Articles: operative.
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There is a common concern about the pain and rehabilitation of the knee after femoral retrograde intramedullary nailing. It is essential for early postoperative knee function required for physical self-maintenance in daily life. And a favorable rehabilitation of the knee usually promotes the quality of life. However, early rehabilitation is absent or insufficient for many patients in postoperative management. This retrospective study aims to evaluate the effect of early knee function improvement in comparison to postoperative fascia iliaca blocking (FIB) and multimodal drug injection (MDI). Patients and Methods. A retrospective analysis of 41 patients receiving femoral fracture treatment with retrograde intramedullary nailing, was performed during 2018-2020. 19 patients were treated with MDI as postoperative analgesia, and 22 patients were treated with FIB. Rehabilitation started on the first postoperative day and lasted for 3 months. Visual analog scale (VAS), the range of motion (ROM) of the knee, and single assessment numeric evaluation (SANE) were assessed. ⋯ The knee pain was commonly experienced in this series of retrograde femoral nailings. Both MDI and FIB provided immediate and effective pain control after femoral fracture surgery. MDI was more beneficial to continuous pain control and knee rehabilitation in the early follow-up. The extent of pain relief and knee function improvement reached the same level at postoperative 3-month.
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Case Reports
Hereditary Antithrombin Deficiency: A Balancing Act of Perioperative Hemostasis and Thromboprophylaxis-A Case Report.
Hereditary deficiency of antithrombin (AT) is associated with increased risk of venous thromboembolism (VTE), especially under the circumstances of stress, vascular injury, and immobilization associated with surgery. To date, there is no consensus on the use of perioperative anticoagulant bridging in the setting of hereditary thrombophilia. Balancing hemorrhagic and thrombotic risks associated with anticoagulant bridging and AT deficiency can be challenging to perioperative physicians. We present a case of a 65-year-old woman with inherited AT deficiency with history of multiple VTEs who was admitted for presurgical anticoagulant bridging before microvascular decompression craniotomy for trigeminal neuralgia.
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Randomized Controlled Trial
Evaluation of antihyperalgesic and analgesic effects of 35% nitrous oxide when combined with remifentanil: A randomised phase 1 trial in volunteers.
Remifentanil is an effective drug in peri-operative pain therapy, but it can also induce and aggravate hyperalgesia. Supplemental administration of N2O may help to reduce remifentanil-induced hyperalgesia. ⋯ Administration of 35% N2O significantly reduced hyperalgesia, allodynia and pain intensity induced after remifentanil. It might therefore be suitable in peri-operative pain relief characterised by hyperalgesia and allodynia, such as postoperative pain, and may help to reduce opioid demand.
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Traumatic abdominal injury is associated with significant mortality, especially in hemodynamically unstable patients. Trauma management now supports more conservative surgical management with judicious non-operative management. The aim of this study is to use STAG data to characterize abdominal trauma outcomes, focusing on factors that may influence mortality. ⋯ About 7% of patients in the STAG registry display abdominal injury. Mortality was found to have strong associations with older age, hemodynamic instability, poor neurological status, and head and neck injury. Outcomes may improve with the anticipated creation of the Scottish Trauma System.