Journal of surgical orthopaedic advances
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Total ankle arthroplasty is a procedure that has been shown to greatly improve patient quality of life. However, it is associated with moderate to severe postoperative pain. ⋯ Nerve blocks in particular afford high-quality relief from pain while avoiding many of the side effects of traditional systemic therapies. This review highlights the state-of-the-art practice for providing postoperative analgesia following total ankle arthroplasty.
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The utilization of multimodal pain management following total joint arthroplasty (TJA) has positively affected the quality of postoperative care, reduced surgical pain, and decreased the magnitude of opioid consumption and subsequent dose-related complications. The advent of liposomal bupivacaine is proving to be a highly efficacious and safe method of postoperative pain management with favorable pharmacokinetics that reduces the risk of amide-related toxicity. Additionally, the therapeutic levels of bupivacaine, which are below the toxic range and sustained for 72 hours after injection, are providing an effective mechanism for early hospital discharge and rapid recovery after TJA. This article reviews the rationale behind liposomal bupivacaine, its mechanism of action, pharmacokinetics, indications, and contraindications for use.
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The aim of this prospective cohort study was to investigate the effect of head and neck positioning on cerebral perfusion during shoulder arthroscopy in the beach chair position. Regional cerebral tissue oxygen saturation (rSO2) was monitored intraoperatively using near-infrared spectroscopy on 51 consecutive patients undergoing arthroscopic shoulder surgery in the beach chair position. The head of each subject was manipulated by the examiner and sequentially positioned for 45 seconds in terminal flexion, extension, bilateral rotation, and bilateral lateral bending. ⋯ When comparing preoperative baseline rSO2 to intraoperative supine and intraoperative upright rSO2, there was no significant decrease in saturation levels for any of the six tested positions. Frequent intraoperative evaluations of the head and neck position as well as careful preoperative positioning may reduce the risk of position-related complications in patients undergoing elective shoulder arthroscopy in the beach chair position. In this study's patient population, however, head and neck position was not found to cause significant cerebral desaturation for the time period tested compared to preoperative baselines.
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The authors of this study sought improved understanding of the radial nerve course through the brachium and hypothesized that the most proximal aspect of the triceps tendon (PATT) serves as a useful superficial landmark for localizing the nerve. It was also hypothesized that a poorly appreciated area of vulnerability for nerve injury exists where the radial nerve runs along the lateral cortex of the humerus proximal to its transit through the lateral intermuscular septum (LIMS). The authors assessed 33 fresh-frozen cadaveric specimens. ⋯ The nerve at the posterior midline of the humerus is 2.3~cm proximal to the level of the PATT. The radial nerve lies directly on the lateral humeral cortex for 2~cm proximal to its transit through the LIMS. The PATT appears to be a consistent and practical superficial landmark to determine the location of the radial nerve from a posterior approach.
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This study examines the amputees from the Army and Marine Corps, the two military branches that have sustained the majority of combat-related amputations. All U. S. service members who sustained major extremity amputations from October 2001 through July 2011 were analyzed. ⋯ Marine amputees were significantly (p < .0001) more likely to be dismounted than Army amputees. The number of multiple amputees increased substantially in 2010 and 2011. Marine amputees, particularly dismounted, are at an increased risk of sustaining multiple amputations.