Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 2014
ReviewCan regional anesthesia and analgesia prolong cancer survival after orthopaedic oncologic surgery?
The perioperative period of major oncologic surgery is characterized by immunosuppression, angiogenesis, and an increased load of circulating malignant cells. It is a window period in which cancer cells may seed, invade, and proliferate. Thus, it has been hypothesized that the use of regional anesthesia with the goal of reducing surgical stress and opioid and volatile anesthetic consumption would avoid perioperative immune suppression and angiogenesis and ultimately cancer recurrence. ⋯ Although basic science studies suggest a potential benefit of regional anesthesia and stress response reduction in cancer formation, we found little clinical evidence to support the theory that regional anesthesia and analgesia improve overall patient survival after oncologic surgery.
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Clin. Orthop. Relat. Res. · May 2014
Randomized Controlled Trial Comparative StudySingle-injection or continuous femoral nerve block for total knee arthroplasty?
The ideal local anesthetic regime for femoral nerve block that balances analgesia with mobility after total knee arthroplasty (TKA) remains undefined. ⋯ Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · May 2014
Randomized Controlled TrialDoes limb preconditioning reduce pain after total knee arthroplasty? A randomized, double-blind study.
Total knee arthroplasty (TKA) can be associated with considerable postoperative pain. Ischemic preconditioning of tissue before inducing procedure-related underperfusion may reduce the postoperative inflammatory response, which further may reduce associated pain. ⋯ Given the ease of this intervention, ischemic preconditioning may be considered as part of a multimodal analgesic strategy. However, more study into the impact of different preconditioning strategies, elucidation of mechanisms, safety profiles, and cost-effectiveness of this maneuver is needed.
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Clin. Orthop. Relat. Res. · May 2014
Randomized Controlled Trial Comparative StudyDeltoid-split or deltopectoral approaches for the treatment of displaced proximal humeral fractures?
Proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated. ⋯ Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · May 2014
Peripheral nerve blocks in shoulder arthroplasty: how do they influence complications and length of stay?
Regional anesthesia has proven to be a highly effective technique for pain control after total shoulder arthroplasty. However, concerns have been raised about the safety of upper-extremity nerve blocks, particularly with respect to the incidence of perioperative respiratory and neurologic complications, and little is known about their influence, if any, on length of stay after surgery. ⋯ Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.