly lower in the interpleural group (p=0.04) and hospital stay was shorter in the interpleural group but not significantly so (p<0.9). We conclude that interpleural analgesia improves the quality of postoperative care in breast reconstruction with latissimus dorsi flaps.
-
Scand J Plast Recons · Jan 2008
Intra-articular bupivacaine as treatment for postoperative pain after arthroscopy of the wrist.
Intra-articular injection of local anaesthetic is a confirmed method of treatment of postoperative pain, particularly after arthroscopy of the knee. The wrist however, has a limited capacity for intra-articular instillation of local anaesthetic, and the aim of this study was to investigate the effect of intra-articular bupivacaine on postoperative pain after arthroscopy of the wrist. ⋯ The bupivacaine group reported less pain and less use of analgesics in the first postoperative hours, but for the remaining five postoperative day's pain and the use of analgesics were similar in the two groups. We conclude that intra-articular injection of 0.5% bupivacaine 5 ml after wrist joint arthroscopy reduces pain and use of analgesics during the first postoperative hours, but has no effect during the following five days.
-
Scand J Plast Recons · Jan 2008
Comparative StudyComparison of carpal tunnel injection techniques: a cadaver study.
The purpose of the study was to evaluate the accuracy of injections into the carpal tunnel using three different portals in cadavers, and to define safe guidelines. In this study, 150 wrists of 75 cadavers (54 male, 21 female) were included. To compare three injection sites, 50 wrists of 25 cadavers were used for each technique; we used 23 gauge needles, and acrylic dye. ⋯ Median nerve injuries caused by injection was seen mostly with the second technique. Although a steroid injection may provide symptomatic relief in patients with carpal tunnel syndrome, the median nerve and other structures in the carpal tunnel are at risk of injury. Because of that, the injection should be given using the correct technique by physicians skilled in carpal tunnel surgery.