Continuous PENG block for hip fracture: a case series

IntroductionThe pericapsular nerve group (PENG) block is a novel regional technique indicated for analgesia for hip joint pain. We administered PENG blocks and performed catheter insertion for continuous infusions in patients with femur fractures on hospital admission. In this case series, we describe our initial experience of pain management in 10 patients with continuous infusion and its associated adverse events.Case seriesThe PENG block was administered with an introducer needle. The catheter was then inserted 3 cm beyond the needle tip. In three patients, blood aspiration through the catheter occurred. In each patient, the catheter was repositioned 0.5–1.0 cm more medially. No blood aspiration or visible hematoma occurred subsequently. The presence of any vascular structure deep to the iliopsoas muscle was excluded postoperatively based on a Doppler color flow scan.DiscussionOverall, eight patients had femoral neck fractures, and two patients had intertrochanteric fractures. All 10 patients reported good pain relief. The median (IQR) Numerical Rating Scale (NRS) score decreased from 7 (6–7) before the block to 2 (2–2.75) 20 min after PENG catheter placement. The median (IQR) NRS score after 12, 24 and 48 hours were 2 (2–3), 2 (2–3), and 2 (0.25–2), respectively. Patients underwent surgery 24–48 hours following catheter placement. Catheters were removed by an Acute Pain Service nurse 72 hours postinsertion. We want to highlight the potential for intravascular catheter placement in this anatomical region. Further studies are required to confirm if this is a technical error or an associated complication of continuous PENG blocks.

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The Use of a Dynamic Elastomeric Fabric Orthosis in Supporting the Management of Athletic Pelvic and Groin Injury

Journal of Sport Rehabilitation ◽

10.1123/jsr.2014-0266 ◽

2016 ◽

Vol 25 (2) ◽

pp. 101-110 ◽

Cited By ~ 4

Author(s):

Leanne Sawle ◽

Jennifer Freeman ◽

Jonathan Marsden

Keyword(s):

Outcome Measures ◽

Rating Scale ◽

Numerical Rating Scale ◽

Preliminary Investigation ◽

Case Series ◽

Baseline Period ◽

Numerical Rating ◽

Straight Leg Raise ◽

Type Of Injury ◽

Groin Injury

Context:Athletic pelvic and groin injuries are a common yet challenging problem. Pelvic belts have been successfully used to reduce pain and improve function but are not a practical solution for athletes. Therefore, there is scope to explore the use of a more dynamic intervention developed to aid in the management of this type of injury.Objectives:To undertake a preliminary investigation into the effectiveness of a dynamic elastomeric fabric orthosis (DEFO) in supporting the management of athletic pelvic and groin injury.Design:A case series with an AB design. Daily assessments were undertaken over 15 days; the onset of intervention was randomized with a minimum baseline period of 6 d. Follow-up assessment was undertaken after 1 mo.Settings:Community and university.Participants:8 athletes presenting with pelvic or groin injury confirmed through clinical screening.Intervention:A bespoke DEFO.Main Outcome Measures:Force produced on bilateral resisted hip adduction and self-scored pain (using a numerical rating scale of 0–10) at rest and during an active straight-leg raise and a broad jump.Results:In 7 cases a significant improvement was observed on at least 1 measure (2-SD method, celeration line, and/or the point of nonoverlapping data). The remaining case showed minimal symptoms during testing.

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Balanced Suspension versus Pillow on Preoperative Pain for Proximal Femur Fractures: A Randomized Controlled Trial

Advances in Orthopedics ◽

10.1155/2020/3073892 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Varah Yuenyongviwat ◽

Chonthawat Jiarasrisatien ◽

Khanin Iamthanaporn ◽

Theerawit Hongnaparak ◽

Boonsin Tangtrakulwanich

Keyword(s):

Proximal Femur ◽

Rating Scale ◽

Numerical Rating Scale ◽

External Rotation ◽

Controlled Trial ◽

Preoperative Pain ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Group A ◽

The Mean

Introduction. To evaluate the efficacy of a balanced suspension system, using the Thomas splint, with Pearson attachment, compared with a pillow for preoperative pain in patients with proximal femoral fractures. Materials and Methods. Sixty patients with proximal femur fractures were randomized into two groups: a balanced suspension group and a pillow group. In the first group, a balanced suspension was applied after length adjustment, to match the patient’s leg and thigh. In the pillow group, a pillow was placed below the patient’s leg, to position the patient’s hip in a semiflexion and external rotation position. Preoperative pain severity, by using a verbal numerical rating scale (VNRS), the amount of morphine consumed, and complication were recorded. Results. There were no differences in patient characteristics between the groups. The mean VNRS for pain was not statistically different between the groups, from the start of the study up to 48 hours. The mean of morphine consumption was not different between the groups at the start of the study, on day 1, and on day 2 (p=0.25, 0.89, and 0.053, respectively). Conclusions. A balanced suspension did not improve patient outcome to the same level as other tractions in previous studies. Hence, other methods for reducing pain, while waiting for definite operations, should be focused on. The clinical trial is registered with TCTR20150514002.

