Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 2014
ReviewThe influence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty: a systematic review.
Despite the overall success of total joint arthroplasty, patients undergoing this procedure remain susceptible to cognitive decline and/or delirium, collectively termed postoperative cognitive dysfunction. However, no consensus exists as to whether general or regional anesthesia results in a lower likelihood that a patient may experience this complication, and controversy surrounds the role of pain management strategies to minimize the incidence of postoperative cognitive dysfunction. ⋯ Both anesthetic and pain management strategies appear to influence the risk of early cognitive dysfunction after elective joint arthroplasty, although only one study identified differences that persisted beyond 1 week after surgery. Investigators should strive to use accepted, validated tools for the assessment of postoperative cognitive dysfunction and to carefully report details of the anesthetic and analgesic techniques used in future studies.
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Clin. Orthop. Relat. Res. · May 2014
Comparative StudyContinuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA.
Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established. ⋯ Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · May 2014
Observational StudyPain trajectories identify patients at risk of persistent pain after knee arthroplasty: an observational study.
Persistent postsurgical pain is a major source of dissatisfaction after knee arthroplasty. Postoperative pain trajectories allow a dynamic view of pain resolution after surgery and might help to identify patients at risk for persistent pain. ⋯ Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · May 2014
Comparative StudyCan Internet information on vertebroplasty be a reliable means of patient self-education?
Studies of the quality and accuracy of health and medical information available on the Internet have shown that many sources provide inadequate information. However, to our knowledge, there are no published studies analyzing the quality of information available online regarding vertebroplasty. Because this has been a high-volume procedure with highly debated efficacy, it is critical that patients receive complete, accurate, and well-balanced information before deciding a treatment course. Additionally, few studies have evaluated the merit of academic site authorship or site certification on information quality, but some studies have used measurements of quality that are based primarily on subjective criteria or information accuracy rather than information completeness. ⋯ Level IV, economic and decision analyses. See the Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · May 2014
Continuous femoral nerve block using 0.125% bupivacaine does not prevent early ambulation after total knee arthroplasty.
Continuous femoral nerve block has been shown to decrease opioid use, improve postoperative pain scores, and decrease length of stay. However, several studies have raised the concern that continuous femoral nerve block may delay patient ambulation and increase the risk of falls during the postoperative period. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.