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Therapeutic Effects of Saireito (Chai-Ling-Tang), a Traditional Japanese Herbal Medicine, on Lymphedema Caused by Radiotherapy: A Case Series Study

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/241629 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Aiko Nagai ◽

Yuta Shibamoto ◽

Keiko Ogawa

Keyword(s):

Herbal Medicine ◽

Rating Scale ◽

Numerical Rating Scale ◽

Case Series ◽

Tumor Control ◽

Therapeutic Effects ◽

Case Series Study ◽

Custom Made ◽

Japanese Herbal Medicine ◽

Series Study

Despite the development of radiotherapy machines and technologies, a proportion of patients suffer from radiation-induced lymphedema. Saireito (SRT) is a traditional Japanese herbal medicine that has been used for treating edema and inflammation in conditions such as nephritic disease. This study investigated the effect of SRT on lymphedema caused by radiotherapy. Four patients were treated with SRT at a dose of 9 g/day. The severity of lymphedema was evaluated using the Common Terminology Criteria for Adverse Events version 4 and Numerical Rating Scale before and after SRT treatment. After the treatment with SRT, 2 of 4 patients (50%) showed apparent improvement in lymphedema. One of the cases had difficulty in wearing the custom-made thermoplastic cast, but after SRT administration, he could wear the mask easily. One case decided to stop taking SRT 3 days after initiation because cough and fever appeared. In conclusion, it is important to control the side effects of radiotherapy, which leads to improved tumor control rates. Prospective randomized studies are necessary to confirm the findings of this case series study.

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The Limitation of Endoscopic Surgery Using the Full Endoscopic Discectomy System for the Treatment of Destructive Stage Pyogenic Spondylodiscitis: A Case Series

Minimally Invasive Surgery ◽

10.1155/2021/5582849 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Tomoyuki Setoue ◽

Jun-Ichiro Nakamura ◽

Jun Hara

Keyword(s):

Back Pain ◽

Conservative Treatment ◽

Endoscopic Surgery ◽

Revision Surgery ◽

Rating Scale ◽

Numerical Rating Scale ◽

Case Series ◽

Bone Destruction ◽

Pyogenic Spondylodiscitis ◽

Endoscopic Discectomy

Introduction. Conservative therapy, including appropriate antibiotics and bracing, is usually adequate for most patients with pyogenic spondylodiscitis. If conservative treatment fails, surgical intervention is needed. However, major spinal surgery comprising anterior debridement and accompanying bone grafting with or without additional instrumentation is often related to undesired postoperative complications. In recent years, with minimally invasive surgery, the diagnostic and therapeutic value of endoscopic lavage and drainage has been proven. This study reports a case series of patients who required open revision surgery after treatment with endoscopic surgery using the full endoscopic discectomy system (FED), indicating the surgical limitations of endoscopic surgery for pyogenic spondylodiscitis. Methods. We retrospectively investigated the medical records of 4 patients who underwent open debridement and anterior reconstruction with posterior instrumentation following endoscopic surgery for their advanced lumbar infectious spondylitis. They had been receiving conservative treatment with antibiotics for 12–15 days. They also had various comorbidities, including kidney disease, heart failure, and diabetes. Numerical rating scale pain response, perioperative imaging studies, and C-reactive protein (CRP) levels were determined, and causative bacteria were identified. Primarily, the bone destruction stage was classified using computed tomography with reference to Griffiths’ scheme. Results. All patients had severe back pain before surgery with no relief of the pain after FED. Increased pain, including radicular pain after FED, was noted in one case. Causative pathogens from biopsy specimens were identified in 3 (75%) of the 4 cases. In preoperative radiological evaluation, all cases were classified as destructive stage in Griffiths’ scheme. The CRP levels of all the patients decreased slightly after endoscopic surgery. Relapse of spinal infection after revision surgery was not noted in any patient during the follow-up period. Conclusion. The surgical treatment of destructive-stage spondylitis with FED alone can increase low back pain due to aggressive debridement.

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Reactive oxygen species in an oleic matrix for healing deep and narrow wounds: a case series

Gastrointestinal Nursing ◽

10.12968/gasn.2020.18.sup4.s23 ◽

2020 ◽

Vol 18 (Sup4) ◽

pp. S23-S30

Author(s):

Giulia Vidotto ◽

Teresita Gaiani ◽

Umberto Cazzarò ◽

Sara Maria Lupi ◽

Ognibene Lina Carmela ◽

...

Keyword(s):

Reactive Oxygen Species ◽

Rating Scale ◽

Hypochlorous Acid ◽

Numerical Rating Scale ◽

Case Series ◽

Reactive Oxygen ◽

Oxygen Species ◽

Chemical Additives ◽

Numerical Rating ◽

Dressing Change

Use of reactive oxygen species (ROS) involves continual introduction of molecular oxygen to a wound, activating the local immune system and inducing the development of hypochlorous acid, with beneficial antimicrobial effects. NOVOX is an ROS device that uses olive oil, over-oxidised through an ozone (O3), to create an oleic matrix, with film-forming and protective functions. By avoiding accumulation of exudate, it decreases bacterial proliferation. It is administered to the wound bed through a prefilled plastic syringe, without antimicrobials or chemical additives, for safe and easy self-treatment and painless dressing change. The oil's consistency allows for a homogenous spread, reaching all tunnelling tracts and promoting contact between wound bed and dressing. A case series was carried out of 34 patients with deep and narrow wounds, most in the leg or sternum and resulting from dehiscence (80%). ROS therapy was used in combination with a secondary dressing, such as negative pressure wound therapy or polyurethane foam. At baseline, average wound/fistula depth was 1.6cm, Wound Bed Score (WBS) was 11.8 and Numerical Rating Scale (NRS) for pain was 3.6. Average wound/fistula depth decreased by 43% at 2 weeks and 77% at 4 weeks. WBS increased by 11% at 2 weeks and by 27% at 4 weeks. NRS decreased by 60% at 2 weeks. Most wounds took 2–4 weeks to heal, and there were no episodes of intolerance or recurrence.

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Coronal Correction Using Kickstand Rods for Adult Thoracolumbar/Lumbar Scoliosis: Case Series With Analysis of Early Outcomes and Complications

Operative Neurosurgery ◽

10.1093/ons/opaa073 ◽

2020 ◽

Vol 19 (4) ◽

pp. 403-413 ◽

Cited By ~ 1

Author(s):

Thomas J Buell ◽

Peter A Christiansen ◽

James H Nguyen ◽

Ching-Jen Chen ◽

Chun-Po Yen ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Adult Spinal Deformity ◽

Case Series ◽

Wound Dehiscence ◽

Transforaminal Lumbar Interbody Fusion ◽

Leg Pain ◽

Complication Rates ◽

Iliac Screw ◽

Coronal Correction

Abstract BACKGROUND The “kickstand rod technique” has been recently described for achieving and maintaining coronal correction in adult spinal deformity (ASD). Kickstand rods span scoliotic lumbar spine from the thoracolumbar junction proximally to a “kickstand iliac screw” distally. Using the iliac wing as a base, kickstand distraction produces powerful corrective forces. Limited literature exists for this technique, and its associated outcomes and complications are unknown. OBJECTIVE To assess alignment changes, early outcomes, and complications associated with kickstand rod distraction for ASD. METHODS Consecutive ASD patients treated with kickstand distraction at our institution were retrospectively analyzed. RESULTS The cohort comprised 19 patients (mean age: 67 yr; 79% women; 63% prior fusion) with mean follow-up 21 wk (range: 2-72 wk). All patients had posterior-only approach surgery with tri-iliac fixation (third iliac screw for the kickstand) for mean fusion length 12 levels. Three-column osteotomy and lumbar transforaminal lumbar interbody fusion were performed in 5 (26%) and 15 (79%) patients, respectively. Postoperative alignment improved significantly (coronal balance: 8 to 1 cm [P < .001]; major curve: 37° to 12° [P < .001]; fractional curve: 20° to 10° [P < .001]; sagittal balance: 11 to 4 cm [P < .001]; pelvic incidence to lumbar lordosis mismatch: 38° to 9° [P < .001]). Pain Numerical Rating Scale scores improved significantly (back: 7.2 to 4.2 [P = .001]; leg: 5.9 to 1.7 [P = .001]). No instrumentation complications occurred. Motor weakness persisted in 1 patient. There were 3 reoperations (1-PJK, 1-wound dehiscence, and 1-overcorrection). CONCLUSION Among 19 ASD patients treated with kickstand rod distraction, alignment, and back/leg pain improved significantly following surgery. Complication rates were reasonable.

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Knee mega-prosthesis in the management of complex knee fracture of the elderly : a case series and review of the literature

Acta Orthopaedica Belgica ◽

10.52628/87.2.21 ◽

2021 ◽

Vol 87 (2) ◽

pp. 347-351

Author(s):

Gautier Beckers ◽

David Mazy ◽

Philippe Tollet ◽

Olivier Van Nieuwenhove

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Rating Scale ◽

Tumor Resection ◽

Oxford Knee Score ◽

Case Series ◽

The Elderly ◽

Osteoporotic Bone ◽

Femur Fractures ◽

Total Knee

The management of complicated distal femur fractures (DFF) of the elderly continues to pose a challenge. Knee mega-prosthesis are mostly used for Total knee arthroplasty revision and tumor resection surgery but they can be used for the treatment of complex knee fractures. The purpose of the present study is to examine the short- to mid- term outcomes of their use for complex DFF of the elderly. We retrospectively identified 4 patients with DFF AO33C3 on osteoporotic bone treated by total knee arthroplasty from September 2015 to October 2019. The average age at the time of the surgery was 79,5 years (range, 69 to 95 years). All patients were females and underwent a total knee replacement by one senior surgeon, with the OSS TM Orthopaedic Salvage System (Zimmer Biomet, Warsaw, Indiana, USA). Outcome measures included clinical outcome scores, radiological analyses, reoperation rate and complications. At an average follow-up of 2,3 years (range, 0,6 to 4,2 years), the average Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) was 17,25 (range, 7 to 37), the average Oxford knee score was 35,25 (range, 25 to 41) and the average pain Numerical Rating Scale (NRS) was 0,5 (range, 0 to 1). 3 Patients had postoperative anemia but no implant related complications has been reported. Complex DFF of the elderly treated with mega knee arthroplasty exhibit good clinical outcomes scores. The patients should be selected carefully as the complication rate found in the literature remains high.

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Effect of non-invasive intranasal neurostimulation on tear volume, dryness and ocular pain

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315065 ◽

2019 ◽

pp. bjophthalmol-2019-315065 ◽

Cited By ~ 1

Author(s):

Monika Farhangi ◽

Anny Mansim Cheng ◽

Brandon Baksh ◽

Constantine D Sarantopoulos ◽

Elizabeth R Felix ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Case Series ◽

Phenol Red ◽

Ocular Pain ◽

Symptom Report ◽

Subjective Change ◽

Pain Scores ◽

Lower Baseline ◽

Numerical Rating

PurposeTo evaluate the effect of one TrueTear session on change in tear volume and symptoms of dryness and ocular pain.MethodsRetrospective interventional case series of patients seen in a dry eye clinic. Seventy-five individuals underwent an ocular surface examination and one session of neurostimulation. Outcome measures included objective change in tear volume measured via phenol red test, and subjective change in sensations of dryness and ocular pain measured on a 0–10 Numerical Rating Scale.ResultsThe mean age of the 75 individuals was 59±13 years, and the majority were male (73%). Intranasal neurostimulation increased tear volume (mean 13.40±8.00 mm, p<0.0005) and reduced intensities of dryness (mean −2.85±2.79, p<0.0005) and ocular pain (mean −1.48±2.41, p<0.0005 for both). However, these effects were independent of one another as change in symptom report did not correlate with change in tear volume (r=−0.13, p=0.25 for dryness; r=0.07, p=0.56 for pain). In a multivariable model, the strongest predictors for increased tear volume were lower baseline tear volume (standardised beta (β)=−0.50, p<0.0005) and absence of an autoimmune disease (β=−0.36, p=0.001) (R2=0.30). The strongest predictors for reduced dryness and pain scores were lower baseline dryness and ocular pain scores. No complications related to neurostimulation were noted.ConclusionIntranasal neurostimulation increased tear volume and reduced intensities of dryness and ocular pain, independently of one another.

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BENEFITS OF THE WALANT TECHNIQUE AGAINST THE COVID-19 PANDEMIC

Acta Ortopédica Brasileira ◽

10.1590/1413-785220212905244505 ◽

2021 ◽

Vol 29 (5) ◽

pp. 274-276

Author(s):

RAFAEL SALEME ALVES ◽

DANIEL ALEXANDRE PEREIRA CONSONI ◽

PEDRO HENRIQUE OLIVEIRA FERNANDES ◽

SANDRA UMEDA SASAKI ◽

ISABELLA MARTINS ZAIA ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Case Series ◽

Hand Surgery ◽

Anesthetic Technique ◽

Public Health Services ◽

Level Of Evidence ◽

Hand Surgeon ◽

Numerical Rating ◽

Private And Public

ABSTRACT Objective: Evaluate the experience of private and public health services with the WALANT procedure in the COVID-19 pandemic. Methods: This is a retrospective, multicenter longitudinal study gathering cases of hand surgery subjected to the WALANT technique in the Hospitals Dr. Radamés Nardini and IFOR during the COVID-19 pandemic (August 2020). As a parameter, the verbal numerical rating scale for twenty patients referring to the preoperative, intraoperative and postoperative periods was applied. Results: The patients did not feel any pain during surgery, which showed the efficiency of the anesthetic technique in its purpose. Conclusion: The results indicate the WALANT technique as beneficial when facing the COVID-19 pandemic, as the main differential of the technique is that it is applied by a well-trained orthopedic hand surgeon. Level of Evidence IV, Case Series.

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